bluuebunny/crossref_metadata_2025 huggingface dataset:
Integrating mental health into emergency preparedness and response: lessons learned from Covid-19
Authors: Alkasaby MA , Baingana F , Bosu WK , Abdulaziz M , Mwaisaka R , Kakunze A , Keita N , Saeed K , Eaton J , Walker I
Published: October 2022

Introduction

The COVID-19 crisis has disrupted health systems all over the world. In a survey by the WHO, 93% of the countries reported disruption in their mental health services. This research assessed the extent to which mental health was included in the national response to the COVID-19 pandemic in African countries. It also explored barriers and enablers to mental health integration into the COVID-19 response. Lessons learned from COVID-19 can help improve the response to future public health emergencies.

Methods

A web-based survey was sent to mental health focal points in 55 African countries. The survey assessed the perceived degree of implementation of the Inter-Agency Standing Committee (IASC) “14 Globally Recommended Activities” for mental health response to COVID-19. This was followed by in-depth interviews to explore barriers and enablers to mental health integration into the COVID-19 response.

Results

Responses were received from 28 countries. Lack of political will, poor funding, limited human resources, and weak pre-existing mental health systems were the key challenges in addressing mental health needs during COVID-19. Participants highlighted the need to capitalize on the increased attention to mental health during COVID-19 to support its integration into the emergency preparedness and response plans and strengthen health systems in the longer term. They have also stressed the importance of sustaining and strengthening the new partnerships and service delivery models that emerged during the COVID-19 pandemic.

Conclusions

The number of recommended mental health activities implemented during the COVID-19 pandemic varied considerably across African countries. Several factors limit mental health integration into emergency response. However, there are signs of optimism, as mental health gained some attention during COVID-19, which can be built on to integrate mental health into emergency response and strengthen health systems in the long term.

Key messages

• Capitalize on the increased attention to mental health during COVID-19 to support its integration into the emergency preparedness and response plans and strengthen health systems in the long term.

• Sustain and strengthen the new partnerships and service delivery models that emerged during the COVID-19 pandemic.
Civil-military cooperation to contain COVID-19 epidemic in Israel- Lesson learned
Authors: Mor Z , Davidi N , Alroy Preis S
Published: October 2022

Issue

Public Health Services (PHS) has a major role in controlling COVID-19. As the epidemic propagated, and due to limited resources, PHS in Israel reached it capacity to contain the outbreak. Following a political decision in June 2020, the Home Front Command (HFC) of the Israeli Army was assigned to integrate in operating the National epidemiological efforts, while the PHS remained responsible for policy, setting guidelines and supervision.

Problem

The civilian PHS and the military HFC had to establish cooperation, institute new hierarchical structure and divide the responsibility, despite the differences in organizational cultures, financial and human resources. Additionally, inter and intra organizational interests had to be resolved.

Results

Formal and informal efforts were needed to bridge between the two organizations, while utilizing the comparative advantage of each agency. PHS has experience in controlling outbreaks, well-established intra-organizational communication, high professional identity, commitment and familiarity with different populations in Israel. HFC is a flexible, creative, learning and fast-responding organ, experienced in controlling emergencies and has well-established chains of command. HFC is supported by IT and intelligence officers. Organizational disadvantages had to be resolved. PHS is deficient in resources, has limited capacity in operating staff during irregular hours, and is obliged to share the health leadership and authority with the army. HFC has to confront high rotation of its manpower, difficulty in succumbing to non-military guidelines and regulations and possible mistrust between the army and special populations, such as Arabs or ultra-religious Jews.

Lessons

Civil-military epidemiological cooperation can boost the National response in containing epidemics. Policymakers from each agency should use leadership skills to encourage integration while being sensitive to the needs and expectations of all participants.

Key messages

• Civil–military epidemiological cooperation boosts the National response in containing epidemic. Mutual organizational sensitivity is crucial for constructive integration by leaders from each agency.

• Civil–military epidemiological cooperation boosts the National response in containing epidemic. Mutual organizational sensitivity is crucial for constructive integration by leaders from each agency.
Estimated excess mortality figures in the year 2020-2021 in casentino municipalities (Italy)
Authors: Gennari M , Fratini M , Nante N , Vigiani N
Published: October 2022

Background

In 2020, the total deaths from all causes were the highest ever recorded in Italy since World War II (15.6% excess), with peaks during Sars-Cov2 waves and reductions in periods of national lockdown. On the contrary, in 2021, the total number of deaths from all causes reduced compared to the previous year. Analysing local mortality data, our study aims to assess whether, in the Casentino Valley (Arezzo, Tuscany), an excess of deaths from all causes occurred between January 2020 and December 2021 compared to the five years 2015-2019.

Methods

We used the official mortality data from the Italian Institute of Statistics (ISTAT), and that are published in the Table of deaths by the municipality on March 2, 2022. From this database, we extrapolated all deaths from all causes between January 1, 2020, and December 31, 2021, in the 10 municipalities of Casentino. The data collected were processed using Microsoft Excel 2016 software. We then distinguished by total per month, gender, and age group and then compared these data with the previous five years’ average by calculating the percentage change.

Results

Overall, both the years 2020 and 2021, it is shown an increase in the deaths percentages compared to the previous five-year period, respectively 5.66% and 8.07%. In particular, there is an excess of mortality in November and December 2020. The increase in mortality is more remarkable for males (13% in 2020 and 20% in 2021). The highest percentage increase was recorded in 2021 for the 75-84 age group (+15%) and in 2020 for males over 85 (+29%).

Conclusions

The data analysed confirms the excess mortality in 2020-2021 compared to the average of the previous 5 years in Casentino. There are peaks in November and December 2020, corresponding with the second wave of Sars Cov2 infection. The results obtained establish the basis for subsequent analyses that will verify the correlation of mortality peaks with the incidence of Sars-Cov2 cases in the territory studied.

Key messages

• Between January 1, 2020, and December 31, 2021 there was an excess of all-cause mortality in our area.

• This excess mortality appears to be related to peaks in Sars-Cov2 infection.
Covid-19 Hospitalization Costs Assessment in an Italian Covid Hospital
Authors: Scattaglia M , Campobasso GA , Cremona A , Morandi M , Gianino MM
Published: October 2022

Introduction

Many consequences resulted from the breakout of the COVID-19 pandemic in Europe, which have disrupted our economic, social and medical world. This allowed us to measure and assess the hospitalisation costs regarding the COVID-19 disease at Martini Hospital in Turin, one of the hospitals entirely committed to the COVID-19 care, between January and June 2021.

Methods

In this single center retrospective study, we collected and analysed cost data on patients admitted at Martini Hospital in the time frame of January-June 2021 and compared the analysis with the same period in 2020, at a time when the hospital was not dedicated to Covid-19 patients. Cost data included full-time and temporary employees salaries, drugs, medical and non-medical supplies and equipment and facility utilities. We then estimated the cost per treated COVID-19 episode, in comparison with the cost per any desease including Covid-19.

Results

The first 6 months of 2021 registered 2,136 hospital discharges, while same period in 2020 counted 4376. The mean duration of the hospital stay was 7,67 days in 2020 and 12,83 in 2021. The average charge per treated episode doubled (+52,5%) from Euros 8997 in 2020 to Euros 19026 in 2021. The mean revenue increased of 35% from Euros 3280 in 2020 to Euros 5041 in 2021. This is due to the major complexity of care required for Covid patients. As it is, in 2021 the average complexity index of 2.13 while in 2020 it was 1.39.

Conclusions

Clinical management and treatment of COVID-19 economically strain the European health-care systems. The study of COVID-19 treatment costs, and their differences between 2020 and 2021 suggests an economic challenge for the entire Italian health system and emphasises the necessity to avoid the recurrence of such an economic impact by implementing effective infection prevention and control policies.

Key messages

• The Covid-19 pandemic has been straining both the European health and economic systems.

• Studying the Covid-19 expenditures allows to frame unexpected new challenges regarding health-care systems.
Is it really possible to leave sars-cov-2 outside the door?
Authors: Bocci BM , De Palma I , Amodeo D , Cevenini G , Nante N , Messina G
Published: October 2022

Background

In this historical period, it has become very important to live in healthy environments. By using everyday objects, cross-contamination is possible because of prolonged microbial persistence on surfaces. UV-C irradiation is an environmentally friendly method to disinfect objects as no harmful chemicals or heat are involved. This study aims to determine the virucidal activity, against SARS-CoV-2, of UV-C irradiation occurring in a designed UV device, ‘Purity Capsule'.

Methods

An experimental study was performed in September 2020. The ‘Purity capsule’ has an 11 W lamp (3.5W UV-C) positioned in the centre of the device. The lamp has a dome covered with a reflective, protective coating. Three metal carriers were placed at the maximum distance from the UV-C lamp in three different positions and tested at 30 and 60 seconds 3 times. The carriers were inoculated with 100 µL of SARS-CoV-2 viral suspension with a concentration of 106.5 TCID50 /mL. After treatment, laboratory procedures were used to transfer the treated virus from carriers to multiwell plates. The samples were compared with positive controls (not exposed to UV-C light) after incubation, at 37 °C in 5% COÕ · in a humidified atmosphere, for 3 days. The residual viral activity was tested by assessing the 50% infectious dose per tissue culture (TCID50%).

Results

Tests performed at 30 seconds of UV-C irradiation show an average viral reduction of 4.0 Log10 (99.99%). All three tests performed at 60 seconds reached the maximum measurable log10 viral reduction: 5.0 Log10 (99.999%).

Conclusions

The study assessed the effectiveness of the device in significantly reducing the viral load on all carriers regardless exposure time and distance from the UV-C light source, with no impact on the level of environmental pollution.

Key messages

• UV-C light has the property of inactivating viral growth; its physical approach is considered a good compromise between cost and effectiveness.

• The device was effective in disinfecting all small everyday objects tested.
Management of vaccine-related issues during a pandemic emergency: activation of a referral center
Authors: Cintori C , Diegoli G , Mattei G , Belloli G , Viale P , Attard L , Marconi L , Lugli C , Azzalini D , Artoni C
Published: October 2022

Issue

Vaccine hesitancy (VH) and the challenges faced by healthcare workers (HWs) in evaluating the complex risk-benefit ratio of vaccines’ threaten the effectiveness of vaccination policy. The threat is enhanced when new vaccines are adopted during a pandemic emergency. In Italy, the Emilia-Romagna Region (ERR) created a specialized referral board called Vax-Consilium (VC) to support and guide HWs.

Description of the problem

During a pandemic emergency, rapid and appropriate vaccine implementation is necessary to protect fragile individuals and to encourage vaccine adherence among exposed groups. Challenges in the realm of vaccination emerge, especially when dealing with patients with a complex medical history or previous vaccine adverse events. HWs were able to consult VC via a standardized digital form after obtaining the patient’s informed consent. After a multidisciplinary and evidence-based evaluation, VC provided a conclusive report on the individual vaccine risk-benefit analysis. No cost is charged to the patient.

Results

During the anti-COVID-19 vaccination campaign in 2021, 148 interrogations were submitted to VC: 121 were evaluated, whereas 27 were withdrawn by the HWs or rejected because of insufficient documentation. Mean patient age was 44 years. No absolute contraindication was found, whereas in 23 cases VC recommended immunization with a different vaccine. The disciplines most frequently involved were neurology, angiology and cardiology.

Lessons

VC implementation in EER proved highly effective. Indeed, during the pandemic, anti-COVID-19 vaccination coverage reached >90%. In addition, DTaP-polio-HBV-HIb and MMR vaccination coverage reached >95%. VC proved to be a high-quality public health service. Not only was citizens’ trust in the healthcare system enhanced and was VH reduced, but HWs knowledge improved even in cases not considered in national and international guidelines.

Key messages

• A specialized referral board (Vax-Consilium) could be an effective tool for enhancing citizens’ trust in vaccines.

• A specialized referral board (Vax-Consilium) contributes to lowering VH and supporting HWs decision-making process.
Don’t be scared to touch! Effectiveness of a new disinfection technology based on Ag ions & Zeolite
Authors: Peruzzi V , Amodeo D , De Palma I , Messina G
Published: October 2022

Background

Disinfection of contact surfaces has become common practice since the two-year Covid-19 pandemic. The transmission of microbial agents has long been the focus of public health and hygiene awareness campaigns. Indeed, the development of new disinfection technologies and approaches is attracting considerable interest in the scientific community. Mixed plastic powders with antimicrobial properties and silver ions that compromise the metabolism of microorganisms could reduce the contamination of the contact surfaces. We aimed to evaluate an inorganic antimicrobial agent (IAA) based on Ag ions and zeolite mixed in a resin.

Methods

This experimental study was carried out at the University of Siena, Italy. Different objects were produced in two versions: i) with an IAA mixed in plastic resin; ii) with a standard plastic mixture. To the eye, the two versions were indistinguishable and were randomly contaminated with the hands of several operators. After the hand contamination, T0, we sampled the objects using RODAC plates at T1 (1h) and T2 (6h), incubating at 36 °C for 48 hours. Comparisons of the biocidal effect were made at T1 and T2. Statistical analysis was carried out with Stata.

Results

The mean level of contamination of the objects made with standard plastic were, respectively 50 CFU (SD 36.5) at T1 and 20 CFU (SD 13.6) at T2. In comparison, the objects made with IAA resin showed a mean level of contamination of 10 CFU (SD 5.9) at T1 and 6 CFU (SD3.6) at T2. The objects made with IAA resin have shown a mean percentage reduction of contamination of 79.5% at T1 and 78.3% at T2.

Conclusions

IAA resin reduced contamination on objects that came into contact with hands. Antimicrobial plastic blends, are a valuable aid in counteracting the spread of infection related to contact with surfaces and fomites. The public health system could support and raise awareness for using these innovative materials for everyday applications and in healthcare facilities.

Key messages

• Inorganic antimicrobial agent based on Ag ions and Zeolite mixed in a resin are efficient in reducing the contamination on different items in a real-life context.

• Public health system have to support and sensitize to production with inorganic materials with proven antimicrobial properties.
Impact of the pandemic on surgical oncology in Piedmont, Italy: a retrospective observational study
Authors: Ragusa P , Lo Moro G , Aglietta M , Airoldi M , Comandone A , Previti C , Bert F , Siliquini R
Published: October 2022

Background

To prevent the spread of SARS-CoV-2, containment measures were implemented leading to huge healthcare changes worldwide. This study aimed to describe the impact of COVID-19 pandemic on surgical oncology healthcare in a large Italian sample.

Methods

A retrospective observational study included 99651 patients admitted to the hospitals of Piedmont (Northern Italy) to undergo oncological surgery, provided in ordinary hospitalization. We compared data of 2020 with 2016-2019 mean values. Data were stratified by tumor site, year, month and admission way. Chi-squared tests were used to assess differences in the percentage of admission modes between 2020 and 2016-2019.

Results

An overall reduction in oncological surgery (-12.3%) was observed in 2020 (n = 17923) compared to the mean of period 2016-2019 (n = 20432). A relevant decrease began in March (-11%), continued in April (-18%) and peaked in May (-26%). There was a greater reduction in surgery of breast (-19.2%), bladder (-17.5%), colorectal (-16.5%), kidney (-14.2%), prostate (-14%). Little or no difference was observed for liver (-5.2%), body of uterus (-0.54%), ovary (-0.07%), lymphoma (+4.5%). There was a marked reduction of non-emergency admissions (-13.6%), in particular for some tumor sites: colorectal (-19.4%), breast (-19.4%), bladder (-18.7%). The overall volume of surgeries following an emergency access was unchanged (-0.3%). The proportion of hospitalizations with emergency access increased (p < 0.001).

Conclusions

Our results highlight the burden of the reduction in cancer surgery in 2020 and the risk of delays in diagnosis and treatment for time-dependent conditions. For cancers that can be diagnosed early thanks to screening, the reduction in surgery is likely to be an indirect consequence of discontinuing screening activities. Therefore, further studies are needed to assess, as soon as data are available, the trend in 2021, and to compare our results with those reported in other European countries.

Key messages

• The COVID-19 pandemic caused a significant decline in cancer surgeries in 2020 in Piedmont, Italy. It is necessary to compare our results with those reported in other European countries.

• These results show an increase in the proportion of oncological surgical admissions following emergency access in 2020 compared to the average for 2016-2019.
Impact of COVID-19 pandemic on population-based cancer screening: Interrupted Time Series Analysis
Authors: Pereira Godinho Simões JDG , Pita Ferreira P , Pinto de Carvalho C , Pinto Leite P , Peralta-Santos A
Published: October 2022

Early evidence suggests that the COVID-19 pandemic may have reduced the proportion of individuals submitted to cervical, colorectal and breast cancer screening. However, the recovery from the pandemic impact was very heterogeneous. We aim to explore the impact of the pandemic on cancer screening and estimate the time to recover lost screening opportunities in Portugal. We used an interrupted time series to analyze the impact of the pandemic on the implementation of cancer screening. The study population was the eligible individuals screened for cervical, colorectal and breast cancer by month and health region between 2018 and 2021. We used Poisson regression with health region random effects to estimate the trend before and after the first lockdown (March 2020) and the impact of the first lockdown. We predicted the counterfactual evolution without a pandemic to estimate lost screening opportunities. The first lockdown resulted in 93,1% (95%CI 92,9-93,2), 89,4% (95%CI 89,2-89,5) and 84,1% (95%CI 83,8-84,3) decrease in the proportion of expected cervical, colorectal and breast cancer screening tests. Nonetheless, we document an increased trend difference between pre and post lockdown of 6,0% (95%CI 5,9-6,0) and 5,3% (95%CI 5,3-5,4), 3,7% (95%CI 3,6-3,7) per month. However, by December 2021, there are still many lost screening opportunities due to the pandemic - 293k cervical cytology tests (42,2% less than expected), 247k fecal occult blood tests (28,7%) and 388k mammograms (38,4%). The first lockdown resulted in an abrupt decrease in cancer screening. However, we document an increase in the cancer screening trend after the pandemic. Nevertheless, there are still considerable lost screening opportunities after 2 years.

Key messages

• The pandemic caused a massive disruption in cancer screening. Although there was an increase in screening trends after the first lockdown, 2 years later, many lost screening opportunities remain.

• Population-based screenings need to increase the outputs to account for lost screening opportunities due to the pandemic.
Response to the COVID-19 pandemic in the legally deprived population of liberty in Cali (Colombia)
Authors: Torres Agredo M , Tamayo J , Mina E , Luna L , Guerrero-Jaramillo P , Benavides-Cordoba V
Published: October 2022

With the COVID-19 pandemic, the challenge of reducing the transmission of the disease has led to new challenges in decision-making. The vulnerability of persons deprived of liberty led to the design of contagion mitigation alternatives. Since February 2020, at the Villahermosa Penitentiary and Prison Center in Cali, the Secretaría de Salud Pública (SSP) began a series of actions that intensified on March 11, when the WHO declared COVID -19 as a pandemic. The SSP, in an articulated work; configured a series of strategies aimed at mitigating the impact and speed of contagion, infectious disease doctors and internists were also summoned who provided recommendations and contributed to decision-making. An intervention model was designed, which was guided by two main processes: promotion and prevention actions and service provision actions. The articulated work and the high commitment of the actors involved, the development of strategies for biosecurity, hygiene, isolation, rapid detection, and, above all, immediate control of symptoms and medical care on-site with adjustments that allowed managing patients inside the institution; It has meant that to date mortality is below 1% and that for the time being the situation is under control.

Key messages

• The humanization of health service provision is essential to achieve effective results.

• The rapid and articulated responses made it possible to maintain a mortality of less than 1% in this population.
Religious pilgrimage and COVID-19. An observational report in Italy from contact tracing activities
Authors: Ferraro F , Frisicale EM , Rapiti A , Marotta C , Bonfigli S , Angeloni U , Maraglino F , Rezza G
Published: October 2022

Issue/Problem

Religious Mass Gathering (MG) represent one of public health challenges for Health Authorities due to potential spread of communicable diseases. This is much more true during a pandemic as COVID-19. Surveillance is crucial to prevent further spreading of infectious disease related to a religious MG.

Description of the problem

During international contact tracing activities an increase of reporting of COVID-cases with a travel history to a Catholic shrine in Europe was observed, despite travel restrictions put in place. In order to promote public health actions as risk communication, a risk evaluation was conducted. A descriptive analysis was carried out: personal and vaccination data were collected; for cases, date and type of positive tests, date of symptoms’ onset were collected; for high-risk contacts, date and type of negative tests at the end of follow-up were collected. Frequencies were calculated.

Results

Six journeys back from Medjugorje were identified, with at least one positive case. All trips took place between 18/09/2021 and 29/10/2021. 31 positive cases out of 160 travellers were identified, with number of cases per travel ranging from 1 to 11.

Lessons

Religious MG represent an important global health issue. Even though a specific surveillance was not activated, international contact tracing activities turned out a great source of epidemic intelligence and consequent surveillance and control activities led to risk assessment and communication actions.

Key messages

• In the pandemic context, where travel restrictions were put in place, surveillance for Religious MG should be always implemented.

• Cooperation among all the stakeholders involved as Church, travel agency, Regional Health Systems and Government Bodies has to be promoted for specific surveillance in religious MG events.
A study on determinants of COVID-19 knowledge and preventive practices among Polish schools teachers
Authors: Molas-Biesiada A , Gańczak M , Biesiada D , Kalinowski P , Michalska J , Piechowicz K , Stoliński M , Komorzycka J
Published: October 2022

Background

Sufficient knowledge and preventive practices are crucial to control the spread of SARS-CoV-2. To date, some data regarding these issues have been reported among different professions, whereas such information is inaccessible in teachers.

Methods

An institution-based cross-sectional study was conducted between May-June 2021 in 3 randomly selected Polish provinces, in 26 schools. An anonymous, self-administered questionnaire which included 10 questions related to COVID-19 knowledge and 13 questions about preventive practices was used. Each correct answer to the question about COVID-19 knowledge was given 1 point and question about preventive practices was given 1 to 3 point (max. 11 and 39 points respectively). Bi- and multivariable logistic regression models were fitted to identify the predictors of COVID-19 knowledge; simple/multiple linear regression analyses were done for factors associated with practices.

Results

464 teachers were included (response rate was 55%), 92% females, mean age 45.6±10.2 years. The average COVID-19 knowledge score was 6.6±3.76 points; in 77% of teachers the knowledge level was >50%. The mean of preventive practices score was 15.8±1.78 points; 204 (55.1%, 95% CI 50.0% to 60.2%) respondents scored above the mean score of preventive practices. Wearing a mask (β: 0.09 95%CI 0.00-0.03), washing hands (β: 0.09 95%CI 0.00-0.02), avoiding crowds (β: 0.12 95%CI 0.01-0.07), and avoiding visiting relatives (β: 0.10 95%CI 0.00-0.07) were significantly associated (p < 0.05) with knowledge about COVID-19. Knowledge was the strongest predictor of avoiding crowds (β coefficient = 0.12).

Conclusions

Significant number of school teachers had inadequate COVID-19 knowledge and were poorly engaged in COVID-19 preventive practices. As knowledge level strongly influences adequate preventive behavior, additional educational intervention is urgently needed for teachers to help them better manage the pandemic at the school setting.

Key messages

• This study assessed COVID-19 knowledge and preventive practices, as well as related determinants among primary school teachers.

• This study assessed the attitudes of primary school teachers towards the Covid-19 pandemic.
The LoCo (Lockdown Cohort)-effect: Socioeconomic differences in fertility during the pandemic
Authors: Oberndorfer M , Tilstra AM , Dundas R , Leyland AH , Pearce A
Published: October 2022

Background

The economic and social disruptions caused by the COVID-19 pandemic and its mitigation measures may have affected fertility unequally across social strata. If a compositional change in maternal socioeconomic characteristics is confirmed, counterintuitive changes in future population health - the LoCo-effect - are likely.

Methods

We analysed data from maternal inpatient discharge records containing births between January 2018 and November 2021 by Scottish Index of Multiple Deprivation (SIMD) quintile. We used monthly number of births before November 2020 to estimate expected monthly births after November 2020 and compared against observed births in each SIMD quintile. Further, we estimated associations between monthly average stringency of national mitigation measures (Stringency Index (0-100)) and births 9 to 13 months later using distributed lag models.

Results

Between November 2020 and November 2021, there were 1301 (10.3%) fewer births than expected for the most deprived quintile (Q1; 953 (8.7%) and 375 (4.1%) less in Q2 and Q3). In the two least deprived quintiles, however, fertility remained mostly unchanged. A 10-point increase in monthly average Stringency Index in Q1 was associated with an average cumulative decrease of 8.5 births (95%CI: -14.1; -2.8, p = 0.006) 9 to 13 months later. Conversely, this estimate was a 4.4 increase (95%CI: 1.3; 7.5, p = 0.008) in Q5 and a 5.9 increase (95%CI: 1.4; 10.4, p = 0.013) in Q4.

Conclusions

Apart from their exposure to pandemic and lockdowns, it is likely that, due to compositional changes in births, the observed LoCo started life, on average, more socially advantaged than previous birth cohorts in Scotland. We show a substantial decrease in fertility in the most deprived areas, while fertility remained little changed in the least deprived areas. Increases in the stringency of lockdown measures were associated with a decrease in births in the most deprived but an increase in the least deprived areas 9 to 13 months later.

Key messages

• Between November 2020 and November 2021, there were substantial decreases in births among deprived areas in Scotland while fertility in the least deprived areas remained mostly unchanged.

• For these births, the observed compositional shift in maternal socioeconomic characteristics may lead to changes in current and future health and health needs – the LoCo (Lockdown Cohort)-effect.
Managing Innovation for Sustainable Health:rethinking training of health officials in fragile states
Authors: Båge K , Batte C , Tomasdotter L , Mala Ali M , Alasow M , Ndejjo R , Hellden D , Ndeezi G , Alfven T , Wanyenze R
Published: October 2022

There is great urgency for action to achieve the Sustainable Development Goals, especially in fragile settings, which face acute and complex challenges. Yet, the public sector may be limited in its capacity to address these appropriately, with devastating effects on the health of people and environment now and in the future. The challenges to sustainable health require professionals who are trained relevant competences. In 2020, Karolinska Institutet, Sweden, and Makerere University, Uganda, developed the Centre of Excellence for Sustainable Health under which a new partnership was established with Benadir University, Somalia, Kinshasa School of Public Health, the Democratic Republic of Congo, and Tinkr, Norway to develop training on innovation for sustainable health. The aim of “Managing Innovation for Sustainable Health” (MISH) is to strengthen the capacity to contribute to achieving sustainable health through innovation in the public sector. It targets managers in Somalia, DRC and Uganda from the public and private sector, academia, and civil society. It is one year long, part-time and delivered online with one study trip. It features three modules covering Agenda 2030 and Sustainable Health; Multisectoral Collaboration and Implementation Science; and Innovation and Innovation Management. Integration of participants’ learnings into their professional role, mutual learning between participants, and an emphasis on applicability, all underpin the learning strategies of the program. Quality is monitored through expectation surveys, baseline mid and final impact assessments, module and final program evaluations. MISH has trained about 50 managers, 85% of which say that the training was useful. All partners are represented in both operational and strategic organizational bodies of the program. Our model shows what is possible through collaborative online international learning delivered by partnerships defined by teamwork, trust, and a dedication to true impact.

Key messages

• There is great urgency for action to achieve sustainable health especially in fragile settings.

• There is momentum for higher education to leverage the opportunities of the covid-19 to rethink learning for the global challenges.
Racism in German medical education – Perspectives of racialized physicians and medical students
Authors: Vogt H
Published: October 2022

Background

The impact of racism on health and the quality of health care services for racialized patients have been the object of prior research. The experiences of racialized medical students and physicians, who operate in a field of tension between natural sciences and practical application and between a ‘medical habitus’ and exclusionary discrimination, have hardly been examined to date. The education of (future) physicians is an especially fruitful research area in the context of the study of institutional racism in the health care system, as informal everyday experiences come together with formal knowledge and normative learning.

Methods

Based on expert consultations and preliminary interviews with civic stakeholders, teaching and learning materials in German medical studies were randomly sampled and used as a starting point for qualitative guided interviews with physicians and medical students in Germany who are themselves affected by racism. The first steps of the thematic analysis of these interviews are reflected upon and further developed in focus group discussions with the interviewees.

Results

The study is particularly concerned with the question of how certain dimensions of racism in the health care sector are related, and how racist normativity appears in this context. This is concretized in the relationship between formal and informal medical curricula as well as in the interweaving of everyday experiences and teaching materials.

Conclusions

There are different dimensions of relation between a hegemonic normativity in the medical curriculum and the everyday experiences of racialized medical students and physicians in Germany. Politics, faculties, publishers, and civic society may be the target of several recommendations for action regarding those diverse dimensions, e.g. the line between omission and stereotyping of several patient groups.

Key messages

• Hegemonic normativity in German medical education is an important and challenging issue. There are several institutional levels of medical knowledge reproducing racism in the health care sector.

• Both racialized physicians and racialized patients are affected by symbolic and material forms of racism in the German health care system, which are interweaving and crucial on diverse levels.
Epidemiological factors affecting health service utilization in diabetic patients in Ethiopia
Authors: Benoni R , Sartorello A , Paiola E , Andreani G , Moretti F , Tsegaye A , Tardivo S , Manenti F
Published: October 2022

Diabetes-related deaths reached 2 million in 2019. The highest percentage of undiagnosed diabetes (59.7%) was observed in Africa, where accessibility to health services is pivotal to improving the outcome of diabetic patients. The study aims to assess the association between diabetic patients’ epidemiological factors and accessibility to healthcare services in a low-income country. The retrospective cohort study included diabetes-related outpatient department (OPD) visits and hospitalizations from 01/01/2018 to 31/08/2021 at St Luke Hospital (Ethiopia). Potential predictors were sociodemographic factors, COVID-19 cases, mean monthly temperature, and precipitations. The ARIMA method was applied to OPD visits and hospitalizations time series. OPD visits increased over time (p < 0.001) while hospitalizations were stable. The time series model was ARIMA(0,1,1) for OPD visits and ARIMA(0,0,0) for hospitalizations. Diabetes OPD patients were 1,685 (F = 732, 43%). Females had an average of 16% fewer OPD accesses per month (p = 0.002). Patients missing follow-up were 801 (48%). The time between follow-ups was longer as age increased (p < 0.001). There were 57 fewer forecast OPD visits per month on average using COVID-19 cases as ARIMA regressor. OPD visits decreased differently by geographic area as COVID-19 cases increased (p < 0.001). Hospitalized patients for diabetes were 408, 85 (20.8%) newly diagnosed. The odds ratio (OR) of diagnosis at admission was lower as age increased (OR 0.98, p = 0.009). Compared to type 1 diabetes, hospitalized females with type 2 (117-39.7%) were fewer than males (p = 0.019). Readmissions were 52, 10 (19.2%) within 30 days, without OR difference by sex, age, or diabetes type. Despite an increase in OPD visits for diabetic patients over the study period, the number of losses at follow-up and diagnoses at hospitalization remains high. Gender and age influenced service utilization. Females’ access to care is still problematic (concept of “missing women”).

Key messages

• Primary health care should be implemented to improve access to health services and diabetes management.

• Ensuring equity in healthcare accessibility should be a priority in low-income countries.
Health System Performance Assessment: Does Germany provide good access to healthcare?
Authors: Blümel M , Hengel P , Achstetter M , Schwarzbach M , Busse R
Published: October 2022

Background

Providing equal access to health care is a major goal of health systems and a criterion for health system performance assessment (HSPA). The first systematic HSPA for Germany has been piloted in 2021. Access is one dimension of the conceptual framework (others are, e.g., population health, quality, and efficiency), which will be analysed in the following.

Methods

Nine indicators to measure access were selected based on a systematic search of established instruments in (inter)national HSPA initiatives. Included indicators are availability and accessibility of services (e.g., waiting times) and financial risk protection, among others. Other criteria for the inclusion of indicators were data availability and international comparability. Indicators were evaluated in terms of their trend over time (2000-2020), in international comparison (e.g., Austria, Denmark, France), and according to various equity categories (e.g., age, gender, region).

Results

The indicator access to palliative care could not be evaluated due to lack of data. Overall, access is good in Germany. Internationally, Germany performs better than average on most of the indicators, and its performance has improved over time. Physician density in the inpatient and outpatient sectors has increased since 2000 and is above the average of comparator countries. For some specialties, physician density in rural areas is lower than in urban areas, but the gap has decreased in recent years and does not apply to primary care. Furthermore, only 0.3% of the total population report having foregone care, although they had considered it necessary.

Conclusions

Nine indicators were identified and calculated to assess the performance of the German health system in terms of access to healthcare. Access can be assessed as predominantly positive, but inequities exist. Identified gaps and future extensions, e.g., additional data sources, can provide impetus for evidence-based policy management.

Key messages

• First systematic Health System Performance Assessment for Germany has been piloted.

• Access to health care is good in Germany, both over time and in international comparison, but inequities exist.
Maternal educational inequalities in child’s birth weight: ONS Longitudinal Study
Authors: Pikhartova J , Shelton N
Published: October 2022

Background

Studies found that maternal education is the most frequently assessed predictor of child’s birth weight. Lower level of education was consistently found as indicator of lower child’s birthweight. In turn, inequalities in child’s birthweight have been repeatedly shown to be closely related to inequalities in later adult health. The aim of this project is to evaluate the association between the highest achieved level of maternal education and birthweight of single born babies in large English and Welsh population sample, taking into account factors such as child’s gender, parity, maternal age, partnership status, ethnicity, and household socioeconomic characteristics.

Methods

Using Office for National Statistics Longitudinal Study (ONS LS) based on English and Welsh Census data, information from almost quarter of a million children born since 1981 to ONS LS sample mothers were used. Maternal education was categorised in 3 categories (below secondary, completed secondary education, degree and higher), and its association with child’s birth weight was analysed by logistic regression accounting for range of available covariates.

Results

Significant association between the level of education and birth weight was found in crude analysis (p < 0.001). When adjusted, the magnitude of the association with education gradient declined but remained highly significant and was found to considerably increase over the years. The birth weight difference between those born to mothers with below secondary education and those born to mothers with degree increased by more than 60 grams (p for change <0.001) between 1981 and 2016.

Conclusions

These findings support previous evidence based on different population samples. According to our results, children of mothers with below secondary education tend to have lower birth weight. Our results suggest that the inequalities in birth weight by the highest education level achieved by mother significantly increased since 1981.

Key messages

• Lower levels of maternal education predict low birth weight in children.

• The differences in birth weight by maternal educational demonstrate increase in inequalities over the years.
Epidemiology of Tuberculosis in Kazakhstan: Data from National Electronic Healthcare System 2014-2019
Authors: Sakko Y , Madikenova M , Kim A , Gaipov A
Published: October 2022

Background

Tuberculosis (TB) remains a global public health threat. WHO determined Kazakhstan as one of 18 high-priority countries for TB elimination in Europe, with reported TB incidence >20 cases per 100,000 population. There is a lack of comprehensive reseach of TB epidemiology in the country. This study aims to estimate the prevalence, incidence, mortality rates and survival hazard ratios of TB in Kazakhstan, using large-scale administrative health data records in 2014-2019.

Methods

This is a population-wide retrospective study assessing 150 thousand TB (ICD10: A15-A19) patients’ incidence, prevalence and mortality. Demographic factors, diagnoses and comorbidities were analyzed. Univariate, bivariate and multivariate statistical analyses were performed. Cox regression and Kaplan-Meier survival analysis have been done.

Results

Out of 150 thousand all TB patients, 61 percent were male and 94 percent had respiratory TB. During 2014-2019, the TB incidence, prevalence and mortality per 100K population declined (227-15.2), doubled (325.3-746.6) and increased (8.4-15.2), respectively. Age-specific TB incidence was lowest for 0-10 y.o., highest for 20 y.o. Being an old person, male, urban resident, retired, with HIV and diabetes was significantly associated with lower survival compared to a young, female, rural resident, employed, with no comorbidities.

Conclusions

This was the largest TB study in Kazakhstan, presenting the country’s TB by demographic groups, incidence, prevalence, mortality trends, and risk factors against survival.

Key messages

• During 2014-2019, the TB incidence, prevalence and mortality per 100K population declined (227-15.2), doubled (325.3-746.6) and increased (8.4-15.2), respectively.

• Being an old person, male, urban resident, retired, with HIV and diabetes was significantly associated with lower survival compared to a young, female, rural resident, employed, with no comorbidities.
Case-mix and outcome variability in people with diabetic foot complications in England and Scotland
Authors: Meza B , Heiss C , Joy M , Feher M , Leese G , Cunningham S , DeLusignan S , Carinci F
Published: October 2022

Background

We assessed the difference in survival rates for people with diabetes experiencing LEA in England and Scotland, using large databases held by the Royal College of General Practitioners (RCGP) and the Scottish Diabetes Register (SCI-DC).

Methods

Observational retrospective study of T2D adults 18+ years with LEA between 1/1/2008-1/1/2018 from 1,800 general practices in England (7.4%) and all primary, secondary care units in Scotland. Significance tests were carried out using univariate odds ratios within each database.

Results

On 1/1/2018, N = 127,100 people with T2D were registered alive in RCGP, with N = 1,052 (832 per 100,000) experiencing prior LEA, vs N = 2,200 (783 per 100,000) out of 280,908 in SCI-DC. Among them, England recorded N = 405 patients (72.5%) with prior DFU diagnosis vs N = 993 in Scotland (74.3%), with a median time DFU to LEA of 2.0 vs 2.4 years. The median time spent with LEA was 3.4 years in England vs 3.9 years in Scotland. After including those dying earlier, different univariate patterns were found for England and Scotland. In both networks, increased risk was found for those aged 50+ at first LEA, with prior history of acute myocardial infarction, peripheral arterial disease, ischemic heart disease, cerebrovascular event, higher glomerular filtration rate and major LEA first. In England, reduced risks were found for males (OR = 0.77, 95%CI: 0.64-0.93) and people with retinopathy (0.69; 0.57-0.82), while higher risk were found for hypertension (1.29; 1.09-1.54). In Scotland, lower risks were found for obese (0.59; 0.52-0.66) and those with DFU after LEA (0.74; 0.62-0.89), vs higher rates among those of non-white ethnicity (1.63; 1.19-2.23) and dyalisis (2.31; 1.75-3.07).

Conclusions

Notable differences were found between England and Scotland in terms of characteristics associated with different outcomes following LEA among T2D adults. Multivariate analyses of aggregate patterns are currently ongoing to adjust for potential confounding.

Key messages

• Routine datasets from England and Scotland showed a differential impact of case-mix characteristics on lower extremity amputations among adults with Type 2 diabetes.

• Information available from different clinical networks can be mapped against the available standard sets to compare health care outcomes of people with different complex conditions.