bluuebunny/crossref_metadata_2025 huggingface dataset:
Healthcare workers and measles outbreaks in Italy: is it time to act? A systematic review
Authors: Baccolini V , Sindoni A , Adamo G , Rosso A , Massimi A , Pitini E , De Vito C , Marzuillo C , Villari P
Published: November 2019

Background

Despite healthcare workers (HCWs) vaccination against measles is strongly recommended in Europe, many studies showed their low vaccination coverage and a significant involvement in hospital and community outbreaks. The aim of this systematic review was to analyze the available evidence on HCW role in measles outbreaks and identify the epidemiological characteristics of the transmission patterns related to HCW infection.

Methods

PubMed, Scopus and ISI Web of Science were searched to detect the measles outbreaks occurred in Italy and involving at least one HCW. English or Italian records were considered eligible. The quality assessment was performed using the ORION checklist. We also analyzed national or regional measles reports and the Measles outbreaks reporting forms that are annually submitted to the World Health Organization (WHO) of the period 2014-2018.

Results

Twenty-one articles were identified in the literature search and were in general of good quality. Of these, six were regional or Italian reports, two referred to one city, 13 were single outbreak reports. The national data showed that the number of infected HCWs increases with the rise of the total number of cases. A total of 72 descriptions of measles outbreaks were retrieved from the WHO reports. The vast majority was confined to the hospital or started at the hospital and spread in the community. The index cases were mainly patients seeking care for measles-related symptoms but, in the last years, a growing number of infected HCWs was identified as infection source. Similarly, the number of outbreaks with more than one infected HCW recorded a small increase over time.

Conclusions

HCWs play a critical role in measles transmission especially in hospital outbreaks, which are significantly costly and disruptive for the healthcare delivery quality and safety. Vaccination policy aiming at increasing their immunization rate is crucial to limit the virus spread and the economic impact on the institutions.

Key messages

In spite of the remarkable progress, measles elimination in Italy is far from being met and the virus transmission in healthcare settings is increasingly notified. Vaccination policies aiming at increasing HCW immunization coverages are essential.
Overview of three-year trends of antimicrobial consumption and resistance in Sicilian hospitals
Authors: Barchitta M , Quattrocchi A , Maugeri A , La Rosa M C , La Mastra C , Sessa L , Cananzi P , Oteri A , Murolo G , Agodi A
Published: November 2019

Background

Antimicrobial resistance (AMR) is one of the ten threats identified by the WHO in 2019. In order to face this issue and in the framework of the National Action Plan on Antimicrobial Resistance (PNCAR) 2017-2020, the Sicilian Health Authority has implemented a surveillance system of antibiotic consumption in the hospital sector and in the community and of antibiotic resistance in the Sicilian hospitals. The aim of the present work is to report the results of three-year surveillance.

Methods

From 2015 to 2017, data on antibiotic consumption have been collected from pharmacies of participating hospitals. AMR data on seven bacterial pathogens isolated in blood and cerebrospinal fluid have been collected from hospital laboratories, using routine clinical antimicrobial susceptibility tests. Antibiotic consumption was expressed as Defined Daily Dose (DDD) per 100 patient-days. Antibiotic resistance rates (RRs) were calculated as the number of non-susceptible isolates divided by the total number of isolates multiplied by 100.

Results

The most commonly consumed antibiotics in participating hospitals were fluoroquinolones in 2015, penicillins in 2016, and beta-lactams in 2017, respectively. RRs of Klebsiella pneumoniae significantly increased for all antimicrobial classes (p < 0.001), but carbapenems. By contrast, RRs of Escherichia coli resistant to third-generation cephalosporins and carbapenems showed significant decreasing trends (p < 0.001).

Conclusions

The implementation of the Sicilian surveillance system provides Sicilian reference data to monitor trends and target interventions and policies for reducing the threat of AMR. Recently, using toolkits of the ECDC-EAAD initiative adapted with regional surveillance data, an educational campaign “Obiettivo Antibiotico” - https://www.obiettivoantibiotico.it/ - was designed and launched to raise awareness of prudent use of antibiotics in the general public and in healthcare professionals in Sicily.

Key messages

Inappropriate antimicrobial consumption observed in Sicilian hospitals contributes to the emergence and selection of AMR. Surveillance system of antimicrobial consumption and AMR can help identify strategies for preventing spread of multi-drug resistant microorganisms.
A digitalized methodology to strengthen health equity: control, influence and participation
Authors: Magnusson M , Bertolino C , Hallmyr M
Published: November 2019

Problem

Angered Hospital is situated in the northeast of Gothenburg, Sweden, serving municipalities with high prevalence of ill health. Dedicated to increase health equity, the hospital has established a Public Health Unit (PHU) to support residents to healthier lives. PHU found that lack of transparency concerning strategies, reflections and results hindered knowledge-exchange between public health practitioners. Also, information from the execution of public health interventions and programs needed to be more accessible for policy-makers and researchers.

Description

PHU developed a digitalized methodology for systematic steering. It draws on control, influence and participation, using Social Cognitive Theory to plan for strategies. The evaluation build on norm-critical reflections of structured reports. Themes include: How to improve efforts on the structural level? What measures do we plan for and conduct to enhance participation from residents? Quantitative goals were set.

Results

222 activity reports were launched and discussed by team members, leading to professional development. Strategies to support self-efficacy were used throughout. The strategy “reciprocal determinism” was planned for more than used, due to giving floor to participants to raise their issues. Methods that draw on transparency, sound evidence and continous collaboration allow for residents to rethink their lifestyle and strive for change. Issues for future development included the importance og giving time for trust and shared values to emerge. Quantitive goals were reached.

Lessons

Quality assurance of public health work enables formative and summative evaluation, increases potential to close the health gap, provides policy-makers with valuable knowledge and opens for research. Trust and shared values are vital at all levels. The methodology allows for organizations to develop their health literacy in order to include and give voice to people in underserved areas.

Key messages

Public health units aiming at health equity should use tailored evidence based methods, including norm-critical reflections. Digitalizing a methodological instrument increases accessability and transparency which enables common knowledge development.
Sickness absence trajectories following labour market participation patterns in Catalonia, 2012-2014
Authors: Hernando-Rodriguez J C , Serra-Saurina L , Benavides F G , Ubalde-Lopez M
Published: November 2019

Background

Working life is characterized by transitions between different employment status which could affect future health status. Previous studies on sickness absence (SA) have focused on risk factors in the workplace; however, there is scarce evidence regarding labour market participation (LMP) patterns. The aim of this study is to examine the association between prior LMP patterns and the course of SA.

Methods

Cohort study based on a sample of 11,968 salaried workers affiliated with the Spanish Social Security system, living in Catalonia, who accumulated more than 15 days on SA at least in one quarter during 2012-2014, from three working life cohorts according to the working life stage in 2002: early (18-25 years), middle (26-35 years) and late (36-45 years). Sequence analysis was used to identify LMP patterns (2002-2011). Latent class growth analysis was applied to identify SA trajectories (2012-2014). Finally, crude and adjusted odds ratios (aOR) were estimated using multinomial logistic regression models.

Results

Overall, four SA trajectories were identified: low stable (83%-88% of the workers), decreasing (5%-9%), increasing (5%-11%) and high stable (7%-16%) accumulated days on SA, for men and women. Similarly, seven LMP patterns were obtained: stable employment (63%-81%), increasing employment (5%-22%), delayed employment (7%-8%), decreasing employment (4%-10%), varying employment (13%-14%), steeply decreasing employment (9%), and steeply labour market exit (8%). No significant associations were observed among LMP patterns and SA trajectories, except for young men, where an increasing employment pattern was significantly associated with a lower risk to increase days on SA over time (aOR: 0.21 [95% CI: 0.04-0.96]).

Conclusions

A prior 10 years of LMP pattern does not seem to show an effect on the course of SA. A closer working life to the SA course could be considered to assess this relationship.

Funding: Grants FIS PI17/00220 and PI14/00057

Key messages

A longitudinally approach is warranted to evaluate the relationship between working life and sickness absence. Extended prior working lives are not related to the course of future sickness absence.
Age-group differences in associations of working hour characteristics and short sickness absences
Authors: Ropponen A , Koskinen A , Puttonen S , Härmä M
Published: November 2019

Background

Working-hour characteristics are linked to disturbed sleep, but little is known about their association with short sickness absences (SA). We investigated the association between working hour characteristics in shift work and the incidence of short (1-3 days) SA in three age groups.

Methods

The data was from the hospitals’ electronic working time records. The final sample was restricted to the first incidence of short SA (1-3 days) from 2008 to 2015 and to shift working employees (n = 12156, 89% women). Age groups were < 35 (n = 5652), 35-49 (n = 3592) and ≤ 50 years (n = 2545). Work shifts (morning, day, evening, and night), quick returns (< 11 hours between two work shifts), length of work shift and weekly working time were calculated for case-crossover study design to compare the working hour characteristics of the 28 days preceding SA (exposure window) and those of the 28 days before the exposure window (control window). Conditional logistic regression models were run for odds ratios (OR) with 95% Confidence Intervals (95%CI).

Results

Working hour characteristics, especially length of working hours, played the clearest role among those < 35 years of age. In this age group, exposure to > 25% of > 40 weekly working hours associated with an increased likelihood of short SA (OR 1.30, 95%CI 1.17-1.44), whereas weekly working hours had OR 1.02 (95%CI 1.02-1.03). Having only a few (≤ 4) quick returns decreased the likelihood of SA (ORs 0.31-0.54), whereas having ≥25 quick returns increased it (OR 2.75, 95%CI 2.44-3.11). The results showed mostly similar trends among those of 35-49 years of age whereas among older workers (≤ 50 years) only an association for quick returns was observed.

Conclusions

Long working hours increase the risk of short SA among those ≤ 49 years of age and several quick returns among all age groups. These working-hour characteristics should be avoided to minimize SA and increased costs for the employer, but also to maintain public health.

Key messages

Unhealthy working-hour characteristics should be paid special attention in shift scheduling to avoid sickness absence. Good shift scheduling could assist in maintaining workability and therefore public health.
The impact of psychosocial factors on breastfeeding duration in the BaBi cohort study, Germany
Authors: Grosser A , Doyle I-M , Löffler A , Breckenkamp J , Spallek J , Razum O , Miani C
Published: November 2019

Background

Breastfeeding is considered beneficial for both mother and child. In Germany, national guidelines recommend fully breastfeeding for at least 4 months, a goal reached by only 34% of mothers in 2012. The WHO’s recommendation of exclusively breastfeeding for six months was met by 19% only. Hardly modifiable factors such as socio-economic status and migration background have been associated with duration of breastfeeding but little is known about the impact of psychosocial factors such as personality traits and social support. We hypothesise that there are differences in the psychosocial profiles of mothers regarding the duration of breastfeeding.

Methods

We analyse baseline and follow-up data of the Bielefeld BaBi birth cohort (2013-16). They include detailed migration and socio-economic backgrounds, as well as three measures of psychological characteristics: the optimism scale, the Big Five inventory and the locus of control scales. We perform bivariate and multivariate analyses in order to identify psychosocial determinants of fully breastfeeding for four and six months.

Results

Out of 780 BaBi study participants, 548 fully breastfed for four months (70.3%), of which 279 continued until at least six months (35.8%). Logistic regression analyses show that fully breastfeeding for at least four or six months is independently associated with the intention to breastfeed and the attendance of antenatal class during this or previous pregnancies. Personality characteristics, social status and migration background show however no significant association with breastfeeding duration.

Conclusions

Our study results support the promotion of individuals’ breastfeeding intention and attendance to antenatal classes to increase breastfeeding duration. Since differences in breastfeeding practices have the potential to create inequalities in maternal and child health, more efforts are needed to intensify research on modifiable factors influencing breastfeeding duration.

Key messages

Neither psychosocial factors nor socioeconomic status were associated with breastfeeding duration. Two modifiable factors, breastfeeding intention and attending antenatal classes, were the main predictors of breastfeeding duration.
Perception of health risk linked to environmental factors by pregnant women
Authors: Sauvant-Rochat M , Kouamé N G L , Bernard L , Marie C , Lémery D , Vendittelli F
Published: November 2019

Bacground

Recently, the International Federation of Gyneco-Obstetrics (FIGO) advocates limiting exposure to chemicals present in everyday products during pregnancy. To date, the chemicals, and the risks related, are not well-known, as well by perinatal health professionals (PHP) as by pregnant women (PW). AIMS: to estimate the sensitivity to the environment and the perception of risks related to chemical substances by pregnant women.

Methodology

A descriptive cross-over study was carried out among pregnant women ((followed or hospitalized in different health establishments in Auvergne). The collection of data (socio-demographic characteristics, sensitivity to the environment, use of cosmetics, perception of environmental risks) was carried out by interviewers, using a standardized questionnaire. The statistical analysis (logistic regression) was performed with Modalisa® 8.0 (Kynos, Paris).

Results

Three hundred questionnaires were analyzed. The sensitivity to the environment is estimated at 6.3 ± 1.7 (scale 0 to 10). For the majority of women, exposure to chemicals is primarily related to the use of cleaning products, DIY products, and gardening products. Food can also be a source of exposure (especially for pesticides). On the other hand, cosmetics are not perceived as products containing chemical substances, with potential risk to health. This vision of chemical substances is related to age, educational level, socio-professional category and sensitivity to the environment. Only 5% (19/300) of PW considered health professionals as referents on chemical substances and environmental problems.

Conclusions

This study highlighted the sensitivity of pregnant women to environmental issues, but a lack of knowledge of chemicals and the risks which they represent for health. It is important to reinforce the information given to pregnant women by perinatal health professionals about healthy behaviors.

Key messages

Pregnant women don’t know all sources of exposure to chemical substances. Training in environmental health must be increased for perinatal health professionals.
Capacity Building in Nurturing Care in Serbia
Authors: Jankovic S Mladenovic , Matijevic D , Tamburkovski G , Grujicic A , Markovic M
Published: November 2019

Background

Training program for home visitors on early child development was developed and implemented within UNICEF supported projects involving 25 primary health centers. Training content was notably based on resource modules “Supporting Families for Nurturing Care”, adapted according to the local context. Health professionals are seen as the critical actors to support development of young children and their families. Family-centered approach that addresses social as well as medical dimensions of problems became priority in their practice with a special focus on working with children from socially deprived settings and children with disabilities.

Objectives

The main objective was to improve knowledge and practice of home visitors on early child development based on most recent scientific evidence. Broad spectrum of topics was covered including engaging fathers, early detection of postpartum depression, attachment, developmental monitoring, age-appropriate play, home safety, stigma and discrimination. Training were organized as interactive face to face sessions and online courses and attendees were actively engaged in reflection. Comprehensive check list with various assessment instruments was developed to provide guidance to home visitors in implementation of gained skills.

Results

Increase in knowledge of 150 home visitors was between 57.6% and 82.9%. Enhanced knowledge and skills have been applied in 14912 families of which socially deprived was 34.5% during 2-year period of implementation. Parent-child interactions, assessed by visiting nurses, were improved by 32.6%, responsive feeding practices by 27.4%, while age-appropriate play by 34.4% after interventions during home visits.

Conclusions

Well-developed monitoring system was crucial for implementation of gained knowledge and skills in practice of home visitors.

Key messages

Home visitors were empowered to take a strengths-based approach in their work with families. Developed tools facilitated prioritization of most vulnerable families and tailoring support according to needs.
Prenatal exposure of extra vitamin D from fortification and later risk of inflammatory bowel disease
Authors: Duus K S , Moos C M , Frederiksen P , Andersen V , Heitmann B L
Published: November 2019

Introduction

Inflammatory bowel disease (IBD) is a chronic immune-mediated inflammatory disease that can affect the entire digestive tract. Approximately 1% of the Danish population has IBD today. Both the incidence and prevalence of IBD are increasing globally, but the etiology of IBD is still not fully understood. Some, but not all studies find that vitamin D has both protective and therapeutic effects on IBD. To our knowledge, no other study has investigated prenatal exposure to extra vitamin D from either fortified food, diet or supplements in relation to IBD. The aim of this study was to investigate whether a small extra dose of vitamin D from fortification during gestation, was associated with a lower risk of developing IBD in the offspring.

Methods

In 1985 mandatory fortification of margarine with vitamin D in Denmark was canceled. To investigate the effect of this policy change we selected all individuals from 2 full year birth cohorts before and after the termination of the mandatory fortification. All individuals were followed for 30 years. By merging data from the Medical Birth Registry with the Danish National Patient Registry, we identified individuals with IBD.

Results

217,249 individuals were included in the analysis. 875 among the exposed and 1102 among the unexposed fulfilled the criteria for being diagnosed with IBD. A lower odds ratio OR = 0.867 (95% CI: 0.792;0.947) for IBD was observed among those who had been exposed to extra vitamin D from fortified margarine during gestation, compared to those who had not been exposed. The analysis was adjusted for sex and season of birth, but results were essentially similar before and after this adjustment.

Conclusions

This study shows, that a small extra dose of vitamin D from fortified margarine during gestation may lower the risk of developing IBD in the offspring, until the age of 30. If these results can be replicated, fortification with vitamin D could be recommended to prevent IBD on a public level.

Key messages

Prenatal exposure of vitamin D from fortified food could lower the risk of IBD later in life. Fortification with vitamin D even at a relatively low level could have public health benefits.
Individual-level high definition spatial distribution of mammography uptake in Geneva (Switzerland)
Authors: Sandoval J L , Himsl R , Joost S , Guessous I
Published: November 2019

Background

The local social and physical environment influences health outcomes and individual behaviour. It remains unknown if the environmental influence is independent of individual socioeconomic status (SES). We studied the spatial distribution of mammography screening uptake in the Swiss urban population of Geneva and determined its independence from SES.

Methods

We used individual-level geo-referenced data (n = 5 002) from the participants in the Bus Santé study, a population-based cross-sectional study ongoing in Geneva since 1992. Data from 1992 to 2014 have been included in this study. Local indicators of spatial association (LISA) were calculated and used to assess the spatial dependence of mammography uptake (defined as having had a mammography in the past). We report unadjusted spatial clusters; adjusted for neighbourhood income and individual educational attainment; and for demographic variables (age and Swiss nationality). Furthermore, we evaluated the association between the distance to the nearest screening centre and the identified spatial clusters.

Results

Mammography uptake was not randomly distributed, with spatial clusters overlapping with those of SES. Spatial clusters were reduced to 56.2% of their initial size (n = 1,033) after adjustment for SES variables. Adjustment for age and nationality further reduced the proportion of individuals exhibiting spatially-dependent behaviour (to 36.5% of the initial size). Distance to the nearest screening centre was not associated with the spatial distribution of mammography uptake.

Conclusions

High definition spatial distribution studies using analysis of individual data allow identifying spatial clusters which are not based on pre-determined administrative units (e.g. postal code) but rather on individual behaviour. Persistent spatial clusters after adjustment for SES and demographic confounders suggest additional area-level determinants influencing the spatial distribution of mammography uptake.

Key messages

High definition spatial studies can help uncover new patterns of health outcomes distribution independent of SES and based on individual behaviour, rather than administrative units. While SES explains a great proportion of the spatial distribution of mammography uptake, other still elusive factors may be contributing to the observed spatial inequalities in mammography uptake.
Mathematical modeling of medical equipment needs for public health purposes
Authors: Gajic J , Gengeljacki I , Tesic N , Misanovic N , Zunji M , Bjelica N , Cocic S , Jevtic M , Luzanin Z , Jakovetic D
Published: November 2019

Issue

A public health challenge facing many developing countries is the lack of medical equipment, such as mammograms and CT scanners, as well as the unequal access to available equipment. In order to rationalize costs and provide patients with more equal access to preventive and diagnostic services, optimized distribution based on actual needs, considering factors such as population structure and private sector capacities is necessary. The suggested optimization was made in cooperation between students of public health, applied mathematics, and information technology.

Description of the problem

Based on Open data released by the institutions of Republic of Serbia, pertaining to radiological equipment operated by state healthcare facilities over a period of three years (2015, 2016 and 2017) and projected population, by sex, age, and region, a mathematical model has been made, aimed at optimizing equipment distribution across the 4 regions. With the goal of finding an adequate model, region and year specific data were used for calculating the Gini coefficient. Multiple alternatives were tested over a period of a few months, with the results displayed graphically, using a web application presenting the equipment distribution.

Results

In maximizing the territory covered, the availability of the equipment to the patients was increased, and with it, the equipment’s utility. The results indicate savings can be achieved, taking into consideration the capacities of the private sector.

Lessons

An adequate mathematical model can contribute to a better distribution of equipment, as well as cost saving. Taking into consideration that inadequate funding is one of the major challenges faced by state healthcare services worldwide, with appropriate data, the model would find use in other countries as well.

Key messages

Open medical data opens up new space for action by the interested parties. Inter-professional cooperation holds great potential in solving public health problems.
Azienda Sanitaria Locale Roma 4: the external evaluation as strategy to improve vaccination services
Authors: Fusillo C , Sinopoli M T , Morucci L , Marchetti C , Quintavalle G
Published: November 2019

Issue

Azienda Sanitaria Locale (ASL) Roma 4 is one of the ten local healthcare companies of Lazio Region. Vaccination Service (VS), organized in 15 ambulatories, is managed by dedicated and trained staff and this organization has led to high vaccination coverage over the years. In 2017, the National Immunization Plan and the new law on mandatory vaccination required a reshaping of VS. The Health Management of ASL Roma 4 has requested an external evaluation of the VS to a private company (PC) with the aim to highlight weaknesses and strengths.

Description of the problem

The PC, through inspections and questionnaires addressed to personnel, analysed four features: amplitude of the access to the ambulatory; management of the access; communication; tools. The analysis focused specifically on vaccination for people under 18 years old.

Results

The PC underlined these weaknesses: massive free access; strong influx of users from other adjacent ASL; computerized vaccination registry not available online; absence of a centralized booking and information request system; lack of targeted use of social networks. Best practices of the VS are: vaccination stocks centrally managed; preventive interview for travellers; structured procedures shared throughout the territory; focused vaccination campaigns; information material sent to the families of the new born; online portal available to users to view their personal data and download vaccination certificates; vaccination counselling; openings dedicated to specific user categories.

Lessons

The PC suggested these solutions: division of ambulatory opening into free access and booking/active call; online computerized registry; unique call center constitution; creation of official social network pages. ASL Roma 4 activated the unique call center and taken corrective actions for the other weaknesses.

Key messages

Best practices can be used in other healthcare setting and the periodically external evaluations can improve the vaccination service. Continuously monitoring the activities improves the quality of the vaccination service.
Vaccine Prevention of Paediatric Chronic Lung Disease: Targeting Haemophilus
Authors: Parkes M , Grady KA O
Published: November 2019

Background

Chronic Suppurative Lung Disease (CSLD) is an emerging term encompassing a spectrum of chronic childhood respiratory disease. Characterised by early and severe infections and recurrent exacerbations, it is associated with progressive deterioration in lung function and quality of life. CSLD is highly unequally distributed and largely preventable, and is a major contributor to the global burden of chronic paediatric respiratory disease. Relatively few pathogens comprise the main culprit organisms identified in the aetiology of CSLD, over which Non-Typeable Haemophilus influenzae (NTHi) predominates.

Methods

We review developments that establish the role of NTHi in disease progression, focusing on high-risk population subgroups with an established CSLD burden. We consider current studies examining the role of prenatal NTHi and pneumococcal vaccination in preventing CSLD through reducing infections in high-risk populations, and discuss current directions in future research, including the need for precise identification of the pulmonary microbiome in CSLD.

Results

Early, repeated NTHi infections are clearly implicated in the aetiology of CLSD. Early results of current studies indicate NTHi vaccination may reduce the frequency of causal infections in high-risk groups. Clinical and immunological data show vaccination also reduces frequency of exacerbations and antibiotic usage in CSLD.

Conclusions

We provide the first clinical and immunological data for H. influenzae vaccination in children with CSLD. Targeted vaccination strategies may prevent CSLD establishment, slow progression, and potentially reduce morbidity, healthcare presentations and antibiotic consumption. This implicates vaccination as a potential aid in both antimicrobial stewardship and prevention of chronic disease. In the face of threats posed to health systems by antimicrobial resistance and the growing burden of chronic disease, vaccination is again emerging as a uniquely powerful public health tool.

Key messages

Hi vaccination can reduce infective exacerbations and antibiotic use in children with CSL. Vaccines may have a role in preventing chronic disease progression and reducing antibiotic reliance.
Severe outcomes following invasive pneumococcal disease in adults in France
Authors: Danis K , Ploy M C , Varon E , Levy-Bruhl D ,   SIIPA group, Gaillat J
Published: November 2019

Pneumococcal vaccine serotypes and host factors may increase the risk of severe invasive pneumococcal disease (IPD). In France, pneumococcal vaccination in adults is recommended for at-risk groups (immunosuppression or at-risk conditions/diseases). In 2014-2017, we conducted a study of IPD in adults to identify factors/serotypes associated with disease severity.

We included IPD cases, excluding meningitis, in adults from 25 acute-care sentinel hospitals in six regions. Severe cases were IPD patients either admitted to an ICU or under mechanical ventilation or with severe sepsis or shock. Infectious disease specialists collected clinical/microbiological data on all cases. We calculated adjusted risk ratios (aRR) using binomial regression.

In 2014-2017, 908 cases (median age 71 (range 18-101) years) were diagnosed; 48%(431/908) were severe and 84%(764/908) were at-risk. Compared with non-risk individuals, the risk of severe disease increased from 20% (aRR 1.2; 95%CI 1.0-1.4) in cases with 1-2 chronic diseases to 30% (aHR 1.3; 95%CI 1.0-7.0) in those with >2 chronic diseases. The risk of severe disease was 42% (aRR 1.4; 95%CI 1.2-1.6) higher for PCV13 serotypes compared with non-vaccine serotypes. Among cases infected with PCV13 serotypes, the risk of severe disease did not differ (aRR 0.96; 95%CI 1.2-23) between no-risk or at-risk cases. However, among cases infected with non-vaccine serotypes, the risk increased 49% (aRR 1.5; 95%CI 2.1-22) in at-risk compared with no-risk cases (homogeneity test p = 0.03).

We observed a cumulative effect of concurrent comorbidities on severe IPD outcomes. The risk of severe IPD increased for vaccine serotypes regardless of risk status. However, non-vaccine serotypes increased the risk of severe outcomes only in risk groups, suggesting a different interplay between host factors and the pathogen in vulnerable groups. We recommend enhancing vaccination among risk groups and especially in those most at risk for poor IPD-related outcomes.

Key messages

Cumulative effect of concurrent comorbidities on severe invasive pneumococcal disease outcomes. Non-vaccine serotypes increase the risk of severe invasive pneumococcal disease outcomes only in vulnerable groups.
Potential predictors of unmet health needs among the elderly: a population-based study in Serbia
Authors: Milićević M Šantrić , Kostadinović M , Nikolić D , Todorovic J , Terzic-Supic Z
Published: November 2019

Background

This study assessed the prevalence of unmet health needs of the elderly and the associated factors regarding socioeconomic, health and functional status.

Methods

A secondary analysis of the 2013 National Health Survey data was conducted on a representative sample of 3540 persons aged sixty-five and older (the lowest response rate was 99.7%). Participants characteristics such as socioeconomic status, health self-perception, diagnosed chronic disease, physical functional limitations, performing essential daily activities in the home and daily personal care were explored with logistic regression analysis (Odds Ratio - OR and 95% Confidence Interval) in relation to five aspects of unmet health needs.

Results

15.8% participants had unmet health needs due to the long waiting times, 16.1%, had unmet needs for medical care, 17.7% for dental care, 15.2% for drugs prescription and 96.9% participants for mental health care. Common predictors exist for medical, dental drug prescription and due to long waiting times unmet needs including older age years, middle education, rural residence, lower wealth index, single persons, with average or bad self-perceived health, chronic disease and difficult daily performance of personal care and of home activities. Unmet mental health needs by 61% less likely had participants with average wealth index, while a greater likelihood had participants with average and bad self-perceived health by 3.7 times and 8.4 times (p = 0.035, p = 0.001) respectively, by 6.2 times those with difficulties (p < 0.001) and by 5.9 times unable (p = 0.045) to perform daily activities of personal care and by 1.7 times those with difficulties (p = 0.037) to perform home activities.

Conclusions

Unmet health needs reported less than 20% of the elderly but almost all have unmet mental health needs. Unmet health needs are associated with negative health outcomes, age, low education level, single persons, rural settings, poorer households, and limited daily activities.

Key messages

Unmet mental health needs of the elderly are an extremely important problem for the health system and healthy ageing in Serbia. A strong association of unmet health needs of old, low educated elderly without partners, from rural settings and poor households with health and functional outcomes, requires responsive policies.
Midwifery matters: resilience and subjective wellbeing of midwives
Authors: Caiazzo D , Kundisowa L , Bocci G , Vonci N , Alaimo L , Ardis S , Nante N
Published: November 2019

Introduction

Resilience is the ability to resist, cope with life positively after suffering a negative event. Midwifery has been defined as ’emotionally demanding’; midwives with an higher levels of resilience experience higher levels of subjective well-being (SWB). The aim of this study was to evaluate the relationship between resilience and SWB amongst midwives.

Materials and methods

Data were collected using a questionnaire, distributed between September 2018-January 2019 in hospitals in the Tuscany region (Italy). For evaluation of SWB, we used OECD scale (2013) evaluating three items: actual happiness (AH); emotive wellbeing (BE) composed of positive (PA) and negative affect (NA) and life satisfaction (LS). Also, job satisfaction (JS) was evaluated. Resilience (RS) was evaluated using the Italian version of the Resilience Scale by Wagnild and Young. All items were expressed on the Likert scale, statistical analysis was performed with Minitab 18.

Results

In total 123 questionnaires were analyzed. The average scores were: AH: 6.9±1.8; BE: 5.9±1.6; PA: 6.0±1.8; NA: 4.2±2.1; LS: 7.1±1.6; JS: 6.5 ± 2.4. Average R was 130.3±18.1. RS was correlated (p < 0.001) to AH (Coef=0.4), PA (Coef=0.4), BE (Coef=0.3) e LS (Coef=0.4). The sample was divided into three groups according to RS: low (LR)<116, medium (MR):116-139 and high (HR) ≥140. MR represented 44%, followed by HR (35%). AH, PA, BE values were significantly higher in the HR group (ANOVA; Tukey; p < 0.001). For NA the highest values were observed in the LR group, but the difference was not significant. LS resulted significantly lower in LR group (ANOVA; Tukey; p < 0.001) and JS was significantly higher in medium resilience group in confrontation to other two groups (ANOVA; Tukey; p < 0.001).

Conclusions

Our results confirmed, that the higher levels of RS influenced positively almost all components of SWB (AH, PA, BE, LS). On the other hand to achieve a higher level of JS the level of RS should not be nor too high, nor too low.

Key messages

Midwifery has been defined as ’emotionally demanding’, higher levels of resilience influenced positively almost all components of subjective wellbeing. The medium resilience was correlated to higher level of job satisfaction.
Serum modified HDL was associated with cardiovascular disease in a Japanese community-based cohort
Authors: Okamura T , Sata M , Iida M , Kakino A , Harada S , Hirata A , Usami Y , Sugiyama D , Sawamura T , Takabayashi T
Published: November 2019

Background

Previous studies have shown that high density lipoprotein (HDL) is protective against cardiovascular disease (CVD). However, recent studies suggested that function of HDL was more important than HDL cholesterol levels. The present study aimed to clarify the relationship between modified HDL levels and CVD incidence.

Methods

LOX-1 (lectin-like oxidized LDL receptor) is the receptor that mediates modified LDL (low density lipoprotein) activity; however, some lipoproteins with apolipoprotein A1 (Apo A-1) are also bonded to LOX-1. In this study, serum LOX-1 ligand containing Apo A-1 was defined as modified HDL, which were measured by our new development method. We conducted a nested case-control study in a Japanese cohort study, involving 11,002 community dwellers. During 4.0 years follow-up, we observed 127 new CVD onsets. For each CVD case, age and sex matched three controls were randomly selected (N = 381). Serum samples collected at baseline survey stored at − 80 °C were used for the measurement of modified HDL. We estimated multivariable-adjusted odds ratio (OR) and 95% confidence interval (CI) for the association between modified HDL levels and CVD by conditional logistic regression.

Results

Modified HDL levels were associated with increased risk of CVD (OR for one unit increase of log transformed modified HDL, 2.05: 95% CI, 1.16-3.62) after adjustment for body mass index, hypertension, diabetes, LDL cholesterol, HDL cholesterol, lipid lowering agents, chronic kidney disease, smoking and alcohol drinking. The magnitude of OR was almost equivalent to those of hypertension and diabetes, which were 2.33 (95% CI, 1.37-3.98) and 2.61 (95% CI, 1.48-4.59), respectively. On the other hands, other lipids markers showed relatively weak associations with CVD.

Conclusions

Serum modified HDL, i.e., LOX-1 ligand containing Apo A-1, might be a novel predictive marker for CVD in apparently healthy individuals.

Key messages

Recent epidemiologic studies suggested that function of high-density lipoprotein (HDL) was more important than HDL cholesterol level itself to predict cardiovascular disease. Modified HDL measured by a novel cell-free, non-fluorescent method as LOX-1 ligand containing Apo A-1, was a predictive marker for CVD after adjusting for other traditional risk factors.
Are neighbourhood characteristics associated with physical activity levels in schoolchildren?
Authors: Kaya Gulin , Ay Pinar , Hidiroglu Seyhan
Published: November 2019

Background

Moderate-vigorous physical activity (MVPA) is an essential determinant of health for children. However 82% of children aged 11-17 years in Turkey are physically inactive. The objective of this study was to determine the prevalence of physical inactivity (PI) and sociodemographic and neighbourhood characteristics associated with PI among children aged 9-13 years.

Methods

The population of this cross-sectional study was 5-7th grade students attending schools in a district of Istanbul. Two schools from urban and two from semi-urban localities were selected in order to capture different neighbourhood characteristics. Sample size was calculated as 344 assuming a difference of PI prevalence of 15% between neighbourhoods, an alpha error of 0.05, a power of 80%. Data were collected by child and parent questionnaires. PI was defined as < 60 minutes MVPA per day within the previous week. Neighbourhood characteristics were evaluated as physical (walkability levels, structure of sidewalks, presence of yards/parks, traffic density) and social (characteristics of social networks, trust among neighbours). Factors associated with PI were analysed by logistic regression.

Results

A total of 334 students participated with a response rate 96%. The median age was 11 years and 52.9% were girls. The prevalence of PI was 79.3% (95%CI: 75.0-83.7%). Neighbourhood characteristics were not associated with PI (p > 0.05). PI was associated with ownership of mobile phones (OR: 1.96, 95%CI: 1.01-3.78), not being a member of a sports team (OR: 2.83, 95%CI: 1.21-6.58) and having ≤1 day of physical education classes at school (OR: 2.10, 95%CI: 1.08-4.09).

Conclusions

The prevalence of PI is very high among schoolchildren. School-based interventions as motivating children to participate in sports teams and having physical education classes >1 times per week could be achievable strategies to combat PI. There is a need to adapt objective methods for assessment of neighbourhood characteristics.

Key messages

PI is a prevalent public health problem among school children in urban and semi-urban environments. The effectiveness of increasing structured physical activity levels at schools by utilizing sports teams and physical education classes should be evaluated in future studies.
Intraspecific Diversity and Phylogeography in Southern Appalachian Dasycerus carolinensis (Coleoptera: Staphylinidae: Dasycerinae)
Authors: Caterino Michael S , Langton-Myers Shelley S
Published: November 2019

The southern Appalachian Mountains in eastern North America host exceptional diversity, a substantial proportion of which has been generated in place. Yet, beyond broad generalities, bio- and phylogeographical patterns, and the temporal scale of diversification in the region are poorly resolved. Using one mitochondrial and one nuclear marker, we analyze intraspecific diversity patterns in a flightless, litter-inhabiting rove beetle Dasycerus carolinensis Horn. Our goals were to reconstruct the phylogeographical history of this species, producing a dated intraspecific phylogeny, and to examine previous hypotheses of possible cryptic divergence across populations of the species. Samples derive from a mix of old-growth fragments and secondary growth forests, and we also ask whether old-growth remnants host a larger proportion of genetic diversity in the species. We recover a strong primary subdivision among major lineages across the French Broad River basin (dated to ~5.8 MYBP), and a secondary subdivision among western populations dating to ~4.5 MYBP. Most interpopulation uncorrected divergences exceed 5%, strongly suggesting cryptic differentiation. Old-growth populations do not show greater genetic diversity than secondary-growth populations, indicating that most populations have persisted through recent anthropogenic disturbance.
Rainfall risk, fertility and development: evidence from farm settlements during the American demographic transition
Authors: Grimm Michael
Published: November 2019

I analyze whether variation in rainfall risk played a role in the demographic transition. The hypothesis is that children constituted a buffer stock of labor that could be mobilized in response to income shocks. Identification relies on fertility differences between farm and non-farm households within counties and over time. The results suggest that in areas with a high variance in rainfall the fertility differential was significantly higher than in areas with a low variance in rainfall. This channel is robust to other relevant forces and the spatial correlation in fertility. The effect disappeared as irrigation systems and agricultural machinery emerged.
Prognostic value of lymph node ratio in non-small-cell lung cancer: a meta-analysis
Authors: Zhou Jian , Lin Zhangyu , Lyu Mengyuan , Chen Nan , Liao Hu , Wang Zihuai , Hao Jianqi , Yan Chunyi , Liu Lunxu
Published: November 2019

Background

This meta-analysis aimed to investigate the prognostic value of lymph node ratio in non-small-cell lung cancer.

Methods

We searched systematically for eligible studies in PubMed, Web of Science, Medline (via Ovid) and Cochrane library through 6 November 2018. The primary outcome was overall survival. Disease-free survival and cancer-specific survival were considered as secondary outcomes. Hazard ratio with corresponding 95% confidence interval were pooled. Quality assessment of included studies was conducted. Subgroup analyses were performed based on N descriptors, types of tumor resection, types of lymphadenectomy and study areas. Sensitivity analysis and evaluation of publication bias were also performed.

Results

Altogether, 20 cohorts enrolling 76 929 patients were included. Mean Newcastle–Ottawa Scale was 7.65 ± 0.59, indicating the studies’ quality was high. The overall result showed non-small-cell lung cancer patients with lower lymph node ratio was associated with better overall survival (HR: 1.946; 95% CI: 1.746–2.169; P < 0.001), disease-free survival (HR: 2.058; 95% CI: 1.717–2.467; P < 0.001) and cancer-specific survival (HR: 2.149; 95% CI: 1.864–2.477; P < 0.001). Subgroup analysis prompted types of lymphadenectomy and the station of positive lymph node have an important effect on the prognosis. No significant discovery was found in sensitivity analysis.

Conclusion

Patients with lower lymph node ratio was associated with better survival, indicating that lymph node ratio may be a promising prognostic predictor in non-small-cell lung cancer. The type of lymphadenectomy, an adequate examined number and the removed stations should be considered for more accurate prognosis assessment.