bluuebunny/crossref_metadata_2025 huggingface dataset:
The relationship between participation to social activities, life satisfaction, isolation on aged
Authors: Erdem O , Erol S , Aydoğan A , Subaşı B , Kılıç L
Published: November 2019

Objective

This study was conducted to determine the relationship between the participation of people living in the nursing homes to social activities and their life satisfaction, social isolation and loneliness.

Methods

The study was performed between January 2017 and April 2018 in three nursing homes using the cross-sectional research design. The study population consisted of 310 elderly people in total, 118 women, 192 men, who were over 65 years of age and had no mental and communication problems. Ninety percent of the population was reached. The data were collected by using a questionnaire, Standardized Mini Mental Test, Satisfaction with Life Scale (SWLS), Social Isolation Scale (SIS) and Loneliness Scale for Elderly People (LSEP). Descriptive statistics, Mann-Whitney U test, Kruskal-Wallis variance analysis and Spearman correlation analysis were used in data analysis.

Results

The mean age of the elderly subjects was 74.10 ± 7.57 years, and 61.9% were male and 38.1% were female. Elderly subjects’ SWLS and LSEP scores were below the median, and their SIS score was above the median value. Elderly people without disabilities, who can meet their own needs, do not feel alone, stay in the healthcare facility of their own accord, are satisfied with the services healthcare facility and with life, do sports, go to cinema and theater in their free time and go out more often had high SWLS median values and low SIS and LSEP values (p < 0,05). Examining scale correlations, a moderate and negative correlation between SWLS and SIS (r= -,59; p=,000) a highly significant and negative correlation between SWLS and LSEP (r= -,70; p=,000) and a positive, statistically moderately significant correlation between SIS and LSEP (r=, 65; p=, 00) were found.

Conclusions

Life satisfaction increases and social isolation and loneliness decreases when elderly people living in nursing homes participate in social activities.

Key messages

Loneliness of elderly individuals can be reduced by increasing participation in social activities. Social isolation of elderly individuals can be reduced by increasing participation in social activities.
Factors promoting health empowerment of young people: a qualitative pre-interventional study
Authors: Corneloup M , Millot I , Ponthier N , Peteuil A
Published: November 2019

Background

Angata, an intervention research project led by the regional instance of health education and promotion (Ireps) of Burgundy-Franche-Comté, aims to strengthening the autonomy and decision-making ability of vulnerable youth regarding their health. It is implemented in several facilities. The goal is to improve well-being and quality of life of young people benefiting from socio-educational measures by working with them and the professionals in their living environments. The objective of the study presented was to analyze the factors promoting health empowerment of young people, prior to this intervention, in the Employment Integration Facility (Epide) of Belfort.

Methods

Interviews were conducted with 8 young people and 13 professionals to explore their representations regarding well-being, nutritional health (eating habits, nutrition, physical activity), self-esteem and physical appearance. The determinants of health, lifestyles and organization in the living environment as well as the biographical pathways of young people were also collected.

Results

The Epide, structured on a military model, welcomes young people out-of-school, without qualifications and with complex life courses. The Epide can be seen as a functional community whose whole effort is dedicated to the goal of young volunteers leaving for a job or professional training. The support provided by educators (professional social or former military) is focused on building skills and restoration of self-esteem. Critical consciousness develops over time spent within the structure. The factors promoting empowerment within this strict framework are numerous, but young people’s participation in the decisions taken within the structure remains at the solicitation stage.

Conclusions

The framework provided at the Epide allows an environment conducive to the process of individual empowerment. These leverage can be mobilized to reinforce health empowerment of youth during the Angata project.

Key messages

An empowering educational environment, even strict, can foster the health empowerment of young people subject to vulnerabilities. The allowed level of participation remains an important factor to consider in order to fully promote health empowerment of young people.
The profile of people living in extreme poverty in the region of Crete
Authors: Papadakaki M , Stamouli M A , Diamanti S , Lioliou S , Maragkaki P , Pachiadaki M , Stavropoulou S , Kasotaki K , Tzamalouka G , Chliaoutakis J
Published: November 2019

Background

The financial crisis of the last decade has increased the number of people living in extreme poverty in Greece. Until today, there is no research evidence on the bio-psycho-social needs of the population. The current study, among other, aimed at investigating the living and working conditions, the health and mental health status of these people and produced recommendations for health care policy and planning.

Methods

A cross-sectional study was carried out in Crete Region with adult beneficiaries of material support benefits (according to income-related criteria). The study was part of the program FAED, which was co-funded by the EU and offered material support (e.g. food, material for personal hygiene, etc. to more than 17.000 beneficiaries in Crete region within 2016-2017. A structured questionnaire extracted information on various aspects including, working, housing and living conditions, health and mental health status.

Results

798 individuals (46.5% male; 43.3 years) consented to participate and completed the questionnaire. Mean time of unemployment was 4.2 years. 26.8% was accommodated by relatives, 23.5% rented a house and 18% lacked heating. Nearly half of the participants reported a chronic disease (47.0%), 24.1% reported disability certified by health authorities. 4.9% had severe alcohol-related problems, 50.6% had mild to severe depression symptoms and 40.3% mild to severe symptoms of anxiety disorder. 12.0% totally lacked a support network for daily practical and emotional issues.

Conclusions

Personal psychosocial needs seem to have been neglected because of complex family needs. Socioeconomic deprivation seems to have exacerbated chronic disease management due to neglect of health care needs. A huge burden of mental diseases is evident necessitating community mental health care.

Key messages

Mapping of bio-psychosocial needs is important for social policy and health care planning. Integrated care is necessary to meet the complex needs of people living in extreme poverty.
Improving Health Literacy in Austrian Companies: Results from a Systematic Company Recruitment
Authors: Hofer-Fischanger K , Movia M , Tuttner S , Fuchs-Neuhold B , Müller A , Amort F , Grasser G
Published: November 2019

Issue

The HL-Survey-EU-2011 showed limited health literacy (HL) among the Austrian population (51,6%), especially in the federal state of Styria (63,1%). The project “Auf Gesundheitskurs - gesundheitskompetent in Feldbach” focuses on individual and organizational HL by training and educating production and service company workforce in a rural region in Austria.

Description

The population in the target region is especially disadvantaged regarding HL due to the parameters of age, gender, education, income and ethnicity. There are several small and medium-sized businesses within this area. This project (2018-2020) aims to improve knowledge, competences and skills of multipliers from different companies concerning organizational and individual HL, based on an in-person training programme. However, in order to recruit participants for this research project, a systematic recruitment approach was used.

Results

A total of 783 companies, listed in the community database, were contacted via email in order to inform about the project and to invite for an interview. After the initial email, 40 companies were selected, based on four characteristics: industry sector, company size, distance to town centre, relevance to HL, and contacted via phone as well. However, 7 companies out of 783 confirmed the first interview and 6 out of 7 signed the project cooperation. 18 out of 40 phone contacts led to personal meetings, 9 resulted in signing the cooperation. In total, 15 companies have decided to participate in the project.

Lessons

Overall, telephone contact led to much higher response rates than email alone. The parameters which effected positive outcomes during the interaction by phone and in-person were demonstrating benefits (healthy workplace, motivated staff, positive atmosphere, new customers), explaining the practical value, clarifying costs, expenditures and time effort. Although the topic of workplace health promotion is popular in this rural region, the focus on HL is new.

Key messages

Key factors in company recruitment for HL initiatives in rural regions are telephone and personal contact. Pointing out specific benefits for companies within the recruiting process seems also crucial.
Eating disorders among university students: a public health challenge. An European study
Authors: Ladner J , Lukács A , Brumboiu I , Ciobanu E , Croitoru C , Sasvári P , Tavolacci M P
Published: November 2019

Background

Eating disorders (ED) and behavioural risk factors among students in higher education remain to be investigated. The aim of the study was to identify the prevalence of ED and the behavioural factors associated with ED in university students in four European universities: Chisinau (Ch) in Republic of Moldava, Cluj-Napoca (CN) in Romania, Miskolc (Ms) in Hungary and Rouen (R) in France.

Methods

In the four countries, students in higher education completed an anonymous standardized self-questionnaire, from 2016 to 2018. The questionnaire collected age, gender (M, W), housing, curricula, smoking, cannabis consumption, alcohol abuse problems (ADOSPA test), and perceived stress (Cohen score). The Sick, Control, One stone, Fat, Food (SCOFF scale) screening test was used to identify student with ED.

Results

A total of 3076 students were included, 705 in Ch, 582 in CL, 534 in Ms and 1255 in R. The sex-ratio was M:F=0.31 Ch, 0.30 in CN, 0.44 in Ms and 0.66 in R. The mean age was 21.2 (SD = 3.98) in Ch, 21.2 (SD = 3.2) in CL, 23.8 (SD = 5.1) in Ms and 20.0 (SD = 3.4) in R. The global prevalence of ED was 23.8%. According to the gender, the prevalence of ED in the four universities was 14.7% in M and 38.3% in W in Ch, 21.8% in M and 24.7% in W in CN, 19.7% in M and 21.4% in W in Ms and 16.1% in M and 34.0% in W in R (p < 10-4). After logistic regression, significant positive relation between the positive SCOFF was observed with female gender, alcohol abuse problems and stress level.

Conclusions

ED prevalence patterns were quite similar in the four countries, with high prevalence of ED, even in men. Associated behavioural risk-factors were quite similar. It might be necessary in the future to screen students for potential ED upon entry to the university and also to inform student about the risk of ED and advise them to consult a healthcare professional.

Key messages

Our study highlights the high prevalence of eating disorders, with similar behaviours in university students in four countries. Because of the detrimental effects of ED on physical and emotional health, it seems mandatory to set up public health programs (health promotion, prevention).
Age, period, and cohort effects on infectious disease mortality in Korea, 1983-2017
Authors: Kim H-S , Eun S J
Published: November 2019

Background

Infectious diseases are a leading cause of death worldwide, and constitute a significant burden of disease, even in developed countries including Korea. Although different ages, periods, and cohorts may affect mortality, few studies analyzed the epidemiologic pattern of infectious disease mortality considering these effects. This study aimed to estimate the age-period-cohort effects on infectious disease mortality in Korea.

Methods

The national death certificate and census mid-year population estimates data from 1983 to 2017 were categorized into 5-year age groups and 5-year periods. Infant deaths were excluded due to incomplete data. Intrinsic estimator regression models were fitted to estimate age-period-cohort effects on infectious disease mortality.

Results

A J-shaped age effect declined from age 1-4 years (intrinsic estimator coefficient [IEC] 0.68; 95% confidence interval [CI] 0.52, 0.85), the lowest at age 20-24 years (IEC -1.68; 95% CI -1.85, -1.51), and then increased with age. The declining trend of period effects was slowed down in 1998-2002 (after the 1997-1998 Asian economic crisis), and turned to an upward trend from 2008-2012 (after the 2008-2009 global financial crisis). The cohort effect increased from the earliest cohort born before 1905 (IEC -1.17, 95% CI -1.35, -0.98), peaked in the 1941-1945 cohort (IEC 1.20, 95% CI 1.10, 1.29), then plateaued out (IEC ranged from 0.93 to 1.10), and has continued to decline since the 1966-1970 cohort in which rapid economic growth began.

Conclusions

There were clear age, period, and cohort effects on infectious disease mortality in Korea. Through the period and cohort effects, the economic downturn and upturn might have increased or reduced infectious disease mortality, respectively. Recent upward trend in infectious disease mortality after the 2008-2009 financial crisis suggests a need to strengthen prevention and control of infectious diseases.

Key messages

It is important to consider age-period-cohort effects in identifying the epidemiologic pattern of infectious disease mortality trend and finding its underlying drivers. Economic cycle might have influenced infectious disease mortality through period and cohort effects.
Effect of rotavirus vaccination offer to children observed in Italy between 2010-2018
Authors: Antinolfi F , Brunelli L , Gallo T , Valent F
Published: November 2019

Background

Rotavirus (RV) is the most common cause of gastroenteritis (GE) among children under 5 years. Since 2012 Friuli Venezia Giulia (FVG) Region (Italy) has offered free RV vaccination to low birthweight preterm and other at-risk babies. Starting from 2018, the offer has been extended to all newborns. Aim of the study is to investigate the effectiveness of RV vaccination offer on coverage and GE-related hospital admissions among FVG children under 1 year between 2010-2018.

Methods

With a retrospective analysis we identified FVG Region children <1y with at least one dose of RV vaccine and children <1y admitted to hospital with a diagnosis of Non-Specific GE (NSGE; ICD9-CM codes 001-009) and RVGE (008.61) from 2010 to 2018. Vaccination coverage and hospitalization risk in each annual child cohort were calculated. Hospitalization and vaccination data were also linked using a univocal anonymous stochastic key.

Results

Of 77,330 children (51% males) born in FVG during 2010-2018, 8209 (11%) were vaccinated for RV. Coverage progressively increased from 0.2% in 2010 (22/9736) to 23% in 2017 (1782/7747) and then almost tripled in 2018 reaching 67% (5006/7425). During the 9 years observed, 414 children were hospitalized for NSGE (0.5%) and 172 for RVGE (0.2%). NSGE hospitalizations started from 48 (0.5%) in 2010 and reached 58 (0.8%) in 2018. Admissions for RVGE were 27 (0.3%) in 2010 and decreased to 15 (0.2%) in 2018. Annual hospitalization rate fluctuated with no clear pattern. In the observation period, 11 RV vaccinated children were admitted to hospital for NSGE (2.6% of total NSGE admissions), 1 of them specifically with RVGE.

Conclusions

The offer of RV vaccination to newborns results to be effective to gain vaccine coverage among children under 5 years. The impact of this offer on GE-related hospital admission and RVGE in particular cannot be properly evaluated yet, as not enough time has passed since the implementation of free offer to all newborns.

Key messages

Defining and implementing an appropriate vaccination offer is essential to ensure adequate levels of coverage against Rotavirus among children under 5 years. The evaluation of the effect of Rotavirus vaccination on hospital admissions for NSGE and RVGE needs a careful and continuous assessment in next years.
Assessment of the links between awareness about MI and behavior related to vaccination
Authors: Jasiukaitienė V , Stankutė I , Miščikienė L
Published: November 2019

Backgrounds

In Lithuania, the morbidity rate of meningococcal infection (MI) is one of the highest in the European Union. In year 2017 - 81 MI cases were reported (2.9 cases / 100 thousand inhabitants). The aim of the study - to assess the links between awareness of parents of pre-school children about meningococcal infection and behavior related to vaccination.

Methods

Anonymous questionnaire survey was carried out in pre-school educational institutions of Kaunas city in 2019. 165 questionnaires were presented to parents (response rate 91.52%). Associations between categorical variables were measured using Chi square test. A statistically significant difference was defined when p < 0.05. Z criterion was used for evaluating hypothesis of variable dependence.

Results

55.0% of respondents know that MI is caused by bacteria and it is spread by air (84.8%). 40.1% of parents indicated that they have vaccinated their children or are planning to do so. 38.0% of respondents chose not to have their children vaccinated and did not plan vaccination in the future. Answers of parents, who have vaccinated or are planning vaccination of their children, showed a statistically significant increase of awareness of the risk of MI spreading by air (44.4% and 0.0%, p < 0.05) and that in order to avoid the risk of MI (42.3% and 0.0%, p < 0.05) children need to be vaccinated following recommended vaccination plan (53.4% and 25.0%, p < 0.05), as well that in Lithuania MI vaccine has been included in the recommended vaccination plan in 2018 (43.7% and 12.5%, p < 0.05).

Conclusions

More than half of the respondents know the pathogen of the MI, the way of it spreading, but less than half of them have vaccinated or are planning to vaccinate their children. Links have been identified between the vaccination of children and awareness of the ways of MI spreading and prevention of it.

Key messages

The behavior of parents with better awareness is related to decision of vaccination. Parents with better awareness have vaccinated or are planning to vaccinate their children from MI.
Risk factors of healthcare associated infections: prevalence surveys over five years
Authors: Ghali H , Ben Cheikh A , Bhiri S , Khefacha Aissa S , Dhidah L , Ben Rejeb M , Said Latiri H
Published: November 2019

Background

Healthcare associated infection (HAI) is alarmingly increasing in low income settings. In Tunisia, the burden of HAI is still not well described. We aimed to analyze risk factors independently associated with HAIs in hospitalized patients in Sahloul Hospital for the last five years.

Methods

We conduct every year a prevalence survey, as part of the program for the prevention and control of HAI at Sahloul Hospital. It is a cross-sectional study of one-day prevalence with a single pathway. All departments were included in the survey, except emergency and hemodialysis services due to their very short length of stay. Data collection was carried out using NosoTun plug (national HAI prevalence survey). Logistic regression was performed to identify independent risk factors of mortality among infected patients with p value less than .05.

Results

Over five years, prevalence of HAI ranged from 11.4% in 2014 to 7.1% in 2018. In 2014, independent risk factors of HAIs were the use of peripheral venous catheter, central venous catheter, and undergoing a surgery. Intensive care units and surgical departments were independently associated with the occurrence of HAIs. In 2015 and 2016, in addition to the factors already mentioned, antibiotic therapies for the last six months as well as parenteral feeding were also found as independent risk factors. In both 2017 and 2018, intrinsic factors were found in multivariate analysis; in fact diabetes as underlying disease was independently associated with HAIs.

Conclusions

Identifying risk factors that contribute to develop HAIs may support the implementation of strategies for their prevention, therefore maximizing patient safety.

Key messages

Identifying risk factors for HAIs may improve patient safety. Insertion of medical devices was the main risk factor for patients over the five years.
Influenza vaccination campaigns targeted at healthcare workers:results of four hospitals in Rome
Authors: Tognetto A , Abbondanzieri A , Cerone G , Di Pumpo M , Nardi A , Paglione L , Franco E , La Torre G , Orsi G B , Laurenti P
Published: November 2019

Background

Seasonal influenza vaccination (SIV) of health care workers (HCWs) is well recognized as a public health measure that can protect both HCWs from infection and patients from the risk of influenza complications. Nevertheless, vaccination coverage rates among this specific population result generally lower than the recommended target. With our study, we aimed to describe the activities and the outcomes of four different SIV campaigns targeted at HCWs and organized during the season 2018/2019 in four hospitals in Rome.

Methods

A cross-sectional study involving four teaching hospitals was performed. The collected data were synthetized into a set of descriptors and indicators, validated through a previous study that had involved the same Centers.

Results

The Medical Directorates, in collaboration with the University Hygiene and Public Health Units of the four hospitals organized different strategies: Hospital 1, 3 and 4 realized educational courses for HCWs and actively promoted the campaigns through e-mail invitations to all HCWs. As for the access to vaccination, all the hospitals provided a dedicated unit for SIV; Hospital 1 and Hospital 4 organized also on-site vaccination sessions in the hospital wards, that required a large number of staff. The vaccination coverage rates resulted: 22.37% in Hospital 1, 18.10% in Hospital 4, 9.28% in Hospital 2 and 8,51% in Hospital 3.

Conclusions

Our results demonstrate that multi-activity campaigns, involving education, promotion and easy access to vaccination constitute an effective approach to reinforce the value of SIV. Our findings suggest that on-site vaccination may play a key role in determining a higher vaccination coverage.

Key messages

Multi-activity vaccination campaigns, involving education, promotion and easy access to vaccination constitute an effective approach to reinforce the value of seasonal influenza vaccination for HCWs. On-site vaccination may play a key role in determining a higher vaccination coverage.
The Knowledge on antibiotics and antimicrobial resistance among Polish medical students
Authors: Sobierajski T , Wanke-Rytt M , Mazińska B , Karpierz K , Hryniewicz W
Published: November 2019

Background

Antimicrobial resistance (AMR) is one of the biggest threats to public health worldwide, compromising ability to treat infections. Medical students as a future doctors will have an important role to play in preventing the spread of antibiotic resistance. The aim of this study was to analyse the knowledge and attitudes of Polish medical students towards antibiotics and AMR.

Methods

A questionnaire containing 24 questions, on medical students’ knowledge, attitudes and perceptions of antibiotic prescribing and antibiotic resistance was developed. The survey was conducted in May-June 2018 among medical students of Medical University of Warsaw at various years of their studies.

Results

The study group consisted of 291 students (70% women, 30% men). Forty six of the students had used antibiotics within the previous 12 months. The prevailing reasons for taking an antibiotic were: pharyngitis (25%), bronchitis (12,8%), sore throat (12%), cough (8.3%), pneumonia (7.9%), urinary tract infection (7.6%), cold (6.6%). Ninety-two percent of the respondents considered AMR to be a significant problem, and 7.9% stated it will become in the future. Four percent of respondents believed that antibiotics are effective in treating common cold. The majority of students (83.5%) expressed the opinion that doctors often prescribe an antibiotic without need. Most respondents think that too frequent prescription and low awareness of the consequences of their overuse have an impact on the rise and spread of antibiotic resistant bacteria. The vast majority of respondents (80%) declared that university studies enabled the gaining of a wider knowledge about the use of antibiotics. The vast majority of respondents (92.4%) indicated a willingness to extend their knowledge on antibiotic use.

Conclusions

Medical students are aware that AMR is a growing problem resulting in diminishing treatment options. The results of the study should be taken into future education programs.

Key messages

Medical students have a good understanding of the health risk of AMR but consider antibiotics for viral infections. More training on rationale antibiotic use included in the curriculum is warranted.
Prevalence of measles IgG antibodies among immigrant workers in South Korea
Authors: Kim Y M , Kim B G , Hong Y S
Published: November 2019

Background

After the national vaccination for measles was introduced in 1985, the measles has been controlled in South Korea despite the epidemic in 2000-2001. Current cases in Korea were assumed to be transmitted from outside the country. Because the dynamics and social changes of the population has emerged as important factors in the measles epidemic, this study aimed to assess the prevalence of measles IgG antibodies among immigrant workers.

Methods

The cross sectional seroprevalence survey was conducted in Gyeongsangnamdo province, Korea. Because the representative sampling frame could not be possible, the voluntary foreign workers who have agreed informed consents with a translated format into the native language, participated in this study. IgG antibodies of measles was examined by ELISA using the automation equipment (BEP III- ELISA). This study obtained the approval of Dong-A University Clinical Research Ethics Review Committee.

Results

364 people of foreign workers participated in the study. Regional distribution for study participants was composed of 30 people in Vietnam (16.5%), Uzbekistan 71 people (19.5%), Thailand 70 people (19.2%), China 60 people (16.5%), Philippines 36 people (9.9%), and Indonesia 32 people (8.8%). The average age was 33.0 ± 6.9 years old and 86.5% of the total was men. High school or higher education accounted for 74%. 93.7% showed positivity (95% CI: 95.7-98.9%) for measles IgG antibody and 3.6% showed equivocal.

Conclusions

The measles seropositivity among immigrant workers in Korea was considered to be at the recommended level.

Key messages

The measles seropositivity among immigrant workers in Korea was considered to be at the recommended level. International cooperation is needed to prevent global measles epidemic.
Influenza vaccination: a multi-modal approach to increase compliance in an italian teaching hospital
Authors: Celotto D , Malacarne F , Battistella C , Bucci F G , Antinolfi F , Brunelli L , Cocconi R , Tignonsini D , Faruzzo A , Brusaferro S
Published: November 2019

Issue

Influenza vaccination of Healthcare workers (HCW) has a key role in avoiding flu transmission among patients and HCWs and is annually recommended by health authorities. Despite the 75% target identified by WHO, coverage is still inadequate in many European countries.

Description of the problem

The Infection Control Team and Public Health Residents of a University Hospital annually cooperate to actively offer flu shots directly in the Units, but in 2017-18 campaign only 12,1% of HCWs took advantage of the service. From July to December 2018 a composite intervention was performed to increase immunization rates. In each Unit a medical doctor and a nurse (midwife for the Obstetrics unit) were identified as Link Professionals (LPs).Two educational meetings with Infectious Diseases and Public Health experts were organized for LPs to deal with their hesitancies and to engage them for the vaccination promotion among colleagues.The calendar (2/week ambulatory + 16 in-ward appointments), tailored to maximise the HCW accessibility, was sent to medical consultants and head of departments, to all physicians, and to head nurses for dissemination. Promotional posters and videos were displayed across the hospital.

Results

Educational meetings were attended by 130 LPs. A total of 772/3420 HCW took advantage of the 2018-19 active campaign (22,6%), with a significant increase from the previous year (+10,4%; 95%CI 8,7-12,2; p < 0,001). The immunization rates raised in all HCWs categories: 279/660 doctors (it was 167/660 in 2017-18; +17.0%; 95%CI 11,9-21.9; p < 0,001); 303/1615 nurses (150/1615 in 2017-18; +9.5%; 95%CI 7.1-11-9; p < 0,001); 13/43 midwives (2/43 in 2017-18; +25,6%; 95%CI 9.7-40.8; p = 0,002).

Lessons

Despite the significant increase,further efforts are necessary to reach the WHO target rate. All HCWs categories were positively affected by the multi-modal intervention. LPs seem to play an important role in promoting vaccination among colleagues, in a peer-to-peer trust relationship.

Key messages

Influenza vaccination rates needs to be increased in healthcare workers for their protection and for patient safety. A well-structured multi-modal intervention programme involving prepared HCW promoters into wards is essential to increase compliance.
Vaccination, Autonomy, Complexity, Solidarity - Ethical analyses of a German policy discourse
Authors: Schröder-Bäck P , Gille F , Brall C , Martakis K , Kuhn J
Published: November 2019

Background

Currently, measles immunization is high on the agenda of academic and public discourses - on both sides of the Atlantic. In Germany, the discussion of mandatory (measles) immunization was intensively publicly discussed in Spring 2019. Many stakeholders, including federal politicians, plea for mandatory measles immunization. In our paper we analyse the discourse from an ethical point of view.

Methods

Statements and arguments from German stakeholders in the public debate in 2019 are analysed (among them statements of the federal minister of health, the German Medical Association, NGOs and the National Ethics Council). A vaccination ethics framework and a public trust framework are applied in the analysis.

Results

Politicians and other public stakeholders debate (measles) immunization and increasingly demand mandatory (measles) vaccination. However, frequently it is unclear which vaccinations or immunization programmes they refer to. They often do ignore the epidemiological situation of immunization rates in Germany, regional differences, relevant target groups and implementation mechanisms, including potential sanctions. This way they simplify the complex problem and offer (populist) simplistic solutions. Normative arguments of stakeholders repeatedly use conceptions of ’autonomy’ and ’harm’; but sometimes also ’solidarity’ is mentioned.

Conclusions

The call for mandatory measles immunization of school and kindergarten children is offering no adequate and sufficient solution to the problem of elimination of measles. Nevertheless, it contributes to reducing infection risks for the children in care and schooling facilities. Rather, the problem has to be understood in its complexity before discussing the ethical challenges and making effective policy recommendations. When discussing ways to increase immunization rates, ethical values like public trust and solidarity have to be in the foreground - not (only) the debate of autonomy and its restriction.

Key messages

In German policy discourses 2019, the discussion of “mandatory (measles) vaccination” often shows inaccuracies regarding definitions and facts. These have to be clarified before ethical analysis. Ethical issues regarding the voluntariness of measles vaccination relate also to the ethical concepts of solidarity and public trust and not only to autonomy.
A model of Carbapenemase-Producing Enterobacteriaceae spreading in the French hospitals network
Authors: Roux J , Massonnaud C , Crépey P
Published: November 2019

Background

Carbapenemase-Producing Enterobacteriaceae (CPE) are spreading at an alarming rate and threaten health systems and patient safety worldwide. In France, their transmission is driven by importation of international cases and inter-regional dissemination due to patients’ transfers between hospitals. This study aims at defining a mathematical model reproducing CPE transmission on the French network of hospitals.

Methods

CPE spreading is modeled using a stochastic susceptible-colonized-infected (SCI) hospital-based model. It takes into account both CPE dissemination through patient transfers, and importations either from foreign countries or in-town transmission. The patient transfer network was reconstructed using data from the French hospital discharge database (PMSI) over the years 2014-2017. Epidemiological parameters were estimated from surveillance data of CPE episodes from August 2010 to November 2016 from the French national Healthcare-Associated Infections Early Warning and Response System.

Results

Our epidemiological model replicates the number of CPE hospital outbreaks occurring in France on a network of 2,433 hospitals. It allows to estimate the number of unobserved hospitals’ colonization and differentiate outbreaks due to foreign importation from outbreaks due to patient transfers. Finally, the model can be used to benchmark control strategies based on patient redirections, or targeted screening.

Conclusions

This study is the first to simulate CPE spread in France using real-life patient transfers data. Our mathematical model may further help public health authorities in the definition and evaluation of new control strategies of CPE transmission based on patient flows between hospitals.

Key messages

The mathematical model take into account CPE spreading through hospital transfers and importations from origins using real-life data. Our stochastic susceptible-colonized-infected (SCI) hospital-based model reproduces CPE spread in France and further help in evaluating control strategies of CPE transmission.
How to build the partnership between researchers and field actors?
Authors: Ferron C , Joanny R , Le Grand E , Porcherie M , Rohou S
Published: November 2019

In health promotion, the partnership between researchers and practitioners (field actors) is necessary for multiple reasons: to build intervention research together, to share our knowledge and experience, to produce new knowledge and experience, and to improve the quality of interventions, decisions... and research.

In order to build this partnership and to achieve these goals, two dimensions were explored during several mixed workshops (researchers and field actors) organized in Brittany (France): their reciprocal perceptions, and what they can mutually bring to each other.

During the first workshop, a facilitation technique called “the figure,” (which health educators use when they need to underscore the perceptions of a group of professionals about a specific population) shed light on mutual misconceptions and helped rectify them. During the following workshops, both groups identified their common assets, resources, difficulties and stakes. They also highlighted what they could bring to each other.

Indeed, the relationship between researchers and field actors is usually considered in terms of the contributions of research to actions. However, field actors are more than simple “users” of a knowledge produced by others, they are also “producers’ of knowledge. They can contribute to define research questions, issues, hypotheses (with a social twist...); challenge the relevance and feasibility of research; promote the link and the understanding between the two separate worlds of practice and research; encourage the making of certain research protocols; facilitate experimentation; check the validity of the research projects in terms of social usefulness; make research more visible to field professionals and policy makers; and support knowledge transfer and exchange.

The ways in which the partnership between researchers and health promotion actors actually enrich both categories of professionals, are detailed in this presentation.

Key messages

Reciprocal representations of researchers and practitioners in the field of health promotion must be highlighted to lay the foundations of their partnership. In health promotion, knowledge transfer must be understood as an exchange between researchers and field actors, the latter being experts in their domain of intervention and producers of knowledge.
MENTAL HEALTH ACT, MALTA 2012 - A personal reflection on 5 years working with a new legal framework
Authors: Cachia J M
Published: November 2019

The Commissioner for the Promotion of Rights of Persons with Mental Disorders (CMH) was established in Article 5 of the Mental Health Act approved by the Maltese Parliament in December 2012. The whole Act was completely in force on 10th October 2014.

The involuntary care process is being closely monitored. Patients are being followed up within the time-frames established by the new law. Although not strictly comparable, length of stay in involuntary care has diminished radically. Patients are being discharged from compulsory treatment orders or transferred to community treatment orders rather than being left on “leave of absence”. Community involuntary care is the preferred option of following up difficult cases. This shift requires commitment to strengthen community support services and render them sustainable.

The applications for involuntary care are progressively being better completed and the quality of the information backing requests for involuntary detention of persons is improving. Care plans are being submitted, but their completeness and their quality merits revision. The issue of availability of human resources is a critical issue which regularly features in feedback with care teams. Evidence of greater involvement of patients and responsible carers in the care planning process should be better documented if it is indeed happening. The level of awareness of patients’ rights in terms of the Act merits deeper evaluation.

The CMH must continue to provide a voice to vulnerable persons with mental disorders and their loved ones. Maximization of the potential of persons with mental disorders is not only a question of social justice but also critical for the sustainability of our health system and the prosperity of our society. The burden of mental disorders is increasing exponentially with the modernization of our society and those who are not coping with this burden merit active consideration and support.

Key messages

Public health advocacy and the improvement of patient rights. The use of legislative tools in reforming service delivery.
Suicide epidemiology in Italy: a population-based study in Piedmont Region
Authors: Mamo C , Coggiola N , Dalmasso M , Pitidis A , Costa G
Published: November 2019

Background

Among the largest Italian Regions, Piedmont (Northern Italy) is the one with the highest rate of suicide. Aim of the study was to describe intentional self-harm related deaths in Piedmont analyzing trends by gender, age, area of residence, socio-economic level.

Methods

Observational mortality study of the resident population in Piedmont from 2003 to 2014. Age-standardized rates of suicide (ICD-10: X60-X84) were estimated, by gender, health district of residence, mountain/level ground, and educational level. Suicide methods and places of occurrence by gender and age were inquired.

Results

In a context of declining injury related mortality, especially for traffic accidents, the regional trend of suicides shows only a slight decrease, becoming the main cause of injury deaths since 2009, equal to 21% of all injury deaths in the studied period. There are no significant trend variations related to the period of economic crisis. The occurrence is higher among men in general and particularly in older people, persons with low educational level and those living in deprived areas. The main suicide method used by women is “jumping from a high place” (36.7%) while the main one for men is “hanging, strangulation and suffocation” (50%). This is globally the most frequent method for all ages. “Self-poisoning” gains importance between 30 and 49 years old. Suicides occur for over half of cases in home.

Conclusions

Suicides are a public health and social concern. Yet despite its extent, this problem is still not adequately considered in public health prevention programs. Social and geographical gradients highlitght the importance to improve mental health service provision in deprived areas and to enhance public social welfare measures. Further contributions to a deeper understanding of the determinants of self-harm behaviour and suicidal risk can be obtained from health information systems, in particular data from Emergency Departments and multiple causes of deaths records.

Key messages

In Italy, suicides are the main cause of injury deaths, without trend variations. Occurrence is higher among men, older people, persons with low educational level and those living in deprived areas.
Mental health service use among university students with adverse childhood experiences
Authors: Jakovljevic M , Matejic B , Medarevic A , Mladenovic Jankovic S , Neskovic A , Tripkovic K , Belamaric G
Published: November 2019

Background

Adverse childhood experiences (ACE) are a risk factor for mental health disorders and serious somatic illnesses. There is a need for preventing ACE and using mental health care by youth who experienced them. Aims of this study were to examine which ACE are related to mental health service use and to identify a scope of unrecognized needs for these services among students who had experienced abuse/neglect in childhood.

Methods

Descriptive cross-sectional study was performed on a sample of 2.381 first-year students from six universities in Serbia in 2014. The survey instrument was a questionnaire developed by WHO and CDC. Thirteen ACE (covering household dysfunctionalities, abuse, neglect, peer and collective violence) and using of mental health services at least once during lifetime were assessed. Data were analyzed by univariate and multivariate logistic regression.

Results

Compared to respondents without particular ACE, odds (±95% CI) of mental health service use were higher only in those with next adversities: parental divorce, OR = 2,26 (1,53-3,33); suicidal/mentally ill family member, OR = 2,21 (1,42-3,44); witnessing partner violence, OR = 1,51 (1,04-2,18); peer violence, OR = 2,14 (1,51-3,03); collective violence OR = 1,48 (1,05- 2,10).

Among respondents who had experienced emotional neglect, 81% have never used professional help. For physical neglect, physical and psychological abuse this percentage was 83%.

Conclusions

The study highlights ACE associated with mental health service use and shows a significant presence of unrecognized needs for these services. There is need for: determining barriers in this area and formulation of effective health promotion strategies; more consistent application of legislation; conducting screening on child abuse/neglect in families with a higher risk for them.

Key messages

High share of youth with childhood adversities remains without help of mental health specialists.It opens the issue of barriers on the side of youth as well as on the side of health system and society Considering consequences of adverse childhood experiences, there is need for comprehensive public health interventions in order to increase mental health service use among young people with ACE.
The impact of participation in support groups on mental health of parents having children with autism
Authors: Alibekova R , Kadyrzhanuly K , Chan C K , An S , Gusmanov A , Yerubayev Z , Yessimkulova F , Bekisheva A , Ospanova Z , Rakhimova M
Published: November 2019

Introduction

Whilst there is accumulated evidence about the high prevalence of stress and mood disorders in parents of children with autism, few studies have shown that participating in parental support groups was associated with less mental health problems. This study was aimed to explore the association of participation in support groups with stress and mood disorders in parents of children with autism in Kazakhstan.

Methods

Participants (n = 146) were recruited to this cross-sectional survey from autism non-governmental organizations and Republican Children’s Rehabilitation Center in Nur-Sultan city during April-December 2018. A 59 item survey consisted of questions on parental socio-demographics, needs, participation in support groups, depression, anxiety and stress (DASS), and Multidimensional Scale of Perceived Social Support (MSPSS). Descriptive, bivariate and multivariate logistic regression analyses were performed in STATA 15.

Results

44.4% of parents reported experiencing stress, and almost half of the sample had elevated depressive (53.7%) and anxiety symptoms (47.4%). 45.3% of participants were members of parental organizations; there were no significant differences in the prevalence of stress and mood disorders among members and non-members of parental support groups. Results of the multivariate logistic regression showed that parents with older autistic children (OR 1.37, p-value 0.001), less family support (OR 0.894, p-value 0.044) and higher income (OR 3.01, p-value 0.025) were more likely to be members of support groups.

Conclusions

These findings indicate the need to increase support groups to under-served populations of Kazakhstan’s families with autistic children. Additional efforts are needed to strengthen the role of support groups in meeting the emotional needs of the parents.

Key messages

Parents of children with autism spectrum disorder experience elevated level of stress and mood disorders; however participation in support groups was not beneficial for relieving parental distress. Further research is warranted to explore the benefits of participation in support groups, and interventions are needed to strengthen the role of support groups in meeting the needs of parents.