bluuebunny/crossref_metadata_2025 huggingface dataset:
Activation of 574 new Alzheimer’s special care unit beds in the Metropolitan City of Milan
Authors: Castelli B , Centurione E , Marino A F , Garau L , Cofano R , Ferrara A , Pannese C , Raimondi A , Gandolfi C E , Da Re N R
Published: October 2020

Issue

Dementia is among the main causes of disability and dependency in the elderly. It was defined a public health priority by the WHO. The health and social-care system of the Lombardy region (SSR) plays a key role in implementing assistance and care pathways specifically designed for fragile populations, including those affected by dementia and Alzheimer's disease, its most common form.

Description of the Problem

The SSR provides residential care options especially conceived for dementia patients, known as Alzheimer's special care units (ASCU). However, waiting lists are concerning, and distribution of these facilities is inconsistent throughout the region. In 2018 there were 981 accredited and SSR-covered ASCU beds in the Metropolitan City of Milan (MCM), translating in 1.26 beds/1000 people aged ≥ 65. With regional legislation (DGR 1046/2018), the SSR proposed activation of new ASCU beds in all territories with less than 2 beds/1000 people aged ≥ 65. The MCM Agency for Health Protection (ATS) thus analyzed the distribution of ASCU beds in afferent districts, defining specific needs for each district. The aim was to fund and activate 574 new ASCU beds homogenously among previously accredited and SSR-covered residential care facilities, reaching the targeted 2 ASCU beds/1000 people aged ≥ 65. Applicant facilities had to respond to specific personnel, technological, therapeutic and structural requirements.

Results

Preliminary results indicate 29 residential care facilities applied for evaluation in 2019. The ATS received and evaluated all applications. Following site-inspection, 8 facilities were deemed inappropriate.

Lessons

In 2019, 21 residential care facilities were approved for funding and activation of 558 new ASCU beds. Residual beds will be funded in 2020. Main messages: Activation of new ASCU beds in 2019 and 2020 increased specialized long-term care beds for dementia patients by almost 60%, allowing a more homogenous distribution among MCM districts.

Key messages

The health and social-care system of the Lombardy region proposed activation of new Alzheimer’s special care units beds in all territories with less than 2 beds/1000 people aged ≥ 65. Activation of 574 new Alzheimer’s special care units beds increased by almost 60%, allowing a more homogenous distribution among Metropolitan City of Milan districts.
Health promotion interventions involved medical students: a semi-experimental design assessment
Authors: Ladner J , Demaegdt C , Villard S , Vérin E , Vittecoq O
Published: October 2020

Background

In France, a new approach of health promotion re-enforcement was developed in 2919. The purpose is to train health students in health promotion interventions in different communities during two weeks and on a specific thematic, and associating interdisciplinarity partnership between curricula. This national policy is called “national health service” (NHS). The objective was to assess the NHS among medical students

Methods

A semi-experimental design “before-after” was used. Two anonymous self-questionnaires was completed by medical students (3rd year, preclinical course). A first questionnaire “before” the NHS, the second “after” in April 2019. For comparisons, identical information were collected 'before' and 'after'. Specific information to the two stages were also collected. An additional qualitative study based on same design (”before-after”) with interviews was also conducted.

Results

A total of 221 students in the “before” stage (exhaustivity: 92.9%) and 206 in the “after” (86.8%) were included. Schools represented more than half of community sites. Before the NHS, 49.5% of the students considered themselves insufficiently trained. Comparisons between the two stages showed, respectively: satisfaction with the health promotion intervention thematic (33.7% vs 53.2%; p = 0.0001), a major interest in the PS approach in the curriculum (21.3% vs 33.6%; p = 0.001), a major desire to integrate PS into future professional practice (33.6% vs 42.4%; p = 0.02), an interest major in the PS approach in interdisciplinarity (45.2% vs 59.8%; p = 0.0001).

Conclusions

The first edition of the NHS shows promising results, the training ground and the action carried out in cross-professionalism, declared interest in prevention actions and integration of health promotion in professional practice. This health promotion policy includes in the initial training of health students could be a innovative approach for a reinforcement of the French preventive health system.

Key messages

Innovative health portion intervention: first edition of the French NHS. Longitudinal approaches are needed to measure and assess the potential impact of the NHS.
Tobacco industry data on illicit tobacco trade: a systematic review of existing assessments
Authors: Gallagher A , Evans-Reeves K A , Hatchard J L , Gilmore A B
Published: October 2020

Background

The tobacco industry portrays itself as key to solving Illicit Tobacco Trade (ITT) and presents its funding of research on ITT as its attempt to address the problem. In recent years, transnational tobacco companies (TTCs) have been a major funding source of data on ITT which is heavily publicised, especially when a tobacco control policy is being debated.

Methods

Papers and reports assessing tobacco industry-funded data on ITT were obtained via systematic searching of academic and grey literature through databases and Google/website searches respectively. Characteristics of assessed industry funded data and criticisms/praise of them as detailed in the assessments were coded using a framework based on existing literature on methods for measuring ITT and for assessing the quality of estimates on tobacco tax avoidance and evasion.

Results

Of the 35 assessments reviewed, 31 argued that tobacco industry estimates were higher than independent estimates. Criticisms identified problems with data collection (29), analytical methods (22) and presentation of results (21), which resulted in inflated ITT estimates or data on ITT that were presented in a misleading manner. Lack of transparency from data collection right through to presentation of findings was a key issue with insufficient information to allow replication of the findings frequently cited.

Conclusions

Our findings demonstrate that the contribution of tobacco industry-funded data on ITT thus far in aiding understanding of ITT is extremely limited, if not counterproductive, as tobacco industry funded data on ITT is unreliable and primarily serves as a platform for the industry to lobby against tobacco control policies, including tax increases.

Key messages

TTC-funded data routinely exaggerate/overestimate levels of illicit when compared with independent sources and fail to meet the standards of peer-reviewed publications. A potential means for providing high-quality and transparent ITT research would be a tax on tobacco companies, with funds going towards independent development of established methodologies.
Hazardous workers and risk for third parties
Authors: Magnavita N , Ciprani F , De Lorenzo G , Garbarino S , Sacco A
Published: October 2020

Impaired workers, unable to practice their activities with effective skills and adequate safety protection because of physical or mental illness, alcohol and drug addiction, inappropriate behaviour as a consequence of fatigue, sleepiness, or distress, may be hazardous for colleagues and customers.

To properly manage these workers, public health must resolve the ethical dilemma arising from the legitimate interests of all stakeholders. The sick worker's interests include career expectations, role in organization, right to privacy, and right to freedom from discrimination. The customer's interests include protection from harm, right to autonomy, and right to informed choice. The society's interests include maintaining effective and affordable public services, as well as the benefits and burdens of any policies. Traditional ethics, oriented toward the individual relationship, failed to find an uncontroversial solution to these complex issues. Our research pointed to the organisation level.

The La.R.A. Study group on Hazardous Workers was set up in 1999 in Italy, to study how to protect the health and safety of impaired workers and that of third parties, without prejudice to the civil rights of workers. The group includes many subject matter experts like: doctors from different specialties, jurists, bioethicists, employees' and employers' representatives. It is independent and not financed.

The ethical, legal and operational aspects of each specific problem are discussed from different points of view and at the end a consensus document containing the practical indications for the prevention operators is produced. Over the years, Lara has produced 10 consensus documents on specific problems and has stimulated companies to develop policies for hazardous workers, preferably according to a bottom-up participatory model.

The collective definition of methods and solutions allows management of hazardous workers.

Key messages

Disability management is preferable to exclusion from work. A shared company policy is the basic principle of management of hazardous workers.
Making equal rights to health an election issue in NZ local body elections
Authors: Stone P , Leyland D e b
Published: October 2020

In New Zealand there are 20 district health boards (DHBs) with local elections every 3 years. There is low voter turnout for these, we suspect because the public has low cognizance of the role DHBs have in governing their health and disability system. Good governance ensures everyone whatever ethnicity, gender or sexual proclivity, from birth to old age, able or disabled, mentally well or unwell, drugfree or addicted, has equal rights of dignified access to healthcare. Without public engagement in DHB elections, the community risks having candidates elected that also don't understand their role through a preventative public health framework or human rights lens. The United Community Action Network (UCAN) developed a human rights framework and Health Charter for people driven into poverty by the costs of staying well in NZ. The framework outlines 6 social determinants of health needing protection through policy, to ensure all enjoy their rights to health. UCAN and the Public Health Association of New Zealand (PHA) partnered to raise public and the candidates' awareness during 2019 elections, of these social determinants causing inequity in health outcomes. A series of short explainer-videos were created for sharing through social media during the election build-up period, helping to promote PHA Branches' public Meet the Candidates events. Post-election, a longer film was produced to send to the elected DHB members. Our theory of change centred on spotlighting health inequity for voters, so that they would elect DHB members who had the greatest understanding and commitment to addressing this issue. With shareable videos we aimed to attract audience, raise awareness and debate the policy solutions to health inequity with candidates, enabling more informed choice amongst the voting public. Post-election, we maintain supportive relationships with the elected DHB members that promised their commitment to our Health Charter during their campaigns.

Key messages

Using videos and social media, local body elections provide an opportunity to promote everyone’s right to affordable healthcare, supporting and informing voter decision-making. UCAN's Health Charter is an advocacy resource for raising awareness of the social determinants of health inequity and poverty for people with mental illness, addiction and disability.
Swedish politicians’ reflection of health effects for newly arrived migrants in decision-making
Authors: Svanholm S , Carlerby H , Viitasara E
Published: October 2020

Background

The political context of health promotion is important, however politicians' role has been sparsely researched. The aim was to explore whether politicians reflect on health effects of newly arrived migrants during political decision-making.

Methods

In total 667 politicians from municipalities and regional councils in the north of Sweden answered a web-based survey in 2019. The variable self-reported reflection of health effects during decision making in the last three months, focused on newly arrived migrants and the general population in the area, was used for analysis. Differences between political groups were analysed through Chi-squared test and differences in focus between the general population and newly arrived migrants were analysed by Wilcoxon Signed Rank Test.

Results

Preliminary results indicate that out of the participants 29,0% reported reflection on health effects for newly arrived migrants in large parts of their decisions, 50,5% having done so a few times, while 20,5% did not reflect. The politicians from the regions reported to a higher degree, compared to the municipality politicians, to have reflected on health effects (p = 0,003, Cramer's V = 0,136). Politicians more often considered the health effects of the general population in their decisions than for newly arrived migrants (z=-0,006, p < 0,001, r = 0,249). This difference remained when testing the municipality politicians (z=-7,417, p < 0,001, r = 0,228) and regional politicians (z=-5,138, p < 0,001, r = 0,346) separately.

Conclusions

Not all politicians reflect on the health effect of their decisions, especially not for newly arrived migrants' health. Politicians in the municipalities, responsible for many of the social determinants of health, did so to a lesser degree than the politicians in the regions, responsible for the healthcare system. The potential for politicians to promote health is thus not realized and political decisions can unintentionally affect health.

Key messages

Only a relatively small part of politicians considers health effects for newly arrived migrants in large parts of their decision-making. Municipality politicians, whose political decisions affect many determinants of health, consider health effects in a lesser degree than regional politicians do.
Are we going to do something about the calamity of prostitution? A Public Health perspective study
Authors: Sanchez-Rodriguez D , Arana-Aragon B , Rueda-Nieto S , Monteagudo-Perez J F
Published: October 2020

Background

Regulatory attempts throughout history have not concluded in an improvement of living and health conditions of sex workers. The main purpose of this work is to defend the abolition of prostitution with a reflection from the historical and current evidence provided by Public Health workers.

Methods

We perform a systematic strategy for literature searching in both primary and secondary sources of biomedical information, obtaining original articles, systematic reviews, case reports, thesis and legal texts. We included those studies focused on prostitutes placed in Spain and Europe within nineteenth and twentieth century. Encounters with local associations are being arranged in order to achieve information about sex workers' situation in Region of Murcia.

Results

In 2011, the average age of prostituters was 28,01 years old. The origin of the sex workers was Spanish in 11.3% of the cases, declaring 61% of them being single at the current moment. The use of drugs and the inconstant use of protection during sex are other factors that coexist with this activity. These results are provisional since local data are not available yet.

Conclusions

Nowadays prostitution is still an uncomfortable problem in most democratic countries. Governments have shown unable to approach the phenomenon with equity and gender perspective. Poverty is widely recognised as the main cause that push not only women to prostitution, but also cis males and transsexuals. However, there is a cornerstone question regarding gender determinants in health and patriarchal structure of our society. Those are topics that cannot be eluded by Public Health policies.

Key messages

Management of health problems derived from sex work is mandatory for Public Health workers. Future solutions must include equity and gender perspective in order to achieve the abolition of prostitution.
Health workers on the move: the need for global policy
Authors: Hinlopen C , Ligterink L , Bemelmans M , Koutsoumpa M , Kramer K
Published: October 2020

Issue

WHO's Global Code of Practice on the International Recruitment of Health Personnel was adopted in 2010 by WHO Member States to 1: monitor and address unethical international recruitment practices; 2: to strengthen national health workforces. Unethical recruitment and lack of investments in resilient health workforces was leading to increased health inequalities worldwide. The WHO Code provided non-binding behavioral principles to address these.

Description

The WHO Code came with a monitoring and review mechanism. Member States were to report on Code implementation every three years and every five years the Code's relevance and effectiveness is reviewed. In the 2018/19 reporting round, non-state actors, too, submitted reports to WHO. Wemos carried out a qualitative analysis of these (14) reports and presented the findings to the Expert Advisory Group (EAG) tasked to review the Code in 2019/20.

Results

Non-state actor reports provide important additional information to Member States' reports on Code implementation. The 14 submissions included cases of unfair treatment of migrant health workers and indicated some improvement in health workforce planning and forecasting. Moreover, they pointed to a lack of efforts (or results thereof) by governments to invest in more resilient health workforces, fueling health worker mobility globally.

Lessons

These findings are consistent with observations from civil society, trade unions, health professional associations and employers' organizations, as evidenced during the roundtable discussions with the EAG in June 2019. They noted that increased global mobility, not just by health workers, is a given and actually further accelerated by a growing number of inter-country migration agreements, undermining equitable access to a health worker across the globe. They urged for supra-national policies and practices in order to achieve Universal Health Coverage for all by 2030.

Key messages

With increased global mobility of individuals, an equitable distribution of health workers worldwide surpasses the policy scope of national governments and requires supra-national measures. The involvement of civil society in the monitoring of mobility trends and equity effects of health workforce policies is essential for shared prosperity as envisioned in the SDG Agenda.
Alcohol purchases from a large Finnish retail chain before and after a change in alcohol legislation
Authors: Uusitalo L , Nevalainen J , Rahkonen O , Erkkola M , Saarijärvi H , Fogelholm M , Lintonen T
Published: October 2020

Background

In January 2018, the legal limit for alcoholic beverages in grocery stores changed from 4.7 to 5.5 % alcohol. The increased availability of stronger beer, cider and ready-to-drink beverages was expected to increase the total amount of 100% alcohol bought. The study aimed to examine how the change in alcohol legislation affected the purchasing of 100% alcohol from grocery stores by comparing the years 2017 and 2018.

Methods

The study data consisted of 47,066 loyalty card holders of Finland's largest retail chain, who gave their consent and provided background information by an online questionnaire. The data contained the type, volume and alcoholic content of the purchases, from which we calculated the amount of 100% alcohol bought. The mean individual alcohol purchases in the years 2017 and 2018 were compared by age, gender, level of education and household income using repeated measurements ANOVA models.

Results

There was only a small, non-significant change in the total amount of 100% alcohol between 2017 and 2018 (mean 1.9 l and 2.0 l, respectively, p = 0.220). Lower income was associated with a decrease in total 100% alcohol purchased, whereas higher income groups showed an increase. Increase in 100% alcohol bought as ready-to-drink beverages was seen in all population groups.

Conclusions

The availability of stronger alcoholic beverages in grocery stores did not result in a notable overall increase in total purchases of 100% alcohol. The increased purchases of alcohol as ready-to-drink beverages were, on the average, compensated for by decreased purchases of alcohol as other beverages. The association of income with total alcohol purchases may indicate the effect of price in consumer behavior.

Key messages

The raise in the legal limit of alcohol content raised did not result in a significant increase in the total amount of 100% alcohol bought from grocery stores. Alcohol purchased as ready-to-drink beverages increased in all population groups.
The precarious public policies related to asbestos in Brazil
Authors: Ribeiro E A , Paiva C H A
Published: October 2020

In this decade, Brazil was the world's third largest producer of asbestos, and the fourth largest consumer, with an estimated 500,000 Brazilian workers being exposed to asbestos during the working day, and millions of users to several asbestos materials. In Brazil, the precarious public policies related to asbestos production and commercialization contributes to the invisibility of the problems related to its exposure. Thus, an immersion in the discussion of public policies related to asbestos was necessary. A qualitative investigation of an exploratory type was conducted, based on documentation research of requirements of commissions, ordinances, bills, and public hearings published in the period from 1970 to 2019, related to asbestos, by the Brazilian National Congress. We found 624 occurrences/documents, which were analyzed and discussed in this study. The complexity of the interrelations between actors and the State in the formulation and implementation of public policies is demonstrated, asbestos being the subject on the decision-making agenda several times, however, the creation of a national public policy occurred only on a few occasions. International scientific cooperation is one of the ways to cope with asbestos-related diseases, as it allows the transfer of know-how of best practices. When discussing the Brazilian reality, it is possible to disseminate the attitudes that were important in the process of policy construction in Brazil, thus preventing the waste of time and practices in procedures that have already proved wrong.

Key messages

Precarious public policies contributes to the invisibility of the asbestos problems. International scientific cooperation is one of the ways to cope with asbestos related diseases.
Addressing childhood obesity - Are we doing enough?
Authors: Borg M , Cauchi D , Calleja N , Gauci C
Published: October 2020

Background

The prevalence of childhood overweight and obesity is increasing worldwide, with Malta having one of the highest rates among European countries. Childhood obesity is likely to track into adulthood, and can have multiple physical and psychological health outcomes. It also causes a substantial economic burden on society. A cross-sectional study that aimed to identify barriers to maintaining a healthy weight among children attending primary school, and to assess the level of support for a range of policies aimed at addressing childhood obesity as expressed by their parents/guardians, was conducted in Malta.

Methods

Data were collected using a paper-based questionnaire that was distributed to a stratified random sample of parents whose children attended free State schools, subsidised Church schools and fee-paying Independent primary schools in Malta and Gozo in 2018. Data were analysed using SPSSv25.

Results

Responses from 1169 parents were received. There was a dissonance between the most common barriers identified, that were primarily related to the food environment, and the policies that received the most support. Providing more spaces for safe physical activity was the most supported policy (94% in favour). Participants were least supportive of taxation policies, a phenomenon also observed in other countries. The level of support for policies varied significantly by various demographic and socioeconomic factors.

Conclusions

Recommendations were developed to inform future policies and strategies to address obesity. Policymakers need to take bold, possibly controversial decisions to mitigate against the barriers faced by the population in accessing healthy food and being physically active. Given the globalised nature of media advertising and the food system, a joint international effort is necessary to address this epidemic, such as stricter audio-visual media advertising regulations, food reformulation and mandatory standardised food labels.

Key messages

The majority of participants supported most of the proposed policies to address obesity. Taxation policies received the least support. Most policies supported are trans-sectoral, therefore a health-in-all policies approach and international collaboration are necessary.
Health research saves lives
Authors: Higgins C
Published: October 2020

This presentation will argue that increased investment in health research is a significant public health imperative. It will use New Zealand as an illustrative case study and also draw upon international experiences.

Over the last ten years New Zealand government investment allocated to health research has stood at between 0.6% and 0.8% of government health care costs. Health research advocacy organisation New Zealanders for Health Research (NZHR) argues that the level of investment should be increased to at least 2.4% in order to align with international norms, improve the population's health and well-being and save lives. New Zealand's annual amenable and non-amenable premature mortality currently stands at about 5000 and 7000 deaths respectively. Increased investment in health research holds the key to significantly impacting these figures and should be regarded as an important public health issue.

NZHR is one of five similar health research advocacy organisations globally, the others being Research America, Research Canada, Research Sweden and Research Australia. All consistently demonstrate strong public support for their governments to be more actively committed to achieving increased investment in health research. New Zealand is scheduled to have a General Election in September 2020, so the results of NZHR's own polling, supported by that of our sibling organisations, are of particular relevance as NZHR seeks to make health research investment an election issue.

The presentation will include comparative information from the five health research advocacy organisations globally, and will note that health researchers irrespective of where they are based are part of an international community where knowledge is shared to the benefit of all nations globally. The presentation therefore will challenge all countries, including New Zealand, to examine, and where necessary address, the adequacy of their own levels of health research investment.

Key messages

Health research saves lives. Health research investment is a public health issue.
Environmental pollution as a risk factor for autism spectrum disorders in children and adolescents
Authors: Szponar L , Matczuk E , Pietraś E
Published: October 2020

Autism spectrum disorders caused, inter alia, by environmental pollutions have been in focus of public health leaders, doctors (paediatricians, perinatologists, nutrition experts). Based on the data from 2016 Demographic Yearbook, it has been established that among children and adolescents in the age below 17, the population of boys is 3155000 and girls 3994000. In USA in recent decades the CDC studies have shown that the incidence of ASD has increased from 1 case per 150 children in 2000 to 1 case per 59 children in 2014 i.e. it more than doubled. Three groups of factors modifying the risk of ASD development in children and adolescent populations, being more common in boys population, were identified: the declining environmental chemical pollution by POP, probably reduces the inflammation status of microglia cells in the central nervous system. Significant gender distinction of the microglia cells of the mouse brain, caused probably by steroid hormones at the transcriptome level, results in a different behaviour of the microglia in female individuals. The microglia cells of this gender reduce the level of microglia damage caused by acute focal ischemia. It seems likely that the lower prevalence of ASD in girls may be due to the effective protective activity of female sex hormones, at this level. Meanwhile the elimination of chemical pollutants from the discussed substances on the gastrointestinal tract - white part of the brain axis strengthens the proper functioning of the intestinal microbiome - brain axis. Demographic data, it has been estimated that the number of boys at risk of ASD in Poland may be approximately 30000 and girls fourfold less, i.e. approximately 7500. A definite absence of epidemiological data collected through representative studies on the prevalence of ASD in children aged 3-17 years in Poland indicates a need for a proper diagnosis in order to develop a more effective health care system for population in question compared to the existing one.

Key messages

The female sex hormones protect the majority of girls against ASD, probably at a brain microglia level. Brain microglia, may be key to mitigation of the risk of asd health disorder in the population of girls and women.
Systematic review on citizens’ literacy in omic sciences and web search of initiatives to improve it
Authors: Sassano M , Calabrò G E , Tognetto A , Federici A , Ricciardi W , Boccia S
Published: October 2020

Introduction

We are assisting to a progressive change in the classical approach to patient care toward so-called personalized medicine, mainly driven by the development of omic sciences. To implement omic sciences into practice it is important to address healthcare professionals', policy makers', leaders', and citizens' literacy

Methods

As part of a project funded by the Italian Centre for Disease Prevention and Control (CCM), we carried out a systematic review (SR) on citizens' attitude, knowledge, and educational needs in omic sciences. The search was carried out on Pubmed, Web of Science, and Embase. We also conducted a separate web search on Google, Yahoo, and Bing on initiatives published in Italian and English aimed at improving citizens' literacy in the same field. Websites of retrieved initiatives were examined to identify additional resources

Results

Forty-nine studies were included in the SR. Most studies (n = 26, 66.7%) reported low levels of knowledge in omic sciences among citizens, and conflicting attitudes related to potential risks and benefits of omic sciences. Eleven studies (22%) evaluated citizens' educational needs, and most (n = 9, 82%) reported a clear knowledge gap. As for the web search, 13 initiatives were identified in Italy, 4 in Europe, and 22 in non-European Countries. Overall, 33% of them required in-person attendance, while 67% were web-based resources. The former included exhibitions, seminars, courses, symposia, information stands in public places, guided visits at research laboratories, and interactive laboratories; the latter included web-pages for reading, online lessons and courses, web portals for information, videos and short movies, animations, apps for mobile devices

Conclusions

Results show a clear need to improve citizens' literacy. To achieve this goal, the implementation of effective strategies and initiatives is crucial, hence this effort to summarize the existing ones will be essential for future plan developments.

Key messages

The current challenge is to identify effective methods of improving citizens' literacy and implementing them. Only through citizens’ empowerment the implementation of omic sciences in the Health System will be possible, since citizens are increasingly active in the health context.
Genetic variants associated with the early onset of type 2 diabetes in the Hungarian population
Authors: Werissa N , Pikó P , Fiatal S , Sándor J , Ádány R
Published: October 2020

Background

It is generally accepted that early detection of type 2 diabetes mellitus (T2DM) is important to prevent the development of complications and comorbidities, as well as premature death. In addition to the environmental risk factors, genetic factors may also contribute to the development of T2DM. The aim of our study is to identify single nucleotide polymorphisms (SNPs) which have an effect on the early onset of T2DM in the Hungarian population.

Methods

This study included 891 T2DM patients (438 males and 453 females). The onset of T2DM varied between 25 and 90 years of age. Pearson correlation analysis was carried out for 16 SNPs to define how they are associated with the patient's age at onset of T2DM and genetic risk score was calculated for each patient by computation of alleles identified as risk ones. Linear regression analyses were used to estimate the effect of GRS on the early onset of T2DM independently of conventional risk factors (sex, BMI and TG/HDL-C ratio).

Results

Six SNPs (rs111875 in HHEX gene, rs560887 in G6PC2 gene, rs11071657 in the C2CD4B gene, rs5219 in KCNJ11 gene, rs10830963 in MTNR1B gene and rs11671664 in GIPR gene) were identified as risk polymorphism in the correlation analysis and GRS was calculated by defining their number/subject. The GRS showed significant association (β=-0.486, p = 0.008) with younger age at onset of T2DM. The correlation of GRS with the risk of earlier onset of T2DM was significant in the male population (β= -0.581, p = 0.024) and close to significant in female one (β= -0.471, p = 0.068).

Conclusions

Our findings indicate a considerable genetic predisposition for early onset of T2DM, which is mainly attributed to the cumulative effect of 6 SNPs presently known to be susceptible alleles. This set of SNPs and the genetic risk score calculated can be used for estimating the risk of earlier onset of T2DM on individual and population levels.

Key messages

SNPs were identified to play a role in the early onset of T2DM in the Hungarian population. The genetic risk score calculated by computation of susceptible alleles can be used for risk estimation of early onset of T2DM.
Distance learning training in genetics and genomics practices for Italian healthcare professionals
Authors: Calabrò G E , Mazzaccara A , Carbone P , Barbina D , Guerrera D , Di Pucchio A , Sassano M , Federici A , Ricciardi W , Boccia S
Published: October 2020

Background

Genomics and related fields are becoming increasingly relevant in healthcare practice. Italy is the first European country with a structured policy of Public Health Genomics and dedicated guidelines that focus on three pillars: Health Technology Assessment of omic applications, promotion of citizens' literacy, and promotion of extensive training for all healthcare stakeholders. In January 2019 we initiated a project funded by the Italian Ministry of Health and entitled 'Capacity building and Citizens-Omics'.

Objectives

The project is coordinated by the National Institute of Health and is aimed at implementing the “Italian National Plan for innovation of the healthcare system based on omics sciences” published in 2017.

Results

The project had set-up two distance-learning courses on genetic/genomics: an advanced course for physicians and biologists, and a basic one for the remaining healthcare professionals. The courses focused on genetic/genomic testing in clinical practice, pharmacogenomics and oncogenomic and they were developed according to the main models of andragogical training (Problem-based Learning and Case-based Learning). The courses include audio-video lectures and interactive clinical cases and they will be accessible free of charge for a year (from February 17th 2020). In three weeks, we had 2129 participants (1101 physicians, 1028 biologists) for the advanced course and 10.000 for the basic one.

Conclusions

Genomic literacy among healthcare professionals is essential to ensure optimal translation to healthcare delivery of research. The distance-learning training in genetic/genomic practices represents an effective method to improve healthcare professionals' knowledge in the immediate and mid-term time scale. Our courses represent the third Italian experience in distance training in omic field. The educational effects related with online courses could potentially be relevant internationally and across a wider range of potential audiences.

Key messages

In view of the ongoing rapid developments in genetics research it is important that omic literacy among healthcare providers be enhanced to ensure translation to healthcare delivery of research. E-learning training appears to offer a cost-effective and time-efficient method of improving omic knowledge and it could be relevant across a wider range of potential audiences.
Study of submerged cases of violence on healthcare workers in an emergency department
Authors: Piras I , Piras G , Portoghese I , Azara A , Piana A , Contu P , Galletta M
Published: October 2020

Background

Violence at work has negative effects on both workers and organizations. Among healthcare workers, nurses are the professionals most at risk, especially those who work in emergency departments. However, literature data are estimated to be the tip of the iceberg. The study aims at analyze violence events that are not reported by professionals via common reporting system, in order to measure the real extent of the problem and allow the organizations introducing adequate prevention measures.

Methods

The study took place in November 2016 in an emergency department in Southern Italy. A retrospective analysis was carried out by reviewing both the delivery registers (DR) used by nurses and doctors during the service, and the reports of security guards (RSG), in the period between 2011 and 2015.

Results

The results show that violence frequency was higher than that present in the risk management reporting (only one case). In the DR, 40 violence events were reported, yet in the RSG, 109 cases were registered. More nurses (n = 33) than doctors (n = 8) reported violence events in the DR. In the RSG, guards reported the same number of cases involving nurses, and 26 cases for doctors. In 50 cases, the professional involved was not specified. The violence type was physical (5 DR vs 13 RSG), physical threats or attempted violence (4 DR vs 13 RSG), and verbal (24 DR vs 67 RSG). Weapons (e.g., knife, hammer, syringe) were used in 2 cases as reported in DR and in 4 cases according to RSG. The aggressor was mainly the patient (15 DR vs 83 RSG) and the companion (14 DR vs 16 RSG). The shifts with more frequency of events are afternoon (15 DR vs 40 RSG) and night (12 DR vs 48 RSG).

Conclusions

The data show an amount of submerged cases and highlight a discrepancy between report of professionals and violence events where security guards intervened.

Key messages

Under-reporting violence cases require attention by the organizations. Prevention and protection strategies must be implemented. The use of the reporting system must be improved.
Comparison of fall risk assessment scales in the triage of an Italian emergency department
Authors: Piras I , Murenu G , Piras G , Pia G , Azara A , Piana A , Galletta M
Published: October 2020

Background

Falls in hospital are adverse events with serious consequences for the patient. Fall risk assessment requires easy tools that are suitable for the specific clinical context. This is important to quickly identify preventing measures. The aim of the study is to identify an appropriate scale for assessing fall risk in patients from an emergency department.

Methods

For the fall risk assessment in the emergency department, three scales were identified in literature: Kinder 1, MEDFRAT, and Morse. MEDFRAT and Morse classify the patient in high, moderate, and low risk; Kinder 1 split patients “at risk” (also when there is only one positive item) and “non-risk” (in which all items are negative). The study was carried out in July 2019 in an Italian emergency department. Patients who arrived in triage were assessed for the fall risk using the three scales.

Results

On a sample of 318 patients, the used scales show different levels of fall risk. For Kinder 1, 83.02% is at risk and 16.98% is not at risk; for MEDFRAT, 14.78% is at high risk, 15.09% moderate, and 70.13% low risk; for Morse, 8.81% is at high risk, 35.53% moderate, and 56.66% low risk. As Kinder 1 implies as “high risk” that all items of the questionnaire are positive, to compare Kinder 1 to the other scales with three measurements, we assumed only one positive response as “moderate risk”, all negative responses as “low risk”. Thus, Kinder 1 shows no cases at high risk, 83.02% moderate risk, and 16.98% low risk. All the scales show that the moderate-high risk increases with age. MEDFRAT and Morse have concordant percentages for young (13.6%), elderly (61.2%), and long-lived (66.6%) people. Kinder 1, 59%, 96.7%, and 100%, respectively.

Conclusions

The comparison between scales shows inhomogeneity in identifying the level of risk. MEDFRAT and Morse appear more reliable and consistent.

Key messages

An appropriate assessment scale is important to identify the fall risk level. Identifying accurate fall risk levels allows for implementing specific prevention actions.
Control Policy of RF electromagnetic field in Bulgaria. Practical approach
Authors: Zaryabova V , Shalamanova T s , Petkova H r , Israel M
Published: October 2020

Problem

Public concern about the possible health risk of the impact to electromagnetic fields (EMF) is growing strongly. International organizations propose specific policy approach to be implemented. Bulgaria has very restrictive legislation concerning EMF which further complicates the implementation of these recommendations.

Description of the Problem

Legislation in Bulgaria implements two-stages of control: on the base of documentation for calculation of the safety zone, measurements of the EMF values.

Many problems arise

Exposure assessment; Implementation of new technologies, even more the new 5G standard; Problems standing in front of experts, control bodies and administration.

Results

Following steps are taken to resolve the Issues: A proposal for changes in the legislation has been prepared.A communication program of establishing a dialogue with the population has been developed and implemented.An Expert Consultative Body has been created by the Ministry of Health which includes experts, industry and administration.An electronic information system of the telecommunication sources located on the territory of the country has been established. Its purpose is to provide detailed information on the EMF values for the population and to support the expert evaluation of the sources and the control.Annual monitoring of the telecommunication sources is carried out, providing data for the electronic information system.

Lessons

Combined efforts of experts, industry and administration lead to successful solving the problems and decision-making for implementation of the European practices and policies to protect the public health. Implementing the date of the monitoring carried out by the control bodies into electronic system, we manage to provide information of the population.

Key messages

Implementation of the European legislation in the country in line with the contemporary challenges of new technologies and ensuring public health. Providing information of the EMF exposure to population.
20-year trends in overweight, nutrition and physical activity habits among Lithuanian population
Authors: Kriaucioniene V , Petkeviciene J
Published: October 2020

Background

Changes in diet and physical activity can affect the prevalence of overweight. The study aimed to evaluate trends in overweight and lifestyle factors among Lithuanian population considering socio-demographic factors.

Methods

The data were obtained from eleven cross-sectional postal surveys of Lithuanian Health Behaviour Monitoring, carried out in 1994-2014. For every survey, a nationally representative random sample of 3000-4000 individuals aged 20-64 was drawn from the National Population Register. In total, 8738 men and 11822 women participated in these surveys. Self-reported body weight and height were used to calculate BMI. Questions about food consumption and physical activity were included in questionnaires.

Results

Between 1994 and 2014, the proportion of men with overweight (BMI≥25 kg/m2) increased from 47.5% to 58.6 and the proportion of men with obesity (BMI≥30 kg/m2) - from 10.7% to 19.5%. The increasing trends were observed in all socio-demographic groups. In women, the prevalence of overweight decreased from 51.7% in 1994 to 46.0% in 2014; the prevalence of obesity has not changed significantly and was 17.3% in 2014. The most remarkable decrease in BMI was observed in women of the youngest age group and with university education. Socio-demographic differences in the trends in nutrition habits were in line with changes in BMI. The highest decrease in fatty meat and milk products consumption and an increase in fresh vegetable consumption were reported by younger, highly educated and living in city women. Since 1994, the proportion of men and women having leisure-time physical activity at least four times a week has increased, however, only to 29.1% of men and 24.5% of women. Older people and those with lower education were less physically active.

Conclusions

Over 20 years, the prevalence of overweight increased in Lithuanian men and decreased in women. These trends were related to trends in diet and physical activity habits.

Key messages

Over 20 years, the increasing trends in the prevalence of overweight were observed in all socio-demographic groups of men and decreasing trends in the youngest age group and high-educated women. Positive changes in BMI were associated with improvement in food habits and physical activity level.
Exposure to particulate matter and risk of dementia in subjects with mild cognitive impairment
Authors: Vinceti M , Filippini T , Malagoli C , Cherubini A , Maffeis G , Chiari A
Published: October 2020

Background

Exposure to air pollutants increases the risk of several chronic diseases, possibly including neurodegenerative disease such as Alzheimer's dementia. In this study, we aimed to evaluate the effect of long-term exposure to as major outdoor air pollutant, particulate matter ≤10μm (PM10), on the risk of dementia in a cohort of subjects with mild cognitive impairment.

Methods

We recruited a cohort of 53 subjects newly diagnosed with mild cognitive impairment residing in Modena and Reggio Emilia provinces. We geocoded their residence address, and we estimated their exposure to PM10 from motorized traffic using a validated air dispersion model. We investigated the relation of baseline exposure to subsequent conversion to dementia using a Cox proportional hazards model. We computed hazard ratio (HR) and 95% confidence interval (CI) of dementia according to increasing PM10 exposure, adjusting for sex, age, and education.

Results

During a median follow-up of 42 months, 24 participants developed dementia, 19 of Alzheimer's type. Baseline average PM10 exposure concentrations were 9.6µg/m3. Using PM10 levels below 5µg/m3 as reference, we found a dose-response increase in any dementia risk, with a HR of 1.04 (95% CI 0.41-2.66) 5-10µg/m3, 1.32 (95% CI 0.36-4.92) at 10-20µg/m3, and 1.38 (95% CI 0.14-13.13) above 20µg/m3.

Conclusions

Using a cohort study design, we found that exposure to outdoor PM10 was associated with increased risk of conversion from mild cognitive impairment to dementia. However, the limited study size suggests caution in the interpretation of this finding.

Key messages

Air pollution may be a risk factor for dementia. Dementia risk may be linked to modifiable environmental risk factors.