bluuebunny/crossref_metadata_2025 huggingface dataset:
Junk food advocacy. Countering the industry
Authors: Moore AM M
Published: October 2020

Background

The junk food and alcohol industries have taken a page from the tobacco industry play book in an attempt to resist regulation through delay, self-regulation and effective lobbying. The junk food industry internationally is constantly seeking to increase sales at a time when the obesity crisis continues to grow. The industry thrives through widespread marketing with a particular focus on children.

Methods

An assessment of the number of lobbyists engaged to influence members of Parliament in Australia is being conducted to understand attempts to influence policy. This follows a scan of the lobbyists' register by Daube et al in 2018 that found the junk food industry had 33 direct and 13 indirect lobbyists. A re-examination of the register in 2020 is expected to reveal an increase in these numbers as international junk food companies become more concerned about regulation by government in areas such as front of pack labelling and marketing. There will also be an examination of the State and Territory registers in an attempt to understand the extent of influence in all governments across Australia.

Discussion

This examination is focused on the Australian Parliament/s. However, the message will be similar world-wide. Many companies have been challenged about their approaches to marketing and the sales of junk food. However, despite some attempt at corporate responsibility (Ronald McDonald House), they continue to sell their products to the detriment of community health.

Presentation

The presentation will focus on the importance and methods of countering the efforts of industry to increase availability of junk food by opposing regulation. It will also provide a series of steps that public health advocates can take in order to persuade governments of the importance of protecting community health through appropriate regulation of the marketing and sales of junk food.

Key messages

Junk food industry employs multiple lobbyists to resist regulatory reform. There are tools available for public health advocates to counter this influence.
Up to Their Old Tricks. Tobacco Companies and eCigarettes
Authors: Moore AM M
Published: October 2020

Background

Tobacco companies face an ever-increasing rate of marginalisation. They use eCigarettes as an opportunity to improve their credibility. In the past it was “just filter it” and “light cigarettes”. More recently, Philip Morris established a “Foundation for a Smoke-free World” pumping millions of dollars into distorting arguments about harm reduction.

Methods

The presentation will examine tactics used in traditional and social media to promote eCigarettes and to undermine arguments put by opponents. Tactics deployed that will be examined are: Use of the term harm reductionWithout the harm minimisation context that includes supply reduction and demand reductionAttacks launched in social media platforms such as twitter and FacebookOn individuals who publish papers identifying harms associated with eCigarettesPapers that are critical of eCigarettesDeployment of lobbyists in parliaments and to governmentsPresenting eCigarettes are a viable method of quitting tobaccoOther tactics

Specific examples will be provided illustrating cherry-picking, distortion of peer review and translation of this material into the traditional and social media

Discussion

The methods deployed by tobacco companies have been successful in some countries and have been countered in others. To enhance arguments, Big Tobacco has deployed public health figures like Dr Derek Yach and Dr Moira Gilchrist. Public Health England is one example of a strong and successful supporter of an open market for eCigarette.. A similar story is true in the USA and New Zealand. In Australia, both government and opposition have required approval by the Therapeutic Goods Administration consistent with other smoking quitting aids. The policy is that that these devices should be available to those who really need them after they have been proven as efficacious and not causing significant harm.

Key messages

Tobacco giants are distorting eCigarettes policy as a way of improving credibility. Public health advocates do have the tools to counter big tobacco approaches.
Evaluation and cost estimation of laboratory tests overuse through a CCDSS in a university hospital
Authors: Vallone D , Tamburrano A , Carrozza C , Urbani A , Cambieri A , Nicolotti N , Sanguinetti M , Laurenti P
Published: October 2020

Computerized Clinical Decision Support Systems (CCDSS) are information technology-based systems that use specific patient characteristics and combine them with rule-based algorithms. The aim of this study is to conduct a survey to measure and assess the over-utilization rates of laboratory requests and to estimate the monthly cost of inappropriate requests in inpatients of the “Fondazione Policlinico Universitario A. Gemelli IRCCS” Care Units.

This observational study is based on the count of rules violations for 43 different types of laboratory tests requested by the Hospital physicians, for a total of 5,716,370 requests, over a continuous period of 20 months (from 1 July 2016 to 28 February 2018). Requests from all the hospital internal departments (except for Emergency, Intensive Care Units and Urgent requests) were monitored. The software intercepted and counted, in silent mode for the operator, all requests and violations for each laboratory test among those identified.

During the observation period a mean of 285,819 requests per month were analyzed and 40,462 violations were counted. The global rate of overuse was 15.2% ± 3.0%. The overall difference among sub-groups was significant (p < 0.001). The most inappropriate exams were Alpha Fetoprotein (85.8% ± 30.5%), Chlamydia trachomatis PCR (48.7% ± 8.8%) and Alkaline Phosphatase (20.3% ± 6.5%). All the exams, globally considered, generated an estimated avoidable cost of 1,719,337€ (85,967€ per month) for the hospital.

This study reports rates (15.2%) similar to other works. The real impact of inappropriateness is difficult to assess, but the generated costs for patients, hospitals and health systems are certainly high and not negligible.

Key messages

It would be desirable for international medical communities to produce a complete panel of prescriptive rules for all the most common laboratory exam. That is useful not only to reduce costs, but also to ensure standardization and high-quality care.
Development of a neighborhood drivability index and its association with transportation behavior
Authors: den Braver N R , Lakerveld J , Gozdyra P , van de Brug T , Moin J S , Fazli G , Brug J , Moineddin R , Beulens J W J , Booth G L
Published: October 2020

Background

To develop and validate a drivability index for the City of Toronto and examine its association with transportation mode choice.

Methods

We used exploratory factor analysis to derive distinct factors (clusters of one or more environmental characteristics) that reflect the degree of car dependency in each neighborhood, drawing from candidate variables that capture density, diversity, design, destination accessibility, distance to transit, and demand management. Area-level factor scores were then combined into a single composite score, reflecting neighborhood drivability. Negative binomial generalized estimating equations were used to test the association between driveability quintiles (Q) and primary travel mode (>50% of trips by car, public transit, or walking/cycling) in a population-based sample of 63,766 Toronto residents enrolled in the Transportation Tomorrow Survey (TTS), adjusting for individual and household characteristics, and accounting for clustering of respondents within households.

Results

The drivability index consisted of three factors: Urban sprawl, pedestrian facilities and parking availability. Relative to those living in the least drivable neighborhoods (Q1), those in high drivability areas (Q5) had a significantly higher rate of car travel (adjusted rate ratio (RR):1.80,95%CI:1.77-1.88), and lower rate of public transit use (RR:0.90,95%CI:0.85-0.94) and walking/cycling (RR:0.22,95%CI:0.19-0.25). Associations were strongest for short trips (<3 km) and in analyses where both residential and workplace drivability was considered (RR for car use in high/high vs. low/low residential/workplace drivability: 2.18, CI:2.08-2.29).

Conclusions

This novel neighborhood drivability index predicted whether local residents drive or use active modes of transportation and can be used to investigate the association between drivability, physical activity, and chronic disease risk.

Key messages

The association between neighborhood drivability and car use was strongest for short trips. The drivability of the neighborhood where people work is a strong determinant of car use.
Co-creating nature-based solutions for healthy and sustainable cities: Urban public health approach
Authors: Skodra J , Zorita S , Garcia Perez I , Moebus S
Published: October 2020

Issue

Urban green spaces are necessary for developing healthy and sustainable cities. Benefits of Nature-based solutions (NBS) that increase the amount and quality of urban green go beyond environmental aspects (noise/air pollution mitigation) and have positive impact on mental health, active lifestyles and social cohesion. However, there is a need for the transdisciplinary co-creation processes including multidisciplinary partners and local community to ensure that different population groups use NBS and that health, social and environmental benefits are maximised. The Horizon2020 project CLEVER Cities (2018-2023) focuses on the development of NBS in deprived areas to address health, socio-economic and ecological challenges in a transdisciplinary co-creation approach.

Description

The three pilot cities, Hamburg, London and Milan, have formed Urban Innovation Partnerships (UIP) based on the stakeholder mapping. Each UIP involves citizens, companies, universities and local authorities to support CLEVER Action Labs (CAL) as alliances of local actors involved in the co-creation and assessment of place-based NBS interventions. The Theory of Change method (impact chain) was used to structure the transdisciplinary process, by initially determining the desired long-term outcomes related to the above-mentioned challenges. Proceeding from the identification of the local conditions, the necessary “outputs” were identified to achieve short-term and intermediate outcomes, which themselves lead to the determined long-term outcomes.

Results/lessons

Preliminary results show that Theory of Change provides a good structure for transdisciplinary discussions as well as an overview of a complex transformative change, underlying assumptions and unintended negative effects. Involving urban public health experts is essential to determine the relationship between different NBS and health outcomes, to maximize health benefits for all population groups and to reduce potential side effects.

Key messages

Inclusion of local community in the collaborative co-creation process is essential to ensure that NBS is adapted to their needs and that the desired health and wellbeing outcomes are achieved. The involvement of urban public health experts in the Theory of Change is essential to raise the awareness about the relationship between NBS interventions, their use and multiple health outcomes.
Financial performance of public hospitals: a cross-sectional study among Polish providers
Authors: Dubas-Jakóbczyk K , Kocot E , Kozieł A
Published: October 2020

Background

there is growing evidence of a positive association between health care providers' financial standing and the quality of care. In Poland, the instable financial situation and growing debt of public hospitals has been a source of concern for more than two decades now. The objectives were: (1) to compare the financial performance of public hospitals, depending on the ownership and organizational form; (2) to analyze whether there is an association between financial performance and the chosen variables (e.g., total assets, revenues).

Methods

we conducted a cross sectional study covering the whole population of public hospitals operating in 2018. The total number of included units was 805 (659 classic public hospitals, 17 research institutes and 129 corporatized). The hospitals' financial outcomes were measured by several variables and compared between the hospital groups; Spearman's rank correlation was calculated and a multivariable logistic regression model was performed.

Results

in 2018, the majority of public hospitals in Poland (52%) generated a gross loss, while 40% hospitals had overdue liabilities. There were statistically significant differences between hospital groups, with university hospitals and those owned by counties (local hospitals) being in the most disadvantageous situation. Also, corporatized public hospitals performed worse than those functioning in the classic legal form of independent health care units. All three variables which can be used as proxy indicators of hospital size (total assets, revenues or costs) were positively correlated with the value of overdue liabilities and the debt ratio, and negatively correlated with the gross profit margin.

Conclusions

there is high diversity in public hospital financial standing in Poland, with numerous units facing liquidity problems in 2018. Urgent actions are needed to measure and monitor the potential impact of financial performance on the quality of care.

Key messages

The instable financial situation and growing debt of public hospitals in Poland has been a source of concern for more than two decades now. In 2018, local hospitals owned by counties as well as highly-specialized university clinics and research institutes were in the most disadvantageous financial situation.
Out of pocket expenditure for availing maternal health care services in Northern India
Authors: Singh A , Jain P , Kumar S , Singh S , Singh N
Published: October 2020

Introduction

Maternal and child health comprise one of the most important parameters of the health situation in a country at any given time. Maternal and new born child's health are inter-related to a great extent and while improving one, we might greatly affect the other; hence, joint efforts are required to cope with the rising demands of better healthcare for both. Out-of-pocket expenditure act as a major deterrent, especially to underprivileged communities, in accessibility to maternal health care services and knowledge of the determinants of maternity related expenses helps in outlining policies.

Material and Methods

This is a community based cross sectional study conducted in state of Uttar Pradesh between July 2019 to December 2019 among 848 women who delivered in past six months at a public health facility. A pretested, semi structured questionnaire was used to collect data. The data thus collected was entered into Microsoft Excel spreadsheet and was analysed using Statistical Package for Social Sciences (SPSS) version 24.0, IBM Inc. Chicago, USA software.

Results

The analysis showed that the median OOPE was INR 1000 (US$ 13.89) which varied between INR 950 (US$ 13.19) for normal delivery and INR 4900 (US$ 68) for caesarean section. OOPE for availing diagnostic facilities especially ultrasound with a median value of INR 500 (US$ 6.94) contributed to the major share. Women from households with income more than INR 7500 (US$ 104.17) per month, education higher than high school, primi-gravida, occupation of mother and type of delivery were significant predictors for high OOPE. Awareness level about various free entitlements in public health facility was significantly associated with overall out of pocket expenditure.

Conclusions

Although services at the public health facility in India are supposedly provided free of cost, considerable out of pocket expenditure is still incurred on beneficiaries while availing maternity services.

Key messages

Out of pocket expenditure is a major deterrent in availing institutional deliveries in public health facilities. Zero-cost, equitable and accessible maternal health care services through timely access to health care facilities is of paramount importance for reducing MMR and IMR in every country.
Developing a National Public Health Laboratories Policy and Strategy
Authors: Boncy J
Published: October 2020

With the support of the European Union, the National Laboratory for Public Health and partners did an analysis of the primary healthcare and hospital laboratories in health facilities and identified strengths and weaknesses of the national network of public health laboratories. With that knowledge the LNSP developed in a participatory way a new national Laboratory Policy and thereafter a Strategic Plan 2019 - 2024 that guides the country in strengthening the labs at all levels. This is very much needed as Haiti still suffers of high levels of malaria, tuberculosis, HIV and other infectious diseases. The policy fits in the international Health Security Agenda.

Most important lesson learned: by a systematic step by step process of analysis, policy formation and action planning, a research institute can - with support of stakeholders - make an impact on policies and practices.
5.H. Workshop: Developing more responsive systems to deliver catch-up vaccination to migrants arriving in Europe
Authors:   Organised by: ESGITM,   Chair persons: Michael Edelstein - UK, Teymur Noori - Sweden
Published: October 2020

Background and Objectives

Migrants are thought to be one of several under-immunised groups in Europe, and involved in outbreaks of vaccine preventable diseases - including the recent large pan-European outbreak of measles. They may be under-immunised because of poor functioning of the health systems in countries they come from, because of barriers to catch-up vaccination and health services on arrival to Europe, and vaccine hesitancy may play a role. Amid substantial migration to Europe in recent years, ECDC public health guidelines for newly arrived migrants to EU/EEA countries have defined new recommendations, including focusing on catch-up vaccination in adult migrants. Yet there is an urgent need to better define what strategies work to improve vaccine coverage and to better understand the views of migrant communities, which will be the focus of this workshop. In this workshop we will explore various facets of migration and vaccination in the European context, and seek audience participation in better defining innovative implementation models and models of best practice to improve vaccine coverage in migrant populations residing in the region.

Workshop plan

The workshop will start with 15-minute presentations by each of the 4 speakers (to include a short Q&A after each talk). This will then move into a 30-minute audience discussion centred around seeking specific feedback on examples of innovation, good practice, and lessons learned across EU/EEA countries in engaging migrants and improving vaccine coverage in this group.

Speakers and topics

Sally Hargreaves (St George's, University of London): Are migrants to Europe an under-immunised group and involved in outbreaks? implications for health systems, policy, and practice.

Elizabeth de Vito (Università degli Studi Di Cassino e del Lazio Meridionale, Italy)

Barriers and facilitators to catch-up vaccination in migrant populations: defining effective and cost-effective implementation strategies.

Ines Campos-Matos (Public Health England, UK)

Vaccination on the move for asylum seekers and refugees: evidence, policies and practicalities.

Christina Louka (University of Groningen, The Netherlands)

Perspectives of asylum seekers, refugees, and other migrant groups on approaches to catch-up vaccination on arrival to Europe.

Key messages

Migrants are likely to be an under-immunised group in Europe, with new ECDC guidelines outlining key recommendations for catch-up vaccination on arrival. There is a need to better define more effective strategies to improve vaccine coverage in migrant populations in Europe.
Are migrants to Europe an under-immunised group and involved in outbreaks? Implications for health systems, policy, and practice
Authors: Hargreaves S
Published: October 2020

Migrant populations (defined as foreign-born) in the EU/EEA may be one of several under-immunised populations yet their role in outbreaks of vaccine-preventable diseases (VPDs) has been poorly defined to date. In this talk, SH will summarise our current understanding of the problem and explore implications for heath systems in Europe, policy, and practice in light of new ECDC guidelines detailing approaches to vaccination in recently arrived migrants to Europe.
The power of administrative data in national studies: experiences from the Scottish Burden of Disease study
Authors: Grant I , Wyper G M A , Fletcher E , McCartney G , Stockton D
Published: October 2020

In 2013, the Scottish Burden of Disease Study (SBoD) study set out with an ambitious aim of comprehensively estimating the burden of 132 causes of ill-health and mortality. The study utilised the rich and widespread data which is recorded as a by-product of individual encounters across the universally available and free at point-of-contact healthcare services in Scotland, and other long-standing survey initiatives. It was carried out as an independent national burden of disease study, but used Global Burden of Disease methodology for disability weights. In 2017, our first report outlined the contribution of causes of disease and injury of DALYs. This was followed up in a 2018, with a further report highlighting the effect of socioeconomic inequalities in DALYs.

In this presentation we will show the key steps involved in undertaking the SBoD study drawing on available data sources in Scotland. From the Scottish experience we will highlight important issues in knowledge translation for national burden of diseases studies to consider when specific choices are made on the methodological inputs into calculations for both YLL and YLD, specifically: (i) the differential impact between different life tables; (ii) the impact of differences in severity distributions; and (iii) the impact of using different standard populations when directly standardising rates.
Health is everyonés business - private sector partnerships for a healthy planet and healthy people
Authors: Ersbøll C
Published: October 2020

It is clear that we need to accelerate transformational change to address complex and inter-connected global challenges such the climate crisis, growing populations and the NCD pandemic. The private sector has a leading role to play in providing equitable and sustainable access to key determinants of health and well-being, including clean water, clean air, healthy and nutritious food and affordable and quality healthcare. Charlotte Ersbøll will argue that when businesses unite with other partners, they can be a powerful force for good. She will present examples of UN Global Compact initiatives convening businesses, UN, academia and civil society partners to set a new agenda for planetary health in business, such as the platform “Putting a Human Face to Climate Change” which helps businesses understand where they have the greatest potential impact and can best deliver science-based co-benefits for climate, food systems and health.

Panelists:

Guy Fones

Secretariat of the GCM/NCD, Office of the Deputy Director-General, WHO, Geneva, Switzerland

Contact: fonesg@who.int

Margot Neveux

World Obesity Federation, London, UK

Contact: mneveux@worldobesity.org

Filippo Addarii

PlusValue, London, UK

Contact: filippo.addarii@plusvalue.org
Using Telemedicine as a method for providing physician coverage: A pilot experience in a pediatric endocrinology clinic
Authors: Yafi M
Published: October 2020

Background

Telemedicine (TM) has been a rapidly growing method of providing health. Using technology to provide healthcare at a distance can be helpful in improving access and providing immediate medical care when needed. We evaluated families' choice and acceptance of TM visit in a pediatric endocrinology clinic as an alternative to rescheduling appointments. Based on these experiences potential and limitations will be discussed.

Methods

The families of our patients were informed about the TM visits and given the option to participate. The TM visits were designed for follow-up patients, only. Scope of TM visits was to review the medical condition, laboratory results, anthropometric measures, calculate height velocity, review, and develop medical management plans without performing physical examinations remotely. Satisfaction was obtained at the end of the TM visit.

Results

14 families were offered a TM visit when their physician was not available to conduct the visit. Six families (42%) agreed to participate in the TM visits, of which 2 dropped out. Patients seen were diagnosed with short stature or growth hormone deficiency. All of the participating families (100%) expressed satisfaction and would participate in TM visits in the future. Families who declined the TM visit chose to reschedule for traditional physician visits later.

Conclusions

Telemedicine can offer a practical solution to provide coverage for general and specialized physicians, suddenly unavailable, or to increase access to medical visits in underserved areas. Patients should be informed about TM visits and related details of the process, expectations, privacy, and outcomes prior to starting any TM clinic visit. Although a small sample, our pilot indicates a high hesitancy to participate. Efforts to increase acceptance of TN visits in a highly developed health system cannot be underestimated.
The impact of burnout on nurses' work satisfaction
Authors: Vévoda J , Vévodová Š
Published: October 2020

Background

The public health is a “big” employer, it employs approximately 10 % of all workers in the whole European Union, but it suffers from a lack of workers. Approximately 2,500 nurses are lacking in these days in the CR. If the lack will continue to increase, this reality will threaten the functioning of the whole healthcare system. The increasing of a work satisfaction and motivation becomes one of the important factors of nurses' stabilisation. Nevertheless, work dissatisfaction and low motivation is not the only element which can increase the fluctuation. Psychosocial risks (e.g. burnout) which 40 % of nurses in the CR suffer from, can be a problem as well.

Methods

A cross-sectional design is used in the survey. A principle of the survey was to find out how the burnout syndrome influences a list of factors of work dissatisfaction and motivation. Two questionnaires were used. The first questionnaire contained the list of factors of work environment, and it was created according to Herzberg motivation theory. The second one was Maslach Burnout Inventory. A survey was conducted in 2018, 462 nurses participated in the survey. Descriptive statistics and non-parametric test and Euclidean distance model was used for data processing.

Results

The survey revealed that burnout effect affects the subjectively perceived order of factors of work environment. The nurses, who do not suffer from burnout effect, prioritize direct patient care on their ranking of work value system. On the other hand, the nurses, who do suffer from burnout, consider a salary as the most important factor.

Conclusions

Healthcare providers' management should not only seek to increase work satisfaction or motivation on their own. Work satisfaction and low fluctuation can be achieved only through the comprehensive impact on the entire work environment.

Key messages

Job satisfaction and motivation are closely related to psychosocial risks. Reducing these risks will ensure job satisfaction.

Panelists:

Dimitra Panteli

Department of Health Care Management, Berlin University of Technology, Berlin, Germany

Contact: dimitra.panteli@tu-berlin.de

Erin Webb

Department of Health Care Management, Berlin University of Technology, Berlin, Germany

Contact: e.webb@tu-berlin.de

Erica Richardson

European Observatory on Health Systems and Policies, London, UK

Contact: erica.richardson@lshtm.ac.uk

Sabine Vogler

WHO Collaborating Centre for Pharmaceutical Pricing and Reimbursement Policies, Vienna, Austria

Contact: Sabine.Vogler@goeg.at
Acting the part – managers view on employees with repeated short-term sickness absence
Authors: Moldvik I , Müssener U , Ståhl C
Published: October 2020

Background

Repeated short-term sickness absence has been identified as a risk factor for long-term sickness absence. This association indicate the need for workplaces to pay attention to employees' sickness patterns and has led to guidelines which encourages employers to acknowledge frequent short-term absence so early interventions may be put in place. It is likely that employer attitudes have an impact for these employees, and for the development into sickness absence. One way of making sense of the employer relationship is to identify which roles they act upon, and how the setting influences these actions. By applying role theory, the aim of the study was to explore managers view of employees with repeated short-term sickness absence.

Methods

The study is a qualitative interview study. Semi-structured interviews were conducted with managers, health- and safety/union representatives and HR-managers at 17 different workplaces, a total of 44 individuals participated in the study. The material was analysed inductively using thematic analysis, focusing on the latent content.

Results

The results suggest that managing repeated short-term sickness absence is viewed as troublesome by the managers and it is not uncommon to express negative attitudes towards these employees. The results indicate that the managers' views of people on short-term sick leave goes through several phases, which we analyse as acts in a play, where their given roles are prescribing which actions to take, and which resources they have available for acting these parts. These acts describe an increasingly controlling attitude, where the sick leave is seen as an individual problem best managed by repressive tactics.

Conclusions

Great responsibility is put on the manager without enough decision latitude for them to handle the sick leave and rehabilitation process, leaving them with the option of focusing on individual actions.

Key messages

Role theory offers the possibility to analyze managers' attitudes and behaviours by considering the workplace and the manager-employee relationship as regulated by norms and organizational factors. The conditions within the organization influence how the managers deal with sickness absence and have an impact on how they view the employees with repeated short-term sickness absence.
Systematic review on Screening for antimicrobial-resistant Gram-negative bacteria in inpatients
Authors: Scardina G , Arzilli G , Casigliani V , Moi M , Lucenteforte E , Petri D , Rello J , Manissero D , Lopalco P L , Tavoschi L
Published: October 2020

Background

Infections with antimicrobial-resistant Gram-negative bacteria (AMR-GNB) are increasingly being reported worldwide. Early identification of carriage at hospital admission is essential to reduce the risk of onward transmission within the health facility. This systematic review aimed at exploring screening practices for AMR-GNB faecal colonization among patients on admission to hospital in high-income countries and estimating its prevalence.

Methods

We searched on Pubmed, Scopus and Cochrane databases for studies published from 2010 up to April 2019. We included studies reporting on patients ≥18 years old and hospitalised (excluding long-term care facilities).

Results

The search retrieved 9496 articles, 85 were included after screening: 10 reported screening activities in outbreak situations (not included in the analysis); 75 in non-outbreak situations. Based on the target patient groups and setting we identified four subsets of screening approaches: all admitted (AA) in high risk (HR) wards (36 studies, 48%), HR patients in HR wards (12, 16%), HR patients in low risk wards (LRW) (11; 15%) and AA - LRW (15, 20%). HR patients-based screening targeted patients with certain clinical conditions (mostly oncologic patients, 37%), travellers 29%, previously hospitalised and individuals with multiple risks 34%. HR wards-based screening was performed mostly in ICU (73%), while LRW-based screening in hospital-wide setting (58%). We investigated the overall prevalence rates of AMR-GNB (15.1%; 95%CI: 9.5-21.6), Klebsiella spp (KB) (4.1%; 3.1-5.3), E. coli (9.6%; 7.7-11.7) P. Aeruginosa (7.6%; 1.7-16.8), A. Baumannii (2.1%; 0.5-4.4) and other Enterobacterales (0.8%; 0.59-1.1). Reported KB-prevalence varied according to screening approaches, with statistically significant higher prevalence in HR wards.

Conclusions

According to our data, screening for AMR-GNB mostly followed targeted approaches. Overall prevalence of AMR-GNB carriage at hospital admission was considerable.

Key messages

This systematic review gives un overview on the screening procedures for AMR-GNB faecal colonization among patients on hospital admission in high-income countries. According to our results, overall prevalence of AMR-GNB carriage was considerable (15.1%), varying among specific pathogens but with no significant correlation with screening approaches, except for KB.
Measurement of gender as a social construct in quantitative health research – a critical review
Authors: Wandschneider L , Batram-Zantvoort S , Razum O , Miani C
Published: October 2020

Background

The relevance of gender as a social determinant of health inequalities is now broadly acknowledged. However, the plethora of existing approaches to capture gender, which are often stemming from disciplines outside of public health, makes it difficult to assess their practicality and relevance for a given research purpose. We conducted a critical review to 1) map the evidence of how gender can be operationalised in quantitative health research and 2) critically evaluate the identified measures.

Methods

We identified peer-reviewed articles in electronic databases (PubMed, Embase and PsycINFO), as well as grey literature in OpenGrey and on the website of governmental and not-for-profit organisations that actively encourage gender-sensitive public health research. Eligible sources described the quantitative operationalisation of the social dimension of gender. With the help of a newly developed scorecard, we assessed their relevance from a theory perspective (e.g. intersectionality) and the potential for implementation from a practical, epidemiological point of view.

Results

Gender measures principally assessed gender roles, gender-based discrimination and gender (in)equality. The majority lacked theoretical foundation, and tended to reinforce the binary understanding of gender identity through stereotypes of femininity and masculinity. An intersectional approach was found mostly in data-driven composite measures. Those also had the advantage of being easy to construct with standard health monitoring data.

Conclusions

A range of gender measures are readily available for public health research, addressing different levels and dimensions of gender as a social construct. With our theory-informed, practice-driven critical review, we highlighted their strengths and limitations and provided analytical tools for researchers interested in conducting intersectional gender-sensitive analyses.

Key messages

Gender and its impact on health can be captured through a range of measures (e.g. scales, indices). Among those, non-binary, theory-informed understandings of gender remain underrepresented. With the help of a newly developed scorecard, our critical review highlights the various gender measures’ strengths and limitations from a theory perspective and a practical point of view.
The Association between Depression and Anxiety with Online Social Networking
Authors: Višnjić A , Jović Vraneš A , Šantrić Milićević M , Stojanović M , Stanković M , Jovanović Tamara
Published: October 2020

It would seem that today, for many individuals the most important thing is to have a good profile picture on online social networks. Accordingly, there is a serious possibility that addiction to social networking sites (SNS) can lead to psychosocial and behavioral disorders, and other negative consequences on health-related issues. So, the aim of this study was to determine the association between the use of social networking sites and its dependence on symptoms of depression and anxiety. This cross-sectional study was carried out at the University of Niš, Faculty of Medicine from February to May, 2019. All of the respondents were assessed by using an appropriate questionnaire. The study included 1405 randomly selected respondents (411 males and 994 females). The strongest predictor of whether one has high levels of depression symptoms was state of conflict, where the odds ratio was 10.28. This indicates that the respondents with higher scores of the conflict component have symptoms of depression 10.28 times more often than others. It has been observed that depression symptoms are also more common in those respondents with expressed withdrawal symptoms (OR = 4.27), and with mood modification (OR = 1.82). Anxiety symptoms, similar to those of depression, are most present in individuals with conflict state (OR = 10.31), in those with withdrawal symptoms (OR = 6.83), and then with mood modification (OR = 2.55). The number of active accounts/profiles and number of devices, as well as state of salience and tolerance played no part in any of the cases. There is no doubt that there is a direct link between SNS and depression and anxiety. While these links may not be causal, it is quite certain that overuse of social networks exacerbates these symptoms.

Key messages

There is no doubt that there is a direct link between SNS and depression and anxiety. Strategies for self-control and limited SNS use should be developed by mental health professionals.
Hospital STI prevention scheme adapted to target undiagnosed LGBT migrants in Paris area since 2018
Authors: Bouchet-Mayer C , Segouin C , Kouadio-Sankadio C P , Sow A , Ramirez-Diaz W , Ferez S , Shelly M
Published: October 2020

Background

In Île-de-France region, 10 000 people do not know they are living with HIV (Supervie, 2016). 70% are men, including 40% men having sex with other men (MSM) and 40% sub-Saharan African migrants. From 35% to 49% of those sub-Saharan African migrants are infected in France. The main HIV prevention issues is to target populations that are unrepresented in screening test centers.

Methods

To achieve these aims, a sexual health promotion scheme has been designed by a public health association, a Sexual Transmitted Infections (STI) center and an association supporting people asking asylum because of their “sexual orientation or gender identity”. Outreach STI screening test actions are organized monthly in places crowded by asylum seekers and associative sexual health consultation including screening, results reporting, treatments, vaccinations and Pre-Exposition Prophylaxis (PrEP), devoted to asylum seekers are taking place weekly into the hospital. Pear community members have been trained to be referent in health matters and enhance the scheme effectiveness.

Results

549 people were screened for STI through 110 actions from March 2018 to December 2019, of which 25 were outreach and 85 inside the hospital. 74% were from sub-Saharan Africa and 86% were presumed MSM. 89% were under 40 years old. 20% of the screened people were diagnosed positive to at least one STI and 52 people have been engaged in PrEP treatment after a risky assessment. Pear referent involvement reduced the number of unreported results, 10% are still unreported. 21 people have stopped PrEP follow-up. Around 3/4 of those followed by the association on the period stand unreached.

Conclusions

The scheme allowed to targeted population according to epidemiology's indicators but we don't know if the most exposed part of the population is reached. Partnership between associations and hospital improved public health system as well as community involvement.

Key messages

Public health system needs adaptations to struggles epidemics. Community involvement must be a priority to increase prevention’s efficiency .
Perinatal outcomes among Venezuelan immigrants in Colombia: A cross-sectional study
Authors: Garnica Rosas L , Lamadrid-Figueroa H , Granich Armenta A , Salvador Dominguez M
Published: October 2020

Introduction

In the last decade, Venezuela suffers a humanitarian crisis, leading to massive emigration to border countries, including Colombia. One of the most vulnerable migrant groups is pregnant women. They face social and economic challenges, in addition to the barriers to access public health care services. These circumstances might increase adverse perinatal outcomes. This study aims to analyse the perinatal outcomes of Venezuelan migrants in Colombia and determine if the migration factor impacts on the perinatal results.

Methods

Data were obtained from the 2017 Colombian national birth register (n = 1,085 births in Venezuelan migrants and n = 654,829 in Colombian women). The premature birth (PB), low birth weight (LBW), 1-minute, and 5-minute Apgar score were compared to identify any association with the demographic, obstetric and neonatal characteristics, considering motheŕs origin as the primary exposure variable. Logistic regression models were used for the binary outcomes and linear regression models for continuous outcomes.

Results

The main difference was found in the low prevalence in health insurance coverage among Venezuelan women in comparison to natives (2.5% vs. 86.4%), and antenatal care visits (Mean 3.35±2.60 vs. 6.37±2.56). Venezuelan women were more likely to have newborns with LBW (OR 1.27; 95%CI 1.01, 1.58), lower Apgar scores at 1-minute (ß -0.09; 95%CI -0.14, -0.025) and 5-minute (ß -0.13; 95%CI -0.17, -0.08) in comparison to Colombians.

Conclusions

Our findings support that some neonatal outcomes among the Venezuelan migrants differed significantly from those of the Colombian women. The disadvantages found in health insurance coverage and antenatal care among migrants group were considered influencing factors. More effort among public health policies is needed to allow the migrant population having effective access to health care services, in order to improve the conditions of these women and their offspring.

Key messages

Pregnant migrant women are a vulnerable group in Colombia, facing health access barriers with neonatal consequences. The action is required by the application and reinforces of inclusive health policies among migrant population in Colombia.
COVID-19 serological testing for Healthcare Workers in Lombardy, Italy
Authors: Del Castillo G , Castrofino A , Grosso F , Barone A , Crottogini L , Toso C , Pellegrinelli L , Pariani E , Castaldi S , Cereda D
Published: October 2020

Issue

COVID-19 pandemic began in Italy on February 20th, 2020. Since the beginning of the emergency Healthcare Workers' (HCWs) involvement was prominent, mainly due to direct assistance to COVID-19 patients. Therefore, we implemented a prevention policy for HCW screening through serological and RT-PCR testing.

Description of the problem

HCW screening for SARS-CoV-2 infection is essential for prevention and control of the pandemic. Lombardy's Healthcare authorities settled a screening process for HCWs divided into three steps: 1) body temperature assessment at the beginning and the end of work shift, if fever > 37.5 °C was present the HCW was sent back home and a nasopharyngeal swab was performed; 2) progressive recruitment for serological testing; 3) on those positive to IgG a nasopharyngeal swab was performed and tested for viral RNA by RT-PCR.

Results

Among 79185 HCW tested, 9589 (12%) were positive on serological IgG testing. Of the 9589 positive a nasopharyngeal swab was performed on 6884. Of these 358 (5%) tested positive and the remaining 6526 (95%) negative to RT-PCR. We calculated a Positive Predictive Value of 5.2%. The rate of positive serological tests for each Healthcare facility varied between 0% and 78%. Five percent of all facilities, belonging to Brescia, Bergamo and Cremona area, reported a positivity rate higher than 40% in HCWs. A second cluster (18% of all facilities), involving the same geographical area, reported a rate between 20% and 40%, whereas the remaining facilities (76%) of the region a rate <20%.

Lessons

Serological IgG testing can be, if followed by immediate nasopharyngeal swab testing, a valid screening intervention on asymptomatic HCWs especially in a high infection prevalence setting.

Key messages

Serological IgG testing can be, if followed by immediate nasopharyngeal swab testing, a valid screening intervention on asymptomatic HCWs. Infection prevention in HCW may benefit from a screening campaign especially in high prevalence settings.
Influenza surveillance system and Covid-19
Authors: Castrofino A , Del Castillo G , Grosso F , Barone A , Gramegna M , Galli C , Tirani M , Castaldi S , Pariani E , Cereda D
Published: October 2020

The clinical presentation of symptomatic SARS-CoV-2 not only includes viral pneumonia, but also milder illness overlapping with influenza-like illness (ILI), allowing a potential tracking of the infection in the framework of the national influenza surveillance system (SS). By comparing the data recorded by the influenza SS in 2019-20 season to those collected for the previous years, we want to evaluate whether the implementation of ILI SS could succeed in early detection and monitoring of Covid-19 diffusion.

We analyzed the data recorded by the influenza SS and we compared the distribution of ILI incidence rate by week for 2017-18, 2018-19 and 2019-20 season in order to understand whether the SS detected any abnormality coinciding with Covid-19 outbreak.

The distribution of ILI cases in the three seasons presented a similar pattern up to the 9th week; after then, a reduction in the ILI incidence rate was observed in the 2017-18 and the 2018-19 season while an increase was detected for 2019-20. During 2019-20 season, three major characteristics stand out: i) at the beginning of Covid-19 epidemic (7th-9th week) 9,17/1000 cases were reported; ii) during the recognition of the COVID-19 outbreak (9th-10th week) 6,36/1000 cases; iii) during the spread of Covid-19 (10th-11th week) an unexpected increase to 7,72/1000 cases. Additionally, their geographical distribution was concentrated in the areas known to be most affected by the epidemic.

The influenza SS enabled us to detect the introduction and distribution of COVID-19. Implementation of the system should be prioritized in order to early identify new waves of Covid-19 but also any future novel respiratory pathogen. In order to empower the SS, it would be advisable to increase the population coverage about 2% which is the actual standard.

Key messages

The influenza surveillance system detected the first wave of Covid-19 in Lombardy Region, Italy. The influenza surveillance system should be implemented in order to bring a benefit both to the current situation and in sight of future public health challenges.