bluuebunny/crossref_metadata_2025 huggingface dataset:
The effect of pre-ESRD care program on potentially inappropriate medication in advanced CKD patients
Authors: Lai CP , Chen YY , Deng CY , Wu CK
Published: October 2021

Background

Due to the multiple comorbidities and the associated complications among advanced CKD population, assessing potentially inappropriate medications (PIM) in these patients is an important task for physicians and multidisciplinary care team members. This study aimed to investigate the impact of the national pre-ESRD pay-for-performance (P4P) program on prescribing quality in Taiwan.

Methods

We conducted a retrospective cohort study using data from National Health Insurance Research Database (NHIRD) maintained by the Health and Welfare Data Science Center, Ministry of Health and Welfare (HWDC, MOHW). The incidents of CKD in year 2010 were observed until the end of 2017. Adult patients who initiated maintenance dialysis therapy were enrolled. To identify the use of PIM that should be avoided in advanced CKD patients, the Beers 2019 criteria and latest Taiwan Manual of Renal Injury Prevention and Drug Safety were applied. We measured PIM use in one year before starting long-term dialysis.

Results

Among 7,828 participants underwent continuous dialysis treatment, 2,119 (27.1%) were P4P patients. Most (90.4%) participants were prescribed one or more PIMs before ESRD initiation. After adjusted age, sex, Charlson Comorbidity Index (CCI) and the number of nephrologist visits, the logistic regression showed lower probability of PIM use in the P4P enrollees (OR = 0.56, 95% CI = 0.47-0.66). The effect of P4P on PIM was more prominent in the subgroups of patients who were female and CCI≤3.

Conclusions

The implementation of the pre-ESRD P4P program might reduce PIM use among CKD patients. Our results underline the strategy of financial incentives in the payment design to improve prescribing patterns.

Key messages

Prescribing potentially inappropriate medications is common among patients who were approaching ESRD. The study highlights the importance of implementing the pre-ESRD P4P program to reduce PIM use in advanced CKD patients.
Associations between space weather events and the Incidence of cardiovascular diseases
Authors: Vaičiulis V , Venclovienė J , Tamošiūnas A , Kiznys D , Lukšienė D , Krančiukaitė-Butylkinienė D , Radišauskas R
Published: October 2021

Introduction

Different studies have shown that solar and geomagnetic activities (GMAs) affect human health outcomes, especially cardiovascular systems being the most clearly impacted.

Aim

To analyse the associations of geomagnetic storms (GSs) and other space weather events with morbidity from acute myocardial infarction (AMI) during the period 2000–2015.

Methods

To evaluate the influence of space weather variables, we used adjusted rate ratios (RRs), their 95% confidence intervals, and p-value of coefficients in the Poisson regression model.

Results

12330 AMI cases (men and women n = 6942 and 5388, respectively) were registered. The study revealed that a higher risk of AMI and were related to the period of 3 days before GS—a day after GS, and a stronger effect was observed during the spring-autumn period. The strongest effect of high-speed solar wind (HSSW) was observed on the day of the event. We found significant associations between the risk of AMI and the occurrence of Solar flares (SFs) during GSs. We also found a statistically significant increase in rate ratios for all AMIs between the second and fourth days of the period of interplanetary coronal mass ejections (ICMEs).

Key messages

This Abstract is a part of PostDoc project. One of the goal of this project is to determine and evaluate heliogeophysical factors that have an effect on morbidity and mortality from CVD.
Environmental substances associated with Alzheimer's disease – A scoping review
Authors: Elonheimo H , Katsonouri A , Andersen HR
Published: October 2021

Background

Dementia is an overarching term for memory-affecting and progressive diseases interfering with cognitive abilities, behaviour and daily living of persons affected. Deterioration of cognitive function influences the processes of memory, thinking, orientation, comprehension, learning and language capacity as well as judgement. Alzheimer's disease (AD) is the most common form of dementia, prevalent in approximately 50-70% of the dementia cases. In 2015, there were 47 million people affected by dementia worldwide, and the figure was estimated to increase to 75 million by 2030 and to 132 million by 2050. Genetics, environmental factors and lifestyle patterns are risk factors for developing AD.

Methods

In the framework of the “European Human Biomonitoring Initiative” (HBM4EU, https://www.hbm4eu.eu/), a set of 18 substances or substance groups were prioritized for investigation. For each of these, a scoping document was developed, summarizing current knowledge and policy-related knowledge gaps. This work presents a scoping review of chemical substances, which may be associated with AD, based on the HBM4EU scoping documents and relevant recent scientific literature.

Results

Exposure to pesticides is possibly a risk factor for AD. Exposure to mercury is possibly associated with AD development, but results are inconsistent. Though results on cadmium and arsenic and AD are conflicting, they are possibly associated with the risk of disease. The evidence regarding lead is weak. Harmful exposures to these substances in Europe were mostly connected to occupational settings.

Conclusions

Although there is tentative evidence on exposure to environmental substances and risk for AD, more research is needed. Some evidence is inconsistent and there is a lack of extensive human studies. Attention should be paid to certain occupations, such as farmers exposed to pesticides and workers exposed to heavy metals, since these substances may be linked to increased disease rates of AD.

Key messages

Exposure to pesticides, mercury, cadmium and arsenic may adversely affect cognitive abilities and contribute to risk of AD. High-quality epidemiological research is needed to confirm the findings. Because adverse environmental chemical exposures affect both workers in certain occupations and general public, protecting humans from the chemical hazards is an essential public health issue.
Distribution of Salmonella spp. serotypes in poultry flocks in Abruzzo and Molise, Italy (2015-2020)
Authors: Perilli M , Telera GC , Sericola M , Di Marcantonio L , Marotta F , Romantini R , Del Matto I , Pomilio F , De Massis F
Published: October 2021

Issue/problem

The Italian National Health System has implemented a National Control Program for Salmonella in poultry populations in order to reduce the prevalence of infection. Starting from 2019, the control program has introduced health measures against Salmonella breeding flocks of Gallus gallus, positive to Salmonella Infantis, an emerging serotype at European level, and widespread along the entire poultry primary production chain.

Description of the problem

Recent data from the European Union One Health 2019 Zoonoses Report published by EFSA, highlighted that most of the Salmonella isolates (70%) originated from broilers. Interestingly, Salmonella Infantis accounted for 29.7% of the total.

Results

In the framework of the Italian Salmonella National Control Program the isolation of Salmonella spp. is carried out according to ISO 6579-1: 2017 from faeces, dust and boot socks. During the 2015-2020 period, testing in the Italian Regions Abruzzo and Molise was performed on 2,791 samples and 5,039 sample units. The percentage of samples positive to Salmonella spp. in Abruzzo and Molise was 16,9% and 10,1%, respectively. Out of 395 Salmonella spp. strains isolated, Salmonella Infantis was the most prevalent, representing the 54,9% and 61,9% for Abruzzo and Molise, respectively, followed by Salmonella Livingstone (18,4%) for Abruzzo and (14,4%) for Molise.

Lessons

The record of Salmonella Infantis in the areas under study reflects the European trend highlighted by the EFSA 2019 Report and justifies the decision to increase the biosecurity measures in farms where this serotype is isolated and to proceed with destruction of positive animals according to the Regulation 1069/2009/EC.

Key messages

Salmonella Infantis represents a risk for human health due to the presence of antimicrobial resistance genes that confer resistance to relevant antibiotics used in the treatment of human infections. Biosafety guidelines and disinfection practices on poultry farms should be improved in order to reduce the spread of this serotype, also considering its capability to form biofilm.
Evaluation of COVID-19 case investigators’ interviewing skills in a portuguese public health unit
Authors: Durão J , Souto A , Hernández LM , Simões JD , Teixeira V
Published: October 2021

An effective control of the COVID-19 pandemic requires a thorough epidemiological interview of reported cases. The interviewer's skills and preparation directly affect the outcome of the investigation. This study applied a self-assessment survey of the COVID-19 patient interviewing skills on a local public health department workforce. The findings may be used to improve the quality of the interview process and the overall response to the pandemic at a community level. A 50-item questionnaire using a four-point Likert scale was adapted from the COVID-19 Patient Interview Skills Assessment Form created by the Centers for Disease Control and Prevention (CDC) and applied to 50 healthcare workers involved in epidemiological investigation of COVID-19 cases in Almada and Seixal, two municipalities of the Lisbon Metropolitan Area, from January to April of 2021. The most frequently executed steps concern checking patient data in advance (92%), questioning symptoms (97.2%), contact tracing (100%) and determining isolation periods for high risk contacts (100%). Least performed tasks include confirming the testing technique used (50%), asking about hospitalization (44.4%), assessing conditions for home isolation (44%), explaining how to self-monitor symptoms (61%) and checking if the patient understood the instructions (47%). In addition, 8% admitted to not always keeping patient information confidential. While caution is necessary as the data was limited to a single public health local department, our findings show that a majority of healthcare workers fulfill the essential steps of an epidemiological investigation. Areas in need of improvement include inquiring about infection severity, assessing social conditions for quarantine and confirming instructions for self-monitoring and follow-up. In line with CDC recommendations, we believe regular evaluation and feedback of case investigators' skills are crucial to quality assurance of a public health department.

Key messages

A detailed interview provides critical data for monitoring infected individuals and quickly trace, test and isolate those who might have been exposed, thus breaking chains of transmission. The results of this assessment can be used to introduce training measures such as shadowing and role-playing to ensure continued improvement in epidemiological investigations.
Sustainable Planning for Health – Review of Frameworks for Health System Strengthening
Authors: Rasch L , Quentin W , Geene R
Published: October 2021

Background

Imbalances in the distribution of health as well as global interconnectedness led to the consideration of health as a global public good. Health is placed therefor at the center of the goal-based movement for sustainability led by the United Nations (UN). Health System Strengthening (HSS) is an approach to align and harmonize all stakeholders in sustainable planning for health.

Methods

Frameworks published by nation states, multilateral institutions or global health initiatives were retrieved and analyzed in form of a critical realist review informed by poststructuralist curiosity. The aim was to understand how these frameworks contribute to the context of sustainable planning for health with the overall goal of improved health system performance.

Results

Eleven frameworks published by nation states, multilateral institutions or global health initiatives were obtained for this thesis. The frameworks support an understanding of how a health system is structured, how resources are allocated, how the financing and delivery of care is organized and how the different stakeholders of a health system are governed. Frameworks for health systems are a policy tool to introduce a common language for the architecture of health systems and to describe the way in which performance relates to functions in the form of a result-chain. The stakeholders involved in the development and implementation of these approaches are limited and predominantly from the global south. Gender, Equity and Human-rights criteria (GER-criteria) to address values are not sufficiently reflected in the frameworks.

Conclusions

The analysis in this thesis shows that HSS is an approach that requires an understanding of health system architecture and how it relates to performance. Although the different frameworks make the case for performance assessment and the linkage to resources, what is missing is a value-based approach that centers the knowledge generated by the Global South.

Key messages

Frameworks for HSS are policy tools for a common language for the architecture of health systems and to describe the way in which performance relates to functions in the form of a result-chain. Value-based approaches that center the knowledge generated by the Global South need to be included in sustainable planning for health.
Associated factors to breast feeding practice in neonatal intensive care unit
Authors: Sylla A , Soukaina L , Nani S , Hassoune S , Lehlimi M , Badr A , Hajjaji S , Chemsi M , Habzi A , Benomar S
Published: October 2021

Background

Improving breast milk feeding (BF) can avoid globally per year 800000 deaths in children under 5 years old. In Morocco the breast milk feeding rate decreased from 51% to 27,8% between 1992 and 2011, the breast feeding rate in neonatal intensive care unit (NICU) is lower (12,4%). The objective of this study is to determine the associated factors of BF practice in NICU.

Methods

A cross-sectional study was conducted between 04 January and 20 April 2021 in NICU ward of teaching hospital Ibn Roch of Casablanca (Morocco). We included Moroccan couples mother/newborn who can practice the BF presents during the study period. We used face to face interview using questionnaire. Student, Mann-Whitney-Wilcoxon and Khi2 tests were used to test association between BMF and potential associated factors. The potential associated factors with p ≤ 0.05 were considered as associated factors of BF practice. Data were analyzed using R 3.6.3.

Results

We included 107 couple mother/newborn. Around 77% of mothers practice BF. The mother factors associated with BF practice were: residence (30.5% rural; 69.5% urban; p = 0.007); marital status (2.4% single; 0% divorced; 97.6% married; p = 0.02); getting prior information about BF (6.2% no; 93.8%yes; p = 0.02), mother knowledge score about BF (median score yes = 10, no = 9;p= 0.03). The newborn associated factors were: hospitalization reasons (50.7% respiratory distress; 17.3% infections; 13.3% jaundice; 18.7% others; p = 0.03) and the gender (58.2% male; 41.8% female; p = 0,02)

Conclusions

The practice rate is lower for rural single mother who don't get any prior information about BF (lower knowledge). These mothers must get more attention from the healthcare staffs and training programs to improve the breast feeding in NICU.

Key messages

We can do better about the management of newborn hospitalized in NICU with actions like BF practice (promotion of breastfeeding). The benefits of breast feeding practice are significantly greater than his risks about the management of newborn hopitalized in NICU.
Determinants of mothers knowledge about breastfeeding in neonatology intensive care
Authors: Sylla A , Sana A , Nani S , Hassoune S , Lehlimi M , Badr A , Hajjaji S , Chemsi M , Habzi A , Benomar S
Published: October 2021

Background

Breastfeeding (BF) is one of the most effective ways to ensure child health and survival. In Morocco the BF rate decreased from 51% to 27,8% between 1992 and 2011. The breast feeding rate in neonatal intensive care unit (NICU) is lower 12,4%. Studies showed if we improve the mothers knowledge, the BF practice rate increase in NICU. We aim to determine associated factors of mothers knowledge about BF in NICU of Ibn Rochd teaching hospital in Casablanca (Morocco).

Methods

A cross-sectional study was conducted between 04 January and 23 April 2021 in NICU ward of teaching hospital Ibn Roch of Casablanca (Morocco). We included Moroccan mothers who can practice the BF presents during the study period. We used face to face interview using questionnaire. A scoring system from 0 to 16 points was used to measure the knowledge. The student, ANOVA, Mann-Whitney-Wilcoxon, Kruskal Wallis, Pearson and spearman correlation tests were used to test association between BF and potential associated factors. Associated factors with p ≤ 0.05 were considered as determinants of BF. Data were analyzed using R 3.6.3.

Results

We included 111 mothers. The mean score of knowledge was 10.38 ± 2.31. Associated factors with BF knowledge were: healthcare staffs support (yes mean score =11.06 and no = 9.72; p = 0.002); getting prior information about BF (yes mean score =10.53 and no = 9; p = 0.012). The knowledge increase with age of mother (correlation coefficient = 0.26; p = 0.005) and parity (correlation coefficient = 0.30; P = 0.001).

Conclusions

Mothers and specifically younger primiparous should receive more attention from training program and healthcare staffs in NICU to improve the knowledge and practice of BF.

Key messages

we can enhance significantly the survival and health of newborn hospitalized in NICU by simple actions as advices, encouragement toward the newborn mothers to improve their knowledge about BF. Healthcare staffs and facilities have to be the teachers and school about breast feeding.
Survey of Public Health Professionals on perspectives towards Direct-to-Consumer Genetic Tests
Authors: Sassano M , Hoxhaj I , Stojanovic J , Acampora A , Boccia S
Published: October 2021

Background

The diffusion of Direct-to-Consumer Genetic Tests (DTC-GTs) requires properly literate professionals to appropriately address the challenges they pose to Public Health (PH). Hence, we conducted a survey to assess the current state of knowledge, attitudes, and behaviors of PH professionals members of the European Public Health Association (EUPHA) towards DTC-GTs.

Methods

The results of a scoping review conducted on PubMed to identify articles on healthcare professionals' perspectives towards DTC-GTs were used to elaborate a survey, which was validated through a focus group with experts. EUPHA members were invited to participate through email invitation, and EUPHA and EUPHAnxt newsletters. We performed a descriptive analysis of the results, and a univariate analysis to evaluate associations between selected variables.

Results

Two hundred and seventy-seven PH professionals (44.4% male, 55.6% female) completed the survey, 67.1% of whom were not involved in genetics or genomics within their professional activities. Although 78.0% were that companies are advertising and selling genetic tests directly to consumers, most of them reported a low level of awareness towards DTC-GTs applications and regulation aspects. The majority reported that a qualified health professional be involved in the DTC-GT process (91.7%), and did not feel prepared to address citizens' questions (64.6%). Eventually, 72.6% of the respondents stated that the provision of DTC-GT should be regulated on a national level, similarly to medicines.

Conclusions

Our results revealed a high level of awareness about the existence of DTC-GTs. Despite the overall positive attitudes, PH professionals reported a high need for strengthening regulatory aspects of DTC-GTs provision process. The growing interest of DTC-GTs among citizens and the poor knowledge of PH Professionals about these tests highlights the need to identify strategies for literacy improvement.

Key messages

Given the challenges for health systems, improving Public Health professionals' literacy on new technologies such as Direct-to-Consumer Genetic Tests is essential. The need for strengthening the regulation of Direct-to-Consumer Genetic Tests expressed Public Health professionals should guide policymakers.
Robotic surgery - prevention of the risk of cytokine storm in women with endometrial cancer
Authors: Tzvetkova S , Tsvetanova K , Dimitrov T
Published: October 2021

Background

Endometrial carcinoma is frequently diagnosed gynecologic neoplasm all over the world. Most often, women aged between 50 and 70 are affected by it. One third of the diagnosed patients pertain to a younger age group. The data of Bulgarian National Cancer Registry show that uterine body cancer accounts for 8,3% of all oncologic diseases of women.

Methods

97 women with endometrial carcinoma, Ist stage, with clarified diagnosis for one year (2020) and already operated in UMHAT “Dr.G.Stranski”- Pleven, have been tested. 62 of these patients had undergone robotic surgery and 35 - conventional surgery. The immunologic parameters were tested before the surgical intervention, at the 3rd hour and on the 3rd day via Human ELISA-Diaclone. Statistic processing is with STATGRAF.

Results

The comparative survey between the robotic surgery patients and open surgery patients demonstrated that in the early post-operation period the open surgery patients had considerably increased serum cytokine level compared to the robotic surgery patients. The minimal invasive surgery demonstrates a reduced acute-phase response and a better preservation of cellular immune mechanisms compared to the open surgery.

Conclusions

The acceptance and implementation of mini-invasive surgical system Da Vinci in Bulgaria for treatment of endometrial carcinoma (Ist stage) reduces the cytokine explosion, decreases the post-surgical risk as well as the reanimation care days and hospital stay. Psychological stress and hospitalization time are reduced, quality of life is improved.

Key messages

Surveying the robotic surgery role in the treatment of women with endometrial carcinoma, Its stage via cytokine profile determination. Through Da Vinci, the hemorrhage and post-surgical complications are minimal, the psychological stress and hospital stay are reduced, the treatment cost is diminished and life quality is improved.
Can hospitals impact users’ experience? Application of an evaluation tool to enhance Design for All
Authors: Mosca EI , Steinfeld E , Capolongo S
Published: October 2021

Background

Design for All (DfA) strategy addressing human diversity, social inclusion and equality, can have an impact on users' well-being in healthcare facilities. However, evaluation tools are needed to identify the extent to which DfA influences users' experience and service quality. This study explores the application of the Design for All A.U.D.I.T. (Assessment Usability Design & Inclusion Tool).

Methods

The tool's structure is based on a multicriteria framework that evaluate hospital areas through a rating system. The hierarchical framework includes three Categories of DfA outcomes (Physical-spatial quality; Sensorial-cognitive quality and Social quality) with related criteria, indicators and requirements. The tool has been applied in the evaluation of two private hospitals, one in Buffalo (US) and one in Milan (Italy).

Results

The analysis of findings addressed both spatial and DfA qualities. For spaces, Horizontal circulation had the best scores in both hospitals (76% Italy, 88% US). The Italian hospital Vertical circulation had the lowest score (46%), while in the Buffalo facility Outdoor spaces had the lowest scores. Regarding DfA qualities, the Italian hospital obtained the highest score in Environmental Factors (84%), due to a sustainable design approach, while Social Inclusion got the lowest score (54%). The Buffalo facility scored higher on Social Inclusion (87%) because it provides diverse services for users. Both the hospitals had problems with Wayfinding due to layout and signs, scoring low on this criterion (59% Italy, 39% US).

Conclusions

The analysis of the hospitals demonstrated that the tool can evaluate spaces and DfA outcomes along dimensions of health and well-being. The system can be used to identify critical aspects and suggest design strategies, defining priorities for interventions. Further research directions will consider applications in different hospitals to ensure the tool scalability and application to new building projects.

Key messages

The evaluation tool enhances Public Health by measuring hospital quality in terms of Design for All and user needs. The tool can be applied in the decision-making process during design and renovation of specific areas of hospitals to implement Inclusive Design.
Disability benefit application in Switzerland: An analysis of linked administrative and survey data
Authors: Altwicker-Hamori S
Published: October 2021

Background

One priority of the European Disability Strategy 2010-2020 was to increase the labor market participation of individuals with disabilities. Switzerland shares this priority: The guiding principle of disability insurance is ‘rehabilitation before pension'. Access to rehabilitation measures to restore, maintain or improve the earning capacity of individuals with disabilities via disability insurance benefit (DB) application is essential. The aim of this study was thus to identify factors associated with DB application in Switzerland.

Methods

A novel dataset was created linking survey information from the 2010 Social Protection and Labour Market with administrative data on DB application (2009-2018). Multiple logistic regression was used to examine the association between health-related, demographic and socioeconomic factors and DB application in adults aged 18-55 (N = 18,448).

Results

Higher odds of DB application were found for those suffering from long-term health-related activity limitations (OR 2.88; 95% CI 1.29-6.44); born outside of Switzerland (OR 1.75; 95% CI 1.32-2.32); living without a working partner (OR 1.54; 95% CI 1.17-2.02); living without a child aged 0-14 years (OR 1.70; 95% CI 1.29-2.26); aged 18-39 (OR 1.41; 95% CI 1.09-1.83); with an occupation in ‘Manufacturing' (OR 2.75; 95% CI 1.68-4.50), ‘Construction and mining' (OR 2.03; 95% CI 1.13-3.66), ‘Trade and transport' (OR 2.12; 95% CI 1.30-3.45), ‘Business and administration' (OR 1.68; 95% CI 1.03-2.72), and ‘Health, teaching, culture and science' (OR 1.55; 95% CI 1.05-2.29); and renters (OR 1.44; 95% CI 1.07-1.94). No statistically significant association was found between sex or registered unemployment within five years preceding the survey and DB application.

Conclusions

This study confirmed limited European evidence suggesting that DB application is more than a health-related phenomenon. However, it presented a less consistent picture on the role of marginalisation in DB application.

Key messages

One of the main contributions of this study stems from the promising and innovative method of linking detailed survey information to highly reliable administrative records. As such, the study not only offered novel results but also demonstrated the potential of the dataset for public health research.
Managers’ experience-based understanding of capacity to work in workers with common mental disorders
Authors: Tengelin E , Hensing G , Holmgren K , Ståhl C , Bertilsson M
Published: October 2021

Background

The capacity to work among workers with common mental disorders (CMD) is important to understand but scarcely explored from a manager perspective, even though their views could add essential knowledge. The aim of this study was to explore and describe managers' experience-based understanding of capacity to work in individuals with CMD.

Methods

This qualitative focus group study used inductive manifest content analysis as analytic technique. First-line managers with experiences of employees with CMDs were recruited via organizations and networks. Eight focus group interviews with altogether 31 participants were performed.

Results

The analysis resulted in five categories of managers' experience-based understanding of occupational functioning in workers with CMDs: (1) The capacity to mentally focus on work tasks decreases or disappears, with negative consequences for work output. (2) The capacity to commit to continuous and coherent tasks changes, making tasks that span over longer periods of time difficult. (3) The capacity to independently adapt to the needs of the situation decreases, causing the worker to need more guidance and instructions than usual. (4) The capacity to keep up professional appearances is reduced, meaning that the worker struggle with the professional role. Finally, (5) the ability to interact socially and professionally decreases, which potentially causes conflicts at the workplace.

Conclusions

This study shows managers' experience-based understanding of CMDs in workers as severe changes and reductions of employees' capacities needed for occupational functioning. These findings add to the understanding of the construction of the capacity at the workplace. A deeper understanding of reduced work capacity is also needed to adapt workplaces and our findings can facilitate work accommodations for employees with CMDs.

Key messages

This study adds a manager perspective to the increasing knowledge about how capacity to work is influenced by CMD. This study shows that managers experience that CMD in workers severely change and reduce employees’ capacities needed for occupational functioning.
COVID-19 impact on financial security: evidence from the National Public Engagement Survey in Wales
Authors: Allen J , Cotter-Roberts A , Kadel R , Hughes K , Dyakova M
Published: October 2021

Background

A nationally representative COVID-19 Public Engagement Survey for Wales, led by the World Health Organization Collaborating Centre on Investment for Health and Well-being at Public Health Wales, has been ongoing from April 2020, helping to inform a sustainable recovery from the COVID-19 pandemic. A data analysis was performed as part of the Welsh Health Equity Status Report initiative focusing on income and job security, which influences living conditions and lifestyle behaviours.

Methods

A Generalized Linear Model was used to calculate the predicted probability of response for variables of interest, e.g. whether an individual reported being in a worse financial situation due to the pandemic, across the life course, socio-economic gradient and sex. Data collected via telephone between 03 April - 25 July 2020 produced a sample ranging between approx. 2,500 - 7,500 participants. The sample was weighted according to deprivation quintile (using the Welsh Index of Multiple Deprivation), age group and sex.

Results

A significantly higher proportion of survey respondents (18 - 24 years of age) reported being worried about losing their job or not being able to find one, than any other age group. A significantly higher proportion of survey respondents in the most deprived population fifth (33.7%) reported being in a worse financial situation as a result of the restrictions, compared to the least deprived fifth (21.7%).

Conclusions

COVID-19 has had a major impact on people's lives and livelihoods in Wales, hitting the most deprived and vulnerable the most. It has increased job insecurity, especially among younger/working age people. The government has taken unprecedented financial and other measures to address inequities; nevertheless, most are temporary and not specifically targeted to support specific (vulnerable) groups. Measures to promote sustainable economic recovery, job security and safeguarding due to the COVID-19 pandemic need continuity and consistency

Key messages

COVID-19 has had a significant impact on income and job security in Wales, disproportionately affecting the most deprived. To mitigate COVID-19 harms, a continuous and consistent focus on equity is essential to promote sustainable economic recovery.
COVID-19 pandemic impact on Primary Health Care Accessibility in Portugal
Authors: Leiras G , Nunes AB , Martins A
Published: October 2021

The COVID-19 pandemic disrupted health systems worldwide, mobilizing most of its resources to COVID-19 care. In Portugal, since mid-March 2020, the scheduled assistance activity of the primary health care services has been altered or interrupted, to respond to the needs of users with suspected or diagnosed SARS-CoV-2 infection. This study intends aims to assess the impact of the COVID-19 pandemic in terms of access to primary health care during 2020 in Portugal. Primary Health Care accessibility data were extracted from the national data transparency portal. Data were aggregated by the 5 health regions and compared to homologous periods for years 2019 and 2020. In Portugal, in 2020 the number of primary health care consultations decreased in the regions of Alentejo (-5%), Algarve (-1%) and Centre (-1%) but increased in both North (+6%) and Lisbon and the Tagus Valley regions (+7%). The number of scheduled appointments decreased in the 5 regions (-16%), increasing the unscheduled appointments (+24%). Those differences were higher during the first lockdown (-42% schedule appointments vs + 13% unscheduled appointments). Presential consultations decreased by 38%, non-presential increased by 101%, and domiciliary consultations were reduced by 37%. Changes to regular activity of primary health care units compromised the access to presential health care by the non-COVID-19 population. After the first pandemic wave, the resumption of scheduled activity changed from face-to-face to non-presential consultation. The adoption of new technologies and telemedicine increased the total of registered consultations, compared to previous year. However, not all non-presential consultation is in fact patient-facing teleconsultation, with some of them being just for prescription renewal or to prescribe complementary exams. Predominantly urban regions were less affected by the suspension of presential activity, maintaining their assistance by non-presential provision of care and telework.

Key messages

Amidst the COVID-19 pandemic, the Portuguese primary health care services ensured the assistance to their population by non-presential provision of care. Predominantly rural regions were most affected by the suspension of presential consultation.
Importance of pharmacists’ activity in the area of public health and barriers for expanding
Authors: Sevikyan A , Kazaryan I , Vardanyan L , Amirkhanyan A
Published: October 2021

In many countries pharmacists are actively involved in implementing public health services. The objective of this work was to study pharmacists' perspective on value of their services for improving population health and existing barriers to expand the scopes of these services in Armenia. Survey was conducted at community pharmacies in different regions of Armenia. Pharmacy staff was asked to complete pre-tested questionnaire that includes questions about their opinion on importance of developing public health services in community pharmacy, the current involvement and existing barriers. Data were analysed with SPSS statistical software, version 22.0. The great majority of 242 responders consider that providing public health services at community pharmacies is able to provide valuable input in preventing chronic noncommunicable diseases (NCD) in Armenia (73.6%) and in improving population health in general (82.6%). However, only a part of professionals is engaged (13.6%) or sometimes engaged (36.0%) in assessment of NCD risk factors. Only 17.8% of respondents participate in public health campaigns and only 30.6% are interested to be involved in vaccination. Respondents indicate following barriers for providing public health services: poor collaboration with other health care professionals (75.6%), lack of knowledge and clinical skills (74.0%), poor access to additional training (70.7%), lack of resources (70.2%), absence of financial stimuli (69.0%), lack of information about patients (68.2%), lack of patients' motivation (64.9%), lack of clinical tools (61.6%), lack of time (55.0%), lack of space (42.1%). 68.5% of respondents suppose that introducing financial stimulus can be effective. Most of pharmacy professionals believe that offering public health services at community pharmacies can lead to improving population health in the country. There are numerous barriers for engagement; however certain interventions can be helpful in overcoming barriers.

Key messages

Community pharmacy staff is an important resource for activity aimed to improve population health. There are numerous barriers for community pharmacists to provide public health services; appropriate strategies aimed to overcoming barriers can be developed and introduced.
Health promotion through collaborative health: a Tuscan model
Authors: Erba F , Moscatelli C , Agostinelli V , Iavazzo F , Ingeborg U , Trapè P , Bellucci S , D'Amato G , Dei S , Doretti V
Published: October 2021

Background

chronic diseases affect in Italy about 39.1% of the total population and 85.3% of the over 75 years. A new experimental approach has been studied that, through the communities, activate collaborative processes to improve the health and well-being of population. The ASL Toscana Sudest for the three years 2017-2020 has acquired from the Self-management Resource Center (SMRC, University of Stanford California) licenses for implementing self-management programs for chronically ill people. The training process is subject to quality control by SMRC with annual report.

Objectives

the goal is to train participants in the solution of problems, to make decisions, to set objectives and define priorities, to undertake actions for clinical-emotional management and its social role. The self-management education processes carried out have been addressed primarily to the diabetes program.

Results

57 conductors were trained through the administration of 30 hours of frontal lessons to nurses and lay people. Subsequently, the conductors implemented 77 programs in which a total of 750 people participated. Of these, 90% took part in at least four of the six seminars provided for in the program. In addition, a specific program has been launched for a group of 13 Bengali citizens resident in Italy with particular attention to the risk of development of dysmetabolic diseases and the possible correlation with Ramadan.

Conclusions

the engagement of the citizen in terms of Public Health manifests itself with a cumulative impact of small behavioral changes at the level of individuals, communities, and the population. Main message: the project aims to introduce the concept of ‘Collaborative Health' offering concrete examples of experiences already present in the Tuscan context, formulating possible recommendations for stakeholders for the innovation of the system and stimulating greater sustainability, appropriateness and equity of services and health models in Italy.

Key messages

Collaborative health is a winning strategy for health promotion. Chronic diseases are a main topic for health promotion.
A scoping review of systematic reviews on reducing lifestyle risk behaviours in disadvantaged groups
Authors: South E , Rodgers M , Wright K , Whitehead M , Sowden A
Published: October 2021

Background

Lifestyle risk behaviours are key risk factors for non-communicable diseases. Some disadvantaged groups face particularly poor health outcomes, which may be exacerbated by high prevalence of risk behaviours. The aim of this scoping review was to identify and bring together evidence from systematic reviews on reducing risk behaviours in these groups and highlight where there is insufficient evidence to inform policy.

Methods

MEDLINE and Embase were searched up to October 2020 for English language reviews, with supplementary searching in Epistemonikos and Health Systems Evidence. Systematic reviews reporting behavioural outcomes of interventions targeting smoking, alcohol use, diet or physical inactivity in nine disadvantaged groups were eligible. Reviews of population-level policies reporting differential effects for these groups and qualitative reviews of barriers or facilitators to change were included. Literature was mapped based on the group and behaviour targeted.

Results

Ninety-two systematic reviews were included. The majority (n = 68) focused on low income or socio-economic status. Fewer reviews were identified that included prisoners (n = 14), deprived areas (n = 12), homeless people (n = 10), people with learning disabilities (n = 9), unemployed people (n = 3) and refugees or asylum seekers (n = 2). We identified no reviews on care leavers or Gypsies, Travellers or Roma. In total only 11 reviews targeted alcohol use. There were some gaps for specific group and behaviour combinations and no intervention reviews on refugees.

Conclusions

A number of gaps were identified, highlighting where new syntheses or primary studies could add value. For example, reviews on interventions in refugees, Gypsies, Travellers and Roma, and care leavers could be useful for policy-making. Other useful contributions might include an overview of the perceptions of disadvantaged groups allowing common barriers to behaviour change to be identified as well as factors unique to specific groups.

Key messages

Nearly 100 systematic reviews focused on reducing risk behaviours in disadvantaged groups; they addressed different combinations of behaviours and groups. Gaps in the literature were identified where new syntheses could make a useful contribution to developing programmes and policies.
Building and sustaining a healthy alliance and network facilitated by participatory action research
Authors: de Jong M , Wagemakers A
Published: October 2021

Background

In health promotion programmes (HPP), it is crucial to have intersectoral collaboration within coalitions and to build networks between health and other societal sectors. However, collaboration in coalitions and networks does not develop just because it is needed. Several factors that affect intersectoral collaboration are identified and defined as prerequisites for success in coordinated action for health in the Healthy Alliances (HALL) framework. A health broker role is recognised as being helpful in connecting the coalition with the broader network, and participatory action research is deemed supportive because it facilitates evaluation, reflection, learning, and action. Because insight into how processes that affect collaboration develop over time lack, this study aimed to provide insights into the processes that facilitate building and maintaining a coalition and its network within a HPP programme.

Methods

As part of participatory action research, the coordinated action checklist (CAC) and a composed network analysis (CNA) were used in 2018 and repeated in 2019. Respondents were coalition members (n = 6). The CAC and CNA results were linked back into the coalition in five group sessions and used for reflection on progress and future planning.

Results

Coalition governance, interaction with the context, network building and brokerage, and generating visibility emerged as the most prominent processes. Important insights concerned the health broker's role and positioning, the programme coordinator's leadership, and the importance of visibility and trust leading to investment in continuation.

Conclusions

The combined research instruments and group sessions supported discussion and reflection, sharing visions, and adjusting working strategies, thereby strengthening the coalition's capacity. Thus, participatory action research was useful for evaluating and simultaneously facilitating the processes that affect collaboration.

Key messages

Participatory action research is useful for evaluating and simultaneously facilitating the processes that affect collaboration. Besides insights into the processes that facilitate building and sustaining a coalition and its network, the yields of the collaboration became visible through participatory action research.
Adherence to 24-hour movement guidelines among Japanese elementary and junior high school students
Authors: Kyan A , Takakura M , Miyagi M , Kobayashi M
Published: October 2021

Background

For optimal health benefits, the Canadian 24-Hour Movement Guidelines for Children and Youth (aged 5-17 years) recommend an achievement of ≥ 60 minutes of moderate-to-vigorous physical activity (MVPA), <2 h of recreational screen time (ST), and 9-11 h for 5-13 years or 8-10 h for 14-17 years of sleep time (SLT) each day. There is little evidence showing the proportion of the recommendation in Japan, so we need to investigate. The aim of this study thus was to reveal the compliance to the recommendation with a large sample of Japanese elementary and junior high school children.

Methods

This study included 2408 students enrolled in fifth grade (aged 10-11 years) in 31 elementary schools, and 4360 students enrolled in eighth grade (aged 13-14 years) in 30 junior high schools. Each behaviour was assessed by a self-reported questionnaire. To analyze the differences in adherence to the recommendation between the school-aged group, we conducted a chi-analysis.

Results

Overall, only 4% of participants complied with all three recommendations, and 20% of the students did not comply with any of the recommendations (χ2=1390.87;p<.001). Compared with MVPA and ST, SLT had a trend to be likely to achieve the recommendation in each school-age group. Elementary school students had a higher percentage of non-adherence to all recommendations (39%) than junior high school students (10.3%). The adherence to the recommendation of the ST & SLT simultaneously had no differences in each age group (11.5% for elementary schoolers and 12.7% for junior high schoolers). However, adherence to the recommendation of MVPA only, ST only, and MVPA & ST were higher in elementary schoolers, and the adherence to the recommendation of SLT only and MVPA & SLT were higher in junior high schoolers.

Conclusions

The proportion of adherence to at least one of the three recommendations is better in junior high school students than elementary school students in Okinawa, Japan.

Key messages

Health behaviour required improvement may differ by age group. It is necessary for particularly elementary school children in Okinawa to take proper countermeasures to improve the movement behaviours.