bluuebunny/crossref_metadata_2025 huggingface dataset:
Geospatial data sources to produce new evidence for routine population health monitoring
Authors: Costa C
Published: November 2019

Background

Many public agencies collect geospatial data in relation to Environment and Territorial Planning. This data is harmonized, standardized, made available online, and it is often collected for a group of countries. These characteristics make this data particularly useful for population health studies, yet in public health there is a certain lack of knowledge with regard to this type of data. The large datasets, the data format and the ways to access this data all hamper their use. The aim of this work is to present an overview of geospatial databases that produce routinely available geospatial data able to support population health monitoring and interventions. The process of how to transform this data in evidence at the local scale will also be highlighted.

Methods

First, we conducted a survey via the websites of international public institutes with relevant geospatial data gathered for Europe. Second, we identified how we could transform the data into evidence relevant to both, population health studies and decision makers, namely at the local level.

Results

At the EU level, the European Territorial Observatory Network (ESPON), EUROSTAT, the Joint Research Centre and the Environment European Agency (EEA) are some examples of public agencies both producing and offering access to geospatial data. They are responsible for collecting data regarding, e.g., land use, road and rail networks, amenities and pollution.

Although geospatial data has been compiled all over Europe, it can be used to produce evidence at the local level. For instance, it is possible to extract information on the greenspace area at a local administrative level from the Corine Land Cover project, managed by the EEA, and then, measure the share of area per inhabitant.

Conclusions

Geospatial data have much more to offer than the obvious location factor. It brings new evidence at the local level, supporting studies and empowering decision-makers at all levels.
Example C: Using online respondent-driven detection for communicable disease control
Authors: Helms Y B , Hamdiui N , Eilers R , Hoebe C J P A , Dukers N , van den Kerkhof H , Timen A , Stein M L
Published: November 2019

Online respondent-driven detection (online-RDD) is a novel method of case-finding that may enhance contact tracing (CT). However, the opportunities and barriers of online-RDD for public health practice have not yet been investigated from the perspective of public health professionals (PHPs). Therefore, it is unclear what the potential strengths and limitations of online-RDD for CT are.

We conducted a sequential exploratory mixed methods research. First, we conducted semi-structured interviews with Dutch PHPs involved in CT. Questions were derived from the diffusion of innovations theory. Second, we distributed an online-questionnaire to 260 Dutch PHPs to study the main findings in a larger population. We used hypothetical scenario’s (scabies, shigella, and mumps) to elicit PHPs’ perceptions of online-RDD.

Twelve interviews were held. Response rate to the online-questionnaire was 31% (n = 70). Four themes related to characteristics of online-RDD that influenced PHPs’ intention to adopt online-RDD emerged: advantages over traditional CT, task conflicts and opportunity costs, public health risks, and situational compatibility. PHPs believed online-RDD may enhance CT through increased reach, low-key communication options, and saving time. Limitations were foreseen in the delivery of measures, supporting patients and contacts, missing information and contacts, and causing unrest. Online-RDD may be particularly applicable in situations with digitally skilled and literate target populations, low urgency, low time-pressure, and a simple perspective for action. A majority of PHPs (70%) had a positive adoption intention towards online-RDD.

PHPs perceived online-RDD as beneficial to public health practice. Further development of online-RDD should focus on facilitating opportunities for personal contact between PHPs, patients and contacts. A comparative study of ‘traditional’ CT and online-RDD could yield further insights in the potential of online-RDD for public health practice.
Santino Severoni
Authors: Severoni S
Published: November 2019

Dr Severoni will present perspective from the World Health Organization on its priorities on UHC and the SDGs, and how these intersect with its work on migrant health at the European and global levels; and the opportunity of the NLO checklist as a tool to support these goals at the national and local levels.
Political support for the institutionalization of health assessment within Environmental Impact Assessment
Authors: Moya Ruano L , Rodríguez Rasero F J , Madrid Verdugo E , Vela J
Published: November 2019

Health Impact Assessment (HIA) as a stand-alone report integrated in environmental impact assessment has been compulsory for the last 5 years in Andalusia. In this time, it has been proven as a successful tool for implementing the Health in All Policies strategy, delivering consistently better outcomes for the examined projects.

The effective implementation of HIA required huge institutional and political support as this choice was very controversial and sparked opposition from developers. They alleged it would worsen the adverse socioeconomic situation and made claims about how it would generate unfair competition for companies in the region.

Nevertheless, the main source of opposition was located within administrations, unaccustomed to collaborative work. There were also fears about the increased bureaucracy and lack of coordination in procedures. It was a major challenge, as it seemed conflicting with other political objectives as achieving economic growth and job creation, while offering doubtful political gains due to difficulty in achieving results in the short term.

The support implied assuming a political leadership focused on the inclusion of health in the government’s list of priorities, advocating for the population value as a strategic element. It also meant raising awareness among all sectors by searching for strategic alliances and being prepared to compromise and reach agreements.

It needed technical and organisational leadership too. First, by defining a feasible model of HIA, and then by building bridges between the different sectors. Regarding coordination, several joint instructions have been drawn up to clarify the activities that each organization must undertake, including deadlines and persons in charge. Finally, other successful strategies have been the development of facilitation mechanisms and the provision of specific training courses for developers and administrative staff.
The Sweden cohort consortium (Cohort.se)
Authors: Sundstrom J S
Published: November 2019

The scientific literature is continuously flooded with non-replicable results from underpowered studies. The insight that very large sample sizes are needed in order to generate robust results has led to the establishment of very large cohorts and cohort consortia in the last decades. Sweden is a country with unique opportunities for epidemiological research. Sweden has a large number of carefully collected population-based cohorts that have been followed for decades, ongoing recruitment into several cohorts, and a variety of high-quality national socio-demographic and medical registries covering the whole population since many decades. However, Swedish cohort research is poorly coordinated. Many research projects are underpowered by using only one cohort at a time, leading to uncertain results with little benefit to patients and the public. We have proposed a coordination of all Swedish cohorts in a common national infrastructure, the Swedish Cohort Consortium (Cohorts.se), aiming to facilitate greater use of Swedish cohorts for better-powered research. Coordination of all Swedish prospective population-based cohorts in a common infrastructure would enable more precise research findings and facilitate research on less common exposures and outcomes, leading to better utilization of study participants’ data, better return of funders’ investments, and higher benefit to patients and populations. A standing Swedish cohort consortium may drive development of epidemiological research methods and strengthen the Swedish epidemiological competence, community, and competitiveness.
Workshop: Care4Care: the migrant care workforce in Europe
Authors:   Organised by: EUPHA (HWR), EUPHA (HSR), EUPHA (PHPP) Chair persons: Ellen Kuhlmann - EUPHA (HWR), Judith de Jong - EUPHA (HSR)
Published: November 2019

Background

Foreign trained health workers increasingly fill the care gaps caused by labour market shortage and governance failures. As doctors, nurses and carers they make a crucial contribution to health system performance and the health of the population. These contributions are likely to increase in future, especially in high-income countries, where demographic change and NCDs reinforce the gap between demand for care and labour market supply. However, health system demands for migrant carers do not sit easily with the new wave of nationalism and populist movements in Europe and globally; they may also reinforce the ‘care drain’ in less well-resourced sending countries. There is an urgent need for more inclusive health workforce governance in order to take ‘care’ for the migrant health workforce both nationally and globally and ensure ‘health for all’.

Objectives

This workshop addresses these questions and fosters critical debate. It has three major aims: to make the migrant carers visible as important part of the health workforce and health system performance, to unmask the threats of growing nationalism and populist movements to healthcare systems and universal healthcare coverage, and finally to critically discuss how to govern the migrant care workforce in ways that improve both integration in the host country and solidarity across Europe and globally. The workshop brings together knowledge and expertise from the areas of health workforce, health services, and health policies and systems. It is organised as round table discussion, facilitated by an overview of migrant care workforce patterns and policies in selected European Union (EU) high-income countries and two in-depth country cases, namely Italy and Austria, both known for growing populism and nationalism and strong anti-migrant policies in the EU. The three panelists will discuss the role of migrant care workers and explore, from different perspectives, how to build capacity for new forms of health workforce governance that move beyond narrowly defined national/regional interests of health systems. The workshop will foster a wider debate on migrant careers and health workforce needs, and how public health can contribute to better take ‘care’ for the human resources for health.

Key messages

Migrant carers form an important part of the health workforce in European countries. Health systems must take care of the migrant health workforce and counteract growing nationalism.
Nation-wide profile of women using hormonal contraception in Finland in 2017
Authors: Toffol E , But A , Heikinheimo O , Latvala A , Partonen T , Haukka J
Published: November 2019

Background

Up to 69% of European women use contraception. Nordic countries have traditionally high levels of contraception use, of welfare and social equality. However, the uneven population distribution across the Finnish territory makes the easiness of access to health care structures and trained professionals an important issue in relation to effective contraception use. Understanding the patterns of contraception prescription and their underlying determinants is crucial to guarantee the best contraceptive option for each woman.

Methods

In Finland, users of hormonal contraception (HC) can be identified from register records only starting from 2017. This nationwide, register-based study includes all women with at least one HC prescription in 2017, and a reference cohort of non-users, matched by age and municipality. Through linkages to Finnish National Registers we retrieved sociodemographic data. We calculated national and regional rates and distributions, and compared distributions with t-test, Kruskal Wallis or Chi-squared test.

Results

The HC cohort included 294445 women aged 15-49 years (mean 28.9, SD 8.6), 25.8% of Finnish women of that age range. The majority of them were unmarried (71.8%) and employed (71.6%). Compared to non-users, HC users were more often unmarried, a cohabiting couple without common children, employed, had upper secondary or bachelor level education, and higher annual income (p < 0.001). Differences between HC users and non-users were non-homogenous across 70 Finnish regions.

Conclusions

These preliminary results show different sociodemographic correlates of HC use across Finnish regions. Our findings will guide public health strategies aimed at guaranteeing the best contraceptive option for each woman across the whole country.

Key messages

Sociodemographic correlates of HC use differ across Finnish regions. These differences may reflect differences in access to health care services, in prescribers’ characteristics and in HC methods.
Health situation and health care of women aged 50 years and older in rural regions in Germany
Authors: Prütz F , Krause L , Nowossadeck E , Thißen M , Dini L
Published: November 2019

Background

In many countries demographic changes and regional differences lead to inequalities in healthcare provision. In Germany, this applies especially to rural regions and could affect the healthcare situation of middle-aged and older women in particular. Our study, which is part of the project “Frauen 5.0”, explores the health and healthcare situation of women 50 years and older in Northeastern Germany, with focus on outpatient gynaecological and general medical care and reasons for healthcare utilisation.

Methods

Our analyses comprise the health situation of women aged 50 years and older, their utilisation of outpatient gynaecologists and general practitioners (GPs), reasons for utilisation, access barriers to outpatient care, the demographic situation and the spatial distribution of gynaecological and GP practices in Northeastern Germany. We use a variety of data sources; main data source is the German Health Interview and Examination Survey for Adults (DEGS1, 2008-2011), which was carried out by the Robert Koch Institute and is representative of the German adult population.

Results

There is an unequal distribution of gynaecologic and GP practices in Northeastern Germany, with the highest density in and around Berlin. About 30% of gynaecologists and GPs in the study region are aged 60 years and older. Whereas in all age groups at least 80% of women used GP services in the last 12 months, the use of gynaecologic services declines from 80% in 18- to 29 year-old to 45% in 70- to 79 year-old women. Most important reasons for seeking gynaecological treatment are menopause and early detection of cancer.

Conclusions

The analyses show that there is need to ensure adequate health care for women aged 50 and over in rural regions in Germany. Based on the results, within the project “Frauen 5.0” innovative solutions for this task, e.g. interprofessional cooperation, will be identified.

Key messages

Analyses of outpatient healthcare services show an unequal distribution of gynaecologic and GP practices in Northeastern Germany; about 30% of the gynaecologists and GPs are aged 60 years and older. Whereas in all age groups at least 80% of women used GP services in the last 12 months, the use of gynaecologic services declines from 80% in 18- to 29 year-old to 45% in 70- to 79 year-old women.
Mothers’ Oral Health Literacy and children’s oral health: study in the department of Pikine, Senegal
Authors: Dieng S , Lombrail P , Cissé D , Azogui-Levy S
Published: November 2019

Background

Several studies have shown that social conditions in which children are raised and family psychosocial factors affect their oral health. Oral health literacy (OHL) has been shown to be associated with prevalence of dental caries, access to care and prevention of oral diseases. No studies have addressed this issue in Senegal.

Objective: To study the characteristics of the mothers’ OHL and its association with children’s dental health.

Methods

Cross- sectional study in the district of Pikine, a suburb of Dakar including 16 municipalities. Two-stage cluster sampling and a sample comprising 315 children from 3 to 9 years old and their mothers. Data on oral health status were collected from clinical examinations, sociodemographic and OHL (Sistani et al’ OHL-AQ) data were collected during face-to-face interview.

Results

More than half of the mothers (56.5%) had a low OHL, but 68.9% had an adequate score for the communication/interactive dimension. The level of OHL increased significantly with education level, household wealth and dynamism of the social support. Prevalence of dental caries was 64.8%, following a social gradient and significantly associated with the mothers’ OHL level (OR = 5.2) CI[2.2-14.1]. The oral health behaviour of families was significantly associated with the level of OHL and children’s dental health. A structural equation model showed the OHL was a mediating factor between social characteristics and oral health behaviours.

Conclusions

The OHL of mothers is an important variable to be included in the study of social inequalities in oral health. The communication/interactive dimension seems to be decisive in the African context of an oral culture and dynamic social support which makes it possible to provide better knowledge and preventive behaviour.

Key messages

High maternal OHL should be reinforced to lessen oral health inequalities among Senegalese children. The communication/interactive dimension seems to be decisive in the African context of an oral culture and dynamic social to enhance OHL.
Medical records completeness: can Link Professionals improve quality in a Rehabilitation Hospital?
Authors: Scarpis E , Poletto M , Guardini I , Dal Bo O , Maestra M R , Tea G P , Zampa A , Lattuada L , Castriotta L , Brusaferro S
Published: November 2019

Background

The completeness of Medical Record (MR) is an indicator of the quality of care provided. IMFR (Medical and Physical Rehabilitation Institute), a hospital part of the Udine Healthcare Trust with 400 discharges yearly, launched at the end of 2017 a MR-quality program based on the involvement of Link Professionals (LP): doctors, nurses and therapists specifically trained. The main aim of this study is to determine if involving LP would improve MR completeness and would keep it over time. The second aim is to describe the 1-year experience of MR completeness and professional attitude toward recording medical information in it.

Methods

In December 2017 a new MR was introduced at the IMFR and its completeness was evaluated in January 2018. From January to April 2018, 17 LP educated all colleagues on the recording behavior through periodic meetings and focus groups. Then, LP peer-reviewed 20 inpatients paper-based MRs, assessing completeness, in April 2018 and then quarterly until January 2019. The evaluation was performed with a tool including a total of 73 items, divided in pertinence to the three professional figures involved. Feedbacks on MR completeness were given to professionals by LP in two-weeks. External data validation was performed to ensure data consistency. Significance (p < 0.01) was assessed by Cochran-Armitage test for trends.

Results

The overall completeness of MR improved significantly from 59.6% (552 items out of 926; Jan-18) to 77.0% (738/959; Apr-18), settling to 78.3% (696/889) in January-19, with an overall trend of + 18.7%. Items pertaining to doctors improved significantly from 56.4% (217/385) to 81.4% (1173/1441), nurses’ from 60.7% (165/272) to 78.6% (740/941), therapists’ from 79.0% (79/100) to 91.7% (277/302). External validation results in 75% of agreement.

Conclusions

The involvement of LP proved effectiveness in encouraging professionals behavior, supporting the MR completeness improvement and keep it over one year time.

Key messages

Professionals involvement and short-term feedbacks contribute to the healthcare quality improvement. Peer-reviewing medical records improves professionals attitude in recording behavior.
Educational requirements for Health Information Systems: A scope review of the literature
Authors: Beja A , Nogueira P , Lapão L V
Published: November 2019

Background

Sound and reliable information is fundamental to decision-making across all health system. New information technologies can contribute to a more accurate and efficient public health action, requiring new and more sophisticated skills to support this change. Considering the European context, where public health professionals vary by country and cover different areas, and the need for a skilled workforce, the objective of this study is to identify the basic educational components required for a public health information specialist. This study is part of the ongoing research under INFACT Joint Action.

Methods

A scope review (Pubmed/Ebsco, free access texts, no time restrictions) was carried out in order to answer the following question: Considering the set of activities of public health, what are the main topics and trends of the literature on both Human Resources and Health Information Systems (HIS) training? Abstracts were read by two reviewers and the select texts analyzed using HOT-FIT framework for HIS.

Results

Among the 53 records, it was possible to identify different study designs and elements related to different contexts and HIS. There is a trend for new publications, with a significant increase since 2014. The content analysis showed more frequent themes in three main categories - Human, Organization and Technology, allowing identifying a wide range of public health professionals and their educational needs.

Conclusions

Results reinforce the link between information systems and public health, showing the importance of regular HIS as data source for monitoring population health, specific events and determinants, management and research activities and during the stages of the planning cycle of public health activities. The proper workforce capacitation emerges as a success factor for HIS implementation, as well as several professional profiles that carry out public health activities and the areas where it is necessary to strengthen their training.

Key messages

There’s growing interest in the use of technologies for the development of public health information systems. Workforce needs to develop specific skills for the technological challenges in Public Health.
Community hygiene against lassa fever disease and its predictors in a Nigerian rural settlement
Authors: Gobir A A , Ejembi C L , Aliyu A A , Garba M B , Igboanusi C J C , Usman B , Umar Z Z , Istifanus I A
Published: November 2019

Background

Lassa fever disease (LFD) is a viral haemorrhagic fever that is endemic in some West african countries where an estimated 300,000 to 500,000 cases and 5000 deaths occur yearly. The World Health Organization described it as a global health threat. At community level, its prevention relies on promoting good “community hygiene”. This study was conducted to assess practice of community hygiene measures against LFD and its associated factors.

Methods

A cross-sectional, community based descriptive study conducted during a LFD epidemic in a a rural community of Nigeria. An interviewer-administered questionnaire was used to collect data from 556 adult respondents, selected using systematic random sampling technique. Data was analyzed using SPSS.

Results

A majority of the respondents were females (52.9%). Educational attainment was significantly associated with safe food storage at the multivariate level (aOR= 1.31, 95% CI: 1.10-1.54,P= 0.002) while having a good knowledge of LFD was a significant predictor of maintaining good housing standards (aOR= 3.73, 95% CI: 1.09-12.80,P=0.036).

Conclusions

Predictors of practice of community hygiene against LFD include education and having an excellent knowledge of LFD. To improve community hygiene practices in the community, there is need for a comprehensive LFD behavior change communication intervention.

Key messages

Cubing the global threat of LFD depends on its effective prevention in endemic West African communities. This study shows that such preventive measures are poor and there is need for more response to address the problem.
Sentinel physicians network in Reunion: an essential and key actor for epidemiological surveillance
Authors: Daoudi J
Published: November 2019

Issue/Problem

The surveillance of seasonal infectious diseases in Reunion is based on a Sentinel physician’s network of 52 volunteers, which is coordinated by the Indian Ocean regional office.

Description of the problem

The main objectives are to identify and monitor outbreaks of infectious diseases like influenza-like-illness (ILI) gastroenteritis, dengue, and conjunctivitis. A virological surveillance set up to characterize circulating respiratory viruses from a nasal swab collected by the physicians. Swabs are tested by RT-PCR for influenza in the reference laboratory.

Results

The surveillance demonstrated that the influenza season during the 2018 austral winter ran from September to October. More than 55 000 consultations related to ILI were estimated. The virological surveillance confirmed the circulation of A (H3N2) principally in 2018. The physician’s network identified the first cases of chikungunya in Réunion Island in 2005 and data collected by this physician’s network provide the epidemic trends with weekly estimation’s of total numbers of consultations in the Reunion Island. More than 25 000 community consultations of dengue-like-illness have been estimated. The physician’s network took part in the surveillance of conjunctivitis outbreak in 2016 and identified an outbreak of norovirus gastroenteritis in Reunion Island in 2007 and 2012.

Lessons

This network is an essential tool for disease surveillance and control activities.

Key messages

The network provides provisional virological and severity data on circulating influenza several months before the onset of influenza season in mainland France. The network is engaged and active which enables the early detection of any emergent diseases.
Situation analysis on evidence-informed health policy-making in Poland
Authors: Dubas-Jakóbczyk K , Kocot E , Domagała A , Mikołajczyk T , Adamski J , Kuchenmüller T
Published: November 2019

Background

Over the last few years, increased international attention has been paid to bridging the gap between health research and policy-making. The situation analysis on evidence-informed policy-making (EIP) in Poland aims to increase understanding of interactions among a country’s research and policy-making communities, to determine where and how to best establish a knowledge translation platform (KTP), i.e. an organization or network that through its structure and functioning brings the worlds of research and policy together.

Methods

The methods were guided by the EVIPNet Europe Situation Analysis Manual and included a literature review, key-informant interviews and survey data analysis.

Results

In Poland, the existence of incentives or requirements stipulating the use of research evidence in health policy varies, depending on the type of policy. The use of evidence is a standard practice in drug policy, and in decisions related to the inclusion of services in the health benefit package. In other areas, some good practice examples of using evidence in policy can be identified. Yet these are rather individual, isolated and bottom-up initiatives, which neither occur systematically, nor routinely. Key challenges in view of strengthening a systemic approach to EIP relate to: overlapping mandates of key health system and research institutions, generally low research capacity and lack of knowledge translation skills.

Conclusions

Establishing and operationalizing a KTP can be an effective means of supporting sustainable EIP. Building such infrastructure, however, is a longer-term and complex process that needs to be based on the current characteristics of the country’s EIP landscape. The proposed model of a future KTP in Poland is a network with a joint secretariat within the Ministry of Health. Such form can take advantage of existing organizations’ competencies via information exchange and cooperation.

Key messages

Although systemic mechanisms for evidence-informed health policy are missing in Poland, its importance is recognized among major health system stakeholders. The proposed model of a future knowledge translation platform in Poland is a network with a joint secretariat within the Ministry of Health.
Validation of a Screening Tool for Social Vulnerability in Pediatrics
Authors: Laporte R , Jouve E , Daguzan A , Gentile S
Published: November 2019

Background

Screening for social vulnerability is emphasized improve access and quality and of healthcare. In pediatrics although some specific tools exist, a global screening tool for social vulnerability and access to healthcare was missing. A Vulnerable Child Scale (VUCHIS) was developed with expert focus groups. It included short evaluation about several issues: medical follow-up, health assurance, children schooling, housing, close entourage, comorbidities, recent migration, language comprehension and food insecurity. Fifteen items were addressed in a short and easy to translate interview. The aim of this study was to validate this tool.

Methods

This multicenter study was conducted in two pediatric emergency departments in France. VUCHIS questionnaire was completed by the emergency department caregiver. Another blinded interview with a social worker, expert in social vulnerabilities diagnosis, was conducted to assess the need for care in a clinic for socially vulnerable children. Clinical exam was recorded. The main criteria for this study was the clinimetric properties of VUCHIS compared to the expert caregiver opinion.

Results

480 children were included. Their mean age was 8.3 years (SD = 3.8); 264 (55.0 %) were boys. The expert evaluation identified 57 (11.9 %) children with social vulnerabilities. VUCHIS ranged from 0 to 79 (mean = 6.9; SD = 14.7). ROC curve area was 0.83 (SD = 0.04). The selected diagnostic threshold was 10. This showed sensitivity = 0.70; 95% confidence interval (CI) = [0.56; 0.81]; specificity = 0.89; CI = [0.86; 0.92]; positive likelihood ratio = 6.60; CI = [4.77; 9.12] and negative likelihood ratio = 0.33; CI = [0.22; 0.50].

Conclusions

VUCHIS has good clinimetric qualities that will promote the screening of social vulnerability in pediatric clinical practice.

Key messages

Pediatricians need global and easy-to-use tools to implement social vulnerabilities in their clinical routine, especially in emergency departments. Implementing tool-mediated screening for social vulnerabilities in pediatrics prevent inappropriate orientation and prescriptions and poor therapeutic adherence.
Can nurses improve self-management among pediatric patients? A systematic review and meta-analysis
Authors: Mele A , Nardi A , Prencipe G P , Migliara G , Massimi A , Rega M L , Anderson G , Casasanta D , De Vito C , Damiani G
Published: November 2019

Background

Few studies report educational interventions for pediatric patients with asthma or diabetes type 1 as a fundamental instrument to engage them and improve their health. The aim of this systematic review and meta-analysis was to synthesize evidence about behavioral changes in life style, disease management and clinical outcome in pediatric patients after a structured educational intervention delivered by nurses.

Methods

A systematic review of the literature was carried out in MEDLINE, Scopus and CINHAL including only RCTs. Methodological quality of the studies was assessed using Cochrane tool. Meta-analyses on HbA1c reduction for diabetes and hospitalization, emergency department (ED) visits and medication for asthma were carried-out.

Results

Of the 3559 papers initially retrieved, 5 regarding diabetes and 19 asthma met the inclusion criteria for the systematic review and 14 for the meta-analyses. Included studies were highly heterogeneous in terms of type of intervention and follow-up duration. Almost all the studies showed an improvement but only few were statistically significant. All studies regarding diabetes showed a low risk of bias (only one RCTs had a high risk of bias in one domain), while almost all RCTs on asthma showed a high risk of bias. The pooled mean differences in favor of the experimental groups were: HBA1c -0.02 (IC95%: -0.26 - 0.22), Hospitalization 0.58 (IC95%: 0.19 - 1.78), Medication -0.10 (IC95%: -0.43 - 0.23), ED Visits 0.82 (IC95%: 0.44 - 1.54).

Conclusions

There is a general agreement about the central role of educational intervention delivered by nurses to pediatric patients and the assessment of the behavioral changes after educational interventions is strongly recommended in pediatric population. However, more efforts are requested in designing studies on patients with asthma and to program more appropriate follow-up and periodic recall in order to engage pediatric patients in the management of their own chronic disease.

Key messages

educational intervention delivered by nurses to pediatric patients with asthma or diabetes type 1 as a fundamental instrument to engage them. more efforts are requested in designing studies on patients with asthma and to program more appropriate follow-up and periodic recall in order to engage pediatric patients.
Exposure to car smoking among youth in seven countries of the European Union
Authors: Mlinarić M , Schreuders M , Mons U , Kunst A E
Published: November 2019

Background

In the USA and Canada, cars are a major source of secondhand smoke (SHS) exposure among youth. Little is known about the magnitude of this public health problem in European countries. In this report, we study SHS exposure in vehicles among adolescents across 7 member states of the European Union (EU), with a particular focus on socio-economic characteristics and adolescents’ smoking environment.

Methods

Data on self-reported SHS exposure in cars during the past seven days was obtained from the 2016/17 cross-sectional SILNE-R study from 14-17-year old adolescents in EU seven countries (N = 10,481). We applied two multivariate logistic regression models with sociodemographic characteristics and mediating smoking-related factors.

Results

SHS car exposure varied widely across the 7 EU countries: 6% in Finland, 12% in Ireland, 15% in the Netherlands, 19% in Germany, 23% in Portugal, 36% in Belgium and 43% in Italy. Low paternal educational levels were strong correlates of SHS exposure in cars as well as migration background. Other correlates were one’s own smoking status and the relation to the family and peer smoking environment, such as parental smoking, permissive smoking rules at home, and best friends smoking.

Conclusions

In most of these seven countries, a considerable proportion of youth, particularly those from disadvantaged backgrounds, is exposed to SHS in cars. There is a need to ensure adoption and sustained enforcement of smoke-free car legislation. Given the long-term effectiveness of smoke-free car policies, our finding suggests that such policies can contribute towards reducing smoking inequalities.

Key messages

We assessed adolescent secondhand smoke (SHS) exposure in cars in 7 EU countries, which varies widely, ranging from 6% in Finland to 43% in Italy. The findings point to a social gradient, environmental factors in SHS car exposure and call for the rapid implementation of smoke-free car legislation.
The development of a monitoring instrument to measure the strength of health promoting systems
Authors: Fransen G , Wagemakers A , Molleman G
Published: November 2019

Background

In the region of the Municipality Health Services Gelderland-South, each municipality has its own health broker. He or she advises the local policy makers, signals/pleads for addressing health problems, and facilitates effective approaches. By doing this health brokers try to strengthen the local health promoting system. To show the results of health brokers and to monitor changes of the local health promoting system, the MHS needs a monitoring instrument. The aim of this study was to develop this instrument and to test it in practice.

Methods

Participatory action (qualitative) research is used to develop an online questionnaire. Structured group processes with the health brokers has led to the identification and definition of eight variables, reflecting the health promoting system: collaboration, support, integrated approach, visibility of results, health monitor data assessment, consistency, reach of the target population and sustainability. A literature study identified appropriate instruments. The online questionnaire is expanded to test the reliability, to evaluate the usability and to gain insight into the strength of the health promoting system in 16 municipalities.

Results

The questionaire is based on validated questionaires like the Coordinated Action Checklist, and contains 28 items. Sumscores per variable ranged from 0 (weak) to 100 (strong). Health brokers and their partners (N = 147, 4-9 per municipality) filled out the questionnaire. Support and collaboration had the highest mean scores (70,5 resp. 69,8), and visibility of results and sustainability the lowest (61,3 resp. 59,4). Differences between municipalities were identified and can be used to know which variables can be improved. The test-retest reliability (mean r = 0,713) and the Crohnbachs alphas (all > 0,70) were reasonable good.

Conclusions

The questionnaire can help to provide useful insights in the strengths and weaknesses of the local health promoting system.

Key messages

Eight variables reflect the health promoting system: collaboration, support, integrated approach, visibility of results, health monitor data assessment, consistency, reach and sustainability. The questionnaire can help to provide useful insights in the strengths and weaknesses of the local health promoting system.
Healthcare costs and outcomes: a value-based assessment tool for Clinical Governance
Authors: Specchia M L , Arcuri G , Di Pilla A , Ricciardi G , Bellantone R
Published: November 2019

Issue/problem

Health systems sustainability is a critical public health issue. A value-based approach is essential to improve patient-centeredness, appropriateness, quality and funding allocation in healthcare.

Description of the problem

This project was aimed to develop an innovative transferable tool to assess value-based activities in Hospital by monitoring care pathways costs and outcomes. Main questions were to: assess cost and outcome variance in homogeneous groups of patients; evaluate clinical activities contribution to the hospital budget; identify and monitor critical points. In 2018 a Business Intelligence system fed by different Hospital datasets was developed and tested in a Teaching Hospital in Rome to quantify and integrate data on pathways efficacy and costs. It was based on an algorithm of 20 indicators related to Women and Child Care Pathways.

Results

Preliminary results showed a great variance for the same intervention/procedure concerning length of stay (3-8 days), waiting times (1-4 days), innovative technologies costs (2000-6000€) and obsolete reimbursement rates (2000-5000€) that do not guarantee adequate economic contribution margins. Improvement actions were defined concerning pathways’ workflow and organizational appropriateness. The need for negotiations with Ministry of Health was highlighted, aimed to update reimbursement rates.

Lessons

The tool, built on a value-based process view, allowed analyzing online outcomes and costs data aggregated by path, benchmarking results, identifying critical issues and providing improvement solutions. It turned out to be an innovative methodology - also applicable in other settings/countries - to trigger changes in health management and pursue quality and efficiency in healthcare.

Key messages

Value-based healthcare is the new public health paradigm. Assessing simultaneously Hospital costs and outcomes is a valuable way to derive overall healthcare value, improve quality and rationalize resources allocation.
The Bundle approach to reduce SSI rate of colon surgery, Piedmont (Italy): experience of 2012-2017
Authors: Scacchi A , D’Ambrosio A , Rainero E , Vicentini C , Furmenti M F , Zotti C
Published: November 2019

Background

According to ECDC, Surgical Site Infections (SSI) are the second most frequent type of Healthcare Associated Infections (HAI) in Europe and in USA, and 9.5% of colon surgical procedures develop SSI. SSIs are associated with prolonged hospital stay, higher costs burden and higher attributable morbidity and mortality. Interventional programs can reduce the risk of SSI. Care bundles are a complex of EBM-based interventions on a specific population and setting, in order to improve clinical outcomes. A bundle is successful only if all its items are properly applied, through the ‘all-or-none’ method. Application of a bundle does not exclude other good clinical practices.

Methods

Data from 37 hospitals participating in the Regional SSI surveillance of Piedmont (Italy) were collected from 2012 to 2017. In hospitals applying the bundle, 4 bundle items had to be used in all the procedures: Temperature control, preoperative shower, trichotomy, antimicrobial prophylaxis. 6909 patients undergoing colon surgery were followed for 30 post-operative days to detect SSI events (According to ECDC 2016 Protocol). For some procedures, compliance to Bundle item application was ≤ 75%.

Results

6909 procedures were assessed: 3631 with no bundle application and 3278 with bundle application; in particular 974 were compliant to all bundle items (100%), while 2304 were compliant to 3 items or less (≤ 75%). We report a SSI risk of 11.20% for surgical procedures performed without bundle application; this risk decreases to 5.63% (OR: 0.49, 95% CI: 0,36-0,67; p < 0.001) when compliance to bundle is 100%. When compliance to bundle is ≤ 75% instead of 100%, SSI risk raises to 8.47% (OR: 1.49, 95% CI: 1.07-2.04; p = 0.002).

Conclusions

Care bundle, if properly applied, is associated to statistically significant reduction of SSI rate (51%) for colon surgical procedures. Bundle programs should be encouraged and improved in hospitals to reduce healthcare costs and burden of HAIs.

Key messages

The use of the 4-item Surgical Care Bundle is associated to statistically significant reduction (51%) of SSI rate for colon surgical procedures. Surgical Care Bundle programs should be recommended and improved in every hospital to reduce healthcare costs and burden of HAIs.
Obstetric interventions among native and migrant women: a survey of episiotomy in Portugal
Authors: Lorthe E , Teixeira C , Rodrigues T , Barros H
Published: November 2019

Introduction

It is unclear whether migrant women experience worse pregnancy outcomes than native women. A better comprehension of obstetric care provision, including controversial interventions such as episiotomy, is important to improve equity of service provision, overall maternal and neonatal health and to support evidence-informed perinatal health policy-making. We aimed to determine if migrant and native women giving birth vaginally have different risks of episiotomy and if the risk differs by migrant sub-groups.

Methods

This study is based on a cross-sectional survey of foreign-born women with a random sample of native women, implemented in 32 public maternity units in mainland Portugal. We included 3583 women with vaginal delivery. Migrant status was defined by the woman’s country of birth (migrants, born abroad, vs natives, born in Portugal), then as subgroups of migrants from Brasil, Portuguese-speaking African countries (PSAC) and non Portuguese-speaking countries vs natives. The association between migrant status and episiotomy was assessed using multilevel logistic regression models, stratified by delivery mode, and adjusted for main risk factors of episiotomy.

Results

The overall frequencies of episiotomy were 52.6% and 48.2% among the 1707 natives and the 1876 migrants, respectively (p = 0.01). With spontaneous delivery, migrant women had decreased odds of having an episiotomy (adjusted OR 0.70 [95% CI 0.58-0.83]), especially those from PSAC (aOR 0.57 [0.46-0.71]). However, with instrumental delivery, migrant women had increased odds of episiotomy (aOR 2.47 [95% CI 1.50-4.07]), especially those from Brasil (aOR 3.24 [1.18-8.92]) and non Portuguese-speaking countries (aOR 3.75 [1.82-7.71]).

Conclusions

These results suggest non-medically justified differential care during childbirth and highlight the importance of developing evidence-based recommendations for episiotomy use, in a country with a high frequency of medical intervention during delivery.

Key messages

Portugal displays a high frequency of medical interventions during delivery, including episiotomy, highlighting the need for developing evidence-based recommendations. Migrant and native women have different risks of episiotomy, suggesting non-medically justified differential care.
Misconceptions and lack of vaccine confidence: even First Responders are not spared
Authors: Riccò M , Vezzosi L , Balzarini F , Mezzoiuso A G , Veronesi L , Colucci M E , Signorelli C
Published: November 2019

Introduction

First Responders (FR) are front-line healthcare workers potentially exposed to different infectious agents. Characterizing their knowledge, attitudes and practices (KAP) towards immunizations has therefore the potential to significantly improve occupational health and safety.

Methods

A questionnaire-based cross-sectional study was performed during October 2018, collecting a convenience sample among FR from the Parma Province. Participants were inquired on 3 recommended vaccinations (i.e. seasonal influenza vaccine, SIV; measles vaccine, MeV; pertussis vaccine, Pa) and for meningococcal vaccines (MEN, not officially recommended in FR). Knowledge status (KS) and Risk Perception (RP) were assessed as percent values. Multivariate odds ratios (mOR) for factors associated with vaccination status were calculated by means of a binary logistic regression analysis.

Results

A total of 161 questionnaires were retrieved (mean age 45.1±14.1 years; seniority 10.8 ± 8.6 years). Internal consistency was good (Cronbach’s alpha = 0.894). KS was unsatisfying (46.5% ± 32.4) with uncertainties on the recommendations for MeV and MEN (39.1% and 34.2% incorrect answers). The majority of respondents were favorable towards MEN (89.4%), MeV (87.5%), Pa (83.0%), while 55.3% exhibited a favorable attitude for SIV, and 28.0% had received SIV 2018 (self-reported lifetime status for MEN 26.1%, MeV 42.2%, Pa 34.8%). RP was unsatisfying, particularly for SIV (33.9% ± 18.4). Interestingly enough, neither KS nor RP were associated with vaccination rates, being the main predictor for SIV 2018 a seniority ≥ 10 years (mOR 3.26, 95%CI 1.35-7.91), and higher educational achievements for both Pa (mOR 3.27, 95%CI 1.29-8.30) and MeV (mOR 2.69, 95%CI 1.09-6.65).

Conclusions

Reasons for vaccination gaps in FR apparently do not find their roots only in FRs’ incomplete KS or RP. However, the very low vaccination rates for SIV, MeV and Pa recommends stronger and more appropriate information campaigns.

Key messages

Main drivers of vaccination status in First Responders are not solely their knowledge status or risk perception. Achieving better vaccination rates in First Responders requires the understanding of a complex interplay of individual factors.