bluuebunny/crossref_metadata_2025 huggingface dataset:
AEFIs active surveillance projects as vaccinovigilance traineeship: Puglia (Italy) experience
Authors: Stefanizzi P , Bavaro V , Spinelli G , Anona D , Stella P , Tafuri S
Published: October 2020

Surveillance of Adverse Events Following Immunization (AEFIs) is a crucial part of vaccination strategies because the most important concern of “No-vax group” is the safety of vaccination. According to UE laws, in Italy a passive surveillance system of AEFIs is established by law and managed by National Drug Authority (AIFA) and Regional Health Governments. The performance of surveillance system is different in the 21 Italian Regions and in some Region, such as Puglia, the AEFIs reporting rate has been, for several years, lower than National figure. The implementation of AEFIs active surveillance projects could increase the performance of AEFIs surveillance system, also after the end of the project.

In Puglia, since 2017, May to 2018, November, an active surveillance of AEFIs has been established, focused on MMRV vaccine. In this study, we analysed the AEFIs general picture in Puglia in 2016 and 2019, before and after active surveillance project. The source of data is the AIFA database; data were reported as number of AEFI and rate for Puglia population (reporting rate RR). The AEFIs were classified as serious, not serious and unclassifiable and causality assessment was performed according to WHO recommendations.

The number of AEFIs detected by the passive surveillance system is 91 for 2016 (RR 2,2 per 100.000 people), and 168 for 2019 (RR 4,2 per 100.000 people). The percentage of serious AEFIs was 23.1% (21/91) in 2016 and 31% (52/168) in 2019 and unclassifiable AEFIs were 22% (20/91) in 2016 and 0 in 2019. The percentage of serious AEFIs for which the result of causality assessment was “consistent” is 23,8% (5/21) in 2016 and 55,8% (29/52) in 2019.

The experience of AEFIs active surveillance project increase the performance of AEFIs surveillance system. From 2016 (pre-project time) to 2019 (post-project time) the number of AEFIs detected was doubled, the number of unclassifiable AEFIs (proxy of poor reliability of the system) was reduced to zero.

Key messages

AEFIs passive surveillance system could be affected by underreporting and lack of quality. The AEFIs active surveillance project are an important occasion of traineeship for vaccinovigilance system, that could increase the sensibility and the reliability.
Modelling the global impact of the 13-valent pneumococcal vaccine on antibiotic use for otitis media
Authors: Moffatt M , Wasserman M
Published: October 2020

Background

Antimicrobial resistance (AMR) is a critical issue in global health causing approximately 1 million annual deaths. Vaccines are essential in addressing AMR as they reduce resistant strains and prevent development of resistance by preventing spread of disease and resulting antimicrobial use. This analysis evaluates the impact the 13-valent pneumococcal conjugate vaccine (PCV13) has had on dispensed antibiotic prescriptions (DAP) due to otitis media (OM), one of the largest drivers of DAP globally.

Methods

An Excel-based model was developed to estimate number of infants vaccinated with PCV13, and the associated reduction in OM cases in children <5 since 2010. OM cases averted were based on a global meta-analysis and estimated cases averted were applied to infants vaccinated by country. DAP avoided were estimated assuming 90% of OM cases were prescribed an antibiotic. We then compared our modelled estimates to metrics measuring number needed to vaccinate to prevent DAP from any outcome.

Results

Over the past 10 years, we estimated 286,54m infants were vaccinated with PCV13, with 158,33m OM cases and as many as 142,49m DAP avoided globally. By WHO region, reductions in OM rates and DAP respectively are estimated to have been; Africa and Eastern Mediterranean (103,05m; 92,74m), South-East Asia and Western Pacific (8,82m; 7,94m), Europe (20,70m; 18,63m) and Americas (25,76m; 23,18m). Using rates from the literature of 0,20 to 1,79 total DAP avoided per child vaccinated, results ranged from to 71,63m to 511,68m.

Conclusions

PCV13 use has resulted in substantial reductions in OM and DAP. As we focus on OM in children <5, results underestimate the full impact of PCV13 on DAP as vaccine impact on other pneumococcal diseases and adults through herd effect are not included. Recognition of the role of vaccination in addressing AMR burden is an opportunity to encourage patients, providers and healthcare systems to continually prioritize vaccination in public health efforts.

Key messages

Over the past 10 years, PCV13 has led to considerable reductions in dispensed antibiotic prescriptions globally, highlighting the importance of prioritizing vaccination in global healthcare systems. Our findings illustrate how vaccines can play an essential role in reducing the global burden of antimicrobial resistance through reduction of antibiotic use.
Influenza immunization among Tunisian health care workers in the 2018-2019 influenza season
Authors: Cherif I , Kharroubi G , Bouabid L , Gharbi A , Boukthir A , McCarron M , Ben Alaya N , Ben Salah A , Bettaieb J
Published: October 2020

Background

Given the nature of their activities, health care workers (hcws) are at higher risk of contracting influenza and transmitting the disease to their patients. Influenza vaccine (IV) remains the most effective way to prevent influenza and its complications. To the best of our knowledge, no national data on IV coverage among hcws is available in Tunisia. The present study aimed to assess the flu vaccination coverage among Tunisian hcws in the 2018-2019 influenza season and factors associated with IV uptake through a study of knowledge and attitudes related to influenza vaccination.

Methods

A cross sectional study was conducted in Tunisian primary and secondary health care facilities from March to May 2019. Hcws with direct patient contact were recruited according to a self-weighted multistage sampling. Survey data collection was based on a face to face questionnaire containing both open and closed questions.

Results

A total of 1231 hcws were enrolled in this study. Among respondents, 15.3% (95% CI: [12.3-17.2]) were vaccinated against influenza during the 2018-2019 influenza season. High confidence regarding vaccine efficacy (OR = 3.5, 95%CI: 2.5-4.8), belief that hcws' influenza immunization may decrease illness and deaths among patients (OR = 1.7, 95% CI: 1.2-2.3) and belief that influenza vaccination can reduce work absenteeism (OR = 1.7, 95% CI: 1.2-2.4) were associated with a higher IV uptake among hcws. In addition, participants who mentioned hcws as a target group for influenza vaccination (OR = 2.0, 95% CI: 1.5-2.8) and who were agree that IV is indicated annually for hcws (OR = 3.1, 95% CI: 1.9-4.9) were more likely to receive the IV.

Conclusions

Influenza vaccination coverage among Tunisian health professionals in 2018-2019 was low. Our findings suggest that knowledge and attitudes regarding influenza vaccine influence vaccine compliance among hcws and should thus be targeted by vaccination campaigns to promote flu vaccine uptake in the health community.

Key messages

Vaccination coverage among Tunisian healthcare workers was low in the 2018-2019 influenza season. Our findings suggest that knowledge and attitudes regarding influenza vaccine influence vaccine uptake among Tunisian health care workers.
The new public health imposed and its missing links - people, cultures, anthropology, health for all
Authors: Špoljar Vržina S
Published: October 2020

Critical medical anthropology has been active throughout the decades (Baer, Susser, Singer 1986; Lock, Nichter, 2002; Lupton, 1995. 2000, 2015) in proving that public health is not only an addition to equations of equity in health care but rooted in cultures of people globally (Špoljar Vržina 2003, 2007, 2008; 2011, 2013, 2021; Špoljar Vržina, Rudan, 2009). Italian anthropologist codified the postmodern 'doing good only in states of emergencies' (Pandolfi, 2010). In times of Corona Covid 19 -2020 epidemiological freights we are urged to take this further into account, especially since witnessing racial stigmatizing on the basis of ethnicity and nationality. Paradoxically, Italy as one of the cradles of quarantines is facing the potential permanent closure of neighbouring borders rather than experiencing a historically practiced cooperation, as in the case with Croatia, over centuries (Blažina, Blažina 2015). If there should be a New Public Health (Baum 2016, 2019; Lupton 1997, 2000) it should be recalibrated by anthropological findings that re- focus towards the good of people, cultures and their cooperation. The work of this paper presents this urgent challenge. This anthropological research is a long-term follow up of Croatian medicine system dismantling (Špoljar Vržina, 2008 onwards) through a continuous analyses of micro (people), intermediary (governmental) and macro (international) changes (Bear et al. 1986), departures from functioning for the benefit of people and finding entry points for ethical corrective interventions. The analysis proved an existing switch of the public health paradigm from global health into states of neoliberal sickness, with clear possibilities of returning to 'health for all' if disengaging from the politics of culture/public health. Public health enhancements need to be based on the recalibration towards knowledges of populational and cultural realities.

Key messages

Reintroducing the ‘innovative’ wisdom of doing good for all regardless of emergencies is the core of a new public health agenda. The new public health agenda is based on recognizing cultures as pillars of communities and global societies that matter.
Management of Food and Feed Safety Alerts in ATS VAL PADANA (Italy)
Authors: Troiano G , Chiesa M , Ghisetti M , Gelpi A , Meggiorini A , Firmi A M , Clasadonte V
Published: October 2020

Issue

The rapid alert system is a procedure codified in the European Community, designed to guarantee the speed of communications and consequent measures, that should be adopted if a food or feed represents a serious risk for health.

Description of the Problem

ATS Val Padana implements several measures in cases of food or feed that don't satisfy safety requirements, imported, produced, processed, or distributed by companies located in its area of competence. ATS checks the completeness and effectiveness of the actions undertaken/planned by the food/feed industry operator. The checks are focused on: - Preparation of the distribution list Activation of withdrawal/recall procedures;information provided to consumers;management of the withdrawn products;adoption of measures to prevent the placement of product on the marketAdoption of the traceability systemNotification to the authorities

Results

In November 2018-November 2019, 205 alerts were registered (11 in 2018, 191 in 2019) and specifically: - Alert notifications (risk requiring rapid action in another country): 154 Information notifications for follow-up (product present or that could be placed on the market in another Member State): 22Information notifications for attention (product present only in the Notifier country or has not been placed on the market or is no longer on the market): 29

The notifications concerned: the Department of Veterinary and Safety of Animal Origin Food(89), the Department of Hygiene and Health Prevention (89), both departments jointly (27). ATS Val Padana has managed the alerts and closed them on average within 7.59 days (DS 5.80, range 0-42). In one case the alert was closed after a month.

Lessons

The effectiveness of the Alert System depends first of the communications speed, as well as of the guarantee of rapid times to analyze sampled matrices. Our results demonstrate how ATS Val Padana operates ensuring the maximum effectiveness of the Alert System.

Key messages

The rapid alert system is a codified procedure in the European Community, designed to guarantee the speed of communications and consequent measures. The effectiveness of the Alert System depends primarily on the speed of communications.
Wild mushrooms poisoning: a public health challenge
Authors: Troiano G , Firmi A M , Adorni C , Porro R , Aroldi E , Mazzurini E , Pizzacani R , Pedrazzani S , Lopopolo F , Clasadonte V
Published: October 2020

Issue

Mushrooms are considered as ingredient of gourmet cuisine across the globe and mushroom poisonings can occur because of misidentification of a poisonous species as edible. Of the vast number of mushroom species, approximately 100 are toxic(**).

Description of the Problem

Mushroom poisoning is a public health problem. People should be educated about this poison as often there are no guidelines about the treatment of mushroom toxicity. Despite treatment, the prognosis can be mortal. In the Department of Hygiene and Health Prevention (ATS Val Padana, Italy) expert mycologists offer their consultation free of charge to people who pick mushrooms and register, for each consultation, quantity and toxicity of collected mushrooms.

Results

In 2018-19, 279 consultations were offered: 124(44.44%) in 2018, 155 (55.56%) in 2019. 58.42% of mushrooms were considered not dangerous for human health, without any difference among the two considered years (p = 0.167). 233.7 kg mushrooms were considered edible (mean 2.71, SD 16.44), 92.95 kg were considered dangerous and destroyed (mean 1.39, SD 6.99). The most identified species were: Agrocybe aegerita (11.47%), Armillaria Mellea (29.75%), Boletus edulis (6.45%), Macrolepiota venenata** (1.43%, N = 4), Xerocomus badius (2.51%), Lyophillum loricatum (1.79%), Agaricus Xanthodermus** (3.23%, N = 9). Intoxications occurred among people who did not refer to our mycology unit.

Conclusions

Mushroom poisoning represents a major health risk and as it's often consequence of misidentification, a free of charge consultation offered by experts is fundamental to avoid intoxications or deaths.

Key messages

Mushroom poisoning presents a major health risk. A free of charge consultation offered by experts is fundamental to avoid intoxications or deaths.
Children’s experience of using a smartphone application to promote healthy eating behaviour
Authors: Rageliene T , Grønhøj A
Published: October 2020

Background

Childhood obesity continues to grow in industrialized and developing countries becoming one of the major public health crises worldwide. This, in turn, causes short and long term financial and psychosocial burden to individuals and society. However, obesity can be prevented and reversed by changing one's diet. Previous studies showed that children who have a balanced diet rich in a variety of fruits and vegetables are less likely to be overweight and obese. Smartphone apps could be a useful tool for encouraging healthy eating behaviour and hinder obesity. The aim of this study was to evaluate children's experience of using a smartphone app designed to encourage healthy eating among 9-13 years old children.

Methods

According to dietary recommendations a smartphone app “Food Boss” was developed. The app consists of several different parts designed to promote healthy eating habits and knowledge about a balanced diet. A food diary, games, and the possibility to interact with peers were included. Children were asked to test the app for 2 weeks. Afterwards, two gender-specific focus groups were conducted.

Results

Children found the app easy to use and expressed a positive attitude to the user interface design. The app was perceived as being useful for learning about healthy eating and remember to eat more fruits and vegetables. User's engagement, interest and general satisfaction of using the app varied among the children, boys being more positive about their experience than girls. Though children asserted using the app in the future and recommending it to their friends. Suggestions for further app improvement was also disclosed.

Conclusions

Children's overall experience of using the app was overall positive and they found it useful for learning about healthy eating.

Key messages

Childhood obesity can be prevented and reversed by changing one’s diet. The “Food Boss” app can be an attractive way of reaching children and useful in encouraging healthy eating among children. Children’s overall experience of using the app was overall positive and they found it useful for learning about healthy eating.
Do food skills protect from food insecurity? A study among asylum seekers living in Norway
Authors: Terragni L , Arnold C , Henjum S
Published: October 2020

Background

Food insecurity has a high prevalence among asylum seekers living in Western countries. Previous studies suggest that food skills can protect against food insecurity. This study investigates the impact of food skills on food security and dietary diversity among refugees living in Norwegian reception centers.

Methods

The study has a cross-sectional research design. Eight asylum reception centers where selected and 205 asylum seekers (131 men and 74 women) were recruited through convenience sampling among the largest asylum seeking groups. We measured food skills by adopting questions from the Canadian Community Health Survey 2013 Rapid Response on Food Skills. Food skills were divided into cooking skills (ability to prepare meals) and shopping skills (ability to plan meals and budgeting). Food security was measured with the 10-item version of the Radimer/Cornell Hunger and Food Insecurity Scale. Dietary data was collected via a 24-hour recall, and the Food and Agriculture Organization of the United Nations (FAO) dietary diversity score was calculated to assess dietary quality. Data were analyzed with bivariate logistic analysis.

Results

Cooking skills and shopping skills contribute differently to food security and dietary diversity. Higher cooking skills were associated with higher dietary diversity but not with food security. Shopping skills were not associated with either food security or dietary diversity. Women had better cooking skills then men, but there were no gender differences in shopping skills. Married asylum seekers had better shopping skills than those who were not married.

Conclusions

Cooking skills have an impact on dietary diversity, initiatives promoting cooking skills should be encouraged. Further research is needed on what kind of purchasing skills can be useful for asylum seekers coping. Despite high food skills the level of food insecurity remained high. Initiatives addressing the multiple causes of food insecurity are needed.

Key messages

Food skills alone do not protect from food insecurity. Cooking skills are easier to transfer in a new food environment than shopping skills.
The effect of intermittent fasting on cancer prevention: a systematic review
Authors: Giannakou K , Papakonstantinou C , Chrysostomou S , Lamnisos D
Published: October 2020

Background

Cancer consists of a large group of diseases and is considered one of the key health problems in developed countries as it negatively affects patients' life expectancy and quality of life. At the forefront of research is the prevention of cancer through diet. The aim of this study is to examine the effect of intermittent fasting on cancer prevention.

Methods

A systematic review was performed in PubMed and EMBASE from inception to December 2019 to identify relevant preclinical studies examining the above association. The search strategy included a combination of search and MESH terms related to intermittent fasting and cancer. Specific inclusion and exclusion criteria were set for the selection of articles. Two researchers systematically screened articles and data were extracted from shortlisted articles. Qualitative data was synthesised thematically, and a narrative synthesis was produced.

Results

307 reports were assessed, but only 6 preclinical studies met the inclusion criteria. Most studies concluded that intermittent fasting had a positive effect in the appearance of tumours, either by slowing down the cancer incidence through the reduction of the number of lesions and inflammation of the tissues, or by reducing the risk of certain types of cancer.

Conclusions

Intermittent fasting with calorie restriction appeared to have an anticancer effect in animal experiments. However, due to the limitations of the studies included, future well-designed randomized clinical trials should examine the effect of intermittent fasting over longer periods of time, parallel forms of cancer and different patient populations.

Key messages

Animal experiments indicate a possible preventive effect of intermittent fasting on certain types of cancers. Due to the methodological shortcomings and heterogeneity across the studies included, more clinical experiments are strongly needed.
First report of HEV-3 subtypes e and f in the wild boar population in Abruzzo region, Italy
Authors: Scattolini S , D'Angelantonio D , Di Lollo V , Olivieri S , Marcacci M , Mangone I , Lorusso A , Pomilio F , Migliorati G , Aprea G
Published: October 2020

Background

Hepatitis E virus (HEV) is a zoonotic pathogen and wild boars are recognised as reservoirs. HEV is the most common cause of acute viral hepatitis worldwide and it is usually transmitted by faecal-oral route. EU reported more than 21.000 human cases over the last 10 years (1). At the present, HEV comprises 8 genotypes and several subtypes. HEV genotypes 3 and 4 (HEV-3 and HEV-4) are zoonotic. This is the first report of HEV-3 subtype e and f in the wild boar population in Abruzzo region.

Methods

During the hunting season 2018-2019, liver samples from wild boars were analysed using Real Time RT-PCR for the detection of HEV RNA. Among these, positive sample were subjected to Whole Genome Sequencing for genotyping. After the quality check, reads were mapped using the nearest identified ref. sequence (KU176129) and the resulting HEV RNA sequences have been analysed using HEV net (open source software).

Results

Overall, 40 samples were tested positive for the detection of HEV RNA. Among these, 19 samples, with a Ct value ≤ 38, were selected for phylogenetic analysis. All RNA viral samples belonged to HEV-3. In particular, 2 RNA viral samples belonged to subtype e and 1 to subtype f. The others, instead, belonged to HEV-3 subtype c.

Conclusions

Up to now, only HEV-3 subtype c has been reported among wild boars in Abruzzo, an Italian region officially recognized as an HEV hot spot because of the high number of human cases and for the strong sero-prevalence among blood donors. In this study, we report for the first time the presence of HEV-3 subtypes e and f in the wild boar population of this area. Since HEV-3 subtypes e and f are commonly associated to human disease from consumption of raw/undercooked pork meats, these findings suggest the potential risk also associated with the consumption of wild boar meat. Nevertheless, this speculation needs further investigations.

1.EFSA (2017). Public health risks associated with HEV as a food-borne pathogen. E. Jou., 15(7)

Key messages

First report of the presence of HEV-3 subtypes e and f among wild boar population in Abruzzo region. Potential risk for human health of HEV transmission associated with raw/undercooked wild boar meat consumption.
Zoonotic bacteria in the food chain: antimicrobial resistance and associated factors in Portugal
Authors: Costa M , Cara d'Anjo A , Cardo M , Leite A
Published: October 2020

Antimicrobial resistance (AMR) poses a threat to public health and animal food-production plays a crucial role in AMR spread. We thus aimed to characterize AMR profiles and associated factors in zoonotic bacterial isolates in Portugal.

Data from the Portuguese AMR surveillance program on animal populations and derived food, 2014-2018, was used. AMR frequency was described in E coli, Campylobacter and Salmonella isolates from poultry and pigs, according to antibiotic and samples tested. For Salmonella, AMR associated factors were studied: animal populations (broilers, laying hens, pigs) and derived meat, sampling stage (farm, slaughterhouse, processing plant), sample type (environmental, carcase, food), sampler (HACCP, industry, official, official and industry), sample context (control and eradication programmes, monitoring), year (2014-2018) and season. Logistic regression was applied to estimate crude (OR) and adjusted odds ratio (aOR) with 95% confidence intervals (95%CI). The final model was obtained using a backward stepwise method.

We assessed 2157 E Coli, 561 Campylobacter and 826 Salmonella isolates. AMR rates were higher to cefepime (91-98%) in E coli in all sample types; cefotaxime (100%) in E coli in broiler's meat; nalidixic acid (79-96%) in E coli and Campylobacter in poultry and derived meat; ciprofloxacin (50-98%) in all bacteria isolates from poultry and derived meat. For Salmonella, AMR was more likely in pig's meat (OR 3.66; 95%CI:1.19-2.82), slaughterhouses (OR 10.18; 95%CI:4.69-26.70), carcases (OR 5.90;95%CI:3.74-9.69). The final model indicated a lesser chance of AMR in laying hens (aOR .21; 95%CI:.11-.37), industry sampling (aOR .25; 95%CI:.07-.73), 2018 (aOR .24; 95%CI:.13-.42), and a higher chance in summer (aOR 2.39; 95%CI:1.34-4.28).

The findings support the need for control measures on the use of key antibiotics in veterinary medicine. AMR occurrence in Portugal seems to be related to summer, although less in laying hens and in 2018.

Key messages

AMR in bacterial isolates suggests the need for integrated actions to mitigate and control the use of 3rd and 4rd generation cephalosporins, fluoroquinolones and quinolones in animal production. AMR occurrence in Portugal seems to be further related to summer conditions, while comparing to other seasons.
Evaluation of the presence of Aflatoxin-M1 in milk samples sold in the region of Campinas-SP
Authors: de Souza Zocante A C , de Souza S J , de Souza Rodrigues V F , Caminada M L , Palaria Joaquim L O
Published: October 2020

Milk and its derivatives are fundamental foods in the human diet. However, milk is highly susceptible to microbial contamination, among which is Aflatoxin M1 (AFM1), presenting a risk to public health. Aflatoxin M1 is the main hydroxylated metabolite of aflatoxin B1 present in the milk of animals that have ingested feed contaminated with B1. These toxins have carcinogenic and genotoxic potential and similar toxicities. According to Resolution RDC 07/2011, published by the National Health Surveillance Agency (ANVISA), the level of tolerance for AFM1 is 0.5 µg / Kg in Brazil. The present study aimed to evaluate qualitatively and quantitatively Aflatoxin M1 in raw milk samples, being 2 samples of bovine milk and one sample of goat milk.

The raw, bovine and goat milk samples were purchased from local stores and were kept at approximately 5 ºC for 8 hours and subsequently frozen at 6 ºC for conservation purposes. The tests were carried out at the premises of Hexis Científica, Av. Antonieta Piva Barranqueiros, 385 - Distrito Industial - Jundiaí-SP, which provided training and use of the laboratory. The Scientific Charm Kits, Test SLAFMQ-EZ-20K were used. It is a quantitative test that uses ROSA immunoreceptors (Rapid Assay Step One) lateral flow technology. The milk sample interacts with colored spheres and the intensity of the color in the test area and is read as ppt (parts per trillion) by the reader.

According to the analyzes, all the samples studied presented Aflatoxin M1, with a concentration of 2,507 ppb; 2,410 ppb; 2,627 ppb, respectively for bovine and caprine milk samples, which characterizes a concentration five times above the allowed by the current legislation, according to RDC 07/2011, published by the National Health Surveillance Agency (ANVISA).

Key messages

According to studies, most of the negative results obtained on the incidence of aflatoxin M1 can be attributed to the low sensitivity of the analytical methods employed. The presence of Aflatoxins M1, represents a public health issue, since milk is among the products most consumed by man and, constituting the basis of infant feeding.
Long-term effectiveness of smoking cessation courses for Turkish-speaking migrants in Switzerland
Authors: Paz Castro R , Salis Gross C , Haug S
Published: October 2020

Background

Migrant populations usually report higher smoking rates. Among those migrant populations, Turkish- and Kurdish-speaking migrants are often overrepresented. Providing equal access to health services is one of major challenges of our time. The need for adapted smoking-cessation treatments for Turkish-speaking populations to achieve equity in health led, in 2006, to the development and implementation of the Tiryaki-Kukla smoking-cessation program in Switzerland. Since 2006, 5'305 Turkish-speaking migrants in Switzerland were reached with tobacco-related information and the offer of tailored treatment. In short, the treatment was grounded in behavioral therapy and was adapted from the weekly group-counseling sessions applied by the Cancer League Zurich. The adaptation focused on language, cultural and health literacy issues. The aims of the study were to evaluate one-year quit rates for smoking-cessation courses held from 2006 to 2018 and investigate whether certain characteristics predict long-term abstinence.

Methods

Evaluation of the program included a pre/post questionnaire (session 1/ 3 months after the quit day) and a follow-up telephone call twelve months after the quit day. To elucidate factors associated with long-term abstinence, Cox regression analysis and Weighted Generalized Equation Models were used.

Results

Of the 478 who participated in smoking-cessation courses, 45.4% declared themselves non-smokers at one-year follow-up. Characteristics associated with long-term abstinence were length of the course (eight vs. six sessions), adherence to the course, use of pharmacotherapy or NRT products, and baseline level of dependence.

Conclusions

Our findings are consistent with existing evidence supporting culturally-adapted smoking cessation interventions to reduce health inequity in migrant populations. However, achieving harm reduction in smokers with higher dependence scores remains challenging.

Key messages

A culturally-adapted smoking cessation course showed effective to reduce health inequity. One challenge remains: Achieving harm reduction in migrants with higher dependence scores.
Health inequalities within professional health education at the University of Malta
Authors: Copperstone C , Bonello M
Published: October 2020

Background

Addressing health inequalities is a crucial public health issue. It is thus imperative that health professionals are equipped with explicit competences to recognise and address health inequalities.

Methods

This is a multi-phase mixed-methods study exploring health inequalities and training within professional health curricula at the University of Malta. Phase One consists of a scoping study which explores whether and how health inequalities feature within the health professions' undergraduate curricula. This involved a systematic search of undergraduate health professional curricula, including competency profiles in each programme of study, using information available in the public domain. Academic year reviewed was 2019-2020. To ensure harmonisation, the two independent reviewers used the following search strategy: a) using a keyword descriptive approach (MeSH terms divided into two levels: direct, level one, and more general keywords, level two) and b) a more subjective approach to assess wider topic elements.

Results

Preliminary results emanating from mapping of 19 different programmes of study will be presented. A wide range of occurrences, from zero occurrences in some programmes to a maximum of one occurrence for level one and 12 for level two keywords in other programmes, was observed.

Conclusions

There is a wide disparity between the awareness of and training of inequalities across different professional training programmes. This provides the groundwork for Phase Two of this research during which public health stakeholders' attitudes and perceptions on health professional training and current practices will be explored. Findings from this study will provide the evidence and the impetus for possible interdisciplinary modules and/or continuous professional development programmes in health inequalities.

Key messages

The need for developing short courses/reviewing health curricula to incorporate health inequalities is encouraged. Public health professionals have a responsibility to address health inequalities in their professional practice.
A review of the World Health Organization’s discourses of equity
Authors: Amri M
Published: October 2020

Given the heightened rhetorical prominence the World Health Organization has afforded to equity in the past half-century, it is important to better understand how equity has been referred to and its conceptual underpinning, which may have broader global implications. Therefore, this study conducted a scoping review and focused on peer-reviewed literature by scanning Ovid MEDLINE and SCOPUS databases, and supplementing by hand-search. Articles were included if they met inclusion criteria - chiefly the explicit discussion of the WHO's concept of health equity, for example in terms of conceptualization and/or definitions. Articles which mentioned health equity in the context of WHO's programs, policies, and so on, but did not discuss its conceptualization or definition were excluded. Results demonstrate the WHO has held - and continues to hold - ambiguous, inadequate, and contradictory views of equity that are rooted in different theories of social justice. Moving forward, the WHO should revaluate its conceptualization of equity and normative position, and align its work with Amartya Sen's Capabilities Approach, as it best encapsulates the broader views of the organization. Further empirical research is needed to assess the WHO interpretations and approaches to equity.

Key messages

The WHO has held — and continues to hold — ambiguous, inadequate, and contradictory views of equity that are rooted in different theories of social justice. The WHO should revaluate its conceptualization of equity and normative position, and align its work with Amartya Sen’s Capabilities Approach.
The causal effects of transition into poverty on mental health in the UK working-age population
Authors: Thomson R M , Pearce A , Leyland A , Katikireddi S V
Published: October 2020

Background

Addressing the impact of poverty through income and welfare policies is likely important for public mental health; however, few studies assess potential effect size using causally-informed methodologies. To provide meaningful information for policymakers, we aimed to estimate the average treatment effect of transitioning into poverty on mental health.

Methods

We used data for working-age adults (aged 25-64) from nine waves of the nationally representative UK Household Longitudinal Survey (2009-2019, n = 39,553 obs=155,963). Exposure was transition into poverty (household equiv. income <60% median). Outcome was score ≥4 on General Health Questionnaire-12, indicating likely common mental disorder (CMD). To minimise the influence of reverse causation and time-varying confounders we used a marginal structural modelling (MSM) approach to create inverse probability of treatment weights. We performed secondary analysis stratifying by sex, and calculated population attributable fractions for each model.

Results

Good balance of confounders was achieved between exposure groups. Experiencing new poverty was associated with increased odds of CMD (adjusted OR 1.33, 95% CI 1.24-1.42, p < 0.001) with a 4.8% (3.6-6.0) absolute difference in prevalence: 24.0% vs 19.2%. There was a difference in relative effect by sex, with OR 1.40 (1.25-1.56, p < 0.001) for men vs OR 1.28 (1.18-1.38, p < 0.001) for women. However, there was no marked difference in absolute effect by sex: 4.9% (3.1-6.8) for men vs 4.5% (3.0-6.1) for women. For all analyses traditional logistic regression using the same confounders underestimated the effect in comparison with MSM.

Conclusions

Moving below the poverty line increased odds of CMD by 32.7% after accounting for confounding and reverse causality, with a greater relative impact on men. Our causal estimates suggest transition into poverty currently accounts for 10.7% of the burden of CMD in the UK working-age population - 8.9% for women and 13.1% for men.

Key messages

Reductions in household income worsen mental health, and traditional analytical approaches may be underestimating this causal relationship. Applying causal methodologies to observational data can provide exposure-outcome estimates less susceptible to common biases, which may be of more use to policymakers.
Smokers’ perception of cigarette packaging in France before and after the plain packaging
Authors: Pasquereau A , Andler R , Guignard R , Richard J B , Nguyen-Thanh V
Published: October 2020

Background

The new mandatory packaging for tobacco products (plain pack with larger graphic health warnings) was implemented in France on January 1st 2017. This study examines the impact of this new packaging on smokers' perceptions of their pack by comparing perceptions before (2016) and after (2017) the implementation.

Methods

Data come from the Santé publique France Health Barometer, a national telephone survey with random sampling. In the 2016 and 2017 editions, respectively 15,216 and 25,319 adults were asked about their tobacco consumption. Two questions were asked to smokers, identical in 2016 and 2017, on the appreciation of the appearance of the package and on the embarrassment to take out the package because of its appearance.

Results

- The share of smokers stating they do enjoy the look of their pack was divided by 3 between 2016 (53%) and 2017 (16%). Smokers stating that they are embarrassed of taking out their pack in plain sight because of its look were twice as numerous in 2017 (12%) as in 2016 (6%).A reduce appeal of cigarette pack was observed among the youths (18-25 yo) and they are now as few as their elders to enjoy the look of their pack.

Conclusions

The introduction of plain packaging has certainly had an impact on smokers' perceptions and, within a strong tobacco control context, probably contributed to denormalize smoking in France.

Key messages

Since the introduction of plain packaging, appeal of cigarette pack decreased and smokers are more often embarrassed of taking out their pack in plain sight because of its look. Our study suggests that the introduction of plain packaging has had an impact on smokers’ perceptions of their cigarette pack.
Coverage and inequalities in health interventions in Ecuador 1994- 2012
Authors: Rios-Quituizaca P , Gatica-Dominguez G , Santos J Ferreira , Nambiar D , Bruck S , Vidaletti L , Barros A
Published: October 2020

Several Latin American countries have reported significant reductions in inequalities and increases in coverage of essential health interventions across the continuum of reproductive, maternal, newborn and child health (RMNCH) care. Although Ecuador has had significant political and economic progress, few studies have evaluated the magnitude and trend of inequalities in RMNCH coverage interventions, a critical step in defining priorities for future health policies and strategies. This cross-sectional study used data from four national representative, standardized health surveys (1994, 1999, 2004 and 2012), analyzing coverage of seven interventions, stratifying by wealth quintile, urban-rural residence and geographic location. We used a variance-weighted least squares regression to calculate the average annual absolute change in coverage across interventions and mapped the results. Using the latest round of the survey, simple and complex measures of inequality were computed. Between 1994 and 2012, in almost all analyzed interventions the differences between rich and poor decreased, especially from 2004 to 2012, period in which primary health care policies were strengthened. In 2012, nevertheless, the most unequal intervention was improved sanitary facilities with 2.4-fold difference between rich and poor (ratio quintile 5:1; concentration index 15.4% 95% CI; 15.0-15.9%); and antenatal care, institutional delivery and improved drinking water kept significant inequality by economic status. While interventions related to the provision of health services showed reduction in inequality gaps, basic sanitation and drinking water had high gaps. Several provinces failed to improve coverage interventions over time, gaps which are masked by national averages and need additional intersectoral approaches to be addressed. Further analysis should focus on other dimensions of inequality such as ethnic group to identify gaps and generate strategies adapted to local realities.

Key messages

In Ecuador from 1994 to 2012 inequality gaps between rich and poor in most RMNCH coverage interventions declined, mainly from 2004 to 2012, but national means mask inequalities at the provincial level. Interventions related to the provision of health services showed reduction in socio-economic inequalities, while inequalities in basic sanitation and drinking water intervention coverage remained high.
Maternal Mortality in Paraguay tendencies and risk factors: 2004-2015
Authors: Villalba A , Sánchez M
Published: October 2020

Background

Maternal mortality remains a serious challenge worldwide, it being part of the Sustainable Development Goals. Progress is tracked through maternal mortality ratios (MMR), which demonstrate the current development of a health system. Our study describes tendencies and factors involved in the MMR in Paraguay, South America.

Methods

A retrospective cross-sectional study was undertaken. Data were extracted from the national system of vital statistics published by the Ministry of Public Health and Social Welfare. MMR was expressed as the number of maternal deaths per 100,000 live births. The causes of maternal deaths were classified according to the CIE-10. The tendency and fluctuations of the variables were analyzed through Pearson and Spearman correlations. A significance level of 5% was established.

Results

During the period of 2004-2015 in Paraguay there was a significant reduction in the tendency of the number of maternal deaths (r= -0.895; p < 0.001) with a decrease of 37.1%; Accordingly, there is a decreased tendency of the MMR (r= -0.929; p < 0.001) with a reduction of 45.4% and an annual mean decrease of 3.95%. It was observed that women aged 40 years and older and women characterized as single possessed a higher MMR, with each group showing 317.7/100 000 and 377.5/100 000, respectively. The 75% of death causes were Postpartum Hemorrhage, Eclampsia, Concurrent maternal deaths, Abortion and Puerperal Sepsis.

Conclusions

Our study showed significant decreased tendency of MMR, although remaining high compared to high income countries. More studies to support this result are recommended due to the difference with international estimates. The main causes of death showed the need to strengthen prenatal follow-up in primary care far from high-complexity hospitals.

Key messages

Our study describes the situation on Maternal Mortality in a developing country, showing the importance of health care access and prenatal follow up for preventable complications. Our work showed the urgent need for more studies about abortion prevalence and also to determine the cause of higher MMR on single women in our country.
Health and social needs of unprotected unaccompanied minors in Paris in the context of COVID-19
Authors: Gautier L , Quesnel-Vallée A
Published: October 2020

Background

Unaccompanied minors (UMs) are children under 18 settling in foreign countries without the care of a guardian. Host countries' governments are responsible for the care of UMs. In France, UMs theoretically receive child protection. However, assessment systems frequently deny their protection because of minority status rejection. As a result, they navigate through social precarity and have limited access to healthcare services. In Paris, the non-governmental organisation Médecins du Monde (MdM) offers them medico-psycho-social care. In March 2020, lockdown measures to contain COVID-19 further reduced unprotected UMs' access to social and healthcare services. This critical situation prompted MdM to adapt their care provision to the pandemic. In this research, we sought answers to the following research question: what were unprotected UMs' social and healthcare needs during lockdown and what was MdM's response?

Methods

First, we estimate the evolution of social and healthcare needs of a cohort of 58 unprotected UMs during the eight-week lockdown using secondary data. Second, using interview data with MdM volunteers and staff (n = 15) we further explore UMs' needs and document the experience of phone consultations with this cohort of UMs.

Preliminary Results

Time series show a constant increase of UMs' needs through time. MdM's new form of care provision may have contributed to alleviate their feeling of isolation. It also had unintended consequences.

Conclusions

In light of the alarming healthcare status of unprotected UMs, we recommend that France implements the public health authorities' recommendation to provide appropriate shelter to UMs regardless of their status, at least during health crises.

Key messages

This study fills a research gap related to a pressing political and public health issue. This study advances evidence-informed debates debates on the influence of models of care provision on UMs’ social and healthcare needs during health crises.
Burden of food insecurity in older adults from diverse global settings: policy recommendations
Authors: Pirkle C , Peltzer N , Câmara S , Gomes J , Ylli A
Published: October 2020

Food insecurity prevalence is highest in low and middle-income countries, yet there is a dearth of research on the burden in older adults in these settings. Food insecurity has long-term consequences for the health of older persons. We examined cross-sectional food security data from 1,482 participants in the 2016 wave of the longitudinal International Mobility in Aging Study (IMIAS) conducted in Canada, Albania, Colombia, and Brazil. These are community samples between 68 and 79 years. Food security was assessed with the Latin American and Caribbean Household Food Security Scale and recoded to yes/no. Covariates of interest included sex, site, income, living arrangement, and education. Descriptive statistics, with tests of statistical significance, were used. Responses to scale items varied from 10% of participants reporting worry about running out of food and being unable to eat healthy foods to 2% reporting not eating for a whole day or having to beg for food. Food insecurity in the sample was 17%. Few Canadian respondents (<5%) were food insecure, compared to 30% in Tirana, 28% in Manizales, and 18% in Natal. Better educated and income sufficient respondents were significantly more food secure than lesser educated, lower income ones. Respondents living with spouses were significantly less likely to be food insecure than those living alone or in other arrangements (e.g. with children). The exception was Tirana; 25% of those in other arrangements were food insecure compared to 32% living with a spouse and 44% alone. Food insecurity did not differ significantly by age or sex. Site, income, living arrangement, and education were all associated with food insecurity status. Study findings contribute to a significant gap in literature about food security in older adults. Because food insecurity in older adults leads to negative health outcomes, results suggest specific interventions to improve health and reduce burden on healthcare systems is needed for elderly.

Key messages

Food insecurity has severe health consequences for elderly and location, income, education, and living arrangement contributes to health inequalities in this population across diverse settings. Little to no research has been done on food insecurity in elderly outside of North America and study findings contribute to significant gap in research in this population across global settings.