bluuebunny/crossref_metadata_2025 huggingface dataset:
Mexico’s health system: in longstanding pursuit of universal coverage and integration
Authors: González Block M , Reyes H , Cahuana Hurtado L , Balandrán A , Méndez E
Published: October 2020

Mexico's system is dominated by corporatist, social insurance organizations governed by employer and employee trade unions in close relationship to the federal government, supplemented with government services for the uninsured, and a thriving private sector. Social insurance covers about half the population, although coverage for most is sporadic. Furthermore, these organizations have divergent service, financing, and governance structures, posing inequities and barriers in responding to beneficiary needs. Profiting from a growing capacity gap, the private sector now provides almost half of total outpatient consultations. Major public health challenges include obesity and diabetes, and social and health inequalities. Fiscal policy and improved preventive programs across institutions have had some effect on reducing health risks. Health policy has aimed towards universal coverage through coordinating government providers and strengthened public health programs. Since 2004 Seguro Popular had made progress toward universal health coverage, protecting about 85% of the population, reducing catastrophic expenses, and increasing coverage of high-cost interventions. However, to address health care package limits, attain universal financial protection and respond to corruption, President Lopez Obrador's administration canceled Seguro Popular from 2020 and established the National Health Institute for Wellbeing (INSABI). INSABI aims to equalize benefits across the insured and uninsured and re-centralize health authority by establishing the federal government as sole funder and provider of coverage for the uninsured. The separation of funding and provision, a hallmark of Seguro Popular, was replaced with supply-side funding, following the social insurance model. While these policies have challenges, they could facilitate integrating social insurance and tax funding into a single-payer capable of increasing efficiency and continuity of care as well as achieving greater equity.
Care integration as means for developing efficiency in budget constraints
Authors: Sinervo T
Published: October 2020

Background

Care integration has been an aim in government policies since 2000s in Finland. In 8 counties municipalities have created regional joint health and social care authorities in responsibility of all health and social services to boost service integration. Joint management gives possibilities to change organizational structures and organizing care paths in new ways. Most of these joint authorities suffer from severe budget constraints and layoffs has been done. Care integration has been seen as alleviating in budget constraints and to increase efficiency. In this study the views of top and middle managers and personnel on care integration as means to develop efficiency is explored.

Methods

A large, newly established joint authority of 200000 inhabitants participated the study. The joint authority had a large gap in its budget, hence layoffs were planned. We compiled a data of regional policy documents, carried out individual and group interviews of management (21) and a survey to employees (N = 2047). In the interviews, views of top and middle managers on how efficiency should be developed and on views of care integration in relation to efficiency were studied. The views of employees were explored in the survey.

Results

The joint authority was launched in a very short time and care paths were not planned before the organizational change. The managers saw that siloed practices created inefficiency and care integration increasing efficiency although the research evidence was seen insufficient. In the survey the views of the employees of developing efficiency and care quality were more negative than managers. Both groups, however saw that care integration was underdeveloped. Developing integration especially at primary level became also a key strategy of the joint authority.

Conclusions

Joint management creates a good basis for integration. The implementation of care integration, however, requires managers' collaboration and organisational culture supporting integration.

Key messages

In managers views care integration can increase efficiency. Joint management is a good basis for integration, but care processes have to be planned.
A case control study for factors of Multidrug Resistant Tuberculosis in East Sikkim, India
Authors: Zaman F A , Mehta V K
Published: October 2020

Background

Tuberculosis (TB) remains a major public health problem in the developing world and India is the highest TB burden country in the world in terms of absolute number of incident cases that occur each year. The emergence of Multidrug Resistant Tuberculosis (MDR TB) is posing threat to global efforts of TB control. The hilly state of Sikkim has the highest proportion of MDR TB cases in India. Hence there is an emerging need to identify the factors for the rapid rise of MDR TB in Sikkim.

Methods

All the MDR TB cases registered under Revised National TB Control Programme in East district of Sikkim in the first & second quarter of 2019 was compared with double the number of matched controls taken from the same geographical area and ethnicity but not from the same family members.

Results

A total of 78 cases and 156 controls were studied. The mean age of the study participants was 43 years (SD ± 14 years). The most statistically significant risk factors were as follows: overcrowding (OR 2.68); household air pollution (OR 2.55); inadequate ventilation (OR 2.05); previous history of tuberculosis (OR 4.03) with history of relapse/failure; known contact of MDR tuberculosis (OR 4.01); having diabetes (OR 3.96); smoking (OR 3.96)

Conclusions

This study shows that clinical and demographic features can be used to indicate higher risks of drug resistance in this setting. Information was obtained on why Sikkim being a small State with very less population and a good per capita expenditure in health has the highest proportion of MDR-TB in India.

Key messages

Sikkim is the smallest state in India with the highest proportion of MDR TB. Previous history of TB with history of relapse/failure, contact of MDR TB emerged as the most significant risk factors.
Ethical challenges experienced by researchers in community-based participatory research
Authors: Wilson E , Kenny A , Dickson-Swift V
Published: October 2020

Background

Political, economic and climate events continue to bring the dismantling of communities and creation of new ones. Understanding successful models of adaptation and working with communities to address their health and wellbeing needs requires ethically sound public health research. Community-Based Participatory Research (CBPR) has been proposed as an equitable, empowering partnership approach to collaborative health research that encapsulates analysis, advocacy and action for the future wellbeing of communities. Meanwhile, a strong interest in ethical implications of CBPR continues in international literature, yet with a notable lack of research that captures the experience of researchers who had ethical challenges in their CBPR studies. The aim of this research was to address this lack of evidence by exploring those experiences of CBPR researchers internationally.

Methods

An innovative data collection method was designed utilising a purpose-built blog. This internet-based, qualitative online study enabled asynchronous international data collection on the blog. Participants were researchers with experience of CBPR and were recruited through social media platforms. Blog narratives of first-hand experiences of CBPR researchers were analysed using thematic analysis.

Results

The themes that emerged from blog data analysis were researchers' challenges with balancing participant protection and autonomy, dealing with partnership tensions, and the enduring impacts on the researchers.

Conclusions

This study enhances our understanding of ethical challenges in CBPR with evidence of enduring impacts on researchers of the 'tightrope' they walked in the interests of maintaining research integrity and ethical responsibility towards their partnering communities. Challenges arose largely from complexities of CBPR coupled with rigid regulatory structures of human research ethics review that struggles to respond adequately in the interests of communities and researchers.

Key messages

At this critical time for the future of humanity, communities can benefit from CBPR. A positive way forward for ethical review of CBPR exists for those with power to make a difference.
DNA debate. An online public engagement initiative
Authors: Mayeur C , Van Hoof W
Published: October 2020

Because of personalized medicine and the need for massive data sharing, genomics is becoming everybody's business. There is a need to raise public awareness and to make citizens' voices heard on the ethical, legal, and societal issues (ELSI) in genomics. Therefore, Sciensano - the scientific Institute of Public Health in Belgium - organized an online public debate on the use of genomic information in health care, to produce recommendations based on citizens' values for health policymakers, related experts, and stakeholders.

To launch this public debate, Sciensano created an interactive website with a discussion platform. We provided more than 75 high-schools with an educational package to help them organize the debate in classrooms, and organized an essay contest. We developed an online teaser test, based on 15 ethical dilemmas in genomics, and a short information video. The DNA debate was covered by national newspapers, television, and radio stations.

In total, 1106 users voiced 1247 opinions on the website. Preliminary results from the qualitative analysis of these contributions show great diversity in societal norms and values surrounding genomics. The general interest for the DNA debate indicates that citizens realize that genomics can have a big impact on the organization of health care and that they are willing to contribute to the discussion about how genomic information should be governed in society.

This DNA online debate shows that citizens can make meaningful contributions to a complex field like ELSI in genomics. Continued involvement of the public in the governance of genomic information in society is vital. It ensures that societal norms and values guide the technology and not the other way around.

Key messages

The online DNA debate raised public awareness and made citizens’ voices heard on the ethical, legal, and societal issues in genomics. Continued involvement of the public in the governance of genomic information in society is vital.
Life expectancy and healthy life years associated with diabetes in Germany
Authors: Baumert J , von der Lippe E , Paprott R , Du Y , Reitzle L , Heidemann C , Schmidt C , Scheidt-Nave C
Published: October 2020

Background

While life expectancy (LE) is rising, years lived with severe health impairments especially due to chronic diseases also increase. Diabetes is one of the major chronic diseases with high potential for co-morbidity and premature deaths needing life-long care. Therefore, information about loss in LE and healthy life years (HLY) in people with diabetes compared to people without diabetes is essential for assessing the burden of diabetes.

Methods

Data on all-cause mortality rates for the general population of Germany in 2014 was drawn from the Federal Statistical Office; mortality rate ratios for people with diabetes compared to people without diabetes were based on claims data from about 70 million people covered by statutory health insurances in 2014. Data of three nationwide health telephone surveys conducted among adults in Germany 2009-2012 (n ∼ 60,000) were used to assess severe health impairments defined as self-reported limitations in daily activities due to diseases for at least six months in people with and without diabetes. Based on these figures, estimates on LE and HLY could be calculated by sex and 5-year age-groups for people with and without diabetes aged ≥ 30 years.

Results

In both sexes and in all 5-year age-groups, LE and HLY were substantially lower for people with than for people without diabetes. For example, among women in the age group 30-34 years, LE and HLY estimates were 48.0 and 36.4 years for those with diabetes compared to 54.9 and 47.6 years for those without diabetes; in men, these figures were estimated as 42.6 and 32.4 years for those with diabetes compared to 50.3 and 44.1 years for those without diabetes. Differences in LE and HLY between people with and without diabetes attenuated with increasing age.

Conclusions

The present study revealed substantial reductions in LE and HLY related to diabetes and underlines the importance of integrating both figures in a national diabetes surveillance.

Key messages

There are substantial differences in life expectancy and healthy life years between people with and without diabetes. Specific intervention and prevention activities should be implemented to tackle disability in persons with diabetes.
Type 2 Diabetes Mellitus in urban and rural districts in the area of Wolisso Hospital, Ethiopia
Authors: Madia A , Soprana M , Mele A , Kadhim C , Binello N , Lanzafame A , Cori M S , Battistella C , Azzimonti G , Putoto G
Published: October 2020

The prevalence of Diabetes Mellitus has been rapidly growing in developing countries, both in urban and rural contexts. Ethiopia has the largest diabetes population in sub-Saharan Africa (2.6 million adult people). At Wolisso Hospital, a collaboration is underway between Doctors with Africa CUAMM and the local Association of Diabetic Patients, with the aim of guaranteeing the correct monitoring and treatment of the disease.

Between December 2018 and May 2019, 244 diabetic patients were visited in a dedicated outpatient room in Wolisso Hospital; in 55 selected patients (type 2 Diabetes Mellitus, ≥ 2 visits in the 6 months, on insulin therapy), a further set of variables was measured, including: modality of insulin storage, monthly glycemic measurements, compliance with prescribed therapy, glycemic control, knowledge of glycemic target.

Based on their urban or rural provenience, patients were split in two groups (27 urban, 28 rural). The χ2-test was used to determine significance. P ≤ 0.05 was considered statistically significant. A statistically significant difference was reported for the following variables: availability of a fridge for insulin storage (51.9% urban vs 21.4% rural, p = 0.039), compliance with prescribed therapy (63.0% urban vs 35.7% rural, p = 0.043), prevalence of hypertension (55.6% urban vs 28.6% rural, p = 0.043), alcohol consumption (32.1% rural vs 11.1% urban, p = 0.018). 13/27 urban patients and 21/28 rural patients reported that they stored insulin in the sand. No substantial variation between the groups is observed for BMI, glycemic control, number of monthly glycemic measurements and knowledge of glycemic target.

The differences highlighted between type 2 diabetic patients from urban and rural districts of the area of Wolisso suggest that these populations probably have different features and risk factors; this consideration may be useful in the organization of specific public health interventions aimed at addressing the issue in the different settings.

Key messages

The prevalence of Diabetes Mellitus has been rapidly growing in developing countries, both in urban and rural contexts. The differences highlighted between type 2 diabetic patients from urban and rural districts of the area of Wolisso suggest that these populations probably have different features and risk factors.
Overview of equity in maternal health care coverage by ethnicity
Authors: Armenta-Paulino N , Sandín Vázquez M , Bolúmar F
Published: October 2020

Background

Indigenous women are one of the most vulnerable groups in Latin America. They experience substantially worse maternal health outcomes than most of the population and less likely to benefit from services. Therefore, inequities in maternal health care between different ethnic groups should be monitored to identify critical factors that could limit health care coverage.

Methods

Cross-sectional analysis of the continuum of maternal health care, the indicators covering the continuum of women's care from pregnancy to the puerperium were estimated. We used nationally representative demographic surveys from Bolivia, Guatemala, Mexico, and Peru (2008-2016) to explore the coverage gaps across maternal health care by ethnicity. Women were classified as indigenous through self-identification, and we measured a relative inequality by ethnicity through the estimation of adjusted coverage ratios (CR), CR = 1 means that the coverage is equal between indigenous and non-indigenous. We estimated the CR with Poisson regression models adjusted for sociodemographic variables.

Results

Indigenous women in all four countries had less coverage than non-indigenous in the continuum of maternal healthcare. The most relevant inequalities occur in the coverage of skilled-birth-attendant and in the use of contraceptives, mainly for Bolivia [CR = 0.64, p < 0.001; CR = 0.91, p < 0.001] and Guatemala [CR = 0.78, p < 0.001; 0.77 (0.73;0.80), p < 0.001]. Peru and Mexico are the countries with the smallest gaps throughout the continuum care and Guatemala with the largest.

Conclusions

The differences observed reflect the inequities that indigenous women face in the coverage of maternal health care. Therefore, it is useful and necessary to monitor ethnicity inequalities to identify the factors that limit the coverage of care that indigenous women receive to design culturally appropriate programs and policies to reduce the risks of maternal mortality and the inequities in care that indigenous women face.

Key messages

As long as the inequalities persist, identifying them will be the first step in their elimination. If not reduce the differences in care, it will be difficult to reduce maternal mortality that indigenous women face.
The FOODia-Net Protocol
Authors: Graps E A , Giuliani R , Graffigna G , Bosio C , Damiani G , Francesconi P , Chiaramonte F , Lattanzio F , Franchetti M , Castelli N
Published: October 2020

The increasing of chronic diseases represents a worldwide issue and conceiving effective operating models of preventive care looks mandatory to satisfy new health and social needs. It is known from Evidence-Based Medicine that to combine a multidisciplinary/multiprofessional care approach with the promotion of patients’ health literacy and correct lifestyle can improve chronic diseases management at global level.

Five Italian Regions are currently collaborating in the framework of the National Centre for Diseases Prevention and Control Research Call funded by the Italian Ministry of Health. The Project ultimate goal is the implementation of an innovative skill-mix-change operating Protocol aimed to promote patient engagement and food literacy about diabetes and its complications. To pursuit this objective and to conduct the Project dissemination activities, the creation of a dedicated web-based platform is scheduled. The assessment of the effectiveness and sustainability of the whole Project is foreseen.

A non-systematic review of available publications about existing skill-mix-change approaches designed to promote food literacy and patient engagement has been performed and a cross-sectional study to investigate food literacy of diabetic patients has been drawn up. It was approved by Local Review Board in February 2020. Meanwhile a requirements audit among Partners has been carried out to outline the ICT framework for commissioning the creation of the web-based platform to support dissemination activities.

The Project is ongoing. With the aim to preliminary map existing educational initiatives on diabetes an initial scenario analysis shows that: counselling initiatives are performed in 89% of GPs groups; patient engagement initiatives in 52% and training initiatives in 58%. Training initiatives for professionals take place in 27% of clinics; at least 1 initiative, on diabetes prevention or food literacy promotion, is carried out in each of the 9 Associations registered.
17.D. Workshop: Healthier populations through addressing environmental health topics and the SDGs
Authors:   Organised by: EUPHA Environment and health section, Regional Health Network of WHO Europe,   Chair persons: Julia Nowacki - Germany, Marija Jevtic - EUPHA-ENV
Published: October 2020

The strategic priority of promoting healthier populations with 1 billion more people enjoying better health and well-being as expressed in the General Programme of Work (GPW) 13 by the World Health Organization (WHO) emphasizes the need of multisectoral action to address the social and environmental determinants of health including climate change. WHO data from 2016 show that approximately one quarter of the global burden of disease are caused by known avoidable environmental risks to health, with at least 12.6 million premature deaths every year. Out of this total, 7 million deaths a year are attributable to both ambient and household air pollution, placing it among the top global preventable health risks. As human influence on the environment continues to grow, global environmental challenges will escalate, including climate change and rapid urbanization. Many of the resulting risks exacerbate disease and injuries, while impacting our quality of life, reducing our productivity, and weighing on our health systems. The global endorsement of the sustainable development agenda with its Sustainable Development Goals (SDGs) provides a clear signal that the world expects greater cohesion between people and the planet, with benefits for health and health equity. More sustainable ways of functioning go hand in hand with creating healthier and more sustainable environments, with enhanced focus on prevention through action on the root causes of disease.

The SDGs set a broad agenda to advance health and equity by 2030. Health is centrally positioned within the SDGs, with SDG 3 - Ensure healthy lives and promote well-being for all ages. However, achieving this goal means more than just improving health care. It involves action in key economic development sectors, like housing and transport, as well as in the settings where people live and work in cities and rural areas. These areas are covered by SDGs such as: Achieving Affordable and Clean Energy (SDG 7), Sustainable Cities and Communities (SDG 11), and Climate action (SDG 13). Progress on these SDGs will not only significantly reduce but also support primary prevention of some of the world's most serious disease threats - including heart and lung diseases, cancers, stroke, injuries, and more. At the workshop different topics and tools that support the achievement of WHOs one billion goal of achieving healthier populations and through this the SDGs will be discussed.

Key messages

By addressing environmental health risks through progress on SDGs supports also the 1 billion goal to achieve healthier populations. Multisectoral action and turning this action into everyday practice is needed to support achieving the SDGs and the 1 billion goal of WHO.
Conversion of industrial contaminated sites into residential areas –safeguarding health and wellbeing
Authors: Nowacki J , Braubach M , Baranyi G
Published: October 2020

Across Europe, urban settlements are changing and expanding. Due to lack of land resources, urban development often relies on the re-use and conversion of former industrial areas - land which has had special functions before but now is being used for urban, public, recreational and residential functions. This challenge is often referred to as land recycling or brownfield conversion, and is associated with urban processes labelled e.g. urban sprawl, renewal, revitalization, regeneration or redevelopment.

Urban revitalization and the use of former non-residential land for urban functions raise potential challenges related to health, wellbeing and equity. The use of former industrial areas can be associated with contamination which, if not fully remediated, can pose health risks to new residents. With increasing urbanization in many countries there is a need for cities to provide new residential areas.

The WHO Regional Office for Europe is developing a compilation of health impacts of such urban land-take processes - including a review of lessons learned and a collection of practical experiences - that can provide better understanding of the scope of the problem, related health challenges and guidance for action for countries and cities where such conversion projects take place. The work will contribute to achieving SDG 11 by discussion practical processes for multi-stakeholder engagement in all stages of urban development that build consensus, inclusion, resilience and sustainability when converting former industrial areas into residential areas.

The presentation will focus on environmental, social and health implications and experiences of urban and residential use of land resources with formerly different functions. The presentation will include lessons learned regarding the assessment of risk associated with land contamination etc.
Health care’s climate footprint: the health sector contribution and opportunities for action
Authors: Karliner J , Slotterback S , Boyd R , Ashby B , Steele K , Wang J
Published: October 2020

While vastly differing in scale, each nation's health sector directly and indirectly releases greenhouse gases (GHG) through energy consumption, transport, and product manufacture, use, and disposal. Until recently, however, the health sector has not been measured as a coherent segment of the world's climate footprint. A 2019 report by Health Care Without Harm, in collaboration with Arup, provides the most comprehensive global analysis of health care's contribution to climate change to date, based on full global coverage of spending data together with detailed information from 43 countries. It identifies key sources of health care emissions while allowing for comparison between nations and among many regions of the world. Among the report's key findings are that health care's climate footprint is equivalent to 4.4% of global net emissions; that the top three health care emitters-the United States, China, and the European Union-comprise more than half of the global footprint; and that 71% of emissions are derived from the health care supply chain. The findings inform a series of international, national, and subnational policy recommendations for health care climate action, and it identifies opportunities for further research and methodological development to support the health sector in its efforts to understand and address its climate footprint. Additional findings from 2020 will also be presented. Ultimately, these estimates of health care's climate footprint provide the baseline information needed to devise pathways and track progress toward health care de-carbonization across the sector.
Regions for health case study: Turning Welsh legislation for sustainable development into everyday practice
Authors: Weatherup C , Zambon F
Published: October 2020

In 1998, Wales became one of the first nations in the world to have a legal requirement in relation to sustainable development. The introduction of the Well-being of Future Generations (Wales) Act 2015 bolstered previous schemes, by providing an enabling framework for thinking and working differently, and embedding a Health in All Policies approach. With seven well-being goals which aim to make Wales a healthier place, where the social, economic, environmental and cultural well-being of Wales is improved, the Act impacts on public bodies, including local authorities, to make sure that when making their decisions they take into account the impact they could have on people's well-being, that they involve citizens, and they look to the future as well as focusing on the now. Wales also became one of the first nations in the world to establish a legislative link to the international SDGs.

A new report gives practical examples and case studies demonstrating how organizations can respond to the legislation. Informed by a review of the international evidence, the report makes five key recommendations for practical implementation of sustainable development principles.

Although the report reflects the Welsh public sector context, the findings can act as a go-to guide for any organization seeking to address global issues such as climate change, biodiversity and de-carbonization, as well as to implement the globally agreed Sustainable Development Goals (SDG). The report is positive about the Welsh legislative approach; suggesting it could make a significant and long-lasting difference to the people living in Wales, with the potential to set an example globally.

The presentation will provide examples on how this is translating into practical action for the Welsh NHS system change including collective action on a de-carbonization pathway and how staff and the wider public are being motivated and engaged to 'Be The Change'. to create a network of champions will be given.
HIV-targeted health promotion: Can we learn from the experience in Tanzania?
Authors: Gross M
Published: October 2020

The overall rise in deaths from preventable communicable diseases in the African Region is of utmost concern from a public health perspective. Sub-Saharan Africa (SSA) is home to a severe generalized HIV epidemic with the value of targeted health promotion only recently gaining momentum. The transport sector and transport corridors represent a major transmission route for HIV, fueled by unemployment, multiple sexual partnerships, gender-based violence (GBV), migrant workers and poor access to quality health information and services. In Tanzania, targeted sensitization and health promotion interventions spanning two major road corridors and their large-scale construction projects led to improved knowledge and behavior change among the road construction workers, community leaders and local residents in the communities along the road project as measured during a baseline and end line survey. Taking a comprehensive approach to health promotion the road project in Tanzania focused on: Educational and behavioral change campaigns, aimed via road shows at creating awareness on HIV and AIDS, STI, TB and GBV and encouraged people to know their sero status at mobile outlets of the HIV Counselling and Testing Services (HTS) during community bonanzas, featuring edutainment.Training peer educators from communities and road construction workers on basic knowledge and communication skills to transfer information along the roads, within the communities and in the nearby schools.Establishing village multi-sectoral HIV/AIDS committees.Development of SBCC materials with targeted messages to road construction workers and community members, developed jointly with multiple stakeholders.HIV Testing Services in collaboration with districts and health facilities along the roads.Capacity development of health workers and relevant stakeholders.

Lessons learnt can provide guidance for similar settings in SSA and stimulate also a fresh view on promotive activities in Europe.
Interprofessional health education and its impact on integral healthcare
Authors: Silva C , Abreu L , Santos K , Santos S , Figueiredo A
Published: October 2020

Background

Interprofessionality is a tool for optimizing the human resources available towards the consolidation of a resolutive healthcare. However, applying it is a challenge due to the fragmented training of health professionals.

Objective

to describe the experience of planning and executing an interprofessional health education activity.

Methods

An educational workshop was developed aiming at interprofessional health practice. A clinical case was distributed, which addressed the story of an elderly person who suffered a stroke and lived with the sequels of this episode in addition to emotional trauma from the experience. Each professional was asked to define a therapeutic proposal for the case and one of them was invited to present his proposal and complement it based on the suggestions of the other members.

Results

the workshop enabled the perception that, in isolation, no profession would be able to fully contemplate the patient's needs. Therefore, it encouraged the use of integrated action between different professionals by demonstrating that punctual and disjointed actions would not be sufficient to act effectively in the care and needs related to the individual's health.

Conclusions

the final product of this workshop resulted in a consistent activity contemplated by multiple perspectives, experiences and knowledges which would not be so successful if planned in isolation by a single professional group.

Key messages

Due to its low cost, interprofessional action responds to the new health needs of contemporary times and its implementation is of great value in combating the fragmented trend in health training. The interprofessional view is a common ground to health not only where the study took place but worldwide, consolidating itself as a valuable asset to the construction of integral healthcare.
Improving pertussis vaccination in pregnant woman. A new pathway in an Italian Local Health Authority
Authors: Massetti L , Saracino S , Scaccia F , Rossetti R , Moroni V , Marcolini P , Fiacchini D , Cimini D , Branchesi E , Poscia A
Published: October 2020

Pertussis is quite common in adolescents and adults, but it is especially dangerous in new-borns. The national immunization plan (NIP) 2017-2019 recommended a Tdap booster for every pregnancy at 28-36 weeks, but adherence is still far from the optimal level. This work aims to evaluate the effectiveness of a dedicated pathway organized by the department of prevention to improve the Tdap coverage among pregnant woman attending antenatal class.

The women attending from November 2019 to October 2019 the public antenatal class organized by the local health authority have been evaluated for their Tdap coverage in pregnancy. From May 2019, public health experts have been involved for 30 minutes during the first lesson to explain the NIP with a focus on vaccination in pregnancy. Then the eligible women (28-36 weeks not yet vaccinated) who voluntarily agree were accompanied to the ambulatory to be vaccinated. Pre-post Tdap vaccination coverage and pregnancy weeks at vaccination have been evaluated respectively by chi2 and t-test.

90 pregnant women have been included in the study. Their mean age was 32.3 (SD 5.2) and the overall Tdap coverage was 44.4%. The Pre-post Tdap coverage was 26.7%(12/45) before May 2019 and 62.2% (28/45) after the introduction of the new pathway (p = 0.001). 50% of the vaccinated women decided to receive the booster the same day of the antenatal lesson, while the remaining 50% delayed the vaccination till a maximum of 30 days. We observed a clinical, but not statistically, significant anticipation in the pregnancy week in which they received Tdap booster (32.4 weeks before and 31.3 after May 2019; p = 0.150).

The introduction of a short intervention on vaccination in the antenatal class followed by the opportunity to receive the booster in a dedicated time and without waiting list significantly improved the Tdap coverage in pregnancy. This study encourages the cooperation among the different public health actors involved in the field of antenatal care.

Key messages

Antenatal class represents a great opportunity to improve vaccine confidence in pregnant women. Intervention aimed to ameliorate vaccine convenience could improve Tdap coverage in pregnancy.
Root internalization of Salmonella Typhimurium in basil plants
Authors: Scattolini S , D'Angelantonio D , Di Lollo V , Mancini V , Serio A , Centorotola G , Di Marzio V , Olivieri S , Pomilio F , Aprea G
Published: October 2020

Background

Foodborne pathogens present in soil or irrigation water have the potential to internalize via root into edible parts of the plants and survive, representing a serious hazard for consumer's health (1). The present work assesses the ability of Salmonella Typhimurium (ST) to enter basil plants (Ocimum basilicum L., cultivar “Napoletano”) from roots. This situation may represent a risk in food safety since that vegetable is largely used raw/undercooked, in the Mediterranean diet.

Methods

Sixteen basil plants were cultivated in hydroponics, from the seeds. Roots from 14 plants at 4 leaves-stage were individually immersed in liquid media contaminated with a suspension of ST isolated from Aterno river in Abruzzo region, Italy (9 log10 cfu/mL final concentration). Two plants were used as negative controls (no ST challenge); surface swabs were taken from leaves and stems to exclude external contaminations. After 24 hours, plants were tested for detection (UNI EN ISO 6579-1:2017) and enumeration (in-house method) of ST in leaves and stems.

Results

ST detection gave positive results in 14/14 plants; in particular, ST was present in 14/14 plants in the leaves and for 9/14 plants also in the stems. The internalized ST strains were also enumerated in 10/14 plants. In particular, 3/14 plants gave positive results both in the leaves and stems, 2/14 only in the stems and other 5/14 only in the leaves. The average ST counts were of 4 log10 cfu/g in leaves and stems. All negative ctr/surface swabs were negative to ST.

Conclusions

Even though antimicrobial properties of basil plants have been described (2), this study demonstrated the potential of ST to internalize, survive and spread to edible parts. The findings highlight the risk of human infections by ST in plant following root uptake, suggesting the importance of applying appropriate preventive pre-harvest strategies.

Biblio

EFSA. E. Jour. (2014);12(3):3600 Tenore et al. (2017). Natural product research, 31(17), 2067-2071

Key messages

The ability of Salmonella Typhimurium to internalize, survive and spread to edible parts of basil plants. Pathogenic bacteria root uptake represents a potential risk for human health.
Roma socioeconomic status has higher impact on smoking behaviour than genetic susceptibility
Authors: Merzah M A , Pikó P , Ádány R , Fiatal S
Published: October 2020

Background

Prevalence of smoking in Hungarian Roma (HR) population is two to five times higher than in Hungarian general (HG) population. Our study aims to examine genetic susceptibility and other possible determinants associated to smoking behaviours in these populations.

Methods

A questionnaire based cross-sectional study was designed in HG (N = 412) and HR (N = 402) populations. Ten Single Nucleotide Polymorphisms (SNPs) were genotyped known to be robustly linked to smoking behaviours. Risk allele frequencies were compared. Additive genetic risk scores (unweighted GRS and weighted GRS) were constructed to compare genetic load from SNPs in genes NRXN1, CHRNA5/4, AGPHD1, MAOA, TRPC7, KCNJ6, GABRA4, and CYP2A6. Smoking behaviour were associated with GRSs and confounders (age, gender, BMI, socioeconomic status-SES) in several regression models. SES was calculated based on Modified Kuppuswamy scale 2019.

Results

Risk allele frequencies of four SNPs were found to be different between populations (p < 0.01). Median of GRS was equivalent among in populations; whilst wGRS median was slightly higher among Roma (5.2 compared to Hungarian 4.9; P = 0.02). In Roma both genders were more likely to be heavy smoker (OR = 2.05, 95%CI: 1.47-2.86; OR = 1.89, 95%CI: 1.58-2.25, for males and females, respectively) compared to counterparts from general population. GRS were higher among heavy smokers of both populations compared to other smoking behaviours (ORRoma= 1.06, 95%CI:0.98-1.15; ORHungarian=1.05, 95%CI=0.91-1.2). Strong reversible relationship was found between SES and smoking behaviours among study populations (p < 0.0001). Heavy, moderate, and former smokers were having lower SES compared to never smokers of both populations (SES β=-0.037, P = 0.04 for Hungarian; β=-0.039, P = 0.02 for Roma).

Conclusions

Socioeconomic status was shown as a priority indicator based on multifactorial regression analysis. The highest efforts should be focused on improving the SES of Roma population.

Key messages

Result of this study indicate the priority impact of SES instead of genetic susceptibility on Roma smoking behaviours variations. Interventions on improving socioeconomic status of the Roma might result in decreasing their cigarette consumption.
Trends in mortality due to noncommunicable diseases in Brazil and the sustainable development targets
Authors: Carvalho Malta D , Felisbino-Mendes M S , Teixeira R , Machado ÍE , Duncan B B , Ribeiro A L P , Velasquez-Melendez G , Passos V , Glenn S , Nagavi M
Published: October 2020

Background

Monitoring premature mortality due to noncommunicable diseases (NCDs) is a global priority, as part of the Agenda 2030.

Objective

The current study aims to describe the mortality trends and disability-adjusted life years (DALYs) lost due to NCDs between 1990 and 2017 for Brazil and states, projections for 2030.

Methods

We analyzed the following NCDs: cardiovascular diseases, chronic respiratory diseases, neoplasms, diabetes mellitus, comparing deaths and mortality rates between 1990 and 2017, for Brazil and states. The study used the concept of premature mortality used by the World Health Organization (30 to 69 years). The absolute number of deaths, mortality rates, DALYs, years of life lost (YLL), were used, comparing 1990 and 2017. We also analyzed the premature death fraction (YLL) for NCDs attributable to risk factors.

Results

There was a reduction of 35,3% from 509.1 deaths/100,000 inhabitants (1990) to 329.6 deaths/100,000 inhabitants due to NCD in 2017. DALYs rate decreased by 33.6% and the YLL rate by 36.0% in the same period. There was a reduction in the NCD rates in all 27 states. The main risk factors related to premature deaths by NCDs in 2017 among women were - high body mass index, diet risks, high systolic blood pressure, tobacco, and among men, diet risks, high systolic blood pressure, tobacco, high body mass index. Trends in mortality rates due to NCDs were declining in the period, however, after 2015, the curve reversed and fluctuation and tendency to increase rates were observed.

Conclusions

Trends of mortality rates by NCD were declining in the period, however, after 2015, the curve was inverted and the fluctuation and trend of increasing rates was observed, which can compromise the SDG goals in 2030.

Key messages

The austerity policies adopted and the economic crisis in Brazil after 2015, resulted in increased poverty and worsening NCD mortality indicators. With the NCD indicators worsening in 2015, SDG targets may not be achieved.
The prevalence of neutropenia in chemotherapy cancer patients at a provincial hospital, Thailand
Authors: Suwannapong Y , Chinwong D , Niamhun N
Published: October 2020

Introduction

Cancer patients with neutropenia (<1500 cell/mm3 absolute neutrophil count [ANC]) are at high risk of febrile neutropenia and serious complications which can cause the delay treatment, reduction of chemotherapy dose, leading to morbidity and mortality. We lack of information of the prevalence of neutropenia in Thailand and its' consequences. Thus, this cross-sectional study aimed to investigate the prevalence of neutropenia at a provincial hospital in northern Thailand.

Methods

We retrospectively reviewed electronic medical records of cancer patients with solid tumor and receiving chemotherapy from September 2018 to October 2019.

Results

A total of 248 cancer patients (79 men, 169 women, mean age of 58.36±12.03) were included. The top 3 cancers were colon, breast and lung cancer (50.53%, 34.33%, 6.88%). They received chemotherapy 1,803 cycles of treatment. The top 3 regimens of treatment were FOLFOX (oxaliplatin/ fluorouracil/ leucovorin), AC (doxorubicin/ cyclophosphamide) and paclitaxel (42.65%, 17.75%, 9.67%). The prevalence of neutropenia (<1500 cell/mm3) was 264 episodes: 64 episodes of ANC 1,000-1,500 cell/mm3 (3.55%); 172 episodes of ANC 500-1,000 cell/mm3 (9.54%); and 28 episodes of ANC <500 cell/mm3 (1.55%). Most of them were postponed the treatment, but 16 episodes were still received chemotherapy. The dose of chemotherapy in 78 episodes were decreased and 16 episodes were related to the treatment of febrile neutropenia. The treatment of febrile neutropenia chemotherapy patients was 8 + 3 days with an average of US$ 400 per person, per cost of treatment.

Conclusions

We found that the effects of neutropenia in chemotherapy patients were delayed treatment, dose reduction and a major risk factor of febrile neutropenia. This decreased the efficiency of chemotherapy in patients with cancer. The result should be informed and encouraged our patient care team to develop practical action for prevention and management of serious neutropenic events.

Key messages

The result should be informed and encouraged our patient care team to develop practical action for prevention and management of serious neutropenic events. If we can manage cancer patients with neutropenia, the cost of treatment for serious febrile neutropenia and other complications will be reduced.
The association between secondary care multimorbidity in mid-life and premature mortality
Authors: Johnston M , Black C , Mercer S W , Prescott G J , Crilly M
Published: October 2020

Background

Multimorbidity (MM) is the co-existence of two or more health conditions. Whilst its prevalence is higher in older adults, in absolute numbers there are more multimorbid young people. Recently, the trends for increasing life expectancy observed in high income countries have stalled or reversed. The relationship between MM and premature mortality requires exploration. We assessed the prevalence of secondary care MM in mid-life and its association with premature mortality in the Scottish Aberdeen Children of the 1950s (ACONF) cohort.

Methods

Prospective cohort study. ACONF members were linked to electronic hospital records and mortality records. Secondary care MM was assessed using hospital records in 2001 when participants were aged 45-51 years. The association between MM and mortality over 15 years (to age 60-66 years) was assessed using Cox proportional hazards regression. There was adjustment for key covariates: age, gender, social class at birth, childhood intelligence, educational attainment, alcohol, smoking, body mass index and adult social class.

Results

Of 9,625 participants (51% male), 3% had MM. Higher childhood intelligence and adult social class were associated with reduced MM. In relation to the reference group (no MM), those with MM had a mortality hazard ratio of 4.5 (95% CI 3.4-6.0) over 15 years. The association remained when adjusted for the covariates (2.5 [95% CI 1.5-4.0]).

Conclusions

Secondary care MM prevalence was 3% in mid-life and associated with premature mortality. Younger adults with MM are an important group at risk of premature mortality which should be the focus of public health action. This includes reducing the impact of social inequality and reconfiguring secondary care services to offer comprehensive management of younger multimorbid adults.

Key messages

Multimorbidity in mid-life is associated with premature mortality and may be an important influence on reducing life expectancy trends. Much focus is upon multimorbidity in older adults, however younger adults with multimorbidity are at risk of premature mortality, requiring public health action.