bluuebunny/crossref_metadata_2025 huggingface dataset:
Azathioprine in the maintainance remission in inflammatory bowel disease patients: 7-year follow up
Authors: Cassieri C , Mastromatteo A M , Pica R , Zippi M , Corazziari E S , Paoluzi P , Lecca G P , Vernia P , Brandimarte G , Nasi G
Published: October 2020

Background

Azathioprine (AZA) and thiopurine are widely used for induction and maintenance of remission in steroid dependent patients with inflammatory bowel disease (IBD).

Methods

Aim of this study has been to investigate its efficacy and safety in maintaining steroid-free remission in steroid dependent IBD patients seven year after the institution of treatment. Data from consecutive IBD outpatients referred in our Institution, between 1985-2016, were reviewed and all patients treated with AZA were included in this retrospective study. AZA was administered at the recommended dose of 2-2.5 mg/kg.

Results

Out of 2802 consecutive IBD outpatients visited in the index period, AZA was prescribed to 433 patients, 236 (54.5%) were affected by Crohn's disease (CD) and 197 (45.5%) by ulcerative colitis (UC). One hundred and seventy-nine patients with a follow-up < 84 months were excluded from the study. Two hundred and fifty-four patients were evaluated, 141 (55.5%) with CD and 113 (44.5%) with UC. One hundred and thirty-nine (54.7%) were male and 115 (45.3%) female (average age of 35.62 ± 14.20 SD years, range 14-74 y.). Seven year after the institution of treatment, 127 (50%) patients still were in steroid-free remission (83 CD vs 44 UC, 58.8% and 38.9%, respectively, p = 0.0024), 71 (27.9%) had a relapse requiring retreatment with steroids (29 CD vs 42 UC, 20.6% and 37.2%, respectively, p = 0.0047), 56 (22.1%) discontinued the treatment due to side effects (29 CD vs 27 UC, 20.6% and 23.9%, respectively). Loss of response from 1st to 7th year of follow-up was low, about 20%.

Conclusions

Seven year after the onset of treatment 50% of patients did not require further steroid courses. After the first year loss of response was low in six subsequent years. In the present series the maintenance of steroid-free remission was significantly higher in CD than in UC patients. The occurrence of side effects leading to the withdrawal of AZA treatment has been low.

Key messages

An important therapeutic moment of IBD is mantaining remission in steroid dipendent patients. AZA can be a viable and inexpensive alternative to treath these patients.
Hospital resilience after the 2015 earthquake in Nepal: a qualitative study with hospital staff
Authors: Moitinho de Almeida M , van Loenhout J , Singh R , Mahara D P , Guha-Sapir D , Aujoulat I
Published: October 2020

Background

Research on hospital resilience is scarce and favours top-down approaches, and evidence from the field and operational levels is lacking. The aim of our study was to understand the mechanisms of hospital and individual resilience experienced by staff from a tertiary hospital in Kathmandu, Nepal, after the 2015 Earthquake.

Methods

We conducted semi-structured interviews with different professionals in May 2018; undertook a deductive thematic analysis of hospital resilience using the framework proposed by Bruneau et al; and used an inductive thematic analysis for individual resilience.

Results

The earthquake caused different types of burden to the hospital and individuals. Redundancy was mostly influenced by linkages with lower levels of care. Resourcefulness consisted mostly of spontaneous adaptations, with task shifting the most important for human resources. External provision of resources enabled the transfer of part of the burden but precipitated accountability-related challenges. The hospital's robustness depended not only on its physical resistance, but also on the functional capacity to provide life saving care, although routine services were interrupted and quality decreased. The hospital ensured rapidity in providing life saving care to the victims and re-start of routine activities, but recovery to a sense of normality was more conflicting and dependent on the individual. Individual resilience was dictated by safety, a sense of meaningfulness, self and external appreciation, and community support.

Conclusions

Our study shows the importance of staff experiences to improve hospital resilience. Disaster plans should acknowledge the role of task shifting, and basic care should be taught to all, not just those with clinical functions. Health workers are extremely overwhelmed during disaster response, and disaster plans should engage staff at an early stage to ensure they feel safe and sufficiently supported.

Key messages

Our work is one of the first to study hospital resilience with field data from qualitative interviews with hospital staff. Hospital resilience strategies should also address individual resilience of hospital staff.
Early scientific response to COVID-19 epidemic: a scientometric perspective
Authors: Golinelli D , Nuzzolese A G , Boetto E , Rallo F , Greco M , Degli Esposti M , Fantini M P
Published: October 2020

Background

The recent COVID-19 epidemic is showing how the response of the scientific literature is fundamental in the first days following the onset of a new epidemic. Quantifying which studies have a greatest impact can help researchers and policymakers in controlling the epidemic. The aim of this study is to describe the early scientific production in response to the COVID-19 epidemic through a scientometric analysis.

Methods

The study consisted of: 1) review of the scientific literature produced in the 30 days since the first paper related to COVID-19 has been published on Pubmed; 2) Identification of papers' Digital Object Identifiers (DOI) and analysis of related metrics with the construction of a 'Computed Impact Score' (CIS) that represents a unifying score over heterogeneous bibliometric indicators. The CIS takes into account all the bibliometric indicators both traditional (i.e. counting of citations) and alternative (i.e. altmetrics). In this study we use the altmetrics provided by Plum Analytics (PlumX). All bibliometric indicators for the selected papers have been collected by using their corresponding DOIs as the key for querying Scopus API, which integrates PlumX. On top of those indicators we compute the CIS. The papers with higher CIS are discussed and presented.

Results

239 papers have been included in the study. A threshold for CIS of t = 1.04 (i.e.95% quantile) allowed us to record 8 papers as potentially impactful. The 8 papers are: 6 case reports, 1 methodological study, 1 editorial. First authors come from China (n = 6), USA (n = 1) and Germany (n = 1). The main topics are: case/s description (n = 5), outbreak investigation (n = 2) and 1 genomic study.

Conclusions

The early response of the scientific literature during an epidemic does not follow a pre-established pattern. Tracing the traditional and non-traditional metrics measures of papers can help to understand and evaluate the impact of literature on the scientific community and general population.

Key messages

The dynamic of the scientific community represents an important aspect of the early response to the onset of a new epidemic, which must be studied also to increase systems’ preparedness. In a connected digital world, tracing metrics measures of scientific papers can identify those with the greatest impact and help professionals to correctly inform the population.
Individual preparedness for natural disasters: a cross-sectional study from Portugal
Authors: Ferreira R , Rodrigues C , Correia-Santos P , Moreira M , Silva S
Published: October 2020

Background

Individual preparedness is critical in mitigating the adverse effect of natural disasters (ND). Factors influencing preparedness are complex and multifaceted, with certain groups having different needs and vulnerabilities. We aimed to explore the factors associated with individual ND preparedness in residents from Vila Nova Gaia (VNG), Portugal.

Methods

A cross-sectional study was conducted in VNG, Portugal, in January 2020 (N = 192; ≥18 years). Data on sociodemographic characteristics, risk perception, and preparedness were collected using a structured questionnaire, in parishes randomly selected. Crude and adjusted odds ratio (OR) and respective 95% confidence intervals (CI) were estimated using logistic regression models.

Results

About 33% of participants aged ≥65 years and 66% had low education. Results show that 20% had a survival kit. In univariate comparisons, older (11% vs. 24%, p=.029) and lower educated participants (≤12th grade: 13% vs. >12th grade: 32%, p=.002) were less likely to have a survival kit; only education remained associated after adjustment for age (OR = 2.61, 95%CI:1.22-5.58). About 21% had a family plan for disaster and only education level is associated (≤12th grade: 17% vs. >12th grade: 29%, p=.040). Almost 35% had a family member with basic life support training; older age, lower education and higher risk perception were negatively associated and these remained after adjustment (≥65 vs. <65 years OR = 0.36, 95%CI:0.16-0.77; ≤12th vs. >12th grade OR = 0.40, 95%CI:0.21-0.78; risk perception OR = 0.66, 95%CI:0.45-0.95). Only 22% participated in community drills; older people (6% vs. 31%, p<.001) and less educated (14% vs. 39%, p<.001) were less likely to have ever participated, which persisted in multivariate model.

Conclusions

Our findings revealed a low-level of ND preparedness, and older and less educated people seem to present worse preparedness. This highlights the need to design specific public health interventions among these groups.

Key messages

We found a low-level of individual preparedness for natural disasters in VNG, Portugal. Community-based public health interventions are needed to improve individual preparedness for natural disasters. Specific interventions targeting older and less educated people should be designed to decrease their vulnerability facing a natural disaster.
Knowledge and attitudes of medical students about SARS-CoV-2
Authors: Taneri P E
Published: October 2020

Background

Since the declaration of the new coronavirus outbreak, there is a growing concern and panic among people worldwide. The aim of the study is to evaluate the knowledge and attitudes of medical students towards current outbreak.

Methods

This cross-sectional study was conducted between 20 February - 4 March 2020 via an online survey with 285 students from one faculty of medicine in Turkey. Ethical approval was obtained from Bahcesehir University Clinical Research Ethics Committee.

Results

Among participants, 59% were female and 70% were Turkish citizen. Mostly, students were getting updates from media (70%) and the following source was WHO (18%). Of all participants, 60% correctly stated that SARS-CoV-2 has lower mortality rate than SARS and MERS. The most used protections were hand-sanitizers, avoiding close contacts with Asians and using masks in crowded areas (respectively 67%, 30%, 29%). On the scale 1 to 10 (1: strongly trust, 10: strongly do not trust); median for WHO's information process was 7, WHO's outbreak management was 6, Turkish Ministry of Health's (TMH) information process was 5 and TMH's outbreak management was 5. Turkish students significantly had lower trust for all of the matters (Mann-Whitney U = 7157.0, p = 0.040; Mann-Whitney U = 6405.5, p = 0.001; Mann-Whitney U = 5313.0, p < 0.001; Mann-Whitney U = 4679.5, p= p < 0.001). Of the participants, 19% said they would not get vaccinated if there was a vaccine. Most common reasons were not feeling at risk and not trusting new vaccines.

Conclusions

There is a lack of the knowledge of SARS-CoV-2 among students, and for that reason a scientific conference about SARS-CoV-2 took place at the faculty in 6th March as an intervention. Especially Turkish students had lower trust for information process and outbreak management of WHO and TMH. One out of five students was not considering to get vaccinated if there was a vaccine for COVID-19.

Key messages

Turkish students had lower trust for information process and outbreak management of WHO and Turkish Ministry of Health. One out of five students was not willing to get vaccinated if there was any.
A silent “shipyard eye”: lessons from an epidemic keratoconjunctivitis outbreak in Portugal
Authors: Moreira A , Abreu Gomes F , Mouro M , Lopes D , Bragança Pereira M , Duarte S , Cunha I , Machado Gil M , Calado J
Published: October 2020

Issue

Adenoviral conjunctivitis is the most common cause of conjunctivitis. Its most severe form is epidemic keratoconjunctivitis (EKC). This highly contagious disease is the only form to significantly involve the cornea and may cause visual impairing sequelae that persist for years.

Description

On January 2020, staff members at a childcare facility (CCF) alerted the Public Health Unit of Loures-Odivelas to a suspected conjunctivitis outbreak. The CCF was responsible for 57 children, separated in different rooms: a nursery (4-12 months), a pre-school (1-3 years) and a kindergarten (4-5 years). At the initial assessment, 4 cases of active disease were identified, all of which were at home and under treatment. CCF staff had previously identified 33 cases. Symptom onset of the index case had occurred more than 5 weeks before the alert. Infection control and epidemiological investigation were initiated. CCF staff was instructed to implement preventive measures, including careful disinfection of surfaces and toys, as well as frequent handwashing. Information about the disease and recommendations were sent to the children's caretakers.

Results

A total of 87 cases distributed in 8 weeks were identified: 28 at the CCF (25 children and 3 workers) and 59 close contacts (50 adults and 9 children). Average duration of disease was 14.1 days. In total, 43.9% of the children attending the CFF were affected. The highest attack rate was observed at the pre-school (69.2%, against 38.9% and 17.6% at the nursery and the kindergarten, respectively). 88.0% of the CCF children's households were affected. The average number of affected close contacts per affected child attending the CCF was 2.63. Corneal involvement was observed in 17,4% of cases.

Lessons

EKC outbreaks may go unnoticed by public health services, despite its high contagiousness and impact. Improvement of communication with organizations in the community is essential to secure future early detection and intervention.

Key messages

Epidemic keratoconjunctivitis is a highly contagious disease with potential long-term consequences. Early detection and intervention by public health services are essential to mitigate the impact of outbreaks and depend on well-established communication lines with institutions in the community.
A content analysis of Canadian master of public health course descriptions and core competencies
Authors: Apatu E , Sinnott W , Piggott T , Butler-Jones D , Anderson L N , Alvarez E , Dobbins M , Harrison L , Neil-Sztramko S
Published: October 2020

Background

The Master of Public Health (MPH) is a common graduate-level professional degree that is offered by Canadian Universities. To date, few studies have examined competency-based MPH education in Canada.

Objective

To examine the degree to which MPH programs' course descriptions align with the Public Health Agency of Canada's (PHAC) core competency categories in order to identify strengths and training gaps in such programs across Canada.

Methods

A content analysis of MPH programs in Canada was conducted from July 2019 to November 2019. A sampling frame of programs was obtained from a list from the PHAC website. Program information, including mandatory and elective course descriptions was extracted from each program's website and analyzed in NVivo 12. Course descriptions were independently categorized by two researchers into one or more of the seven categories of the core competencies outlined by PHAC.

Results

We identified 18 universities with MPH programs with 267 courses across Canada. Thematic analysis revealed that 100% of programs had coursework that addressed the “Public Health Sciences” and “Assessment and Analysis” categories; 93% addressed “Policy and Program Planning, Implementation, and Evaluation”; 67% addressed each of “Communication,” “Leadership,” and “Partnerships, Collaboration, and Advocacy”; and only 56% had course descriptions addressing “Diversity and Inclusiveness.”

Conclusions

We find that Canadian MPH programs may lack course offerings addressing core competency categories relating to diversity and inclusiveness, communication, and leadership. Our findings were limited in scope as we relied on program Web sites; thus, further research should explore course content in more depth than this course description analysis allowed and identify ways to close the MPH curricular gaps we identified.

Key messages

Further research should be conducted to determine if the current model of competency education in Canada is successfully guiding MPH programs in meeting local and international workforce demands. Continued discussion is needed to raise the importance of MPH competency-based education in Canada.
Reform design, institutional and workforce factors affecting the pace of change
Authors: Krczal E , Franczukowska A , Braun A
Published: October 2020

Background

When implementing health care reforms the pace of change is often lacking behind the expectations of policy makers. This research is exploring in-depth the experiences of a primary care initiative from the perspective of general practitioners. The physicians' perspectives on design features, supporting environment and acceptance of the pilot are being explored. Enabling and constraining factors that may influence the pace of change of health care reforms are identified. Implications can be drawn for the strategic planning and smooth implementation of the change process.

Methods

14 problem-focused interviews with general practitioners working in pilot projects and 2 focus group discussions with 4-6 general practitioners working in single practices have been conducted. In addition, document analysis of secondary qualitative data and relevant policy documents has been conducted.

Results

Analysis revealed 9 codes: (1) Status of the general practitioner; (2) Institutional and legal framework; (3) Between cooperation and competition; (4) Hesitation from the young generation; (5) Reluctance from sole practitioners; (6) Personal drivers for starting a pilot (7) Challenges during set-up phase; (8) Challenges during growth phase; (9) Working conditions in primary care pilot projects. Enabling factors were a strong desire to be pioneering primary care provision and improved working conditions. The main constraining factors were low status of the general practitioner, uncertainty about future directions, lack of information and advice, high perceived financial risk, fear of losing autonomy and uncertainty about functioning teamwork.

Conclusions

For a smooth implementation of the primary care reform, system changes should improve education and training, compensation schemes and competence profiles of the professional groups involved. Further, initiatives should provide information and advice for practitioners striving for participating in a pilot project.

Key messages

The success of health care reforms also depends on institutional and workforce factors that may affect the pace of change. Health care reforms need strategic planning for a smooth implementation.
Work overloading, rate of health and sick leave in connection with quality of management
Authors: Ratkajec T
Published: October 2020

Description of the Problem

In some companies, production increases and workers are feeling overloaded. Managers have role in an organisation of work and in a handling various situations. The aim of study was to analyse if a quality of management of working situations is in connection with overloading, health rate and sick leave.

Methods

575 workers filled out a questionnaires in the period May to September 2017. We used Karasek-Theorell questionnaire, work ability index and seven questions about work organisation. We chose a three questions from all and asked workers: Are you generally overloaded with work in past year? Answers were: yes, frequently; yes, seldom; no, rarely and no. Does your superior organize, plans work and solves disputes well? Four possible answers were: no, no fully; yes, fully and yes, very good. How would you rate your health in the last year 1-5? Have you been absent from work in the last year more than 9 days? In statistics we used the h-square and the t- test.

Results

156 workers or 27.1% declared overloading, 111 or 19.3% rarely or not at all feld overloaded. The overloaded workers reported statistically poorer management (answers no and no fully), hi-square = 7.84, p = 0.01 and had lower health rating t-test = 7.22, p = 0.01 in comparison with non overloaded workers (2, 7 points vs. 3.4). The overloaded were not more absent from work than non overloaded workers (t-test=0,005).

Lessons

Work planning and a solving dispute impact on health status and work overloading in workers in glass factory. Overloaded workers did not have higher sick leave and that indicates a presentism in this group.

Key messages

The study showed that a managers could be have important role on the health of workers. Overloaded workers did not have higher sick leave than non overloaded which indicates a presentism in this group.
Fit for purpose and for practice? The self-perception of Serbian nurses
Authors: Šantrić Milićević M , Vasić V , Gačević M
Published: October 2020

Background

Nursing competencies are paramount to the quality of care outcomes and patient satisfaction. Serbia is lagging behind developed countries in the number of highly educated nurses. The study objective was to examine how well hospital nurses' competency fit for purpose (fit the needs of patients) and fit for practice (fit the needs of job requirements).

Methods

In the 2016 survey, 356 nurses in a general hospital have self-assessed how well their competencies fit for purpose and how well they fit for practice. In total 29 competencies that were classified as a health care professional competencies and managerial competencies were analyzed. Similar to the literature, we used educational standards and curriculum to construct a survey instrument - a two-dimensional questionnaire with two sub-scales. The paired-samples t-test and repeated measure general linear model were used to calculate the effect size of parameter estimates. The bivariate correlation analysis was also used, namely Pearson's and Spearman's rho correlation coefficient, and the effect size of the estimated correlation coefficients was calculated as well as their 95% confidence interval based on 1000 simulated samples via the bootstrap procedure.

Results

The survey instrument had Cronbach alpha 0.889 and 0.908 for health care and management competencies, respectively. Competency compliance rate was 69% (competency ratio 20 for purpose v 29 for practice). More fit for purpose were collaborating with external professionals and motivating patients for a healthy lifestyle, while prevention of intrahospital infections and the use of information technology better fit for practice. Low-income nurses have better-complied competencies. The nurses value teaching method the most.

Conclusions

In Serbia, nurses' competencies are moderately fitted for purpose and for practice. Managerial competencies are insufficiently acknowledged in nursing practice.

Key messages

Hospital nurses in Serbia have more competencies that are fit for purpose than is required for their current position. The development of higher education for nurses and the revision of job descriptions should be strategically oriented towards meeting the needs of patients.
The European campaign to fight musculoskeletal disorders - the need for eHealth
Authors: Hristova L , Tzacheva N , Kundurzhiev T , Stoycheva M
Published: October 2020

The study is based on the National Science Program 'eHealth in Bulgaria (e-Health)', funded by the Ministry of Education and Science. Partnership Contract No. D-01-200/16.11.2018.

Background

The focus of the European Health and Safety Agency's 2020-2022 campaign is on the prevention of work-related musculoskeletal disorders (MSD). In the employment of medical professionals, they are common. The introduction of eHealth in Bulgaria supports the processes of information, monitoring and prevention.

Methods

An adapted Neck Injury Index (NII) questionnaire was developed by: Vernon, H. & Mior, S. (1991) to determine specific injuries in the cervical spine, administered to 251 healthcare professionals from a large medical establishment.

Results

A study of the relationship between gender and the answers given in the ten sections of the questionnaire revealed a statistically significant difference in the answers for 'headache', 'driving' and 'sleeping' with p = 0.005, p < 0.001 and p = 0.020 respectively. 74.6% of men and 63.7% of women gave negative answers for headache, no driving pain, with men leading by 92.3% and a lower proportion of women than 56.1%, and without any sleep disturbances. 94.9% of men and 68.9% of women surveyed. The relationship between the profession and the medical profession indicating symptoms of neck damage, statistical significance was confirmed except in the above sections and also in 'lifting weights' (p = 0.009) and 'reading' with p = 0.002. As 65.3% of physicians, 51.9% of healthcare professionals and 56.5% of paramedics have no complaints of additional neck pain when lifting weights. A significant correlation was also found between mild injury rate (10 to 28%) and work experience over 10 years in 53.5% of those working in the hospital (p = 0.031).

Conclusions

The multifactorial influence of gender, position, and special length of service in the surveyed health care professionals did not cause symptoms indicating specific changes in the neck.

Key messages

It is important to establish a database through the introduction of eHealth with an information system. Identification changes in health and the presence of MSD in working nurses.
Improving the system continuous professional development of the health workers
Authors: Koikov V , Baigozhina Z , Abdrakhmanova A , Kabdullina G , Mergentai A , Derbissalina G
Published: October 2020

Issue

In modern conditions of the labor market, there is a need to implement an effective system of continuous professional development (CPD) of health workers (HWs) in accordance with existing and emerging health care needs. The system of CPD of HWs should be aimed at maintaining and improving the competencies (knowledge, skills, abilities) of each individual specialist, important to meet the changing needs of patients and the health system.

Description of the Problem

The lack of effectiveness of the CPD system of HWs in the Kazakhstan is due to the lack of accounting for many types of training activities in the system for confirming the qualifications of HWs (with certification of HWs every 5 years). So at present, when confirming a certificate, only formal additional education courses are taken into account, however, they do not correspond to the qualification level of a HW. Such types of activities in the CPD are not taken into account: non-formal education (fellowships, master classes, online trainings, etc.), activities that are aimed at developing and maintaining professional competencies such as mentoring young specialists, publication articles, participation in conferences, etc.

Changes: We have developed a new system for the CPD of HWs, harmonized with the procedure for regularly confirming the certificate of a HW (physician, nurse, pharmaceutical worker, specialist of the sanitary and epidemiological service), which gives access to professional work. The new CPD system is based on the credit accumulation mechanism in which Professional Development Units are assigned for each type of activity of formal and non-formal additional education and other types of activity aimed at professional development (mentoring, articles, conferences, expert activities, etc.).

Lessons

The introduction of a new CPD system allows for the effective maintenance and improvement of the qualifications of health workers.

Key messages

The lack of effectiveness of the CPD system of HWs is a serious barrier to maintaining the HWs qualifications at a sufficient level. The introduction of credit accumulation mechanisms for recording achievements in non-formal and non-formal additional education has enabled the formation of an effective system for the CPD of HWs.
Evaluation of training effects in the person-centered clinical method through active methodologies
Authors: Barros M
Published: October 2020

The Patient-Centered Clinical Method (PCCM) recognizes the particularities of each person who falls ill and values the therapeutic role of the doctor; promotes a holistic approach to the patient and / or the disease in its context; highlights the reasoning and decision-making process leading to the diagnosis taking into account the patient's expectations, feelings and fears. The proportion of patients who remain without a specific diagnosis is high because the clinical conditions present with nonspecific symptoms and the patient's understanding is the key to understanding. The challenge that is faced is training professionals with these skills and competences. The PCCM is an approach that respects the patient's preferences and in which communication has an effect on health outcomes, through self-confidence and motivation for change that can contribute to adherence and self-care. This work aims to present an experience of training new professionals at PCCM based on active methodology and mentoring in which the student himself is a source of reflection and study. The course was taught within the Residency Program in Family and Community Medicine in the Municipality of Vitória da Conquista, Bahia, Brazil, developed in 9 meetings of 4 hours each with themes such as, family, life cycle, genogram, ecomap, sexuality, death, diagnostic disclosure, ICU experience, psychosomatics. Many group dynamics and participatory techniques were used to enable involvement, at the end of the course they were asked to evaluate it, the writings were analyzed qualitatively through discourse analysis. The students showed a great willingness to bring their own experience of illness and style of illness, producing a greater empathy with the patient's condition. Trained professionals change from the authority paradigm to that of partnership, solidarity, empathy and collaboration. Training at the PCCM is a differential in the quality of care of any health professional.

Key messages

Allows to get closer to the user, facilitates understanding his problems and propose the developing joint strategies or plans - based on your expectations, limitations, feelings. PCCM tools contributed to the structuring of the clinical consultation in Primary Health Care (PHC), valuing the listening and the use of open questions.
Portugal's primary health care human resources assessment
Authors: Oliveira Miranda J , Santos Luis P , Sarmento M
Published: October 2020

Background

Primary health care services are the cornerstone of all health systems. Having clear data on allocated human resources is essential for planning. This work intended to map and compare the primary health care human resources of the five administrative regions (ARS) of the Portuguese public health system, so that better human resources management can be implemented.

Methods

The chosen design was a descriptive cross sectional study. Each of the five ARS were divided into primary health care clusters, which included several primary health care units. All of these units periodically sign a “commitment letter”, where they stand their service commitments to the covered population. This includes allocated health professionals (doctors, nurses), and the information is publicly accessible at www.bicsp.min-saude.pt. Data was collected for 2017, the year for which more commitment letters were available. Several ratios were calculated: patients/health professional; patients/doctor (family medicine specialists and residents); patients/nurse and patients/family medicine specialist. Mean, standard deviation, minimum and maximum values were calculated.

Results

National patients/health professional ratio was 702 with the mean of the 5 ARS calculated at 674+-7.15% (min 619, max 734) whilst the national patients/doctor ratio was 1247 with the mean of the 5 ARS calculated at 1217+-7.17% (min 1074, max 1290). National patients/nurse ratio was 1607 with the mean of the 5 ARS calculated at 1529+-13.08% (min 1199, max 1701). Finally, national patients/family medicine specialist ratio was 1711 with the mean of the 5 ARS calculated at 1650+-6,36% (min 1551, max 1795).

Conclusions

Human resources were differently spread across Portugal, with variations between the five ARS in all ratios. The largest differences occur between nursing staff, and may translate into inequities of access, with impact on health results. A more homogeneous human resources allocation should be implemented.

Key messages

Human resources in the Portuguese primary health care services are not homogeneously allocated. A better and more homogeneous allocation of human resources should be implemented to reduce access health inequities.
Tensions in the workplace: reflections on gender violence in contemporary Brazil
Authors: Santa Rosa G , Turatti B
Published: October 2020

Background

Women's control over their own bodies was highlighted by the expansion of their participation in the professional market, as well as by the greater liberalization of customs, thus provoking the transformation of previously male domains, especially in the workplace. However, this insertion and permanence occurred in an unstable way, impregnated with stereotypes, which sometimes result in different remunerations and harassing attitudes, especially in the gestational period.

Objective

The general objective of this work was to understand the process of becoming a pregnant woman in the working world in contemporary Brazil.

Methods

We sought to highlight the excerpts according to the chosen theoretical framework, namely the female performativity as pregnant, as a door to violence in the working world, in the light of Judith Butler's theoretical framework. This was an exploratory, descriptive, qualitative study that used the Internet to search and draw the national profile of women cases in the gestational period that had their labor lawsuits judged by the Regional Labor Courts of Brazil. After reading and selection of the speeches, three main groups of categories were identified: labor issues, exclusion of women's bodies in the working world and consequences for the the mother-child binomial`s health.

Results

From the moment women have had the option to control motherhood, they have made significant advances towards emancipation. Controlling motherhood does not mean not desiring it but rather having the right to choose it. Moreover, when a woman chooses to become pregnant and remain in the labour market, the challenge deepens, as she begins to be viewed as a failed piece in the oppressive machinery of labour.

Conclusions

The highly prejudiced scenario portrayed here, translates the fundamental brand of culture that is known: patriarchy. It means that women are forced to perform as men to conquer things and spaces in the masculine universe of work.

Key messages

The discrimination and barriers impeding women's professional and personal development are not present only in the professional environment but are also a reflection of the society. Violence against women is shaped by the naturalisation of gender inequality, which is based on hierarchical and historically constructed categories.
Bottled water consumption habits in Estonian residents and their opinions of possible health hazards
Authors: Vahur K , Ploomipuu I , Pastak E
Published: October 2020

Human needs about 28-15 mL/kg body weight of water daily (National Institute for Health Development). The sources of drinking water are either tap water, private wells or bottled water. According to the Health Board of Estonia, 89.13% of Estonian population used tap water in 2016 and 88.87% in 2017. Of all the consumers, 99.2% used water, for which the microbiological, chemical and indicator parameters did not exceed any normative (except for radiological parameters) (Joogivee..., 2017). However, more and more people are consuming bottled water and this trend is global (Kodumaine..., 2016). For example, in Estonia 72% of consumers used bottled water in 2007 (Noop & Riivits-Arkonsuo, 2007).

Different authors bring out that convenience, purity, better taste, better odour and quality were the main reasons for consuming the bottled water (Foote, 2011; Akpinar & Gul 2014). Some studies have shown that socio-demographic factors influence bottled water consumptions (Rothwell, 2006; Dupont et al, 2010).

The aim of this research was to determine the bottled water consumption habits of Estonian residents and their subjective assessment of the potential health impact of bottled water. The sample of this research were Estonian residents (n = 869) who agreed to take the online questionnaire through 21.11.2016-20.01.2017. For statistical analysis, X2 - test was used.

The conclusions of the research were: 1. Most of the respondents use bottled water and the main reasons are convenience and good taste or odour. 2. Factors as gender, income, education or having children do not affect the consumption of bottled water, but age and marital status do as younger and single or married/in relationship respondents buy bottled water more frequently. 3. About half of the respondents could not tell if the consumption of bottled water can affect health or not. Those respondents who thought that it could, mentioned carcinogenicity, digestive problems, toxicity and bad influence on teeth.

Key messages

Most of the respondents use bottled water, even if the tap water is of good quality, safe and cheaper, and the main reasons are convenience and good taste or odour. About half of the respondents could not tell if the consumption of bottled water can affect health or not.
Prevalence of endoparasitors in rural communities in Central Brazil: a cross-sectional study
Authors: Souza Rocha B , Alves Guimarães R , Sérgio Scalize P , Pagotto V , Souza Fiaccadori F , Fatima C , Rosso Weirich , Ribeiro N , Teixeira Bezerra , do Espírito Santo Filho K
Published: October 2020

Background

Studies show that the magnitude is high in regions lacking basic sanitation, such as rural areas. Despite this, there is little evidence on the prevalence of endoparasitosis in rural communities in developing countries. The aim of this study was to estimate the prevalence of endoparasitosis in residents of rural communities in Central Brazil.

Methods

Cross-sectional study conducted within the scope of the Sanrural Project that aims to assess the health and sanitation conditions of rural communities in 2019. The target population of this study consisted of residents of 17 settlements, 24 quilombola and 7 riverside communities in Central Brazil. By listing the total number of residents of each household in the communities, residents were selected by simple random probability sampling. Then, stool samples were collected in sterile plastic containers and identified. After collection, the samples were transported for analysis by direct examination of the feces. The descriptive analysis was made. The study was approved by the Research Ethics Committee of the Federal University of Goiás.

Results

Data from 680 individuals (children and adults) who had stool samples collected were analyzed. The prevalence's of the endoparasites found were: Entamoeba coli (13.5%; 90%CI: 11.5-15.8%); Giardia lamblia (2.8%; 90%CI: 1.9-4.4); Ascaris lumbricoides (1.5%; 90%CI: 0.9-2.4); Ancyslotoma (0.9%; 90%CI: 0.5-1.7); Enterobius vermicularis (0.7%; 90%CI: 0.4-1.5%); Taenia (0.6%; 90%CI: 0.3-1.3); Hymenolepis nana (0.6%; 90%CI: 0.3-1,3); Itamoeba (0.4; 90%CI: 0.2-1.1); Hymenolepis diminuta (0.3%; 90%CI: 0.1-0.9), Strongiloides (0.0%); Trichuris (0.0%) and, Schistosoma mansoni (0.0%).

Conclusions

An intermediate prevalence for principal endoparasites was observed. This result may suggest the persistence of precarious sanitation conditions. Thus, the implications of the study include the need for systematic action by managers and health professionals in improving sanitation conditions.

Key messages

A current diagnosis will be made on the health and sanitation situation of rural communities in Goiás, based on the analysis of clinical samples and water quality, among other conditions. Based on this diagnosis, together with the community, we will seek solutions for sanitation and health through a Rural Sanitation Security Plan (PSSR).
Hand hygiene: are WHO Framework scores consistent with hand rub consumption data? A regional study
Authors: Garlasco J , Vicentini C , Emelurumonye I N , Quattrocolo F , D'Alessandro G , Zotti C M
Published: October 2020

Background

Hand hygiene represents one of the most effective measures to prevent infection transmission in healthcare facilities and may reduce healthcare-associated infections by up to 15-30%. In Piedmont (a region in North-West Italy), hand hygiene compliance is routinely monitored through the WHO Hand Hygiene Self-Assessment Framework (HHSAF) and each hospital is also required to provide data about alcohol-based hand rub (ABHR) consumption as part of the regional performance indicator surveillance system. The aim of this study is to assess whether these two systems yield consistent results, i.e. whether numerical data matches the self-reported status of hand hygiene compliance.

Methods

For the years 2015-2018, data on ABHR consumption (in millilitres per patient-day, ml/PD) were collected annually at a facility level (40 hospitals) and then aggregated according to the corresponding local health unit/hospital unit, whereas the HHSAF scores were collected at a health/hospital unit level (18 units). The analysis was performed through logistic regression, by taking the WHO HHSAF score (continuous variable) as predictor and ABHR consumption as response variable, dichotomously considered as “low” or “high” (respectively below or above the 20 ml/PD threshold commonly accepted for good practice in hand hygiene).

Results

This study found that a high level of ABHR consumption is more likely to be observed in hospitals/health units with higher HHSAF scores, with a 1.14-fold increase in the odds for every 10-point increase in the HHSAF score. Despite the limited number of observations due to data aggregation, the result reached borderline statistical significance (p = 0.05).

Conclusions

The ABHR consumption surveillance provides feedback heading in the same direction as the results of the HHSAF, therefore the two surveillance systems are consistent. These findings provide further support for the validity of the HHSAF score as a reasonable predictor of hand hygiene compliance.

Key messages

The WHO Hand Hygiene Self-Assessment Framework score is a reliable predictor of hand hygiene compliance, as a high hand rub consumption is more likely to occur in hospitals with higher HHSAF score. Surveillance through the WHO HHSAF should be encouraged, along with alcohol-based hand rub (ABHR) measurement, and these results should be used to guide action plans to promote hand hygiene.
Appropriateness of antibiotics for medical prophylaxis: evaluation of data from the Italian PPS-2
Authors: Cremona A , Garlasco J , Gintoli I , D'Ambrosio A , Quattrocolo F , Vicentini C , Zotti C M
Published: October 2020

Background

Antibiotics (AB) are administered for medical prophylaxis (MP) to prevent infectious complications. The second national point prevalence survey (PPS) of healthcare-associated infections and AB use was conducted in Italy in 2016-2017. The survey found MP accounted for nearly 25% of all registered ABs, more than twice the EU/EEA proportion. The aim of this study was to evaluate how many ABs were administered for MP and how frequently general indications were followed.

Methods

Data from the PPS were used to evaluate the prevalence of indications for MP over the total number of ABs, the proportion - among these indications - of those justified by a motivation in the patients' charts, and the prevalence of ABs considered appropriate for MP. The evaluation was made in 12 hospitals out of 14 participating in the PPS in Piedmont, chosen on the basis of patient traceability. According to national guidelines, the indications for MP that were considered appropriate in this study were: Trimethoprim/sulfamethoxazole for P. carinii pneumonia, Rifaximin for diverticulitis, Penicillin for Streptococcal infections and for splenectomized patients, and Rifampin for TB infections.

Results

1844 AB prescriptions were registered among 1334 traceable inpatients in Piedmont. The prevalence of indications for MP was 16.2% and 253 ABs (84.6%) were prescribed with a motivation. Only 3% of ABs registered as MP were appropriate for this indication: Bactrim 2%, Rifaximin 0.3%, Penicillin 0.2% and Rifampin 0.4%.

Conclusions

This study found an extremely high rate of inappropriate ABs for MP, that will be further investigated through qualitative analysis of medical records to evaluate whether a misunderstanding of the PPS protocol occurred and empirical therapy was confused with MP. Nevertheless, this study highlighted the need for interventions to improve prescribing appropriateness for MP.

Key messages

This study found that only 2.98% of ABs registered as MP among traceable patients in Piedmont were appropriate for this indication. 15.38% of prescriptions for MP were not justified by a motivation. Interventions to improve prescribing appropriateness for MP could lead to a considerable reduction in inappropriate use of ABs, which is crucial in a country facing hyperendemic levels of AMR.
Epidemiology of Carbapenemase-Producing Klebsiella pneumoniae in a Portuguese Tertiary Hospital
Authors: Peres D , Pereira-Rocha N , Alves C , Correia S
Published: October 2020

Background

Carbapenemase-producing Klebsiella pneumoniae (CPKp) are considered a public health problem. To manage this multidrug-resistant organism (MDRO), it is important to identify individuals at higher risk. We describe risk factors for CPKp among a population who acquired this MDRO, in a tertiary hospital Center (THC), from 2017 to 2019.

Methods

Descriptive study, with data from medical record, in a 1100 bed THC, with active surveillance (high risk population at admission and CPKp direct contacts). Participants: patients > =18 years old, with length of stay (LOS) >48 hours, in which CPKp was identified in clinical samples > =48 h after admission and without previous history of this MDRO.

Results

Incidence rate increased from 0.031 (2017) to 0.090 (2018) cases per 1000 patient-days and was 0.081 in 2019 (p = 0.004). Evolution of CPKp proportion was 1.6%, 3.9% and 4.1%, respectively. In 2019, 12 patients (40.0%) were at intensive care when this MDRO was detected. During these 3 years, CPKp was more frequently identified in urine (31.3 - 54.5%) and respiratory products (13.3 - 36.4%). The median LOS until CPKp isolation was 10.0 to 24.0 days and, until discharge, 15.0 to 25.5 days. Fatal outcome occurred in 8 (25.0%) and 7 (23.3%) patients in 2018 and 2019, respectively. Most cases were exposed to antibiotics (81.8 - 90.6%), had a urinary catheter (63.6 - 75.0%) and were dependent for hygiene activities (63.6 - 66.7%). Many had a central line (21.9 - 43.3%), previous surgery (45.5 - 63.3%) and hospital admission in the previous 6 months (27.3 - 40.6%). Along these 3 years, none of these variations was statistically significant.

Conclusions

In this THC, CPKp increased from 2017 to 2018 and remained stable afterwards. It affected mostly male patients, exposed to antibiotics, with urinary catheter and dependent in their hygiene activities. In order to have an adequate CPKp containment strategy it is essential to know the population who acquired this MDRO.

Key messages

CPKp increased from 2017 to 2018 and remained stable afterwards, affecting mostly male patients, exposed to antibiotics, with urinary catheter and dependent in their hygiene activities. In order to have an adequate CPKp containment strategy it is essential to know the population who acquired this MDRO during their stay.