bluuebunny/crossref_metadata_2025 huggingface dataset:
Cardiovascular risk factors and social determinants in a population study in Rio de Janeiro, Brazil
Authors: Ferreira L , Flumignan V , Marinho B , Sampaio F , Morais J , Botelho B , Mello T , Silva R , Fernandes A , Muxfeldt E
Published: October 2020

Background

The association of cardiovascular (CV) diseases and their risk factors with socioeconomic status has been well described, but its influence is often underestimated in epidemiological studies in Brazil.

Objective

To evaluate the relationship between the main CV risk factors and socioeconomic indicators in a population of adults registered in a Family Health Care (FHC) unit in a great urban center - Rio de Janeiro, Brazil.

Methods

Cross-sectional population study that included adults aged between 20 and 50 years living in the area covered by the FHC unit in Rio de Janeiro. Demographic data (gender and age), socioeconomic data (education level, profession, employment), CV risk factors (smoking, sedentary lifestyle, obesity, hypertension, diabetes, dyslipidemia) were recorded. The metabolic profile is evaluated through laboratory tests. Those who studied up to high school were considered poorly educated.

Results

604 individuals were enrolled [39% male, mean age: 38.8 ± 8,9 years] The median of schooling was 12 years. 288 individuals had high schooling, 44.5% were male. A total of 130 individuals did not study or work. Women with low education had a higher risk of smoking, obesity and hypertension with no difference regarding labor or study activities. Otherwise, men with low education had a higher risk of sedentary lifestyle and hypertension. Among men, not working or studying increased the risk of smoking and hypertension.

Conclusions

We found an inverse association between socioeconomic conditions and the prevalence of CV risk factors. Women are more affected by low schooling, while men are more affected by their working occupation. The study suggests that socioeconomic factors influence the CV risk, affecting men and women differently, pointing to the need for more comprehensive public health policies that effectively reverse this situation.

Key messages

We found an inverse association between socioeconomic conditions and the prevalence of CV risk factors. Socioeconomic factors influence cardiovascular risk differently according to gender.
Hydration status and hypertension in University workers
Authors: Padrão P , Moreira P , Silva-Santos T , Abreu S , Pinho O , Gonçalves C
Published: October 2020

Background

Vascular function and blood pressure regulation may be impaired by acute hypohydration but data on the association between hypertension and hydration status is scarce. The objectives of this study were to evaluate the hydration status in a sample of university workers and to assess the association between hypertension and hydration status.

Methods

A cross-sectional evaluation of a sample of 60 university workers (32 women) was conducted in 2019/2020 in Portugal. A 24-hour urine sample was collected; urinary volume, creatinine and osmolality were quantified. Free water reserve (FWR) was used to assess hydration status and subjects were classified as hypohydrated (FWR<0) or euhydrated (FWR > =0). Arterial blood pressure was evaluated [average of 2 blood pressure (BP) measurements] by researchers using standard methodology and participants with systolic and diastolic blood pressure ≥130 mm Hg and/or ≥80 mm Hg, respectively, were classified as hypertensive. A binary logistic regression model was used to estimate the association between hypohydration and hypertension, adjusting for sex, age and use of anti-hypertensive drugs. Odds Ratios (OR) and respective 95% Confidence Intervals (95%CI) were calculated.

Results

Hypertension was observed in 40.6% of women and 67.9% of men whereas hypohydration affected 31.3% of women and 32.1% of men. After adjusting for confounders, hypertension was associated with a 7-fold increased risk of hypohydration (OR = 7.56; 95% CI: 1.81-31.59).

Conclusions

These results stress the positive association between hypohydration and hypertension and highlight the need for implementing strategies for the promotion of water intake, particularly in the hypertensive patients.

This project was granted by Fundação para a Ciência e Tecnologia - Grant POCI-01-0145-FEDER-029269.

Key messages

Hypohydration affect nearly one third of this sample of university workers. Hypertension was associated with a 7-fold increased risk of hypohydration.
Barriers in access to cancer treatment in Europe: a systematic review of the European Literature
Authors: Jachmann A , Klingberg K , Zapata-Garcia M C , Srivastava D S , Exadaktylos A , Martin-Moreno J M
Published: October 2020

Background

Within NCD`s, Cancer accounts for the 2nd most frequent cause after Cardiovascular diseases and in some European countries it´s the leading cause of premature deaths. One of the challenges within cancer therapy can be found in inequity in access to cancer treatment, because this causes worse health outcomes, which are attributable to the accessibility of health care and thus avoidable. The objective of the systematic review was to identify barriers in access to cancer treatment in Europe (inter-country) and within 6 European countries (intra-country): Spain, Germany, Switzerland, Finland, Bulgaria, UK.

Methods

To obtain data scientific (PubMed, CINAHL, Embase) and grey literature were searched using keywords relating to inequity in access to cancer therapy in Europe. Collected Abstracts of published articles in English between 01/2013 and 05/2018 were reviewed independently. Identified barriers in access to cancer therapy were grouped into 2 categories: patient and health system/provider factors, followed by thematic analysis for each category.

Results

Out of 786 unique articles, 14 were included in the systematic review. The most frequent cited barriers within Europe were patient socioeconomic status (n = 7, 50%), age (n = 4, 28.6%) and reimbursement and availability of cancer medicine (n = 4, 28.6%).

Conclusions

This review showed that different barriers in access to cancer therapy still exist in Europe and therefore demonstrated an urgent need for actions to reduce these disparities across all Europe. Additional to the known equity stratifiers the role of health system factors concerning different reimbursement processes and shortages in widely used cancer drugs was emphasized. The amount of available studies with main focus on barriers in access to cancer therapy in Europe varies by equity stratifier, cancer site and type of treatment and seems to be very limited, showing a need for future investigations upon this topic with possibly uniform scales.

Key messages

This review showed that different barriers in access to cancer therapy still exist in Europe and therefore demonstrated an urgent need for actions to reduce these disparities across all Europe. Additional to the known equity stratifiers the role of health system factors concerning different reimbursement processes and shortages in widely used cancer drugs was emphasized.
The brand narratives of Philip Morris International: developing methods to identify corporate voices
Authors: Fitzpatrick I , Gilmore A , Cranwell J , Byrne D
Published: October 2020

Background

Existing research into marketing and advertising of tobacco companies shows the industry continues to spend huge sums of money promoting harmful products. In the face of increasing controls on the advertising of these products, and restrictions on their participation in policy development enshrined in a global treaty, tobacco companies must adapt to remain competitive in an unfavourable climate. Although there has been much engagement with the development of corporate messages by the 4 big tobacco brands, no systematic review of textual and visual corporate messaging used by these companies exists. This research presents the case of Philip Morris International (PMI), and maps out its key messages to investors and public audiences.

Methods

This research combines corpus linguistics with inductive coding to illustrate key topics, themes and the linguistic habits of PMI. A linguistic comparison with the messaging of 40 other transnational corporations provides a reference from which the unique characteristics of PMI's language can be identified.

Results

Thematic analysis of written and visual content highlights several dominant themes, namely Science, Transformation, Sustainability and Permissibility. Redemptive tropes were common in the sample, apparent in repeated reference to a desire to be and do better and to improve the lives of smokers around the world. Similarly, a strong emphasis on science was apparent in both the use of imagery and language, including scientific notation, laboratories and individual scientists.

The identification of linguistic and visual brand strategies will facilitate the education of advocates and consumers about the approach of the tobacco industry in their pursuit of continued business. Identifying the core values PMI is actively promoting could help to identify emerging corporate strategies in influencing public health policy, including the promotion of corporate goodwill in markets where product-specific advertising is banned.

Key messages

Big tobacco using new platforms to influence policy making. Corporate narratives impact perception of tobacco harm.
Qualitative appraisal of stakeholders’ perspective on diabetes mellitus policy in Jakarta, Indonesia
Authors: Bachtiar A , Edward A , Candi C , Sarena A
Published: October 2020

Background

Diabetes prevalence in Indonesia increased from 6.9% to 8.5% between 2013 and 2017.1 It was the third-leading cause of death in 2017. The government responded by introducing the Health Minimum Service Standard Policy (HMSS) in 2016. This study aims to perform a rapid qualitative appraisal of strategic stakeholders and capture their perspective on policy implementation.

Methods

We used a qualitative approach by interviewing stakeholders from the Ministry of Health, provincial and district-level governments, and 12 primary healthcare providers in Jakarta. The interview was performed from December 2019 to January 2020. Policy dissemination, implementation, and evaluation were also assessed during the interview. Triangulation was done with direct observation and routine data review at primary healthcare.

Results

The policy was disseminated from the MoH to state and district-level governments through workshops. It improved the coverage of screening, from 7.13% to 26.92% between 2017 and 2019 in Jakarta. Most stakeholders concerned about the problem with people's awareness and multisectoral collaboration to improve the coverage of diabetes services. PHC managers expressed internal threats (limited health workers, ineffective teamwork, and limited budget) and external threats (poor care-seeking, people's awareness, and commitment from across stakeholders) in implementing the policy.

Conclusions

Diabetes screening coverage in PHC has increased since the implementation of the policy, but below far from reaching a universal target. The government should collaborate with PHC to address the issues of internal and external threats.

Key messages

The 'SPM' policy introduced in 2016 has provided guidance for state and district-level government to assist the efforts on improving diabetes screening by PHCs in Indonesia. Coverage for diabetes screening in Jakarta, the capital city of Indonesia, has not reached the target. Further exploration of external and internal threats at PHC level is needed.
Cancer cluster and citizen alarms: epidemiological and statistical approaches
Authors: Miligi L , Stoppa G , Piro S , Caldarella A , Intrieri T , Mannesci G , Ferrari C , Biggeri A , Catelan D
Published: October 2020

Background

Respond to alarms for possible cancer cluster is a public health problem, but the management of these alarms is difficult and sometime conflictual.

Methods

We reviewed the guidelines on the management of disease clusters developed in various countries and the approaches used in previous disease cluster episodes in Tuscany. Statistical approaches for cluster detection were also reviewed. We performed a clustering analysis (spatio or spatio-temporal when appropriate) on childhood leukemia using data from Tuscany Cancer Registry (RTT). We used spatial hierarchical Bayesian model on aggregate data at municipality level. We performed test for general clustering and cluster detection on individual data.

Results

More than 100 tests for clustering analysis has been identified in the literature. Bayesian analysis on aggregate data did not show areas at higher risk with the exception of the city of Florence for childhood cancer among males. We did not found clusters for leukemia. In previous studies on disease clusters in Tuscany, most investigations have been started from community concerns and in the majority of situations a multidisciplinary approach was used. In some case an increase of incidence rate was observed, but rarely specific cluster cancer tests were used.

Conclusions

Hierarchical Bayesian models to aggregate data provided useful to identify long range geographical patterns while clustering analysis on individual data is a useful tool for small scale patterns. Both represent important tools for epidemiological surveillance studies particularly on childhood cancer. The best test for all situations doesn't exist, but the choice is determined by the type of question being asked from the data, by different situations and by different approaches. The Tuscany cancer clusters survey and the review of the guidelines on the management of clusters developed in different countries, give us the opportunity to formulate some suggestions for the health agencies.

Key messages

Respond to alarms for cluster of cancer and suggest recommendations for epidemiological and statistical standardized approaches is a public health issue. Tuscany cancer clusters survey and the review of the guidelines on the management of clusters developed in different countries, give the opportunity to formulate some suggestions for health agencies.
Prostate cancer incidence and predictions: Observational Study (Monastir, Tunisia: 2002-2030)
Authors: Bannour R , Zemni I , Ben Nasrallah C , Aroua N , Kacem M , ben Fradj M , Dhouib W , Abroug H , Sriha A
Published: October 2020

Introduction

Cancer is an eminent public health issue in the developing countries. The risk factors incriminated in cancer higher incidence are multiple such as the growing population rates, increasing tobacco consumption, the changes of diet and lifestyle. In Tunisia, there are three population-based cancer registries at the present time providing data on cancer incidence and survival. According to the data published by WHO International Agency for Research on Cancer (IACR) (GLOBOCAN 2018), prostate cancer in Tunisia ranks fifth among cancers with almost 819 new cases per year. The aim of this study was to we report trends in the cancer incidence during the span of time between 2002 and 2013 from the population-based cancer registry of the centre of Tunisia, and to predict the future number of cancer cases by 2030.

Methods

The cancer incidence data were collected from the Center cancer registries from 2003 to 2012.The data were stratified by cancer site, sex and age. We used SPSS software in order to calculate the crude incidence rates and age-standardized incidence rates. SPSS software was used in order to estimate the future number of cancer cases by 2030.

Results

A total of 725 cases of prostate cancer were enregistrated. The mean age of patients was 71.6 ±10.61years. The crude incidence rates were estimated 23.537. The standardized incidence rate was 33.92. A significant positive trend was noted with a b = 0133 and p < 10-3. 1033 new cases are predicted by 2030

Conclusions

The data of the cancer register of the center shows that the incidence of cancer is rising, and it is consistent with the National cancer intelligence, but some cancer incidence showed slightly higher, such as thyroid cancer and prostate cancer. In order to face this alarming situation, many preventive steps should be done such as strengthening early screening and diagnosis of cancer, improving clinical research in order to better control the risks factors.

Key messages

Prediction of the future number of cancer cases is of great interest to society. Prostate cancer in Tunisia ranks fifth among cancers.
Addressing oral health-related quality of life of the elderly – A Oral health promotion approach
Authors: James A
Published: October 2020

Background

Older people are representative of the vulnerable population. According to census 2011, the proportion of elderly in India is 8.6%. Owing to social transformation and evolving lifestyles, the number of old age homes is increasing rapidly with institutionalized elderly having poorer oral health status. This study was conducted to assess the situation among the sample of institutions meant for the elderly and to plan relevant intervention, policy development aligning with principles of health promotion to improve the oral health quality of life.

Methods

A mixed-method study was adopted after approval from the institutional ethical board. To plan an appropriate intervention, situation analysis was done by conducting in-depth interviews, administrating questionnaires and direct observation. The intervention was planned based on the data obtained by building healthy public policy by a memorandum of understanding (MoU) between institutions, distribution of oral hygiene aids, oral health education, and demonstration of oral hygiene techniques. Institutionalized elderly selected for intervention in an old age home were 82. At baseline, oral health quality of life was assessed using the Geriatric Oral Health Assessment Index (GOHAI). After 3 months follow-up, Paired t-tests were used to compare baseline and follow-up data.

Results

Qualitative data on thematic analysis revealed that administrators highlighted on fiscal, economic, administrative, personnel, ethical aspects of policy instrument and type of oral health care services to be provided. Quantitative results showed that mean and SD for the pre and post GOHAI score was 1.6 ± 0.41 and 3.06 ± 0.80 (P < 0.001)

Conclusions

Oral health promotion approach to address challenges and issues at the community level appears a more promising approach as it facilitates a systematic process and more comprehensive. Policy initiatives with stakeholders brought a sustainable improvement of oral health quality of life.

Key messages

Ottawa charter model oral health promotion based intervention with the coordination of stakeholders helps in improving functional ability and intrinsic capacity of institutionalized elderly. To improve the quality of life among institutionalized elderly there is a need for transformation of health systems away from disease based curative models to comprehensive health care models.
Trends in cardiovascular disease in the region of Monastir (Tunisia) over 12 years
Authors: Abroug H , Ben Fredj M , Zemni I , Kacem M , Bennasrallah C , Dhouib W , Sriha A
Published: October 2020

Background

Cardiovascular diseases (CVDs) are the major cause of morbidity and mortality worldwide. However, CVD prevalence trends is still weakly documented in Tunisia. The objective of this study is to examine trends in the prevalence of CVDs in the Monastir region between 2002 and 2013.

Methods

Data were collected from the regional register of hospital morbidity. The register refers to the WHO International Classification of Diseases, 10th revision (ICD-10). Data were verified and analyzed using IBM SPSS Statistics version 22.0 software. Linear regression was used to calculate the slope 'b' of the least-squares line to estimate admission trends for each CVD category according to sex and age group. A p-value of 5% was considered statically significant.

Results

From 2002 to 2013, cardiovascular diseases accounted for 21,240 hospital admission in the region of Monastir, representing more than a quarter (28.7%; CI 95%: 28.1-29.3%) of all Non Communicable Disease admissions in adults. Males represented 55.9%. The median age at admission was 64 years (IQR 54-71 years). The CVD crude prevalence rate (CPR) was 3.60 /1,000 inh. The age-standardised CVD rate (ASR) was 4.56 per 1000 PY and it was higher in men than in women (5.41 vs. 3.72, respectively, p < 0.001). CVD prevalence rate increased over time (b = 17.78; p<.001). This increase was significant in men (b = 33.69; p < 0.001) and in age groups over 40-years-old (b = 15.30; p < 0.001). However, it declined significantly in women (b= -16.32; p < 0.001). Coronary heart diseases (CHD) were the most prevalent CVD categories (47.7%).

Conclusions

Hospital admissions for CVD increased over the study period, in particular in men and in age groups over 40-years-old. CHDs were the prevalent disease. A comprehensive prevention strategies focused on lifestyle habits such as unhealthy diets, physical inactivity and tobacco consumption are greatly recommended to improve this prevalence trends.

Key messages

Over a 12-year period, CVD prevalence increased in men but not in women at the university hospital of Monastir. A comprehensive prevention strategies focused on lifestyle habits such as unhealthy diets, physical inactivity and tobacco consumption are greatly recommended to improve this prevalence trends.
DICA endoscopic classification: 2-year analysis from an international, multicenter prospective study
Authors: Nasi G , Tursi A , Di Mario F , Elisei W , Picchio M , Bafutto M , Dumitrascu D , Regula J , Mastromatteo A M , Brandimarte G
Published: October 2020

Background

Diverticulosis of the colon is the most frequent anatomical alteration detected during colonoscopy. The endoscopic classification “DICA”(Diverticular Inflammation and Complication Assessment) has been recently developed in order to have an objective endoscopic description of the colon harbouring diverticula. Aim of this multicentre, international, prospective study was to assess the predictive value of this classification in term of acute diverticulitis and surgery occurrence on a 2-year observational follow-up period.

Methods

2215 prospective patients at the first diagnosis of diverticular disease were enrolled after exclusion of radiological signs of acute diverticulitis; inflammatory bowel diseases; ischemic colitis; prior colonic resection; patients with severe liver failure (Child-Pugh C) or severe kidney failure; pregnant women; patients who are currently using or who have received any laxative agents or mesalazine or probiotics or antibiotics < 2 weeks prior to the enrollment; inability to comply with study protocol; patients with or history of cancer, of any origin, within 5 years before enrollment; history of alcohol, drug, or chemical abuse.

Results

1377(62.15%) patients were classified as DICA 1, 599(27,04%) as DICA 2 and 239(10.80%) as DICA 3. The risk of acute diverticulitis occurrence/recurrence, as well as the risk of surgery, were significantly linked to the severity of DICA score at entry. Overall, acute diverticulitis occurred in 123 (5,5%) patients: it occurred in 32 (2,3%) DICA 1, 53 (8,9%) DICA 2 and 32 (16.4%) DICA 3 patients respectively (p < 0,0001). Overall, surgery occurred in 35 (1,6%) patients: it occurred in 2 (0.1%) DICA1, 15 (2,5%) DICA 2 and 18 (7,6%) DICA 3 patients respectively (p < 0,0001).

Conclusions

The 2-year results of this prospective study seems to confirm that DICA endoscopic classification has a significant prognostic role on the risk of acute diverticulitis occurrence/recurrence and surgery in these patients.

Key messages

DICA is the first endoscopic classification of diverticular disease. The risk of occurrence/recurrence of acute diverticulitis and the risk of surgery are strictly linked to the severity of DICA score.
Lower predicted probabilities of attained Lifés Simple 7 factors in the presence of sleep problems
Authors: Felisbino-Mendes M , Andrade F , Dias Moreira A , Hernandez R , Vieira M A , Velasquez-Melendez G
Published: October 2020

Background

Given that sleep disturbances seem to be increasing in Brazil, this may have serious implications on Cardiovascular Health and mortality.

Objective

To examine the predicted probabilities of attained Lifés Simple 7 factors (LS7) in the presence of sleep problems among Brazilian adults.

Methods

We used data from the 2013 Brazilian National Health Survey (PNS), a nationally representative cross-sectional household survey of adults in Brazil. Cardiovascular Health was assessed by the sum of Lifés Simple 7 factors (LS7), which includes four behaviors (smoking, physical activity, body mass index and diet) and three biological factors (hypercholesterolemia, hypertension and diabetes). We analyzed self-reported data from 36,480 Brazilian adults aged 18 and over, including the sleep problems. We estimated predicted probabilities after multivariate Poisson regression.

Results

Mean CVH scores was higher among those who did not report sleep disturbances [4.2 (95% CI: 4.1; 4.2)], than those with sleep disturbances [3.8 (95% CI: 3.7; 3.8)]. Predicted probabilities of attained LS7 and CVH score was lower in the presence of sleep complaints, with a dose response for blood pressure, glucose, smoking and CVH score in both unadjusted and adjusted analyses, for age, sex, schooling, depression and night work shift.

Conclusions

Brazilian adults with sleep disturbances are less likely to achieve LS7 and consequently ideal cardiovascular health. Given that sleep disturbances seem to be increasingly more common in Brazil, recent gains in CVH mortality may be affected.

Key messages

Sleep disturbances may potentially affect metabolic outcomes and modifiable lifestyles behaviors as decreased physical activity and smoking. Sleep disturbances is novel risk factor for metabolic diseases.
Risk Management in nursing homes: an Italian experience in 2019
Authors: Furmenti M F , Bert F , Rucci M , Fiandra U , Scarmozzino A , Guerrieri A , Ripa F , Siliquini R
Published: October 2020

Background

The ageing of the European population leads to an increasing demand for Long-Term Care services. The security and well-being of the elderly population hosted in nursing homes (NHs) needs an effective Risk Management policy, officially sanctioned in Italy by the so-called “Legge Gelli” n.24 (March 8th, 2017) and the Directive 2011/24/EU on the application of patients' rights in cross-border healthcare. In order to verify the effective application of common “best practices” in terms of Risk Management in NHs, a tool useful to analyse risk management attitudes in Northern Italy was conceived and applied in a sample of NHs.

Methods

The tool, developed in collaboration with the health insurance company SHAM Italia, is composed of 124 items (with a dichotomous answer -YES/NO) on topics related to various Risk Management practices. This tool was submitted in a face-to-face interview to several Directors (Health Directors or Nursing Coordinators) of NHs in the Piedmont Region. A list of randomly-chosen NHs was contacted: 4 of them were selected for the pilot study and compiled the questionnaire. Answers were gathered and analyzed through Microsoft Excel.

Results

Only the 25% of NHs has a Risk Management plan with objectives and indicators of effectiveness and uses Risk Analysis instruments for a pre- and post-” risk detection. Only one has employees working mainly on Risk Management alone. The 75% of the reported events were “Adverse Events”, and all the NHs (100%) have a protocol for a patient voluntary departure or for fall prevention or for bedsores prevention; while 50% have a protocol for prevention of aggressions towards operators or for patients' suicide prevention.

Conclusions

This work provides a starting point to face new challenges that are looming on the European Health-care Systems: the care for the elderlies needs to be perfected to reduce inefficiencies, cut useless costs and improve safety of patients in the NHs setting.

Key messages

Despite safety of older patients in nursing homes is not only important but mandatory in Italy, risk management tools for this setting are lacking in literature. A new tool applied in Italian nursing homes showed that risk management needs to be implemented in practice and these results can be extended to European context.
Smoking prevalence, nicotine dependence, and intention to quit among cigarettes smokers
Authors: Algabbani A , BinDhim N
Published: October 2020

Introduction

Tobacco consumption remains a challenging issue to the global and public health that requires close monitoring of the spread of this epidemic and its impact. This study aims to assess the national prevalence and determinates of cigarette smoking and nicotine dependence in Saudi Arabia.

Methods

A cross-sectional national survey of a sample of 5148 of Saudi residents' ages 18 years or older was conducted through web-based-computer assisted telephone interviews. The two main measurements were current cigarette smoking status and nicotine dependence assessed using the Fagerstrom Test for Nicotine Dependence. Data was weighted by age, gender, and region to account for the different probabilities of selection. Descriptive and logistic regression analyses were used to assess cigarette smoking and nicotine dependence determinants.

Results

The national prevalence of cigarette smoking was 16.18% (95% CI:14.59-17.77) with 14.12% (95% CI:12.64-15.59) current daily smoking prevalence. Almost 72% of smokers started smoking before the age of 22 and 27% of smokers were highly dependent on nicotine. Having a smoker parent (AOR=1.84[95%CI:1.31-2.58], P < 0.001) or a smoker close friend (AOR=6.49[95%CI:3.89-10.81], P < 0.001) were significantly associated with being a smoker. Higher nicotine dependence level was significantly associated with early onset of regular smoking (ages<18) (AOR=2.71 [95%CI:1.38-5.34],P<0.001) and lower attempting to quit (AOR=0.51[95% CI:0.32-0.83],P<0.01).

Conclusions

Cigarettes smoking and nicotine dependence are prevalent in Saudi Arabia. The study found the majority of smokers started regular smoking before the age of 22 and the early onset of smoking was associated with a higher nicotine dependence level. Restrict access to tobacco products to those below the age of 22 will help reduce smoking prevalence and lifetime addiction to nicotine.

Key messages

Majority of smokers initiated smoking by the age of 21 and early regular smoking initiation was associated with higher nicotine dependence. Strategies to prevent initiation before the age of 21 will help prevent addiction to nicotine.
Self-efficacy among nursing assistants in Denmark after dementia specific education
Authors: Rasmussen B M , Waldorff F B , Berg-Beckhoff G , Andersen P T
Published: October 2020

Background

The care needs for people with dementia (PWD) constantly needs adjustment which makes it difficult for nursing assistants (NA) to accommodate optimal care to PWD. Dementia education to NAs may increase staff skills, self-efficacy and care quality. The study aims to investigate NA's experience of self-efficacy and how it changes during dementia education.

Methods

NAs received dementia-specific education focusing on behavior management through a person-centered approach. A phenomenological hermeneutic study using semi-structured interviews with 18 NA from two municipalities in Southern Denmark. Interviews lasted approx. one hour and were conducted at worksites. Analyses were made with a phenomenological hermeneutic approach. Concept maps were constructed during the process to follow changes in understanding.

Results

Dementia education increases the feeling of self-efficacy for NAs through acknowledgement, trial-and-error and social inspiration by peers and educators. NAs experience dementia education differently depending on whether NAs have a structural or citizen-centered focus to their work. NAs with a citizen-centered focus experience greater impact and that higher self-efficacy increases motivation for action and providing good care. They also more frequently experience successful situations due to a more analytic approach to daily challenges. NAs with structural-centered focus identified several structural barriers to establish new routines and therefore did not experience the same increase in self-efficacy.

Conclusions

Higher feeling of self-efficacy among NAs after dementia education seems to produce more motivation and engagement in daily care. NAs with a citizen-centered focus in their work, experience a higher level of self-efficacy and are frequently confirmed in this belief.

Key messages

Increasing needs for continuing dementia education. Nursing assistants with citizen-centered focus experience greater impact of dementia education.
Violence against disabled persons: Brazilian’s Health Service’s Notifications, 2011 to 2017
Authors: Freitas de Mello N , Pereira V O M , Pereira E L , Santos L M P
Published: October 2020

Background

Violence has important consequences for the people who experience it, for families and for societies. It becomes an even greater challenge for disabled persons (DP), who face various kinds of barriers and suffer all kinds of discrimination, prejudice, stigma and oppression. This work aimed to analyze the panorama of violence against DP from the characterization of cases of violence reported in the Ministry of Health's Violence and Accident Surveillance System (Viva) by Brazilian's health services. The profile of the DP in violence's situation, the type of violence perpetrated against this people and the profile of the probable perpetrators of violence allow us to understand the context of vulnerability and exclusion to which the DP are immersed.

Methods

It conducted a descriptive epidemiological analysis of violence reported against DP between 2011 and 2017. To this end, it used the Pearson chi-square test, with a 95% confidence interval, to assess differences between proportions by sex.

Results

It showed that, in most of the reported cases, the victim is female (67%), white (50.7%; p < 0,001), adults (61.6%; p < 0,001) and mentally disabled (58.1%; p < 0,001). It highlighted the notification of physical violence (51.6%; p = 0,107), psychological/moral violence (23,0%; p < 0,001), neglect / abandonment (15,0%; p < 0,001) and sexual violence (12.2%; p < 0.001). The probable perpetrators are predominantly family and close partners (58,0%; p < 0.001).

Conclusions

It is concluded that there are enormous challenges related to the confrontation of violence against DP in Brazil, such as the dissemination of information on the subject. Thus, this work is intended to subsidize public policies to combat violence against DP from the knowledge of its panorama, in addition to supporting awareness raising actions among society, health professionals and public managers.

Key messages

The reported cases of violence against DP indicate predominantly female, white, adult and mentally disabled victims, occurrence of physical violence and by aggressor family members or close partners. The analysis of the panorama of violence against people with disabilities allows subsidizing actions and public policies to combat this type of violence.
The Pathway Study: Commonalities Across New Food Bank Users in Rural, Suburban and Urban Areas
Authors: Roncarolo F , Mercille G , O'Loughlin J , Riva M , Sylvestre M P , Perez E J , Potvin L
Published: October 2020

Background

Few studies investigate long-term effects of food donation programs on food insecurity, diet, social integration or health. We describe household food insecurity (HFI), health, social integration and sociodemographic characteristics of 1003 new food banks users in rural, suburban and urban areas in Quebec, Canada.

Methods

Adults requesting food aid for the first time in the past 6 months were recruited in 117 food aid organizations (32 in rural, 35 in suburban, 50 in urban areas) using a nested sampling technique. Baseline data were collected from Sept 2018 to Jan 2020 in computer-assisted face-to-face interviews. Participants will be followed biennially. HFI was assessed with the 18-item Household Food Security Survey Module. Perceived physical and mental health scores were assessed with the SF12V2 module. Psychological distress and social integration were assessed with the Kessler scale K6+ and a modified version of MSPSS Scale. Differences across groups were tested with Chi square, ANOVA and post-hoc tests.

Results

Most participants reported high levels of materiel deprivation, with some variability across settings. Severe HFI was more prevalent in rural (51%) and urban (47%) areas than in suburbs (38%). More urban participants reported <20000 CAN$/yr (79% vs 74% in suburbs and 69% in rural) although low education level was more prevalent in rural areas (82% reported <12th grade education vs. 67% in suburban and 64% in urban areas). Psychological distress was higher in the suburbs (28%) compared to urban (21%) or rural areas (22%). No differences were detected across settings in social integration or physical or mental health scores.

Conclusions

New users of food banks report markedly high levels of material, social and health-related deprivation. In-depth analyses will permit more meaningful interpretation of these differences. The Pathways Study will permit better understanding of the life experience of persons requesting food assistance.

Key messages

People demanding food aid for the first time reported high levels of materiel deprivation, with some variability across settings. Severe housefold insecurity is around 50% among new food aid demanders in rural and urban settings.
Lung cancer survival trend in Umbria, Italy, 1994-2016: preliminary results
Authors: Ostorero A , Gili A , Violi S , Stracci F
Published: October 2020

Background

Lung cancer is the second most common cancer worldwide and the leading cause of death for cancer (18.4%). During the last 30 years, lung cancer incidence and mortality increased in women and decreased in men, because of tobacco smoking exposure. Population survival trend reflects both the influence of disease severity at diagnosis and treatment effectiveness. Some studies reported an increase in global lung cancer survival and linked it to new treatment options. However, change in the overall survival may also reflect a shift towards morphologies with more favorable prognosis. We analyzed overall and morphology specific survival trends for lung cancer to gain insight on the role of new treatments and changing exposures.

Methods

We analyzed lung cancer 1 y-survival and 3 y-survival after diagnosis in Umbria (890'000 inhabitants) in the period 1994-2016. Population-based data were obtained from the Umbrian Cancer Registry (RTUP), Italy. We estimated relative net survival (Pohar-Perme approach) stratified both for sex and histotype (NSCLC, SCLC, NOS), considering six diagnostic periods from 1994 to 2016 (4 years for period, except 3 in the last one) for 5'268 lung cancer cases (26% women).

Results

Overall survival by gender resulted 40,5% (1y) and 16.5% (3y) in men, 47,3% (1y) and 23,2% (3y) in women. NSCLC survival increased in women during the period 1994-2016 from 41% to 53% (1y) and from 23% to 33% (3y), and remained unchanged in men. SCLC 3 year-survival did not change significantly neither in women nor in men.

Conclusions

We did not observe a significant increase in lung cancer survival over a 25 years period. We observed a significant increase in survival probabilities for NSCLC among women only. Thus, our data don't confirm a major role of new treatments in improving lung cancer control. We will provide further analyses for adenocarcinoma and a comparison of incidence and mortality trends to understand the influence of exposures and treatments on survival.

Key messages

A general increase in lung cancer survival, as could be expected after the introduction of new highly effective treatments is not present in western countries. Reducing exposure to tobacco smoking and environmental pollution remain the main intervention to improve lung cancer control.
Audit methodology for the quality assessment of medical records in the emergency department
Authors: Chiappa F , Vigezzi G P , Salvati S , Scardoni A , Oradini Alacreu A , Zandalasini C , Sancini S , Odone A , Signorelli C
Published: October 2020

Issue

Filling out medical records properly in Emergency Departments (ED) can be challenging, due to the high number of daily admissions and the variety of involved health care professionals (HCP).

Description of the Problem

The ED of IRCCS San Raffaele Hospital (OSR), with a mean of 198 admissions per day in 2019, suffers of frequent overcrowding; patients are managed by multiple HCPs, based on specific care needs; coordination and handover between them are crucial to guarantee quality care. The OSR Healthcare Directorate, the ED's Staff and the School of Public Health of Vita-Salute San Raffaele University developed and validated a model of internal audit to identify ED medical records' quality issues and to implement corrective actions. The workflow included: developing a structured checklist, mapping critical processes and highlighting each figure's tasks. A group of auditors, made up by medical residents in Public Health, tested n = 300 medical charts, filled out during the first semester of 2019, picked up in order to provide a representative sample of the triage priority codes assigned to patients in this period.

Results

To assess completeness and quality of ED's medical records, a new checklist was developed, comprising 4 major sections, furtherly divided in 14 items, scored from 1 (poor adherence/completeness) to 5 (excellent), providing a total score for each record, ranging from 14 to 70. Specific comments to items could be added and an ultimate judgement was written by each auditor. This approach made medical records measurable and comparable.

Lessons

The new checklist and the audit process are useful instruments for the evaluation of medical records and the identification of corrective measures in the ED of our hospital. Next steps will be the extension of the sample, the implementation of corrective actions, and the institution of a stable working group for a regular evaluation.

Key messages

ED's medical records must be clear, understandable and complete. The developed checklist is a tool for preventing and correcting wrong behaviours in a continuous improvement perspective.
Advancing in the institutionalization of Evidence-Informed Policy in Brazil
Authors: Oliveira S , Bento A , Valdes G , Oliveira S , Souza A , Barreto J
Published: October 2020

EVIPNet Brazil was launched in 2007, coordinated by the Ministry of Health. Its expansion has promoted the institutionalization of a national knowledge translation platform, and has also been active at the local level. Local Health Evidence Labs were implemented to institucionalize working groups linked to EVIPNet. In this multiple case study, we discuss the advances in the institutionalization of Evidence-Informed Policy-making in Brazil, based on a mapping of the Health Evidence Labs' institutional capacity to acquire, evaluate, adapt and apply evidence and analyzed organizational arrangements and implementation barriers. The coordinators of 15 responded to a self-assessment questionnaire from the Canadian Health Services Research Foundation. The main products reported are evidence briefs and deliberative dialogues focused on regional problems, training activities and different kinds of rapid responses. Health Evidence Labs have the resources to acquire and evaluate research evidence, but have a low capacity to adapt and apply evidence, indicating that they do not have all the factors (skills, structures, processes, and organizational culture) to promote and use research results in decision-making. The lower capacity to 'adapt' and 'apply' evidence may be related to low development of exchange process with external experts. Governance is joined between managers of the departments with technical bodies; the service provision occurs to attend internal and external demands; financing is public or utilizing public research calls. The implementation barriers described are the staff turnover, inadequate funding arragements for develop knowledge translation products, paid access to evidence databases, lack of a repository for their production, and lack of monitoring and evaluation. Brazil has improved in the institutionalization of evidence-informed policy but still some important barriers to achieve a complete national knowledge translation platform.

Key messages

Brazil has institutionalized evidence-informed policy from the structuring of EVIPNet Brazil Network. To achieve the network sustainability, it is vital to consider the alignment of organizational elements with an emphasis on governance, financing, and its monitoring.
Theme cities for health: are they the superior Healthy Cities?
Authors: De Leeuw E , Forbat J , Simos J
Published: October 2020

Since the early 1980s we have witnessed a proliferation of 'Theme Cities' with the WHO 'Healthy Cities' networks a very early adopter, together with local government initiatives that focused on environmental health and sustainability. These days such networks range very broadly, from Citta Slow and Child-Friendly Cities to sustainable, resilient, festival, happy, garden, winter, safe, inclusive and many more theme-centered international networks of local governments and communities.

We undertook a political analysis of the extent to which these networks formally recognise and address the drivers of inequity in societies around the world, and to which extent they are ready to act truly glocally. We found that 'Sustainable Cities' rank highly, with WHO/EURO and PAHO style 'Healthy Cities' a close second. 'Transition Towns and Communities' are in a category of their own and can be considered a potentially important political voice for glocal health equity.

Key messages

Healthy Cities are Theme Cities - but not all do well to promote health equity. Sustainability and health (as per the SDGs) have enormous glocal health potential.