bluuebunny/crossref_metadata_2025 huggingface dataset:
Adaptation of HLS-EU-Q47 for the Russian population
Authors: Lopatina M V , Popovich M V , Kontsevaya A V , Drapkina O M
Published: October 2020

Background

Health literacy (HL) is recognized as one of the major determinants of health. International population HL surveys in Europe and Asia using a unified measurement of European Health Literacy Survey Questionnaire (HLS-EU-Q) demonstrated similar results of approximately 50% of population having poor or problematic health literacy level. In the present study the HLS-EU Q47 was adapted for the Russian population for the first time. Russian language is spoken widely beyond the Russian Federation (RF). Among international migrants, more than 25 million are from the RF or former Soviet Union, typically speak Russian and have a common historical and cultural background.

Methods

Adaptation of the questionnaire was based on the HLS-EU methodology and included 5 stages: translation from English into Russian, back translation by two independent translators, focus group (n = 12), online expert opinion (n = 12), field-testing (n = 90). For the focus group, the purposeful sampling was used, stratified by gender, age, education level and place of living (urban/rural). The field-testing was conducted by personal interviews in households, using a random stratified sampling based on gender and age.

Results

The translations analysis identified discrepancies on the use of plain language, and allowed to simplify the wording in 10 questions (13%). The focus group and expert opinion qualitative analysis allowed identifying and adapting cultural and linguistic peculiarities, so 24 questions (31%) were adapted. The field-testing showed 86% feasibility of the questionnaire in real settings.

Conclusions

Despite that the instrument was translated into Russian and used in some countries for the Russian-speaking population, a substantial adaptation of the questionnaire is necessary, taking into account the cultural and linguistic characteristics and background of the studied population. The instrument can contribute for measurement of HL in Russian population living in different countries.

Key messages

The HLS-EU-Q 47 was adapted for the Russian population. The adapted instrument can contribute to further health literacy measurements of the Russian population worldwide.
Implementation of Adverse event surveillance system in a Tunisian tertiary care hospital (2018-2019)
Authors: Ben Rejeb M , Ben Cheikh A , Bhiri S , Ghali H , khefacha-Aissa S , Said-Latiri H
Published: October 2020

Background

We found a high incidence of Adverse Events (AEs) following a survey conducted at Sahloul Hospital. Therefore, a surveillance system of AEs was implemented as a part of the implementation of the quality and risk management approach at Sahloul hospital, since April 2018. The aim of this study was to describe results of this system between May 2018 and April 2019.

Methods

It is a descriptive longitudinal study conducted at the Sahloul Hospital for a period of one year from May 1st, 2018 to April 30, 2019. Each service is provided with a data sheet that allows staff to report each adverse event they have witnessed. This does not include AEs that are part of alertness, blood exposure accidents or occupational accidents, or nosocomial infections which are assessed by specific circuits already in place.

Results

During the follow-up period, 93 AEs were reported. These AEs predominate in the sterilization unit followed by medical resuscitation and nephrology department with respective rates of 17.2%, 12.9% and 11.8%. The most frequent AEs were for maintenance (21.5%), medical device disinfection (20.5%), material resources (16.1%), and human resources (8.6%). According to criticality, the majority of AEs are tolerable under control (41.9%), unacceptable in 33.3% of cases and acceptable in 24.7% of cases.

Conclusions

In order to ensure proper functioning of the AEs surveillance and reporting system, the awareness of health professionals and their training would be essential. Quality of the information to be reported represents a challenge to be met to enable the planning, implementation and evaluation of improvement actions. Experience feedback would be with considerable benefit to improve the quality of professional practices.

Key messages

Surveillance and reporting system data analysis allow to identify mecanisms of the occurence of adverse events. Experience feedback is with considerable benefit to improve the quality of professional practices.
The use of electronic cigarettes in Thailand: a cross-sectional national survey
Authors: Baiya P , Chankeaw T , Chinwong D , Chinwong S
Published: October 2020

Background

An electronic cigarette (e-cigarette) is an electronic nicotine delivering system that may be widely used by smokers in Thailand for some reasons, although e-cigarette is an embargo good in Thailand and their benefits are not clear. Moreover, the behaviors of Thai e-cigarettes users remain insufficient and ambiguous. This study aimed to survey behaviors of using e-cigarettes and rationales among Thai e-cigarette users.

Methods

We conducted a cross-sectional study from December 2019 to February 2020 throughout Thailand. The participants were Thais with at least 18 years old and currently using e-cigarette, and they were invited to voluntary participate in the study using an online questionnaire posting on social media.

Results

Of 1,050 participants, most of participants were men (89.1%); the average age was 31.2±8.4 years old. They were from all regions of Thailand, but most of them (64.5%), were from the central part of Thailand. Of currently Thai e-cigarette users, 43.2%, 23.1%, and 14.9% were private employees, business owners/ freelancers, and students, respectively. Most of the users were graduated with a bachelor's degree (53.8%), and Senior high school or Vocational certificate (25.0%). E-cigarette users reported the top 3 rationales for using e-cigarette were the belief of less harmful of e-cigarette than a conventional cigarette (81.0%), using as a smoking quitting aid (80.6%), and lacking attaching normal cigarette odor (58.2%).

Conclusions

This study shows that most of the e-cigarette users were males with an average age of 31 years old. Smokers used e-cigarette because of the belief of less harmful of e-cigarette than a conventional cigarette and being a quitting aid. The public health organizations and health care providers should provide accurate information and raise awareness of users about the harm of e-cigarettes and inconclusive evidence of using e-cigarettes as a quitting aid.

Key messages

The public health organizations should provide accurate information and raise awareness of users about the harm of e-cigarettes and inconclusive evidence of using e-cigarettes as a quitting aid. Most of Thai e-cigarette users were men, at the average age of 31 years old, from the central part of Thailand, work as private company employees and bachelor’s degree graduated.
Sociodemographic and clinical factors are associate with fragility fractures in women in Portugal?
Authors: Barcelos A , Rodrigues A , Canhão H
Published: October 2020

Background

Osteoporosis is a public health problem worldwide responsible for fragility fractures (FF). All osteoporotic fractures, correspond to an estimated 40 000 annual osteoporotic fractures in Portugal. The social and economic burden of these fractures is enormous. Most patients die within one year after the fracture and 50% become dependent on others to perform basic self-care. The aim of this research is to study the association between sociodemographic and clinical factors that can influence the occurrence of FF in Portuguese women ≥ 50 years.

Methods

Data were collected from women ≥ 50 years participating in the prospective population-based cohort study called Epidemiology of Chronic Diseases, who self-reported to surfered FF during 2011 and 2015. Were collected sociodemographic and clinical data, and quality of life (EQ-5D). We divided this group in 2 subgroups: with and without prevalent FF. Descriptive, bivariate analysis and Odds Ratio were estimated. All statistical tests were performed using the SPSS 26, considering the significance level of 5%.

Results

A total of 3,662 women ≥ 50 years of age were included and divided into 2 subgroups with (N = 646) and without FF (N = 2,978). In the group of women with FF, rheumatic disease was the most self-reported chronic disease (62.9%), followed by hypertension (58.8%) and mental illness (30.0%). There was a significant association between the existence of FF and hypertension (OR = 0.82 (0.68-0.98); p-0.03), diabetes mellitus (OR = 0.78 (0.63-0.97); p-0.02) and mental illness (OR = 0.70 (0.57-0.85); p < 0.0001), even when adjusted for age and rheumatic disease. There was no significant association between the existence of FF and education, when the OR was adjusted for age and rheumatic disease. Quality of life was reported as worse in women with FF.

Conclusions

FF are associated with non-communicable chronic diseases and this should awareness to the need to have health policies that focus on prevention.

Key messages

Osteoporosis is a public health problem worldwide responsible for fragility fractures. It is urgent address this problem as a non-communicable chronic diseases and start to work in prevention. Population aging combined with new professions and lifestyles, predict that this problem will tend to increase exponentially in the next years.
Between health needs and agenda-setting: a procedural analysis of the compositional layers of space
Authors: Winckler M , Zioni F , Ferreira P
Published: October 2020

Background

This study aims to offer a view of the current situation arising in the Brazilian Health System (SUS) regarding the relationship between the health needs of its users and the health policies developed by the system.

Methods

The qualitative analysis was organised in two stages: 1) Comparative analysis of the social representations of health needs in which the data were analysed by the Health Needs Taxonomy (Matsumoto, 1999), as an instrument to assess health needs, format the interview guide and organise the empirical data; the Theory of Social Representations (Jovchelovitch, 2000) to capture health needs, and Content Analysis (Bardin, 2004), as an instrument of analysis and comparison of perceived needs. 2) Analysis of the agenda-setting in which the data were obtained and analysed by the Grounded Theory (Strauss; Corbin, 1990), Narrative Analysis (Taylor, 1979), and the Procedural Analysis Model (Ferreira; Alencar; Pereira, 2011) for contextual analysis of public health policies. The fieldwork was a Brazilian municipality and 39 representatives of civil society organisations and stakeholders were interviewed.

Results

The data showed a complex social fabric made of a plot that alternates between conceptual knots and structural voids which has been sewn by many actors and has served multiple purposes. It also showed that an insufficient institutional capacity for assessing needs, professional turnover, managers' personal decision and the manipulation of actors and institutions according to the interests at stake have kept the health needs unmet.

Conclusions

A positive representation of SUS will only be achieved through both the intertwining between biomedical knowledge to the determinants of health and the strengthening of a democratic culture. Without this perspective, the health system will remain fragile, plentiful in structural knots and voids, and unable to relocate people's health needs from the fringes to the main layers of this social fabric.

Key messages

An insufficient institutional capacity for assessing needs, managers' personal decision and the manipulation of institutions according to the interests at stake have kept the health needs unmet. A positive representation of SUS will only be achieved through both the intertwining between biomedical knowledge to the determinants of health and the strengthening of a democratic culture.
What are the perceptions of stakeholders on the utility of the nKPIs for Indigenous services?
Authors: Finlay S , Williams M , Judd J , Brown A
Published: October 2020

Background

The Australian Commonwealth Government has introduced national key Performance Indicators, (nKPIs), for Indigenous primary health care services, including Aboriginal Community Controlled Health Organisations (ACCHOs). The nKPIs aim to assist in the monitoring of Indigenous people's health and aid ACCHOs to monitor their service delivery. The nKPI development and its ongoing implementation have involved stakeholders including the Council of Australian Governments; national and jurisdictional ACCHO peak bodies; government departments; software developers, and researchers. While high-level information is available about the nKPIs, there is very little publicly available information about how they were developed and implemented. This presentation discusses perspectives from stakeholders on the development and implementation of the nKPIs.

Methods

Stakeholder interviews (n = 15) aimed to understand the utility and appropriateness of the nKPIs and barriers/enablers to implementation. Stakeholders with knowledge of the development, management or reporting of the nKPIs were recruited. The analysis was conducted inductively and deductively and organised using NVivo.

Results

The interviews focused on the history of the nKPIs and the context within which these are collected and managed. Several key themes and sub-themes arose from the stakeholder interviews. These themes included the nKPI purpose, development, implementation, and appropriateness. Several interviewees considered the nKPI development process to be flawed, leading to poor data quality and an increased burden on ACCHOs.

Conclusions

The ACCHO sectors' needs and perspectives were mostly ignored in the development process. Numerous research papers and government documents highlight the need for active engagement of Indigenous people to be actively engaged in the design of policies, programs, and frameworks seeking to improve the health of Indigenous people.

Key messages

The nKPI implmentation issues could have been avoided had they been developed in partnership with Indigenous organisations. Indigenous policy development needs to be developed in partnership with Indigenous people.
Tobacco control laws and smoking in Turkish movies between 1992-2016
Authors: Erik H , Çolaklar M , Yardım M , Özcebe H
Published: October 2020

Background

Advertisement and promotion of tobacco products were banned in 1996; sponsorships ban was in 2008. Smoking in movies are not accepted as advertisement, but they can interfere young people' beliefs about smoking. In this study, the relation between tobacco control law and tobacco scenes in movies were evaluated.

Materials and

Methods

The sampling of this descriptive research was 50 films selected two most watched Turkish movies from Turkish Cinema Studies and Box Office between 1992-2016. The movies were evaluated in three time intervals according to 1996 and 2008 Laws. The movies was watched by using the data record form including information about tobacco scenes. The content analysis method was used to evaluate the data; ethical principles were taken care of by the researchers.

Results

The selected films were watched by maximum of 7.4 M people and a minimum of 20 K people. Tobacco products were observed in 84% of the movies, the most observed was cigarettes (93%). The number of scenes with tobacco products had the range of 45 and 1; the duration is between 21.46-0.08 seconds. In tobacco images, 87% men, 78% adult age group and 40% leading actor while drinking were observed as smokers. It was found that two indicators (the average numbers of scenes; the scene duration) increased 1.6 times (p > 0.05, p > 0.05) between two tobacco laws. After banning sponsorship in 2008, 3.6-fold decrease in the number of scenes and a 5.3-fold decrease in the duration of the movies were observed compared with the period between two tobacco laws (p < 0.01, p < 0.05).

Conclusions

Stable and comprehensive tobacco control policies had an impact on reducing tobacco scenes in motion pictures in Turkey. However, the increase in watching movies on the internet today requires the development of new strategic interventions.

Key messages

Restrictions and prohibitions on the advertising, promotion and sponsorships of tobacco products should be systematically controlled in the cinema industry. A comprehensive and multidisciplinary approach is required to tackle the impact of the tobacco industry on motion pictures.
Managing transition to ValueēBased hospital care pathways
Authors: Scardoni A , Sancini S , Ambrosio A , Signorelli C , Odone A
Published: October 2020

Issue

San Raffaele Hospital (OSR) is part of a European alliance of 9 University Hospitals (EUHA) which promotes comparison and excellence in the clinical, research and training strategies.

Description of the Problem

The development of Value-Based (VB) strategies has been active in OSR since March 2019, with multidisciplinary healthcare pathways and with the promotion of patient engagement.

Results

The prostate cancer pathway was identified as a pilot and replicable model to promote the VB culture in different areas, in particular in the field of digitalization, human resources, research, redesigning of paths and outcomes collection. The other clinical pathways progressively launched during 2019 were: breast cancer, stroke, heart failure and pancreatic cancer.

The project was realized by: • setting up a Multidisciplinary disease teams; developing a training course on VB, involving all the healthcare professionals (clinicians and managers);involving patient associations in the development of the pathway;adopting sets of clinical outcomes, Patient-Related Outcome Measures (PROMs) and Patient-Related Experience Measures (PREMs) with a specific collection platform, currently under implementation;identifying new IT support tools, activated from March to December 2019 in 11 Disease Units: HealthMeeting, a platform supporting document and data sharing, connecting different Specialists and performing advanced digital multidisciplinary meetings; DNM-Digital Narrative Medicine, a platform connecting patients with their clinical team, supporting web-based storytelling and personalized therapeutic approach.

Lessons

The introduction of a new shared and patient-centred work model, with the reorganization of spaces, resources and dedicated IT tools, has improved the diagnostic-therapeutic process.

Key messages

The main challenge of hospital transition to VB pathways is organizational and cultural. For VB implementation is needed sustainable use of available resources and IT, to achieve better outcomes.
New public health policy intervention for diabetic foot management in Mexico
Authors: Luna L , Babich S , Garcia-Alva J R , Cuen C , Arzola L , Lopez-Peña G , Laparra H , Lozano R , Anaya-Ayala J E , Hinojosa C A
Published: October 2020

Problem

In Mexico, an estimated 12 million people have diabetes, with complications of diabetes contributing to 25-90% of non-traumatic amputations.

Description of the Problem

We conducted a review through the literature of available studies in English-language databases and libraries, including PubMed and UNAM digital Library to determine the role of teaching first contact health workers and the creation of limb salvage teams in the prevention of amputations. Through this review, we present the basis of our proposal about implementing these strategies to improve a care coordination system for diabetic foot management in Mexico.

Results

There were 25 publications from different countries, 12 eligible for this review. The review emphasizes that the creation of Specialized Diabetic Foot Teams to treat patients and teach first contact medical workers could help to achieve the following objectives which result in the reduction of amputations and improved patient outcomes: Standardize and simplify the diabetic foot clinical examination.

Timely reference of patients with DM with a moderate and high risk of diabetic foot complications.

Timely reference of patients with diabetic foot and peripheral arterial disease to third-level hospitals.

Periodic first-contact health workers training on risk detection and stratification of diabetic foot.

Lessons

Implementing the policy of creation of Specialized Diabetic Foot Teams to treat patients and teach first contact medical workers will contribute to reducing major amputations due to diabetes in our country. We aim to implement a successful policy in Mexico to strengthen the health system and improve outcomes and therefore the quality of life of patients with diabetic foot complications. We aim to serve as a legislative voice for all patients in Mexico facing major amputations and other diabetes complications.

Key messages

New public health policy implementation for diabetic foot management in Mexico. Prevention of major amputations.
Prevalence of second-hand tobacco smoke in relation to smoke-free legislation in the European Union
Authors: Schiavone S , Anderson C , Mons U , Winkler V
Published: October 2020

Background

Second-hand smoke (SHS) is still an important public health problem. With joining the Framework Convention on Tobacco Control (FCTC), all parties acknowledged the health risks of SHS and agreed to implement policies to protect their populations from SHS in public places. The aim of this study was to explore the SHS exposure in restaurants and bars as well as its associations with smoke-free legislation in the European Union.

Methods

Data of Eurobarometer surveys 2014 and 2017 were used to estimate prevalence of SHS exposure. We also extracted data on individual confounders such as smoking status, gender, sex, age and information on social economic status. Additionally, we collected data on country specific data on smoking regulations in restaurants and bars from the Tobacco Control Scale to analyse associations with SHS exposure using multilevel logistic regression. Smoking regulations were categorized into the following three categories: partial ban, comprehensive ban with minor exceptions, and complete ban.

Results

Preliminary results on the prevalence of SHS in restaurants showed a decrease from 11.8% (95% confidence intervals (CI) 11.2-12.5) in 2014 to 8.8% (95% CI 8.3-9.3) in 2017. The crude multilevel model controlling only for smoking prevalence resulted in an odds ratio of 0.39 (95% CI 0.19-0.77) for comprehensive ban with minor exceptions and 0.28 (95% CI 0.16-0.50) for complete ban versus partial ban. Odds ratios remained at significant levels when controlling for all available confounders.

Conclusions

Between 2014 and 2017, SHS exposure in restaurants decreased significantly. Furthermore, strong associations with smoking regulations were observed suggesting a high compliance. Many tobacco control policies have been introduced during the last years but several countries need to strengthen their smoke-free tobacco control policies to further reduce SHS exposure preventing death, disease and disability.

Key messages

SHS exposure remains a significant public health challenge. The implementation of effective measures could be strengthened through a convergence of tobacco control strategies and policies among European Union member states.
A public health Italian ethical movement to sustain the beveridge model: health promotion and equity
Authors: Sessa G , Occhini G , Milani C , Marini G , Sarro A
Published: October 2020

Worldwide sustainability of the National Health Systems (NHS) has been facing different challenges, such as population ageing, epidemiologic transition and deep social transformations. All these changes are struggling Italian welfare state and its public NHS. Following the principle of the Right to Health of the Declaration of Human Right and the Italian Constitution, a group of young health professionals from all over Italy founded a campaign called “2018 Primary Health care: Now or Never”(PHC Campaign) reminding WHO report of 2008 “primary Health Care: Now more than never”. This movement promotes a reform of the NHS focusing on comprehensive-PHC (C-PHC) and health promotion to guarantee sustainability of the Beveridge model italian system, fight health inequalities and answer the complexity of population needs in a period of spending cuts.

Since the beginning, the movement started an educational program through the study of the literature and the research of the Italian and international best practices of C-PHC and community health promotion. As a result, to achieve the goal of this project, PHC campaign organized peer education training sessions, educational site-visit of some Italian best practices, lectures and workshops with Italian and foreigner health professionals experts on the field. Several national and regional events had been organized all over Italy. Members of “PHC” Campaign have been invited to write books, news on web-based newspapers on this topic and participate in congresses. To date, PHC campaign might be considered one of the strongest not-institutional voices in Italy in supporting the public beveridge-model NHS

Moved from a strong ethical health policy view underlined the importance of the Right-to-Health and of a C-PHC based NHS, since the beginning, “2018 Primary Health care: Now or Never” Movement identified three asset of action: advocacy, education/knowledge and diffusion.

Key messages

The experience showed the importance of health professionals engagement in public health topics such as sustainability of public NHS in order to promote a reform towards health promotion and equity. PHC Campaign is an example of how a bottom-up ethical movement on public health from different Health professionals could actively contribute to promoting cultural and health policy change.
Anthropological analysis on recent covid-19 infection in Italy
Authors: Sironi V A , Riva M A
Published: October 2020

The recent epidemic caused by the Covid-19 virus, which originated in China and then spread rapidly, can rightly be defined as the real 'first' epidemic in the social era. In an increasingly globalized world other recent epidemics (but more circumscribed, even if severely more lethal, such as Ebola and Sars) have been experienced with less media and emotional involvement, while the recent epidemic due to the new coronavirus has generated deserving reactions of analysis from an anthropological and social point of view, rather than on a health aspect. In Italy the epidemic event provoked sometimes excessive and irrational psychological reactions (from an unjustified panic to an irresponsible underestimation) and a cognitive distortion on anthropological level (wrong perspective perception of the pathological event). It has also generated disproportionate social repercussions at national level (refusal of stay for subjects coming from the lands in which diseased people are present) and at international level (foreclosure of landing of Italian tourists in some foreign countries). There was also incorrect medical information (confusion between infected - asymptomatic and/or non-hospitalized paucisymptomatic -, real patients with important symptoms - hospitalized - and sometimes in need of intensive care, subjects - the elderly and carriers of other serious diseases - died not for but with the Covid-19 infection) generated and amplified also by the pounding informative role of the mass media and by the news (often inaccurate and generating fake-news) spread in real time through social media.

Key messages

Irrational reactions must be avoided. Correct medical information are indispensable.
How are the women in Germany? The Women’s Health Report of German Federal Health Reporting
Authors: Prütz F , Hintzpeter B , Krause L , Saß A-C
Published: October 2020

Issue

The aim of Federal health reporting (GBE) is to continuously provide up-to-date information on the population's health and healthcare utilisation in Germany. Since women and men differ significantly in terms of health and disease, health reporting should always take gender into account.

Description of the Problem

A new report on women's health in Germany is published in mid-2020 by the Robert Koch Institute (RKI), containing data on women's health situation, health behaviour and health care. GBE publications are based on a comprehensive database, including official statistics, RKI health monitoring data, routine data and cancer registry data. We will present exemplary data on key indicators of the report.

Results

Life expectancy of women in Germany has been rising for many decades. With currently 83.2 years, it is at the EU average. Cardiovascular diseases are still the leading cause of death, accounting for 40% of all deaths. The second leading cause of death in women is cancer. With about 69,000 new cases per year, breast cancer is most common, although incidence and mortality rates have significantly declined. 53% of women in Germany are overweight (EU: 44%), 22% undertake health-enhancing physical activities at least once a week (EU: 10%), the 30-day prevalence of binge drinking is 19% (EU: 10%). Women with a migration background have a lower prevalence of risky alcohol consumption and practice physical activities less frequently. A low birth rate and the postponement of the first birth to a later age are characteristic for Germany (summarized birth rate: 1.57). The caesarean section rate slightly decreased to 30.5% in 2017. In 2018 there were 100,986 terminations of pregnancy, with a declining trend.

Lessons

The Women's Health Report provides an overview of key issues of women's health in Germany. These can help to improve prevention and health care. In some areas (e.g. benign gynaecological diseases), there are still data gaps in spite of high prevalences.

Key messages

The Women's Health Report of Federal Health Reporting is published in mid-2020 and provides an overview of key issues of women's health in Germany. Women’s life expectancy in Germany has been rising for many decades and is currently 83.2 years, with cardiovascular diseases and cancer still being the most common causes of death.
The Operational Control Unit in the Health Protection Agency of the Metropolitan City of Milan
Authors: Dadda F , Nicolosi D
Published: October 2020

Issue

Lombardy health system (SSL) separates the function of purchasing health benefits from the provision of services. Hospitals may be public or private and must be accredited and contracted with SSL to be refunded.

Description of the Problem

The Health Protection Agency of the Metropolitan City of Milan covers about 3,500,000 inhabitants and 54 hospitals. The SSL has funded 548,250 episodes of ordinary hospitalization and Day Hospital. Total reimbursement of these admissions was 2,175,426,335 € with an average reimbursement of 3,697€ per average hospitalization of 7 days. The main diagnoses were cardiovascular (16.1%) and muscular-skeletal diseases (13.2%); the main reasons for hospitalization are birth and delivery (5.3 and 4.2% of admissions); hip and knee replacements absorbed 5.9% of total reimbursements and 2.7% of hospitalizations.

Results

The Operational Control Unit (NOC) evaluate settings and duration of hospital stays, diagnosis and procedures encoding on hospital discharge forms (SDO) and compilation of clinical documentation quality assurance. NOC make yearly inspections on a specific percentage of hospitalizations decided by the Lombardy Region by a targeted sampling mode or by a validation of hospitals' self-evaluations.

Lessons

In 2019 NOC evaluated 40,040 hospitalizations with targeted sampling mode that meant a total refund of 156,374,990 € and economic cuts in 19.2% of cases, that is 9,236,586 € (5.9% of the original reimbursement). In 2,428 cases NOC made changes in diagnosis or procedures of SDOs, in 916 cases reduced days of hospitalization, in 1,408 cases turned admissions into outpatient services and in 982 cases they applied a refund reduction due to quality failures in clinical documentation. Concerning self-evaluations, all admissions related to 2019, NOC analyzed 35,424 hospitalizations for a total refund of 130,781,615 € and modified 4,168 of them, the 11.8% of the total sample, returning an economic cut of about 5,259,532 €.

Key messages

NOC in 2019 evaluated 75,464 hospitalizations in 54 hospitals amending 11,838 admissions, the 15.7% of the total, returning an economic cut of 14,496,118 €, about the 5% of the total amount. NOC activities can have a remarkable impact on correct reimbursement of hospitalizations.
Biosimilar formulations of gonadotropins in a central Italian region: use patterns and time trends
Authors: Rosa A , Belleudi V , Addis A , Ciardulli A , Pacchiarotti A , Davoli M , Kirchmayer U
Published: October 2020

Background

Gonadotropins (Gonas) are hormones that play a central role in the follicular growth of women but also useful in male infertility. Gonas used for infertility treatment in women are available as urinary extracts or recombinants. In 2015, the first biosimilar of follitropin alfa was authorised.

Objectives

We aimed to evaluate use patterns, temporal and spatial variations of Gonas biosimilar formulations in an central Italian region.

Methods

From administrative healthcare databases of Lazio region, we extracted prescriptions that have occurred over the years 2015-2019. Gona's use was grouped as treatment with urinary (u) and recombinant (r). Special focus was made on biosimilar r-Gona. Use patterns were investigated with respect to characteristics of the patients treated, time trends, differences among local health units and type of prescribing physician.

Results

For the study period, we retrieved 136,333 Gona dispensations for 22,325 patients. The 10,927 r-Gona biosimilar dispensations (8.01% of all claims, of which 99.43% Bemfola®, and 0.57% Ovaleap®), were mostly referred to women, aged 18-45 years, (87.11% of all patients). Median age was 37 years for women, 38 for men. Since its authorisation, biosimilar r-Gona steadily gained market from 2015 (0,4% of claims) to 2017 (22,7%) followed by a decrease in 2019 (4,3%). Biosimilars claims are more frequent in treating men (10,8%) than women (6,1%). Most biosimilar prescriptions were issued by general practitioners (86.4%), followed by specialists (10.2%) and others. Biosimilar use patterns varied between different local health units (IQR 3.2%-8,5%).

Conclusions

In clinical pratice, r-Gona biosimilar dispensation, 8,8% of Gonas. are mostly prescribed from general practitioners and are proportionately more targeted at men than women. Further investigation is needed.

Key messages

More and more men and women are using artificial insemination techniques; it is important to monitor fertility drug use patterns. In times of savings for the economic system,the use of the biosimilar drugs is of increasing interest.
Temporal trends in female breast cancer mortality in a state in Legal Amazon
Authors: Oliveira J C S , Galvão N D , Souza B S N , Andrade A M C S , Cabral J F , Caló R S , Silva A M C
Published: October 2020

Background

Breast cancer is the fifth most common cause of death from cancer in women worldwide. In Brazil, mortality rates are increasing. Therefore, the aim of this study is to analyze breast cancer mortality between 2000 and 2018 in Mato Grosso, a Brazilian state in Legal Amazon.

Methods

Ecological study analyzing temporal trends. Data were extracted from the Mortality Information System. The selected variables were: sex (female), cause of death (C-50, in the 10th revision of the International Classification of Diseases - ICD 10), age (less than 50 years-old, equal or older than 50 years-old) and year of death (2000-2018). Resident population data were obtained from the Ministry of Health's database (DATASUS) for calculation of breast cancer annual mortality rates. Temporal trends were estimated using linear regression. All analyses were done in the STATA 14.0.

Results

Between 2000 and 2018, 2,276 deaths from breast cancer were registered in women. Of these, 756 (33.2%) in the youngest age group and 1,520 (66.8%) in the oldest age group. A statistically significant increase in breast cancer mortality was found for both age groups (p < 0.001). In the annual mortality rates analysis, women in the youngest age group had the lowest rate in 2003 (1.98 deaths/100,000 women) and the highest rate in 2018 (7.88 deaths/100,000 women). The oldest age group had the lowest mortality rate in 2000 (21.48 death/100,000 women) and the highest rate in 2017 (47.09 deaths/100,000). The mean mortality rate was 5.69 for the youngest age group and 33.19 for the oldest age group. The annual percentage of change was 33.31 for the youngest group and 62.49 for the oldest group.

Conclusions

There is a statistically significant increase in female breast cancer mortality rate in Mato Grosso, one of the Brazilian states in Legal Amazon. It is imperative to invest in breast cancer screening to enable the reduction of the mortality rate of the disease.

Key messages

Our study presents information of breast cancer in a state from Legal Amazon that has increased death rates by the years 2000 to 2018. Besides breast cancer is relevant in Brazil, this is the first analysis from this specific data, potential to support improvement in disease control.
Travel Clinics, where we are and where we are going: a national survey in Italy
Authors: Canale A , Giardi F , Giorgi S , Lopalco P , Tomasi A
Published: October 2020

Background

In a world where travelling can play a central role among human activities, due to the migratory flows increase and to the facilitation of exchanges between distant countries, the need to ensure healthcare to all travellers becomes a key point among healthcare activities. The aim of the study is to assess Italian Travel Clinics activity, critical issues, requirements and tips for improvement.

Methods

During the period from May to September, the Italian Society of Travel Medicine and Migrations (SIMVIM), performed a national on-line survey addressed to all Italian Travel Clinics.

Results

More than a third of Italian Travel Clinics replied the survey (79 clinics). The results show that on average for each clinic there are 4 healthcare workers (2 physicians, 1 nurse and 1 health worker), about 10 hours/week are dedicated to the clinic, the users are 18 and the Visiting Friends and Relatives (VFR) are 17%. In only 25% of cases the clinic is open access and in 80% there is a digital immunization registry. More than 70% of the healthcare workers have the last update in the two-year period of 2017/2018. Major critical issues are shortage of staff, limited opportunities to update, absence of a dedicated software, expensive vaccinations particularly for VFR, reduced visibility of the clinic and difficulties in accessing, Travel Clinics not sufficiently integrated into the National Health System.

Conclusions

Italian Travel Clinics are carring out a good service to ensure healthcare to the greatest number of travellers, but there is extensive room of improvement.

Key messages

We should create a network where Travel Clinics work together with General Practitioners, Pediatricians, other Specialists, Pharmacists, travel agents and above all with stakeholders. In this way Travel Clinics can involve an increasing number of travellers through an active offer of vaccinations and a careful risk assessment based on professional skills and expert knowledge.
Estimated Cancer Incidence and Mortality in Europe for the year 2020
Authors: Randi G , Dyba T , Martos C , Giusti F , Dimitrova N , Neamtiu L , Flego M , Nicholson N , Carvalho R , Bettio M
Published: October 2020

Background

Up-to-date cancer burden indicators are essential to support political decision making, to enable epidemiological research and as an information source for citizens. Nevertheless, observed cancer incidence and mortality suffer from an endemic registration delay in the data production workflow. To overcome this, the European Commission's Joint Research Centre in collaboration with the WHO's International Agency for Research on Cancer have computed estimates of cancer incidence and mortality, for the year 2020 and for European countries, in the framework of the European Cancer Information System (ECIS).

Methods

Predicted values for the year 2020 are based on the incidence data of more than 150 European population-based cancer registries included in the ECIS, and on the WHO mortality database. According to previously developed and applied methodology, the estimates of 2020 cancer incidence and mortality rates were produced for 40 European countries, on the basis of the most recent time trends of observed data, where possible. Estimated rates were then applied to the projected 2020 population from EUROSTAT, to calculate the predicted number of new cases and deaths for 2020 in each European country.

Results

The number of new cancer cases and deaths in 2020 has been estimated per country by sex and age group, for 25 major cancer sites. The results are included and disseminated through the ECIS web application (https://ecis.jrc.ec.europa.eu/).

Conclusions

The release of up-to-date cancer incidence and mortality estimates is of crucial importance in supporting evidence-based EU cancer policies. The homogeneity of the estimation methods applied throughout Europe guarantees the comparability of the estimated values between countries. Reliable and comparable estimates enable highlighting differences between countries in cancer incidence and mortality, thus facilitating the identification of possible intervention areas.

Key messages

The EC’s JRC, in collaboration with WHO’s IARC, have computed estimates of cancer incidence and mortality for the year 2020 for European countries, in the framework of the ECIS. The number of new cancer cases and deaths in 2020 has been estimated in 40 European countries for 25 major cancer sites and included in the ECIS web application (https://ecis.jrc.ec.europa.eu/).
Knowledge about human visceral leishmaniosis in an endemic area in Pernambuco, Brazil
Authors: Machado D M R , Arias-Pacheco C A , Calchi A C , Ferraudo A S , Carvalho A A B , Pereira L E C , Ramalho W M , Melo M M
Published: October 2020

The timely detection and adequate attention of cases of Human Visceral Leishmaniasis can provide a reduction in the morbidity and mortality of this disease. This study evaluated the degree of knowledge about Human Visceral Leishmaniasis among professionals from basic health units in the municipality of Caruaru, an endemic area for Visceral Leishmaniasis in the state of Pernambuco-Brazil. From June to August 2017, questionnaires were applied to doctors and nurses of the units that presented cases and / or deaths due to LVH between the years 2006 and 2015. Regarding the results, it was possible to verify, from the analysis of multiple correspondence, important interdependence relations such as the lack of knowledge of the endemicity of the Municipality in question with the misinformation about treatment, in addition to the association between not knowing the etiologic agent of the disease and the lack of knowledge about the treatment and the municipal health unit, suggesting an impediment to the control of LVH. The results also demonstrated a general lack of knowledge regarding the etiological, epidemiological, assistance and surveillance aspects of this condition in the city and the need to train these professionals on the subject, considering that knowledge about visceral leishmaniasis is considered a protective factor and capable to reduce the risk of this disease occurring. Therefore, we emphasize the need to maintain, review and restructure the control and prevention measures already known and implemented. However, it is necessary to strengthen a valuable and fundamental area in the fight against the disease, that of health education, focusing mainly on primary care professionals, who are still the main source of welcome for sick individuals. These are fundamental to reduce the morbidity and mortality of human VL, as a link in the transmission chain, but also as perpetuators of information about the disease in order to prevent it through attitudes.

Key messages

One of the main impacts of this work is the applicability and utility in health services in Brazil and other countries that face neglected diseases such as visceral leishmaniasis. Another great contribution of this work is to demonstrate, in a practical example, how education is fundamental in prevention and health promotion strategies.
Effect of occupational hazards and safety practices among petrol attendants in Nigeria
Authors: Chijioke S
Published: October 2020

Background

The petrol station attendants are the first point of contact to customers who visit the station to purchase fuel. They encounter several health hazard and health problems while working. This study was conducted to determine the occupational hazards, health problems and safety practices of petrol station attendants and subsequently to train the PSAs on the identified occupational hazard, associated health problems and safety practices while working.

Methods

This is an intervention study carried out among all consenting attendants working in filling stations owned by independent petroleum marketers in Enugu. Data was collected using semi structured interviewer-administered questionnaire cast in English language. The data was analyzed using statistical package for social sciences version 23. Descriptive and inferential statistics were calculated. Level of significance was set at 5%.

Results

A total of 400 respondents participated in the study. The mean age of respondents was 24.3 ± 4.6 years for the male and female respectively. Hazards reported included inhalation of petrol fumes, confrontation from customers, armed robbery attack and noise. Health problems reported included headache, low back pain, sciatic pain, muscle spasm, eye irritation, dizziness, cough and nausea. Awareness about the correct use of personal protective equipment was very poor prior to the intervention but increased up to 94.5% immediately after the intervention. The results of this study shows that the PSAs who participated in this study were exposed to various health hazards. Awareness and use of PPE was very poor prior to the commencement of this study but significantly increased after the intervention.

Conclusions

Therefore, it's important to engage various stakeholders in this sector to ensure that owners of filling stations take responsibility for the health safety of their workers and ensure regular health education on safety practices.

Key messages

This study was conducted to determine the occupational hazards, health problems and safety practices of petrol station attendants and to train them. Relevant means and standard deviation were calculated. Inferential statistics were calculated using t-test, analysis of variance and Chi-square test.