bluuebunny/crossref_metadata_2025 huggingface dataset:
Antibiotic consumption and healthcare associated infection in a third level Italian hospital
Authors: Gori F , Vonci N , Tinturini A , Basagni C , Messina G , De Marco F
Published: October 2020

Background

The extended length of stay (LoS) is one of the main causes of hospital infections (HAI), followed by an increase in antibiotics consumption. The final step is the development of multiresistant microorganisms, with a consequent increase in costs for the national healthcare system. Aim of this study is to evaluate the prevalence of HAI and to analyze ATB consumption in a teaching hospital

Methods

Between 17-21 June 2019 the infection control team collected the clinical records of 425 patients to perform a point of prevalence analysis (PPA). Eligible patients were hospitalized in surgical and medical wards of the teaching Hospital (615 beds) in Siena, Italy. For each patients according to guidelines of European Centers for Disease Control and Prevention (ECDC 4.2) we searched for evidence of HAI and for all indication of ATB consumption. Data were processed using Stata12

Results

Overall 425 patients have been analyzed (48.24% female), mean age was 60.88 (SD 26.11) years, mean LoS 8.37 (min 1 max 86) days. Patients were admitted mostly in General Medicine wards (48.94%); 34% underwent surgery. 63.8% of patients had Peripheral Venous Catheter, 20% Central Venous Catheter and 31.06% Urinary Catheter. Twenty-nine HAI were discovered (PPA 6.82%); the higher prevalence (19.23%) was in Intensive Care Unit. LoS (OR:1.07;IC95%1.04-1.1) and devices (OR:2.17;IC95%1.39-3.37) were the two variables that significantly influenced the infection risk. Forty-six percent of all patients received ATB, the most used were third generation Cephalosporines (26,18%), followed by Penicillines (24,73%). The main use was to treat community infections (62.12%), followed by medical prophylaxis (30.81%)

Conclusions

PPA of HAI was 6.82%, comparable to 2017 national PPA (6.5%); prolonged LoS is probably the main cause of this result. Our analysis showed that ATB consumption was quite high, in agreement with the Italian prevalence (44.9%), but the percentage of medical prophylaxis was still high.

Key messages

The way to achieve the health care infection control is still long, the length of the hospitalization could be a field to be improved. High consumption of antibiotics for prophylaxis is still the main point to fight in the battle against the multiresistant microorganisms.
Surveillance and control of M. chimaera infections in the Tuscany Region, Italy
Authors: Casini B , Tuvo B , Totaro M , Baggiani A , Privitera G
Published: October 2020

Background

Disseminated M. chimaera infections among patients who underwent open-chest surgery with cardiopulmonary bypass have been associated with the contamination of heater-cooler devices (HCDs). The Tuscany region in the Decree 3822/2019 issued recommendations for the surveillance and control of M. chimaera infections.

Methods

In three Tuscan cardiac surgery centers, the case finding was carried out through evaluation and testing of patients with a history of HCD exposure (past 6 years) was performed. Water and aerosol samples were analyzed from each HCDs to determine the microbiological parameters required by the Directive 98/83/CE and to assess the presence of non-tuberculous mycobacteria (NTMs), according to the regional protocol.

Results

M. chimaera infection was not found in any patient and all clinical specimens tested negative. 22 HCDs were sampled (n.12 LivaNova, n.1 Terumo and n.9 Maquet) for a total of 114 samples (45, 8, 2 and 59 respectively). All the microbiological parameters were compliant, excepted for total microbial count at 36 °C that exceeded 100 CFU/ml in 50% (57/114) of samples and for the presence of P.aeruginosa in 10% (12/114). NTMs were detected in 16% (18/114) of HCDs: M. chimaera was identified in 11% (13/114) of samples and in 4% (5/114) M. gordonae. All aerosol samples were negative for NTMs, but in the HCDs Maquet, B.cereus were detected in 7% (4/59) of the samples, K.oxytoca in 2% (1/59), B.ursincola in 2% (1/59) and S. paucimobilis in 3% (2/59). Only S. paucimobilis was isolated also in the same HCD water sample.

Conclusions

The implementation of maintenance and disinfection procedures of HCDs was able to reduce the risk of contamination and aerosolization by NTMs but not of other microorganisms.

Key messages

Further strategies should be put in place for the cases finding. Moreover, reliable decontamination and identification of agents that can disrupt biofilms and increase chlorine susceptibility of mycobacteria are required.
Know your enemy, fight the outbreak: an Italian experience
Authors: Cuccaro C , Tarroni M , Tinturini A , Cresti S , Basagni C , Nante N , Messina G , De Marco F M
Published: October 2020

Issue

The New Delhi-Enterobateriaceae producing metallo-beta-lactamase NDM, resistant to carbapenems, are responsible of hospital outbreaks. The European Centre for disease prevention and control has published a report about the NDM outbreaks in Italy. Knowledge and application of all types of precautions is necessary to obtain adequate control.

Description

Between June and August 2019 an outbreak of Klebsiella pneumoniae producing NDM-1 occurred in an acute cardiac surgery setting from medium to high intensity, in a third level-hospital in Italy. Every patient with at least one positive typing test for NDM in clinical specimens was defined as a case. The infection control team sought patient 0, reviewed patients' daily records and created a timeline to control movements, verifying risk factors and time to positivity. The correct application of isolation and standard precautions was assessed. Auditing and training sessions were carried out. Our aim is to verify if these actions sufficed to control and halt the outbreak.

Results

Fourteen cases were identified, mean age=66.28 (SD = 13.55), 71.43% of them had a previous negative test. Positivity was found in samples from 13 rectal swabs (prevalence 12.38%), 7 lung aspirates, 3 urine cultures, 2 blood cultures and 2 wound swabs. Eight patients were positive in multiple body districts, 5 have been admitted to the same hospital within the year before, 3 came from other hospitals. The patient 0 has been moved in from a medical ward. After auditing, a training class was given to healthcare staff. The class concerned NDM phenotype, hand hygiene, isolation and personal protective equipment, with further observation in wards. In the following three months no new cases were registered.

Lessons

A continuous high-level adherence to standard precautions and hand hygiene by healthcare staff should be supported by adequate training. This is confirmed to be a strong action to prevent or stop cross-contamination.

Key messages

Colonization of multiresistant germs in healthcare due to cross-contamination has to be tackled promptly. Auditing and training actions should be taken into serious account in order to ensure an effective reaction from healthcare staff.
Simulated operating room aerodynamics to improve air quality and prevent surgical site infections
Authors: Messina G , Spataro G , Tarroni M , Cevenini G
Published: October 2020

Background

Proper operating room (OR) ventilation and air filtration are important measures to prevent infection of the surgical site and consequently reduce hospital stay and healthcare costs. In order to identify how changes in the air system can affect air quality, tailor-made researches need to be conducted in ORs. The aim of the study is to verify how a mobile air filtration system can affect the air quality of ORs when placed in different positions.

Methods

This is a descriptive study conducted during April and May 2018 in the University Hospital of Siena, Italy. We measured air flows through the vents of both the OR air system and a mobile novel air system unit, which includes a patented crystalline ultraviolet C reactor and an HEPA filter. Using a CAD 3D simulation software (SolidWorks 2017) the air flows interactions were simulated in the replicated OR.

Results

The device influenced the original airflows generated by the integrated OR ventilation system. Simulations have shown that when the device is positioned close to the wall with its intake beside the entrance and its outlet towards the operating table, air from outside can enter the room because the air intake from the device prevails over the internal pressure of the OR, increasing contamination. If the device is placed near the OR centre with its suction towards the operating table and its outlet towards the OR entrance, if the door is opened, airflows towards the outside of the room prevail, improving ability to retain outgoing contaminants.

Conclusions

The different positioning of mobile devices that generate clean air flows within ORs can have a significant impact on aerodynamics, which can turn can affect critical aspects of the surgical outcome. In order to achieve an effective device placement and orientation, OR-specific environmental measurements should be carried out.

Key messages

Movable devices may help boosting the performance of air systems in operating rooms. Every operating room needs a speciﬁc study in order to obtain the best proﬁt.
Results of screening for emergent highly resistant bacteria in Tunisian intensive care units
Authors: Ben Rejeb M , Ben Cheikh A , Bhiri S , Ghali H , Kahloul M , Khefacha-Aissa S , Hmouda H , Bouallegue O , Said-Latiri H
Published: October 2020

Background

The infections caused by emergent highly resistant bacteria (eHBR) that develop in intensive care units (ICUs) may result in significant patient illnesses and deaths, extend the duration of hospital stays and generate added costs. Facing this problem, the screening that emphasizes early identification of colonized patients, reduces the prevalence and incidence of infection, improves patient outcomes and reduces healthcare costs. In this context, we have implemented a screening for eHBR in ICUs of Sahloul university hospital of Sousse (Tunisia), which we report in this study the first six-months outcomes.

Methods

Rectal swab cultures were collected to detect Vancomycin resistant enterococcus (VRE) and Carbapenemase producing Enterobacteriaceae (CPE) among patients admitted in six ICUs of Sahloul university hospital of Sousse (Tunisia) and more than three times, at least one week apart, between 1 June and 31 December 2018.

Results

During the study period 174 patients were screened. Of them, 69.5% were male and 73.6% were admitted in surgical ICU. In total, 161 and 152 samples were realized respectively for the detection of CPE and VRE. These samples were positive in 15% and 8.5% respectively for CPE and VRE. Klebsiella pneumoniae OXA 48 was the most isolated CPE (80%).

Conclusions

Our screening program helped us in infection control by early identification of patients, thereby facilitating an informed decision about infection prevention interventions. Moreover, these results encouraged us to improve and generalize this program throughout the hospital.

Key messages

eHRB screening becomes an important axis in the prevention of eHRB infections in our facilities. eHRB screening allows the reinforcement of the basic infection prevention and control measures.
Klebsiella pneumoniae acquisition in ICUs: patient-based and laboratory-based surveillance
Authors: Barchitta M , Maugeri A , La Mastra C , La Rosa MC , Sessa L , Favara G , Magnano R , Lio S a n , Mattaliano A R , Agodi A ,   Study Group
Published: October 2020

Klebsiella pneumoniae - and especially multidrug-resistant K. pneumoniae - represents a global threat for Public Health, due to its high dissemination in Intensive Care Units (ICUs) and its association with mortality. Here, we investigated the molecular epidemiology of multidrug-resistant K. pneumoniae strains in ICUs from Catania, Italy.

We used data and samples from the Italian Nosocomial Infections Surveillance in ICUs - SPIN-UTI project, which has been surveying the epidemiology and the risk of Healthcare-associated infections (HAIs) in Italian ICUs. The SPIN-UTI network adopted the ECDC protocols for patient-based HAI surveillance. In a sample of ICUs the patient-based surveillance was integrated with a laboratory-based surveillance of MDR K. pneumoniae isolates. K. pneumoniae isolates were genotyped by multilocus sequence typing (MLST), and patterns of K. pneumoniae acquisition (i.e. carriage, colonization and infection) were identified using standard definitions.

Our analysis included 155 patients who stayed in two ICUs for a total of 2254 days, from October 2016 to March 2017. Trauma patients were more likely to be infected with K. pneumoniae than other patients (OR = 5.9; 95%CI=2.4-14.8; p = 0.004). A total of 109 K. pneumoniae strains were isolated from different sites of 39 patients, which in turn were defined as 45.2% colonization, 25.8% infection, and 29% carriage. 79.3% K. pneumoniae isolates resistant to carbapenems and 100% resistant to penicillins and cephalosporins. The MLST identified two major clonal groups: the ST395 and the ST37, which represented respectively the 65.6% and the 21.3% of typed isolates.

Surveillance of colonization and infection by high-risk clones might help in implementing appropriate strategies, which are crucial to reduce the spread of K. pneumoniae in ICUs.

*Study Group AOU 'Policlinico-Vittorio Emanuele', Catania, Italy: Patrizia Bellocchi, Giacomo Castiglione, Alida Imbriani, Marinella Astuto, Giuseppa La Camera, Agata Sciacca

Key messages

Multidrug-resistant K. pneumoniae still represents a threat for Public Health in Italy and globally, due to its high dissemination in intensive care units. Surveillance of colonization and infection by high-risk clones might help in reducing the spread of Klebsiella pneumoniae.
Water, sanitation and hygiene in health facilities and how they affect health in European countries
Authors: Grossi V , Shinee E , Schmoll O , Kistemann T
Published: October 2020

Background

Water, sanitation and hygiene (WASH) are human rights as well as important targets of the Sustainable Development Goals and a key component of quality of healthcare. Poor access to safe WASH impacts patients' health as it increases the risk of contracting infectious diseases, mental distress or avoidance of WASH services with additional negative health consequences. Global statistics show that the greatest risk exists in developing countries, while there is little data available from the WHO European Region. Our research aims at gathering an up-to-date overview of WASH data and health consequences on the example of a number of districts from four middle- and high-income countries in the European Region.

Methods

A mixed-methods analysis was conducted, including literature review, one-shot surveys addressing different types of healthcare services and different socio-economical settings, policy analyses, expert interviews and desk-review of health statistics.

Results

Preliminary results show that differences and commonalities are observed with respect to the WASH provision and management in healthcare across the considered areas in the region. While basic drinking-water is widely provided, other aspects, such as sanitation, are in need of attention both at the regulatory and implementation level. Also within countries, local differences are observed. Conditions of WASH services in health care are linked with the spread of (resistant) nosocomial infections through many different pathogens with consequences for patients, mothers and children, and for the broader population, influencing morbidity and mortality.

Conclusions

New insights on the condition of WASH services in healthcare facilities and increasing relevance of WASH-related health outcomes, such as antimicrobial resistance and nosocomial infections, show the need for increased attention to basic services such as sanitation and hygiene in healthcare also in European countries and for locally-targeted interventions.

Key messages

Water, sanitation and hygiene are a critical component of quality of health care and severely affect staff’s performance and patients’ health, with consequences for the population. Water, sanitation and hygiene need more attention in middle- and high-income countries in the WHO European Region, both at the regulatory and implementation level.
Surgical antibiotic prophylaxis adequacy in colorectal cancer surgery in Murcia, Spain
Authors: Monteagudo J F , Pérez-Romero S B , Podio-Martínez M , Aracil-Terrés G V , Arana-Aragón B , Sánchez-Rodríguez D
Published: October 2020

Background

In 2018 an antimicrobial stewardship program (ASP) was established in our Hospital, implementing guidelines for preoperative surgical antibiotic prophylaxis (SAP). Our objective was to describe the adequacy of SAP in colorectal cancer surgery (CCS) in our centre.

Methods

A prospective study was carried out in Hospital General Universitario Reina Sofia, Murcia. Patients subjected to CCS between January 1st and November 30th of 2019 were included. No exclusion criteria were established. Interventions were classified following ECDC Surgical Site Infection Surveillance guidelines. ASP data were obtained from clinical documents and electronic records, evaluated following ASP guidelines and classified as adequate or inadequate. Inadequate SAP was divided into five categories: “Length of administration”, “Antibiotic election”, “Inadequate Timing”, “Antibiotic indication” and “Other”.

Results

A total of 77 interventions were recorded, 75.3% being laparoscopic (LCOL) and 24.7% open (OCOL). All the interventions received SAP, but only 41.5% were adequate. The main causes of inadequacy were inadequate timing (40%) and length of administration (37.7%). Among the LCOL procedures, the main causes were length of administration (42.8%) followed by timing (37.1%). In contrast, the cause of inadequacy in OCOL was inadequate timing (50%) followed by an inadequate antibiotic election (30%)

Conclusions

Despite the implementation of an ASP and diffusion of guidelines among professionals, we found that less than half of colorectal cancer surgeries in our centre received an adequate SAP. Overall, inadequate timing of administration was the main cause, although we found length of administration as the main cause of inadequacy in LCOL. Due to these results, a PDCA cycle was started.

Key messages

Implementation of a program does not always mean compliance. Surveillance is key to monitoring results… and keep improving!
The perspectives of asylum seekers when accessing sexual health services in Cork and Kerry
Authors: Jones M M , Barry F , Davoren M P
Published: October 2020

Background

The World Health Organisation (WHO) states that; “Sexual health is a state of physical, mental and social well-being in relation to sexuality. It requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination and violence.” Asylum seekers are among many vulnerable groups that may face inequalities in terms of sexual health and how sexual health services are accessed. The aim of the present study is to gain an understanding of the experiences of asylum seekers when accessing sexual health services in Cork and Kerry, including the perceived barriers to and factors that facilitate access.

Methods

This is a qualitative study in which data was collected from 14 semi-structured interviews conducted with asylum seekers between May and June 2019. Participants were over the age of 18 and living in direct provision in Cork or Kerry. The present study uses a content analysis to explore the perspectives of asylum seekers when accessing sexual health services in Cork and Kerry.

Results

Participants demonstrated varying levels of understanding around the topic of sexual health and sexual health services. Several barriers and facilitators were identified which can be grouped into socioeconomic, political/legal, systemic, and social/cultural/religious barriers and facilitators.

Conclusions

The findings from this study highlighted several areas for improvement in the provision of information and services in relation to sexual health for asylum seekers living in direct provision and revealed the importance of addressing these issues in order to fulfil the purpose of public health by promoting health, preventing disease and prolonging life for all aspects of society.

Key messages

This study has identified the barriers and facilitators to accessing sexual health services in the context of the direct provision system in the Republic of Ireland. The results of the study reveal the varying ideas and understanding of the topic of sexual health and how this can influence help-seeking behaviour.
Knowledge on sexually transmitted infections and AIDS of women who have sex with women
Authors: Parenti A B H , Ignacio M A O , Buesso T S , Santini M A , Cerqueira A T A R , Nunes H R C , Duarte M T C
Published: October 2020

Introduction

Literature points to a scarcity of studies on sexual health and risk behavior of women who have sex with women (WSW) living in low- and middle-income countries, reporting lack of knowledge, high prevalence of sexually transmitted infections (STI), and low incidence of consistent use of protective barriers.

Objective

Analyze knowledge of WSW on STI and AIDS.

Methods

Cross-sectional study developed in São Paulo state, Brazil. The intentional sample consisted of 182 women (55 WSW and 127 women who have sex only with men - WSM). Data were obtained from April to December 2019 through a questionnaire with questions related to the sociodemographic variables and the validated instrument Sexually Transmitted Disease Knowledge Questionnaire (STD-KQ), which has 28 questions adapted to Brazilian Portuguese in order to assess knowledge on STI/AIDS. The percentage of correct responses in function of sexual orientation, correcting the confounding effects, was adjusted by using a multiple linear regression model. The analyses were performed using the software SPSS 22.0. This research was approved by the ethics committee under protocol number 3.320.951.

Results

Out of the 182 participants, those self-reported as white (79%) and the ones living with their partner (81%) were predominant. The median age was 26 years old (18-48) and the median number of completed years of studies was 14 (1-24). As for their knowledge on STI/AIDS, the average percentage of correct answers was 63%, which on average was 12% lower among WSW compared to WSM.

Conclusions

The data in the present research indicate the importance of implementing public policies concerning the sexual and reproductive health of WSW, especially aiming at knowledge on STI/AIDS and ways to prevent them.

Key messages

Importance of implementing public policies concerning the sexual and reproductive health of women who have sex with women. Scarcity of studies on sexual health and risk behavior of women who have sex with women.
Intercultural and participative strategy for prevention of cervical cancer in indigenous people
Authors: Sarmiento Medina M , Ardila Sierra A , Quintana González E , Vargas Cruz S , Velásquez Jiménez C , Puerto de Amaya M , Fandiño Osorio V
Published: October 2020

Issue

Decline in cervical cancer (CC) worldwide is attributed to coverage of screening programs, but there are barriers to achieve universal care and adherence, such as geographical accessibility, language, lack of knowledge and shame for the procedure.

Description

In indigenous populations barriers are stronger due to beliefs, customs and language. In multi-ethnic countries, it is necessary to use public health strategies that allow approaching communities by respecting their culture. This work proposed a strategy that respects cultures, strengthens community self-management and give sustainability to a CC prevention program. A study of Participatory Action Research with intercultural approach was done with five ethnic groups in a reserve of Colombian Amazon. It was approved by Research Ethics Committee, indigenous authorities and participating women. Indigenous female leaders participated in all phases of the project: 1) Training in qualitative research, ethics and CC; 2)ethnographic research for identifying beliefs and practices on sexuality, gender relations and attitudes towards western medicine and cytology; 3)educational campaign in ancestral languages; 4)training in CC prevention program to promote adherence, sustainability and self-management.

Preliminary Results

No beliefs or practices were found that could be negatively affected by the CC western screening program. Women's attitudes towards cytology are positive as long as it is carried out by female professionals, accompanied by female indigenous leaders and speaking their own languages.

Lessons

Womeńs leadership and reflection on health and prevention of CC were strengthened. Indigenous identity was reinforced and the gap in domination relationships by western culture reduced. A favorable setting for CC screening program was built with a culturally safe practice. In a few months screening campaign will start and it is expected that women feel more interested in their own health and comfortable to attend.

Key messages

Intercultural health prevention programs may be successful when focus on culturally safe practices through the involvement of local indigenous leaders. Cytology perception is positive in indigenous women as long as it is carried out by female professionals, accompanied by female indigenous leaders and speaking their own language.
Mitigating barriers in communication with migrants, results from a survey among health personnel
Authors: Spilker R , Nordström C
Published: October 2020

Background

Ensuring equity in health for migrant is a challenge for society and the health services. This survey map the challenges health personnel face in communication with immigrant patients, and how they wish to mitigate these challenges. Results can be used to inform implementation of measures for health personnel to better meet the needs of their patients.

Methods

In 2017, we conducted a short online survey to map the experiences and needs of health personnel in providing information to patients and relatives with immigrant backgrounds. The questionnaire consisted of six questions with answer options and opportunities to elaborate free-text answers. The survey was distributed through two migrant health networks coordinated by the National Competence Centre for Migration and Health (NAKMI), and by the Norwegian Nurses Organization to different section members. 549 people responded. Most of them nurses (41.5%) and doctors (12.4%) but also other health personnel as midwives, administrative staff, physiotherapists and psychologists.

Results

Nearly 50% of the respondents stated that they experienced weekly or more often communication difficulties with immigrant patients. To overcome communication barriers more than 90% say they would use interpreters when possible, use relatives as interpreters (55%) and/or a multilingual colleague (50%). To mitigate communication challenges, respondents said translated written materials (66%), simple language (43%) or use of pictures, films etc (37%) would be of help. More than 80% believe an electronic resource that gathers advice on how to customize and facilitate information and patient education, overview of translated material and good actions and project experiences will be a good help.

Conclusions

There is a need for increased access to knowledge and resources that can mitigate communication barriers between health personnel and migrant patients.

Key messages

There is a need for a comprehensive system approach to communication barriers in the Norwegian health care system. Health personnel need better access to tools that can help them provide equitable health care to migrants.
Referred morbidity of an African descendant community in the eastern Amazonia
Authors: Castelo-Branco S , Santos R P , Santos B R , Pinnock D D , Silva H P
Published: October 2020

Background

In the Amazon there are several quilombola communities, remnants of the enslaved peoples of African descendant. In Pará/Brazil (Eastern Amazonia) there are over 300 quilombola communities established in rural areas. The aim of this study is to investigate the living conditions and morbidity of individuals aged 18+ years who live in a quilombola community in the city of Ananindeua/Pará.

Methods

A cross-sectional study was done with 132 individuals (71.3% of the population). A household survey and a questionnaire evaluating socioeconomic, life habits and self-reported morbidity were conducted.

Results

Among the participants 90.2% belonged to the D/E economic class, 60.6% were women, the median age was 39.5 years (p = 0.343) and the per capita income was U$41.50/month with no difference between sexes (p = 0.266). 97.0% of the participants self-declared black or brown. Women had more education than men (7x5 years, p = 0.019). Most worked with agriculture and fishing (55.5%). 53.8% of men rated their health status as good while 41.0% of women rated their health as good (p = 0.002). 55.3% had never smoked cigarettes, 25.8% were ex-smokers, and 25.8% were smokers. More men (78.8%) used alcohol regularly than women (43.8%) (p = 0.000), among the users 32.5% reported weekly or daily use. The frequency of self-reported morbidity was as follows: Asthma 21.7%, Hypertension 10.6%, Diabetes 6.8%, Chronic infectious diseases 5.6%, Kidney disease 3.9%, Stroke 3.3%, Angina 3.1%, Liver disease 2.3%, Chronic heart failure 1.5%, with no difference between the sexes. Only 4.0% used medication for diabetes, and 7.6% for hypertension.

Conclusions

The study shows the social vulnerability of this quilombola community, which is similar to others in the region. The rural afro-derived Amazonian populations need to be empowered to help inform policy makers about their main health issues and healthcare needs.

Key messages

There are few studies about health of quilombola communities. This research shows the need for further investigations to produce sensible information and promote the empowerment of these populations. This study shows a high level of vulnerability of this community, similar to others in rural Amazon. Information about their health needs is fundamental to promotion of public policies in the region.
What are the perceptions of Indigenous organisation staff on the utility of the nKPIs?
Authors: Finlay S , Williams M , Judd J , Brown A
Published: October 2020

Background

This presentation will outline the results of five Aboriginal Community Controlled Health Organisation (ACCHO) case studies which sought to understand the impact of national key performance indicators (nKPIs) at the local level. The nKPI framework attempts to collect data to assist the Commonwealth Government to monitor the Closing the Gap Framework and to aid local ACCHOs to monitor and review their service delivery. Understanding how the nKPIs have been implemented and their impact across the various sites is essential to understanding their usefulness.

Methods

A multi-case study approach with a variety of ACCHOs was used. Site recruitment was conducted using a purposive sampling framework with an expression of interest, and/or a direct approach. At each site, several semi-structured interviews were conducted, documents were reviewed, and observations made. Data analysis was conducted using the computer program NVivo.

Results

Case studies (n = 5) were conducted at the five sites between in 2017. Data collection included semi-structured interviews ACCHO staff (n = 24), nKPI site-specific documents (n = 12) and observational. A number of key themes emerged from case studies relating to: • Workforce The usefulness of the nKPIsSelf-determinationWay ForwardACCHO Governance

Conclusions

Across the case studies, it is clear there are a variety perception about the utility of the nKPIs and the barriers/enablers which impact their capacity to report, collect and utilise the nKPIs. All Case Study sites saw the value of data to measure their success and to identify emerging issues among their clients. Their attitudes to the nKPIs varied though, due to issues relating to the design and implementation. The stability and size of the service also influenced their ability to use the data. More work needs to be done by the Commonwealth Government in collaboration with ACCHOs to improve the usability and utility of the nKPIs.

Key messages

Indigenous people need to be involved in the design and implmnetation of monitoring sytems. The nKPIs only report on a small subset of services delivered by Aboriginal Community Controlled Health Organisations.
Access of the LGBTQI+ population from the perspective of community health agents, Brazil
Authors: Souza M H N , Pinho A A , Graever L , Pereira A R , Santana A M S , Junior C J P P , Oliveira J T S , Pereira M E F L , Ferreira N P , Vieira E S
Published: October 2020

Introduction

In Brazil, according to the National Policy for Integral Health for Lesbians, Gays, Bisexuals, Transvestites, Transsexuals, Queers, Intersexuals and other identities (LGBTQI+), it is increasingly necessary to guarantee access to the health system, as well as to train qualified professionals.

Objective

describing the perception of Community Health Agents (CHA) about the approach to and access of LGBTQI+ people to primary health care.

Methods

Quantitative research conducted in October 2019 with 60 community health workers from the municipality of Rio de Janeiro, Brazil. The research was approved by the Ethics and Research Committees of the participating institutions.

Results

it was found that 100% of the CHA have already supported LGBTQI+ people, 19.2% identify prejudiced attitudes and delay in service as barriers to accessing the unit, and 19.2% recognize the presence of group activities in the unit. In the view of the CHA interviewed, LGBTQI+ patients could be approached in groups (50%), individually (19.2%) or both (30.8%). Among the strategies to increase the access of those patients, 61.5% are unaware and 38.5% listed possible strategies to be implemented in the unit. The topics of interest for discussion were: approach to reception, sexual identity, prejudice, psychological support, family, diseases, violence, and rights.

Conclusions

From the perspective of community health agents, the study allowed reflections on how approaching and making access available to LGBTQI+ patients in the primary care network. This evidences stigmas and fragility of professionals in the individual and collective approach to deal with issues regarding guidance sexuality and gender identity of the clientele served. It is important to emphasize permanent education actions among professionals, aiming at a comprehensive health care for the LGBTQI+ population.

Key messages

Welcoming and qualified listening promote comprehensive health care for the LGBTQI+ population. Improvements in the access of the LGBTQI+ population to the primary health care network decrease morbidity and mortality.
The health of immigrant children: a cohort study in the Metropolitan area of Lisbon - Portugal
Authors: Muggli Z , Amado R , Oliveira Martins M R , Pires M , Vaz D
Published: October 2020

Background

Studies in Europe show immigrant children to be more vulnerable to health problems. Portugal has a gap in knowledge about the health of immigrant children. The objective of this paper is to present results on a cohort study for health trajectories of immigrant children in the Amadora Municipality which has one of the highest numbers of immigrants in Portugal. We will analyse health profile characteristics of immigrant and native children and their utilisation of health services.

Methods

Prospective cohort study in Amadora health units (questionnaires and patient registers data). Participants: 420 native and immigrant children born in 2015 registered in Amadora Primary Health Care Centers (PHCC); recruitment from June 2019 to March 2020. Main outcomes: psychomotor development (Mary Sheridan); emotional and behavioural problems (SDQ); BMI; vaccination;

Results

From the 420 children recruited, 48,3% were immigrant mostly from Brazil and Portuguese speaking African countries, 41 children were born outside the EU (1st generation).

From the 126 children who had no routine medical examination at the age of 4, 59% were immigrant. Almost all immigrant children had vaccinations up to date (90%). Around 70% of native and 60% of immigrant children achieved all parameters in Mary Sheridan's test (p = 0.09). Overweight was found in 28% of native and 22% of immigrant children (p = 0.2). Median SDQ score for externalizing behaviours is different for 1st generation immigrants suggesting higher behaviour problems for this group of children (p = 0,003).

Conclusions

Most differences in overall outcomes occur between 1st generation immigrant and other children; immigrants showed significantly higher emotional and behaviour problems. Early identification of above difficulties and higher utilisation of routine health examinations should be a priority.

Key messages

1st generation immigrant children appear more at risk for emotional and behaviour difficulties. Early identification of above difficulties and higher utilisation of routine health examinations should be a priority.
Health curricular training with a focus on gender diversity in selected countries
Authors: Freitas C A M , Carvalho V N , Jesus N N , Bezerra M V R , Kochergin K N , Santos A M , Prado N M B L
Published: October 2020

Background

The discussion on the inclusion of sexuality in the school curriculum is old, but the same cannot be said of the proposition of this theme as a guide of national public policies in the area of education. We discussed in this article, how the absence of the biopsychosocial dimension of sexuality in the training of health professionals compromises the recognition of people's diversity, assistance and the guarantee of human rights.

Methods

Review of the literature in the scientific databases Science Direct, Web of Science and BVS. 16 articles constituted the corpus. This review followed the recommendations of PRISMA. The instrument proposed by CASP was used to evaluate the methodological quality of the selected studies.

Results

The publications on health training highlighted several aspects, from the need for training for the team of health professionals, regarding the reception and clinical care of LGBT people until the creation of teaching materials to fill the curriculum gaps on this subject. Several studies discuss the near absence of LGBT teaching hours in the medical and nursing curricula. The low permeability of LGBT discussions in academia reinforces a sexist, heterocisnormative training that has repercussions on the low quality of care provided to these individuals.

Conclusions

It makes it necessary to understand the uniqueness of the LGBT community for health support for different sexual genders. The inclusion of these themes in the training path can make possible a professional practice that overcomes the prejudices, violence and binarism present in a sexist and heteronormative society and implies breaking with hegemonic power relations. The construction of a pedagogy that values the diversities and a curriculum that does not standardize the subjects from standards, whatever they are, and that even meet those who are on the borders, is necessary for a true democratization.

Key messages

We cannot deny the constant setbacks in the scope of these policies guided in a conservative society in a kind of political and social game with confrontations sometimes aggressive. Promote the longitudinal improvement and insertion along the training, in the interface with other determinants that go through the health care of the integral being.
Stakeholders, Primary Health Care and Dispersed Rurality
Authors: Jaramillo-Mejia M C , Nuñez-Cabrera A , Gil J C
Published: October 2020

Objective

To characterize the existing tensions between actors which condition the implementation of the renewed primary healthcare (PHC), in the context of the most recent Colombian post-conflict years, in the territories of high rurality of the Pacific Coast.

Methods

We performed a qualitative study based on action research methodology with a critical and reflexive analysis of the social and institutional actors in the implementation of the Renewed PHC model in dispersed rural areas (Afro-Colombian and indigenous) the Pacific coast. We analyzed the different interested parties and the concordance between the community and institutional actors.

Results

The level of implementation of the Renewed PHC in high rurality territories of the Colombian Pacific Coast, intersects with tensions arising from the armed conflict, that affect sustainability and governance of the territory, and the intercultural tensions between the national health model in Colombia and the communities' social representations of their own health and development. Only 25% of the Renewed PHC elements are present, under low or medium conditions. Analysis of actors -Stakeholders-, according to their nature, level of presence, and power in the area indicates the absence of the Colombian government in these territories. Members of the community and their health resources constitute 48% of the Renewed PHC parties.

Conclusions

Limited understanding of the ethnic logics on health and development stands out as the main tension among actors to advance with the implementation of the Renewed PHC in post-conflict territories with high rurality. The national health model has a low capacity to accurately address health priorities from the Afro-descendant and Indigenous communities occupying such territories, with a differentiated, intercultural offer that would be able to act integrally on the dynamics of the illegal economy (illegal mining and illicit crops), which can seriously compromise their food security.

Key messages

Only 25% of the components of the renewed PHC are present in the territories with high dispersed rurality. In the post-conflict period, there are still tensions between community actors and stakeholders (Institutions).
Asylum seekers and inequalities in healthcare: a mixed-method research in Emilia-Romagna region
Authors: Gherardi G , Mammana L , Quargnolo M , Bodini C , Damosto D , Florescu C , Fantini M P
Published: October 2020

Background

In the past few years more than 30,000 asylum seekers arrived in Emilia-Romagna region. Guidelines were developed to screen the newly arrived, mainly focused on communicable diseases (CDs). However, asylum seekers who are out of the institutional reception system do not have access to such screenings. In order to assess the implementation and reach of these guidelines with respect to the target population, in 2019 a mixed-method survey was carried out.

Methods

A questionnaire with 35 closed and 11 open questions, based on a synthesis of the regional and national guidelines, was carried out with referents of the regional clinics that provide healthcare to asylum seekers. The collected questionnaires were processed through descriptive statistical analysis for the closed questions and text analysis for the open questions.

Results

Questionnaires were collected from 14 clinics. All clinics provide first visit and screening for CDs upon arrival, following the regional guidelines. However, enrolment in the national healthcare system was found to be delayed for periods of up to 6 months, resulting in discontinuity of care. Administrative and cultural barriers in accessing health and social services were repeatedly reported, the latter often linked to lack of cultural mediation services. Financial barriers were also reported, particularly with respect to dental care and pharmaceuticals. Results also show that asylum seekers within the institutional reception system can more easily overcome the reported barriers compared to those out of the system. Such inequality in accessing healthcare is reported also for the TB screening process.

Conclusions

Even if access to healthcare for asylum seekers is regulated by norms and guidelines, barriers are consistently reported. Moreover, asylum seekers within or outside the reception system face different barriers in accessing healthcare services. Such local evidence can be very relevant to inform actions that improve health equity.

Key messages

Even if access to healthcare for asylum seekers is regulated by law, barriers are consistently reported and impact disproportionately on those who are out of the institutional reception system. A mixed-method approach that generates local evidence on the barriers that asylum seekers face in accessing healthcare and on their causes is key to inform actions that improve health equity.
Restricted care for asylum seekers. An explorative study of rationing practices
Authors: Ziegler S , Bozorgmehr K
Published: October 2020

Background

Access to health care for refugees in many European countries is initially restricted. In Germany, during the first 18 months after arrival, any health services except for acute needs must be requested on a case-by-case basis. As the procedures and criteria applied by medical and state actors leading to provision or denial of services are intransparent, we explored ways to study them and derived first hypothesis about resource allocation criteria to identify possible factors leading to inequities.

Methods

A mixed-method-study was carried out, including six weeks of ethnographic exploration in two refugee outpatient clinics, documention of requests, a free-listing task and 20 in-depth interviews with public administrators, health workers, and translators.

Results

Of 101 requested services, 53 % were granted, 30% denied, 37 % not answered in time. Preliminary qualitative findings show that in dealing with restrictions, medical professionals develop enabling strategies as well as anticipatory obedience, the latter based on speculations about authorities' decision criteria. The effects of observed social classification e.g. of patient's behavior or reasons for migration need further exploration. Interviews suggest that in allocation decisions of authorities, structural and political considerations such as the prospect to remain in Germany, might play a role.

Conclusions

Procedures and strategies of care provision can be explored ethnographically. We found, that in addition to medical factors, individual, formal, social, structural and political factors might play a role in distribution decisions. Continuous documentation of requests is needed to gain further insights. To ensure equal care for all refugee patients information and training of care providers and officials is necessary as well as exchange between the involved actors. The lack of transparent rationing principles opens up opportunities for discriminiation and should be reduced via open discussion.

Key messages

Decision making criteria and procedures to grant or deny medical care for asylum seekers in Germany are intransparent and have not been sufficiently studied yet. Heterogenous local implementation of legal regulations – through medical actors and state officials – can lead to health care inequities within vulnerable populations.