bluuebunny/crossref_metadata_2025 huggingface dataset:
Use of digital tools by PHC professionals as instrument for health decision-making
Authors: David R B , Oliveira V A , Mota L G , Botelho D F , Barral-Netto M
Published: October 2020

Background

Investments have been made in precision public health strategies, as a way to better assess needs and evaluate the health services. Experiences point out that the computerization of health systems reduces costs and improves the quality of information. Primary Health Care (PHC) workers are key elements of this transformation, which can be enhanced with the use of digital health strategies. This paper aims to know the perception of the use of digital tools provided by the Ministry of Health by PHC workers in municipalities in the state of Ceará/Brazil.

Methods

Focus groups and field monitoring were carried out with different professional profiles. The inclusion criterion was the use of digital tools in their daily work. Questionnaires were built to conduct semi-structured interviews. The analyzes were made using content analysis method.

Results

Among the 21 participants (32-49 years old, mostly female),3 reported not having digital knowledge prior to the use of digital tools in their daily work. Mostly associated the use of digital tools with greater agility and ease in the work routine and greater accuracy of information. The challenges were mainly related to the use of the equipment(tablet),such as fear of breakage, theft and problems in the synchronization of the information system. There was a consensus that the data collected are useful, however they are underutilized for the work process in PHC.

Conclusions

The use of digital tools in the health work process is able to foster the critical view of professionals for analysis and decision making, pointing out strategies to face health issues in the territories. Pointed out as a facilitator in daily work, the use of digital tools does not exclude the use of paper sheets. Despite the greater supply of data, these are not used to their full potential, mainly due to insufficient time, given the numerous tasks for professionals.

Key messages

Carefully planned, developed and deployed digital interventions are powerful tools to improve health care system performance. The use of digital tools in the health work process is able to foster the critical view for analysis and decision making, pointing out strategies to face health issues in the territories.
Health impacts of air pollution in Bulgaria
Authors: Tsanova D , Georgieva S , Kamburova M
Published: October 2020

Background

Air pollution is a major cause of premature death and disease, and is the single largest environmental health risk. Heart disease and stroke are the most common reasons for premature death attributable to air pollution, followed by lung diseases and lung cancer. This report aims at investigation and comparative analysis of air pollution and mortality related indicators in Bulgaria.

Methods

Descriptive study design with content analysis is applied on data from accessible national and international databases and publications - Bulgarian National Statistical Institute and The European Environment Agency. To evaluate the health burden attributable to air pollution were used the population-weighted concentration and the estimated number of attributable premature deaths, and the Years of life lost (YLL) per 100 000 inhabitants in 2016. The Ambient Air Quality Directive defines the PM2.5 Average Exposure Indicator which reflects population exposure to PM2.5 and shows the average concentration at urban areas, calculated as a 3-year average.

Results

In 2015, the level of PM2.5 had to be below 20 µg/m3 in any country. In 2017, concentrations were still above that level in three countries - Slovakia 22, Poland and Bulgaria 24. The largest health impacts in terms of premature deaths and YLL, are observed in central and eastern Europe where the highest concentrations are also observed - Kosovo, Serbia, Bulgaria, Albania and North Macedonia.

The premature deaths attributable to PM2.5 exposure in Bulgaria are 13 100, to NO2 - 1 100 and to O3 - 280. The YLL attributable to PM2.5, NO2 and O3 exposure are respectively 1858, 151, 42. All these levels are very high in comparison with other European countries.

Conclusions

Recognition of the full health and economic cost of air pollution and the benefits of pollution reduction should spur increased use of renewable energy, energy efficiency, and clean-fuel vehicles. This is a necessary investment for Bulgaria's future.

Key messages

Responsibility for, and tools to tackle, many environmental determinants of health lie outside the direct control of individuals or the health sector alone. Wider societal, intersectoral and population-based public health approach is needed.
Greenspace and depression in Japanese Older Adults considering physical activities: JAGES study
Authors: Nishigaki M , Koga C , Hanazato M , Kondo K
Published: October 2020

Introduction

Older adult's depression is a public health problem. In recent years, exposure to local greenspace is beneficial to mental health via increased physical activity in people. However, few studies approach the relationship between greenspace and depression while simultaneously considering the frequency, time, and the number of types of physical activity, and large-scale surveys targeting the older adults.

Methods

Cross-sectional data conducted in 2016 by the Japan Gerontological Evaluation Study was used. The analysis included older adults aged 65 and over who did not require care or assistance, and a total of 126,878 people in 881 School districts. The explanatory variable is the percentage of the greenspace of the area, and the greenspace data used is data created from satellite photographs acquired by observation satellites of the Japan Aerospace Exploration Agency. The objective variable was depression (Geriatric Depression Scale 5 points or more). The analysis method was a multi-level logistic regression analysis. Physical activity was the number of sports-related hobbies, the frequency of participation in sports meetings, and walking time in daily life. Other factors such as personal attributes, population density of residential areas, and local climate were also considered.

Results

Depression in the survey was 20.4%. The abundance of greenspace was still associated with depression, considering all physical activity. The odds ratio of depression in areas with more greenspace was 0.92 (95% CI 0.87 - 0.98) compared to areas with less greenspace.

Conclusions

It became clear that areas with many greenspace were still associated with low depression, even considering the frequency, time and number of physical activities. It is conceivable that the healing effect of seeing greenspace, the reduction of air pollution and noise, etc. are related to the lack of depression without going through physical activity.

Key messages

In Japan, older adults are less depressed when there are many local greenspace. It became clear that areas with many greenspace were still associated with low depression, even considering physical activities.
“The Green Sea Yard of Varna” – the innovative project in the focus of early child development
Authors: Valtcheva E , Dimitrova T , Moutafova E , Vladeva-Spasova S , Ivanova I , Stefanova R , Popova I , Slavova A , Dimitrova D , Dokova K
Published: October 2020

We present an innovative approach to early child development (ECD), designated as a priority for all societies. Traditional ECD services of the Bulgarian health system are predominantly medical or pedagogical provided by GPs and nurseries. This leaves space for interdisciplinary services based on the ideas of Françoise Dolto focused on child-parent relationships. The Green Sea Yard of Varna, Bulgaria, aims at providing accessible space for early socialization of children and preventive psychosocial services by experts in ECD.

The process oriented work combines: psychosocial accompaniment, social group & community work, psychoanalytic consultation with medical expertise. Specialists use direct observation, interviews, analysis of available information, hypothesis development. Questions to be answered: is there a recognized need for a space enhancing and stimulating the interaction between the three main subject in ECD child-parents-specialists; is there a need for a transitional space between the home and kindergarten enabling early child socialization; which are the most prevalent mental and behavioral problems and their earliest symptoms.

For 104 working days (December 2018-February 2020), 2 000 visits of 257 children have been performed, including 400 individual consultations of 51 children at risk. Smooth adaptation to nursery was experienced by 15,5% of children. The most prevalent problems are: insufficient to lacking parent-child verbal communication; delayed speech development; aggressive behavior towards peers.

The main lessons are: (1) There is a recognized by specialists, families and the community need for transitional spaces enabling children to experience first social encounters and concepts of social rules and norms; (2) the space stimulates both formal and informal quality communication between specialist and parents and mutual informal support between parents; (3) leading to a new view for the child as an autonomous person.

Key messages

The Green Sea Yard of Varna is the first innovative space for interdisciplinary approach to ECD, early socialization, care & prevention in our community fully applicable to other places and cultures. The project is in line with SDGs, contemporary scientific visions for the first 1000 days of a child's life and the WHO strategy for the prevention of child’s health in the family and in society.
Epidemiological profile of hospitalized self-harm in Chile differs from suicide profile. 2008-2017
Authors: Solorza F , Urquidi C , Ramírez V , Marró P
Published: October 2020

Background

Suicide is a public health problem. The highest rates occur in men of 45-60 years old, and the most common methods are hanging, ingestion of pesticides, and firearms. Self-harm with or without suicide intention is the most critical factor identified for prevention, and it requires health care services. In Chile, the central-south regions are the most vulnerable areas. We described the epidemiological profile and trends of hospitalized self-harm in Chile between the years 2008 and 2017 and identified susceptible geographical regions and subpopulations.

Methods

We analyzed the codes X60-X84 (ICD-10) for self-harm, from the hospital discharge records of the Department of Health Statistics of Chile. Chilean population data (National Statistics Institute) and standard world population information were used to adjust self-injury rates by age. Administrative shapefiles containing boundaries of standard geographic locations were obtained from the Chilean National Congress website. We analyzed data by sex, groups of age, and by administrative Region. Self-injury mechanisms were grouped into six categories.

Results

For the period 2008-2017, 31,363 cases of self-harm were hospitalized. The global self-harm rate for the period was 20.9 per 100.000 inhabitants, 29.5 for women, and 12.0 for men. For age groups 10-19, 20-64, and 65 or more, these rates were 40.4, 15.1, and 7.9, respectively. The highest self-harm rates were observed in the north and central regions (Arica:43.5, O'higgins:37.9, Valparaiso:35.4). The most common methods of self-harm were drugs/substance use (89%), sharp and blunt objects use (4.4%), and hanging/drowning (3.1%). In men, the letality rate of self-harm was 2.5% and 0.6% in women.

Conclusions

In Chile, hospitalized self-harm rates are high in women and adolescents, mainly in the north and central regions of the country.

Key messages

Prevention of suicide should be targeted in different populations than the already known epidemiological profile of suicide. Self-harm should be a public health concern, for prevention and surveillance, especially in adolescents and women.
Short-term association of air pollution and health in Poland. Results from multi-city study
Authors: Rabczenko D , Madej T , Wojtyniak B
Published: October 2020

Background

Although time-series studies of the impact of air pollution on mortality are numerous in the literature there is noticeable lack of the results from multi-city studies in Poland. The aim of our analysis is to fill this gap and give estimates based on the most actual data.

Methods

A multi-city ecological time series analysis was carried out. A database contained a daily number of deaths from all causes (excluding external), by sex and age groups (below 65, 65 and more), PM10 and PM2.5 levels as well as meteorological conditions in 3 agglomerations and 19 big cities in Poland. The analysis was performed using generalized additive models. The distributed lag model method was used to investigate the mortality displacement phenomenon.

Results

Two versions of time-series analysis considering the level of air pollution from the current and previous day (acute effect) as well as from the past 30 days (allowing for mortality displacement) in the total population as well as in sub-populations determined by sex and age-group were done in each localization. The pooled effect estimate was calculated based on estimates obtained in each city. The value of the relative risk of death from all causes associated with an increase of air pollution with PM10 and PM2.5 was equal to (respectively) 1.005 (1.003-1.006) and 1.004 (1.002-1.005) for acute effect and 1.016 (1.011-1.021) and 1.021 (1.015-1.026) for delayed pollution effect. Higher relative risks were obtained for females and in the older age group.

Conclusions

A statistically significant short-term effect of air pollution with both PM10 and PM2.5 on mortality was found. The relative risks for PM2.5 were higher than for PM10. Population of females and people aged 65 years and above were more at risk.

Key messages

The existence of the short-term effect of dust air pollution on mortality in Poland has been confirmed. The air pollution effect modification by sex and age was found.
Psychoactive substance use in patients with tuberculosis, treatment adherence, Brief Interventions
Authors: Abreu A , Espirito Santo S S , Portela L , Barroso T , Sousa A I , Mattos L , Brites R
Published: October 2020

Background

Psychoactive substance use associated with tuberculosis therapy is an urgent public health issue in the contemporary world.

Objective

To characterize the profile and psychoactive substance use of patients undergoing tuberculosis treatment and to analyze the association between health-related variables, consumption, and treatment adherence, from the perspective of Brief Interventions.

Methodology

Descriptive transversal epidemiological study, carried out in primary care units, with 114 patients undergoing tuberculosis treatment, from June 2016 to July 2017. The Self-Reporting Questionnaire (SRQ-20) and the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) were used.

Results

Smokers who drank alcohol (p = 0.058) and those who reported not having chronic diseases (p = 0.024) had a need to receive brief interventions. Cannabis use was more frequent among smokers (p = 0.009). With regard to cocaine use, a significant association was found between smoking and the number of chronic diseases. In this sample, 40% of smokers, 21.1% of alcohol drinkers, 10.5% of cannabis users, and 13.7% of cocaine/crack users adhered to treatment.

Conclusions

These results demonstrated the vulnerability of this population to psychoactive substance use based on treatment adherence and the importance of using Brief Interventions for monitoring, especially in primary care settings.

Key messages

The study showed an opportunity to apply the diagnostic strategy of brief intervention in this population in primary care. It showed an impact on the change in behavior of these patients, in view of greater adherence to treatment and improvement in quality of life.
New issues regarding drug-related deaths: combined suicide
Authors: Jandl M , Hocevar Grom A , Drev A
Published: October 2020

Background

Observing drug-related deaths in Slovenia in the last years we have seen more and more combined suicides; with combination of illicit drugs or medicinal drugs taken in toxic or lethal concentrations and an external cause of death that is not poisoning.

Methods

In the case study we studied 4 cases of combined suicides in 2018, with combination of illicit drugs taken and an external cause of death that is not poisoning. Those deaths occurred among drug users shortly after the consumption of the substances, when drug(s) had reached toxic or lethal concentrations in their body in combination with external cause of death that is not poisoning. We examined forensic reports and toxicology analyses, involvement in treatment of drug addiction and hospital treatments.

Results

We will present 3 case reports of combined suicides, according to basic demographic characteristics, illicit drugs profile, external cause of death, history of treatment of drug addiction and hospital treatments.

Conclusions

Drug-related deaths are becoming increasingly complex and require consideration about the extension of the methodology to determine the cause of death. Cases of combined suicides pose a dilemma of the primary cause of death.

Key messages

Drug-related deaths are becoming increasingly complex. Trend of combined suicides; with combination of illicit drugs or medicinal drugs taken in toxic or lethal concentrations and an external cause of death that is not poisoning.
Community interventions improving mental health in minority ethnic adults in the UK: a scoping review
Authors: Baskin C , Zijlstra G , McGrath M , Lee C , Duncan F , Oliver E , Osborn D , Dykxhoorn J , Kaner E , Gnani S
Published: October 2020

Background

Black, Asian and Minority Ethnic (BAME) groups in the UK are disproportionately affected by poor mental health. This scoping review sought to determine the effectiveness of community interventions designed to improve the metal health and wellbeing of adults from BAME groups in the UK.

Methods

We searched six electronic academic databases for studies published between 1990- 2019. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist and the Template for Intervention description and replication (TIDieR) guide was used for data extraction and intervention descriptions. Quality was assessed using Cochrane Risk of Bias tools. Grey literature results were deemed beyond the scope of this review; numerous (>50) small scale community interventions were found without available outcomes data.

Results

Of 4,501 studies, seven met the inclusion criteria: four randomised control trials, one pre and post pilot study, one cross sectional study and one ethnographic study. Interventions included therapy-style sessions, peer-support groups, educational materials, gym access, and a family services programme. Common components included a focus on tackling social isolation, using lay health workers from within the community, signposting, and cultural adaptation. Only three studies reported a statistically significant positive outcome on mental health and six were appraised as having a high risk of bias. Knowledge gaps emerged around effective interventions for men, some BAME groups, and tackling the wider determinants of mental health.

Conclusions

There is a paucity of high-quality evidence on community interventions focussed on improving public mental health among BAME groups. Decision makers need scientific evidence to inform effective approaches to mitigating health disparities. Our next steps are to map promising community activities and interventions that are currently being provided to help identify emerging evidence.

Key messages

Evidence is limited and weak on community interventions that reduce mental health burden among minority ethnic people. Evaluation of promising interventions at scale can close the evidence gap.
Knowledge and prevalence of depression among students on College of Medicine University of Lagos
Authors: Aina B A , Adebowale D K
Published: October 2020

Background

Depression is a significant mental health problem which tends to be one of the leading causes of disability worldwide. Depression can lead to suicide and is the second leading cause of death in 15 - 29 year olds globally. Psychological morbidity in undergraduate students represents a neglected public health problem and holds major implications for campus health services and mental policy making. This study was therefore carried out to assess knowledge of depression, prevalence of depression and accuracy of depression status among students of the Faculty of Pharmacy and College of Medicine of the University of Lagos.

Methods

This was a descriptive cross-sectional study carried out among students on the College of Medicine campus of the University of Lagos. Multi-stage sampling technique was used to select the participants while data were collected using a self-administered questionnaire. Data was analysed using Epi info 7.0. Chi-square test was used to analyse categorical variables where p < 0.05 is statistically significant.

Results

A total of 400 students across all departments were recruited for this study. Most students were in 18 - 21 years' age group, with almost same proportion of females to males. More than half (56.50%) of the students had good knowledge of depression. The overall prevalence of depression was 36.5% among the students out of which 18.2% portrayed severe depression. More than half of the respondents (54.9%) who perceive they are depressed were actually not depressed. There was statistically significant difference between perceived depressed state and actual depressed state among the students (X2 = 18.14; p = 0.0001)

Conclusions

More than half the students possessed a good knowledge of depression. About one third were actually depressed. It is therefore important to create awareness programs which can serve as a platform to increase the knowledge and also reduce the prevalence of depression among these students.

Key messages

Understanding how much students know about depression will help to fill the identified knowledge gap and prevent them from going into depression. Identifying depressed students will help to alert campus health services to manage these students and thereby prevent potential problems associated with depression like suicide or school drop out.
Role of social integration in the protection against depression in the Chilean elderly population
Authors: de Albuquerque Araújo L , Bello Escamilla N , Sabando Franulic V
Published: October 2020

Chile has improved survival however this process occurs under a framework of socioeconomic and gender inequalities, which results in an impact of mental health, especially in vulnerable groups. The objective was to determine the association between depression and social integration in Chilean older adults.

Cross-sectional study from the National Study of Dependence in Old Person 2010. The risk of depression was amount with Geriatric Depression Scale (>5). The social integration were quantity as frequency of meeting with close relatives (child, partner, daughter/ son-in-law, grandchildren); with other relatives (brother, brothers-in-law, nephews or other relatives) and with friends and neighbors in the last 12 months in 5 categories (never visit; less frequently; 1-2 times a month; 1-2 times a week; every day or almost). Logistic regression models considered the sampling design of the survey to identify association with odd ratio (OR) (never as reference category), adjustment for sex, age, ethnicity, household income, education, housing arrangement and chronic diseases (p ≤ 0,5).

Total of 4179 older adults 25,3% reported risk of depression, the significative association with close relatives was in daily or almost frequency OR:0.42 (95%CI 0.27-0.67), 1-2 times a week OR: 0,57 (95%CI 0,33-0,99), 1-2 times/month OR: 0,56 (95%CI 0,99); other relatives were lower frequency OR: 0.54 (95%CI 0.38-0.78); 1-2 times/month OR; 0.50 (95%CI 0.31-0.81); 1-2 times/week OR:0.35 (95%CI 0.22-0.55); daily or almost OR:0.27 (95%CI 0.18-0.42). And meeting with friends and neighbors in the same frequency order were OR: 0.66 (95%CI 0.44-0.99); OR:0.43 (95%CI 0.26-0.73); OR:0.4 (95%CI 0.25-0.62); OR: 0.32 (95%CI 0.21-0.47).

There is a negative gradient between depression and the frequency of meeting with friends, neighbors and family, independent of sociodemographic and health characteristics. Social integration must be promoted as a protective factor of mental health in elderly.

Key messages

Depression is one of the most common mental illnesses in old age and we found a negative gradient between the frequency of meeting friends, neighbors and family and the possibility of depression. It seems essential for public health to have strategies that address social life in old age to strengthen quality of live and mental health.
Caregivers' and relatives' grief in intensive care unit: a literature review on nursing practices
Authors: Monaco E , Gregori D , Martinato M
Published: October 2020

Introduction

The sudden and unexpected nature, which often characterizes death in intensive care, complicates the processing of the loss by relatives and caregivers increasing the risk of complicated grief (CG). Due to the high social impact and long-term consequences on the quality of life of relatives and caregivers, intensive care nurses should ensure evidence-based grief support interventions. This review aims to identify nursing interventions for the management of the bereavement of relatives and caregivers and to assess their effectiveness, relatives' and caregivers' satisfaction and prevention of CG.

Methods

Research was performed in CINAHL, PubMed, Psycinfo and Scopus databases with no limits on study design and publication timespan. The population included relatives or caregivers of patients died in intensive care unit.

Results

14 studies met inclusion criteria. Two studies show that the communication of the bad news through dialogue between the team and relatives/caregivers can reduce, in the latter, the levels of anxiety and depression and the incidence of post-traumatic stress disorder. The quality study by Kentish-Barnes et al. (2017) shows that subjects perceived support in receiving a letter of condolence, but the RCT of the same author concludes that those who received the letter were more exposed to the risk of CG. Four studies claim that follow-up meetings facilitate the process of adaptation to loss by providing relatives/caregivers the opportunity to clarify the circumstances of death. Finally, two studies report that the events of commemoration arouse positive emotions in family members.

Conclusions

The review process has identified only a small number of evidences on the effectiveness of nursing interventions, preventing the possibility of providing recommendations or guidelines. Further research is needed and it should consist of RCTs of high methodological quality.

Key messages

Due to the long-term consequences of the sudden death on the quality of life of relatives and caregivers, intensive care nurses should ensure evidence-based grief support interventions. The review process has identified only a small number of evidences on the effectiveness of nursing interventions, preventing the possibility of providing recommendations or guidelines.
Prevalence of metabolic syndrome during 2003-2012 among health advise centres clients in Slovakia
Authors: Ostrihonova T , Beresova J , Dorko E
Published: October 2020

Background

Metabolic syndrome (MetS) arises from insulin resistance and is accompanied with abnormal adipose deposition and frequently with obesity. The aim of our cross-sectional time trends study was to characterize the prevalence of metabolic syndrome and its five risk determinants among the clients of Health Advice Centres of Regional Public Health Authorities in Slovakia during period 2003 - 2012.

Methods

Prevalence data were estimated in adults and children (≥10 years, N = 79 904) from the nationwide electronic database of Health Advice Centres of Regional Public Health Authorities in Slovak Republic 'Test of healthy heart'. Only first time visitors of the centres were included in the database. SPSS was used for data analysis, arithmetic means and Student´s t-test were used to establish statistical differences based on sex, age and time trends.

Results

The overall prevalence of metabolic syndrome was 30.2% in males and 26.6% in females, abdominal obesity was confirmed in 48.3% of the male population and 53.9% of females. Increased triglyceride level has higher prevalence among males (33.3%) compared to females (24.2%). Blood pressure (BP) values and fasting glucose values were significantly higher in the male population than comparing to females. We confirmed an increased trend in the age-adjusted prevalence of metabolic syndrome. Abdominal obesity and elevated triglycerides had also increased time trends prevalence in both sexes. The prevalence of people without risk determinants of metabolic syndrome had during following period decreasing trend. A surprising finding is the decrease in the proportion of persons with suboptimal HDL-cholesterol.

Conclusions

During the period from 2003 - 2012 the results of our large cross-sectional study confirmed unfavourable increasing trends in the age-adjusted prevalence of MetS among the clients of Health Advice Centres and a simultaneous reduction in the number of persons without the presence of MetS risk determinants.

Key messages

Population study shows highly prevalence of metabolic syndrome in Slovakia. Metabolic syndrome prevalence results are more visible in population considering older age groups and males.
Current burden of cervical cancer in Bulgaria - epidemiological study
Authors: Karcheva M , Iordanov A , Tzvetkova S
Published: October 2020

Background

The risk factors of cervical cancer are well established and the disease is preventable through vaccination and early detection by screening. The disease ranks as leading cause of female cancer in Bulgaria. The objective of the research was to describe the current burden of cervical cancer in Bulgaria and medical decisions to improve women's health.

Methods

The information were summarized at the national level on the basis of official on-line database from the annual reports of the of the immunoprophylaxis activities of the National Center of Infectious and Parasitic Diseases (NCIPD), National Center for Public Health and Analyzes (NCPHA). Data for morbidity and mortality rate and vaccine coverage were analyzed and presented in tables and figures.

Results

Cancer registration has been compulsory in Bulgaria since 1952. National program for the primary prevention of cervical cancer was applied in 2012 (2012-2016, 2017-2020). From the same year was uses immunization against HPVs for 12 -year-old girls. Through these measures, the state guarantees the right of citizens to affordable primary prevention without imposing obligations. Despite the preventive strategy, the expected results are not observed. In 2018, the total number of registered malignancies of the cervix was 15759. The incidence of 100,000 population was 435.8. Of these, the number of newly diagnosed cases were 850, the incidence was 23.5 per 100,000 population. HPV vaccination coverage in girls by birth cohort was 15.1% - 1st dose and 14.3% - 2nd dose for 12-year-old girls and 7% - 1st dose for 13-year-old girls.

Conclusions

Bulgaria has a leading position in the incidence and mortality of cervical cancer among European countries, requiring mandatory screening and immunization against the Human Papilloma viruses.

Key messages

Cervical cancer, incidence rate, mortality rate. Vaccination coverage, HPVs, Bulgaria.
The potential for coronavirus transmission in waters: what do we know?
Authors: Carducci A , Federigi I , Verani M , Liu D , Thompson J R
Published: October 2020

Background

Although the main route of transmission of SARS-CoV2 is via droplets and close contact, concerns about the possible secondary transmission via waters is growing given evidence for SARS-CoV2 faecal elimination. Here we review studies on coronavirus in water environments.

Methods

A review was carried out of papers writen in English on PubMed, Scopus and Web of Science. Papers were identified using the keywords: coronavirus, SARS, MERS, Covid-19 associated with water, surface water, drinking water, wastewater, sewage, slurry, sludge, biosolid. Papers were screened using their title and abstract to confirm their relevance. They were then reviewed to identify: coronavirus type and strain, type of water sample, type of study, detection methods, monitoring data, survival data, effect of disinfection and treatments.

Results

Since 1978, only 18 papers met the selection criteria. Of these, 11 reported experimental studies, 6 field studies, and one included both field and experimental work. Experimental studies were carried out using samples spiked with SARS-CoV or surrogates: 4 addressed the recovery efficiency of detection methods; 3 reported studies on virus removal from waters by different treatments; 7 were focussed on survival in water samples with results ranging from 2 to > 100 days, depending on virus, type of water, temperature, and detection method. Field studies monitored the presence of coronavirus in waters, sewage, slurry or biosolid. The included in total no more than 200 samples and used different detection methods. Some samples tested positive in 5 studies.

Conclusions

While knowledge of coronavirus in waters appears very scarce and fragmentary, the recent SARS-CoV2 emergency demands new attention be focussed on its survival in natural conditions and following treatment in order to assess the risk of waterborne and food borne transmission as well as developing monitoring within sewage treatment facilities.

Key messages

The potential spread of SARS-CoV2 through waters cannot be excluded without better knowledge. Urgent research on this topic is required.
Are recently arrived migrants at higher risk of developing diabetes in Scania, Sweden?
Authors: Zdravkovic S , Grahn M , Rämgård M , Annersten Gershater M
Published: October 2020

Background

The world is facing increased migration as well as increased diabetes prevalence including earlier disease debut than ever before. Sedentary lifestyle and obesity constitute risk factors for development of diabetes type 2, the most common diabetes type among adults. It is thus important to increase the awareness of diabetes prevalence and of those being at risk for the disease. The aim was to focus on self-reported diabetes and weight in recently arrived migrants (RAM) in comparison with the rest of the population of Scania.

Methods

A cross-sectional study was used to collect data through random sampling using a self-administrated questionnaire. 10 000 questionnaires in Arabic were sent to adult RAM in Scania born in Syria or Iraq and 10 000 questionnaires to a random sample of the Scania population as a control group. The overall response rate was 32.8 %, 3461 were male and 3105 were female and the overall mean age was 44.7 (range 22 -70).

Results

170 RAM and 147 controls reported diabetes, 741 RAM and 585 controls reported a body mass index (BMI) ≥ 30 kg/m2. A significantly higher prevalence of self-reported diabetes was observed among RAM (6.2% compared to 4.9%, p-value = 0.02). In comparison with age, significantly (p-value < 0.05) higher prevalence was present in RAM as compared to the control group in all age categories except the age category 65-80 where the difference was borderline significant (p-value = 0.056). With regard to BMI no significant difference was observed between the RAM and the control group having diabetes, but independently of diabetes the prevalence of BMI 25-30 kg/m2 and BMI ≥ 30 kg/m2 was significantly higher in RAM (p-value < 0.01).

Conclusions

Self-reported diabetes is more prevalent in RAM as compared to a control group representing the rest of the population in Scania. Considerably large amount of the respondents in both groups are overweight or obese and are therefore to be considered at risk for developing diabetes type 2.

Key messages

Self-reported diabetes in Scania is more prevalent in RAM from Iraq and Syria than in the rest of the population in Scania. Health care services need to address that a large number of the population in Scania is being overweight or obese, which is even more prominent in RAM from Iraq and Syria.
Relationship between preterm birth and air pollution in Santos, Sao Paulo, Brazil
Authors: Brandao M E L , Braga B A L F , Martins M L C , Pereira P L A A
Published: October 2020

Santos is a seaboard Brazilian city recognized by its port activity where the road and rail infrastructure along with the large transportation operation, displays an important factor to contribute with all kinds of toxic and air pollutants. Recent studies have suggested associations between air pollution and various birth outcomes. Pollutant gases such as NOx, O3 and particulate matter PM2,5, PM10 have been cited as factors involved in such outcomes. The present study aims to assess the relationship between atmospheric pollutants and perinatal outcomes in the city of Santos from Jan. 2012 to Dec. 2015. Cross-sectional study that analyzed 10.319 singleton births in an area set with 2 km radius of the monitoring stations. Birth weight and information on mother and pregnancy were obtained at the Brazilian “Born Alive National Information System”. Daily records of air pollutants (PM10, PM2.5, NO2 and O3), temperature and relative air humidity, for the study period, were obtained from São Paulo State Environmental Agency (CETESB). Associations between preterm birth and air pollutants mean levels at each gestational trimester were investigated using multiple logistic regression model controlled by the variables: infant sex, type of delivery, maternal education. prenatal care, and number of previous live births, temperature and relative air humidity. NO2 e PM2,5 was not associated with preterm birth. O3 was significantly associated in the first trimester in the fourth quartile (OR = 1,47 CI 95% 1,05; 2,07). PM10 was significantly associated in the first trimester for the fourth quartile (OR = 1,28 CI 95% 1,00; 1,64), second trimester for the second quartile (OR = 1,37 CI 95% 1,07; 1,77).

Conclusions

the results shows evidence that maternal exposure to air pollution especially during the first trimester of pregnancy may contribute to preterm birth. Further actions are needed towards controlling air pollution are strongly recommended for promoting early-life health.

Key messages

This is the first research of this kind that was made in Santos. It brings important evidence of the impact in the life of the population, especially those whose is not even born yet. It can be used as a resource to guide public policies in health, especially the guidelines that dictate the concentration of air pollutants and air quality.
Overestimation of heat tolerance calls for health promotion to limit occupational heat risk
Authors: Hanna L
Published: October 2020

Background

Global warming is accelerating. One degree C warming across Australia has generated a six-fold increase in heat extremes, as days above 35oC (and upwards of 45oC) are increasingly common. Many industries require staff to engage in outdoor work, often involving high levels of physical intensity. Compliance with occupational heat guidelines is reportedly low. Adoption of health protective strategies requires accurate risk perception. Australian heat exposed workers report discomfort when working in hot weather, yet little is known about their personal risk assessment.

Methods

Heat exposed outdoor workers across Australia (n = 112) completed pre-study surveys about their personal heat tolerance and completed daily heat diaries (n = 3421) to record their thermal comfort, heat symptoms and productivity, whilst on-site maximum temperatures and humidity were monitored.

Results

Daily maximum temperatures ranged from 18-43oC, and WBGT levels in parts of Australia exceed hazardous levels most days throughout summer. Significant overestimation of thermal tolerance was reported, as “feeling too hot to keep working” and emergence of symptoms occurred up to ten degrees lower than expected.

Conclusions

Heat exposed workers consistently over-estimate their thermotolerance and capacity to perform physically intensive work. Increasing frequency and intensity of heat waves escalates future risks of health harm and deaths among heat exposed workers. Health protection necessitates active health education/ health promotion campaigns to better align perceived and actual health risks. Main messages: Global warming presents intensifying health and productivity threats. Widespread lack of recognition of personal health threats suggests a critical need for heath education/promotion to increase heat guideline compliance

Key messages

Increasing frequency and intensity of heat waves from climate change escalates future risks of health harm and deaths among heat exposed workers who over-estimate their thermotolerance. Widespread lack of recognition of personal heat exposure threats suggests a critical need for health education/promotion to increase heat guidelines compliance.
Oral health assessment in Senegal: stepwise method
Authors: Kanouté A , Diop M , Dieng S , Mbow S , Niang S , Gaye A , Cisse M K , Faye D
Published: October 2020

Background

The STEPwise approach to surveillance (STEPS) helps to assess the prevalence and risk factors of major chronic diseases. Designed to have the ability to integrate optional modules, it allows any attitude to collect data according to planning, prevention and advocacy strategies for the allocation of resources of member countries. The Ministry of Health of Senegal took the option in 2015 to include the oral health module in the STEPS program. This original public health approach has necessitated the development of specific methods and tools that are presented in this communication.

Methodology

On the initiative of the WHO Regional Office for Africa and the Ministry of Health of Senegal, behavioral, clinical and biological modules have been validated to identify risk factors and the prevalence of dental and periodontal diseases. Integrated into the Stepwise National Observational Transversal Study, including 6306 adults aged 18-69, these modules provide a framework for future studies. The evaluation of the program, via a SWOT analysis, formalizes the positive and negative points and identifies the factors of its environment that may favorably or negatively influence the recommendations.

Results

62.5% of subjects had never used oral care. The prevalence of caries was 76.3% with an average DMF of 5.5. Strong institutional political will to promote oral health as well as good intra sectoral collaboration emerge. However, the economic constraints remain for a sustainability as well as a limit in the harmonization and the political valorization of the data in terms of recommendations of strategies of health.

Conclusions

Integrating oral health into the Stepwise survey provides national information in a context of scarcity of resources. Obtaining integrated quality data should allow for a standardized extension of the program to other countries in the Africa region, subject to adjustments and corrective measures.

Key messages

Integrating oral health into the Stepwise survey provides national information in a context of scarcity of resources. Obtaining integrated quality data should allow for a standardized extension of the program to other countries in the Africa region.
Peer support program (P-SUP) to strengthen self-management in patients with chronic conditions
Authors: Giesen L , Könnecke H , Redaèlli M , Simic D , Heßbrügge M , Vitinius F , van der Arend I , Graf C , Biallas B , Stock S
Published: October 2020

Background

Chronic care programmes (CCPs) ensure a standardised, evidence based and structured patient care. In Germany, CCPs are successful in improving quality of care and making care more patient-centred. Regarding self-management support, however, the programs only feature patient education and shared decisions on treatment goals. Peer support has proven to be a successful component in outpatient care to enhance self-management. The aim of this study is to support patients with type 2 diabetes and coronary artery disease in conducting successful self-management through a multimodal program.

Methods

This randomized controlled trial (RCT) is set up for 27 months and will include a study population of approximately 1800 patients, beginning in summer 2020. The primary outcome (PO) is the reduction of hospital admissions. In addition to the PO, secondary outcomes include motivational and knowledge-based aspects. Furthermore, health-competitive and health-economic data will be collected. The formative evaluation will review the processes for implementation. The central element of the intervention will be peer support groups, in which the group will participate in physical activities and educational lectures on nutrition, exercise or disease related knowledge. Additionally, a specially designed online platform, personalized feedback for patients on medical outcomes from their family doctors, and regular telephone coaching to increase intrinsic motivation and activation will be provided.

Results

In addition to the primary outcome (reduction of hospital admissions), increased motivation levels, improved quality of life and increased health literacy are expected.

Conclusions

This project, funded by the Federal Joint Committee (establishment of statutory health insurance funds and medical providers in Germany), can serve as a blueprint for future implementations of public health approaches and accessible care models for patients with chronic conditions.

Key messages

Peer support as a successful method to enhance self-management in patients with type 2 diabetes and coronary artery disease. A multimodal program, consisting of peer support groups, an online platform, personalized medical feedback and telephone coaching, aiming to improve quality of life in patients with chronic conditions.