bluuebunny/crossref_metadata_2025 huggingface dataset:
The metabolic profile associated with head and neck cancer genetic variation and dietary intake
Authors: Hoxhaj I , Ahmad S , Liu J , Pastorino R , Boccia S , van Duijn C M , Amin N
Published: October 2020

Introduction

Various single nucleotide polymorphisms (SNPs) have been associated with Head and Neck Cancer (HNC) susceptibility and prognosis. The pathogenesis of HNC is related to alterations in metabolite concentrations. Dietary intake may also influence the metabolic profile. We aimed to evaluate the association between serologic metabolites on the one hand and on the other hand HNC related SNPs and dietary intake.

Methods

This study included participants from the Erasmus Rucphen Family Study (ERF). We identified the SNPs associated with HNC from the GWAS Catalog, reaching genome-wide significance at P < 5 × 10−8. We performed regression analyses to evaluate the association of SNPs dosage with the metabolites and the association between metabolites and dietary intake.

Results

The study included 2758 participants, in whom 820 metabolites were analyzed. Four SNPs showed a significant association with circulating metabolites: rs174549 with phosphatidylcholine diacyl (β = 0.45; p-value= 7.17 × 10− 40), rs310518 with lipoprotein IDL sub-fraction, rs1229984 with triglycerides and rs1494961 with propionylcarnitine. The minor variant allele of the 4 SNPs showed increased level of the metabolites in blood. As to the association diet and metabolite concentration, significant associations were found for dairy products with sphingomyelin, fish intake with phosphatidylcholines, cholesterol esters with vegetables and myoinositol with fruits intake.

When the results of both analyses were merged, 5 metabolites were found to be associated with dietary variables and rs174549. In the minor allele carriers, phosphatidylcholines increased with consumption of fish and phosphatidylethanolamine increased with consumption of diary products.

Conclusions

The genetic variants rs174549, which is a determinant of genetic HNC susceptibility, is associated with phosphatidylcholines and phosphatidylethanolamine in the circulation.

Key messages

In the minor allele carriers of rs174549, phosphatidylcholine diacyl level in circulation increased with consumption of fish. In the minor allele carriers of rs174549, phosphatidylethanolamine level in circulation increased with consumption of diary products.
Geographic Information System as a health improvement tool: a resettlement camp in Mozambique
Authors: Pinto de Oliveira A , Kapasula F , Correia F
Published: October 2020

Cyclone Idai have devastated and displaced an estimated 1.85 million individuals across Mozambique. Around 90,000 cyclone survivors have been relocated to 66 resettlement camps. Doctors of the World Portuguese Delegation team is supporting the Sanitary Post of a resettlement camp, located in a remote rural area with limited resources. The first intervention was to build an epidemiological surveillance system in order to prevent and control communicable and non-communicable diseases and to improve access to health care.

The health status in the resettlement camp using conventional and geographic information system techniques were attempted as a community-based census-type cross-sectional study. Location of tents, water holes and latrines were mapped.

There were 2,170 people living in the 402 households interviewed. The reported age range of population was 1 day to 99 years, with a mean 19.3 years and a median of 15 years. Among residents, 4% (n = 90) reported a non-communicable disease: hypertension (75.5%), respiratory disease (22.2%), and a range of conditions (2.3%). The prevalence of mental and physical disabilities was 1.8% (n = 39). Regarding individual behavioral risk factors, 6.7% and 5.6% of the residents over 15 years, were currently using tobacco and alcohol, respectively. The distance from any household to the nearest waterpoint is less than 500 meters and almost all households (98.5%) distance more than 50 meters from the nearest toilet, as the standard recommended. The average number of people in the camp are in the standard recommended of 20 people per toilet facility with a ratio 15.8 person per latrine.

Geographic information system technology was helpful for the improvement of strategies on surveillance, prevention and control regarding communicable and non-communicable diseases, in the resettlement camp. Also made it possible to set up a home health care system, promoting access to health care for the disabled residents.

Key messages

Geographic information systems proved to be very useful in the implementation and organization of the epidemic surveillance system of resettlement camp. The epidemic surveillance system allowed us to implement a home care system for patients with disabilities, to respond to acute illnesses and chronic diseases agudizations, and to identify outbreaks.
Identifying language disorder in bilingual children is possible only if both languages are assessed
Authors: Nayeb L , Sarkadi A , Eriksson M , Salameh E K , Lagerberg D
Published: October 2020

Background

The number of bilingual people increases worldwide. In Sweden, one-third of all preschool age children are bilingual. Previous studies reported that bilingual children are at risk of being overlooked for early identification of language difficulties. There is a need of validated assessment instruments for identification of language disorder in bilingual children.

Aim

To investigate whether the language screening for three-year-olds used in Swedish Child healthcare would detect developmental language disorder (DLD) in bilingual children 6 month earlier.

Methods

Overall, 111 bilingual children (51% girls), 29-33 months, were screened from November 2015 to June 2017. They were recruited from three child health centres serving areas of low socio-economic status in Gävle, Sweden. The children were screened both in their mother tongue and in Swedish at the child health centre and consecutively assessed for DLD by a speech and language pathologist, blinded to the screening outcomes.

Results

Preliminary results from combining screening in Swedish and the child's mother tongue showed good accuracy: 88% sensitivity, 82% specificity, 67% positive and 94% negative predictive values. DLD was confirmed in 32 children (29%), of which 87.5% had screened positive and 12.5% negative. Specificity and positive predictive value increased radically when both languages were assessed, whereas sensitivity was less affected. A majority of the children who did not cooperate in the screening turned out to have DLD.

Conclusions

A language screening should be performed in the child's both languages, in order to achieve adequate sensitivity, specificity and positive predictive value. This procedure is highly relevant for children from low socio-economic families with a complex linguistic environment who tend to be at an increased risk of severe DLD.

Key messages

The procedure combining the child’s two languages identified language disorder in bilingual children at age 2.5 compared with assessment in only one language. Child healthcare nurses should screen bilingual children in both their languages in order to reflect their full language capacity equally as in monolingual children.
Bias correction in self-reported high blood pressure prevalence based on objectively measured data
Authors: Kislaya I , Leite A , Machado A , Tolonen H , Torres A , Nunes B
Published: October 2020

Background

Reliable and precise estimates of high blood pressure (HBP) prevalence are essential to inform decision-making and policies evaluation. Self-reported HBP may be underestimated by surveys due to misclassification of health status by participants. Misclassification may lead to inaccurate inference. We aimed to assess a feasibility of correcting misclassification bias in self-reported HBP in the Portuguese component of the European Health Interview Survey (INS2014) using data on objective blood pressure measurements from a smaller health examination survey (INSEF).

Methods

We assumed that “true” measured HBP status was missing at random for INS2014 participants (n = 13937). Using a multiple imputation method of logistic regression for monotone missing data patterns, HBP was imputed for INS2014 sample. Auxiliary data on measured HBP from INSEF (n = 4910) was used. Crude and corrected HBP prevalence rates stratified by sex and age group were calculated.

Results

HBP prevalence based on INS2014 increased significantly after multiple imputation correction, from 22.0% [CI95%:20.6-23.5%] to 38.8% [35.4-41.9%] for men and from 26.8% [25.3-28.3%] to 33.0% [30.5-35.4%] for women. Corrected estimates were similar to the objectively measured from INSEF, 39.6% for men and 32.7% for women. Corrected HBP prevalence in INS2014 increased from 4.1% [2.9-5.9%] to 7.9% [4.0-11.8%] in 25-34 years old (yo); from 9.3% [7.8-11.0%] to 17.6% [14.0-21.3%] in 35-44 yo; from 22.5% [20.3-24.8%] to 38.7% [34.2-43.2%] in 45-54 yo; from 39.8% [37.2-42.4%] to 53.8% [49.1-58.5%] in 55-64 yo and from 54.3% [51.5-57.1%] to 67.7% [63.1-72.3%] in 65-74 yo. Corrected rates were similar to the obtained by INSEF (5.7%, 17.0%, 35.8%, 54.8% and 71.3%, respectively).

Conclusions

Our results highlight the importance of bias analysis when using self-reported data on HBP. Multiple imputation is a feasible approach to adjust misclassification bias in health outcomes collected by population surveys.

Key messages

The magnitude and direction of misclassification bias in self-reported health outcomes should be investigated. Multiple imputation is a feasible approach to misclassification bias correction in self-reported survey data.
Decannulation in Acquired Brain Injury patients: the clinical impact of the process standardization
Authors: d'Angelo M , Michelutti A , Biasutti E , Quattrin R
Published: October 2020

Background

Decannulation is one of the first rehabilitation goals for Acquired Brain Injury (ABI) patients: from July 2017 the ABI unit of the Institute of Physical and Rehabilitation Medicine 'Gervasutta” adopted a decannulation protocol developed by the Italian Society of Physical Medicine and Rehabilitation (SIMFER). The current study aims to evaluate the impact of the process standardization on ABI patients.

Methods

A retrospective case-control study was conducted: clinical outcome and hospitalization indicators in ABI patients with tracheal cannula were measured in reference to the decannulation procedure applied. Data were collected from patients' records from 2014 to 2017. SISA software was used for the statistical analysis.

Results

A sample of 141 ABI patients was collected: among these 57 (40.4%) were treated with the new procedure. No statistically significant differences between control and case group were reported in terms of age, gender, aetiology of brain damage, cognitive and functional impairment as well as in terms of average days from admission to decannulation [39 (27); 35 (30)] and percentages of respiratory complications [20% vs 29.8%]. Decannulation rate was significantly higher in the case group (OR = 1.8; 95% CI = 1.2- 9.8; p < 0.01). Considering the case group, the simple linear regression analysis highlights a positive significant correlation between the length of hospitalization and days from decannulation to discharge (r = 0.3; p = 0.01) as well as from the date of oral feeding resumption and discharge (r = 0.4; p < 0.01).

Conclusions

Higher decannulation rate with no increase in respiratory complications was registered with the introduction of the new protocol. The shortening of average days from patients' admission to decannulation, even if not statistically significant, as well as the results from the simple linear regression analysis probably highlights further advantages due to a major safety related to the presence of a decision algorithm.

Key messages

The standardization of the decannulation process allowed the achievement of one of the first goals for the rehabilitation of Acquired Brain Injury (ABI) patients. The process standardization allowed a reduction of average days from patients’ admission to decannulation, probably due to a major safety related to the presence of a decision algoritm.
A retrospective study of a pre-travel consultation in the Lisbon Metropolitan Area, Portugal
Authors: Galhano Lopes D , Bragança Pereira M , Machado Gil M , Duarte S , Moreira A , Cunha I , Abreu Gomes F , Bastos L , Esteves H
Published: October 2020

Background

Travel from Portugal to other countries has increased in the past 5 years. A pre-travel health consultation is advised to all travellers to raise awareness and reduce travel-related risk. We describe the experience of a pre-travel consultation centre in the public health service.

Methods

A retrospective observational study about consultations in an international vaccination centre between 2014-2018. Variables included were: sex, age, destination, purpose, referral, and prescriptions. Descriptive analyses were performed for all variables.

Results

Between 2014 and 2018, there were 1,546 consultations. Regarding individual characteristics, 54% were female, and 80% had between 15 and 64 years of age. There was no referral in 66% of the consultations, followed by 16% from general practitioners in the Primary Care Centres Group. The leading destination was Africa (54%), in a downward trend (74% in 2015 and 32% in 2018) followed by Asia (18%) with an upward trend (12% to 28% in the same period). The primary purpose was tourism (83%), followed by work (9%). In total, 3,287 vaccines were prescribed with typhoid fever vaccine accounting for 26%, hepatitis A vaccine 22%, and yellow fever vaccine 15%. Mefloquine was the primary therapeutic drug prescribed for destinations with risk for malaria (41%). Regarding destinations with low risk for malaria, in 42% of the consultations, personal protective measures were the only recommendation.

Conclusions

Our data show that pre-travel consultations seem to be valued and actively asked for by travellers, but medical referral is still insufficient. Regarding health promotion and prevention of diseases, tracking trends in the most common destinations allows to optimize the information provided in the consultation, effectively capacitating the traveller to recognize and act on the most common travel-related health risks. In further studies, a post-travel follow-up should be carried out to determine the impact of the consultation.

Key messages

Pre-travel consultation is an actively sought-after service by the community, but awareness should be promoted in the medical community. Pre-travel consultation can have an important role in the health literacy of travellers.
MoRoNet a network to strengthen the quality of measles and rubella surveillance in Italy
Authors: Magurano F , Baggieri M , Bucci P , D'Ugo E , Sabbatucci M , Maraglino F , Iannazzo S , Marchi A , Nicoletti L
Published: October 2020

Background

Measles is a vaccine-preventable infectious disease and it remains one of the leading causes of infant mortality globally. The World Health Organization (WHO) has adopted the goal of eliminating measles and rubella. Detection and control of communicable diseases would not be possible without accurate laboratory results regarding when and where a particular disease circulates.

Methods

WHO/Europe therefore works with all Member States to steadily improve the quality of the laboratory data in order to determine the Region's progress towards measles and rubella elimination. For this purpose coordinates the European Measles and Rubella Laboratory Network (MR LabNet). National labs in this network undergoes regular external quality assessment through an annual accreditation programme.

Results

In Italy, a Sub-national Reference Laboratories Network for measles and rubella (MoRoNET) has been developed since March 2017 and currently includes 15 laboratories. MoRoNet was developed following the indications of the MR LabNet. It is accreditate, coordinated and supervised by the National Reference Laboratory.

Conclusions

Strengthening the role of national laboratories in overseeing the performance of subnational laboratories has become a critical need in order to properly monitor the Region's measles and rubella elimination efforts. MoRoNet permits to Italy to develop a country-specific work plan for establishing national networks and oversight mechanism, including preliminary monitoring and evaluation indicators compliant with MR LabNet standards. This is very significant not only to optimize the participation in national and regional processes to verify disease elimination, but also to strengthen the quality of vaccine-preventable disease surveillance.

MoRoNet Group: A Amendola; F Baldanti; MR Capobianchi; M Chironna; MG Cusi; P D'Agaro; P Lanzafame; T Lazzarotto; K Marinelli; A Orsi; E Pagani; G Palù; F Pittaluga, A Sacchi; F Tramuto.

Key messages

MoRoNet has permitted to Italy to develop a country-specific work plan for establishing national networks and oversight mechanism, compliant with WHO MR LabNet standards. MoRoNet network has permitted to optimize the participation in processes to verify disease elimination, but also to strengthen the quality of vaccine-preventable disease surveillance.
Implementation of Acute Flaccid Paralysis Surveillance in Emilia-Romagna, Italy: 2018-2019 analysis
Authors: Morgado M , Palandri L , Colucci M E , Affanni P , Zoni R , Pasquarella C , Righi E , Veronesi L
Published: October 2020

Problem

Acute flaccid paralysis (AFP) active surveillance is the gold standard in polio eradication process. Italy was classified in 2017 at intermediate risk of poliovirus reintroduction based on suboptimal poliovirus surveillance. The aim of this study was to restore an adequate level of AFP surveillance in Emilia-Romagna Region.

Description of the Problem

The Emilia-Romagna's Reference Centre for AFP surveillance, in collaboration with the regional Public Health Service identified a collaborative network for AFP Surveillance by analysing the 2015-2017 Hospital Discharge Registers in all region's hospitals. The surveillance protocol was reviewed with the development of a computerized system of Active Surveillance-Zero Reporting sent by e-mail to doctors in the network every 15 days since October 2018. The goal was to restore the AFP notification system to meet WHO requirements sensitivity, completeness of case investigation, completeness of follow-up and to monitor the active surveillance program adherence.

Results

The active surveillance network was composed by 49 doctors from both hospital administrations and clinical wards from 4 University Hospitals and 7 Local Health Authorities throughout the region. By the end of 2019, the mean response to each e-mail was 48.5% (SD 7.5%); 7 AFP cases have been reported; 85.7% received a full clinical and virological investigation and 83.3% completed the 60 day's follow-up. The final diagnosis of the cases was: 3 Guillain-Barre, 1 transient polyneuritis after HAV vaccination, 1 neuromyopathy from chronic disease, 1 acute myelitis in patient with DADA2. In 2 cases the paralysis persisted after 60 days.

Lessons

In 2019, the active surveillance system reached sensitivity, completeness of case investigation and follow-up required. Intervention had no expenses, is easily reproducible, created a direct collaboration between clinical colleagues in the network and the reference center which restored adherence to AFP surveillance.

Key messages

This work proposes how to improve AFP surveillance in a setting with low polio risk perception due to the absence of cases. Additionally, it reinforces the importance of direct collaboration/teamwork between institutions, regional reference centres and clinicians.
Attitudes of Marmara university third grade students towards dating violence
Authors: Daştan B , Sunman Ş , Demircan B , Işıldak S , Aydoslu C , Dogan E , Hıdıroglu S
Published: October 2020

Introduction and Objective

The definition of dating violence is “All of the words, mimics and behaviors that involve the use of painful or hurtful physical, psychological force and threats against the partner”. In the studies conducted, it was determined that one of the groups most at risk in terms of exposure to violence is the adolescent and young adult age group. Prevention of violence in the dating period mayal so prevent many types of violence that may occur in the future. Therefore, it is important to determine the attitudes of individuals in the age group at risk towards violence. The aim of there search is to investigate the attitudes of students studying in the 3rd grade in the Medicine, Pharmacy and Dentistry departments at Marmara University against the dating violence and their relationship with various variables.

Methods

The study is qualitative and there search is cross-sectional. There search population consists of students studying in the third grade in the departments of medicine, pharmacy and dentistry at M.U. As a data collection tool, a 15-question questionnaire with sociodemographic variables and attitude scales for dating violence were used.

Results

Participants: 40.5% consist of Medical faculty, 25.90% Pharmacy faculty and 33.5% Dentistry faculty students. Male participants 'attitudes cores towards psychological violence by men in flirting were higher than female participants' attitudescores towards psychological violence by men. When the attitude scales of the participants towards flirting violence were evaluated according to the faculty they studied, no significant difference was found.

Conclusions

This research has revealed that, like many studies in the literature, men's attitude scores towards dating violence are higher than women. While there is a statistically positive relationship between violence attitude scores towards cigarette smoking;there is a negative relationship between the duration of flirting and violence attidue scores.

Key messages

The dating violence is preventable health problem. The dating violence is silent war.
E-cigarette use among youth in Lebanon: Findings from Waterpipe Dependence in Lebanese Youth ‘WDLY’
Authors: Nakkash R , Tleis M , Asfar T , Maziak W
Published: October 2020

Introduction

E-cigarette use is becoming popular among youth worldwide and represents an emerging threat to public health. No previous study has looked into the prevalence of e-cigarettes use in the Eastern Mediterranean region. We report here on the prevalence of e-cigarette use in a cohort of 496 school and university students from Lebanon (62% males; 17 - 23 years) and differences in perceived harm between e-cigarette smokers and nonsmokers. We used data from Wave 8 of an ongoing cohort study that started in 2015 investigating the development of nicotine dependence symptoms in waterpipe smokers compared to cigarettes in Grades 8 and 9.

Methods

In 2019, we added questions to examine e-cigarette use patterns, risk perceptions, dependence, and susceptibility for future use among this population. Results were described and compared by gender status, e-cigarette users vs. non-users and other modes of tobacco use.

Results

Overall, 14.5 % reported ever use of e-cigarette and 8 % reported current use (use in the last month). Most ever e-cigarette users were cigarette smokers (32.8%), waterpipe smokers (34.3%), or dual smokers (10.45%). Compared to ever users, non-users were more likely to perceive e-cigarettes as more harmful (42% vs. 27% respectively, p= .007) and more addictive (41 % vs. 36% respectively, p= .013) than conventional cigarettes. Among current users, 28 % used e-cigarettes within 5 minutes of waking up. Among non-users, males were more open than female to try e-cigarettes if offered by a close friend (28.8% vs. 17.1%).

Conclusions

Our study suggests significant nicotine dependence among current users. Qualitative studies are needed to better understand why youth are drawn to this new emerging tobacco product. Our preliminary results point to the need to monitor e-cigarette use nationally by introducing questions on e-cigarette use in national school wide surveys such as Global Youth Tobacco Survey or the Global School Health Survey.

Key messages

E-cigarette use is spreading among youth in Lebanon. Results reveal significant nicotine dependence among youth in Lebanon users of e-cigarette.
Menopause, multisite pain and work ability among municipal workers
Authors: Kausto J , Kaila-Kangas L , Lallukka T , Leino-Arjas P
Published: October 2020

Background

A rising number of women will go through menopause while working. We aimed to examine the association of menopausal status with multisite pain and pain interfering with work ability.

Methods

We analysed cross sectional data collected in the Helsinki Health Study. Female full-time municipal employees aged 45, 50, 55 or 60 years and of at least normal weight were studied. Premenopausal group included 2420 and postmenopausal group 1364 participants. First, we examined the associations between menopausal status and multisite pain. Second, among those with pain (n = 1481), the association between menopausal status and change in work ability due to pain was studied. Age, health behaviour (including the use of hormone replacement therapy) and work-related factors were controlled for.

Results

Postmenopause was associated with multisite pain (OR 1,44; 95 % CI 1,11 − 1,87) as compared with premenopause. Postmenopause was also associated with a large change in self¬-perceived work ability caused by pain (OR 1,53; 95 % CI 1,01 − 2,32).

Conclusions

The results underline the importance of menopause to the experience of multisite pain and its contribution to the change in self¬-perceived work ability.

Key messages

This study adds evidence to the underresearched topic of menopause and work. Support for women in menopause and further attention in work issues of women in midlife are necessary.
Work ethic and societal norms influence sick leave and return to work: Tales of transformation
Authors: Moldvik I , Ståhl C , Müssener U
Published: October 2020

Background

Evidence of a positive association between work and health has been gathering up for years and can be explained by social status, contributions to society and the self-worth that work provides. This is maintained through the ideal of work ethic, where working is seen as the moral way of life. Not living up to the morally worthy identity can cause feelings of inadequacy, shame and stigmatisation. Considering this, it is relevant to investigate how people on sick leave manage societal norms and values related to work, and how this influences the sick leave and rehabilitation process. The literature on return to work is extensive and has investigated the issue from different perspectives. How norms influence the return to work process and how individuals and other stakeholders relates to such norms are less commonly explored, which is the focus of the present study.

Methods

This was a longitudinal interview study with a narrative approach, comprising 38 interviews with 11 individuals on long-term sick leave. Data collection was conducted in two phases and analysed iteratively through content analysis.

Results

The results suggest that work ethics and societal norms influence individuals' views of themselves and the sick leave and rehabilitation process. Conforming one's personal values to the work norm can create internal conflicts and cause feelings of shame for not being able to live up to the established norm. The strong work norm may create unrealistic expectations, which in some cases may result in constraining the return to work process.

Conclusions

To transform a sick leave narrative into a positive one, societal norms and their influence on identity needs to be recognised. Stakeholders involved in the process can contribute to a positive transformation by not only supporting return to work, but also to acknowledge and help people manage their self-image as having a disability that limits their ability to work.

Key messages

Full return to work is not always the best option from a quality of life and well-being perspective. Treatment and support from stakeholders should be viewed as meaningful and legitimate, even if it does not lead to return to work.
Development of an online intervention to improve sustainable employability of low-educated employees
Authors: Hazelzet E , Bosma H , Houkes I , de Rijk A
Published: October 2020

Background

Although low-educated employees are more at risk of poor health, they participate less often in workplace interventions, and when they do participate, they tend to profit to a lesser extent than high-educated employees. When developing sustainable employability (SE) interventions, the perspectives of the low-educated employees are often lacking, leading to a mismatch between the intervention and the needs. This group should be included when developing SE interventions in work organizations. The paper describes the development of a web-based intervention for employers to improve the SE of their low-educated employees using the Intervention Mapping (IM) approach.

Methods

The development builds on the first four steps of IM. A needs assessment (step 1), based on empirical evidence from previous literature and focus groups with employees (N = 11) and with representatives of employers (N = 5), was used to formulate the intervention objective (step 2), followed by selecting relevant theoretical methods and translation to practical applications (step 3). Subsequently, a web-based intervention was developed (step 4).

Results

The needs assessment identified the importance of the active involvement of employees and of a true dialogue between employee and employer. An online toolkit, called 'Healthy HR' (HHR) was developed, with eight steps, each consisting of several tasks, for developing and implementing local SE interventions that are tailored to the organization by the employer and employees themselves. Every task comprises one or more supportive dialogue-based tools. Adapted Intervention Mapping was used as the guiding principle to structure the eight steps.

Conclusions

The systematic development resulted in an easy-to-use online toolkit for employers that supports developing SE interventions tailored to the needs of the low-educated employees and organization. Using IM principles is expected by both the researchers and the employers to improve the effectiveness of HHR.

Key messages

‘Healthy Human Resources’ (HHR), is an online dialogue-based toolkit that facilitates employers to develop tailored SE interventions by involving their low-educated employees via dialogue. The principles of intervention mapping (IM) are used at two levels: to develop HHR, and as the leading principle within HHR.
Prevalence and factors related to burnout syndrome among Italian residents: a cross-sectional study
Authors: Sattarinia D , Caricato M , Bori T , Murgia N
Published: October 2020

Background

Burnout syndrome occurs frequently among physicians and begins early in training, but little is known about burnout among resident physicians. The aim of this study is to explore the prevalence and characteristics of burnout among residents and define factors associated with burnout.

Methods

In 2019, an anonymous questionnaire was sent out to residents of the University of Perugia, Italy (n = 419). We collected socio-demographical, occupational data and burnout level through the Maslach Burnout Inventory Human Services Survey (MBI-HSS), calculating mean level of burnout and proportion of residents suffering from low, intermediate and high degree of burnout. Total scores for Emotional Exhaustion (EE), Depersonalization (DP), and Personal Accomplishment (PA) subscales were calculated. Chi-squared tests were computed for correlations between burnout and the other factors.

Results

The response rate was 81,15%. EE and DP, the major components of burnout, were reported, respectively by 55.29% (n = 188) and 47.60% (n = 162) of the residents. Burnout prevalence was 69,70% (n = 237) among the residents, defined as a severely abnormal level of either EE or DP, with 75.6% (clinical group), 67.0% (surgery group) and 65,20% (healthcare services group). Higher prevalence was reported in early residency, in women and in residents with bad lifestyle (fitful sleep, poor physical activity, unbalanced diet, heavy drinking and low social life).

Conclusions

Our findings suggest that residents are an at-risk population. Specific interventions are urgently needed for the potential impact of burnout on work quality, patient care, residents' professional development and lifestyle.

Key messages

Prevalence of Burnout is higher in medical residents than in other helping-professions. There are differences about risk of burnout among different types and years of residency.
Mortality among the Russian working-age population from suicide: official and actual rates
Authors: Semyonova V , Sabgayda T , Zubko A , Gavrilov L
Published: October 2020

Purpose of the study is to assess suicide-related loss of the Russian working-age population in the 2000s and extent of its possible under-reporting. Analysis is based on Rosstat data on deaths among the Russian working-age population (15-59 years) calculated in FAISS-Potential, as well as data on mortality from suicide in the “old” and “new” European Union (EU) (before and after May 2004) from the European mortality database. Officially, mortality from suicide among the working-age population decreased at 3.4 fold in males and 2.9 in females, far exceeding the rate of decline in the overall mortality from external causes which equaled to 2.6 times in males and 2.5 in females in 2000-2018. Currently, the Russian mortality from suicide is multifold higher than the “old” EU one across all working ages and higher than the “new” EU one among population aged up to 45 years only. The rate of decline in mortality from event of undetermined intent among working-age population was lower compared to suicide, adding up to 14.2% and 11.6% vs 3.4 and 2.9-fold. And the Russia's such loss compared to the “new” EU one was about 10-fold in both males and females across all working ages. With a high degree of probability, “events of undetermined intent” are likely to be latent suicides.

Conclusions

Official mortality from suicide among working-age population decreased at extremely high rate with linear trends. A significant share of suicide mortality is latent and is counted as events of undetermined intent. With a high degree of probability, latent suicides cover hanging, jumping/falling from a high place, and drug poisoning of undetermined intent. The trend in loss due to latent suicide is negative. The share of latent events among actual suicide-related loss in 2010s steadily increased, exceeding one third in males and reaching 50% in females in 2018. Currently, mortality from suicide is likely to exceed the Rosstat indicators by 60% in males and over 2-fold in females.

Key messages

In the 2000s, the official mortality from suicide among the Russian working-age population decreased at an extremely high rate with linear trends. The share of latent events among the actual suicide-related loss in the 2010s steadily increased, exceeding one third in males in 2018 and reaching 50% in females.
Forgoing health care is associated with insurance deductibles in a consumer-driven health care system
Authors: Sandoval J L , Petrovic D , Guessous I , Stringhini S
Published: October 2020

Background

The Swiss health care system is consumer-driven with universal coverage and good population outcomes. Deductibles of mandatory insurance plans are self-selected, regulated, and unrelated to pre-existing conditions. In a Swiss population, we aimed to determine if forgoing health care was associated with insurance plan deductibles and if the association was dependent on socioeconomic status.

Methods

We used data from the Bus Santé Study; a cross-sectional survey study ongoing in Geneva (Switzerland) since 1993. We included adult participants in the study between 2007 and 2016. We divided participants according to insurance plan deductibles (low, medium, or high). Forgoing health care information was obtained from the study questionnaire. Forgoing dental health care was considered separately as mandatory insurance plans do not cover dental care. Inequalities were quantified using the regression-based relative index of inequality (RII) adjusted for potential confounders (age, gender, income, educational attainment, known comorbidities, cardiovascular risk factors, additional health insurance plans or subsidized premiums)

Results

We included 9081 participants, with 8.9% reporting forgoing non-dental healthcare. Those with a high-deductible insurance plan were younger, more often Swiss and male, with higher income and educational attainment, less known cardiovascular risk factors and comorbidities. Participants with high-deductible plans had a higher probability of forgoing non-dental health care (RII=2.2, p < 0.001) independently of socioeconomic status and known comorbidities or cardiovascular risk factors. As expected, we did not observe inequalities related to insurance plan deductibles in forgoing dental health care (RII=1.0, p = 0.8).

Conclusions

In a population with universal coverage and good health outcomes, insurance plan deductibles are associated with inequities in forgoing health care independently of socioeconomic status and pre-existing conditions.

Key messages

In a highly performant health system, high insurance plan deductibles are associated with inequities in care independent of individual sociodemographic characteristics, risk factors and comorbidities. Uncovering associations between health system design features and inequities in care could inform decision-makers that seek to curtail inequities through improving their current health system design.
Distribution of Manganese-Substituted Magnetites in Dusts from Taranto, Italy
Authors: Peli M , Bostick B C , Barontini S , Placidi D , Giorgino A , Ranzi R , Smith D R , Conversano M , Lucchini R G
Published: October 2020

Elevated exposure to manganese (Mn) in environmental dusts and airborne particulates, particular from ferromanganese alloy steel production and metal working, is associated with a number of negative health outcomes, including Parkinsonism and other nervous system diseases. Manganese contamination and exposure from industrial sources is difficult to identify or quantify, as manganese is naturally abundant in the environment, and means to distinctly identify or fingerprint Mn arising from different industrial and environmental sources are limited. Here, the chemical and mineralogical properties of Mn in dusts from an active steel production facility in Taranto, Italy, were compared with those of indoor and outdoor deposited dust samples and surface soils collected in a series of schools in the nearby town. X-ray absorption spectroscopy revealed distinct chemical forms of Mn in industrial sources from those in typical background soils. Manganese ore from the facility contained abundant Mn(III, IV) oxides, while Mn-substituted magnetites were the most abundant mineral phase in dusts found in areas of the plant where metal was produced or combustion occurred. All school dusts were primarily composed of Mn-substituted magnetites, while most of the soils contained abundant manganese(IV) oxides. Source apportionment of Mn in regional dust and soil samples was estimated using linear combination fitting with representative industrial source materials. Manganese in dusts from the Taranto area community adjacent to the plant was derived primarily from industrially-sourced dusts produced during high temperature coke or steel production rather than re-suspended local soils or ore source material. Soils contained smaller proportion of industrially-derived Mn and are distinct from dusts, indicating that soil is a minor contributor of dust Mn in this area.

Key messages

Manganese speciation gives useful information in investigating Mn toxicology to humans in urban areas. Manganese-substituted magnetites may represent the target compound useful to distinguish toxic and non-toxic Mn-containing elements.
National health insurance impact on malnutrition in under-five years old children in Indonesia
Authors: Herman B , Pongpanich S , Viwattanakulvanid P
Published: October 2020

Background

The premium-based National Health Insurance Program under Jaminan Kesehatan Nasional (JKN), has been launched in 2014, although it lacks evaluation of the benefits, particularly on clinical outcomes-based. This study aimed to assess the impact of JKN possession on nutrition status among under-five years old children.

Methods

A Cross-Sectional Study was conducted during January-September 2019 in Balikpapan, Indonesia to assess the impact of JKN in the nutrition status of this specific group. Primary data (socio-demographic, feeding pattern, basic knowledge of nutrition and Health Insurance ownership) has retrieved through validated questionnaires from the parents and/or the guardian, followed by anthropometry measurement (Weight per Age Z-Score) to determine the nutrition status. Bivariate analysis was conducted to identify the confounder. Binary Logistic Regression was performed to determine the impact of JKN health insurance on the nutrition status among the target population

Results

As 62 from 312 (19.87%) children fall <-2 Z-Score (Underweight) whereas 5 children were overweight (>2 Zscore) and 2 children were obese (>3 Z Score). Only 77 (24.68%) children have JKN. The education of both parents was associated with nutrition status but no difference in knowledge regarding nutrition and identifying nutritional disease. Various feeding patterns (Breastfeeding status, vitamin A status, and snack intake) were not potential confounders. Adjusted by birth weight and history of disease within 6 months, child who possess Health Insurance (JKN) tend to have a normal weight child up to 1.998 times (AOR = 1.998, 95% CI 1.056-3.780 p = 0.033) compared to underweight, but no significant finding was found between Health Insurance and children with normal and overweight/obese children, adjusted by birthweight (AOR = 3.091, 95% CI 0.639-14.692 p = 0.161)

Conclusions

This study illustrated the significant benefit of JKN to prevent undernourished event but not overnutrition.

Key messages

National Health Insurance Coverage provides benefit on malnutrition prevention in under-five years old children. Children covered with National Health Insurance will unlikely get undernourished but no significant finding in overnourished prevention.
Perceived treatment and unmet need for medical care among people of foreign origin in Finland
Authors: Somersalo L , Kankkunen P , Kuusio H
Published: October 2020

Background

Previous international studies show that perceived unjust treatment is relatively common among people with foreign background (PFB) in medical services. This study examines the association between unjust treatment in medical settings and unmet need for general practitioner's (GP) services among PFB in Finland.

Methods

The data for this study were drawn from Survey on work and well-being among people of foreign origin (UTH) (N = 5449, response rate 66%), conducted in 2014-2015. Respondent characteristics were weighted and summarized, and multivariable logistic regressions were performed to assess the adjusted odds ratios (OR) of association between self-assessed unjust treatment and unmet need for medical care. The analyses were conducted in a three-step process where the first model tested the association between unjust treatment in medical care settings and unmet need for GP services, second model adjusted this association by sociodemographic factors, and the third model further adjusted the previous models by migration related factors.

Results

PFB reporting unjust treatment were significantly more likely to experience unmet need for GP services, even after controlling for other tested factors (OR = 8.73, 95% CI 6.18-12.33, p<.001). Besides unjust treatment, only employment status was associated with unmet need for GP services (OR = 1.43, 95% CI 1.08-1.89, p = 0.123) in the final model. Immigration related factors were not associated with unmet need for care in this model.

Conclusions

Perceived unjust treatment in medical settings is strongly associated with unmet need for GP services.

Key messages

Cultural sensitive treatment could affect the inequities in unmet need for GP services between PFB and overall population. Ensuring cultural competence throughout organizational structures, and not just for individual employees, could create an environment to promote equal treatment of all clients.
A retrospective database analysis to estimate the burden of AOM in children <15y in Veneto region
Authors: Barbieri E , Cantarutti A , Porcu G , Hu T , Petigara T , Prandi G M , Alimenti C , Scamarcia A , Cantarutti L , Giaquinto C
Published: October 2020

Background

Acute Otitis Media (AOM) causes substantial healthcare resource utilization (HCRU) in children. This analysis assessed AOM HCRU and costs following PCV13 introduction in 2010 in Veneto.

Methods

AOM episodes in children <15 years residing in Veneto were identified in Pedianet, a pediatric primary care, database from 2010-2017. Recurrent AOM was defined as at least three episodes in 6 months, or four or more episodes in 12 months. HCRU includes primary care visits, antibiotic prescriptions, diagnostic tests, specialist visits, emergency room (ER) visits and hospitalizations. Incidence rates (IRs) were numbers of episodes/1,000 person-years. Standardized regional incidence rates (SRIRs) were calculated by standardizing IRs with regional population data by age and year. Regional expenditures (€/1,000 person-years) were calculated by multiplying SRIRs with average cost per episode.

Results

Simple AOM episodes were associated with 1.03 primary care visits and 1.52 antibiotic prescriptions on average. Only 2.4% and 0.18% of simple AOM episodes included an ER visit, and a hospitalization respectively. Recurrent AOM episodes were associated with 1.06 primary care visits and 1.62 antibiotic prescriptions. Annual costs per episode were €50 for simple AOM and €54.2 for recurrent AOM, majority of which were associated with primary care visits and antibiotic prescriptions. Average antibiotic prescription costs were €14.2 for simple AOM and €16 for recurrent AOM. During 2010 and 2017, SRIRs declined from 100 to 72/1000 person-year for simple AOM and from 13 to 11/1,000 person-year for recurrent AOM. Regional expenditures decreased from €4702.7 to €3358.5/1,000 person-year for simple AOM and from €672.4 to €572.6/1000 person-year for recurrent AOM.

Conclusions

SRIRs and regional expenditures declined for simple and recurrent AOM after PCV13 introduction. Primary care visits and antibiotic prescriptions account for the majority of expenditures.

Key messages

SRIRs and regional expenditures declined for simple and recurrent AOM after PCV13 introduction. Primary care visits and antibiotic prescriptions account for the majority of expenditures.