bluuebunny/crossref_metadata_2025 huggingface dataset:
Reshaping the tumor microenvironment: extracellular vesicles as messengers of cancer cells
Authors: Bhatta Bibek , Cooks Tomer
Published: October 2020

The tumor microenvironment (TME) comprises an assortment of immune and non-immune cells. The interactions between the cancer cells and their surrounding TME are known to be a cardinal factor in all stages of cancer progression, from initiation to metastasis. Tumor-associated macrophages (TAMs) and cancer-associated fibroblasts (CAFs) are considered two of the most abundant TME members associated with poor prognosis in various cancer types. Intercellular communication between the cancer cells and TME cells might occur via direct cell–cell contact or achieved through secreted factors such as cytokines, growth factors and extracellular vesicles (EVs). EVs are released by almost every cell type and by cancer cells in particular. EVs are loaded with unique molecular cargos that might include DNA, proteins, RNA and lipids, commonly reflecting the physiological traits of their donor cells. Once released, EVs are capable of initiating short- and long-distance communication in an autocrine, paracrine and endocrine fashion. The molecular cargos within the EVs are able to impart phenotypic changes at the receiving end thus allowing EV-releasing cancer cells to deliver messages to TME cells and tighten their grasp over the cancerous tissue. In this concise review, we aim to document the bidirectional EV-based communication between cancer cell, TAMs and CAFs, tilting the balance in favor of cancer progression and metastasis.
Symptoms in Blastomycosis, Coccidioidomycosis, and Histoplasmosis Versus Other Respiratory Illnesses in Commercially Insured Adult Outpatients—United States, 2016–2017
Authors: Benedict Kaitlin , Kobayashi Miwako , Garg Shikha , Chiller Tom , Jackson Brendan R
Published: October 2020

Background

Blastomycosis, coccidioidomycosis, and histoplasmosis cause various symptoms and syndromes, which may present similarly to other infections such as bacterial or viral community-acquired pneumonia, influenza, and tuberculosis.

Methods

We used the IBM MarketScan Research Databases to identify adult outpatients with International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM), diagnosis codes during 2016–2017 for blastomycosis, coccidioidomycosis, histoplasmosis, pneumonia (viral, bacterial, Streptococcus pneumoniae, and unspecified pneumonia), influenza; tuberculosis, and other lower and upper respiratory infections. We compared symptoms on and in the 90 days before diagnosis between patients with these diagnosis codes.

Results

Fever was less common in blastomycosis (2.6%), histoplasmosis (5.3%), and coccidioidomycosis (9.4%) than in patients with influenza (18.5%) or pneumonia (12.6–16.3%). Fungal diseases resembled bacterial, viral, and unspecified pneumonias for many pulmonary symptoms. However, cough was more common with coccidioidomycosis (31.4%) and less common with histoplasmosis (14.0%) and blastomycosis (13.1%) versus influenza (20.2%). Although less frequent, solitary pulmonary nodule (5.2–14.4%), enlarged lymph nodes (3.7–9.0%), hyperhidrosis (<2%), and erythema nodosum (<2%) were particularly suggestive of fungal diseases.

Conclusions

Despite limitations inherent in administrative coding, this analysis of symptom codes across disease types suggests that fungal diseases may be difficult to clinically distinguish from other causes of pneumonia except when certain uncommon symptoms are present. Healthcare providers caring for patients with pneumonia, especially if nonresponsive to conventional treatment, should consider fungal diseases as possible etiologies.
Management of Inflammatory Bowel Disease Patients With Clinical Care Pathways Reduces Emergency Department Utilization
Authors: Lytvyak Ellina , Sutton Reed T , Dieleman Levinus A , Peerani Farhad , Fedorak Richard N , Kroeker Karen I
Published: October 2020

Background

Standardizing care through pathways has the potential to reduce emergency department (ED) utilization. We developed and evaluated inflammatory bowel disease (IBD) care pathways for that purpose.

Methods

Over 2014–2016, IBD patients were retrospectively stratified into those managed and not managed by pathways. Patient data were extracted, and negative binomial regression used to predict the annual number of ED visits.

Results

There was a difference of 30.7 ED visits/100 patients between managed and nonmanaged at 12 months (P < 0.001). The incidence rate ratio of total ED visits occurring annually was 0.750 (P = 0.008).

Conclusions

Management with IBD care pathways reduces ED utilization.
Characterization of G-quadruplex antibody reveals differential specificity for G4 DNA forms
Authors: Javadekar Saniya M , Nilavar Namrata M , Paranjape Amita , Das Kohal , Raghavan Sathees C
Published: October 2020

Accumulating evidence suggests that human genome can fold into non-B DNA structures, when appropriate sequence and favourable conditions are present. Among these, G-quadruplexes (G4-DNA) are associated with gene regulation, chromosome fragility and telomere maintenance. Although several techniques are used in detecting such structures in vitro, understanding their intracellular existence has been challenging. Recently, an antibody, BG4, was described to study G4 structures within cells. Here, we characterize BG4 for its affinity towards G4-DNA, using several biochemical and biophysical tools. BG4 bound to G-rich DNA derived from multiple genes that form G-quadruplexes, unlike complementary C-rich or random sequences. BLI studies revealed robust binding affinity (Kd = 17.4 nM). Gel shift assays show BG4 binds to inter- and intramolecular G4-DNA, when it is in parallel orientation. Mere presence of G4-motif in duplex DNA is insufficient for antibody recognition. Importantly, BG4 can bind to G4-DNA within telomere sequence in a supercoiled plasmid. Finally, we show that BG4 binds to form efficient foci in four cell lines, irrespective of their lineage, demonstrating presence of G4-DNA in genome. Importantly, number of BG4 foci within the cells can be modulated, upon knockdown of G4-resolvase, WRN. Thus, we establish specificity of BG4 towards G4-DNA and discuss its potential applications.
Old friends meet a new foe
Authors: Cepon-Robins Tara J , Gildner Theresa E
Published: October 2020

The novel virus, Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), and the associated Coronavirus Disease 2019 (COVID-19) represent a pathogen to which human beings have limited to no evolved immune response. The most severe symptoms are associated with overactive inflammatory immune responses, leading to a cytokine storm, tissue damage, and death, if not balanced and controlled. Hypotheses within Evolutionary Medicine, including the Hygiene/Old Friends Hypothesis, provide an important lens through which to understand and possibly control this overactive immune response. In this article, we explore the role that infection with soil-transmitted helminths (STHs; i.e. intestinal parasitic worms) may play in dampening SARS-CoV-2 symptoms and mitigating the worst COVID-19 outcomes. Specifically, STHs stimulate the immunosuppressive and regulatory T-helper 2 (TH2) branch of the immune system, which decreases ACE2-receptor expression (i.e. receptors SARS-CoV-2 uses to infect host cells), balances the inflammatory TH1/TH17 branches of the immune system triggered by SARS-CoV-2 infection, and reduces inflammation through the release of anti-inflammatory/regulatory cytokines. Because STHs are common and affect the most vulnerable and marginalized members of society, it is especially important to consider how these parasites may impact COVID-19 outcomes. Areas experiencing endemic STH infections are often characterized by a lack of preventative infrastructure and medical care, which may further exacerbate risk of SARS-CoV-2 infection and COVID-19 development. For this reason, we also explore biocultural factors that contribute to disease outcomes for both SARS-CoV-2 and STH infections. Biocultural and Evolutionary Medicine perspectives on COVID-19 are crucial for understanding the global impact of the disease.

Lay summary: An evolutionary perspective is required to understand the global impact and various presentations of COVID-19. We consider how coinfection with soil-transmitted helminths (common parasitic worms that coevolved with humans) may suppress inflammatory immune activity, thereby potentially reducing COVID-19 disease severity. Structural and lifestyle factors shaping coinfection patterns are also discussed.
The Nutri-Score in France and beyond: development, validation and transfer
Authors: Julia C
Published: October 2020

The Nutri-Score is a summary graded front-of-pack nutritional label, providing a synthetic information to consumers on the overall nutritional quality of a food product, based on its composition in several key unfavourable (energy, saturates, sugars, salt) and favourable (proteins, fibers, fruit, vegetables, nuts, legumes and certain vegetable oils (olive, rapeseed and nuts)). The Nutri-Score was developed by a team of independent scientists, and initially proposed in France in 2014. Following intense opposition by industry and considerable arguments, a 2-yearlong debate, the Nutri-Score was selected to be the official French front-of-pack nutrition label. In parallel, more than 40 publications in peer-reviewed journals investigated its validity on multiple dimensions, further supporting its implementation. Following the implementation of the Nutri-Score, consumer groups' pressure and a growing interest from the public pushed manufacturers to adopt the label, with more than 300 pledges of adoption from industry in 2020. After France, neighbouring countries (Belgium, Spain, Switzerland, Germany and the Netherlands) have now also adopted the scheme, prompting new challenges for development at a larger scale. The implementation of the system in France was made possible by strong public support for such a measure - relayed by consumer groups and disseminated in the media and a strong political will from the Health ministry to put together a validated and helpful system, which finally prevailed upon economic interests. Sustained support from consumers in particular helped turn the tide from a relatively low engagement of stakeholders towards the acknowledgement of the Nutri-Score as a standard for front-of-pack labelling in France and several EU countries. The Nutri-Score is an example of a public health measure informed by scientific evidence that may have a clear impact on the nutritional quality of diets in the population.
Our climate and health emergency - Future role for global public health
Authors: Rispel L
Published: October 2020

Prof Laetitia Rispel is Immediate past President of the WFPHA, and Professor of Public Health at the University of the Witwatersrand: Johannesburg. She has a strong research background and publication record on public health governance, health workforce education, ethics, policy and practice.

Following talks on the relationship between climate change and food and water insecurity presenting a public health emergency, and case examples of recent disasters, Professor Rispel will outline the WFPHA vision for the public health sector's role in the coming decades. The expanding need for well resourced, and well-trained public health sector at national and regional levels will be outlined.

As the world careers ever closer to existential threats from unabated climate change, a key theme covered will be the imperative for multilateral climate negotiations to include public health experts

Following this presentation, the panel will invite questions and discussion from the floor to share experience and develop solutions-based model for expanded role of public health, and how we transition to that new world.
Incentives for smoking cessation in pregnancy
Authors: Tappin D , Bauld L
Published: October 2020

Issue/problem

Most pregnant smokers reply ‘Yes' when asked ‘Do you want to stop smoking?'. This is usually an honest answer but often without intention. About 10% who intend to quit are likely to attend smoking cessation services. Even with good quality counselling and the offer of nicotine replacement therapy only about 3-5% quit. How can the other 90% be reached?

There are two approaches: Redirect counselling away from specialist cessation practitioners and build capacity among all health care workers. This is attractive spreading counselling to health care workers who meet pregnant smokers during routine consultations requiring little resource after training for example General Practitioners, Midwives and Obstetricians. However limited time for training and subsequent counselling endangers the quality and quantity of counselling delivered.Increase the proportion of women who intend to quit smoking during pregnancy by providing a financial incentive payment for engaging with specialist cessation practitioners and quitting.

This policy allows counselling to be delivered by specialists and potentially draws in a larger proportion of pregnant smokers, as many as 50%.

Results

Financial incentives have increased the proportion of smokers who quit by late pregnancy in two large randomised controlled trials. The proportion increased by more than 100%. Local service pilots of financial incentives have seen marked increases in smokers who attend and quit.

Lessons

There are a number of ways to increase smoking cessation among pregnant women. Research evidence should be translated into effective service models to decide which strategy is most cost-effective.

Key messages

Counselling is important; however, it has to be sufficient and of good quality. Drawing more pregnant smokers into cessation services will increase the proportion who intend and manage to quit. This may work better than expecting all health care workers to give effective counselling.
The choices and consequences of seeking care for chronic conditions for disadvantaged populations in Malaysia and the Philippines
Authors: Palafox B
Published: October 2020

Disadvantaged populations in LMICs suffering from chronic conditions are often forced to make care choices that increase the risk of receiving substandard care and facing catastrophic bills. These negative impacts widen health disparities across social, economic and urban-rural lines. This study aimed to understand the economic consequences of the choices made by those living with NCD in disadvantaged communities in Malaysia and the Philippines.

Using hypertension as a tracer condition, we analysed longitudinal data from surveys of 1200 hypertensive adults from low-income communities in both countries to estimate the prevalence and drivers of catastrophic health expenditure and the coping strategies employed. Interviews and digital diary data from a sub-sample of 80 participants was analysed thematically to elicit how such choices lead to sub-optimal management of their condition.

More Filipino households with at least one hypertensive adult experienced catastrophic health spending (40% threshold) than in Malaysia (14.3% vs. 0.4%). Although the average cost of clinic visits in the Philippines was much higher than what was observed in the public sector-dominated system in Malaysia, consultation fees were main drivers of costs in Malaysia, while medication costs predominated in the Philippines (accounting for 38.6% and 70.5% of typical household health expenditure respectively). In both countries, nearly all diagnosed participants were taking antihypertensive medications, however, levels of adherence varied. Participants cited the unavailability, cost and adverse effects of antihypertensives as reasons for poor adherence, delaying treatment and substituting prescriptions.

Understanding the barriers faced by disadvantaged populations in LMICs and the ways that they overcome them as they seek care for a chronic disorder may challenge the assumptions of decision makers, and is crucial for designing responsive and equitable health systems that leave none behind.
Towards understanding power and agency in policy implementation: A stakeholder analysis of a primary care NCD policy in the Philippines
Authors: Balane M
Published: October 2020

The growing NCD burden of demands collective action from many stakeholders. This is often difficult to achieve, largely due to the limited understanding of how actors interact and shape policy processes, especially in LMICs. CVD accounts for a third of deaths in the Philippines, where a national primary care policy for NCD control has been enacted. We describe how we assessed the capacities, power and level of stakeholder engagement in implementing the programme within the Philippine health system and identified ways to support implementation.

A scoping review developed an analytical framework for stakeholder analysis, peer reviewed by health policy experts. Four characteristics were identified: level of knowledge, interest, power, and position of stakeholders. Interviews and a consensus building exercise were used to operationalize it. Respondents were purposively sampled via document review and a snowball technique.

National government has high power but offers moderate support for implementation. Decentralized local governments also have high power but offer varying degrees of support for implementation given competing priorities and limited resources. Frontline health workers and civil society are both supportive but have little power. Professional societies have only moderate power but are an important conduit to reach private providers. The capacities of some actors are not fully mobilized.

Understanding of the power and capacity of actors facilitates approaches to control NCDs in the Philippines. Engagement with national and local governments must be strengthened to improve uptake of the NCD control policy. Frontline health workers, if empowered, can make a key contribution to policy implementation. Professional societies can play an important facilitating and convening role to build collaborations across public and private sectors. Finding the optimal balance and synergies between these diverse roles may be critical for NCD programme implementation.
New MPH curriculum in the United States: Report on successes and challenges
Authors: King L
Published: October 2020

Background

In October 2016, the Council on Education for Public Health, the US accreditation agency for Master of Public Health (MPH) programs, revised its criteria. The new curricular model transitions a nearly 100-year-old knowledge-based curriculum to a competency-based curriculum tailored to today's public health needs in a global society. This presentation will highlight the new content and format of MPH curricula, including programs outside the US that have participated in US accreditation.

Objectives

CEPH has tracked implementation of the new curriculum as well as overall redesign of MPH programs. The presentation will describe strengths and challenges faced by programs implementing new curricula and will describe innovative curricular models.

Results

Data show that MPH programs are strong in epidemiological methods (99%), interpreting data (99%), and designing population-based policies or programs (93%). Programs have struggled to incorporate interprofessional practice (57%), systems thinking tools (55%), and negotiation skills (59%). Data indicate that 13% retained coursework in the traditional five core disciplines; 69% added to or adjusted the core; and 18% created a new or integrated core. Examples of each structure will be provided.

Conclusions

MPH programs in the US are experiencing a major change focused on development of competencies and skills for practice. While methodological skills remain strong, “soft” skills that are important for global public health practice are more of a challenge for faculty to integrate into the current training structure. Successful programs are incorporating innovative and cross-cutting curricula to meet these new requirements.

Key messages

MPH curricular requirements in the US have changed to focus on competencies and skills for public health practice. Critical public health leadership skills such as negotiation and interprofessional communication are lagging behind in integration into the new curriculum.
Public Health Informatics Workforce Skills and Needs: A Descriptive Analysis using the 2017 PH WINS
Authors: Dixon B E , McFarlane T D , Grannis S J , Gibson P J
Published: October 2020

In 2017, the Association of State and Territorial Health Officials fielded the Public Health Workforce Interests and Needs Survey (PH WINS), a nationally representative sample of state-level (SHA) and local health department (LHD) public health workers in the United States. The survey was an opportunity to measure the PHI workforce as well as assess the informatics needs of the broader PH workforce.

We performed a cross-sectional study using the nationally representative 2017 PH WINS. A total of 17,136 SHA and 26,533 LHD employees participated in the survey.

Respondents were asked to rate selected PH competencies with respect to the importance to their day-to-day work (i.e., not important to very important) and their current skill level (e.g., unable to perform, beginner, proficient, expert). We examined skill gaps, defined as discordance between self-reported importance (i.e., need) and skill level, for example, those reporting the competency as “somewhat important” or “very important” and “unable to perform” or “beginner.”

Informaticians accounted for 1.1% of SHA respondents and 0.5% of LHD respondents working in a Big City Health Coalition agency, those that serve the top 30 most populous urban areas in the United States. While informaticians generally reported having the skills they needed for their jobs, other PH roles identified gaps. For example, 22.9% of clinical and laboratory workers felt the ability to “identify appropriate sources of data and information to assess the health of a community” was an important skill but they currently possessed low competency. This group similarly identified a gap with respect to collecting ‘valid data for use in decision making.'

An informatics-savvy health department requires PHI competencies not just among PHI specialists but also among front line workers, program area managers, and executive leadership. Discordance suggests that agencies should examine ways to enhance training for PHI-related competencies for all PH workers.

Key messages

The informatics specialists’ role is rare in public health agencies. Significant data and informatics skills gaps persist among the broader public health workforce.
Challenges and opportunities of digitalization for health and well-being at work
Authors: Teufer B , Lang G , Affengruber L , Grillich L
Published: October 2020

Background

Developments in the working world (e.g. digitalization) are imposing new demands on employees. However, it remains unclear how digitalization affects health and well-being at work and how companies can respond to emerging challenges and opportunities. In order to stimulate the discussion of these issues, the Austrian Health Promotion Fund supported 20 projects focusing on ‘Workplace Health Promotion (WHP) in the Working world 4.0'. The central research questions were: What challenges and opportunities regarding “Work 4.0” were identified and what measures have the companies developed?

Methods

We used a combination of different qualitative and quantitative research methods and instruments. As a first step in this multi-stage process, we conducted workshops with the WHP project managers of each company. Subsequently, we carried out a document analysis of the developed catalogues of measures to identify the underlying opportunities and challenges. To quantify and validate these results, we invited the project leaders and team members to participate in an online survey.

Results

As the WHP projects in the companies progressed, the focus shifted from the challenges to the opportunities offered by digitalization. On average, opportunities were rated more important than challenges in the online survey. The most important challenges were sensitization of managers, permanent accessibility as a health risk and mental stress and strain. The most important opportunities were the optimization of knowledge transfer, communication and documentation. The measures implemented ranged from the use of innovative tools, to knowledge transfer on methods and health-related content, to changes in materials and organization.

Conclusions

The examination of digitalization in the context of health and well-being at work has highlighted the positive aspects of digitalization. The health promotion measures implemented can serve as examples of good practice for other companies.

Key messages

As companies began to consciously examine digitalization in the context of health and well-being at work, the focus shifted from the challenges of digitalization to the opportunities it offers. To meet the challenges of digitalization and to act on emerging opportunities, companies have implemented numerous different measures that can serve as examples of good practice for other companies.
Attitudes toward vaccination among healthcare workers: a cross-sectional study from Italy
Authors: Di Martino G , Di Giovanni P , Cedrone F , D'Addezio M , Di Girolamo A , Masciarelli M , Meo F , Scampoli P , Di Sciascio M B
Published: October 2020

Background

In Italy, the loss of confidence in vaccines has resulted in low vaccination coverage also among healthcare workers (HCWs). Low vaccination coverage among HCWs may lead to dangerous outbreaks and may increase absenteeism. The aim of this study was to investigate vaccine coverage and the attitudes toward vaccination among HCWs.

Methods

A multicenter cross-sectional study was conducted from August to November 2019 among HCWs referring to all the hospitals of the Local Health Authority 02 of Abruzzo Region, Italy. The survey was based on the questionnaire proposed by the H-ProImmune Project, aiming at investigating vaccination coverage and beliefs towards vaccination. Besides a descriptive analysis of the results, a logistic regression analysis was performed to evaluate the association between vaccine coverage and type of occupation (medical doctor, nurse, obstetric nurse, other).

Results

A total of 347 HCWs were enrolled in the study. The 57.3% reported to have missed diphtheritis-tetanus-pertussis (DTP) vaccination, the 50.1% reported to have missed measles-mumps-rubella (MPR) vaccination, and the 62.5% reported to have missed flu vaccination. In comparison with medical doctors, obstetric nurses were more likely to be associated to MPR vaccination (OR 2.8;95%CI 1.1-7.6; p = 0.047). As far as flu vaccination was concerned, both nurses and obstetric nurses showed lower confidence (respectively OR 0.2; 95%CI 0.1-0.3; p < 0.001 and OR 0.1; 95%CI 0.1-0.5; p = 0.003). Moreover, other healthcare professionals reported to believe in natural immunization more than in vaccination (26.5%; p < 0.001) and they were also worried about long-term effects of vaccination (10.2%; p = 0.044). Differently, nurses were more frequently worried about vaccine side effects (24%; p < 0.001).

Conclusions

This survey shows that the vaccination coverage taken into consideration results to be below the 95% threshold. Training on vaccine and mandatory measures may be necessary in order to achieve better coverage.

Key messages

Among HCW all vaccination coverage considered resulted below the threshold. Training on vaccine and mandatory measures may be needed in order to achieve better coverage.
Economic evaluations of public health interventions for mental health: A systematic literature review
Authors: Feldman I , Gebreslassie M , Sampaio F , Nystrand C , Ssegonja R
Published: October 2020

Background

To review the literature on economic evaluations of public health interventions targeting prevention of mental health problems and suicide, to support evidence based societal resource allocation.

Methods

A systematic review of economic evaluations within mental health and suicide prevention was conducted including studies published between 2000 and 2018. The studies were identified through Medline, PsychINFO, Web of Science. The quality of relevant studies and the transferability of their results were assessed using a criterion set out by the Swedish Agency for Health Technology Assessment.

Results

Nineteen studies of moderate to high quality were included in this review, which evaluated 18 interventions in mental health and 4 interventions in suicide prevention. Fourteen (63%) of all interventions were cost-effective. None of the studies that evaluated suicide prevention was of high quality. The interventions largely focused on psychological interventions at school, the workplace and within elderly care as well as screening and brief interventions in primary care. Nine studies (around 50% of included articles) had a high potential for transferability to the Swedish context.

Conclusions

Public health interventions aiming to improve mental health have a high potential to be economically beneficial to society, but high-quality evidence on the cost-effectiveness of suicide prevention is limited.

Key messages

Public health interventions aiming to improve mental health have a high potential to be economically beneficial to society. Evidence on the cost-effectiveness of suicide prevention is limited.
Collective oral health care at Xukuru do Ororubá Indigenous Territory (Pesqueira, Brazil) in 2018
Authors: Santos L F R , Lins F M , Silva I K S , Moreira R S , Mauricio H A
Published: October 2020

Background

Primary oral health care services are responsible for performing collective actions, in order to prevent diseases and promote health through education. Brazilian indigenous populations, especially from the Northeast Region, suffer from insufficient access to oral health services. From this perspective, this study aims to verify the performance of oral health collective actions indicators in the territory of the Xukuru do Ororubá indigenous ethnic group (Pesqueira, Brazil) in 2018.

Methods

An observational and ecological study. Secondary data for 2018 were extracted from the Indigenous Health Care Information System, part of the Brazilian Unified Health System (SUS). Performance of collective oral procedures conducted by the oral health teams in the Xukuru territory was analyzed through indicators applied for the evaluation of oral health actions and services related to primary care.

Results

There was an average monthly coverage of the collective supervised toothbrushing (CST) of 47.8% for the entire Xukuru territory. The average monthly coverage of the collective topical fluoride application (CTFA) was 2.8%. There was an annual average of 6.2 collective dental procedures (CDP) per capita.

Conclusions

Less than half of the population participated in CST actions. CTFA proved to be almost nonexistent, with poor coverage for the general territory population. The annual average of CDP was satisfactory which may, in general terms, demonstrate greater concern with preventive measures. However, it appears that such average gains strength due to the volume of health education actions, which is part of the indicator sum. Analyzing the low coverage of CST and CTFA in isolation, a reality of low access to fluoride in this indigenous population can be seen. Results points to the need for greater provision of collective actions in the indigenous territory studied, aiming at strengthening the prevention of diseases and/or aggravations of oral health, in all life cycles.

Key messages

Measurement of the performance of oral health teams regarding the collective oral health actions in the territory of the Xukuru do Ororubá ethnic group. Analysis of the indigenous oral health stored data quality, aiming to offer support for system management decision making and to the services organization improvement.
Actions of a Brazilian public telehealth service to help coping with the new coronavirus
Authors: Silva L B , Sousa L A P , Resende R E , Fortini A A , Pessoa C G , Alkmim M B M , Ribeiro A L P , Tupinambás U , Oliveira C R A , Marcolino M S
Published: October 2020

Background

In January/2020 the respiratory disease caused by the new coronavirus was declared as an international public health emergency. In Brazil, until June 22nd there were 1,11 million confirmed cases. In this context, the Telehealth Network of Minas Gerais (TNMG), a large-scale public telehealth service, acted quickly to assist professionals and the population in coping with the disease, mainly in low resource settings.

Aim

To report the experience of a Brazilian public telehealth service in actions to manage COVID-19 and its impacts.

Methods

Experience report.

Results

The TNMG developed 15 infographics and 16 web lectures for health professionals and general population about key themes, such as respiratory syndromes, personal care and ventilatory support. Two of them were live, seen in real time by 13,422 professionals, mainly nurses (63.8%) and doctors (31.1%), from 45 medical specialties (most family physicians-34.0%), in all Brazilian states, especially the Southeast region (58.5%). All lectures were uploaded on TNMG's Youtube channel, each one reaching 5,300 viewers on average. Specific to support health professionals: 2 guidelines were developed - one for primary care units and other to emergency/intensive care; a category for offline (second opinion) teleconsultations was created for doubts about coronavirus; and a list with 39 Frequently Asked Questions (FAQs) was developed. For the general population: 65 FAQs were developed; a health team from a low resource setting was trained to provide online teleconsultations; and a chatbot was released to automatically answer COVID-19 related doubts and/or evaluate a user's health condition, indicating if emergency medical care was needed. All resources are freely available on TNMG's website and on its social networks.

Conclusions

Telehealth tools had a notable acceptance and were shown to be an effective way to disseminate information for professionals and lay population throughout the country.

Key messages

Telehealth tools have been proven to be an effective strategy to promote health education, for both professionals and the general population. Telemedicine plays a fundamental role on dealing with public health issues, especially on low resource settings.
Dealing with COVID-19 Barriers to Care: Digital Platform to support and monitor chronic patients
Authors: Lapao L V , Santos M , Maia M , Pedrosa V , Seixas J , Mira da Silva M , Correia J , Heleno B
Published: October 2020

The Covid-19 pandemic is causing a set of disruptions, especially at the delivery of healthcare services. The pandemic has shown subsidiary health effects like, chronic care, mental health, surgeries, and deadlock in the other diseases’ treatment.

A digital health platform (PrimaryCare@COVID-19) was implemented to be used by primary care physicians, and nurses, to address both chronic care and COVID-19-related patients at home or traveling. It has been piloted in three Health centers at Lisbon Health Region and it could be scale-up to all primary care in Portugal in the near future. This project was funded by the National Science Foundation to address Primary Care consultations and chronic care services shortage. The clinical primary care processes were studied and a digital workflow was defined using Design Science Research Methods.

This project‘s innovative digital platform is already covering several dozens of chronic patients while at home and addressing the communication with COVID-19-related patients.

The health professionals (physicians and nurses) are able to safely and rigorously communicate with chronic patients and prescribe the required medicines, as well as inform them about the COVID-19 measures. In case of patients either on quarantine or in isolation this platform also allows for the monitoring and health evaluation.

This eHealth Digital Platform is an opportunity to manage chronic care during epidemics, allowing to follow-up patients, preventing them from becoming uncontrolled and having to go to emergency. The digital platform uses smart algorithms to deal with both medication interactions and vital signs alerts while monitoring, chronic and COVID-19 infected, patients, allowing health professionals to remotely consult these patients at home/travelers (by default with phone, but also via digital videoconferencing) and manage all health information about patients in a secure way (and following GDPR rules).

Key messages

The digital platform uses smart algorithms to deal with both medication interactions and vital signs alerts while monitoring chronic and COVID-19 infected patients. Digital Platform is an opportunity to manage chronic care during epidemics, allowing to follow-up chronic patients, preventing them from becoming uncontrolled and having to go to emergency.
Marketing of alcoholic beverages: what can be done to protect the adults of the future?
Authors: Sarasa-Renedo A , Grammatikaki E , Maragkoudakis P A , Kokkorou M , Cardoso R , Torighelli B , Wollgast J , Caldeira S
Published: October 2020

Issue

Marketing of alcoholic beverages can influence attitudes and intentions to drink including alcohol initiation in adolescents. Globally, alcohol is the leading cause of death among young people (15-49 years).

Description of the problem

Comprehensive restrictions or bans on alcohol advertising are considered 'best buys' to reduce the harmful use of alcohol and its consequences. We present a database with statutory, co- and self-regulatory alcohol-related marketing codes describing their characteristics, scope, target population groups, marketing techniques addressed, marketing restrictions, and information regarding implementation, monitoring and evaluation of such codes. We analysed these codes and asked: what are the critical aspects that an alcohol-related marketing code should include to be effective and protect public and children's health?

Results

Based on our analyses, we present a toolkit to support restrictions of marketing of alcoholic beverages (as well as of foods and non-alcoholic beverages). It includes a checklist for policy-makers to consider all important aspects during the design, implementation, evaluation or update of the code. We suggest specific actions for each point in the checklist and reflect on the implementation of some of these. Finally, the toolkit discusses digital marketing, the challenges it poses and offers potential solutions.

Lessons

Using a combined approach to address marketing to children of foods, non-alcoholic and alcoholic beverages may be more effective in protecting public and children's health than fragmented responses. The fields of nutrition and alcohol-related harm can learn from and complement each other. A code should cover all forms of marketing, including digital marketing. Our database, toolkit, checklist and inventory of actions support policy makers and others in designing or updating alcoholic beverage marketing regulations and codes of conduct.

Key messages

Our toolkit supports policy makers and others in designing or updating alcoholic beverage marketing regulations and codes of conduct. Practical technical guidance is provided in the form of a marketing code checklist and an inventory of specific actions.
Evaluating the impact of Minimum Unit Pricing on population alcohol consumption in Scotland
Authors: Giles L , Robinson M , Beeston C , Lewsey J , McKay D
Published: October 2020

Background

Scotland experiences high levels of alcohol consumption and related harm. The relationship between alcohol price and consumption is well established. Minimum unit pricing (MUP), introduced in Scotland in 2018, sets a minimum price at which a unit of alcohol can be sold. The intention of MUP is to prevent alcohol being sold at below 50 pence per unit, thereby reducing alcohol consumption and in turn related harm to health. Scotland is the first country to implement this form of MUP; the evaluation of the impact of MUP is therefore of international importance.

Methods

Using commercial alcohol retail sales data, we use a natural experiment design with interrupted time series analysis to assess for changes in the level or trend of the volume of pure alcohol sold in Scotland associated with MUP implementation. Data for England and Wales will be used as a control.

Results

Descriptive analysis shows per adult off-trade sales of pure alcohol in Scotland fell by 3.6% in the year following MUP implementation. An increase in the average price of alcohol of 5 pence per unit in Scotland was also observed. There were reductions in per adult sales in all major drink categories with cider having the greatest relative decline (18.6%); cider also had the greatest increase in average price. Results of the interrupted time series analysis have yet to be reported but will be available for the conference.

Conclusions

The early indication of a reduction in total per adult off-trade sales of pure alcohol is an encouraging sign that MUP is having its intended impact. However, the full impact of MUP can only be judged across a range of outcome areas and over a longer time period.

Key messages

Minimum unit pricing appears to be having its intended impact on alcohol consumption at a population level in Scotland in the short term. Further work is ongoing to assess the impact of MUP on a wide range of outcomes and over a longer time period.
The Norwegian industry-led scheme restricting marketing of unhealthy food and beverages to children
Authors: Øvrebø B , Helleve A
Published: October 2020

Issue

The Norwegian food industry has implemented a self-regulatory scheme to restrict the marketing of unhealthy foods and beverages to children under the age of 13 years. In the period 2014-2019, the scheme has treated 77 complaints and made 126 assessments of planned marketing campaigns.

Description

The aim of the evaluation was to explore perceptions of the scheme through interviews with stakeholders from the industry, non-governmental organizations (NGOs), and health authorities. Further, a survey among parents (n = 1117) with children under the age of 16 years was completed to map opinions on marketing of unhealthy foods and beverages to children.

Results

The stakeholders had different views of the scheme, where the industry was positive, while the NGOs had mostly critical views. The dispute relates mainly to the content of the scheme's code and guidance, and less to the practice of the scheme's committee. NGOs and health authorities argue that older children should be covered by the scheme, whereas the industry opposes this. However, the scheme specifies to take precautions when marketing to adolescents below 16 years.

More than 40 percent of parents are worried that their child is excessively exposed to marketing of unhealthy foods and beverages and report that it affects their child. About one-third of the parents had heard about the scheme.

Lessons

The possibility of having an assessment of planned marketing campaigns is a strength; however, there are still disagreements concerning the scheme's code and guidance. To make complaints, consumers need to know how, complicating supervision. However, parents experience that children are exposed to marketing of unhealthy foods and beverages and support regulations protecting them from such marketing.

Key messages

The industry, NGOs, and authorities have different views about the scheme. Disagreement applies mainly to the age range that should be protected from marketing of unhealthy foods and beverages.
Professional development of civic and health communicators: a national platform in Sweden MILSA 3.0
Authors: Zdravkovic S , Carlzén K , Agardh A , Svensson P , Westerling R
Published: October 2020

Background

Establishing oneself in a new country is especially challenging for forced migrants affecting both physical and mental health. The Swedish introduction system includes a mandatory civic orientation program conducted in the refugeés native language, covering different aspects of the Swedish society. MILSA has advocated for including health promotion as a key component in the introduction system, stating that culturally sensitive health communication is a human right for refugees. Through this work, health communication is now included in the program in many parts of Sweden. However, there are challenges due to a lack of professional recognition related to the absence of a recognized training. In order to create a national capacity for a quality based civic and health communication, MILSA has developed a national training program carried out in collaboration with five universities, actors on local, regional, and national levels as well as NGOs and experts in different areas.

Methods

A web-based program including six physical workshops is given nationally. The program consists of 22 modules targeting society and public health issues but also pedagogy, leadership and communication. Evaluation studies are included in the program targeting the education itself and as well as investigating effects on the refugees.

Results

The program has been running for three years ending in autumn 2020 including four admission periods. The early evaluation showed very encouraging results where participants reported a deeper knowledge of civics and public health, resulting in being more secure and comfortable in their daily work, including improvements regarding skills in pedagogy, leadership and conflict management.

Conclusions

The need for an educational platform is recognized by many stakeholders in Sweden. The program has received a very positive evaluation. Due to this, MILSA has initiated a process of establishing a national commissioned program on permanent basis.

Key messages

The program has been highly regarded by the communicators, due to the gained knowledge in their everyday work. The importance of health communication and professional development and its value for the recipients of civic orientation is recognized by many stakeholders within but also outside the country.