bluuebunny/crossref_metadata_2025 huggingface dataset:
Midwifery in Germany – The necessity of developing a workforce and service planning approach
Authors: Raddatz M , Hellmers C , zu Sayn-Wittgenstein F , Stelzig S
Published: November 2019

Background

Midwifery care in Germany is a legal right for every woman (SGB V). Midwives work employed or freelance in hospitals or in community services, providing maternal care from pregnancy until the end of breastfeeding (Sayn-Wittgenstein 2007). Increasingly, a shortage of midwifery care has been observed, forcing hospitals to understaff or to close their birth units, leaving women and their families without care (Sander et al. 2018). At the same time, birth rates are rising, thus leading to an increasing demand of midwifery care (Destatis 2019). As off today there is no central register for midwives across Germany’s 16 states. Therefor the exact number of registered midwives as well as the scope of services provided by midwives are not known (Niedersächsisches Landesgesundheitsamt 2019). Given the present situation, it seems to be imperative to establish effective midwifery workforce planning.

The aim of this poster is to identify already existing health workforce planning approaches and to determine the extent to which those can be transferred to the German system of midwifery care.

Methods

Health workforce planning approaches, already being used on a national and international level, have been analysed, focusing their applicability to midwifery services in Germany.

Results

Particular elements of the workforce planning approaches already being used in Germany for registered physicians seem to be adoptable. However, they need to be adjusted and enhanced to ensure the characteristics of midwifery in the German public health services. Internationally used approaches are not readily transferable due to systemic differences in health care systems.

Conclusions

The development of new specific workforce and service planning approaches for midwifery care in Germany is crucial to meet present and future needs of women and their families during the childbirth period.

Key messages

It seems sensible to consider the peculiarities of a healthcare system in midwifery workforce planning. Establishing workforce research still represents an important task for midwifery in Germany.
The Relationship between strength and academic performance: A new reason to promote physical activity
Authors: Peña J , Yanez C , Gomez C , Martin W , Castillo C , Granados J , Riveros M
Published: November 2019

Background

Experimental studies have determined that higher strength values are associated with more efficient cognitive function and better academic performance. In spite of this, the universities in Colombia are decreasing the time available for physical activity in favour of increasing the time devoted to theoretical subjects. This is one of the reasons why in Colombia, only 18% of young people complied with the world recommendations of physical activity. To examine this problem, the objective of this research was to establish the relationship between strength and academic performance in university students.

Methods

A cross-sectional study was developed in 135 (21.8 ± 4.5 yr; 78.69 ± 9.1kg) students of the fifth semester of the Areandina University in Bogota, Colombia. Each participant developed incremental protocols to determine the maximum weight that he or she could move in six different exercises: squat in smith machine, leg press, leg extension, bench press, pull down and military press. The average of the results of these tests was taken as the value of maximum strength. To determine academic performance, the average of the scores accumulated in the five semesters of their university studies was evaluated. Pearson correlation coefficient was used to find the linear relationship between strength and academic performance.

Results

Overall, 70.3 % of the participants were men and 29.7% were women. The results of the maximum strength tests were significantly higher in the male group than in the female group (P < 0.05). Academic performance was similar in both genders (P > 0.05). A positive correlation was established between maximum strength and academic performance. (r = 0.64 P < 0.05).

Conclusions

The conclusion of this research was that there is a significant relationship between strength and academic performance. These results are fundamental to justify the inclusion of spaces for the promotion of physical activity in public and private universities.

Key messages

Universities are institutions that only focus on academic training and generate contexts in which sedentary behaviours are promoted. Sedentary lifestyles are a public health problem in Colombia.
Smoking behavior and exposure to tobacco smoke in Split-Dalmatia County
Authors: Marasovic Šušnjara I
Published: November 2019

Background

Tobacco use is the leading preventable cause of death, which is why a number of measures to reduce its use are carried out in the world. That’s why the aim of this study were to show the data on smoking behavior and the exposure to the tobacco smoke of the inhabitants of the Split-Dalmatia County, which represent the starting point in the creation of public health interventions

Methods

Via European Health Survey 2014/2015 (EHIS) the data on the smoking behavior and exposure to tobacco smoke in the Split-Dalmatia County were colected. The targeted population was aged 15 and over. The survey included 267 inhabitants (141 men and 126 women) of the Split-Dalmatia County.

Results

The overall sample shows that the daily smokers are 22.43% of the population, men 25.71%, and women 18.69%. Occasionally smokes 3.04% of the population (2.14% of men and 4.06% of women), while non-smokers are 74.52% of the population (77.23% of women and 72.1% of men). Tobacco products consumed are mostly cigarettes (97%). More than half (52.63 %) smokes more than 20 cigarettes a day. According to the survey results, more than half of the population (61.04%) has never or nearly never been exposed to indoor smoking, men rarely (56.03%) compared to women (66.1%). Less than one hour was exposed to 17.74% of the population (21.55% of men and 13.91% of women) and one hour and more 16.45% of the population (18.10 men and 15.65 women).

Conclusions

Indicators of smoking behavior and exposure to tobacco smoke are somewhat more favorable to residents of the Split-Dalmatia County than in the total population of Croatia. Despite the measures taken for years in Croatia, these indicators are still unsatisfactory. Existing measures need to be re-examined and strengthened to overcome this important public health problem as successfully as possible.

Key messages

In order to reduce the prevalence of smoking and improve the health of its population, Croatia needs to strengthen and adopt additional policies on tobacco control. One of the measures would certainly be a ban on smoking in public places, which could, among other things, have a significant impact on denormalising smoking in the community.
Barriers and facilitators of health behavior engagement in ultra-Orthodox Jewish women in Israel
Authors: Leiter E , Finkelstein A , Greenberg K , Keidar O , Donchin M , Zwas D R
Published: November 2019

Background

The ultra-Orthodox Jewish (UOJ) community is a primarily low socio-economic, culturally insular minority sub-sect in Israel. Compared with the general population, UOJ women report higher rates of diabetes and overweight, lower physical activity rates, and have lower breast cancer survival rates. Research in this sub-sect is limited. Identifying the facilitators and barriers to health behavior engagement would facilitate public health intervention design in this population.

Methods

This study describes UOJ women’s barriers and facilitators to engagement in targeted health behaviors (i.e. health nutrition, physical activity), identified through mixed methods analysis. Qualitative and quantitative analyses of interviews (N = 5), focus groups (5, including 35 women), and questionnaires (N = 239) identified barriers to engaging in preventive health behaviors and intervention preferences.

Results

Most of the barriers identified (financial and time limitations, personal preferences, lack of education/awareness, and family-related obstacles) are similar to those reported by women from the general population. Cultural aspects such as women’s role in the home, religious restrictions, and modesty were also identified as barriers to health behavior engagement, comparable to women from other insular communities.

Conclusions

Utilizing a mixed methods approach in identifying barriers and facilitators informed intervention development and improved cultural tailoring, potentially serving as a model for intervention design with additional UOJ communities as well as other difficult to access, low socio-economic, culturally insular populations.

Key messages

This is the first study identifying facilitators and barriers to UOJ women’s health behavior engagement. Findings can inform intervention design in difficult to access, culturally insular populations.
Schoolchildren’s participation in health promotion process
Authors: Maceinaite R , Šurkienė G , Sketerskienė R
Published: November 2019

Background

Health promotion (HP) process enables people to increase control over their own health. Schools offers ideal setting for HP interventions as most children spend a large part of time there. The pupils should be involved in this process. Information about schoolchildren’s participation in HP process is a key when planning measures to improve the situation. The shortage of information about students’ participation in this process leads to the aim of study - to determine schoolchildren’s’ participation in HP process.

Methods

Cross-sectional study was conducted in 2018. 906 schoolchildren aged 14-19 from 29 schools in Lithuania were surveyed by anonymous questionnaire (response rate 80.5%). Logistic regression models with 95% of CI were used for the data analysis. Statistical significance level was p ≤ 0.05.

Results

More than half of respondents (51.4% (95% CI: 48.2; 54.7)) participated in HP process. Participation was significantly related to residence (OR = 2.47 (95% CI: 1.80; 3.39)) and grade (OR = 1.39 (95% CI: 1.06; 1.82)). Participation in health promoting events (57.7% (95% CI: 53.2; 62.1)), assistance in organizing events (33.5% (95% CI: 29.3; 37.9)) - were the most common ways of schoolchildren’s participation. 35.3% of pupils (95% CI: 32.3; 38.5) evaluated their participation as good or very good. 68.7% of schoolchildren (95% CI: 65.6; 71.6)) wanted to participate in HP process more actively. Girls were more likely to want to participate in HP process more actively than boys (OR = 2.08 (95% CI: 1.56; 2.78)), children who lived in countryside were more likely to want to participate in HP process more actively than pupils who lived in city (OR = 1.42 (95% CI: 1.02; 1.99)).

Conclusions

Only half of schoolchildren participated in HP process. The majority of pupils would like to participate in HP process more actively, so it is very important for the school to create the right conditions and encourage schoolchildren to participate in HP process.

Key messages

The participation of schoolchildren in health promotion process is insufficient. The majority of pupils would like to know more about health promotion process.
Analysing local public health action plans: development of a tool for the French CLoterreS Study
Authors: Le Bodo Y , Fonteneau R , Harpet C , Hudebine H , Jabot F , Sherlaw W , Breton E
Published: November 2019

Background

The potential contribution of local authorities to prevention and health promotion is well recognized. In France, since 2009, Local Health Contracts (LHCs) are mobilising Regional Health Agencies, local elected officials and stakeholders to intervene in 4 areas: health promotion, prevention, health care and social care. LHCs remain poorly documented policy instruments.

Methods

As part of the CLoterreS study, a multidimensional coding tool was developed and tested by two coders to explore the place of prevention and health promotion in LHCs. Its development was based on the WHO conceptual framework for action on the social determinants of health and the Self-assessment tool for the evaluation of essential public health operations in the WHO European Region. Preliminary results concern a random sample of 17 LHCs from as many French regions selected among the 165 LHCs signed between 2015 and March 2018.

Results

On average, the LHCs featured 26 action forms (AF) (min: 5; max: 56). In a LHC, the average proportion of AF addressing either the social determinants of health, living circumstances or other determinants targeted by health protection, promotion or primary prevention interventions (SDoH-HPP-P1) was 79% while 44% of the AF address secondary/tertiary prevention, social care or the organization of health care and services. Among the SDoH-HPP-P1 themes (double coding permitted): psychosocial life circumstances were addressed in the 17 LHCs and concerned, on average, 31% of their AF; material living circumstances were addressed to a lesser extent (16 LHCs, 13%); other key themes include environmental health (12, 14%), mental health (16, 12%), alcohol abuse (15, 11%), drug use (14, 11%), smoking (13, 9%), physical activity (13, 12%), healthy eating (12, 12%).

Conclusions

This work confirms that LHCs are instruments with prevention and health promotion at their core. Explanation of the differing investments in this area across our sample will be further explored.

Key messages

Local Health Contracts are promising instruments to address locally a broad range of health determinants. The CLoterreS analytical tool has proven effective in capturing multiple themes and shedding light on differences between Local Health Contracts’ action plans.
Physical Activity Patterns of Primary School Teachers in a District in Istanbul, Turkey
Authors: Surmen A , Ay P , Hidiroglu S , Karavus M
Published: November 2019

Background

Physical inactivity (PI) is determined as the fourth leading risk factor for global mortality. Insufficient physical activity is prevalent in Turkey; approximately 4 in 10 adults are physically inactive and have less than 150 minutes of moderate activity per week. The objective of this study was to assess the prevalence of PI and the factors associated with it among primary school teachers in a district in Istanbul, Turkey.

Methods

This was a cross-sectional study conducted in a district in Istanbul, Turkey. Sample size was calculated as 434 assuming a PI prevalence of 70% with a 95% confidence level, margin of error of 0.05 and a design effect of 2. Twenty out of 39 schools were selected randomly. PI was assessed through using International Physical Activity Questionnaire short form. Logistic regression analysis was used to determine the variables associated with PI.

Results

A total of 345 teachers participated in the study (response rate: 79.5%). Among the participants the mean age was 45.6± 8.3 and %74.1 were women. PI prevalence was 49.2% (95%CI: 43.6%-54.7%). PI was significantly associated with having chronic disease (OR: 1.8, 95%CI:1.0-3.0), having children (OR: 2.9, 95%CI:1.5-5.7), using motor vehicles for transportation (OR:4.1, 95%CI:1.5-11.0) and using elevators (OR:4.4, 95%CI:1.7-11.4). Among women, PI was significantly associated with having children (OR: 10.3, %95CI:1.2-87.1) and using elevators (OR: 8.4, 95%CI: 2.3-30.8).

Conclusions

Approximately half of the teachers were physically inactive. As having children is an important determinant of PI, we need to adopt appropriate conditions so that parents, particularly women can engage in physical activity together with their children. Active transportation and use of elevators should be encouraged. Special attention should be paid to adults having chronic diseases.

Key messages

PI is highly prevalent among school teachers, particularly among the ones who have chronic diseases. Strategies supporting parents especially women to engage in physical activity together with their children, encouraging active transportation and use of elevators should be implemented.
Improving participation of hard-to-reach older people in diet interventions: the INVITE strategy
Authors: Bocquier A , Dubois C , Verger P , Darmon N ,   INVITE study group
Published: November 2019

Background

A lot of behavioural interventions promoting healthy eating and physical activity are focusing older people, but, among them, individuals from low socioeconomic status and/or experiencing social isolation participate less. The aim of the present study was to design, pilot and perform a formative evaluation of an active recruitment strategy called ’INVITE’. This strategy aimed to improve participation of hard-to-reach older people in existing collective workshops combining diet and physical activities dedicated to older people.

Methods

We co-constructed this strategy, based on results from a literature review, qualitative interviews with older people and professionals using the Behaviour Change Wheel framework as a guide. INVITE includes 5 steps: i) identification of socially deprived/isolated people aged 60-85 years in retirement fund databases; ii) postal invitation letter; iii) phone call; iv) home visit by a social worker. The formative evaluation used questionnaires (closed and open-ended questions) completed by 2 social workers in April 2019.

Results

Among the 54 older people selected in the databases, 29 could be reached by phone. Among these 29 persons, 25 reported being interested by the collective workshops; 17 refused the home visit (main reasons: not available during the workshops period, current health problems); 12 accepted the home visit, but only 10 could be visited at home (one was ill; one cancelled the visit). Nine out of these 10 persons accepted to participate to the workshops. The main motivating factors were that workshops were: free; perceived as friendly; and as an opportunity to “go out” and to receive diet counselling to improve diet quality with no additional cost.

Conclusions

The INVITE strategy was perceived positively but adjustments are needed to improve home visits acceptation rate (e.g., by revising the criteria used to identify people in the databases). We will now evaluate the attendance rate to the collective workshop.

Key messages

The INVITE strategy was designed to improve participation of hard-to-reach older people in combined diet and physical activity collective workshops. This strategy was perceived positively by most older people contacted and both social workers.
Romanian students’ attitude and opinion about the smoke-free indoors law
Authors: Prejbeanu I M , Pita O , Cara M L
Published: November 2019

The Romanian Parliament approved the first piece of legislation regarding smoking in public places in 2002; smoking was banned in most indoors but allowed in bars and restaurants. The law has been amended several times; the 2016 amendment banned smoking in nearly all indoor public spaces, in indoor workplaces, in playgrounds and on public transport; there are only two exceptions to the law - cells in maximum security prisons and designated rooms in the transit areas of international airports.

In this context, we asked 498 students (in Law, Business Administration, Electronics, Languages, Sciences, Medicine, Dentistry, Pharmacy or Nursing), aged 21.93 ± 4.21 years, males and females, to answer a 23-item questionnaire on cigarettes smoking; the questionnaire included seven questions related to the Romanian smoke-free indoors law.

A number of 131 students (26.3%) are cigarettes-smokers; there are statistically significant differences among the faculties subgroups (p < 0.01), the highest percent of smokers being in Dentistry (50%) and the lowest - in Languages (13%). Most of the students (N = 466 - 93.6%) agree with the smoke-free indoors law; the disagreement is registered among the smokers (27 vs. 5 non-smokers, p < 0.001). A number of 360 subjects (72.29%) mention they met situations of smoking in public places: in bars/clubs/restaurants (73.3%), staircases of blocks of flats (56.1%), public transport or taxis (44.1%), even hospitals (8.3%) and classrooms (7.7%). In 75.8% out of these situations nobody took attitude; 40 students (11.1%) acted themselves and drew attention (most often successfully) to the smokers about breaking the law. One fifth of the smokers of the group have also smoked/intended to smoke in public places; most of them are students in Electronics and just one - in Law (p < 0.05).

Romanian students seem to be content with the ban of indoor smoking. Actions to reduce consumption of tobacco products and to protect public health have to be continued.

Key messages

Romanian young people seem to be content with the decrease of second hand smoke in indoor public spaces. Intense actions to combat the tobacco epidemic are still needed in Romania.
Sleep problems among Dutch higher educational students, working towards solutions
Authors: Van Der Heijde C , Van Weeren M , Vonk P
Published: November 2019

Background

Lately, attention for the role of sleep in health and wellbeing has increased. Short sleep duration and poor quality of sleep are associated with a higher chance at several (mental) health issues, including a higher mortality risk. Furthermore it is associated with attention problems and lower academic achievement. Poor sleep has a high prevalence, especially among students. We aim to provide (policy) recommendations from studying the associated factors on an individual and social level with poor sleep and its consequences.

Methods

In a cross-sectional survey design (N = 493), the extent of sleep problems and its associated factors was studied amongst a group of Dutch students. The Pittsburg Sleep Quality Index (PSQI) was used. Linear regression analysis was performed. Participants were recruited through social media and e-mail (Male 43%; Female 57%; mean age, 22 years).

Additionally, experts were questioned in a small survey to come up with solutions (N = 24).

Results

59% of higher educational students suffer from poor sleep quality. Factors that were significantly associated with worse sleep quality were: sleep need, behavior and psychology (effects stress overload), having a paid job in the evening/night, loneliness, having the Chinese and other ethnicity and having a sleep-related disorder. Sleep was significantly associated with worse mental health, vitality and drug use. Additionally, sleep was a significant predictor for attention problems and worse academic performance in the current academic year.

Conclusions

Nearly 2 out of 3 students suffered from poor sleep quality, reconfirming the high prevalence amongst higher educational students in other studies. Universities can contribute to better sleep quality of their students by educating their students more about sleep hygiene (including effects of drugs and how to deal with high work pressures), and make them more aware of the availability of student psychologists and student general practitioners.

Key messages

Students in higher education are a population at high risk for poor sleep quality. More attention for the importance of sleep for health, wellbeing and academic achievements should be implemented in the university institutional context.
Evolution of Healthcare-associated infections over five years: results of prevalence surveys
Authors: Ghali H , Ben Cheikh A , Bhiri S , Khefacha Aissa S , Dhidah L , Ben Rejeb M , Said Latiri H
Published: November 2019

Background

Tunisia is not spared from the scourge of healthcare associated infections (HAIs). National surveys on the prevalence of HAIs on a given day have regularly taken place in health facilities. We aimed to describe bacteriological profile as well as treatment modalities of HAIs in Sahloul Hospital for the last five years.

Methods

We conduct every year a prevalence survey, as part of the program for the prevention and control of HAI at Sahloul Hospital. It is a cross-sectional study of one-day prevalence with a single pathway. All departments were included in the survey, except emergency and hemodialysis services due to their very short length of stay. Data collection was carried out using NosoTun plug (national HAI prevalence survey).

Results

Over five years, prevalence of HAI ranged from 11.4% in 2014 to 7.1% in 2018. In 2014, bacteriological analysis was performed in 55.8% of HAI cases. In 66.6% of cases (n = 16), isolated bacteria were gram negative bacilli, the most frequent were Pseudomonas aeroginosa. In 2015, 17 germs were identified, and in 88.2% of cases (n = 5), isolated pathogens were also gram-negative bacilli, the most frequent were Pseudomonas aeroginosa (n = 4) and Acinetoobacter baumanii (n = 3). Besides, cephalosporin 3rd generation was the most frequent antibiotic used for the treatment. However, in 2016, Klebsiella Pneumoniae was the most frequent germ isolated. Among those infected patients, 26 were treated (92.8%). In 2017, 26 germs were identified, the most frequent were Gram Negative Bacilli (53.8%), mostly Escherichia coli and Pseudomonas aerginosa, followed by Acinetobacter baumanii. in 2018, 16 germs were identified, the most frequent were Gram Negative Bacilli (55.5%), mostly Klebsiella Pneumoniae.

Conclusions

The challenges for the future are to minimize infection with gram-negative bacilli while limiting the emergence of antibiotic resistant organisms.

Key messages

Our study helped us to have an insight into the most common isolates identified throughout the last five years. An incidence survey was carried out to better highlight the impact of healthcare associated infections in our hospital.
A systematic review of prediction models used in tuberculosis contact tracing
Authors: Kidy F , Bruno-McClung E , Shantikumar S , Proto W , Oyebode O
Published: November 2019

Background

Contact tracing forms a key part of tuberculosis (TB) control in high-income, low-incidence settings. It aims to reduce morbidity, mortality and onward transmission of TB. Contact tracing is a complex and resource intensive intervention. Risk assessment of contacts is needed to ensure appropriate allocation of resources and greatest possible impact. Current prioritisation procedures are based on expert opinion and consensus. Prognostic prediction models offer a way to synthesise evidence about this decision.

Methods

We searched Medline, Embase, BNI, CINAHL, HMIC, and the Cochrane Library for peer reviewed publications in English about TB contact tracing prediction models. Studies were included if there was statistical combination of predictors. No date, age or other restrictions were applied. Study selection was carried out by two independent reviewers. Data were extracted using the CHARMS checklist and studies evaluated for risk of bias using PROBAST.

Results

Five reports were selected from a total of 16,585 non-identical returns. Each study was carried out in demographically distinct settings (Peru, USA, France, Taiwan). The choice and definition of outcomes and predictors varied. All the models included external validation and some included internal validation. Calibration and discrimination measures were variably reported. The models were at high risk of bias due to challenges in defining TB disease and due to statistical approaches taken: there was poor reporting of sample size considerations, universal use of univariable analysis to select predictors, and dichotomisation of data. There were some concerns about applicability due to differing populations and diagnostic approaches. None of the models included social risk factors.

Conclusions

The use of existing models is problematic. There are constraints upon resources which means that contact tracing needs to be carried out efficiently. A robust prediction model is urgently needed to achieve this.

Key messages

Contact tracing for tuberculosis would benefit from more robust prioritisation tools to save resources and increase impact. Existing prognostic prediction models are at high risk of bias and there are concerns about applicability in high-income, low-incidence settings.
Measles situation in Ukraine during the period 2017-2019
Authors: Rodyna R
Published: November 2019

Background

Measles remains a significant cause of death among children globally, despite the availability of effective vaccine. While global measles deaths have decreased by 84% worldwide from 2000 to 2016, measles is still common in many countries, particularly in Africa and Asia: during 2016 7 million people were affected. In Ukraine 12,000 people suffered from measles in 2012. The last outbreak in Ukraine started in 2017, continued in 2018 and it is ongoing in 2019. Totally about 100,000 people fell ill, 31 died and it is one of the biggest outbreaks in Europe in the last 20 years. Our work was aimed to analyze the measles outbreak in Ukraine and find out its causes in 2017-2019.

Methods

We conducted an analysis of measles incidences in Ukraine during the period 2017 - 2019 using analytical and epidemiological methods.

Results

The number of reported measles cases was: in 2017 - 4782 in 2018 - 53,219, 3 month of 2019 - 34,188. In 2016 the number of measles cases was 102. The incidence rates of measles per 100,000 population were: in 2016 - 0,24; in 2017 - 11,2; in 2018 - 125,2; in 2019 (3 month) - 80,4. Comparatively to the 2016 incidence rates increased 46 times in 2017 and 521 times in 2018. The percentage of children among suffered people was: in 2017 - 66,6%; in 2018 - 55,3%; in 2019 - 47,8%. According to the national vaccination schedule, 1 dose of MMR (MMR1) vaccine children get in 12-month age, the second dose (MMR2) - in 6-years age. Vaccination coverage of MMR1 and MMR2 vaccines has significantly decreased during the period 2008-2016 from 96% to 45% due to challenges in the procurement of vaccines in the country and antivaccination campaigns.

Conclusions

Measles epidemic situation was caused by accumulation of a significant pockets of non-immune population.

Key messages

Measles epidemic situation was caused by accumulation of a significant pockets of non-immune population. The robust supplementary vaccination campaign among children and adult will allow to overcome measles outbreak in Ukraine.
Influenza vaccine among future health care workers: a cohort study on Italian medical students
Authors: Corradi A , Bert F , Pompili E , Catozzi D , Hordila A , Voglino G , Gualano M R , Siliquini R
Published: November 2019

Background

Flu vaccination rates among health workers remain low and very variable between European countries despite the recommendations. Medical schools could be the best phase to educate health workers toward flu vaccine. This study aims to evaluate flu vaccine “prejudice” and vaccine hesitancy in medical students (MSs).

Methods

In 2018/19 flu season a cohort study was conducted at the School of Medicine of Turin, parallel to the flu vaccination campaign. Students were surveyed for sociodemographic variables, knowledge, attitudes and practices toward vaccination, adverse reactions, overall satisfaction toward received vaccination. Data was collected from 377 students. Multivariable logistic regressions were performed. The significance level was p ≤ 0.05.

Results

Females were 70% and median age was 24 (IQR 22.5-25). The 73.2% of the sample was vaccinated in the campaign, although the 60% of this had never been vaccinated before. Poor knowledge on flu vaccine, both self- and objectively assessed, was associated with lower vaccination rate (OR 0.23, p = 0.006; OR 0.15, p < 0.001 respectively). Vaccination was more likely in those who had been vaccinated in the last 3 years (OR 9.14, p < 0.001). Among non-vaccinated students, most frequent reasons to not undergo vaccination was not feeling at risk of contagion (48%). Vaccine decreased flu prevalence (OR 0.33, p = 0.039). Among vaccinated students, the persuasion that vaccination should be mandatory for health workers (OR 5.91, p = 0.039) was associated with higher vaccine satisfaction score while self-diagnosis of flu was associated with a lower score (OR 0.009, p < 0.001).

Conclusions

Lack of flu vaccination among health workers increases flu prevalence and multiplies possible carriers in health facilities. European Medical Schools should start yearly vaccination campaigns to promote good habits in MSs. In parallel, more must be done to teach MSs the benefits of flu vaccination and thus increasing willingness to being vaccinated.

Key messages

Feeling poorly informed and being poorly informed about influenza vaccine significatively decrease likeliness of vaccination in medical students. Students do not feel at risk of contagion. Influenza vaccine uptake is a habitual behavior that should be promoted as early as possible among European health workers, possibly during Medical School.
Community engagement in public health emergency preparedness
Authors: Takacs J , Ciotti M , Tsolova S , Wiltshire E , Baka A , Kinsman J , de Vries D , Cremers L , Rios M , Angrén J
Published: November 2019

Background

Communities that could be affected by infectious disease outbreaks are increasingly recognised as resources that may be effectively utilized by the authorities during public health emergencies.

Methods

This case study project, aiming to identify synergies between communities and authorities, was based on qualitative sources of evidence, including document and media review, stakeholder mapping, interviews and FGDs (N = 137). Four countries were selected for inclusion: Spain and the Netherlands on the basis of emerging tick-born disease incidents; Iceland and Ireland on the basis of acute gastroenteritis outbreaks.

Results

In the Netherlands and Spain strong synergies were identified in tick surveillance activities, and the value of pre-existing networks of interest groups for preparedness and response activities was recognised. The Icelandic norovirus event was unexpected and fast-moving, while VTEC in Ireland is a familiar and slower-burning challenge. As a relatively common disease in Ireland, VTEC-protocols are closely followed, while a generic all-hazards approach was taken in Iceland. There was considerable community support in the responses in both countries., and in Iceland community representatives also actively participated in producing institutional post-event evaluations.

Conclusions

An over-riding principle emerging from this study is that an informed, at-risk community understands the challenges to adopting effective preventive practices for themselves better than anyone. Additional good practices included the utilisation of pre-existing stakeholder networks for information dissemination; and of monitoring community perceptions of any public health incident, including through social media, in order to identify and manage misperceptions. Efforts to build on the community engagement activities that are already in place in the four countries could contribute to better preparedness planning and more efficient and timely responses in future outbreaks.

Key messages

Recognise the community as a real partner in outbreak preparedness, response, and recovery. Optimise communications with communities who may be affected by outbreaks.
Information sources and attitudes of Polish migrants accepting or declining vaccination in Scotland
Authors: Gorman D R , Bielecki K , Willocks L , Pollock K , Munshaw J , Larson H
Published: November 2019

Background

Poland has the lowest EU vaccine confidence scores. The Polish are the largest migrant group in Scotland (91,000) with a high decline rate of nasal influenza vaccination. A new Polish language information leaflet in the 2018 school influenza programme saw consent form return increase but uptake remained low. We compare vaccination attitudes of accepting and declining parents.

Methods

A questionnaire to 365 Polish parents after vaccination asked about the leaflet, vaccination, time in UK and included WHO Vaccine Hesitancy statements. Accepting and declining parents were compared.

Results

128 (37%) responded - 42% of vaccinating and 39% declining parents. 90% were long term UK resident, 72% speak Polish at home. Previous experience had most influence in vaccination decision-making, with social media and personal contacts in Poland and Scotland also key. Decliners were more likely to cite social media than accepters. Concerns about new vaccines, side effects and ’currently uncommon conditions’ are high in the Polish community and decliners hold more negative and scientifically ’incorrect’ opinions. Parents know that Polish and UK immunisation schedules differ for influenza, a condition thought less serious in Poland than UK.

Conclusions

Polish norms strongly influence this migrant group. Differences in how Polish migrants who accept or decline the vaccination respond to vaccine hesitancy statements plus knowing that Polish media and the Polish community shape their views can be used by health authorities to target health messages. It is important to be aware of immunisation status and vaccination beliefs of mobile migrant groups, such as the Polish, to prevent spread of vaccine preventable diseases in Europe. Linking vaccine hesitancy statement responses and behaviour can highlight national characteristics and particular concerns of vaccine hesitant parents. This information could be used to improve vaccine uptake rates among different ethnic minorities.

Key messages

Polish migrant children have low nasal influenza vaccine uptake. Vaccine hesitancy statements show decliners are particularly likely to distrust new vaccines and worry about vaccine side effects. Migrants access Polish social media and information and retain vaccination beliefs and norms post migration. Knowing this allows targeting of information campaigns to increase uptake.
RSV burden among hospitalized patients: 6-years surveillance of Liguria regional reference lab
Authors: Grammatico F , Butera F , Iavarone I G , Schenone I , Arcuri C , Barisione G , Guarona G , Sticchi L , Orsi A , Icardi G
Published: November 2019

Background

Respiratory syncytial virus (RSV) represents one of the most common agent causing respiratory infections in infants and adults. It causes seasonal epidemics, with a peak prevalence in winter. RSV epidemiology and burden are still under-recognized, although it leads to complications and increased mortality in patients at risk, such as infants, pregnant women, the elderly and patients with chronic diseases.

Materials/Methods

Data analyzed in this study were collected during the virological surveillance system activities at the Policlinico San Martino university hospital in Genoa, Italy. The regional reference laboratory receive swabs from all Liguria region, and detects the main circulating respiratory viruses by using molecular methods. The proportion rate of RSV (subtypes A and B) positive samples was determined in the period January 2013 - December 2018, stratifying data by gender, age and hospital units.

Results

From January 2013 to December 2018, 14911 swabs were analyzed, 585 patients reported at least once RSV positive respiratory sample. The median age of RSV positive patients was 56 years (IQR 27-71), with a males: females ratio of 0.93: 1. The peak RSV infection period occurred mainly during first quarter, confirming the seasonal trend of the virus. Greatest proportion of RSV positive samples were received from hematology-oncology wards (45.2% of isolations) and medicine units (31.9%). From 2013 to 2018 an increase of swabs collection of 207% was observed. Neonatology and pediatrics resulted in the highest rate of positive swabs (above 30%), hemato-oncology departments collected 7932 swabs with 3,3 % resulted positive.

Conclusions

A virological surveillance system able to detect the principal respiratory viruses circulating in adult population is a key element to better understand the RSV epidemiology and evaluate therapeutical strategies, in view of the availability of effective vaccines able to prevent RSV infection in the next future.

Key messages

RSV represents a leading cause of respiratory disease in hospitalized patients, especially in hematology-oncology, medicine and intensive care unit wards. Virological surveillance is a key element to better understand RSV epidemiology in all ages, in view of the availability of new effective vaccines.
Show your rare, handle with care: a knowledge brokers network to handle rare disease patients
Authors: Rubba F , Alfano R , Schiavone D , Scamardo M S , Landolfo D , Barbieri O , Carannante I , D’Onofrio G , Guida A , Triassi M
Published: November 2019

Background

In Rare diseases patients. difficult in diagnosis can produce inappropriate pathways of care. A correct diagnosis took almost 5 years in Europe and 7.3-7.6 y in US. The directive 2011/24/EU provides a legal regulatory asset for the European Reference Networks (ERNs). ERNs are designed to connect health care providers and centers of expertise for gaining appropriate pathways of high-quality care and to support sponsorship in order to make healthcare closer to the patients. Federico II University actually has 9 confirmed ERNs.

Methods

We connected the patient related activities inside the ERNs and we planned a project-based network that creates harmonization of diagnostic tools and widespread diffusion of screening activity able to drive diagnostic enrichment. The Hospital Chief Office together with the Public Health Department acts as “Knowledge brokers” (KB) defined as connectors who may crisscross the hierarchical boundaries. We scheduled interventions into the ERNs and future improvements. Interventions areas have been represented in a conceptual map.

Results

Brokers into the network are attended to allow better merged innovation rate and sharing data. Improvements could be directed toward: 1) sharing data and communication, 2) diagnostic enrichment 3) hospital services networking into the path. Including this model in the regional pathways may build a common platform to support appropriate care in disease-endemic regions.

The designed model finally aimed at define how humanization and networking of care can be measured as gain in efficiency along the overall path.

Conclusions

Network potential may overload a simply specific hub focused approach. The “criss cross” knowledge brokering (could be a strategy able to support clinical and diagnostic activities. To proceed over, in orphan disease handling, we may progress from approaches centered on florid cases toward a balanced screening design, able to guarantee a diagnostic enrichment for a rare condition.

Key messages

Implicit and formal Networking cam help rare disease handling. Sharing data and diagnostic enrichment are the main issues.
The development of an evaluation framework on community impact of CSL in the Netherlands
Authors: Visser M W , Zweekhorst M B M
Published: November 2019

Background

Community Service Learning (CSL) is taking ground in higher education. In CSL, students use their academic skills to address society issues in close collaboration with the community. Reciprocity between community and university is conditional for meaningful CSL. Currently, much attention lies on student skills and competency development. There is less focus on the impact of CSL on the community. To move towards higher impact, we developed an evaluation framework on community impact in CSL.

Methods

We conducted a systematic literature review to identify criteria on community impact in CSL. The identified criteria were structured in the CIPP framework (Context, Input, Process and Product). Next, we validated the concept framework in 5 CSL activities of the VU University Amsterdam, using participant observation, interviews, questionnaires and document analysis (multi perspective).

Results

The underlying rationale of the framework is that (supported) community involvement - from start till finish - contributes to higher community impact in CSL. Context criteria relate to motivation and expectations of all stakeholders. Input criteria include available human, financial and material resources. In Process, there is attention to the way CSL is shaped with the community. Product criteria include how community perspectives are integrated in outcomes, and how outcomes are perceived and implemented by the community. The validation of the framework did not result in major changes, but contributed to specification of individual criteria.

Conclusions

The development and validation of the framework is an iterative and cyclic process, open for further validation and improvement. To realize most impact learning and reflection processes with all stakeholders are essential. The framework should not only be used to asses community impact, but also to design and implement CSL in order to realize high community impact.

Key messages

A monitoring and evaluation framework of community impact provides groundwork for high impact CSL activities. Meaningful community involvement will result in higher impact CSL activities.
Participation of medical students in prevention actions: first year of implementation in France
Authors: Herr M , El Kassouani M , Labbe A , Josseran L
Published: November 2019

Background

Prevention has become an essential part of the health policy in France. Since the autumn 2018, medical students, as well as students in midwifery and paramedics, are required to take part in prevention actions in population. This prevention training is mandatory and aims to increase the number of prevention actions in population and to sensitize medical students to the importance of prevention. National guidelines were published to guide the implementation of this training.

Objectives: This communication aims to describe the implementation of this prevention training in the medical school of University Versailles Saint-Quentin-en-Yvelines in France.

Results

A total of 155 students in third year of medical school were included in the training (2018/2019). The first step was the creation of e-learnings in 9 domains related to prevention: prevention policy in France, communication, project management, addictions, nutrition, physical activity, sexual education, prevention for the children and prevention for the elderly. They were elaborated by medical doctors of different specialties, public health professionals, nurses, and physiotherapists. The second step was the recruitment of voluntary settings to perform prevention acitons. They were mainly schools (n = 24), but also institutions for disabled children or adults (n = 8), health forums (n = 4), the university health center and the local center for social reintegration of young people. The types of actions performed by the students will be presented at the conference.

Conclusions

Preliminary results indicate a positive feedback from both the students and the voluntary settings. At this stage, recommendations for the future can already be drawn, such as the inclusion of specific training sessions to lead group sessions of various ages or interdisciplinarity in the actions.

Key messages

The participation of medical students to prevention actions in population has become mandatory in France. Voluntary settings were mainly schools, but also institutions for disabled children or adults.