bluuebunny/crossref_metadata_2025 huggingface dataset:
Gender disparity in the physicians in public sector in Bangladesh: a mixed-method exploratory study
Authors: Tuly I , Bhattacharyya D , Shafique S , Hossain S h , Anwar I
Published: October 2020

Background

Gender equality is needed in health service delivery systems to support universal health coverage (UHC). Women are reluctant to visit male doctors for medical problems. However, number of female doctors is inadequate in many low and middle income countries (LMICs) which is a challenge for establishing gender-sensitive health system. We explored the production and distribution of female physicians in the public sector in Bangladesh to support policy for actions.

Methodology

This is a mixed-method exploratory study using documentary review; Key Informant Interviews and secondary data analysis. Multiple stakeholder consultations and a policy dialogue were organized to validate the study findings.

Results

An increasing trend of female medical students was observed since 2011 in admission. In 2018, out of total 5528 students enrolled, 54% were female whereas 46% were male. However, fewer female doctors were enrolled in the public service compared to their male peers. The male-female ratio was almost 2:1 in the public sector. Out of 471 sub-district health managers, 52 were female; out of 64 district health mangers only one was female; and out of 8 Division Directors only one was female. Female doctors reported to face practical problems in rural settings with regard to housing, safety and security. There is no provision of deploying married couples at the same or nearby health facilities. All these compelled female doctors to quit rural posting or even the government service. Moreover, female physicians prefer certain specialties such as obstetrics and gynaecology, medicine and certain basic subjects which may create more gender imbalance in service delivery system.

Conclusions

In adequate number of female physicians in public sector and their retention in rural areas is a major concern for the health systems in Bangladesh. Policy attention is needed to take necessary steps to make gender-responsive health systems to improve health service to achieve UHC.

Key messages

Poor presence of female physicians in deployed doctors in public sector in Bangladesh creates problems in health service delivery and is becoming a major concern for the health systems in Bangladesh. Policy needs to take remedial measures to make women-friendly working environment in the public sector hospitals in Bangladesh to provide health service delivery for all leaving no one behind.
Assessment of patient safety culture in intensive care units and factors affecting it
Authors: Tlili M A , Aouicha W , Lamine H , Taghouti E , Dhiab M B e n , Mtiraoui A , Thouraya A , Zedini C , Ben Rejeb M , Mallouli M
Published: October 2020

Background

The intensive care units are a high-risk environments for the occurrence of adverse events with serious consequences. The development of patient safety culture is a strategic focus to prevent these adverse events and improve patient safety and healthcare quality. This study aimed to assess patient safety culture in Tunisian intensive care units and to determine its associated factors.

Methods

It is a multicenter, descriptive cross-sectional study, among healthcare professionals of the intensive care units in the Tunisian center. The data collection was spread over a period of 2 months (October-November 2017). The measuring instrument used is the validated French version of the Hospital Survey On Patient Safety Culture questionnaire. Data entry and analysis was carried out by the Statistical Package for Social Sciences (SPSS 20.0) and Epi Info 6.04. Chi-square test was used to explore factors associated with patient safety culture.

Results

A total of 404 professionals participated in the study with a participation rate of 81.94%, spread over 10 hospitals and 18 units. All dimensions were to be improved. The overall perception of safety was 32.35%. The most developed dimension was teamwork within units with a score of 47.87% and the least developed dimension was the non-punitive response to error (18.6%). The patient safety culture was significantly more developed in private hospitals in seven of the 10 dimensions. Participants working in small units had a significantly higher patient safety culture. It has been shown that when workload is reduced the patient safety culture was significantly increased.

Conclusions

This study has shown that the patient safety culture still needs to be improved and allowed a clearer view of the safety aspects requiring special attention. Thus, improving patient safety culture. by implementing the quality management and error reporting systems could contribute to enhance the quality of healthcare provided to patients.

Key messages

The culture of culpability is the main weakness in the study. Encouraging event reporting and learning from errors s should be priorities in hospitals to enhance patient safety and healthcare quality.
Physical multimorbidity, mental health and unplanned admissions from 2008 to 2018 in Abruzzo region
Authors: Cedrone F , Di Giovanni P , D'Addezio M , Di Martino G , Masciarelli M , Meo F , Scampoli P , Staniscia T
Published: October 2020

Background

Multimorbidity is defined as the presence of more than one long-term disorder and it is associated with increased use of health services. Socioeconomic deprivation and mental health conditions may lead to undesirable additional unplanned admission to hospital (urgent or emergency admission). This study examines the association among unplanned admission, multimorbidity, mental health and socioeconomic deprivation for both preventable and not preventable hospitalization.

Methods

We conducted a retrospective analysis of hospital discharge records between 2008 and 2018 in Abruzzo, an Italian region. Multilevel logistic regression models were implemented for both preventable and not preventable unplanned admissions. We set as levels the district of residence and Local Health Authority. As independent variables we used the Italian Deprivation Index of the district of residence to mitigate socioeconomic inequalities, unweighted count of physical health conditions (0, 1, 2, 3, ≥4), the presence of a diagnosis of mental health condition. All the models were also adjusted for age and gender.

Results

We selected 2,017,720 non preventable admissions, 836,808 (41.45%) of which unplanned, and 152,938 preventable admissions, 107,336 (70.18%) of which unplanned. Both unplanned and potentially unplanned admissions were associated with increasing physical multimorbidity (for ≥4 v. 0 condition, OR 4.85; CI95% 4.26-5.53 for unplanned admission and OR 1.42; CI95% 1.11-1.83 for preventable unplanned admission) and with mental health conditions (OR 1.66; CI95% 1.57-1.75 for unplanned admission and OR 1.18; CI95% 1.00-1.38 for preventable unplanned admission).

Conclusions

Co-occurrence of physical multimorbidity and mental health condition was associated either with unplanned admission or unplanned preventable admission. Primary care interventions targeting multimorbidity are necessary to reduce the hospital service burden.

Key messages

Physical multimorbidity substantially affects the use of acute hospital services. Primary care interventions targeting multimorbidity are necessary to reduce the hospital service burden.
Practice of dispensing antimicrobial medicines from community pharmacies
Authors: Amirkhanyan A , Vardanyan L , Sevikyan A , Kazaryan I , Melikyan M
Published: October 2020

Background

Inappropriate use of antimicrobial medicines is one of the main causes of antimicrobial resistance (AMR). The objective of this work was to study the situation on dispensing antimicrobials from pharmacy outlets in Armenia.

Methods

The study was implemented in 30 community pharmacies from different regions of Yerevan. Medicines dispensed to 900 patients/caregivers (30 visitors in each pharmacy outlet) were analyzed. The following indicators were calculated: the percentage of antimicrobials prescribed by physicians, the percentage of visitors, who got antimicrobials without providing a prescription and so on.

Results

Antimicribials (n = 171) consisted 11.3% of all the dispensed medicines (N = 1513). Only 25 (14.6%) antimicrobials were dispensed to visitors who had prescriptions. Only 19 (12.6%) of 151 medicines provided without prescription were OTC-medicines, other 132 (87.4%) were prescription only medicines. According to information received from visitors, 58.5% of all dispensed antimicrobials were selected by physicians, 10.5% of antimicrobials were advised by pharmacists and almost one third was selected by patients, family members, etc. More than 90% of the total number of visitors, whom antimicrobials were dispensed, got them without providing a prescription. 13 patients received 2 and more antimicrobials.

Conclusions

Many prescription only antimicrobials are dispensed from community pharmacies without prescription and some medicines are not prescribed by physicians. That means many antimicrobials are used inappropriately. There is need in strategy that could prevent dispensing antimicrobials without prescription.

Key messages

Dispensing prescription only antimicrobials without prescription can compromise rational use of medicines. Professional knowledge and public awareness about AMR should be improved.
Primary health care and national household random sampling surveys: contributions from Brazil
Authors: Pinto L F , Gonçalves M R , Katz N , Silva R S , Schmitz C A A , Siqueira A C S , Roman R , Molina-Bastos C G , Oliveira M M C , D'Avila O P
Published: October 2020

Primary health care has been considered by the World Health Organization (WHO) as the most efficient way of organizing health systems in order to achieve universal health coverage, preserving its attributes and focusing on people. Several countries in the world have developed instruments to measure access, use of services and lifestyles of their populations. In Europe, European Union members have validated the European Health Interview Survey (EHIS / Eurostat), which is in its third wave of application. Brazil, for over 20 years, has developed, through the Brazilian Institute of Geography and Statistics (IBGE) - the Brazilian Federal Statistics Bureau - in partnership with the Ministry of Health, a national household health survey throughout its territory, the so-called National Health Survey (PNS). PNS-2019 questionnaire innovated by including a module of questions that allows assessing the scores of the attributes proposed by Shi and Starfield in the 2000s. The Primary Care Assessment Tool (PCAT) was included in its brazilian statistically validated version for adult users and applied in more than 100,000 households in all five regions and 27 states in Brazil. Over a six-month period, a sample of approximately 10,000 adults was registered, according to the inclusion criteria of the PCAT considered (being 18 years old or older, having had more than one medical appointment in the last six months, having performed this appointment in a public primary health care facility). We consider it essential to use statistically validated instruments that allow cross-country comparisons and we encourage Governments all over the world to follow Brazilian example in incorporating in their national health surveys a module containing the validated version of the PCAT. This instrument has already been validated and used in the evaluation of primary care in regions of all five continents of the world, demonstrating, therefore, its capacity for cultural adaptation to each reality.

Key messages

PCAT's set of instruments remains current for the evaluation of primary health care services from the users' perspective nationwide. The importance of using National Health Surveys in each country, with random household sampling to assess health systems and conditions.
Health needs, community and network in primary care: an action research program
Authors: Milani C , Occhini G , Francini C , Orsini G , Baggiani L , Maciocco G , Bonaccorsi G
Published: October 2020

Issue

According to the Alma Ata Declaration, Comprehensive Primary Health Care (C-PHC) addresses the main health problems in the community, promotes participation and involves all health related sectors. In Italy the so called Case della Salute model aims at realizing these principles. The purpose of the project is to understand how this model should be implemented in order to better answer the community needs. In the outskirts of Florence there is an area mostly made of public housing, devoted to people with housing and economic problems. There it is Casa della Salute (a health center where a PHC multidisciplinary team works), which could represent the key to cope with health inequalities and to create a network with the multiple associations rooted in the community. The implementation of an experimental model of C-PHC needs to involve local population, community actors, health professionals and researchers in a process of action-research.

Results

• An epidemiological study described a heavily deprived population compared with the rest of the city, with a burden of mortality especially affecting those most deprived and women. Mental health and addictions showed a deep need of care. A map of the neighbourhood was created in order to analyse formal and informal resources.The health needs of the community were deepened using social and ethnographic methodologies (semi-structured interviews, participant observation and focus groups with health workers, associations' representatives and individuals).Standing multi professional briefings were launched in order to facilitate the process of taking care of complex situations as a team.

Lessons

Preliminary results show the need for stronger collaborations with the actors in the community; further exploration of health related topics; community participation in the process of informing and transforming health practices; involvement of health workers in interprofessional practices to create a shared knowledge.

Key messages

Local health networks need a methodology to expand knowledge of peoples’ needs. Complexity in health and inequalities require a paradigm based on social determinants of health such as PHC.
A simulation model of microbe overlapping for the correct estimation of UV-C device log-reduction
Authors: Cevenini G , Amodeo D , Nante N , Messina S , Messina G
Published: October 2020

Background

Candida auris is an emerging pathogen responsible for several outbreaks within healthcare facilities. It can be found on hospital surfaces and patient care devices. UV- C sanitisation may constitute an effective adjunct to routine room cleaning to prevent the spreading of this yeast. Previous findings with this technology suggest to investigate different sources of variability in the study of the biocidal effect of UV devices on C. auris. In this study we develop a computer simulation of surface distribution of microorganisms on a stainless steel carrier, to optimize UV-device experiments.

Methods

Based on the literature about C. auris studies and its estimated average size (about 5 μm diameter), several Matlab simulations have been performed to include as many microorganisms as possible to be ideally placed on a 20 cm2 stainless steel support, avoiding cell overlapping. This was done in order to maximize the effectiveness of UV exposure.

Results

Two initial simulations were performed to evaluate a random arrangement of a very large number of microorganisms (8x107 CFU) on the steel support, widely overlapped. In this case, due to the poor UV-C penetrability, we would not exceed two log10 reduction. By randomly distributing 1x106 CFU, the probability of overlapping was about 1.3%, but even a partial overlap limits the log10 reduction. By randomly distributing 1x105 CFU, the overlaps were at least 10 times less likely.

Conclusions

The simulation results allowed us to evaluate the most appropriate microorganism distribution model able to optimize the biocidal effects of UV-C devices. The overlapping of microorganisms reduces UV-C penetrability. Our simulated study is consistent with literature results where we observed a lower log-reduction by increasing the concentration of microorganisms and therefore the probability of overlapping. The resulting model would simulate any log-reduction scenario, at any distance and any concentration, with and without overlapping.

Key messages

The complete or partial microorganism overlapping plays a relevant role in the outcome of UV-C biocidal experiments. To identify the exponential CFU reduction curve and estimate accurately the inactivation rate constant, simulated experiments should be performed to assess the real effectiveness of UV devices.
Six ultraviolet minutes for cleaner operating theatres
Authors: Bosco R , Gambelli S , Urbano V , Cevenini G , Messina G
Published: October 2020

Background

Sanitizing the operating theatres (OT) is important to minimize risk of post-operative infections. Disinfection procedures between one operation and another is less aggressive than final cleaning procedures, at the end of the day. Aim was assessing the difference of contamination: i) between different levels of disinfection; ii) before and after the use of a UVC Device (UVC-D).

Methods

Between December 2019/February 2020 a cross sectional study was conducted in OT in a real clinical context. 94 Petri dishes (PD) were used in 3 OT. Three different sanitation levels (SL1-3) were compared pre- and post-use of UVC-D: i) No cleaning after surgery (SL1); ii) after in-between cleaning (SL2); iii) after terminal cleaning (SL3). UVC-D was employed for 6 minutes, 3 minutes per bed side. PD were incubated at 36 °C and colony forming unit (CFU) counted at 48h. Descriptive statistic, Wilcoxon and Mann-Whitney tests were performed to assess the contamination levels in total, pre/post use of UVC-D, and between different sanitation levels, respectively.

Results

In total we had a mean of 3.39 CFU/PD (C.I. 2.05 - 4.74) and a median of 1 CFU/PD (Min. 0 - Max. 39), after UVC-D use we had a mean of 2.20 CFU/PD (C.I. 0.69 - 5.09) and a median of 0 CFU/PD (Min. 0 - Max. 133). The UVC-D led to a significant reduction of CFU (p < 0.001). Without UVC-D we had a significant CFU drop (p < 0.05) between SL1 and SL3. Using UVC-D, we observed significant reductions of contamination (p < 0.05) between SL3 and SL1. Comparing SL1 (median 0) post UVC-D use vs SL2 pre UVC-D use (median 0.5), and SL2 post UVC-D use (median 0) vs SL3 pre UVC-D use (median 1) we had a significant reduction of contamination (p < 0.05).

Conclusions

UVC-D improved environmental contamination in any of the three sanitation levels. Furthermore, the use of UVC-D alone was better than in-between and terminal cleaning. Although these encouraging results, the cleaning procedures executed by dedicated staff has to be considered.

Key messages

UVC are efficient to decrease contamination in operating theatres regardless of sanitation levels. The additional use of UVC technology to standard cleaning procedures significantly improves sanitation levels.
Discount Rate Determination for Economic Evaluations in HTA in the Philippines
Authors: Zuniga Y , Kraft A , Uezono D , Fajardo M , Obmana S , Genuino A , Guerrero A
Published: October 2020

To inform the development of a reference case for economic evaluation, we explored various approaches to determine a base case discount rate and rate options for discounting benefits and costs.

We conducted literature review and expert consultations to list approaches to determine base case discount rates, noting the advantages and disadvantages of each approach. The same methods were used to identify whether different discount rates would be applied to costs and benefits. We computed a social rate of time preference using the Ramsey formula: rc = ρ+μg, where ρ = pure rate of time preference μ= elasticity of the marginal utility of consumption and g= growth rate in per capita income. We assumed ρ = 1%, μ = 1.4% consistent with international practice, but used actual g of the Philippines of 4.5%. We compared this with the official social discount rate and with rate most commonly used internationally. These options were presented to the Philippine Health Technology Assessment Council for decisionmaking.

Based on reviewed literature, 10 out of 22 countries used a 3.0% to 3.5% discount rate while 18 countries from the same pool applied equal discount rates for both costs and outcomes. The official social discount rate (SDR) prescribed by the Philippine National Economic Development Authority is 10% for all social investments. Upon input of the values, rc was calculated at 7%, which is above the international norm but below the official rate. Four discount rate options were identified: 3%, 3.5%, 7% and 10%.

Evidence suggested using a discount rate higher than 3% to 3.5% for low-to-middle income countries. A more conservative rate based on the Ramsey formula of 7% base case discount rate was selected in performing economic evaluations. Sensitivity analysis was set between 3% and 10% to allow benchmarking with international practice and with the official SDR, respectively. Given Philippines' early HTA implementation phase, it was agreed to subject these rates to regular review.

Key messages

Setting a discount rate in economic evaluations is a crucial process for HTA institutionalization. Discount rate determination heavily relies on decision context a country considers most relevant.
The introduction of new medical devices in the public health service of a small region of Spain
Authors: Arana Aragón B , Gavrila D , Fernández Gomez V , Ferrandez Cámara M J , Floris Martín J A , García Córdoba F , Quesada Torres J A , Sabuco Tebar E , Soria Aledo V , Parra P
Published: October 2020

Issue

The introduction of health technologies could have a positive impact on the population's health. However, it also plays a significant role on the evolution of the sanitary budget. These circumstances have promoted the development of specific groups of experts in health technologies assessment under the criteria of effectiveness, safety and efficiency.

Description of the Problem

The main goal of Murcia Health Service is to guarantee the health of its population through an optimal use of resources. New medical devices(MD)need to be evaluated prior to their use in medical practice. HTA reports published by international and national agencies are not covering the growing and accelerated offer and demand of new MD

Results

A technical group in charge of the evaluation of new MD requests (GTESIDS)was created in 2014. The group consists of 12 part-time collaborators of different health professions. During 2019, GTESIDS received 69 requests of evaluation, two thirds of which from surgical specialties, mainly general(11),orthopedic(10)and ophthalmic(7)surgery. GTESIDS advised to incorporate 23 and not to incorporate 26 MD, while 20 were still being evaluated as of February 29, 2020. The mean time GTESIDS needed to reach a conclusion and emit a recommendation was 151 days. We have found a published HTA report for only one of the MD evaluated.

Lessons

HTA reports published by international and national agencies are rarely available and need to be adapted to the local framework. The GTESIDS scope would improve with a better resource allocation that will allow a more thorough and rapid evaluation.

Key messages

HTA reports are not covering the growing offer of new medical device. The experience in Murcia has taught us the need to strengthen an actual collaboration between agencies.
Curriculum update for future pharmacy technicians to enhance rational use of antibiotics in Turkey
Authors: Karadag Caman O , Uner S , Arica Yegin B , Ozcebe H
Published: October 2020

Background

Antimicrobial resistance (AMR) is one of the most important global public health issues and training of healthcare professionals and the public needs to be an integral part of all AMR efforts. In 2015, four out of six countries with the highest antibiotic consumption rate in the world were low and middle-income countries, where Turkey was reported as the country with the highest consumption.

Methods

This paper aims to present a new undergraduate course entitled “Rational use of antibiotics”, specifically designed for pharmacy technician students to increase their awareness on AMR and to equip them with knowledge and skills in promoting rational antibiotic use. The curriculum update was part of a larger international project, supported by the Erasmus+ KA2 Strategic Partnership Program (Project no: 2015-1-TR01-KA204-022393).

Results

Pharmacy technicians are among the most critical health professionals regarding rational antibiotic use because they can play a significant role in educating potential antibiotic users and have a multiplier effect in disseminating evidence-based knowledge. The 16-week long undergraduate course was designed by pharmacy and public health faculty with a multidisciplinary approach, focusing on topics such as epidemiology and control of communicable diseases, antibiotics, AMR and its public health consequences, legal regulations and medical practice regarding rational antibiotic use, as well as principles and methods of health promotion and health education.

Conclusions

Quantitative and qualitative evaluation of the newly introduced undergraduate course on the rational use of antibiotics showed promising results, which indicate that designing specific courses for health professions students to combat AMR can be more widely practiced in countries with high antibiotic consumption. Public health academics can take a leading role and responsibility in the design of such multidisciplinary courses for undergraduate programs in health care.

Key messages

Specific courses on rational use of antibiotics can be effective in changing knowledge, attitude, and behaviors of healthcare professionals, and consecutively the general public in combatting AMR. Public health academics can take a leading role and responsibility in design of such multidisciplinary courses for undergraduate programs in health care.
Community health workers & medical students: a strategic partnership for Brazilian public health
Authors: Faria de Moura Villela E , Morato de Oliveira F
Published: October 2020

Introduction

Family Health Strategy represents a successful initiative for reorganization of primary care in Brazil. A differential is the Community Health Workers (CHW), who act facilitating community access to effective professional care in the form of health-promoting actions. However, the way CHW receive training to manage epidemics, as dengue, is almost unknown. In this context, this project addresses the importance of bringing together medical students and CHW in order to strengthening not only continuing education of CHW, but also the experienced learning of future physicians.

Methods

An exploratory study of qualitative approach was done. Two focus groups were conducted with ten CHW in a primary health care unit (PHCU) in Brazilian Midwest. The focus groups were conducted by the tutor and students previously trained on dengue prevention and management.

Results

Students identified difficulties in daily work and informational/ communicational gaps based on what was said by CHW if compared with the Ministry of Health protocol towards dengue control. These gaps were the basis for an action strategy to develop with CHW. Students developed strategies based on knowledge acquired on public health and experienced practices in medical school: meetings with CHW and other health professionals using lectures, conversation circles, role-playing and problem-situations. All activities were previously prepared by students under supervision. After all, we held the second focus group with the same CHW to evaluate the impact of the strategies adopted. 60% said their routine is now more dynamic and effective, only 10% state that their routine remains difficult. 80% said that after the training meetings the manager of the PHCU invited them to participate more actively.

Conclusions

This project brought the students to the reality of CHW health practices, what is a great opportunity to increase their commitment with the local health system and social accountability.

Key messages

The partnership between academy and health service is a challenge but when succeeded it enables changes in and may result in improvement processes in the public health system. The role of community health workers to achieve behavioral change in the community and to improve the public health of a country.
Second Victim Experience and Support Tool: cultural adaptation and psychometric evaluation in Italy
Authors: Scarpis E , Ruscio E , Bianchet B , Doimo A , Moretti V , Cocconi R , Farneti F , Castriotta L , Quattrin R
Published: October 2020

Background

”Second victims” are defined as “healthcare workers (HCWs) involved in an unanticipated adverse patient event, who experienced professional and psychological distress”. The Second Victim Experience and Support Tool (SVEST) is a survey developed and validated in the United States, which describes the experience of second victims. This study aims to perform the cross-cultural adaptation of the SVEST and to evaluate its psychometric characteristics in the Italian context.

Methods

The translation and cross-cultural adaptation process was performed according to the World Health Organization’s guidelines, from March to May 2019. Then HCWs involved in direct patient care (a potential second victim) were asked to complete the Italian version of SVEST in a validation survey, from June to November 2019 at the Academic Hospital of Udine. SVEST consists of 29 items, divided into 7 dimensions, 2 outcome variables and 7 support options. The IT-SVEST was assessed for internal consistency through Cronbach’s α, for content validity with Content Validity Index for Scales (S-CVI) and for Item (I-CVI) and for construct validity with Confirmatory Factor Analysis (CFA).

Results

Collected surveys were 349. Women were 79.4%. Nurses were 40.1%, 18.9% were doctors and 8.6% were residents. HCWs involved in a patients’ adverse event were 205 (58.7%). Out of these, 66.3% were near misses. The internal consistency of the instrument was adequate in its overall evaluation with Cronbach α = 0.88 (95% C.I.=0.86). S-CVI was 0.94 and I-CVI was 0.70. The CFA results showed a good model fit for the nine-factor structure (chi2=676.18, 327 df, p < 0.001). Root Mean Squared Error of Approximation, Akaike’s information criterion, Comparative Fix Index Tucker-Lewis Index values also suggested a good fit to the data.

Conclusions

The Italian version of the SVEST (IT-SVEST) can be used to evaluate second victim experiences, demonstrating adequate validity, reliability and good psychometric properties.

Key messages

Healthcare institutions need an instrument that can direct efforts to prevent and reduce the second victim experience. IT-SVEST is a reliable and valid instrument to obtain accurate information on second victim experience.
Transforming health: Introduction of new management structure at secondary healthcare of Pakistan
Authors: Chaudary N A , Navid Tahir MN , Mubin G
Published: October 2020

While public awareness on health issues is increasing, it has become more significant for the public funded health sector to retain the trust of its patients. It is specifically important in a country like Pakistan where the burden of patients in terms of number is compounded by recurring diseases outbreaks. Recent evidence shows that well-thought management systems can ease the pressure on provision of health services to a larger extent than previously anticipated. To address the managerial challenges of secondary care hospitals, health policy planners of the Punjab (Pakistan) had introduced a New Management Structures (NMS) 'team of non-clinical management graduates' under the Revamping Program of District & Tehsil Headquarter D/THQ hospitals in 2016. After 3 years of execution, a study was designed to evaluate the effectiveness and impact of this initiative. 24 in-depth interviews were conducted with the relevant stakeholders and 10 FGDs were conducted with the NMS teams. Thematic analysis & field observations were used to facilitate the presentation of results. The findings show that NMS teams have ensured greater efficiency in management operations of hospitals. Most of the research participants were appreciated for their skills and dedication to work. The hospital and district Health administrators were satisfied with the concept and need of NMS in healthcare system. They claimed that the need for NMS was justified and the intervention has significantly contributed to address the shortcomings inherent in the old management system. However, few stakeholders highlighted the need for further capacity building and robust service structure of NMS teams. The NMS initiative across all secondary hospitals of Punjab has improved the overall quality of healthcare service delivery in D/THQ Hospitals. It can be safely concluded that a specialized workforce in form of NMS is vital in ensuring smooth transition and up-gradation of hospitals under the revamping project

Key messages

Healthcare delivery is moving towards more specialized skills in terms of both healthcare services and management. NMS is vital in ensuring smooth transition and up-gradation of D/THQ hospitals.
Empowering students to innovate health services: Teaching transferability of health interventions
Authors: Schloemer T , Schröder-Bäck P
Published: October 2020

Background

To improve the health of different populations, health systems need healthcare professionals who are able to innovate health services. In order to empower students from various healthcare professions to change health service practice in a sustainable way, a training was developed based on the PIET-T models of transferability (Schloemer & Schröder-Bäck, 2018). It was evaluated at three universities in Germany and the Netherlands.

Objective

The aims of the training were to enable students to: 1. Critically analyze existing evidence about successful and unsuccessful transfers of evidence-based interventions to specific “real-world” contexts (1 day), 2. Conduct an assessment of transferability with case studies using problem-based learning (1 day), 3. Practice implementation research in a healthcare organization (4 months, 4 hours/week). The training was evaluated through discussions, a written reflection and a questionnaire in order to understand students' learning experiences.

Results

Two bachelor programs for occupational, physical and speech therapists, and one master program for public health professionals took part from 09/2019 to 03/2020, including 66 students. Students valued the training as important, 73 % found it helpful for professional practice. They reflected various ideas how to use the PIET-T models for practice change. Although the implementation research process was perceived as high workload, students valued the experience of getting to know barriers and solutions in a practical setting.

Conclusions

The students of all programs value the practical relevance of teaching with profession-related specifications. Practical application of the PIET-T models opens up new approaches in teaching in order to educate knowledge on improvement of health services in different contexts.

Key messages

Empowering students to improve healthcare requires practical training. Training on transferability helps students develop skills for improvement of health services.
Health impacts of pregnant working women victims of discrimination and moral harassment In Brazil
Authors: Turatti B , Rosa G , Moretti-Pires R
Published: October 2020

Background

Brazilian women are still a recurring target of discrimination in the workplace, facing violence related to gender relations and moral harassment, especially when they are pregnant. When the worker perceives discriminatory acts and attitudes or any violation of the rights guaranteed by law, she may appeal to the Labor Court to initiate legal action. The rights of pregnant women to temporary stability, free time for medical examinations, change of duties and maternity leave contrast with the usurpation of the administration's workforce. Considering pregnancy as a specific moment of change in a woman's life, one issue becomes all the more important: is it possible to be a pregnant in the working world?

Objective

Reflect on the consequence of moral harassment at work for the health of the mother-child binomial.

Methods

This was an exploratory, descriptive, qualitative study that used the Internet to search and draw the national profile of women cases in the gestational period that had their labor lawsuits judged by the Regional Labor Courts of Brazil. After reading and selection of the speeches, three main groups of categories were identified: labor issues, exclusion of women's bodies in the working world and consequences for the the mother-child binomial`s health.

Results

After analyzing 5,238 labor lawsuits, four main groups were identified considering the motivating fator. We sought to highlight the excerpts according to the chosen theoretical framework, namely the increased female performativity during the pregnant, abortion cases, postpartum depression and preterm births.

Conclusions

This research argues that social relations in the workplace imply the exclusion of female bodies in favour of masculine ones and seeks to understand the process of becoming a woman and becoming pregnant in the workplace in contemporary Brazil.

Key messages

This inclusion and permanence of women in the workplace is unstable and steeped in stereotypes, particularly when these women are pregnant, often resulting in violent and discriminatory attitudes. Motherhood must be understood and defended when it is desired as a social function that contributes to building a society based on respect for community. Defending this is part of reproductive rights.
The Burden of Antimicrobial Resistant Infections in Wales: a population-level modelling analysis
Authors: Wang H , Thomas P P M
Published: October 2020

Background

Antimicrobial Resistance (AMR) threatens the sustainability of an effective, global public health response to infectious disease. This study uses routine surveillance data to estimate the public health burden (PHB) of AMR infections in Wales for the period 2017-19, with further stratification by Age, Sex, local Health Board (HB) area and relative deprivation, to guide public health action.

Methods

Welsh AMR Surveillance data, collected as part of the European AMR Surveillance Network (EARS-Net), was collated for the period 2017-19. Adapting the methodology of the European Centres for Disease Control Burden of Communicable Diseases in Europe (BCoDE), we modelled the PHB of five types of antibiotic-resistant infection (invasive and non-invasive), and 7 pathogens which associated with AMR, using the Burden of Healthcare-Acquire Infection (BHAI) R package. Postcodes were used to assign patients' resident health board, as well as their relative socio-economic deprivation, using the Welsh Index of Multiple Deprivation (WIMD).

Results

Preliminary results (median estimation with 95% confidence interval (CI)) were calculated for: number of infections with AMRnumber of deaths attributable to AMRnumber of DALYs attributable to AMR

Estimates were stratified by age; sex; HB; relative deprivation; and pathogen and infection type.

Conclusions

This is the first study of its kind to study the relationship between AMR incidence and relative deprivation. It offers a clear picture of the epidemiology of AMR within Wales to support public health action.

Key messages

Infections from AMR bacteria represent a major PHB in Wales, and the modelling PHB of AMR by socioeconomic group and local area can inform effective public health action. The results of this study are valuable for guiding public health action to address AMR at the national and international level.
Exploring equity, gender and social determinants aspects of antimicrobial resistance: Scoping review
Authors: Saint V , Mohsenpour A , Mühling C , Bozorgmehr K
Published: October 2020

Background

Antimicrobial resistance (AMR) is a considerable threat to modern medicine and global health. Inequity, gender and social determinants of health (SDH) have a significant impact on health and health services, including in relation to AMR. Despite this, there is a lack of systematic focus on these dimensions in AMR research, policy and practice. We aimed to scope and review the existing evidence related to the equity, gender and SDH considerations for AMR globally through a systematic, iterative approach.

Methods

We conducted a scoping review by searching PubMed, Web of Science and CINAHL for empirical research on AMR in humans, with consideration of equity, gender or SDH, published in English between January 2000 and September 2019. In a two-stage process, we analysed full texts to extract information about explicit and then implicit references to equity, gender or SDH.

Results

The search yielded 4628 articles after removing 578 duplicates. 737 articles were analysed with explicit reference to equity, gender or SDH in title or abstract. Preliminary results show that 93.2% of these studies mentioned gender but mostly meaning biological sex (90.8%) rather than its social construct. Articles on equity (6.0%) and SDH (1.1%) reported on associations between AMR rates and income and non-income dimensions of inequality, health system issues and disadvantaged subpopulations within countries. Other articles in this category explored public and policy discourse or approaches for AMR (0.8%) and equity issues for AMR-related R&D (0.7%). These results combined with the PROGRESS-Plus acronym informed the subsequent analysis of the 4628 articles for implicit considerations of equity, gender and SDH.

Conclusions

Despite casting a wide net, we found relatively little research explicitly considering equity, gender and SDH aspects of AMR especially at a systematic or structural level. This reflects an important gap in the current understanding of and efforts to tackle AMR.

Key messages

We conducted a scoping review on equity, gender and social determinants considerations of AMR that indicates limited research on these important aspects of the social and structural drivers of AMR. Further research on these aspects is essential to inform the design of effective policy and practice interventions that target vulnerable groups and address structural inequities.
Carbapenem-resistant enterobacteriaceae: don’t trust your neighbour
Authors: Cuccaro C , Tarroni M , Tinturini A , Cresti S , Basagni C , Nante N , Messina G , De Marco F M
Published: October 2020

Background

The spread of carbapenem-resistant enterobacteriaceae (CRE) outbreaks consists not only of germs producing KPC and OXA-48, endemic already, but also metallo-beta-lactamase such as NDM or VIM. In Tuscany, Italy, a multidisciplinary regional task force has extended, since NDM alert spread out, from 1st Oct 2019 the CRE screening programme, via molecular testing, to newly admitted patients in high risk settings (medical, intensive care, oncology, transplant, infectious diseases, cardiac surgery units) to fight cross-contamination. The aim of the study is to assess levels and types of CRE in an italian teaching hospital (615 beds) after the programme became effective.

Methods

The surveillance team began recording daily all the CRE positive cases, defined as laboratory confirmed colonizations/infections with CRE. Our retrospective, descriptive study covers the time span between 30th Sep - 16th Dec 2019. Cases were classified by infected apparatus and by resistance phenotype, and we calculated descriptive statistics.

Results

In total we identified 97 cases (male 60.82%, mean (+/-SD) age 71.58+/-17.34 years, 74.23% in medical wards); 5 patients had two body districts infected and 9 carried two different phenotypes. Out of 102 positive samples, 92.16% were bowel colonization, 1.96% BSI, 3.92% urinary and 1.96% respiratory. Among these, 21 were NDM (19.81%), 29 KPC (27.36%), 4 OXA-48 (3.77%), 52 VIM (49.06%). The most detected germ was Klebsiella pneumoniae (30.19%), followed by Escherichia coli (2.83%), Enterobacter cloacae (2.83%), Citrobacter freundii and braakii (2.83%), Klebsiella oxytoca (1.89%). 61 agents were unspecified (57.55%). Among the 21 NDM, 76.19% were K. pneumoniae, only one was a BSI.

Conclusions

CREs continue to be present despite constant surveillance. Although high levels of KPC-producing agents persist, the new spread of VIM phenotype is significant, highlighting, however, that the pathogen wasn't detected in over 50% of the samples.

Key messages

Despite increased surveillance, there is still a consistent portion of patients colonized with unidentified CRE. A surveillance mainly focused on NDM-producing CREs had incidentally highlighted an unexpected spread of VIM phenotype.
Evolution of antimicrobial resistance in departments with high risk of cross infections in Tunisia
Authors: Haddad N , Azouzi F , Ben Chaikh A , Kahloun S , Rania A , Ketta S , Boujaafar N , Said Laatiri H , Bouallegue O
Published: October 2020

Background

Antimicrobial resistance is actually a real and ever-changing public health problem. The microbiology laboratory plays a key role to achieve collaboration with clinical services and the prevention and control of infection team.

Objective

Describe the bacterial ecology of departments with high risk of Health care associated infections and analyze the evolution of antimicrobial resistance.

Methods

A descriptive and retrospective study was carried out in the university hospital Sahloul. It concerned all strains isolated in departments with high risk of Health care associated infections. The study period was spread over 7 years from January 1st, 2010 to December 31th, 2016.

Results

A total of 6108 non-redundant bacterial strains were isolated. Isolated pathogens were mainly from the urology departement (n-2651, 43.4%).The most frequent isolated pathogens were Escherichia coli (n = 1329, 21,8%), K. pneumoniae (n = 992, 16,2%), and Acinetobacter baumannii (n = 763, 12,5%). Concerning these main isolated species, significant statistical differences were noticed in bacterial resistance evolution over the years. With E. coli, the evolution was essentially represented by an increase of amoxicillin, amoxicillin clavulanic, cefotaxime, gentamicin, and fluoroquinolones resistance. With K. pneumoniae, cefotaxime resistance was stable, however resistance to imipenem and gentamicin was increasing. There was also a significant increase in fluoroquinolone and aminoside resistance. With S. Aureus, an increase in methicillin resistance was detected from 11.1% in 2010 to 20% in 2016.

Conclusions

Antibacterial Drug Resistance is a dynamic and rapidly evolving phenomenon in our hospital. The most common MDR bacteria studied were enterobacteriaceae producing carbapenemase. The emergence of glycopeptid resistance in enterococci must be controlled in order to prevent its spread to the community and the transfer of staphylococcus resistance genes.

Key messages

Antibacterial Drug Resistance is a dynamic and rapidly evolving phenomenon in our hospital. The most common multi drug resistant bacteria studied were enterobacteriaceae producing carbapenemase.