bluuebunny/crossref_metadata_2025 huggingface dataset:
The Indirect Impact of Covid-19 Pandemic on Hospitalizations for Cardiovascular Diseases in Abruzzo
Authors: D'Addezio M , Di Giovanni P , Cedrone F , Di Martino G , Meo F , Scampoli P , Staniscia T
Published: October 2021

Background

In 2020 the Covid-19 pandemic influenced the organization of all health systems, imposing new rules for accessing the hospitals and delaying or reducing the ability to cope with all the population needs. In addition, people with life-threatening conditions deferred care for their fear of contagion. The study aimed to evaluate the indirect impact of Covid-19 on hospitalization rates for cardiovascular diseases in 2020 in Abruzzo.

Methods

Data were obtained from the hospital discharge records of all Abruzzo. We analyzed all the hospitalizations included in Major Diagnostic Categories 5 (cardiovascular diseases). First, we distinguished both between public or private hospitalizations and ordinary or day-hospital admissions. Second, we compared the first nine months of 2020 with a mean of the same months in the two previous years. Finally, we calculated the variable percentage.

Results

A huge reduction in hospitalization in MCD 5 contest was observed in each subgroup. Specifically, ordinary regimen had a peak of -56,4% in April. Day-hospital admissions were the most affected by Covid-19 with a peak of -84% in April. The largest reduction in hospitalizations occurred in private hospitals, in both ordinary (-81% in April) and DH admissions (-100% in April). A rebound in admissions was reported only for ordinary private regime between June and September, with a peak of + 24% in August.

Conclusions

Covid-19 had a severe impact on Abruzzo hospitalizations. The medical conditions that we examined needed effective hospital treatment to avoid adverse outcomes or death. Subsequently, fewer hospitalizations for such medical conditions were almost certainly associated with patient harm. Despite the pandemic, health system leaders should manage to provide subjects with hospital care, when necessary.

Key messages

Covid-19 had a significant indirect impact on the rate of hospitalizations for cardiovascular disease in Abruzzo. Despite the pandemic, regional health systems should manage to provide effective hospital care for patients with cardiovascular conditions that require hospitalization.
Covid-19 vaccination in a teaching hospital in Rome: preliminary results from a retrospective study
Authors: Pascucci D , Nurchis MC , Castrini F , Sapienza M , Vetrugno G , Staiti D , Cambieri A , Ricciardi W , Damiani G , Laurenti P
Published: October 2021

Healthcare workers (HCWs) are on the frontline fight against the ongoing pandemic with an increased risk of infection from COVID-19. As of December 27, 2020, approximately 89,879 COVID-19 cases had been reported among HCWs in Italy. Vaccination plans recommend that initial supplies of COVID-19 vaccine be allocated to HCWs because their early protection is crucial to preserve capacity to care for patients. The aim of this study is threefold: to investigate the factors influencing the likelihood towards vaccination, to estimate the vaccine efficacy (VE) in a hospital setting and to assess the frequency of adverse reactions (AR). This retrospective study was conducted in an Italian teaching hospital from December 28, 2020 to March 31, 2021 (before the introduction of mandatory vaccination for HCWs). A total of 6,649 individuals was included. HCWs were divided into physicians, nurses and other HCWs. Univariate analyses and a multivariate logistic regression were run with an alpha of 0.05. VE was estimated as the proportionate reduction in disease attack rate between the unvaccinated and vaccinated. Out of 6,649 HCWs, 5,162 were fully vaccinated against COVID-19. Among the selected job categories, 82% of physicians, 79% of nurses and 68% of other HCWs were vaccinated. The findings of the logistic regression depicted that the 41-60 years old age class, compared with the youngest age class, was statistically significant (OR 1.17, 95% CI 1.03-1.33) in influencing vaccination, as well as being nurses (OR 0.80, 95% CI 0.69-0.92) or other HCWs (OR 0.45, 95% CI 0.39-0.52) in comparison with physicians. VE equaled 92.83% (p < 0.05). The frequency of serious and not serious AR was 0.03% and 2.9%, respectively. Sustaining and boosting COVID-19 vaccination campaigns is effective for preventing SARS-CoV-2 infection in real-world conditions. COVID-19 vaccination among HCWs is a critical public health measure to safeguard HCWs themselves, patients and the hospital community.

Key messages

In light of the encouraging efficacy and safety of COVID-19 vaccination, it represents an essential strategy to protect HCWs themselves, their patients and the hospital community. Despite the introduction of mandatory vaccination, policy-makers should set up tailored strategies of clear communication to reduce reluctancy to vaccination among HCWs.
Comparison of SARS-CoV-2 RNA clearance between elderly and young patients with COVID-19
Authors: Zemni I , Bennasrallah C , Dhouib W , Ben Hassine D , Ben Fredj M , Kacem M , Abroug H , Klii R , Bouanene I , Belguith Sriha A
Published: October 2021

Background

The SARS-CoV-2 outbreak in 2020 caused a highly transmissible disease with a significant impact on the elderly. Understanding viral clearance duration of COVID-19 is important to tailor prevention strategies to this vulnerable category. We aimed to investigate the SARS-CoV-2 infection duration and associated factors to prolonged viral clearance among elderly people comparatively to young people.

Methods

We conducted a cohort study of asymptomatic and mild forms of COVID-19 patients admitted to the designated national COVID-19 center in Monastir, Tunisia. Patients included in the study were divided into two cohorts: (elderly group: ≥ 60 years old) and (young group: < 60 years old) and were followed up to their RNA viral conversion. Stratified cox regression was performed to determine associated factors with prolonged viral SARS-CoV-2 RNA clearance in elderly subgroups.

Results

The study included a total of 289 patients with asymptomatic and mild forms of COVID-19. The median term of viral shedding was 20 days (IQR; 16 - 32 days) for the young group, and 21 days (IQR; 17 - 33 days) for the elderly group. The stratified cox regression showed that Age ≥ 60 was an associated factor to prolonged viral shedding in male sex (HR (Hazard Ratio): 1.91; 95% CI: 1.19 - 3.07) and patients with comorbidities (HR:1.68; 95% CI: 1.02 - 2.75) especially diabetics (HR: 2.06; 95% CI: 1.01 - 4.21).

Conclusions

This study, focused on the factors associated with a prolonged duration of viral RNA clearance in elderly with COVID-19. These Potential factors will help planners to chalk out effective strategies among this vulnerable category.

Key messages

Old age is associated with a prolonged duration of viral RNA clearance in specific subgroups. Identifying these subgroups is important to know how prioritize preventive strategies in elderly.
Validation of the 12-item HIV-stigma scale adapted for use among Tunisian COVID-19 patients
Authors: Mlouki I , Zammit N , Ben Fredj S , Ghammem R , El Echi A , Bannour R , Bennasrallah C , Maatoug J , Ghannem H
Published: October 2021

Background

Although, there is a rapidly accumulating body of studies on the various aspects of COVID-19, little interest was given to develop valid specific scales measuring COVID-19-related stigma. The current study aims to testvalidity and reliability ofa modified version of the 12-item HIV Stigma Scale, adapted for adults with COVID-19 infection living in the region of Sousse (Tunisia).

Methods

A cross sectional study was conducted among patients with COVID-19 infection between November and December 2020. The 12-item HIV stigma scale was translated in Arabic and then adapted to the Tunisian context. A preliminary version with twenty items covering the four dimensions of COVID-19 stigma was tested (Personalised stigma, disclosure concerns, concerns with public attitudes and negative self-image). The psychometric evaluation included internal consistency as well as principal component analysis (PCA).

Results

Responses of 346 COVID-19 patients were obtained.Among participants, 60.4% were women with a median age of 40 years (interquartile range, 30 to 54.5 years). Evidence for internal validity was supported by a PCA, suggesting a three factor solution with fourteen items. The 14-item scale demonstrated good internal consistency. The global Cronbach'sα was 0.91, with values of 0.94, 0.93 and 0.98 for social stigma, negative self-image and disclosure concerns respectively.

Conclusions

The results suggest construct validity and reliability of the 14-item stigma scale measuring three aspects related to COVID-19 infection in Tunisia.

Key messages

The 14-item stigma scale is a good psychometric tool to be used in assessing COVID-19 related stigma in Tunisia. Monitoring COVID-19 stigma with a valid and reliable would guide its prevention actions.
Smoking cessation adherence:recurrent cardiovascular events after five years of first manifestation
Authors: Bannour R , Abroug H , EL Hraiech A , Mehrez O , Ben fredj M , Zemni I , Bennasrallah C , Kacem M , Sriha A
Published: October 2021

Background

Smoking is an established risk factor for cardiovascular events, such as myocardial infarction, stroke and cardiovascular death. Although the harmful effects of smoking on health are widely known. Smoking is highly addictive and cessation can be extremely difficult, even after a life-threatening vascular event.

Objective

The present study aimed to assess the relation between smoking status and risk of recurrent Cardiovascular events 5 years after the first hospitalization for acute coronary syndrome.

Methods

A cross sectional study was conducted in the Smoking Cessation Service at University Hospital of Monastir, Tunisia during February 2020. The smoking status and recurrent cardiovascular events were assessed 5 years after the first hospitalization for acute coronary syndrome by phone call among patients attended the tobacco cessation consultation. The statistical analysis was conducted with SPSS software, version 21.0. A p value of < 0.05 was considered statistically significant.

Results

A total of 112 patients were included in our study. All participants were male and the mean age was 56 ±10 years. Most patients (67%) had a high level of nicotine dependence. The rate of smoking abstinence declined from 35.7% at one year to 21.1% at 5 years. During the study period, 4 patients died(3.5%) and 17 (15.17%) had a recurrent cardiovascular event. The recurrent cardiovascular event occurred more in smoking patients but the difference was not significant.

Conclusions

Smoking cessation after a first cardiovascular event should be a key objective for both patients and physicians to reduce the risk for recurrent vascular events. More efforts are needed to maintain smoking cessation in patients at very high cardiovascular risk.

Key messages

Smoking cessation consultation can increase adherence to smoking cessation and helps in reducing the excess risk of recurrent cardiovascular events. Smoking is highly addictive and cessation can be extremely difficult, even after a life-threatening vascular event.
Virulence and antibiotic resistance of Klebsiella pneumoniae strains isolated from wastewater
Authors: Cornacchia A , Centorotola G , Saletti MA , Ciarrocchi A , Marfoglia C , Manzulli V , Galante D , Rodrigues C , Brisse S , Pomilio F
Published: October 2021

Background

Multidrug-resistant Klebsiella pneumoniae (Kp) strains are considered a global public health threat. The aim of the present study was to assess the occurrence of resistant and virulent Kp in Italian environmental wastewater, in order to evaluate the contribution of wastewater as reservoir of virulent and multidrug-resistant bacteria.

Methods

Forty samples of wastewater were collected in six sampling sessions from June to November 2018 in Central Italy and processed to detect Kp. All the presumptive Kp colonies isolated were identified by MALDI-TOF MS (Bruker Daltonics, Germany), then the genome sequences of all the confirmed Kp were obtained using Illumina Sequencing. Finally, characterization of virulence and resistance genes was performed in silico using the BIGSdb-Kp database provided by the Institut Pasteur (http://bigsdb.web.pasteur.fr).

Results

Kp was detected in 32 out of 40 samples (80%) and all strains were confirmed as Kp by MALDI-TOF MS. Genotyping analysis showed that besides the native bla-SHV, bla-LEN, bla-OKP genes linked to β-lactams resistance, gyr and par genes, involved in quinolone resistance, and no other resistance genes were detected. Regarding virulence, all strains carried the fimbriae encoding gene mrk, associated with adhesion and biofilm formation. The ferric aerobactin receptor iutA was harbored by 3 strains (9.4%). The siderophore Yersiniabactin locus (ybtS, ybtX, ybtQ, ybtP, ybtA, irp2 irp1, ybtU, ybtT, ybtE, fyuA), essential for iron scavenging, is carried by 7 out of 32 strains (21.9%).

Conclusions

Our results showed a high prevalence of Kp in wastewater that also harbored several resistance and virulence genes. These results make interesting to investigate more about wastewater as hot spots of enrichment, recombination, genetic exchange and selection of antibiotic resistant “super-bugs” that persisting and surviving in the environment could be a health risk for humans and animals.

Key messages

Wastewater could play a role as Klebsiella pneumoniae reservoir of virulence and resistance genes that can disseminate into wildlife and reach humans. It’s necessary a “one health” approach to deeply investigate about the presence of superbugs bacteria in the environment and the possible risks for human health.
Changing epidemiology and trends in incidence of oesophageal cancer in England, 1985-2017
Authors: Chimba C , Bannister P , Memon A
Published: October 2021

Background

The incidence of oesophageal cancer has been steadily increasing over the past 30 years in many countries. The UK has the highest incidence of oesophageal adenocarcinoma in the world which is associated with obesity and gastro-oesophageal reflux disease. The study aimed to determine trends in the incidence of oesophageal cancer in England between 1985-2017.

Methods

Individual-level data for patients diagnosed with oesophageal cancer in England were obtained from the Office for National Statistics/Public Health England. The national population-based cancer registry data were analysed to determine changes in oesophageal cancer incidence (ICD-10 code: C15) by sex, age (0-49, 50+) and histological subtype. Percentage change in incidence rates was calculated using the change in average annual incidence rate from the first (1985-89) to the last time period (2015-17).

Results

During the 33-year study period, 199,489 cases of oesophageal cancer were registered in England (63.5% males, 36.5% females) with adenocarcinoma accounting for 50.9% of cases. The average annual number of cases increased from 4595/year in 1985-89 to 7612/year in 2015-17. The average annual incidence rates increased by 42%, from 9.7/100,000 in 1985-89 to 13.8/100,000 in 2015-17. The incidence of adenocarcinoma increased by 77%, from 4.6/100,000 in 1985-89 to 8.1/100,000 in 2015-17. The incidence of squamous-cell carcinoma was unchanged. The steepest increase in adenocarcinoma was observed in males (more than two-folds as compared to females).

Conclusions

Over the study period, there was an increase in the incidence of oesophageal cancer in England. The largest increase was seen in rates of adenocarcinoma. Considering obesity has a strong temporal association with oesophageal adenocarcinoma, further research is needed to understand the biological mechanisms of this association to inform public health efforts to reduce the prevalence of obesity.

Key messages

Further research and analysis of routinely collected data on histological subtypes of oesophageal cancer can provide insight into the increasing trend in incidence. Considering the strong association between obesity and oesophageal adenocarcinoma, this research highlights the benefits of reducing the prevalence of obesity.
Has the national fall in smoking rate in Ireland been replicated in cancer patients? a 5-year report
Authors: Bhardwaj N , Fox P , Frazer K , Lyons A , Doherty K , Fitzpatrick P
Published: October 2021

Background

Population smoking rates are falling in Ireland, however many cancer patients continue smoking post diagnosis, despite its association with poorer treatment and clinical outcomes. As part of a feasibility study of smoking cessation for cancer patients in Ireland, a review of smoking rates in cancer patients was undertaken.

Methods

The Hospital Inpatient Enquiry system (HIPE), a national database which collects administrative, demographic & clinical data on discharges from public hospitals in Ireland, provided data (2014-2018) on smoking status of adult discharges with a cancer diagnosis (overall, breast, lung, cervical and head & neck (H&N). Smoking trends were compared with Healthy Ireland data (2015-2018), from a national survey for adults on health & wellbeing.

Results

During 2014-18, current smoking rose for all cancers (10.5%-11.4%), cervical cancer (11%-19.8%) and initially (2014-2016) for H&N (3%-12.7%) and lung (24.7%-27.2%), which dropped to 7.6% and 24% respectively in 2018; breast was stable at 6 ± 0.6%. Rates are lower than the general population (23%-20%). During 2014-17, past smoking rates demonstrated an upward trend among all cancers and specific cancers, with the highest prevalence among lung (30.3-39%) and lowest among breast (7.3-11%); comparative general population data was 23-28%. Current smoking rates for all cancers were highest among 50-59-year-olds (14-16%), which contrasts with the general population (24-35 years at 32-28%). Current and past smoking rates for all cancers were consistently higher among males, similar to the general population.

Conclusions

HIPE data is limited by duplicate episodes of care, and it is recognised that smoking documentation may be an underestimate. However, it is useful to analyse trends, as these limitations should be stable over the 5-year study period. Rates remain high; our further research will document barriers and facilitators to smoking cessation among cancer patients.

Key messages

Smoking rates in cancer patients are high despite proven benefits of smoking cessation. Supportive smoking cessation services as part of routine cancer care are indicated.
Quantifying the burden of premature mortality at national level in France in 2016
Authors: Haneef R , Constantinou P , Rachas A , Ghosn W , Kudjawu Y , Grave C , Torres M , Fayad M , Ung A , Bonaldi C
Published: October 2021

Background

Efforts to accurately measure premature mortality are important to monitor the impact of diseases and injuries on population health and to set policy priorities. This is an ongoing study with a strong collaboration between Santé Publique France and the French National Health Insurance, whose main objective is to provide the first national estimates of Years of Life Lost (YLLs) for all causes of death in France.

Methods

The French national health data system (SNDS) contains detailed nationwide causes of death data, reported using ICD-10 codes. We used the underlying cause, as defined by the Center for Epidemiology on Medical Causes of deaths, of all deaths for year 2016 (the last year available). For this preliminary study without redistribution of ill-defined deaths (IDDs), national sex-specific life expectancy tables were used to estimate YLLs by age class, sex, and cause of death categories at national level. We identified and quantified IDDs and also compared YLLs to crude mortality.

Results

In 2016, we estimated approximately 7.3 million YLLs (586,519 registered deaths), of which 35.1% were due to neoplasms, 17.8% to cardiovascular diseases (respectively 34.5% and 17.3% in men; 35.8% and 18.4% in women) and 10.3% to injuries (4.9% among people aged 65 or more at time of death; 34.5% among people aged 25-44). Approximately 27% of the deaths registered were IDDs, representing approximately 1.8 million YLLs.

Conclusions

These preliminary results confirm the importance of YLLs as a metric to target preventive strategies according to age. Moreover, by quantifying IDDs, we highlight that data gaps are important even in settings with highly developed health information systems. Next steps include applying an IDD redistribution methodology, aspirational life table and computing subnational YLLs. The French collaborative initiative should address those gaps and propose national and subnational burden metrics in the following months.

Key messages

Methodological and data requirements to compute YLLs constitute a challenge even in settings with developed health information systems, highlighting the need of national institutional collaborations. Highlight data gaps in terms of ill-defined deaths in mortality database.
Participation in Population-based Research: A Qualitative, Intersectional Perspective
Authors: Merz S , Jaehn P , Holmberg C
Published: October 2021

Background

Intersectionality scholarship in public health research aims at making visible the interrelated and co-dependent nature of the social determinants of health and illness. Research examining participation in population-based studies has not yet fully integrated this perspective into the analysis such that social heterogeneity remains largely hidden. The interdisciplinary research project AdvanceRecruitment focuses on participation in the German National Cohort (GNC) from an intersectional perspective to examine which individual and collective factors determine a decision for or against participation.

Methods

A selective sampling strategy was employed to recruit interview participants (n = 73) according to age, participation, gender and geographical location from the overall GNC study sample. Individual GNC study centres were responsible for recruitment. Qualitative, semi-structured interviews with both participants (n = 61) and non-participants (n = 12) explored their motivations to participate, decision-making processes and experiences at the study centre. Interviews were recorded, transcribed verbatim and analysed through thematic and intersectional analyses.

Results

Rationales for or against study participation do not primarily vary according to identity-based criteria such as gender or age, but are shaped by a complex assemblage of individual health action, personal biography, experiences of illness and vulnerability, possibilities for social inclusion, available resources and cultural capital. These factors can be better understood through their interrelation in an integrative analysis.

Discussion

Intersectional approaches allow for a nuanced, complex understanding of study participation which should be considered when developing strategies for recruitment.

Key messages

Intersectionality contributes to a more nuanced, complex understanding of study participation. Intersectional approaches can aid the development of strategies for recruitment.
Impact of Haemophilus influenza immunization on hospitalized acute respiratory infections
Authors: Ben Fredj M , Dhouib W , Bennasrallah C , Abroug H , Zemni I , Ben Hassine D , Kacem M , Bouanene I , Belguith Sriha A
Published: October 2021

Background

Immunization is the most cost-effective measure to combat communicable diseases in childhood. Haemophilus influenza (Hib) vaccine was included in the Tunisian expanded program of immunization for the first time in 2002 (Hib Vaccine monovalent) and is currently combined with the pneumococcal vaccine(Hib vaccine pentavalent combination) since April 2019. We aimed to assess impact of Hib vaccine on Respiratory Infection(RI) admissions in children aged up to 3 years.

Methods

It was a cohort study from January 1, 2002 to December 31, 2013. All Respiratory Infection (RI) admissions in children aged up to 3 years in the university hospital of Monastir(Tunisia) were enrolled.

Results

Admissions for RI represented 17.6% (CI95%: 17.3-18.1) of all communicable diseases hospitalizations (n = 6 061/34 289). The median age was 22 years (IQR: 3-52). Admission for Pneumonia with Streptococcus Pneumoniae (SP) increased significantly during study period (b = 25.9 (p < 0.0001)) especially in children up to 5 years old (b = 10.6) and in elderly (b = 6.0). Among children up to 3 years old, the Crude incidence rate per 100,000 for Hib pneumonia admission were 11.6 in Non-Vaccinated Cohort (NVC), 10.6 in Vaccinated Cohort (VC) by protocol 1 (Hib Vaccine monovalent) and 0.80 in VC by protocol 2 (Hib vaccine pentavalent combination).The relative risk reduction was 99% for protocol 2 (p < 0.001).

Conclusions

Admissions for RI in a tertiary level hospital were common with an increasing trend. The Hib immunization program, in particular the second protocol (pentavalent combination), has had a positive impact on the reduction of related acute diseases.

Key messages

The Hib immunization program, has had a positive impact on the reduction of related acute diseases. The “Hib vaccine pentavalent combination “is more efficient than “Hib Vaccine monovalent”.
Hospital financial performance and quality of care – a scoping review of empirical studies
Authors: Dubas-Jakóbczyk K , Kocot E , Tambor M , Kostrzewska O , Szetela P , Quentin W
Published: October 2021

Background

Hospitals operate under constant pressure to contain costs and improve the quality of care (Q). The potential association between hospital financial performance (FP) and Q can have two directions: (1) providers with better FP might have a greater capacity to maintain and/or improve Q; (2) a better Q might lead to better FP, i.e. increased revenues, and/or lower costs. The general objective of this study was to identify and map the available evidence on the association between hospital FP and Q.

Methods

A scoping review based on the methodological framework outlined by Arksey and O'Malley was conducted. Five databases were used: (1) Medline via PubMed; (2) Embase; (3) Web of Science; (4) Scopus; and (5) EconLit. Search strategy combined multiple terms from three topics: (1) hospital,(2) FP and (3) Q. There was no limit for publication years, but only studies in English were included.

Results

After screening 8,015 records and 129 full text papers, 54 empirical studies were included. They are mostly observational studies, applying diverse regression models, published between 1992 and 2019. FP is most often measured by profitability indicators while Q measures are much more diverse. In the majority of studies, FP measures are used as dependent variables, thus the impact of Q on FP is assessed. The comparability of the studies' results is limited, yet a general overview shows that in the majority of papers, a positive association between hospital FP and Q is identified (positive in 24 studies and positive or mixed in 10). The studies' authors emphasize numerous limitations related to both, the data used and the methods applied including the ability to identify associations yet not causality.

Conclusions

There seems to be a growing interest in exploring the association between FP and Q. Our review provides a broad overview of the existing literature and helps to identify areas for further investigations.

Key messages

There is a great diversity of empirical studies on the association between hospital FP and Q, but the majority focuses solely on the United States market. An overview of the existing studies suggests that, although numerous additional factors need to be considered, hospitals might be able to simultaneously improve Q and profitability.
The therapeutic value of waiting areas in access and accessibility to care
Authors: Tsiantou E , Chrysikou DrE , Lad DrH
Published: October 2021

Background

Patients have increased biological metrics when entering healthcare environments as a response to stress. Priming them with nice settings before consultation or procedure might benefit their health. Yet hospital waiting areas might be neglected by regulators. Our aim was to understand how these are perceived by those who commission them and by those who deliver them in terms of their intangible value.

Methods

After a comprehensive scoping literature review of evidence based-design research eight features –daylight, furniture, materials, nature, views, colours, artwork and positive distraction– were identified as the most significant in waiting areas for patient wellbeing. Using those features as criteria we explored the regulators' views comparing and contrasting the UK, USA and Australia's design guidance on waiting areas. Also, 16 awarded hospital buildings provided case studies under the scope of those features. We examined the way these buildings were presented post-award and how those therapeutic features were portrayed in that process.

Results

Results indicate a hiatus between architects and regulators towards the therapeutic value of waiting areas design. Architects highlight qualities such as comfort and aesthetics. Yet, guidelines focus on functionality and transition and do not consider waiting areas design as important.

Conclusions

The welcoming factor of health spaces pre-consultation has been ignored by regulations yet at the same time has been used by architects to communicate their projects to the public. Actions to improve national regulations could impact on waiting areas design and consequently on people's health benefits. They could even have longer-term benefits supporting early detection of disease by reducing the fear and stigma that people feel when engaging with healthcare services. This paper supports a positivist and systemic approach and highlights a neglected area in terms of health services thinking and research.

Key messages

A welcoming pre-consultation experience might affect the patient/clinician relationship and make the patient feel valued by the institution. This should be supported by waiting area design regulations. The research on hospital waiting areas features demonstrates that the therapeutic qualities of healthcare space have been ignored by regulators.
Governance and organization of Academic Medical Centers – a comparative analysis of 11 countries
Authors: Cardinaal E , Dubas-Jakóbczyk K , Behmane D , Bryndová L , Cascini F , Duighuisen H , van Ginneken E , Waitzberg R , Jeurissen P
Published: October 2021

Background

Academic Medical Centers (AMCs) are organizations that link three functions: providing highly specialized medical services, teaching activities and conducting research. The aim of the study was to provide an international comparison of the governance and organization models of AMCs. The analysis covered 10 European countries (Cyprus, Czechia, Denmark, Germany, Italy, Latvia, Netherlands, Norway, Poland, Spain) and Israel.

Methods

The study has an explorative and descriptive character. The methods involved: (1) the creation of a conceptual framework; (2) the development of a dedicated questionnaire; (3) data collection and analysis. The data was collected based on purposive sampling. There were 26 respondents from 11 countries.

Results

There is no standardized definition of AMCs across countries. Different types of hospital providers do link patientcare, teaching and research. Depending on the country and particular institution, the balance between these three functions, as well as the scope might vary a lot. The majority of the participating countries face either public or not-for-profit ownership for AMCs and medical faculties. However, the relationship between hospital and faculty varies substantially. Main internal governance challenges focus on lack of responsiveness to change and financial conflicts between the three core tasks. External challenges relate to financial sustainability and workforce shortages. Most respondents believe that in the nearby future the governance of AMCs will evolve to a more functionally integrated model of the three functions.

Conclusions

The study fills the gap in the literature on organization and governance of European AMCs. Although, there are substantial differences in the models of governance across countries, many challenges are highly similar. This raises important questions for future research (e.g. focusing solely on one function) as well as policy (the potential for cross-national learning).

Key messages

There is no standardized definition of AMCs across countries and different types of organizations are used to link the three functions of providing patientcare, teaching activities and research. Despite the organizational and legal differences, AMCs in different countries face similar challenges (nimbleness and financial conflicts between the three functions; health workforce shortages).
Arterial hypertension in older age: qualitative study
Authors: Vasiljev V , Juraga D , Bilajac L , Marinović Glavić M , Roviš D , Jelaković B , Rukavina T
Published: October 2021

Background

Arterial hypertension a.k.a silent killer is one of the most important cardiovascular, yet preventable risk factors. Although there are more than 7000 clinical studies in 2019 there is still slow progress in global control of arterial hypertension. The aim of this study is to present the results from the qualitative study of the quality of treatment and care of arterial hypertension in older persons in the city of Rijeka, Croatia.

Participants and Methods

In two focus groups with older persons (65+) who had diagnosis of arterial hypertension for more than one year, attitudes toward positive and negative experiences in health and social care system were discussed, as well as their values regarding living with arterial hypertension. In focus groups 15 participants were involved. The focus groups were recorded; transcripts were made followed by analysis of the data reduction.

Results

The specific challenges in the participants' groups were identified such as lack of knowledge about the hypertension and concerns on pharmaceutical industries and lobbies interests which can result in lower adherence to medications. Some of the participants use Internet as a health information source including invalidated websites which can represent threat in adequate care especially in older people with multimorbidities. Self-reliance is most valued among the participants, while financial stability and support in the community are also highly appreciated in the urban population with arterial hypertension.

Conclusions

This research gives a framework for additional research in the population of older people that are living with arterial hypertension. Positive health and social care experiences must be preserved, yet negative experiences such as long waiting lists, additional health care costs, ageism and others must be improved.

Key messages

Although arterial hypertension is a well-known risk factor, more effort should be made in preventive interventions and health education. Adherence to medicines.
Process evaluation of We Can Quit- stop-smoking programme for women in socio-disadvantage in Ireland
Authors: Darker C , Burke E , Castello S , O'Sullivan K , Vance J , Buggy A , Loudon K , Williams P , Dobbie F , Hayes C
Published: October 2021

Background

Smoking tobacco poses a serious risk of early preventable death and disease for women living with socioeconomic disadvantage (SED). A smoking cessation programme ‘We Can Quit' (WCQ) tailored to women living in four SED areas developed in Ireland included group support delivered by trained lay local women and free nicotine replacement therapy (NRT). The intervention was pilot tested in a community-based, cluster randomised controlled trial, ‘We Can Quit 2'. Results of an embedded process evaluation to assess feasibility and acceptability of the programme and trial processes are presented.

Methods

The design was qualitative using the Medical Research Council's (MRC) process evaluation framework. Semi-structured interviews with trial participants (N = 18) and Community Facilitators (CFs) who delivered WCQ (N = 8) were conducted. An inductive approach was used and data were analysed using thematic coding.

Results

Peer-modelling, a non-judgemental environment, and CFs supportive role were viewed as facilitative elements of group support. Potential for broader message diffusion into the social networks of participating women was observed. Participants reported that free access to NRT was helpful for cessation. Some participants expressed concerns about NRT side effects. Community pharmacists provided important guidance relating to NRT and additional support between group sessions. Provision of a saliva samples proved challenging. Low literacy was a barrier to engagement with the programme and completion of trial-related materials. Hypothetical scenarios of direct or indirect observational fidelity assessment for a definitive trial (DT) were acceptable.

Conclusions

The MRC framework proved useful to capture the experience of women smokers in SED areas of engaging with a community-based smoking cessation trial. Programme and trial-related processes were feasible and acceptable. A future DT will need to address low literacy.

Key messages

A group-based stop-smoking programme including free NRT was acceptable and feasible to programme deliverers and women smokers living in disadvantaged communities. Women’s low literacy was a barrier to engagement with trial and completion of programme materials.
Health Care Planning: a method to organize and integrate healthcare networks
Authors: Eshriqui I , Souza EL , de Andrade AT , de Medeiros EB , Paresque MAC
Published: October 2021

Issue/problem

Fragmentation of health care system is a concern in both developed and low and medium development countries, once may compromise cost-effectiveness, equity and quality of health care provision. Healthcare reforms have been focusing on integration, which is complex, considering that requires a methodology and involvement of actors from different sectors and governmental spheres.

Description of the problem

The “Health Care Planning” (HCP) method, proposed by the Brazilian National Council of Health Secretaries to overcome fragmentation of Brazil's public healthcare model, promotes development of local actors' skills and competences to organize healthcare networks through two main activities: (i) Workshops, provided to all health professionals aiming to introduce theoretical concepts and desire of changing; (ii) Tutoring, to guide theory implementation in healthcare services. A strategic group, composed of representatives of health services, managers and technical areas of health secretariats, monitors the whole process.

Results

Since 2018, the PlanificaSUS project is executed to implement the HCP in Brazil, focusing on integration of specialized outpatient care (SOC) with primary care (PC), in the context of healthcare network, coordinated by PC. From 27 health regions that agreed to participate, 25 (in 19 states and 282 municipalities) concluded the first phase in December 2020. Four thematic workshops were conducted with mean participation of 31.233 professionals each. Further, 316 local professionals were formed and conducted 2.131 tutoring activities in PC and 193 SOC. Improvement of PC organization was reported by 70% of PC facilities. In 76% of SOC facilities, team was completed and trained.

Lessons

HCP is an innovative method that could be applied in large-scale and adapted to provide healthcare services organization and integration according to local conditions. Autonomy of State and Municipal Health Secretariats must be encouraged.

Key messages

Health Care Planning is a potential method to provide qualification and integration of healthcare services in different contexts. Support from state management is important to develop organization and qualification of healthcare networks coordinated by the primary care.
Changes on the Demand for Attention for a Mental Health Service During Social Isolation Measures
Authors: Piscitello F , Pizzi RD , Cuneo MM , Farias MA
Published: October 2021

Background

Most of the countries in the world adopted isolation measures during the COVID-19 pandemic. According to Kola L. et. al (2021), “in most settings in low and middle-income countries (LMICs), ongoing in-person mental health services have been disrupted and patients with severe mental conditions and substance abuse disorders are often unable to obtain medications, attend to treatment centres, or receive social services”. The aim of this paper is to describe the effects of the COVID-19 pandemic on the demand for attention in a mental health service as reported by healthcare workers.

Methods

A quantitative cross-sectional descriptive study was conducted and a survey designed by the Secretaría de Políticas Integrales sobre Drogas de la Nación Argentina was applied to a total of 29 healthcare workers of a mental health centre in the Province of Córdoba, Argentina, during the month of November, 2020.

Results

The perception of healthcare workers towards the demand for attention shows that the 3 main reasons for consultation during the first three months of isolation measures were drug abuse (50%), request for treatment (10.3%), and order for medication (10.3%). During the three subsequent months, the reasons for consultation were drug abuse (62.1%), request for treatment (44.8%) and remote treatment modality (24.1%). Healthcare workers state that drug abuse consultations increased 65.5% and the self-inflicted violence consultations increased 44.8%.

Conclusions

The isolation measures generate a change in the demand for attention. There are differences between various phases of the isolation measures, where an increase in the drug abuse consultations and remote treatment modality could be observed.

Key messages

To develop predictability according to the variations in the demand for attention produced during public health crisis. To train healthcare workers in order to make interventions in public health crisis.
The indirect impact of COVID-19 pandemic on the utilization of the emergency medical services
Authors: Lastrucci V , Lorini C , Forni S , Collini F , D'Arienzo S , Gemmi F , Bonaccorsi G
Published: October 2021

Background

Fear of contracting COVID-19 and the large-scale preventing measures may have influenced health service utilization. The aim of the study was to assess the indirect impact of COVID-19 pandemic on the utilization of the emergency medical services (EMS) of Tuscany Region (Italy).

Methods

The study was carried out on administrative data from the public healthcare system of Tuscany (38 general hospitals and 4 university teaching hospitals). Variations in the utilization of out-of-hospital (i.e. calls for emergency medical assistance and dispatch of mobile medical care units) and in-hospitals (emergency department(ED) visits and hospitalizations from the ED) EMS during the first pandemic wave were analyzed (February - July 2020) in relation with corresponding periods of the previous three years. Furthermore, in order to understand changes in illness severity of patients using the EMS, standardized ratios for hospitalizations requiring ICU and in-hospital mortality were analyzed.

Results

Significant decreases in the expected volumes of utilizations were observed in each of the considered EMS starting from the week in which the first case of COVID-19 was confirmed in Italy till the last week of the first wave. In particular, during the peak period of COVID-19 pandemic wave a reduction of 73,041 (-67%, 95%CI -69%; -66%) in ED admissions and of 682 (-38% 95%CI -55%; -43%) in hospitalization from ED were observed. Significant decreases in hospitalizations for life threatening medical conditions were observed. No significant differences were found between the observed and the expected in-hospital mortality and hospitalizations requiring ICU during the COVID-19 epidemic peak period (SR 1.1 95%CI 0.72-1.90; SR 1.0 95%CI 0.83-1.23).

Conclusions

A large and generalized decrease in EMS utilization was observed during the first wave of COVID-19 pandemic. Furthermore, findings suggest that seriously ill patients avoid seeking care as less seriously ill patients did.

Key messages

The falling in the utilization of emergency medical services during pandemic could portend substantial harm to public health, and not simply the absence of real health need. The preparedness of the healthcare delivery system should not focus solely on confronting the pandemic disease, but also on ensuring access to high quality emergency care for other diseases.
Incidence and predictor of tobacco experimentation among high-school adolescents of Sousse, Tunisia
Authors: Zammit N , Bennasrallah C , Ben Fredj S , Ghammem R , Krifa R , Farhaoui S , Maatoug J , Ghannem H
Published: October 2021

Background

Tobacco use is considered one of the leading risk factors for early morbidity and mortality especially in developing countries. Initiation of tobacco use occurs usually during adolescence which is responsible for a longer time of exposure to nicotine and other constituents of tobacco products. The aim of this study is to determine the incidence and the factors associated with tobacco experimentation among high school students in the governorate of Sousse between 2017/2018 and 2018/2019.

Methods

A prospective longitudinal study was conducted in 4 high schools in the governorate of Sousse during the 2018-2019 school year. Pre-trained medical doctors ensured data collection using anonymous self-administered questionnaire. Collected data included socio-demographic and educational features, tobacco use, alcohol use, second hand smoking, illicit substances use, problematic internet use and mental health disorders.

Results

A total of 404 students were included in our study. The sex-ratio was 0.49 and the mean age of high school students was 16.4 (±1.1) years. At the end of the follow up, the incidence of tobacco experimentation among high school students was 9.7%. Problematic internet use was observed among the 36 (100%) adolescents who experimented tobacco while it was observed in 250 (79.9%) of who did not experiment tobacco during the follow up (p = 0.003). Otherwise, maternal tobacco use was the most influential factor on tobacco experimentation among participants with an odds ratio of: 7.1; 95% CI: 1.5-32.8) (p = 0,013).

Conclusions

Incidence of tobacco experimentation among the high school adolescents of Sousse is high. Second hand smoking and other addictive behaviors should be considered in order to reinforce the national prevention program of tobacco use.

Key messages

Reinforcement of the existing prevention program of tobacco use in Tunisia is required. Comprehensive prevention program of tobacco use taking into consideration the other addictive behaviors among adolescent and their entourage would be more effective.