bluuebunny/crossref_metadata_2025 huggingface dataset:
Word lists and the role of academic vocabulary use in high stakes speaking assessments
Authors: Smith George Fredrik , Kyle Kristopher , Crossley Scott A.
Published: October 2020

The current study explored the extent to which academic vocabulary lists could meet the lexical demands of
academic speaking assessments. Indices of word use from lists of academic and general vocabulary were used to predict speaking
scores on three TOEFL tasks. The results found weak associations between list-item use and response scores that varied by task.
Independent response scores were associated with the use of specialized vocabulary from the first level of the Academic
Spoken Word List. Integrated campus situation response scores were most strongly associated with the use of unique
words from the Academic Word List. Integrated academic course response scores were associated with the use of
more sophisticated general vocabulary. Although the findings provide some support for the use of academic vocabulary lists in
speaking assessment preparation, the weak effect sizes point to the need to develop lists of academic vocabulary specific to
academic speaking and assessment.
Simultaneous bilinguals who do not speak a tone language show enhancement in pitch sensitivity but not in executive
function
Authors: Liu Liquan , Chen Ao , Kager René
Published: October 2020

Previous studies have reported perceptual advantages, such as when discriminating non-native linguistic or musical pitch differences, among first-year infants growing up in bilingual over monolingual environments. It is unclear whether such effects should be attributed to bilinguals’ enhanced perceptual sensitivity and/or cognitive abilities, and whether such effects would extend to adulthood. Twenty-four Dutch, 24 Dutch simultaneous bilingual (DSB), and 24 Chinese Mandarin speakers were examined by three sets of tasks assessing their linguistic pitch and music perception, executive function, as well as interactions across these modalities. Results showed degrees of advantages for DSB and Chinese participants’ over their Dutch peers in lexical tone discrimination and pitch-related music tasks. In tasks related to executive function, no difference was observed between DSB and Dutch participants, while Chinese participants’ performances were modulated by cognitive interference of language processing. Findings suggest that listeners’ enhanced sensitivity to linguistic and musical pitch may stem from acoustic (DSB) and experience (Chinese) rather than cognitive factors. Moreover, Dutch participants showed robust correlations between their linguistic and musical pitch perception, followed by limited correlations in DSB, and virtually no correlation among Chinese participants, illustrating how distinct language experiences can lead to specific pitch perception patterns between language and music.
Checkpoint Inhibitor Colitis Shows Drug-Specific Differences in Immune Cell Reaction That Overlap With Inflammatory Bowel Disease and Predict Response to Colitis Therapy
Authors: Lo Ying-Chun , Price Christina , Blenman Kim , Patil Pallavi , Zhang Xuchen , Robert Marie E
Published: October 2020

Objectives

Checkpoint inhibitor (CPI)–associated colitis can limit therapy and has resemblance to inflammatory bowel disease (IBD). Studies exploring mechanistic similarities between these colitides are limited, yet therapeutic targets for either disorder could emerge from shared pathophysiology.

Methods

The morphology and inflammatory content of colonic biopsy specimens from anti–CTLA-4 and anti–PD-1/PD-L1 antibody-treated patients with CPI colitis were compared with initial biopsy specimens from patients with IBD. Predictors of the need for infliximab were sought in CPI patients.

Results

Biopsy specimens from CPI patients showed significantly lower chronicity scores and similar activity scores compared with patients with IBD. Anti–CTLA-4 and IBD groups showed equivalent CD8, CD4, PD-1, and PD-L1 expression, while FoxP3 scores were lower and CD68 scores were higher in anti–CTLA-4 compared with IBD biopsy specimens. Anti–PD-1/PD-L1 group had lower scores for CD8, CD4, and PD-1 and equivalent scores for FoxP3, PD-L1, and CD68 compared with IBD. Anti–CTLA-4 biopsy specimens had higher scores for CD8, PD-1, PD-L1, and CD68 than anti–PD-1/PD-L1 biopsy specimens. CD8/FoxP3 ratios and CD68 scores were higher among CPI patients requiring infliximab therapy for colitis compared with those responding to steroids.

Conclusions

The proinflammatory immune phenotype of anti–CTLA-4–associated colitis has significant overlap with IBD. CD8/FoxP3 ratios may predict therapeutic response in CPI-associated colitis.
Associations Between Arterial Stiffness Indices and Chronic Kidney Disease Categories in Essential Hypertensive Patients
Authors: Kusunoki Hiroshi , Iwashima Yoshio , Kawano Yuhei , Ohta Yuko , Hayashi Shin-ichiro , Horio Takeshi , Shinmura Ken , Ishimitsu Toshihiko , Yoshihara Fumiki
Published: October 2020

BACKGROUND

This study investigated the association between arterial stiffness indices and asymptomatic chronic kidney disease (CKD) risk categories in hypertensive patients.

METHODS

Arterial stiffness indices, including 24-hour brachial and aortic systolic blood pressure (SBP) and pulse wave velocity (PWV), were measured by an oscillometric Mobil-O-Graph device, brachial-ankle PWV (baPWV) by a volume-plethysmographic method, and renal resistive index (RI) by ultrasonography, in 184 essential hypertensive patients (66.0 ± 17.1 years, 47.3% male). CKD was categorized into 3 stages based on the Kidney Disease Improving Global Outcomes (KDIGO) criteria, using a combination of estimated glomerular filtration and albuminuria.

RESULTS

The 24-hour aortic PWV (aPWV), baPWV, and RI increased with worsening severity of CKD risk category (all P < 0.01 for trend). Multivariate logistic regression analysis found that a 1 SD increase of nighttime aortic SBP (odds ratio [OR] 1.52), PWV (OR 4.80), or RI (OR 1.75) was an independent predictor of high or very-high CKD stage (all P < 0.05). After adjustment for potential confounders, day-to-night change in brachial SBP as well as in aPWV differed among groups (P < 0.05, respectively). In a multivariate regression model, day-to-night changes in aortic SBP and PWV, and RI were independently associated with day-to-night brachial SBP change.

CONCLUSIONS

In hypertension, circadian hemodynamics in high CKD stage are characterized by higher nighttime values of aortic SBP and PWV and disturbed intrarenal hemodynamics. Further, the blunted nocturnal BP reduction in these patients might be mediated via disturbed intrarenal hemodynamics and circadian hemodynamic variation in aortic SBP and arterial stiffness.
Hyperkalemia excursions are associated with an increased risk of mortality and hospitalizations in hemodialysis patients
Authors: Karaboyas Angelo , Robinson Bruce M , James Glen , Hedman Katarina , Moreno Quinn Carol P , De Sequera Patricia , Nitta Kosaku , Pecoits-Filho Roberto
Published: October 2020

Background

Hyperkalemia is common among hemodialysis (HD) patients and has been associated with adverse clinical outcomes. Previous studies considered a single serum potassium (K) measurement or time-averaged values, but serum K excursions out of the target range may be more reflective of true hyperkalemia events. We assessed whether hyperkalemia excursions lead to an elevated risk of adverse clinical outcomes.

Methods

Using data from 21 countries in Phases 4–6 (2009–18) of the Dialysis Outcomes and Practice Patterns Study (DOPPS), we investigated the associations between peak serum K level, measured monthly predialysis, over a 4-month period (‘peak K’) and clinical outcomes over the subsequent 4 months using Cox regression, adjusted for potential confounders.

Results

The analysis included 62 070 patients contributing a median of 3 (interquartile range 2–6) 4-month periods. The prevalence of hyperkalemia based on peak K was 58% for >5.0, 30% for >5.5 and 12% for >6.0 mEq/L. The all-cause mortality hazard ratio for peak K (reference ≤5.0 mEq/L) was 1.15 [95% confidence interval (CI) 1.09, 1.21] for 5.1–5.5 mEq/L, 1.19 (1.12, 1.26) for 5.6–6.0 mEq/L and 1.33 (1.23, 1.43) for >6.0 mEq/L. Results were qualitatively consistent when analyzing hospitalizations and a cardiovascular composite outcome.

Conclusions

Among HD patients, we identified a lower K threshold (peak K 5.1–5.5 mEq/L) than previously reported for increased risk of hospitalization and mortality, with the implication that a greater proportion (>50%) of the HD population may be at risk. A reassessment of hyperkalemia severity ranges is needed, as well as an exploration of new strategies for effective management of chronic hyperkalemia.
Intravenous iron therapy and the cardiovascular system: risks and benefits
Authors: Del Vecchio Lucia , Ekart Robert , Ferro Charles J , Malyszko Jolanta , Mark Patrick B , Ortiz Alberto , Sarafidis Pantelis , Valdivielso Jose M , Mallamaci Francesca ,   for the ERA-EDTA European Renal and Cardiovascular Medicine Working (EURECA-m) Group
Published: October 2020

Anaemia is a common complication of chronic kidney disease (CKD). In this setting, iron deficiency is frequent because of the combination of increased iron needs to sustain erythropoiesis with increased iron losses. Over the years, evidence has accumulated on the involvement of iron in influencing pulmonary vascular resistance, endothelial function, atherosclerosis progression and infection risk. For decades, iron therapy has been the mainstay of therapy for renal anaemia together with erythropoiesis-stimulating agents (ESAs). Despite its long-standing use, grey areas still surround the use of iron therapy in CKD. In particular, the right balance between either iron repletion with adequate therapy and the avoidance of iron overload and its possible negative effects is still a matter of debate. This is particularly true in patients having functional iron deficiency. The recent Proactive IV Iron Therapy in Haemodialysis Patients trial supports the use of intravenous (IV) iron therapy until a ferritin upper limit of 700 ng/mL is reached in haemodialysis patients on ESA therapy, with short dialysis vintage and minimal signs of inflammation. IV iron therapy has also been proven to be effective in the setting of heart failure (HF), where it improves exercise capacity and quality of life and possibly reduces the risk of HF hospitalizations and cardiovascular deaths. In this review we discuss the risks of functional iron deficiency and the possible benefits and risks of iron therapy for the cardiovascular system in the light of old and new evidence.
A Trust Framework Utilization in Cloud Computing Environment Based on Multi-criteria Decision-Making Methods
Authors: Trabay Doaa Wagdy , El-Henawy Ibrahim , Gharibi Wajeb
Published: October 2020

Cloud computing (CC) is a complete online system of specialized technical resources for data computing and storage management. Many organizations, including small and start-ups, have recommended using CC technology rather than building their own high-costed data centers. Due to the diversity of cloud service providers, identifying appropriate cloud services that can meet users’ and organizations’ requirements, including trust, is a major challenge. In this paper, we propose a trust framework utilization to evaluate cloud services trust using multi-criteria decision-making and fuzzy logic techniques from different perspectives based on performance, agility, finance, security and usability criteria. The comparison of obtained results with related ones shows that ours are efficient and promising decisions for cloud users and organizations as well.
Docendo discimus: Forwarding Seeing the Patient as a Person to the Future Generation of Physicians
Authors: Greenbrook J T V , Ioannou M
Published: October 2020

Background

Forwarding the finest traditions of a calling, and upholding core components of the Hippocratic Oath, requires forwarding seeing each patient as a unique and autonomous person to future generations of physicians. Whilst clinical teaching is paramount in fostering this ethical perspective in applied contexts, limited empirical research has addressed how and why clinical teachers forward seeing the patient as a person in teaching. The present study endeavored to address this gap.

Methods

Qualitative semi-structured interviews were conducted with 17 randomly sampled clinical teachers, from two major university hospitals in Sweden. Data was analyzed through the phenomenological method.

Results

Two themes emerged: (1) Forwarding seeing the patient as a person by conveying the perspective, including the categories highlighting practical benefits in context, displaying humility and rendering the abstract salient, awareness of clinical teachers' impact on pathway development, and protecting core Hippocratic values in medical education; and (2) the need for active engagement in fostering the perspective, including the categories observing own development on a continuum, requiring constant reminders in applied contexts, finding inspiration through interaction, and the need for dedication and resolve.

Conclusions

Emblematic of the Latin proverb docendo discimus [by teaching, we learn], exemplifying the Hippocratic Oath in applied contexts further fueled and fostered the clinical teacher's own ethical perspective. This observed process accents how focus in teaching is contingent on, and promoting of, clinical teachers' own development and further engagement with the human dimensions of care. Cumulatively, past and present exemplars shape clinical teachers' professional identity and ability to engage with seeing the patient as a person, in turn enhancing the dedication needed to lead by example and revive the core components of the Hippocratic Oath in clinical teaching.

Key messages

Forwarding seeing the patient as a person in teaching is contingent on, and promoting of, clinical teachers’ own development and further engagement with the human dimensions of care. “Docendo discimus [By teaching, we learn]” – The reciprocal effect of fostering the ethical perspective in teaching requires seeking exemplars, to serve both as reminders and sources of inspiration.
BRaVE Project: processing an evidence-based tool to develop and evaluate vaccination strategies
Authors: Carini E , Calabrò G E , Tognetto A , Mancinelli S , Sarnari L , Colamesta V , Ricciardi W , de Waure C
Published: October 2020

Introduction

Deaths and epidemics due to vaccine-preventable diseases still occur even though there are effective vaccines available. Albeit recommendations released by the Italian Ministry of Health, vaccination coverages remain unsatisfactory. An improvement is therefore needed and new strategies are deserved in order to increase coverage. Nevertheless, neither a validated tool nor an institutional guideline to plan and/or evaluate vaccination strategies are available. The aim of BRaVE project was to build an evidence-based tool to develop and assess them.

Methods

In May 2019, a scoping review in MEDLINE and a search of ECDC and WHO websites were performed to look for validated tools to plan and/or evaluate vaccination strategies. The results of the search and the four phases of the Deming cycle (Plan, Do, Check, Act) were used to develop a grid. A multiprofessional panel of 7 experts validated the items included in the grid through a Delphi process followed by a face-to-face meeting.

Results

The original grid submitted to the panel of experts included 30 items (13 planning, 7 implementation, 4 check, 4 act, 2 other). The first round of Delphi led to the suggestion of 11 additional items and to the amendment of 4 out of 30 original items. During the second round of the Delphi the 41 items proposed were approved. At the end of the face-to-face meeting, 1 item was split. Seven items belonging to “Planning” (Plan) and “Implementation” (Do) were labelled as requisites for launching a vaccination strategy and the remaining 35 as items to be considered in their evaluation (15 planning, 11 implementation, 8 check, 4 act, 4 other).

Conclusions

Despite its importance, vaccination coverage is low. Evidence shows possible improvement in coverage, if innovative vaccination strategies are put in place. The developed grid is proposed as an organizational instrument which could improve and standardize vaccination strategies fostering their success and transferability.

Key messages

Novel organizational strategies could be a useful answer to improve vaccination coverage. The proposed grid could be used for the development and assessment of vaccination strategies.
Forecasting the extent of future public health challenges using the Scottish Burden of Disease study
Authors: Wyper G M A , Fletcher E , Grant I , McCartney G , Stockton D L
Published: October 2020

Background

Over the next 25 years in Scotland there is expected to be negative natural change in population growth in a rapidly ageing population. Recent evidence has highlighted the slowing of life expectancy gains and worsening trends in self-assessed general health. We have adapted the Scottish Burden of Disease study to forecast how demographic and health trends will shape future public health challenges. This is important in order to inform policy, service and workforce planning to meet anticipated needs.

Methods

For a baseline period of 2014-16 Disability-Adjusted Life Years (DALYs) were estimated for 132 causes of burden using routine data sources and patient-level record linkage techniques. Disability weights and disease models used to calculate Years Lived with Disability (YLD) were largely based on those from the Global Burden of Disease study, with life tables used to facilitate calculations of Years of Life Lost (YLL). The leading 20 causes were identified and trends in the occurrence of morbidity and mortality are currently being estimated up until 2019, and forecast to 2040, using age-period-cohort modelling. Crude and age-standardised rates will be used to monitor changes due to demography and exposure to the wider social determinants of health.

Results

In 2014-16, the leading causes of burden were ischaemic heart disease, neck and low back pain, depression, lung cancer and cerebrovascular disease. The leading 20 causes represented 68% of all-cause DALYs with ill-health and disability causing almost half of the burden.

Conclusions

Insights of the future trajectory of population health equip us with strong evidence to influence the need for a strong policy response on prevention. Estimates of the future occurrence of morbidities can be embedded in planning to ensure that services and the care workforce are proportionately designed to meet the increasing needs of a vulnerable ageing population.

Key messages

The most recent assessment highlighted that non-fatal and fatal health states approximately contribute equally to the overall disease burden in Scotland. Evidencing how future demographic and population health trends interact allows us to ensure that policy responses, care services and the care workforce can be designed based on anticipated needs.
The Danish implementation study on response to pregnancy complications, MAMAACT
Authors: Villadsen S , Johnsen H , Rasmussen T D , Sørensen J , Christensen U , Nybo Andersen A M
Published: October 2020

Differential incidence and severity of pregnancy complications are likely important contributing factors to the increased risk of poor pregnancy outcomes among ethnic minority women in Europe. To address this issue, the MAMAACT trial has been developed based on a thorough mixed methods needs assessment and co-creation process, feasibility tested, now implemented in a nationwide complex intervention. The overall aim of the Danish MAMAACT trial is to reduce ethnic and social disparity in stillbirth and newborns' health by improved management of pregnancy complications. The overall target group is all pregnant women, and the specific target group is women of non-Western origin. The hypothesis of MAMAACT is that improved communication between pregnant women and midwives regarding body symptoms that need prompt reaction will improve perinatal health among these vulnerable groups. The intervention consists of postgraduate training of midwives in intercultural communication and a smart phone application and a leaflet, both in six different languages. The app and leaflet target the women and explain the most serious warning signs of pregnancy complications and how to respond to them.

MAMAACT is implemented and evaluated in a randomized controlled cluster trial and 10 maternity wards consist the intervention groups, while nine maternity wards are the control groups. The evaluation is a mixed method evaluation focusing on understanding the mechanisms of change, how context at both maternity ward level as well as in the everyday life of women affects the implementation, and finally if effects on health literacy of the women and perinatal health of the children can be documented.
Implementation of systematic fall risk screening in primary care: barriers and facilitators
Authors: Meekes W M A , Leemrijse C J , Korevaar J C , van de Goor L A M
Published: October 2020

Background

Falls are a major problem among older people. Healthcare professionals are often unaware of the high fall risk of their patients because systematic screening does not take place. In the primary care setting systematic implementation of fall risk screening and referral to fall prevention interventions is lacking. This study aims to evaluate the implementation of a systematic and targeted fall risk screening among independently living frail older people in the primary care setting.

Methods

The implementation strategy used in this study consists of the provision of tools to screen for fall risk and identify the underlying causes, and services by physio- and exercise therapists who offer evidence-based interventions. The Theoretical Domains Framework of Huijg et al., (2014) is applied to identify barriers and facilitators of the implementation process. Online focus groups and informal interviews are conducted with the healthcare professionals involved.

Preliminary results

Participating GPs, practice nurses and district nurses acknowledged that fall prevention is part of their job, meaningful, and that they have the knowledge and skills to offer fall prevention. They also highlighted that the underlying causes of falls differ across patients, so personalized care is required. Experienced barriers are the complexity of diagnosing and treating high fall risk adequately versus lack of time, limited reimbursement, and patient's shame or limited motivation. Experienced facilitators are a good professional network, collaboration between GP practices and homecare providers, a motivated practice nurse, and adequate communication and support within the GP practice.

Conclusions

Identifying main barriers and facilitators offers opportunities for improving systematic fall prevention for older people. Hence, fall prevention can become more structurally available, reducing a major threat for the quality of life of older people living independently.

Key messages

Primary care professionals acknowledged systematic screening and fall prevention as meaningful and part of their job. Main facilitators are a good network of professionals, a motivated practice nurse, and adequate communication and support within the GP practice.
Participation, equity and health policies at the local level: tools for their implementation
Authors: Peiro Perez R , Mas Pons R , Ocana Ortiz A , Barona Vilar C , Legaz Sanchez E , Paredes Carbonell J , Pérez Sanz E
Published: October 2020

Issue/problem

In the Valencian Community, (a Spanish region with 5,000,000 inhabitants and 520 municipalities) a network of municipalities for health has been launched. Near 200 municipalities (70% population) have committed themselves to work taking into account health and equity in all policies that has to be decide and implemented in a participatory and intersectoral way. Each municipality organized a group formed by the councilors, technicians, and citizen associations related to the local policies. In order to help and guide in this policy process 2 tools were translated, adapted and tested in various municipalities.

Description of the problem

Describe the usefulness of two tools, the “Place standard” to analyse the participatory form the situation of health determinants and their prioritization, and the adaptation of a 'Fem Salut?' of evaluation of impact on health and equity to be used at the local level. Both were adapted during 2018 and used by a set of municipalities. These processes were made by groups of experts and citizens and after a pilot studies to test it was carried out.

Results

Two municipalities use the “place standard” tool and 6 “Fem salut?”. With the first tool, 8 community groups and 2 community days were organized in each municipality in order to present the tool and analysed the health situation looking at the health determinants and equity aspect. Public transport was the policy prioritize. “Fem salut” was modified using qualitative methodology. The use of support questions and examples was very useful to facilitate the incorporation of equity approach guiding on how each initiative could influence.

Lessons learned

The ease use and understanding by politicians, the technicians and by community of the results obtained promote the participation and also facilitate the participation of vulnerable population in all parts of the process. This experience could be useful to be transferred to other local territories.
Child sleep: assessment of the knowledge of parents of children aged zero to two years
Authors: Oliveira E S , Oliveira L M , Oliveira D T , Viana T R F , Silva L K C , Bezerra C M , Cardoso MVLML
Published: October 2020

Changes in sleep behavior are considered a public health problem, since they interfere with the health of the individual, especially in early childhood, and can impair growth and development. The objective of this study was to evaluate the knowledge about children's sleep in parents of children aged 0 to 24 months. Quasi-experimental study, of the type before and after, with a single group, developed in a pediatric outpatient clinic in northeastern Brazil. Convenience sample of 60 parents of children discharged from the neonatal unit, who represent preliminary data from a larger study. Data collected between November / 2019 and January / 2020, using the CAP survey (Knowledge, Attitude and Practice). A child sleep instrument was used in the pre-test (first time with the parents) and post-test (15 days after the first application). After the pre-test, the parents read an educational booklet containing the information to which they were asked. The knowledge about sleep was assessed including, time, place and sleeping clothes, position in the crib, prevention of sudden infant death syndrome and total sleep time. Scores ≤ 3 represented inadequate knowledge; 4-7 adequate knowledge. Only 5 parents had inadequate knowledge in the pre-test. In the post-test, everyone demonstrated adequate knowledge. The average of points in the pre-test was 4.3, median of 4. In the post-test, the average of points (6.15), median (6). In the pre-test, less correct questions were total sleep time, adequate sleeping position, with 12 and 20 errors, respectively. After the application of the booklet, the question regarding the total sleep time remained with an equal number of errors, however only 7 parents were wrong about the position of the child at the time of sleep. It is concluded that there is a need for guidance to parents on sleep, and it is pertinent to evaluate their previous knowledge, contributing to the strengthening of public policies aimed at children's sleep.

Key messages

Parents should receive guidance on infant sleep hygiene. Strengthening the promotion of children's sleep by health professionals.
Varicella vaccination as useful strategy for reducing the risk of varicella-related hospitalizations
Authors: Marrella A , Casuccio A , Amodio E , Vitale F
Published: October 2020

Introduction

The present study summarizes evidences of the impact of varicella vaccination (VV) on hospitalization rates attributable to this infectious disease in Italy.

Methods

We have carried out a retrospective observational study that analysed hospital discharge records and VV coverage at 24 months collected from 2003 to 2018 by the Italian Health Ministry. All hospitalizations with the presence of an ICD-9 CM 059.X code in the principal diagnosis or in any of the five secondary diagnoses were considered as related to varicella. The hospitalization rate reduction was evaluated by calculating average annual percent change (AAPC) through joint-point analysis.

Results

Hospitalization rates showed a decreasing risk by age: children aged <1 year were the most affected age group in each region (42.56/100,000 per year), whereas lower incidence rates were found in older age groups (23.76/100,000 in 1 to 5 years age group and <4/100,000 in the following groups).

Varicella hospitalization rates decreased significantly after the introduction of VV (3.42 vs. 2.67 per 100,000; P < 0.001). During the first five years after vaccination introduction hospitalization rates showed a statistically significant decrease especially for infants aged <1 year (AAPC -34.98%; p < 0.001) and 1 to 5 years old (AAPC -35.22%; P < 0.01). VV coverage was strongly correlated with hospitalization rates decrease over each paediatric age group (R-squared 0.38 in aged <1 year, p < 0.001; 0.71 in 1 to 5 years old, p < 0.001; 0.93 in 6 to 14 years old, p < 0.0001).

Conclusions

All the previously reported findings confirm that hospitalization rates are strictly related to both the number of years since vaccination introduction and the vaccination coverage. VV confirms to be an important step in public health strategies and the introduction of universal vaccination, with high vaccination coverage, should be considered as an extremely powerful tool for reducing the risk of complications.

Key messages

This study adds update findings to the literature and shows that varicella hospitalizations in Italy, from 2003 to 2018, have reduced their burden, that was high in years before varicella vaccination. Varicella vaccination introduction and high coverage are powerful tools for reducing the risk of varicella complications and related hospitalizations in the general population.
Data inputs and assumptions in calculating the non-fatal burden in burden of disease studies
Authors: Haagsma J , Wyper G , Devleesschauwer B
Published: October 2020

Years Lived with Disability (YLD) is a component of the Disability-Adjusted Life Year (DALY), and measures the healthy time that is lost because of living with a disease or disability. YLDs are calculated by multiplying the prevalence and/or incidence of a disorder by the short- or long-term loss of health associated with that disability (the disability weight) and disease severity (severity distribution).

The process of calculating a YLD involves several components and in this presentation each step will be highlighted through a sequential walk through for each step in the YLD calculation, including counting disease occurrencethe relationship between disability weights, health states and severity distributionsadjusting for comorbiditiesdealing with uncertainty

The aim of this presentation is to provide a simple step by step guide on the key components in the YLD calculation. Using the real-life example of cerebrovascular disease, the presentation will outline the key choices and assumptions that underline each data input in the YLD calculation. Participants in this session will also be provided with links to resources to help facilitate this decision-making process. The workshop will end with an interactive session where the presenters will discuss the implications of the different methodological choices with the audience.
Understanding women’s leadership in health sector; findings of a qualitative study in Kerala, India
Authors: Benny G , Sankar H , Nambiar D
Published: October 2020

Background

The lack of women's representation in health and medicine, especially in leadership positions, is a major global challenge. An exception to this is the state of Kerala in India, where female representation is high, defying national trends. We undertook a study to understand the contexts undergirding women's rise to leadership in Kerala and their experiences in leadership.

Methods

We employed a qualitative research methodology like in-depth interviews. We identified 16 women by peer nomination (respondent-driven sampling) or from public records as leaders in health, working in Kerala's health system, in civil society or political leaders dealing with health issues. Following informed consent procedures, interviews were carried out seeking to understand the work-life balance, challenges, gender norms, motivation and leadership styles of participants. Transliterated English transcripts were analyzed by three researchers using a thematic analysis approach and Atlas.Ti8 software.

Results

Participants were aged 42 years and older, with between 19 and 60 years of occupying senior managerial positions in different levels. Most emphasized family members' influence and support for their leadership roles. Their work in communities and in primary care was described as formative. Women leaders reported a combination of leadership styles to accommodate and adapt to varying circumstances, emphasizing motivation and coalition building. Challenges like false allegations, non-recognition of competence and discrimination were overcome through self-determination and perseverance.

Conclusions

Kerala women leaders have faced hardships and challenges and rely on reflexive and variable strategies. They have climbed up the ranks and developed their leadership styles mindful of and benefitting from the maintenance of community and family relationships, suggesting a different kind of leadership model altogether.

Key messages

Women leaders from Kerala’s health sector have faced unique challenges. Women leaders from the health sector have addressed different challenges by developing a hybrid, distinct leadership style.
'Cocooning' the vulnerable - a main pillar of Malta's COVID-19 response
Authors: Calleja N , Gatt M , Azzopardi M , Xuereb E , GrechMercieca E , Micallef R , Buttigieg D , Camilleri L , Galea A , Gauci C
Published: October 2020

Issue

Early epidemiology established higher risk of morbidity & mortality amongst infected older individuals or those having specific chronic diseases, consuming most hospital care. Also where demand exceeding supply of healthcare, mortality was very high. As an island nation with one central main hospital, not overwhelming the healthcare system whilst avoiding total lockdown was key.

Description

On the 27-03-2020, the Superintendent of Public Health enacted the Protection of Vulnerable Persons Order, specifying that these categories (or subcategories thereof) of persons are to be granted vulnerable status: age >65; pregnant; persons suffering from diabetes; immunosuppressed; cancer; end stage renal failure; respiratory disease; cardiac disease; heart failure. Such persons were entitled to stay at home, to be granted special leave from work, entitled to a monthly allowance by social services. One could go out only to attend to essential or urgent personal matters, e.g. groceries, medicines, medical needs, bank etc. with mitigation measures. Exemptions were only granted to special categories such as healthcare workers, farmers, or headship positions. In addition, the carers & staff of most nursing homes voluntarily decided to isolate themselves inside the homes for periods of 2/3 weeks. Thanks to a very active family support network, offspring, relatives or neighbours ran basic errands for them, or else organised deliveries. This legal status has been lifted on the 5th June 2020.

Results

This status was granted to 126 000 persons, including 14000 employed persons. Only 9 deaths occurred in Malta out of 664 cases in a population of 500000 up till 20th June 2020, with a case fatality rate of 1.35% - one of the lowest in Europe.

Lessons

Protection of vulnerable individuals can be a cornerstone of COVID-19 public health response if mobility is effectively restricted in this subpopulation.

Key messages

Protection of the vulnerable reduces healthcare & mortality burden. Effective legal & economic support measures, & extensive societal engagement required.
Feasibility of implementing Integrated Management of Childhood Illnesses through Mobile Technology
Authors: Dharma V K , Abdullah S , Khan A J , Munir M , Siddiqi D A , Shah M T , Habib A , Chandir S
Published: October 2020

Background

The Integrated Management of Childhood Illnesses (IMCI) strategy was launched by WHO and partners in 1995 to reduce child mortality by enhancing frontline health workers' (FHWs) ability to diagnose and manage childhood illnesses, and strengthen overall health systems. However, although IMCI is associated with decreased child mortality, numerous studies have shown its impact has been limited due to persistent barriers to implementation.

Methods

We developed a digitized version of IMCI (eIMCI) using Android technology to overcome implementation problems, including poor protocol compliance, lengthy trainings, paper-based data collection, and gaps in the referral system. The feasibility and efficacy of eIMCI was assessed through a mixed-methods pilot study encompassing baseline and end-line surveys, interviews, and Focus Group Discussions, in a low-resource rural district of Punjab, Pakistan. During the 8 weeks of deployment, a total of 1,978 children were enrolled in the eIMCI application by 10 participating FHWs, and 47 electronic referrals were generated.

Results

Preliminary outcomes showed reduced disease occurrence (for example, diarrhea decreased from 48% at baseline to 29% at endline), increased adherence to IMCI protocol, and strengthened health system linkages (facility referrals increased from 5% at baseline to 45% at endline). FHWs reported enhanced performance, as well as an improved community response to their services.

Discussion

Indicating the feasibility and efficacy of eIMCI deployment in a low-resource setting, evidence from the pilot demonstrates the benefit of digitizing the IMCI protocol. eIMCI is a digital health solution with the potential to significantly reduce child mortality and improve service delivery and performance of FHWs.

Key messages

eIMCI is a feasible solution for the implementation of IMCI strategy in developing countries and demonstrates increased compliance and enhanced performance by the frontline health workers. Implementation of eIMCI can result in a significant reduction in child morbidity and mortality via timely referrals of patients and reduced disease occurrence.
Health and finance in the post-austerity context: the Portuguese experience
Authors: Perelman J , Avila A , Matias M A , Coelho M
Published: October 2020

In March 2018, a Mission Structure (EMSPOS) was created in Portugal, under supervision of both Ministries of Health and Finance, to analyze the economic situation of the National Health Service (NHS), and propose recommendations to ensure its financial sustainability. The main concern was the recurrent cycles of overdue debt of NHS hospitals, which reached, in September 2018, more than 1.3 billion euros. These debts cycles, mainly to the pharmaceutical industry, were viewed as a combination of (i) under-budgeting during and following the Great Recession; (ii) expenditure growth related to population aging and new technologies; and (iii) a hospital financing and governance model that provided few incentives towards adequate management.

Hospitals' overdue debts limit their autonomy to assume investment compromises, while they deteriorate the NHS negotiation power vis-à-vis suppliers/creditors. Also, these debts were paid through financial bailouts, which shifted from punctual to predictable and regular, constituting an “indebtment reward” that destroyed any incentive towards efficiency and cost containment.

The challenge faced by EMSPOS was to ensure better budgets and autonomy to hospitals, both indispensable to face growing needs (the health sector claim), while providing the right monitoring and incentives to avoid new cycles of debt, inefficiencies, and unsustainable expenditure growth (the Ministry of Finance claim). This last request was reinforced by the Post-Program Surveillance (PPS), by the European Commission and Central Bank, that “measure Portugal's capacity to repay its outstanding loans”.

The EMSPOS proposed a new governance model that included better budgets with an efficiency-related performance component, a new management contract for hospitals' executive boards, and a path towards more investment autonomy, through the approval of “Activity and Budget Plans”. We will discuss the details of this new models and the challenges of its implementation.

Key messages

Portuguese NHS hospitals have been facing regular cycles of overdue debt, related to under-budgeting and inadequate governance models. Better budgets and hospital autonomy are needed to face growing needs (MoH claim), and right incentives are needed, to avoid inefficiencies and unsustainable expenditure growth (MoF claim).
Health financing reform in the primary health care in Montenegro
Authors: Scepanovic L
Published: October 2020

Background

Primary health care financing reform should be undertaken with aim to support universal health coverage, make the health care accessible and to provide a financial risk sharing in a way that prevents suffering of financial hardship.

Objectives

To describe challenges, development and introduction of primary health care financing reform in Montenegro. The specific objective was to assess the effectiveness of the implementation of the capitation formula.

Methods

This retrospective study has been undertaken to describe implementation of a capitation formula in Montenegro.

Results

Eight years after the implementation (2017 data) indicate that some monitoring indicators reflect output increase in the primary health care, such as number of prevention services provided to the patients (adult population of age 18 years and more). However, other indicators. e.g., number of referrals to other levels of healthcare is rising, indicating that primary care might not be meeting the adequate level of health care needs of the population.

Conclusions

Montenegrin experience shows that financing reform in short term resulted in establishment of a system based on output models of health care financing and increased capacities for performing main financing functions.

Key messages

Introduction of a capitation formula represented a fundamental shift in the way primary health care was financed in Montenegro. Further research needs to be done on how primary care responds to the needs of the population.
The bio-psycho-social frailty: a key to the integrate territorial and hospital care in Europe
Authors: Roller-Winsberger R
Published: October 2020

Demographic changes have forced communities and people themselves to reshape ageing concepts and approaches and try to develop actions towards Active and Healthy Ageing (AHA). The prevalence of frailty at population-level is expected to increase in Europe, changing the focus of Public Health. The European Innovation Partnership on Active and Healthy Ageing (EIPonAHA), a private public partnerships (PPP) launched by the European Commission (EC) is aimed at developing new solutions to facilitate AHA. The partnership combined the view on frailty coming from public health as well as the clinical management, and managed to overcome barriers between these two worlds. Bio-Psycho-Social frailty represents a synthetic indicator providing an effective basis to overcome a silos approach that is often performed by health and social professionals working in the field. The A3-Action Group on ' Lifespan Health Promotion & Prevention of Age-Related Frailty and Diseases” proposes good practice models to achieve and support the healthy ageing of European citizens using a bottom-up approach targeting the prevention of frailty and subsequent functional decline. Multiple factors were highlighted by the group as useful for healthcare planning: malnutrition, polypharmacy, impairment of physical function and social isolation were targeted to mitigate frailty and its consequences. Integrated health and social care is a key factors to affect ageing positively either in the field of prevention of functional decline and in the field of care. Studies focused on the management of frailty highlighted that tailored interventions can improve physical performance and reduce adverse outcomes. A crucial role is played by training of health personnel and education at population level in order to achieve a new awareness about AHA trajectory.
Obstetric referrals to the regional maternity of Kasserine (Tunisia)
Authors: Limam M , Sahli J , Alouani D , Gassoumi M , Mellouli M , Mtiraoui A , Ajmi T , Ghardallou M
Published: October 2020

Background

A large proportion of maternal deaths are related to the health care system, including the failure of the referral system between maternity wards. The objectives of this study were to determine the frequency and the indications of obstetric referrals in a Tunisian regional care maternity and to assess the conformity of referral mechanisms with the National Perinatality Programme guidelines.

Methods

A descriptive study was carried out at the regional maternity facility of the regional Hospital of Kasserine in 2018, among parturients referred during a period of three months. Data collection was carried out prospectively from medical records, transfer documents, interviews with parturients and with the nursing staff of the reference maternity hospital. The ICD-10 was used to code recorded indications and diagnoses for referrals.

Results

A total of 234 parturients were included. Referrals represented 15.1% of the obstetric activity in this facility. There were 26 reasons for referrals and the most common was Maternal care for pelvic organ abnormalities (19.7%) and premature rupture of membranes (12.8%). 34.4% of the referrals were unclassifiable according to ICD-10. Most of the indications for referrals (71.4%) did not conform to the list of referral indications of the NPP. Twenty-eight diagnoses were retained after referrals: the most common was Maternal care for pelvic organ abnormalities (15.8%). In 42% of women, reasons for referral did not match with diagnoses established at the time of the patients' admission to hospital.

Conclusions

The referral system must be analyzed in order to ensure a maximum level of safety for the mother-child couple through the formalization of the protocols and the promotion of the role of peripheral maternity facilities, which are the structures of first recourse.

Key messages

The current referral system in the region of Kasserine still faces several challenges that need to be addressed in order to make it more effective. Maternal referral systems are an effective measure to help to reduce preventable maternal deaths, they should be continuously assessed and revised.