bluuebunny/crossref_metadata_2025 huggingface dataset:
Prevalence and economic burden of major comorbidities in multiple sclerosis
Authors: Ponzio M , Borreli P , Monti MC , Amicizia D , Perotti P , Silva S , Ansaldi F , Mallucci G , Bergamaschi R , Montomoli C
Published: October 2021

Background

Although comorbidity is important in Multiple Sclerosis (MS), few validated methods for its assessment exist. Our aim is to estimate the prevalence and economic burden of major comorbidities in people with MS (pwMS) in two Northern Italy study areas (Pavia, PV and Genoa, GE), using routinely collected healthcare data.

Methods

We estimated prevalence of comorbid conditions in pwMS in the period 2012-2017. Anxiety, depression, cancer, leukemia, lymphoma, hypertension, heart disease, cerebrovascular diseases, vascular diseases, ischemic stroke, hyperlipidaemia, bronchopathy, diabetes, gastropathy, gastric ulcer, autoimmune diseases, chronic renal failure, connective tissue diseases and HIV/AIDS were identified by a specific algorithm currently used for monitoring prevalence of chronic diseases by Italian Local Health Authorities (BDA system). Direct healthcare costs were defined by regional and governmental contracts; the aggregated healthcare expenditure was compared between pwMS with/without comorbidities.

Results

The MS cases identified were 2983, 2035 in GE and 948 in PV. 55.6% of pwMS had at least one comorbidity (50.6% GE and 66.5% PV, p < 0.001). The most prevalent comorbidities were: depression (32.9%), hypertension (18.0%), cancer (10.9%), heart disease (7.8%), cerebrovascular diseases (7.0%) and hyperlipidaemia (6.1%). Comorbidity ranking was similar in the two provinces, although we observed significant differences considering specific prevalence rates. The mean direct healthcare costs of MS were substantially higher for individuals with comorbidity (36,463 €vs 26,284 €, p < 0.001), showing 39% of additive costs.

Conclusions

Our study provides evidence of the burden of comorbidities in MS. Comorbidity is common in MS and produce additive costs.

Key messages

The use of administrative data for tracking the MS comorbidity could help knowledge gaps. When additivity situation is involved, preventive policies could lead to monetary savings.
Economic hardship from the great recession and long-term changes in depression and quality of life
Authors: Bonaccio M , Costanzo S , Di Castelnuovo A , Gialluisi A , Bracone F , Persichillo M , Cerletti C , Donati MB , de Gaetano G , Iacoviello L
Published: October 2021

Background

Economic downturns may have detrimental effects on mental health. We investigated whether economic hardship resulting from the late 2000s great recession is associated with long-term changes in mental health over 12.8 years of follow up.

Methods

We analysed data on 2,001 participants from the CASSIOPEA Study, a sub-cohort of the larger Moli-sani study (2005-2010, Italy), who were re-examined between 2017-2020 (mean age at baseline 53±9 y; 55% women). Economic hardship possibly experienced since participants' first visit was assessed retrospectively by a questionnaire scoring the following domains: 1) change in employment status; 2) financial hardship and 3) financial hardship for health expenditures. An Economic Hardship Score (EHS) was computed (range 0-14), with highest values indicating higher economic hardship. Mental health was reflected by measurements of depression (Patients' Health Questionnaire; PHQ-2; higher values indicating more depressive symptoms) and mental quality of life assessed by the 36-Item Short Form Health Survey (increased values indicating improved quality of life). In this analysis, the exposure was economic hardship and the outcomes were changes in depression and mental quality of life measured after a 12.8-y period. Multivariable linear regression analysis (95%CI) was used.

Results

Mean PHQ-2 and SF36 changes over 12.8 years were -0.08 (±1.28) and 0.47 (±9.90), respectively.

In a multivariable-adjusted analysis including duration of follow-up, relevant sociodemographic factors, lifestyles, clinical factors and related life course changes, 1-point increment in EHS was associated with increased depression (β = 0.041; 95%CI 0.022, 0.060) and lower mental quality of life (β=-0.037; 95%CI -0.052, -0.021).

Conclusions

Economic hardship resulting from the great recession in late 2000s was associated with a deterioration of mental health, as reflected by increased depression levels and reduced mental quality of life.

Key messages

Economic hardship resulting from the recession in late 2000s is associated with a deterioration of mental health. These findings support the notion that economic downturns may have detrimental effects on mental health and support the need for adequate strategies for more vulnerable groups.
Monitoring of SARS-CoV 2 on primary production and manually processed foods in Northern Italy
Authors: Bertasi B , Galuppini E , Tilola M , Mangeri L , Meletti F , Righi F , Scarazzato A , Pavoni E , Losio MN
Published: October 2021

Background

SARS CoV2 pandemic has generated interest in research of virus spread sources, apart from human contagion. In particular different studies are performed to understand surfaces involvement; during the epidemic event, different types of studies on surfaces have been performed. However, there is little information regarding the presence of the virus in food; wastewater contamination and poor hygiene practices could be the sources of viral contamination in handled food products. The aim of this work was to analyze different types of food for Sars CoV 2 presence.

Methods

390 samples of molluscs, 353 vegetables, 10 meat, 72 water, 169 berries, 16 seafood products and ready-to-eat dishes were analysed (2020-2021). Samples were selected from those provided for routine analysis during the pandemic period. The preparation was done based on ISO 15216-2 indications, followed by extraction with Nuclisense®Minimag® system; real-time PCR was applied to detect the Sars CoV2 virus Open Reading Frame 1ab, with two different master mixes.

Results

All samples tested were negative for ORF1ab detection. Many hypothesis can be made about negative Results: it could be possible that contamination levels in water, or on surfaces in contact with food, are too low to generate a detection signal; again, handling practices may be sufficient to avoid the transmission of the virus to food. Otherwise, the selected genetic target and the Real-time PCR performed, could have been not so efficient in detecting virus as expected.

Conclusions

In this preliminary work, food does not seem to be a substrate for Sars CoV2 contamination; other food categories or transformation/production processes could be investigated to confirm the obtained results. Also, different targets and amplification systems would have to be evaluated to verify the rule of foodstuffs as Sars CoV2 vehicles.

Key messages

Primary production and manual processed food don't seem to be at risk for SARS CoV2 contamination. Food has not been identified as a source of Sars CoV2 spreading.
Portrait of Hungtinton’s Disease in the Valencian Region: a cross-sectional study
Authors: Cavero Carbonell C , Páramo-Rodríguez L , Moreno-Marro S , Barrachina-Bonet L , De la Natividad M , Guardiola-Vilarroig S , Zurriaga O
Published: October 2021

Background

Huntington Disease (HD) is a rare neurodegenerative disorder of the central nervous system characterized by involuntary choreic movements and behavioural/psychiatric disorders, which compromises the quality of life.

Objective

To identify the distribution of HD by sex, age and province in the Valencian Region (VR) and to determine its prevalence and mortality rate.

Methods

A cross-sectional epidemiological study was performed. HD's cases between 2010-2018 were identified from the Rare Disease Information System of the VR by selecting codes 333.4 (ICD9) and G10 (ICD10). A descriptive analysis was performed by country of birth, province of residence and sex. Median ages at diagnosis and at death, with interquartile range (IQR), and prevalence and mortality rate, with 95% confidence intervals (95%CI), were obtained.

Results

225 cases were identified: 50.2% women, 52.0% residents in the southernmost province, 92.9% born in Spain and 68.9% confirmed by clinical manifestations. Median age at diagnosis was 54.1 years (IQR:41.1-66.1): 54.7 (IQR:41.2-66.1) in men and 53.0 (IQR:40.5-65.8) in women. Prevalence in 2018 was 2.0/100000 inhabitants (95%CI:0.4-2.4), being higher in women [2.2 (95%CI:0.3-2.8)] than in men [1.8 (95%CI:0.3-2.3)]. Even an increasing trend was observed, significant differences weren't found. 49.8% of cases died during the study, being 51.8% men. The median age at death was 62.7 years (IQR:51.1-74.2), 61.1 (IQR:48.7-72.5) in men and 66.6 (IQR:53.3-76.8) in women. The mortality rate in 2018 in both sexes was 0.3/100000 inhabitants (95%CI:0.3-2.3), significant differences weren't found.

Conclusions

Most of confirmations at registry level were based on clinical manifestations, reinforcing that HD has a characteristic pattern of symptoms although most are unspecific. The slight difference between sexes in the median age of diagnosis was significantly increased in the age of death, with men being the group with the highest mortality and an earlier death.

Key messages

In the Valencian Region of Spain, men with Huntington Disease have a higher mortality rate and a lower median age at death (5.5 years earlier) than women. There is a pattern of symptoms which is characteristic of Huntington Disease, although most of them are unspecific.
Assessment of COVID-19 pandemic impact on guaranteeing food security in local school catering
Authors: Barocco G , Maggiore A , Calabretti A , Bogoni P , Longo T
Published: October 2021

Background

The Italian National Institute of Statistics (ISTAT) highlights that in 2020 10% of the Italian population could not afford an adequate meal every 2 days. Families with several children were more affected, for these children school meals represented the only access to a healthy diet. The European Commission Farm to Fork Strategy, concerning the COVID-19 pandemic (CP), underlines the need to act to ensure access to a sufficient supply of affordable food for all. In the Province of Trieste (PT) over 90% of pupils eat in school canteens (12,000 meals per day). The aims of the project were to verify the impact of CP on the food security of public school canteens (PSC) and determine any Nutritional Critical Points (NCPs) - Corrective Actions (CAs) to guarantee healthy equity meals for all pupils.

Methods

The content of Public food procurement and service polices for a healthy diet (PFP) published by the WHO and the Nutrient Analysis Critical Control Points (NACCP) process as indicated by the Ministry of Health were applied. In the first quarter of 2021, all food procurement contracts (n = 6) and all of the school kitchens (n = 45) of PT PSC were verified, the University of Trieste analysed the composition of fresh desserts administered in 7 consecutive weeks.

Results

The NACCP process showed NCPs on the low quality of afternoon snacks and on the quantitative/qualitative fat profile of fresh desserts, with a content of 69 to 72% of saturated fat, of 5 to 7% of trans fat and of 8 to 12% oxidized fat as a “dual quality” food. CAs were activated to support all PT PSC in reformulating fresh desserts, as well as in aiding the assessment of the food procurement landscape, activating regular monitoring of compliance and designing procurements adherent to PFP.

Conclusions

Project outcomes highlight the importance of taking action to continuously support PSC in order to ensure healthy and equitable food environments for all and to contribute to building a resilient food system.

Key messages

Guarantee healthy equity school meals for all pupils by developing on going processes to address the pandemic challenge. Ensure technical assistance to school catering to overcome the impact of COVID–19.
Women’s postnatal care satisfaction during COVID-19 pandemic in public hospitals in Northwest Greece
Authors: Koniari A , Kallianezos P , Bakola M , Kitsou KS , Charalambous G , Jelastopulu E
Published: October 2021

Background

Patient satisfaction is an important process for investigating patients' needs, views, and suggestions about the health services provided by a health care facility. The aim of this study was to investigate women's postnatal satisfaction with healthcare services during COVID-19 pandemic, provided at two regional public hospitals in Ioannina, Greece.

Methods

Using a purposive and snowball sampling technique, a cross-sectional study was performed among women who gave birth in two regional Greek hospitals, during October 2020. An online self-administered 32-item questionnaire was distributed personally, as well as, in social media groups related to young mothers and baby feeding.

Results

A total of 106 women answered the questionnaire, mean age 34 years old, 58.5% had higher education and for 40.6% it was the first birth. 63.2% declared having visited the same hospital already in the past for gynecological services and 69.6% being satisfied with doctors' and nurses' communication, their interaction, behavior giving guidance, and the time they dedicated to the mothers. 60% were satisfied with hospital cleanliness, organization, adequacy, easy access, orientation and 63.6% from the administrative services. 23.8% were not satisfied with waiting times between appointment schedule and medical examination; however, 61.6% indicated that they would either use or suggest the services again. Higher satisfaction was associated with being married and employed, having no previous experience, and being in good health status.

Conclusions

In general, a moderate satisfaction with various dimensions of provided health services was observed. The study highlights the importance of the postnatal care provided by healthcare professionals and health services. Improving the parameters which affect women's satisfaction would increase the quality of postnatal care.

Key messages

Assessing patient satisfaction is an important indicator of measuring the quality of health services.
Rehabilitation pathway for Covid and post-Covid patients
Authors: Madia A , Zilli E , Ruzzante B , Marchi M R , Galligioni P , Sambini M , Di Gregorio G , Giuriato P , Mazzon S , Mariotto A
Published: October 2021

A hospital rehabilitation service has been implemented in the Hospital of Cittadella, ULSS 6 Euganea - Health Trust (District of Padua) to offer hospitalized Covid and post-Covid patients a tailored rehabilitation pathway in the treatment of the different phases of the disease. The SARS-CoV-2 pandemic has determined the admission of a large number of acute patients in Intensive Care Units (ICU), Semi-Intensive Care Units (S-ICU) and non-critic hospital wards. Patients recovering from COVID-19 experience a wide range of impairments requiring the implementation of multidisciplinary rehabilitation care protocols; these include the assessment for anticipated impairments (especially for patients admitted to ICU, older patients, and patients showing indications of impairment); patients who had severe-critical disease usually require a period of inpatient rehabilitation. Between October 2020 and April 2021 at Cittadella Hospital 450 patients (ICU, S-ICU, non-critic hospital wards) were enrolled in the Rehabilitation pathway and followed daily by a team made by physiatrists, physiotherapists and speech therapists. Referral options (hospitalization, community based rehab or discharge with follow up), based on the conditions of the patients, were assessed. The reduction of surgery and orthopedics patients to rehabilitate and the decrease of outpatient rehab services during Covid emergency made it possible to convert Rehabilitation ward (20 beds) to Covid Rehabilitation; according to epidemiological scenarios, patients admitted to Rehabilitation ward were initially SARS-CoV-2 positive with mild, moderate and severe symptoms, then post-Covid SARS-CoV-2 negative discharged from Covid wards. The definition of a tailored rehabilitation pathway in the treatment of the different phases of Covid disease has represented an important professional and organizational challenge for the Hospital. Rehabilitation plays a pivotal role in the management of Covid and post-Covid patients.

Key messages

Patients recovering from COVID-19 experience a wide range of impairments requiring the implementation of multidisciplinary rehabilitation care protocols. The definition of a tailored rehabilitation pathway in the treatment of the different phases of Covid disease has represented an important professional and organizational challenge for the Hospital.
Public opinion on vaccines: the role of the scientific community in Italy
Authors: Paladini A , Regazzi L , Castagna C , Sapienza M , Rosano A , Ricciardi W , Cadeddu C
Published: October 2021

Background

After rising for years, vaccination rates in Italy fell until 2015 because of unfounded safety concerns, abetted by some government and court actions. Public education and a 2017 law on mandatory vaccination have boosted rates since then. So far only a few papers have examined the correlation between beliefs and attitudes towards vaccines and the level of trust in the scientific community regarding vaccinations in the general population.

Methods

Data were extracted from the Italian section of the last two editions of the European Social Survey (ESS), the first carried out between September and November 2017, the latter between December 2018 and March 2019. A descriptive analysis was conducted using survey data. In the two editions respectively 2,626 and 2,745 persons were interviewed. The main outcomes assessed was comparing the two surveys, so as to highlight the key changes in public opinion on vaccines.

Results

In the 2017 edition, 19% of the respondents believed in the harmfulness of vaccines, out of them 29% did not even have trust in the scientific community while those confident in the safety of vaccines were 50%. In the 2019 survey, the proportion of those who believed vaccines to be harmful fell to 15%, the undecided rose to 15%, those opposed to the idea that vaccines are harmful became 63%, not responding people were 8%. Correspondingly, trust in the scientific community about vaccines has increased from 57% in the first survey to 70% in the last one.

Conclusions

The scientific community and research bodies in the last years, in support of the Ministry of Health, have made a huge effort in the public debate on vaccines. This might play a role in increasing the public confidence in the safety of vaccines and the adherence to vaccination campaigns, changing the climate with regard to vaccination in general.

Key messages

Italians changed their opinions on vaccines between two ESS surveys. The scientific community had a relevant role in the public debate on vaccines.
Predictors of perceived pandemic preparedness among general practitioners
Authors: Stöcker A , Demirer I , Gunkel S , Hoffmann J , Mause L , Ohnhäuser T , Scholten N
Published: October 2021

Background

General practitioners (GPs) are essential for providing and maintaining health care during a pandemic. Pandemic preparedness (PP) of GPs can play a vital role in their management of a pandemic situation. This study aimed to examine the association stockpiled personal protective equipment (PPE) and knowledge of pandemic plans on perceived PP among German GPs. This analysis is part of the research project COVID-GAMS (Funding code: 01KI2099).

Methods

Three multivariable linear regression models were developed based on an online cross-sectional survey for the period March-April 2020 (the onset of the pandemic in Germany). Data were collected using self-developed items on self-assessed PP and knowledge of a pandemic plan and its utility. The stock of seven PPE items was queried. For PPE items, three different PPE scores were compared. Control variables for all models were gender and age.

Results

508 GPs were included in the study; 65.16% believed that they were very poorly or poorly prepared. Furthermore, 13.83% of GPs were aware of a pandemic plan; 40% rated those plans as beneficial. The stock of FFP-2/3 masks, protective suits, face shields, safety glasses, and medical face masks were mostly considered completely insufficient or insufficient, whereas disposable gloves and disinfectants were considered sufficient or completely sufficient. The stock of PPE was significantly positively associated with PP and had the largest effect on PP across all models; the association of the knowledge of a pandemic plan was significant but considerably smaller. PPE scores did not vary considerably in their explanatory power. The assessment of a pandemic plan as beneficial did not significantly affect PP.

Conclusions

An adequate stockpile of PPE is essential for perceived pandemic preparedness among GPs. Pandemic plans are considered less important for GPs. General practitioners, health authorities, and policy makers should focus on stockpiling PPE for future pandemic emergencies.

Key messages

Sufficient stockpiled personal protective equipment is the most important factor influencing pandemic preparedness of general practitioners in Germany. Knowledge on a pandemic plan has a subordinate effect on pandemic preparedness of general practitioners; usefulness of a pandemic plan does not have a significant effect.
Trends in vaccination coverage against influenza in the pediatric population: an Italian overview
Authors: Lanza TE , D'Ambrosio F , Messina R , Pezzullo AM , Villani L , Rosano A , Ricciardi W , Cadeddu C
Published: October 2021

Background

Influenza is a major public health issue for its epidemiological, clinical and economic impact. Children are a relevant age group for the diffusion of the infection in the community as they shed the virus in greater amounts and for longer periods of time than adults of any age. Vaccination is the best strategy to fight the disease. In Italy, until last year, influenza vaccination for the pediatric population was offered free only to children in specific risk categories, while in the last season its was extended also to all subjects from 6 months to 6 years old. The purpose of this work is to analyze the trend of vaccination coverage among children in the last decade in Italy.

Methods

We retrieved vaccination coverage data by the Italian Ministry of Health relating to influenza vaccination in the age groups 0-2, 2-4, 5-8 and 9-14 in the years 2010-2020 and analysed trends in and between regions.

Results

A preliminary analysis shows that vaccination coverage in the age groups considered ranged from a minimum of 1.1% to a maximum of 4.5%. The highest average percentage reached was recorded in the season 2010-11 (3.8%), while the lowest in the 2015-16 (1.5%). The highest average values (12,9%; 10,5%) were found in Puglia and Toscana, while the lowest (0.3%) in Friuli Venezia Giulia. From 2010 to 2015 there was a progressive decline in vaccination coverage, while in the following years there was a slight increase, up to the year 2019-2020, in which the average percentage value was 3%. Further results are expected for next summer, when 2020-21 data will be available.

Conclusions

Our analysis shows that in the Italian regions influenza vaccination coverage in children is variable but still extremely low. Childhood vaccination could provide an opportunity to decrease the burden of disease in this age group but may also help to protect the population at risk of serious complications, such as the elderly, due to the social role children play in the spread of this virus.

Key messages

Influenza vaccination in children is a major public health issue. Additional efforts are needed to make vaccination available for children and improve the stakeholders’ awareness on this topic.
Clinical and biological profile of newly diagnosed HIV-infected patients in Casablanca
Authors: Lyazidi S , Marih L , Marhoum El Filai K , Hassoune S , Nani S , Sodqi M
Published: October 2021

Background

HIV infection continues to be a major global public health issue. UNAIDS estimates that 690 000 HIV-related deaths occurred in 2019. In Morocco The number of people living with HIV was estimated at 21,000 in 2018. HIV prevalence in Morocco remains low (around 0.1%) in the general population. It is much higher among female sex workers, men who have sex with men (MSM), people who inject drugs and migrants. In Casablanca the epidemic is concentrated among MSM. The aim of this study was to describe the epidemiologic, clinical and immuno-virological characteristics of people newly diagnosed with HIV infection managed in the Ibn Rochd teaching Hospital of Casablanca.

Methods

A cross-sectional study was performed including patients newly diagnosed with HIV infection and managed in the infectious diseases department from January 1st, 2017 to June 30, 2018. Data were collected from patient's medical records and were analyzed using SPSS 16. Main outcomes were presented as mean and pourcentages.

Results

525 patients newly diagnosed with HIV infection were managed during the 18 months period in the Infectious Diseases Department. The mean age was 36.1 years, with a sex ratio of 1.1. Among them, 43% were single and 61.7% were unemployed. Heterosexual transmission mode represented 65.5% and MSM represented 23%. The seropositivity was discovered through an evocative symptom in 47.8% of all cases. The main clinical symptoms were: weight loss (16.6%) and oral candidiasis (11.2%). The main opportunistic infection was tuberculosis (23%). 36.1% of cases were diagnosed at acquired immunodeficiency syndrome (AIDS) stage. Medians of the first CD4 count and viral load performed were respectively 248/mm3 and 88 174 copies/ml.

Conclusions

Despite a good antiretroviral coverage, HIV infection is still diagnosed late in our country. The emphasis must be on the promotion of voluntary testing mainly among groups at high risk of infection.

Key messages

More active offer of HIV testing, by general practitioners, should play a crucial role in the early identification of HIV infections. Strategies such as use of preexposure prophylaxis should be developed to prevent HIV transmission among MSM.
Impact of sociodemographic factors on children’s immunization in Bulgaria
Authors: Hadzhieva S , Pancheva R , Usheva N
Published: October 2021

Introduction

Vaccinations have been touted as one of the “greatest public health achievements”, but the rate of under-vaccination in child population is steadily declining, especially in low-income groups. Many studies show, that country-specific parental socio-demographic factors may influence on children's immunization coverage.

Aim

To assess which family socio-demographic factors influence parental vaccine hesitancy.

Methods

A survey was conducted among 1195 parents of children under the age of 7y., between 2015-2017, mean age of 30.9±6.4y., of Bulgarian or other ethnic groups, living in Eastern Bulgaria. Questions about family socio-demographic factors, attitude, beliefs and fears were included.

Results

The share of parents who state that they would not have vaccinated their children if the vaccination program was not compulsory is 20.9%. They are mainly in the age range 30-39(42,4%;Spearman's ρ = 0,13;р<0,0001), with higher education(57.6%; Pearson's r=- 0,13;р<0,001), of Bulgarian ethnicity (73,7%;Pearson's r=-0,12;р<0,0001%), living in a larger town, mainly gathering information about vaccines from the Internet(29.9%), mass media(30%) and/or relatives and friends(25.5%). Even of compulsory vaccination programs, these parents tend to have children with missed or postponed vaccinations. Insufficient knowledge and/or shortcomings of the health system are the leading factors for parents with lower education and Roma ethnic group living in relatively smaller settlements, who do not to have a full-scale vaccination program of their children.

Conclusions

Socio-demographic differences in parental attitudes towards compulsory vaccination require a differentiated approach. Preventive health care work is needed to overcome the growing anti-vaccine attitudes. Education and proper evidence-based proofs about vaccines and their benefits is needed for one types of a population group while increased knowledge and improved access to medical services for another population group.

Key messages

A large-scale study, characterized as a representative to the country, about the parents' attitudes towards immunization as a whole in the Republic of Bulgaria was carried out. Some socio-demographic factors that might have affected the readiness of parents to vaccinate their children have been analyzed.
Falls in older people at home and leisure time during the COVID-19 pandemic in Portugal
Authors: Alves T , Rodrigues E , Neto M , Mexia R , Matias-Dias C
Published: October 2021

Falls are one of the most common mechanisms of injury namely at home and in leisure time reaching one of the most vulnerable groups of the population such as the older ones, with expression in morbidity and mortality. The pandemic context we are experiencing it has had effects on the physical, mental and social wellbeing of populations but also on the use of health care whose magnitude and reasons are subject of discussion. The aim of this study is to understand the evolution of falls episodes in victims aged 65 and over, which needed attendance in the emergency room of the Health National Service Hospitals in Portugal based on hospital records, through EVITA system, between 2017 and 2020. A descriptive analysis of the data was performed, with the determination of absolute and relative frequencies (percentages). Bivariate comparisons were performed using Pearson's chi-square test with a significance level of 5%. In this analysis, the statistical program SPSS V.24 was used. In the four years between 2017 and 2020 the older people aged 65 and over represented 27% of the total of attendances in the emergency room. Considering the total of ED attendances in this age group 10% occurred due to fall at home or during leisure time. In the last four years there were 462 953 falls in people victims aged 65+, constituting 46% of hospital ED attendances by fall. From march to december 2020, falls episodes have remained below the values of similar periods in the previous four years (p < 0,01). The largest percentage decrease in falls in 2020 compared to the same period in 2019 occurred in april, with a decrease of 41%. Most of this falls in the study population occurred at home (61%), followed by falls in outdoor spaces (11%). Globally, this reality regarding to the decrease of the ED attendances during this pandemic context is not exclusive to Portugal.

Key messages

The older people represented 27% of the total of attendances in the emergency room in the four years in analysis. 10% of ED attendances occurred due to fall at home or during leisure time. From march to december 2020, was observed a significant decrease of falls episodes compared with the previous four years.
Driving Behaviour in Depressed Patients vs Healthy Controls
Authors: Tsoutsi V , Dikeos D , Basta M , Papadakaki M
Published: October 2021

Introduction

Depression is characterized by mental, emotional and executive dysfunction, and it may have an impact on driving behaviour. The aim of the study was to evaluate driving performance in depression.

Methods

Participants (39 depressed patients vs 30 controls) completed questionnaires and scales on demographics, driving experience and habits, mental and physical health. They also completed two specific questionnaires on driving behaviour and attitude: the Driver Behaviour Questionnaire (DBQ) with three sub-scales (driving errors, traffic violations and attention lapses) and the Driver Stress Inventory (DSI) which assesses drivers' vulnerability to stress reactions while driving and consists of five sub-scales (aggression, dislike of driving, hazard monitoring, thrill seeking and proneness to fatigue).

Results

All driving sub-scales did not differ between cases and controls. For both the total population of participants and for depressed patients separately aggression and hazard monitoring (HM) were found to be positively correlated to fatigue severity scale total score (FSS), HM was correlated with male sex, and proneness to fatigue (PF) was negatively correlated with the total score of STOP-BANG, a questionnaire for probable sleep apnea. Only among depressed patients there was a positive correlation of PF with the total score of Athens Insomnia Scale (AIS), of traffic violations with AIS and body mass index, and of both dislike of driving and HM with the anxiety sub-scale of the Hospital Anxiety and Depression Scale. Only when all subjects were considered together, age was negatively correlated to thrill seeking and traffic violations.

Conclusions

While there are no significant differences between depressed patients and controls, there are parameters which influence driving behaviour and attitude similarly for both groups (especially fatigue and sex) and specific parameters only for depressed patients (anxiety, insomnia symptoms and BMI).

Key messages

Driving behaviour and attitude of depressed patients and healthy controls are influenced by specific parameters. Depression per se and its consequences, such as sleep disorders and anxiety, affect driving performance and attitude.
Long-term outcomes of in utero Ramadan exposure: a systematic review
Authors: Mahanani MR , Abderbwih E , Wendt AS , Deckert A , Antia K , Horstick O , Dambach P , Kohler S , Winkler V
Published: October 2021

Background

Previous systematic reviews have documented perinatal health effects of in utero Ramadan exposure on children. Our study aims to review possible long-term consequences.

Methods

Following PRISMA guideline, we searched PubMed, PsycINFO, EconLit, Index Islamicus, Web of Science, Cochrane Library, WHO Global Index Medicus, WHO Virtual Health Library and Google Scholar for original research articles analysing any long-term outcome of in utero Ramadan exposure, excluding maternal and perinatal outcomes.

Results

Fourteen studies from 4874 non-duplicate search results were included. Most studies suggest negative consequences from in utero Ramadan exposure on health as well as on economic outcomes later in adulthood. Higher under-five mortality rate, higher mortality under three months and under one year, shorter stature, lower body mass index, increased incidence of vision, hearing and learning disabilities, lower math, writing and reading scores, as well as lower probability to own a home were associated with Ramadan exposure during conception or first trimester of pregnancy. Further, age and sex of the child seem to play a pivotal role on the association.

Conclusions

Existing studies suggest that in utero Ramadan exposure may adversely impact long-term health and economic well-being. However, evidence is limited. Meanwhile, increasing awareness of the potential risks of Ramadan fasting during pregnancy should be raised among pregnant women and clinicians and other antenatal care workers should promote better maternal healthcare.

Key messages

In utero Ramadan exposure may adversely impact long-term health and economic well-being. Some negative effects are observed particularly when Ramadan occurred during the first trimester of pregnancy.
Relation between depression and chronic physical disease and healthcare utilisation in the Portuguese
Authors: Pedrosa B , Neto M , Namorado S , Leite A
Published: October 2021

Background

Previous studies show high chronic physical disease/depression comorbidity and higher healthcare use in these patients. Most studies focus on a single physical disease and do not consider number of diseases or depression severity. We aimed to characterise the chronic physical disease/depression relation in the Portuguese and analyse its association with healthcare use.

Methods

We undertook a cross-sectional study, using data (2019/2020) from an existing family panel (Em Casa Observamos Saúde), with “chronic physical disease” as exposure and “depression” and “healthcare use need” as outcomes. The sociodemographic characteristics of the sample were described. Logistic and multinomial regression analysis between depression (presence/severity) and chronic physical disease (presence/type/number) and between this comorbidity and healthcare use need were conducted. Adjusted odds ratio (OR) and 95% confidence intervals (CI95%) were calculated for each analysis. Analyses were weighted to account for complex sample design.

Results

1068 individuals were included. In the population, 8.9% had depression and 72.1% had chronic physical disease. There was no statistically significant relation between general physical disease and depression (OR = 1.68 [CI95%:0.55;5.15]), but there was between allergy (OR = 2.08 [CI95%:1.02;4.25]) and COPD (OR = 3.04 [CI95%:1.21;7.61]). The risk of depression was smaller in those with two physical diseases (vs. three or more, OR = 0.32 [CI95%:0.15;0.68]). A relation between chronic physical disease and depression with healthcare use need was not observed with wide confidence intervals.

Conclusions

This study suggests a relation between COPD, allergy and a higher number of physical diseases and depression in the Portuguese. No evidence of an increased need for healthcare services was identified. Clinicians should be aware of this relation and more research needs to be conducted after the pandemic context.

Key messages

Depression is common in patients with physical diseases and should be treated. Improving coordination between services should be prioritised. No evidence of an increased need for healthcare services was identified but research outside the pandemic context should be pursued.
Social support and health-related quality of life among patients with chronic heart failure
Authors: Bannour R , Harzali Z , Dhouib W , Ben Cheikh A , Bhiri S , Ghali H , Khefacha S , Said Latiri H , Ben Rejeb M
Published: October 2021

Introduction

Heart failure (HF) represents a major public health issue in Tunisia due to its frequency and its consequences in terms of morbidity and mortality. Despite improved treatment, HF is still associated with high mortality and impaired quality of life. Therefore, improvement or maintenance of health-related quality of life (HRQoL) is important when caring for these patients. The aim of this study was to evaluate the health-related quality of life (HRQoL) and explore its associated factors and its relationship with social support.

Material and methods

A cross sectional study was conducted over a period of two months in the cardiology departments in the following university hospitals: Sahloul and Farhat Hached in Sousse, Fattouma Bourguiba in Monastir and Taher Sfar in Mandia. Overall, 92 participants were included. Data was collected using an interview administrated questionnaire in the Tunisian dialect. This questionnaire used the Tunisian version of the SF-36 and MSPSS.

Results

The mean age of the participants was 63.1 ± 10.4 with female predominance (53.3%). The overall score of the SF-36 was 45.1 ± 26.5. The physical component was more impaired than the mental component ((41.2 ± 29.1 VS51.3 ± 27). The two dimensions mental health and social functioning had obtained the highest averages (63.6 ± 22.4 and 51.4 ± 33.1; respectively). The MSPSS score was 52.5 ± 21. The ‘family' subscale had the highest mean (21 ± 8). HRQoL was positively associated with social support (p = 0.013; r = 0.257). The predictors of good HRQoL were: young age, university level of education, cohabitation with family, high socioeconomic level and one-sided HF.

Conclusions

Therapeutic education sessions should be implemented in order to improve the functional symptoms of HF, reduce the rate of readmissions and subsequently improve HRQOL. We also stress the importance of giving priority to strengthening social ties between the patient and their social circles.

Key messages

Heart failure is still associated with high mortality and impaired quality of life. Therapeutic education sessions should be implemented in order to improve the Quality of life of HF patients.
Gender (in)equality in the labor market: a case study of Environmental Health Officers
Authors: Paixão S , Suzano C , Ferreira A , Figueiredo JP
Published: October 2021

The female gender has been discriminated, as it is considered inferior, in relation to the male. In the health sector, although the proportion of women has increased, the occupational segregation still persist. The mortality rate reduction, is largely due to the unrecognized contribution of women. Segregation manifests itself in a variety of ways, ranging from a limited set of opportunities to wage disparities. It's paradox since, even in “mostly female” jobs, like Environmental Health (EH), the minority of men usually have an “escalator”, reaching leadership quickly. This abstract addresses the gaps in the challenges of gender inequality in EH, since the fact that women are a health driver is been ignored. We seek to know the attitudes and opinions of the Environmental Health Officers (EHO), about: identity centralities; discrimination in society, profession and organization. This study is observational, descriptive, cross-sectional and level of knowledge II. The target population comprises by EHO (women and men). The sample design adopted was non-probabilistic and technical for convenience. The information was collected through a digital questionnaire. On average, men presented a more conservative view, compared to the female, associating women to mother's role and housewives, revealing a certain conservatism. There was, therefore, a prevalence of gender stereotypes. A correlation was found, about the organizational discrimination, since who revelead a minor difference between genders, were also those who presented a lower index of stereotypes. In other words, an organization that provides a life balance, leads its workers to desconstruct social and professional stereotypes. In conclusion, a gender diagnosis is essential to identify asymmetries and to start the change. This study identifies and analyzes inequalities in the EH area. Most of the results found follow the literature and are relevant to define future strategies.

Key messages

Global health organizations are starting to recognize the importance of gender challenges as a way to achieve universal health coverage which facilitates a new narrative. Recent data from the International Labor Organization estimate that gender pay gaps in the health sector are higher compared to other sectors, although women hold a large number of health jobs.
Hand hygiene compliance: the experience of three Italian tertiary care hospitals
Authors: Canta I , Bordino V , Libero G , Zotti CM
Published: October 2021

Introduction

Hand hygiene is an important measure in infection prevention to decrease transmission of microbial pathogens. Especially in these last two years, COVID-19 pandemic brought focus on the importance of a correct and frequent hand hygiene. Currently, direct observation is considered the gold standard for hand hygiene surveillance. The purpose of this observational study is to assess healthcare professionals hand hygiene compliance during the World Health Organization's ‘Five Moments for hand hygiene'.

Methods

In this study we examined perceptions, compliance, techniques, and contextual issues of hand hygiene practices among healthcare workers, in three different hospitals. Twelve different wards were observed, including ICU, surgical wards and medical wards. At least 200 hand hygiene opportunities (based on the WHO's ‘Five Moments') were recorded for each ward, using a mobile application called SpeedyAudit™.

Results

The results showed highly variable levels of adherence to the hygiene practices, with compliance rates ranging from 20% to 84%. There was also a wide variability of compliance between the different moments, with compliance rates ranging from 75% after touching patient surroundings to 59% before touching a patient. Overall, physicians had the worst score among the healthcare workers, resulting in 55% of compliance, while social health operators performed best with 70%.

Conclusions

There is still a huge variability in hand hygiene among healthcare workers. Despite the conceivable Hawthorne Effect influence, general compliance was not optimal. Overall hand hygiene adherence and knowledge should be achieved by implementing hand sanitizer distribution, offering further education and raising awareness on the importance of a correct hand hygiene, for the sake of both patients and healthcare workers.

Key messages

Hand hygiene adherence and knowledge should be achieved by implementing hand sanitizer distribution, offering further education and raising awareness on the importance of a correct hand hygiene. There is still a huge variability in hand hygiene among healthcare workers.
Antibiotic resistance in wastewater from socio-spatially different communities
Authors: Schmiege D , Zacharias N , Sib E , Falkenberg T , Moebus S , Evers ME , Kistemann T
Published: October 2021

Antibiotic resistance (ABR) and the spread of multidrug-resistant organisms (MDRO) via wastewater are of global health concern. Simultaneously, wastewater-based surveillance is a promising approach to gain an overview of the local ABR situation providing complementary public health data at lower costs. Research on the general community as one of the biggest dischargers is rather scarce. The objective of this study was to explore spatial and temporal differences in the occurrence of MDRO in community wastewater from socio-spatially different districts. Wastewater from three socio-spatially different districts in the Ruhr Metropolis, Germany, was sampled monthly over a year and analysed for extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli via culture-based methods. Isolates were validated with matrix assisted laser desorption ionization time of flight mass spectrometry. Antibiotic resistance profiles were analysed via microdilution. Phenotypic ESBL-producing E. coli could be isolated from every wastewater sample. The socio-spatially disadvantaged area displayed higher ESBL-producing E. coli loads adjusted for domestic discharge and inhabitants (median: 3.8e+8 CFU/d/inh.) compared to the other two areas (socio-spatially advantaged: 1.5e+8 CFU/d/inh. and socio-spatial average: 2.0e+8 CFU/d/inh.). Aggregated into seasons, values were highest for the winter season. Resistance profiles varied only for those antibiotics, which can be administered in outpatient care, showing lower resistance levels in the socio-spatially advantaged area. The general community is an important contributor of ESBL-producing E. coli in wastewater. Spatial and seasonal influences of ESBL-producing E. coli in wastewater between different communities, depicting the human outpatient sector, are identifiable and suggest a higher ABR burden in a socio-spatially disadvantaged area and during the winter season, as well as lower resistance levels in a socio-spatially advantaged area.

Key messages

The general community is a relevant source of multidrug-resistant bacteria in wastewater with observable spatial and seasonal influences between socio-spatially different communities. Findings suggest small-scale differences with a higher antibiotic resistance burden in a socio-spatially disadvantaged area and lower resistance levels in a socio-spatially advantaged area.