bluuebunny/crossref_metadata_2025 huggingface dataset:
Can innovative digital collaborations help overcome barriers to intersectoral collaboration?
Authors: Nordström C , Kumar B
Published: October 2020

Issue

Health in all policies is desirable, but moving from the silos approach is a challenge for health care systems. New health policies require more cooperation and broader collaboration between governmental, private and volunteer sector, as well as across professions. Though it is key to implementation of national policies and long-term public health work at the local level, intersectoral collaboration remains elusive. Professionals working with public health and migrant health across Norway often work independently of each other and other sectors.

Description of the Problem

Evaluation of the Norwegian network for migrant friendly hospitals showed that with the opportunity to meet and share experiences, participants used the new knowledge and network in developing their practice and organisation of services. They experienced greater support to challenge status quo in their institutions. However, fear of making the network “too big to handle” is a barrier to creating intersectoral network. In a recent survey (2017), health personnel ask for digital solutions for finding resources and support in their practice to give better health care to immigrant patients.

Results

The newly (2020) knowledge HUB part of JAHEE actions brings stakeholders together at the local, regional and national level, ensuring access to the same knowledge, increase evidence based decisions among stakeholders when choosing interventions on the local, regional and national level, including sharing of good practices and promising initiatives at a national level so that they can be replicated.

Lessons

Professional networks that are coordinated and collaborative are important for development of services and implementation of measures for migrant health. However, expanding them across sectors and fields may create challenges. Combining sectoral networks with a common digital platform may overcome some of these challenges.

Key messages

Exploiting the potential of collaborative digital solutions may help overcome some barriers to intersectoral approach to migrant health. Coordinated collaborative professional networks can support the participants in developing their practice and organisation of services for migrants.
Self-care experiences of Indonesian adults with chronic disease living in Montreal
Authors: Lukman N A , Leibing A , Merry L
Published: October 2020

Background

Self-care (i.e., the actions towards monitoring and managing chronic illness and maintaining health) is an essential aspect of chronic disease management. These experiences are shaped by culture and values, health literacy, support from others and access to care. We conducted a study to explore the chronic illness self-care experiences and various influencing factors among a minority immigrant group, Indonesians, living in Montreal, Canada.

Methods

We used a qualitative descriptive approach. Eight adult men and women living with various chronic illnesses were recruited. Data were collected via semi-structured interviews and thematically analyzed.

Results

Three broad themes were identified: What's helpful, Challenges and responses, and Expectations. What's helpful captured different sources of supports of that helped the participants manage and monitor their illness and feel well and healthy. Challenges and responses highlighted the key challenges that participants have faced while living with a chronic illness, and how they have adapted (or not) and responded to these. Expectations include participants' disappointments towards their own self-care and/or support from family, the community and healthcare professionals, and describes what participants wished was different about their situation. The multiple views and nuances of their experiences as well as the various influencing factors of pre- and post-migration were interwoven within the description of each theme.

Conclusions

The self-care experiences of Indonesians living in Montreal shaped by different sources that helpful, challenges they faced and their responses as well as their disappointments and wishes for their own self-care.

Key messages

The self-care experiences of Indonesians living in Montreal are vary and shaped by different factors and sources. Healthcare professionals should engage more and consider the helpful sources for them, their challenges and the responses, their disappointments and hopes shaping their self-care experiences.
Access to health care and Informal Patient Payments for health care in Serbia
Authors: Buch Mejsner S , Lavasani Kjær S , Eklund Karlsson L
Published: October 2020

Background

Evidence often shows that migrants in the European region have poor access to quality health care. Having a large number of migrants seeking towards Europe, crossing through i.e. Serbia, it is crucial to improve migrants' access to health care and ensure equality in service provision

Aim

To investigate what are the barriers and facilitators of access to health care in Serbia, perceived by migrants, policy makers, health care providers, civil servants and experts working with migrants.

Methods

six migrants in an asylum center and eight civil servants in the field of migration were conducted. A complementary questionnaire to key civil servants working with migrants (N = 19) is being distributed to complement the data. The qualitative and quantitative data will be analysed through Grounded Theory and Logistic Regression respectively.

Results

According to preliminary findings, migrants reported that they were able to access the health care services quite easily. Migrants were mostly fully aware of their rights to access these health care services. However, the interviewed civil servants experienced that, despite the majority of migrants in camps were treated fairly, some migrants were treated inappropriately by health care professionals (being addressed inappropriately, poor or lacking treatment). The civil servants believed that local Serbs, from their own experiences, were treated poorer than migrants (I.e. paying Informal Patient Payments, poor quality of and access to health care services). The interviewed migrants were trusting towards the health system, because they felt protected by the official system that guaranteed them services. The final results will be presented at the conference.

Conclusions

There was a difference in quality of and access to health care services of local Serbs and migrants in the region. Migrants may be protected by the official health care system and thus have access to and do not pay additional fees for health care services.

Key messages

Despite comprehensive evidence on Informal Patient Payments (IPP) in Serbia, further research is needed to highlight how health system governance and prevailing policies affect IPP in migrants. There may be clear differences in quality of and access to health care services between the local population and migrants in Serbia.
Similarities and intersections – A comprehensive view in three studies
Authors: Stern A
Published: October 2020

Background

Various groups face difficulties in access to, and usage of health care. Research on marginalization in health care, and programs aiming to reduce inequalities usually focus on one single group at a time. Regarding the heterogeneity of groups defined by a few social characteristics, our aim was to question the specificity of barriers, and similarities between different groups.

Methods

The results of a mixed methods study focusing on elderly people with Turkish migration background were compared to the interim results of a qualitative study focusing on transgender persons, and the interim results of a qualitative study focusing persons with trauma related psychiatric diagnoses.

Results

1) While relevant barriers in access to, and usage of health care seem to be group-specific at the first view, their underlying mechanisms of emergence are analogous. 2) Beside more obvious similarities, 3) further barriers arise by the combination of more than the mainly addressed characteristics of the different groups.

Conclusions

Barriers analogous or similar among different groups lead to underlying structural or professionality-related issues. If different dimensions of marginalization intersect, they may be disguised by a concentration on single characteristics. To target health inequalities on the long term, a closer look on similarities between groups facing health inequalities could improve the development of programs for a broader range of persons.

Key messages

The comparison of different marginalized groups is useful to identify and target systematic inequalities in health care. Researchers and stakeholders should consider mechanisms of multiple marginalization.
Sense of belonging and years lived in Finland: associations among foreign-born population
Authors: Seppänen A , Lilja E , Kuusio H
Published: October 2020

Background

Belonging to different groups is associated with migrants' health. In this study, we examined the associations between sense of belonging (SoB) and years lived in Finland.

Methods

The data from the cross-sectional Survey on Well-Being among Foreign-Born Population (FinMonik, n = 6 836), conducted in Finland in 2018-19, was used. SoB was assessed by the question “Which of the following areas or groups you feel you belong to?” with options: local municipality; Finns; Europeans, country of origin; world citizens; religious or spiritual community; professional group or colleagues; political or ideological group. The data of years lived in Finland were linked from the National Population register and classified into three categories: less than five years; five to 10 years; over 10 years. Those who had lived less than one year in Finland were not included in the survey. Logistic regression was used to test the association between SoB and years lived in Finland, with age, sex and country of origin as confounding variables. In the analyses, weights were used to reduce non-response bias.

Results

Those who had lived in Finland over 10 years had higher odds for SoB towards Finns (OR = 1.74, p = <0.001), local municipality (OR = 2.41, p = <0.001) and Europeans (OR = 1.54, p = 0.001) and lower odds for SoB towards country of origin (OR = 0.68, p = 0.003) and religious or spiritual community (0.73, p = 0.043) when compared to those who had lived in Finland less than five years. No significant differences in SoB were found between less than five years in Finland and five to ten years in Finland.

Conclusions

SoB varied considerably when comparing those who had lived less than five years in Finland and those who had lived more than 10 years in Finland. Belonging to local people is more likely when one has lived in Finland more than ten years. Belonging to country of origin and religious or spiritual community is less likely when lived more than ten years in Finland.

Key messages

Sense of belonging seems to change over the course of stay in the new home country, but first after 10 years of stay. Identifying with local people and even with Europeans becomes more prominent after 10 or more years in Finland.
Health system response to large scale migration: the case of Emilia-Romagna region
Authors: Quargnolo M , Mammana L , Gherardi G , Bodini C , Damosto D , Florescu C , Fantini M P
Published: October 2020

Background

In Italy, recent changes in migration flows posed complex public health challenges. The Emilia-Romagna region (ERR) was one of the first regions to adopt specific policies addressing the health of newly arrived asylum seekers. In our study, we analysed the regional health system response comparing it to the regional and national guidelines, in order to assess its strengths and its critical areas.

Methods

In 2019, we conducted a survey among the referents of the regional clinics that provide healthcare to asylum seekers, in order to learn about local policies, challenges and best practices. A questionnaire with 35 closed and 11 open questions was administered and analysed through descriptive statistical analysis and text analysis.

Results

Regional policies showed good responsiveness and Local Health Authorities (LHAs) adhered to the guidelines. A special permit was introduced to grant asylum seekers access to healthcare, which also allowed integration of health data into the regional health information system. However, data integration was done in only 2 clinics out of 14. Instances of discretion in issuing the special permit were reported, due to ambiguity in the rules and inadequate training of office workers. Policies and LHAs protocols focused greatly on the arrival phase and on Communicable Diseases (CDs) surveillance. Other areas - such as protection of vulnerable groups, health promotion, NCDs - were prioritized in the national guidelines, but unevenly considered throughout the region, also due to lack of resources. Some clinics responded autonomously to these gaps with local resources.

Conclusions

The ERR health response to the influx of asylum seekers was rapid but incomplete. Interventions focused more on CDs surveillance than on responding to asylum seekers' health needs in terms of quality, access and equity. Areas to be strengthened include protection of vulnerable groups, health promotion and NCDs, together with coordination and long-term planning.

Key messages

The Emilia-Romagna region health response to the influx of asylum seekers reflects an emergency approach focused on communicable diseases, while NCDs and health promotion are relatively neglected. The health system in Emilia-Romagna needs to be strengthened in its capacity to respond to asylum seekers’ health needs. Health policies and practices should be planned to ensure equity and quality.
The association between employment status and QOL among foreign origin populations in Finland
Authors: Nyk'nen S
Published: October 2020

Introduction

In Finland the employment rate of people with foreign origin backgrounds appear to be 10% lower than in general population (73.7%). Contradictory, higher levels of self-perceived quality of life (QOL) has been reported among the same population. This secondary data analysis aims to examine the association between level of employment and quality of life from the survey on work and well-being among people of foreign origin in Finland (UTH, 2014).

Methods

People of foreign foreign origin, living in Finland were included in statistical analysis (n = 2,987). Pearson Chi-squared (χ2) and likelihood ratio (LR) testing as well as logistic regression analysis were used to study the association between independent variable 'employment' and the dependent variable of 'quality of life'.

Results

Employment showed increased odds for 'good' QOL. However, when comparing the two gender groups, the odds of having 'good' QOL in employed men were higher (OR: 2.17 CI 2.11 - 2.24) compared to employed women (OR: 1.50 CI 1.45 - 1.53) respectively. When adjusted for sociodemographic and confounding factors, the levels of strength of the association between employment and quality of life remained.

Conclusions

Women with foreign origin backgrounds seem not to have equal benefits of employment and/or equal access to labour markets in Finland. Validation about barriers of entering the labour market in Finland are further needed. Policy implications and actions are needed to improve equal access and benefits of employment for better well-being for women with foreign origin backgrounds.

Key messages

Women with foreign origin backgrounds seem not to have equal benefits of employment and/or equal access to labour markets in Finland. Policy implications and actions are needed to improve equal access and benefits of employment for better well-being for women with foreign origin backgrounds.
Conceptualizing difference: an analysis of physicians’ views on delivering care to asylum seekers
Authors: Jahn R , Biddle L
Published: October 2020

Background

International migration leads to an increasingly fluctuating and superdiverse migrant population in reception countries. In Germany, structural, legal, social and political barriers to adequate care complicate the ability of health care professionals to respond to the challenges associated with caring for such a dynamic patient population. In this analysis, we explore the views of physicians working with asylum seekers and refugees in Germany, and aim to identify the barriers and enablers they face in providing appropriate care.

Methods

We performed a secondary qualitative analysis of 16 semi-structured interviews conducted for two studies on the delivery of medical care to asylum seekers in Germany. To examine physicians' views towards their work with asylum seekers, we analysed evaluative judgements on interpersonal and workplace factors, the external environment, the physician's own self, and individual medical conduct. Analysis was conducted by identifying cross-cutting themes through thematic analysis and mapping these onto a framework matrix.

Results

We found that evaluative judgements made by physicians providing care to asylum seekers emphasized one of three conceptualisations of “difference”: regarding personal or cultural attributes of the patient group; the spaces of care provision; or the context of asylum seeking patients. Emphasis on differences of the patient population and the spaces of care provision to asylum seekers was found to impede appropriate care, while physicians emphasizing contextual factors reported more responsive medical practices.

Discussion

Our findings suggest that processes of “othering” asylum seekers as a patient group as well as the heterotopic spaces of care provision endanger the doctor-patient relationship and responsiveness of care. Appropriate training, physical and human resources and encouraging support between physicians working with asylum seeking patients could alleviate these processes.

Key messages

Physicians’ conceptualisations of “difference” in providing care to asylum seekers focus on the patient group, workplace, or structural context; and affect the way in which medical care is provided. Structural competency training, resource investments, and clear structures could reduce physicians’ experiences of “difference” of the patient group and workplace, and facilitate responsive care.
Quality of life assement of riverside communities of Tapajós and Cupari Rivers in Pará
Authors: Espinosa M V , Reis B , de Oliveira A , Bertaglia L , Rodrigues J , França J N , Ferrero M V , Dias L A , Oliveira A M , Moreira A
Published: October 2020

Introduction

Riverside population lack basic sanitation infrastructure and access to healthcare. In addition, locals encounter difficulties in accessing basic health care due to climate variability and fluvial activity which results in tidal distortion and attenuation. Quality of life is a broad concept and its measurement should be useful to identify determining and conditioning factors in health-illness process which would be key to the guidance of health public policy measures in a specific community. This study aims at assessing the quality of life of Tapajós and Cupari riverside communities in Pará, Brazil.

Methods

A cross-sectional and descriptive study composed of a group of patients aged 18 and over who have sought care during the volunteer health expedition in the Tapajós and Cupari rivers between mid-July and August 2019. The team of students and professors conducting the survey adopted the WHOQOL-bref questionnaire as a measure of quality of life. The questionnaire consists of 25 questions and 5 domains: physical health, psychological, social relationships, environment, and self-assessment of quality of life. Individual scores vary between 4 and 20. Scores ≤ 10 suggest low quality of life whereas >10 suggest higher quality of life. This statistical analysis was carried out in the SPSS program and was described by means of summary measures: minimum, maximum, median, and standard deviation. Outcomes:The five domains scored >10, with the highest being the psychological domain (16,48, dp = 1,71) and the lowest the environment (14,12 dp = 1,99).

Conclusions

In spite of inherent difficulties generally found in riverside communities, participants reported high perception of quality of life in all domains. The lowest overall perception was the environment domain. This result confirms not only the barriers of physical infrastructure but also access to quality services as a negative health and life determinant.

Key messages

Assessing the quality of life is key to determine which factors influence the health-illness process within a community. Assessing the quality of life is fundamental to guide strategies aimed at intervening in social determinants.
Effectiveness of harm reduction intervention: results of low threshold service centres‘ activity
Authors: Perminiene R , Fatkulina N
Published: October 2020

Background

Harm reduction programmes are recommended as an effective HIV prevention among injection drug users by the WHO and UN. Monitoring of clients' risky behaviour is carried out to evaluate the effectiveness of low threshold centres' (LTCs) activity, which allows assessment of services' effect on the public health.

Aim

Evaluation of effectiveness of LTCs' activity, changing clients' behaviour, during 1997-2019.

Methods

Analysis of LTCs’ documentation during 1997–2019; survey of the anonymous questionnaire carried out in the LTC of Klaipėda Mental Health Centre in 2019 (sample 130 people), comparison of the data with the results of 2001 survey.

Results

during 1997-2019 the average number of one client visits to the centre per year increased from 5 to131. The number of means supplied to clients was increasing: the amount of returned used syringes (83% in 1998, 101% in 2019) was increasing in comparison with the amount of issued sterile means. In 2001 58% of respondents who did not attend the centre would hand over used syringes to others while in 2019, after taking the centre services, the number dropped to 13%. A certain number of clients would accept used syringes until coming to the centres (in 2001 25% did not do this), after visits to the centres in 2019 91% did not use used syringes. Clients more often started using condoms with casual partners (17% in 2001, 84% in 2019). The more often clients attend the centres, the more of them take HIV tests (62% in 2001, 96% in 2019). 58% of respondents in 2001 and 97% of respondents in 2019 expressed a wish to give up drug use.

Conclusions

the activity of the LTCs during 1997-2019 attracted increasing number of drug users. The study demonstrated: activity of LTCs is effective in changing risky behaviour of drug users to a more safe one while injecting drugs and having sexual contacts. Majority of clients have a wish to stop using drugs and the more they attend the LTCs the more realistic possibility to do this they see.

Key messages

Monitoring of clients‘ risky behaviour is carried out to evaluate the effectiveness of low threshold centres‘ (LTCs) activity, which allows assessment of services‘ effect on the public health. Activity of LTCs is effective in changing risky behaviour of drug users to a more safe one while injecting drugs and having sexual contacts.
Trend of malaria in Senegal from 2010 to 2017
Authors: Sougou N M , Leye M M M , Bassoum O , Faye A , Diongue M , Seck I
Published: October 2020

Background

In Senegal, many interventions have been carried out in the fight against malaria. Thus, the prevalence of malaria has clearly declined from 2010 to the present day. The objective of this study is to study the factors associated with malaria.

Methods

Senegal is a country in West Africa. The analyses in this study were based on DHS data from 2010 to 2017 from Senegal. Data from 5 DHS surveys were used (2010-2011, 2012-2013, 2014, 2015, 2016). Malaria prevalence had been studied on the basis of RDT positivity. A multivariate analysis with an adjustment over the years was done. The variables studied were socio-demographic characteristics such as age, socioeconomic level and dwelling place (rural vs. urban), variables related to the type of habitat and the use of mosquito nets. The analyses were done using STATA.15.

Results

The results showed a reduction in malaria prevalence from 3.01% to 0.8% from 2010 to 2016. The protective factors are belonging to a well-off socio-economic background (middle OR:046 [0.24-0.90], richer OR = 0.37 [0.15-0.93]). The other factors associated with malaria are the fact of living in rural area (OR: 1.7 [1.06-2.89]).

Conclusions

Despite the decline in malaria prevalence over the years in Senegal, its persistence could be feared if factors related to the socio-economic level are not addressed.

Key messages

Special attention must be paid to people living in rural areas as part of the fight against malaria. The fight against malaria will necessarily involve the fight for the socio-economic emergence of countries in West Africa.
Impact of health education on preventive therapy with integrated monitoring of Tuberculosis cases
Authors: Zaman F A , Mehta V K
Published: October 2020

Background

The hilly state of Sikkim has the highest proportion of Tuberculosis (TB) cases in India. Increasing compliance of preventive therapy among paediatric contacts will help to cut down transmission. Separate visits are being made under the current National TB control programme to monitor preventive therapy & treatment of index Tuberculosis cases in the same house. Integrated monitoring for preventive therapy of the contacts & treatment of index cases will ensure compliance of both but at no extra cost.

Methods

It was a prospective study with universal sampling of all the sputum positive TB patients in East Sikkim. Home visits were conducted initially, after 3 months with health education intervention and finally at the end of 6 months. Focus group discussion (FGD) was done amongst the TB home visitors regarding monitoring visits.

Results

Out of the total 124 paediatric contacts, 86 (69.4%) initiated Isoniazid Preventive Therapy (IPT). After 6 months of follow up, 114 (91.9%) children had completed IPT after the health education intervention. In 96.7% of the houses, it was possible to monitor both index cases and the paediatric contacts simultaneously with the same work force. Content analysis of FGD among TB home visitors revealed lack of programme clarity regarding integrated visits for monitoring of both contacts and index cases.

Conclusions

Health education intervention was found to be an effective tool for increasing compliance of IPT. This study had a huge & far-reaching impact in terms of providing the evidence that integrated monitoring for preventive therapy of the contacts along with health education & monitoring of treatment of index cases can be done simultaneously with no extra cost in the ongoing TB Control Programme.

Key messages

Health education intervention increased compliance of IPT. Integrated monitoring for preventive therapy along with health education & monitoring of index cases can be done with no extra cost.
Is the road to good health paved in gold? HIV and mining in Sub-Saharan Africa
Authors: Hansen C , Miraldo M , Hauck K , Ohrnberger J
Published: October 2020

Background

This paper measures the impact of HIV prevalence on gold production in Sub-Saharan Africa. Gold mining adds billions of gross value to the African economy, however remains a highly-prevalent industry for HIV. Some of the largest global gold producers in South Africa estimate 30% of their workforce to be HIV-positive. In comparison, the current prevalence rate in the country is 3.7% in working-aged males.

Methods

There is a reverse causality between HIV and mining. HIV exerts a direct causal influence on mining production. The mining industry creates working and living environments which accelerate the spread of HIV. Using 22 years of panel data and an external instrumental variable, overseas development assistance, supported by an Arellano-Bond estimator, we measure the causal impact of HIV on gold mining.

Results

We estimate a 1% increase in HIV leads to a decrease in gold production of 9.866 tonnes, valued at over $402 million, nearly 3% of total African gold production, significant at the 10% level. These results are robust to the findings of the Arellano-Bond estimator, which are significant at the 5% level.

Conclusions

International aid foundations and donors have made great strides in funding for HIV treatment, and it is critical for multinational corporations to take necessary action to protect the progress that has been made so far, promoting health and economic outcomes. Understanding macroeconomic impacts will raise the cost-effectiveness of public health interventions, and increase the associated economic benefits to many individual sectors, as well as overall local and country-wide economies.

Key messages

In addition to saving lives and extending the quality of HIV-positive lives, there are economic gains to be had in investing in the prevention of HIV, as demonstrated in the gold mining industry. HIV-related productivity losses readily extend to a variety of industries across Africa and abroad. Policies that minimise these losses, and maximise health gains, can only be mutually beneficial.
Scientific literature response in Pubmed for the novel Coronavirus outbreak: a literature analysis
Authors: Adorno E , Barbieri E , Baschieri E , Esposito F , Minora F , Sandorfi F , Sanmarchi F , Scrimaglia S , Gori D , Fantini M P
Published: October 2020

Background

Recent events highlight how emerging and re-emerging pathogens are actually becoming global challenges for public health. In December 2019, a novel coronavirus (SARS-CoV-2) has emerged. This has suddenly turned out into a global health concern which has led to a very high number of papers published in the scientific literature. Aim of this research is to focus on the bibliometric aspects in order to give researchers a glimpse on what is published in the first 30-days of a global epidemic outbreak.

Methods

We searched MEDLINE (PubMed) electronic database in order to find all relevant studies in the first 30-days from the first publication (which appeared on Pubmed at 14/01/2020), meaning the period 15/01/2020-13/02/2020. We used the following search string: coronavirus* OR Pneumonia of Unknown Etiology OR Covid-19 OR nCoV. We placed a language restriction for English, but no publication status or study design limit was put in place for our search.

Results

From the initial 462 identified articles, 234 articles were found as pertinent and read in extenso in order to classify them. The vast majority of papers come from China, UK and USA. 66.2% of the papers were Editorials, comments, letters or other kind of mainly reported data. 10.7% of papers were secondary literature papers (mainly narrative reviews). The remaining 23.1% were original primary studies. Only 17.5% of the sources used data which were directly collected on the field.

Conclusions

Almost all of data came from China. Even if some preferential channels were guaranteed for publishing those results in the most important journals, it appears that the vast majority of publication in scientific literature in the first 30-days of an epidemic outbreak is based more on reported data and comments, and only a small fraction of the papers have primary data collected in the field. Nevertheless the whole international literature depends on that type of data sources in the early days of the epidemic.

Key messages

This is the first bibliometric research in Pubmed Database on the first 30 days of publications regarding the novel Coronavirus (2019-nCoV) outbreak of 2019. The vast majority of publication in the first 30-days of an epidemic outbreak are reported data or comments, and only a small fraction of the papers has directly collected data.
Trend of specific HIV/AIDS mortality in the elderly in the Distrito Federal, Brazil
Authors: Sacco R C C S , Santos K T , Escalda P M F
Published: October 2020

Background

In the last decade, the number of individuals over 60 years of age with AIDS has increased in Brazil, with the need to know the trend of the mortality of the disease to subsidize educational and preventive actions for service users and health professionals. The objective was to describe the trend of mortality from HIV/AIDS in the elderly in the Federal District (DF), Brazil, from 2007 to 2016.

Methods

Descriptive study, ecological type of time series, from secondary data on mortality obtained from the Brazilian Ministry of Health. Linear regression was performed to analyze trends by sex and by age group, using the Statistical Package for the Social Sciences (SPSS).

Results

Deaths were predominant in men (74.1%) aged 60 to 69 years (70.4%). The sex ratio was 2.85. The married / stable union (43.0%) and white (52%) were the majority. There was a significant increase in males, while in females, it was slightly decreasing in the same period. In the age groups of 60-69 years and 70-79 years, there was a tendency to increase in mortality, decreasing for ≥ 80 years.

Conclusions

There was a predominance and an increasing tendency in young male elderly, demonstrating that prevention actions need to achieve greater reach in this population, with the breaking of barriers related to prejudice and the stigma of the disease. A better organization of the care network for the elderly is suggested, enabling approaches to suspected cases and providing early diagnosis, to ensure greater quality survival for the elderly.

Key messages

There was a tendency to increase mortality from HIV / AIDS in elderly men, aged 60-79 years. There is a need to improve educational activities and early diagnosis and timely treatment for this group.
Temporal trend and risk factors for mother-to-child HIV transmission in Southern Brazil, 2007-2017
Authors: Schuelter-Trevisol F , Vaica I , Cunga Armando , Moehlecke Iser B , Bittencourt B , Augusto da Rosa C M , Cremona Parma G , Trevisol D J
Published: October 2020

Background

HIV infection affects women of childbearing age, and unplanned pregnancies among those infected are prevalent. This fact increases the potential risk for mother-to-child transmission during pregnancy, childbirth or postpartum through breastfeeding. The Brazilian Ministry of Health recommends anti-HIV testing for all pregnant women. Access to antiretroviral therapy is available through prenatal and maternity care, and breastfeeding is contraindicated. The detection rate of pregnant women living with HIV in Brazil has increased by 23.8% in the last ten years. The aim of this study was to estimate the incidence of seroconversion of HIV infection in children exposed to mother-to-child transmission and examine associated risk factors for the period 2007-2017 in Santa Catarina, Brazil.

Methods

A historical cohort study was conducted using secondary data related to the notifications of HIV-infected pregnant woman and follow-up of HIV-exposed infants. Odds ratios were used to estimate the risk of infection.

Results

We identified 5,554 HIV-infected pregnant women and 4,559 HIV-exposed infants, 130 of whom had confirmed seroconversion, which corresponds to a rate of 2.9%. Antiretroviral use during pregnancy [OR = 9.31 (5.97-14.52) p < 0.001] and breastfeeding [OR = 3.10 (1.34-7.20) p = 0.008] were found to be independent risk factors for seroconversion. Between 2007 and 2017, there was a 78.3% increase in the number of HIV-infected pregnant women, but the seroconversion rate among infants reduced by 20.4%.

Conclusions

The study concluded that, between 2007 and 2017, the HIV seroconversion rate was 2.9% among live births, with a tendency to decrease. Seroconversion was associated with not using antiretroviral therapy during pregnancy and breastfeeding. These data reveal gaps in prenatal care regarding adherence to treatment and follow-up of HIV-infected mothers, resulting in new HIV infections among children that could otherwise be prevented.

Key messages

Vertical transmission of HIV is a public health challenge, which requires strategies for surveillance and quality care. This study may provide relevant information to promote public health policies, with quality care for pregnant women and children living with HIV/AIDS.
Definition of a novel vaccination pathway in PLWHA: experience of a Southern University Hospital
Authors: D'Amato S , Pellicanò G F , Genovese C , Mazzitelli F , Nunnari G , D'Andrea F , Squeri R
Published: October 2020

Background

At the end of 2018 across the globe there are ∼37.9 million people with HIV/AIDS also thanks to the use of HAART which led to an increase in life expectancy. The Italy Immunization Plan 2017-19 recommend vaccines to these patients but a protocol still isn't present. Moreover, despite the availability of effective vaccines, coverage remained very low for many reasons including problems with privacy. The objectives of this study were a) the appliance of a shared clinical pathway between the “Immunization Center of Hospital Hygiene Operating Unit” and the “HIV/AIDS Disease Prevention, Diagnosis and Treatment Center of Infectious Diseases Operating Unit” b) the increase in vaccination coverage and the evaluation of side effects.

Methods

A prospective study was conducted from Oct 2019 to Feb 2020 at the G. Martino University Hospital of Messina. In particular, of the 138 patients followed by the Infectious Diseases OU, after evaluation of their immune status, 62% were enrolled in this study. Following the acquisition of informed consent, we collected socio-anagraphical data and we started the free administration of vaccines by providing an hoc calendar in the Immunization Center. Statistical analysis was performed with R software.

Results

The sample was represented by 86 patients (74% males and 26% females, 21% foreigners and 79% Italian, mean age=40±13.6 SD). We didn't observe drop out and no differences were observed for local/systemic AEs generally reported. We obtained an increase of vaccination coverage with a total of 74 doses administered for flu (+164%) and 240 for other vaccines (+172%). In particular, we immunized a total of 74% of patients for HPV (2% in 2018), 42% for HAV (28% in 2018), 37% for HBV (28% in 2018), 58% for pneumococcal (21% in 2018), 54% for meningococcal ACWY and B (0% in 2018).

Conclusions

The undertook clinical pathway showed the relevance of specific management of these patients and the need to increase the vaccination offer.

Key messages

The immunization in people living with HIV is priority to reduce the risk of infectious disease. It’s important to implement a shared clinical pathway to increase vaccination rates of these patients. The application of the protocol had an high impact in patients' adhesion to vaccination also thanks to the chance of accessing to the service in a comfortable setting and suitable to protect privacy.
HIV incidence fall in Italy: a –20% fall in 2018 to be explained
Authors: Salvati S , Croci R , Odone A , Signorelli C
Published: October 2020

Background

HIV is still a critical public health threat in Europe, especially in some at-risk populations. Stigma keeps undermining access to prevention, diagnosis, and care. Treatment as Prevention (TasP) and Pre-Exposure Prophylaxis (PrEP) have spread heterogeneously across the continent. The study aimed to compare recent HIV incidence trends in five European countries (Italy, Spain, Germany, France, UK), and to speculate about TasP and PrEP's relative contribution as preventive measures in Italy.

Methods

We collected incidence data by consulting the ECDC HIV/AIDS Surveillance Report 2019, and a preliminary Italian 2019 report issued by the National Institute of Health. We used the latest ECDC Continuum of HIV care data to appraise European trends in HIV viral suppression.

Results

All the considered European countries reported a decreasing trend in 2018, compared to 2017. In Italy, according to raw preliminary data, the number of new HIV infections dropped from 3,561 (5.9/100,000) to 2,847 (4.7/100,000), thus resulting in a -20% fall. Interestingly, Spain shows an even sharper decrease of -22%, dropping from 3,795 new cases in 2017 to 2,527 in 2018, that is from a rate of 8.2/100,000 to 6.4/100,000.

Conclusions

Since 2008, when the coordinated ECDC/WHO Regional Office for Europe HIV/AIDS surveillance system was set up, Italy has never witnessed such a sharp yearly fall in incident cases, thus representing, together with Spain, an epidemiological peculiarity in the European context. TasP could have played a major role in Italy. Indeed, Continuum of HIV care data show a positive trend in viral suppression in European countries. PrEP has been introduced in the Italian guidelines in 2016 and is nowadays adopted in a few urban areas, as a co-pay, on-demand service for high-risk populations with limited diffusion. It is thus plausible that PrEP carries a much lower epidemiologic weight in the Italian 2018 incidence reduction.

Key messages

We need to spread PrEP, TasP and screening programs, especially in at-risk populations. We must search for a causal association between preventive measures and decreasing incidence.
Young men’s discourses of health service utilization for Chlamydia infection testing in Stockholm
Authors: Briones-Vozmediano E , Stjärnfeldt J , Larson F , Nielsen A , Eriksson M , Salazar M
Published: October 2020

Background

Chlamydia Trachomatis (CT) infection is the most commonly reported sexually transmitted bacterial disease in Sweden, other European countries, as well as globally. CT is often asymptomatic and if it goes untreated it can cause severe reproductive health issues. In Sweden, men test for CT in a much lesser extent than women. The aim of this study is to identify factors influencing Swedish young men to use Health care for CT detection.

Methods

Qualitative study based on 18 semi-structured interviews with young men (18-30 years old) in Stockholm during 2018. A Situational Analysis was conducted (a development of Constructivist Grounded Theory) of the interviews' transcriptions, using Open Code as the software for qualitative analysis in order to code and organize the information obtained. We constructed a situational map to illustrate the positions taken by Swedish young men according to their discourses.

Results

Three ideal types of Swedish young men with different discourses and behaviors towards CT testing were identified: unconcerned men are indifferent about CT and other sexual transmitted infections (STI) and therefore not testing; ambivalent men only test when suspect suffering from an STI and/or are influenced by their social network; Whereas, proactive men test regularly as a way to know they are healthy. The differences between the ideal types are explained by their risk perception, the role of health services, and the positive or negative influence of their social network.

Conclusions

The ideal types of young men identified in this study show a range of discourses linked to their risk perception, the role of health services, and the influence of their social network, which in practice is translated into different behaviours adopted for CT testing. Testing should be encouraged as an important part of CT prevention by educating groups of unconcerned young men about both the consequences of untreated CT and the free testing options available in Sweden.

Key messages

Swedish young men have different discourses towards CT testing depending on their risk perception, the strategies adopted to test and the positive or negative role of their social network. The role of health services and the social support emerged as key factors to promoting testing among Swedish Young men.
Experiences of maternal weight management services among women with a raised body mass index
Authors: Fair F , Soltani H
Published: October 2020

Background

Obesity is associated with increased maternal morbidity and mortality. Maternal weight management services (MWMS) are a good opportunity to influence lifestyle behaviours of mothers. To understand what constitutes the most suitable service, women's views on MWMS are paramount.

Methods

A purposive sample of 13 women with a BMI≥40kg/m² were interviewed at 36 weeks gestation. A semi-structured interview schedule explored their experiences of MWMS provision and advice, awareness of services and the barriers and facilitators to antenatal weight management. Interviews were recorded and transcribed verbatim. Inductive thematic analysis was undertaken.

Results

Four themes emerged. 'Understanding where I am at' showed women's readiness and motivation varied, from being avoidant or unaware of weight as an issue to already making changes. 'Getting information' revealed while a few women felt that they received good information during pregnancy most reported a lack of information or minimal information provided in a 'tick-box' fashion. Women particularly wanted practical advice. 'Difficulties I face' identified physical, emotional and financial barriers and the strategies some women used to overcome these. 'Encountering professionals - a mixed experience' demonstrated women wanted to be treated with respect and sensitivity and that how weight management information was addressed was more important than who provided it. The fine line professionals need to tread was evidenced by women thinking they had received inadequate information and yet that there was too much focus on their weight and its related risks during pregnancy.

Conclusions

MWMS should not be seen as a 'tick box' exercise but should be woman-centred to assist women to move forward in their weight management journey, no matter what their starting point. Women desired practical advice provided in a sensitive, respectful manner not just the continual repetition of the risks of being obese during pregnancy.

Key messages

Maternal weight management services require a woman-centred approach to enable women to move forward on their weight management journey. Women want practical, sensitive advice not just the continual repetition of the risks of being obese during pregnancy.