bluuebunny/crossref_metadata_2025 huggingface dataset:
Analysis of the impact of sub-acute care activities on consumption of hospital resources in Milan
Authors: Perri M G , Zanardi S , Mosconi C , Mosillo M , Nicolosi D
Published: October 2020

Background

In 2011, a new health service called 'sub-acute care activities' (SA) has been provided by Lombardy. It is a protected hospitalization of patients, especially elderlies, suffering for clinical issues following an acute disease or for non-complex clinical failures due to a chronic pathology. This is a hospitalization area between the hospital and home, created to reduce the number of post-acute hospitalized patients who can't be discharged. The goal of this study is the analysis of the hospitalizations in the SA setting within medical structures located in the Metropolitan area of Milan.

Methods

The data extracted from the hospital discharge card database, is focused on hospitalizations in SA that occurred from 2016 to 2019. The analysis describes yearly production, the characteristics of hospitalizations and patients, finally some trends.

Results

16,395 hospitalizations in SA were analyzed (0.7% of the total). Some data are constant in time: hospitalizations (1%), age (average 79), days of hospitalization (average 26). Patients coming from public hospitals (from 28% to 22%) are decreasing while those coming from other in-patient admission typologies within the same organization (from 44% to 54%) are increasing. The major diagnostic categories are related to cardiovascular and respiratory diseases. Over the 85% of hospitalizations are paid with the highest daily rate among those allowed by law. Talking about discharge typologies, 57% of patients return home, 20% are re-transferred to the acute ward, 16% are sent to rehabilitation/long-term care while 7% have died.

Conclusions

The use of the highest daily tariff and the high number of patients who need to be re-transferred to the acute ward place, gives many doubts on how appropriate is allocation of resources and about the accuracy of admissions in the SA unit during the patient care path. We're planning to return to these issues with further targeted studies.

Key messages

The analysis showed constant characteristics of SA activities during the four years. Data showed that there may be management issues in the appropriate use of resources in SA assistence.
Patient Reported Outcome Measures (PROMs) for quality of care assessment: a pilot study protocol
Authors: Fauci A J , Acampora A , Cadeddu C , Angioletti C , De Belvis A G , Iannone P
Published: October 2020

Background

There is emerging interest in integrating Patient Reported Outcome Measures (PROMs) into the assessment of care quality. This study protocol aims at testing the collection and use of PROMs for evaluating and comparing health outcomes by patients with colorectal cancer. This is part of a project of the Istituto Superiore di Sanità and Gruppo Italiano di Reti Oncologiche (GIRO) aimed at promoting Value-Based Healthcare (VBHC) for performance evaluation of oncological healthcare providers.

Methods

A multicentric prospective observational study will be conducted at the seven GIRO oncological hospitals. For each hospital, 40 colorectal cancer patients undergoing either surgery or surgery plus neoadjuvant therapy, will be recruited (20 colon; 20 rectum) over 12 months. The data will be collected twice (before and after surgery) or three times for patients undergoing neoadjuvant therapy, by using EORTC-C30, a generic module for cancer patients and EORTC-CR29, a specific module for colorectal cancer patients. Collected data will be analyzed descriptively and the scores of each hospital will be compared to the overall scores of all the centers. Additional medical information will be used to adjust for the center casemix. Feedback from health professionals and patients will be collected through structured questionnaires and focus groups.

Results

The results will be interpreted to assess and compare the health outcomes reported by the patients among the GIRO hospitals. Feedback from health professionals and patients will help identify barriers and facilitators of implementation of PROs collection.

Conclusions

PROMs have the potential to systematically incorporate the patient perspective into the health outcome measurements for performance evaluation and benchmarking, which is essential to delivering high-value patient-centered care. The PROMs collected in this study will be integrated in a set of process and outcome indicators previously defined within same project.

Key messages

Patient-Reported Outcome Measures (PROMs) have the potential to systematically incorporate the patient perspective, which is essential to delivering high-value patient-centered care. It is critical to integrate PROMs in performance evaluation and comparison among oncological healthcare providers for improving the quality of care in a Value-Based Healthcare perspective.
The MAastricht Instrument for Sustainable Employability – Italian version: a validation study
Authors: Picco E , Houkes I , De Rijk A E , Miglioretti M
Published: October 2020

Background

Health promotion and age management at work are top priorities for governments and employers. To promote sustainable employability (SE) in ageing societies is more necessary than ever. In the Netherlands, an instrument for tapping the employee perspective on SE (MAISE-NL), has recently been developed. This study aims to validate the Italian version of MAISE (MAISE-IT).

Methods

The MAISE-IT (a translated and adapted version of the MAISE for the Italian population), the Work-Health Balance questionnaire and demographics (age, gender, education, and occupational activity) were answered online by a total of 455 respondents (328 public administration workers and 127 respondents recruited on social networks). Construct and criterion validity were tested by CFA, reliability and correlational analyses and subgroup analyses through ANOVAs.

Results

The CFA analysis provided evidence of the MAISE-IT to consist of 12 scales divided over five areas: (1) Meaning of SE; (2) Level of SE; (3) Factors affecting SE; (4) Overall responsibility for SE; and (5) Responsibility for factors affecting SE. Construct validity, reliability and criterion validity were good. Italian employees reported a moderately high level of SE. They considered employers as being somewhat more responsible for SE than employees.

Conclusions

This study showed the validity of the MAISE-IT in the Italian context. The MAISE-IT is valuable to assess employees' needs in order to develop SE interventions that align with the employee perspective. Specific policy regulations and campaigns should be developed to make employees more aware of opportunities to increase their SE.

Key messages

The MAISE-IT can be used to measure the meaning and level of SE, factors affecting SE and responsibility for SE, in order to develop group level SE interventions. As employees in different contexts might have different ideas on SE, an instrument that measures perspectives on different SE dimensions separately is innovative.
Psychosocial interventions at the workplace, a systematic literature review
Authors: Friberg E , Lytsy P
Published: October 2020

The psychosocial work environment has been shown to be of importance for the health and wellbeing of individuals as well as for the productivity, sickness absence levels, and wellbeing of an organization. The aim was to map the existing knowledge, as presented in relevant and well performed systematic reviews, that have investigated the effects of work-related interventions, aiming to affect the psychosocial work environment and health related outcomes in workers/employees and in organizations.

A systematic literature review of published systematic literature reviews was performed to map the knowledge on psychosocial interventions at the workplace. The search was performed in three electronic databases: PubMed, PsycINFO, and Cinahl.

A total of 44 systematic literature reviews, of moderate or good quality, about studies on effects of workplace-related psychosocial interventions on health-related outcomes of the employees or the organization, were included. The types of interventions that were carried out mainly concerned different forms of stress-reducing or stress-management programs, or different forms of health-promotion either aimed specifically for mental ill-health or more general. Interventions aimed at bullying, social support, work efficiency and psychosocial climate in the workplace were also identified. The vast majority of outcomes were related to mental or general health. The majority of the systematic literature reviews reported several different outcome measures. A large proportion of the systematic literature reviews included interventions aimed at a general group of 'workers', or healthcare personnel.

A substantial amount of research regarding effects of psychosocial workplace interventions, have been published to date. Much of the existing knowledge indicates that the psychosocial work environment affects the individual and that active workplace interventions may promote health for the individual as well as the organization.

Key messages

A substantial amount of research regarding effects of psychosocial workplace interventions, have been published to date. Active psychosocial workplace interventions can have beneficial effects for the levels of sickness absence both for individuals and organizations.
An action research to improve social health insurance coverage of Philippines’ informal sector
Authors: Salvador D , Sales R K , Reyes G K , Lechuga J , Llevado J A L , Ting T
Published: October 2020

Background

PhilHealth, the social health insurance (SHI) agency of the Philippines, still does not sufficiently cover the informal sector workers (ISWs) - or the “missing middle”. Previous approaches had limited success. The impetus for finding solutions to protect the missing middle still remains.

Methods

A multi-component action research was done to address the complex social problem. Literature review and interviews were conducted to understand the nature of ISWs. National survey data was analyzed for factors affecting the ISWs' membership and retention in SHI. Findings were triangulated to construct evidence-based and context-rich marketing personas to understand PhilHealth's target clients. Using Human-Centered Design Thinking (HCDT), solutions that aim to address the low retention of ISWs in health insurance (HI) were proposed.

Results

The exact nature of ISWs is still unknown. Costly insurance premiums, poor knowledge of SHI, low perceived value of SHI, and inconvenient payment mechanisms contribute to low participation in SHI. Every additional 1000 PHP (∼20 USD) income increases odds of being an active member by 4%. Those who access private facilities are 2.8 times more likely to be active members. Those who perceive themselves to be sickly were 52% more likely to drop-out of the insurance. The results were fed into the HCDT process producing four prototypes: 1) solutions that explore partnership of PhilHealth with other organizations, 2) use of mobile application platforms for payment and member status updates, 3) automated algorithm to identify and calculate fair premiums, and 4) integration of money-saving strategies.

Conclusions

The government needs to step-up current efforts to extend health financial risk protection for the ISWs. PhilHealth can take advantage of the research results by testing the prototypes produced, and by adopting the HCDT process to improve their service and coverage for the informal sector.

Key messages

This government-funded project integrated principles of public health, epidemiology, health financing, participatory governance, and implementation research to address a complex social problem. The results provide a better understanding of the informal sector workers’ nature and needs with regards health insurance and can help PhilHealth improve coverage of informal sector workers.
Mental health outcomes in road traffic accident survivors: prospective cohort study
Authors: Kovacevic J , Miskulin M , Degmecic D , Vcev A , Palenkic H , Miskulin I
Published: October 2020

Background

Mental health outcomes of road traffic accidents (RTAs) are always investigated amongst the injured. The aim of this study was to investigate psychological consequences and associated factors in all RTA survivors irrelevant of their injury status.

Methods

A cohort of 200 Croatian RTA survivors was assessed one month after experiencing a RTA using the posttraumatic stress disorder (PTSD) Checklist for civilians, the Beck Depression Inventory and the Beck Anxiety Inventory. The New Injury Severity Scale was used for the injury severity assessment.

Results

RTA survivors reported substantial rates of PTSD (35.5%) and depression (20.0%) symptoms, and low rates of anxiety (4.5%). Symptoms of depression were associated with under-average self-perceived economic status (SES) (P = 0.001), irreligiousness (P = 0.001), medication use (P < 0.001), injury severity (P < 0.001), self-perceived threat to life (P < 0.022), hospitalization (P = 0.003), hospitalization duration (P = 0.004), surgical treatment of the injury (P < 0.001), unconsciousness in the RTA (P = 0.033) and post-RTA amnesia (0.039). PTSD symptoms were associated with unemployment (P = 0.034), under average SES (P = 0.004), lack of previous RTA experience (P = 0.025), previous psychiatric illness (P = 0.001), medication use (P = 0.001), psychiatric medication use (P < 0.001), injury affliction (P = 0.001), injury severity (P < 0.001), self-perceived threat to life (P < 0.001), pain after RTA (P = 0.009), hospitalization duration (P = 0.017) and claiming compensation (P = 0.008). Anxiety symptoms were associated with previous chronic (P = 0.037) or psychiatric illness (P = 0.010), previous permanent pain (P < 0.001), psychiatric medication use (P = 0.013) and rehabilitation after injury (P = 0.032).

Conclusions

A RTA is a traumatic event that can result in physical injuries, but also with psychological consequences depending on pre-RTA survivor's characteristics. Psychological support to those at risk may prevent psychological disorders after a RTA.

Key messages

Along with evaluation and treatment of road traffic accidents injuries, health care providers should evaluate pre-accident health status of all road traffic accidents victims. Understanding factors that present risk for poor mental health outcomes after the road traffic accidents is the key step in planning and organizing recovery of accidents survivors.
The impact of tendonitis and RSI/WMSD on HRQoL according to gender: a population based study
Authors: Souza D B O , Barbosa L P , Santini P A , Barros M B A , Lima M G
Published: October 2020

Background

Repetitive Strain Injury (RSI)/Work-related Musculoskeletal Disorders (WMSD) and tendonitis are considered a serious problem in the area of Occupational Health. The present study aims to estimate the prevalence of these disorders on the adult population of a metropolis in the state of São Paulo and to analyze their impact on Health-Related Quality of Life (HRQoL), according to gender.

Methods

A population-based cross-sectional study was conducted using data from the “Campinas City Health Survey (ISACamp 2014/15)”. The sample consisted of 2,166 individuals aged 18 years or older and the SF-36 instrument was used for HRQoL analysis. The association between the variables was verified by the chi-square test and the Poisson simple and multiple regression models were used to estimate the prevalence ratios (PR). In HRQoL estimates, the average SF-36 scores were calculated according to the independent variables.

Results

The prevalence of tendonitis and RSI/WMSD was 8.5%, with 6.7% tendonitis and 2.7% RSI/WMSD. The prevalence was higher among women (11%; 1.34-2.56), on individuals aged between 40-59 years (PR = 3.63; 2.28-5.80), who were on occupational activity (PR = 2.04; 1.12-3.68) or on work leave (PR = 7.07; 2.77-18.03) and on the most educated (PR = 2.45; 1.28-4.70). Subjects with these morbidities decreased in 6 of the 8 HRQoL domains and on stratification by gender, we observed that women had greater decreases in mental component scores in the presence of RSI/WMSD and men in physical component (p < 0.05).

Conclusions

The diseases analyzed can affect men and women differently, and it is essential to consider the peculiarity of the impact between the sexes in the elaboration of interventions and preventive measures aimed at improving the quality of life.

Key messages

No population-based studies were found that assess the impact of RSI/WMSD on HRQoL, according to gender differences, showing the relevance of this study. It is very important to understand how these diseases affect men and women differently so that specific and more effective preventive and rehabilitative measures can be carried out.
The evaluation of low back pain and perceived stress among prehospital emergency care workers
Authors: Kılınç A , Çalışkan Pala S , Arslantaş D , Ünsal A
Published: October 2020

Background

Low back pain (LBP) is one of the most common musculoskeletal system complaints in Prehospital Emergency Care workers consisting of paramedics, emergency medical technicians and doctors. Since their high stress job also includes physical work, such as lifting and bending, it's important to address the LBP. The aim of the study was to evaluate the low back pain and perceived stress in prehospital emergency care workers.

Methods

This is a cross-sectional study conducted on Eskişehir prehospital emergency care workers in 2020. The study group consisted of 372 (77.5%) personnels out of 480. The questionnaire form included sociodemographics, factors related to low back pain, Back Pain Functional Scale (BPFS) and Perceived Stress Scale (PSS). Scoring high on BPFS implies function loss due to LBP while it means high stress for PSS. Mann Whitney U, Kruskal Wallis and Spearman correlation analyses were used to determine the relationship between the variables.

Results

Females made up 55.1% of the 372 participants. The mean age was 32.15±7.5 and it ranged from 18 to 60. In the study group, 280 (75.3%) reported to have low back pain. Among those with LBP, 133 (47.5%) stated that they have had LBP for less than 5 years, 194 (69.2%) workers reported lifting is the most common reason for their LBP and 158 (56.4%) expressed that they've seen a doctor to deal with the LBP. The prehospital emergency care workers scored between 5 and 60 from BPFS, the median score was 49.0 while the mean was 45.74±12.09. There was a weak negative correlation between perceived stress and BPFS (R=-0.187, p < 0.001).

Conclusions

LBP was a common complaint among prehospital emergency care workers. Those who are older than 30, have chronical disease(s), had a family history of LBP, had an injury/trauma, had LBP for more than 5 years and those who worked 24 hour shifts scored less on the FBPS implying a funcionality loss due to LBP.

Key messages

Prehospital emergency care workers are overworked and it takes a toll on both mental and body health. Educating the workers to create a better understanding on lifting and bending may help them with low back pain.
Relationship between falls and Fall Risk Increasing Drugs. A retrospective case control study
Authors: Tiwana N , Pietronigro A , Mosillo M , Principi N , Carnevali D , Avanzi G M , Corna S , Colombo R , Castaldi S
Published: October 2020

Background

Falls and fall-related injuries are a major public health issue which needs global attention due to its clinical and socioeconomic impact. Inpatient falls are the most common adverse event in hospital. Important risk factors for falls are polypharmacy and the assumption of so-called Fall Risk Increasing Drugs (FRIDs). Aims of our study were to investigate the associations between falls and the use of medications among inpatients by conducting a retrospective case-control study in a rehabilitation hospital in Northern Italy in 2018.

Methods

Three unique control for each faller, matched by age, sex and hospitalization ward, were selected. A Conditional Logistic Regression was performed to analyze the impact that 13 types of FRIDs individually and the number of administrated FRIDs had on the risk of falling. A second regression model was obtained adjusting the case-control matching for CIRS, Morse and Barthel scores.

Results

We identified 148 cases and 444 controls. 3 types of FRIDs were significantly correlated (p < 0,05) with an increased risk of falling: Antipsychotics [OR:1,98;CI 95%:1,01-3,89], Antidepressants [OR:2,18;CI 95%:1,32-3,59], Diuretics [OR:1,71;CI 95%:1,09-2,68]. Antidepressants were the only type of FRID significantly correlated (p = 0,008) even in the model adjusted for CIRS, Morse and Barthel scores [OR:2,00;CI 95%:1,20-3,34]. The unadjusted model showed that the addition of one type of FRID to therapy was significantly associated with the fall event (p < 0.05) [OR:1.21;CI 95%: 1.05 - 1.40].

Conclusions

Assumption of drugs and polypharmacy could play a role in hospital falling. Recently developed fall risk assessment tools suffer from low specificity and sensitivity and do not assess these risk factors. A holistic approach with a multidimensional evaluation of the patient through screening tools, functional assessment tools and a full medical evaluation should be improved.

Key messages

Drugs may represent an important variable in determining the risk of falls in hospitalized patients, but they should not be considered alone. Screening tools for fall risk should take into account polypharmacy such as other intrinsic and extrinsic risk factors within an holistic approach.
Assessing health services accessibility in Colombia: Beyond universal health coverage
Authors: Arrivillaga M
Published: October 2020

Background

Colombia has an insurance-based, private and public health care system, with the intermediation of health insurance agencies that control the resources. At present, the Universal Health Coverage (UHC) is around 97%. However, there is wide scientific evidence that criticizes the structure and operation of the system due to the persistent differences between the UHC indicator and real accessibility to health services. This study aimed to analyze the concept of accessibility of health services in order to design and validate alternatives instruments for its assessment beyond UHC.

Methods

A mixed methods approach with concurrent design in three phases was conducted between 2014 and 2017: 1) systematic review of literature and documentary research; 2) design, content validation with experts and pilot test of instruments to assess health care accessibility and 3) definition of a route to assess accessibility.

Results

The reviewed literature revealed five conceptual logics to define accessibility: decent minimum of health care, health care market, factors and multicausality, needs and, social justice and human right to health. A Household Survey on Accessibility to Health Care Services and a Health Care Services Availability Questionnaire was designed and validated with experts and pilot test in representative samples of households and care centers in three cities in Colombia was conducted. Those instruments were designed under the conceptual logic of human right to health. Finally, an alternative route to assess accessibility in Colombia was proposed.

Conclusions

The route for assessing accessibility with primary data, territorial approach and without intermediation of health insurance agencies allow obtaining an overview of the real situation beyond the UHC indicator. The instruments included in this assessing process can be useful to monitor progress in guaranteeing the human right to health, declared in Colombia and other countries.

Key messages

The UHC indicator is not enough to assess real accessibility to health services. This study presents an alternative route and two validated instruments for its assessment with primary data and territory-based approach, applicable to countries with public-private health systems.
How accessible is the Serbian health system? Main barriers and challenges ahead
Authors: Hernandez-Quevedo C , Bjegovic-Mikanovic V , Vasic M , Vukovic D , Jankovic J , Jovic-Vranes A , Santric-Milicevic M , Terzic-Supic Z
Published: October 2020

Background

Access to health care is a key health policy issue faced by countries in the WHO European Region and Serbia is not an exception. There is increasing concern that financial and economic crisis may have delay progress regarding the performance of the Serbian health system. While substantial development has been experienced by the Serbian health system since 2000, we analyse whether barriers to health care access exist in the country and the underlying causes.

Methods

We combine quantitative and qualitative methods to assess the accessibility of the Serbian health system. We use the latest data available both at national (e.g. National Health Survey) and European (EUSILC) level to understand whether barriers to access exist and the underlying causes. On the qualitative side, we analyse the different policies implemented by the Serbian government to improve the accessibility of the health system in the last decade, identifying the challenges ahead for the country.

Results

We find that, in 2018, 5.8% of the Serbian population reported unmet need for medical care due to costs, travel distances or waiting lists, well above the EU28 average and much higher than in neighbouring countries. Financial constraints are reported to be the main reason for unmet needs for medical care. Long waiting times also impede the accessibility of health services in Serbia.

Conclusions

Serbia has a comprehensive universal health system with free access to health care, however, some vulnerable groups, such as those living in poverty or Roma people in settlements, have more barriers in accessing health care. It is expected that Serbia will continue to develop policies focused on reducing barriers to accessing health care and improving the efficiency of the health system, supported by international organisations and in the context of the EU accession negotiations.

Key messages

Some vulnerable groups have more barriers in accessing adequate care in Serbia. National initiatives are in place to increase access to the health system but there is scope for further work.
Accessibility to health services in Italy and in the world
Authors: Marchetti G , Simonelli M , Dente M G , Marceca M , Declich S
Published: October 2020

Background

The Universal Health Coverage (UHC) proposes that an ideal health system must be able to extend the health coverage to the whole population (universality), to guarantee all the necessary services (globality) and to do it without additional direct costs for the people (free of charge). The achievement of the UHC represents the target 3.8 of the Sustainable Developed Goals. The World Health Organization and the World Bank have developed an index to monitor the UHC (an algorithm that contains 16 indicators of essential health services), while for financial protection they rely on the incidence of catastrophic expenditure on health (percentage of families in which the living expenses for health without reimbursement exceed the10% of consumption).

Objectives

To strengthen the Italian operators' knowledge about the accessibility to health services in Italy and in countries around the world utilizing the UHC index and the incidence of catastrophic expenditure.

Results

The National Center for Global Health of the Italian National Institute of Health (ISS) collected the documents and the data already produced and validated by the international scientific community. ISS in collaboration with the Department of Public Health and Infectious Disease of Sapienza University of Rome developed a workshop training program to bring the UHC concepts at national level in a simplified manner. This was developed in order to encourage a reflection and to strengthen the understanding of the complexity of the UHC. The framework and the program of the workshop will be presented during the conference.

Conclusions

Studying the UHC means focusing on the inequalities in health care. To increase the sensibility of professionals may be a resource to promote the health coverage for all in the national territory.

Key messages

Encouraging the discussion between professionals is possible to understand the complexity of the UHC. The achievement of the UHC may happen only through the improving of the knowledge about it.
Searching for Elysium: teaching universal health care as a human right
Authors: Souza I , Garcia T C , Sayão M N
Published: October 2020

Background

Brazil have a huge free health care system. Inspired on UK National Health System (NHS), the Sistema Único de Saúde (SUS, that means Unified Health System) was consolidate as a right for all citizens after 1988's Brazilian Federal Constitution. Despite your spread, part of Brazilian citizens have an opposite opinions about SUS. So, the main question is: How to teach the relevance of a universal free health care system as a human right.

Objectives

The main aim of this work is teaching the recognize of SUS as a human right and ratified by Brazilian Federal Constitution in a High School class. In this sense, we used the cinema and debate for stimulate an effective comprehension of Universal Declaration of Human Rights (UDHR) and health promotion as a human right in a high school class. We used the movie Elysium (Neill Blomkamp, 2013) that show a dystopian world with two social class: citizen and non-citizen of Elysium (an artificial satellite of the Earth with high technology of cure for your citizens).

Results

The class has three Lessons: in first lesson we teaching about different notions about rights and the UDHR. In the second lesson we teaching about free health care systems in the world and a historical perspective about SUS. The third lesson we show the movie Elysium and proceed a debate. In debate we discuss about citizenship and rights, how the movie show two societies with different rights about work, transport and health, and how this aspects impact the quality of life of human being.

Conclusions

What options we have? The notion of free health care as a human right isn't an easy concept. So, efforts are needed for this comprehension and cinema can be used, followed by discussion, as a significant teaching tool for achieving humanistic educational objectives about free health care system as a human right in the high school curriculum.

Key messages

Health care is a human right and free health care system is a concretization of this right. Cinema can be used for stimulate a critical evaluation and effective understanding of rights in a high school classroom.
Incuding behavioral determinants of vaccine demand and acceptance in the EU policy-making process
Authors: Baggio M , Proestakis A
Published: October 2020

Vaccination is one of the most powerful and cost-effective public health measures developed in the 20th century, and remains the main tool for primary prevention of communicable diseases. Yet, in spite of the overall benefits of vaccination, a number of key challenges still remain to ensure sustainable, equitable and effective vaccination programmes in all EU Member States, and to secure that the added benefits of vaccinations are not lost.

The overall purpose of the research programme presented is to facilitate and execute research on vaccine confidence, identifying behavioural determinants of vaccine hesitancy across different subgroups of the population (including disadvantaged and socially excluded groups) and healthcare workers, for specific categories of vaccines in a number of Member States of the European Union (MS of EU).

The research group has facilitated and executed a preliminary research (consisting of a set of focus groups and an experimental survey) on vaccine confidence, for specific categories of vaccines in a number of MS of EU (Spain, Portugal, Romania, Italy, Poland, French). The outcome of the preliminary study will support the identification of the most promising areas of implementation of behavioural insights to improve vaccine confidence. At the time of writing of this abstract, the results are under collection, and will be ready by the end of June 2020.

During the policy design and preparation phase, supported by a behavioural mixed methodology study, a number of behavioural determinants of vaccination demand and acceptance have been identified. This is crucial for policy making at the EU level, especially since the principle of subsidiary limits the possibilities for direct EU action over choice architecture. This requires further coordination with national health authorities

Key messages

During the policy design and preparation phase, supported by a behavioural mixed methodology study, a number of behavioural determinants of vaccination demand and acceptance have been identified. In the policymaking at EU level, including behavioural insight at the design and preparation stage is crucial for effective delivery of policy objectives.
Information needs on vaccinations for older adults and the role of health care professionals in this
Authors: Caputo A , Eilers R , Gagneux-Brunon A , Gavioli R , Jakab I , Nicoli F , Timen A , Vokó Z , Wennekes M D
Published: October 2020

On behalf of all members of work package 4 from the VITAL project
Determinants of influenza vaccination intention among Tunisian elderly
Authors: Kharroubi G , Cherif I , Bouabid L , Gharbi A , Boukthir A , McCarron M , Ben Alaya N , Ben Salah A , Bettaieb J
Published: October 2020

Background

Influenza vaccination coverage among elderly remains unsatisfactory even in developed countries. Since attitudes are predictors of behavior, understanding factors influencing the intention to receive influenza vaccine (IV) among elderly may orientate interventions to increase vaccination rate. The aim of the current study was to identify factors associated to willingness to receive IV next season among Tunisian elderly.

Methods

During 2018 -2019 flu season a cross-sectional study was conducted among older persons aged 60 years and over with chronic disease attending primary and secondary health care facilities. The intention to get vaccinated against influenza was measured by means of a face to face questionnaire. Factors that affect willingness to receive IV were identified using a multiple logistic regression analysis.

Results

Of the 1191 older persons included, 19.4% [17.1-21.9] participants received IV in 2018-2019 flu season, 64.7% [61.9-67.3] expressed willingness to be vaccinated next season. Willingness to receive IV was more likely among persons with chronic pulmonary disease (ORa=2.6), those suffering from diabetes (ORa=1.6), those who received IV in 2018-2019 flu season (ORa=16.5), those who feel that they get enough information about vaccines and their safety (ORa=2.9) and persons who trust the advice of their health care providers (ORa=4.5).

Conclusions

Vaccination status was the most determinant factor associated to willingness to receive the vaccine. Therefore, sustainable efforts to promote IV may lead to cumulative increase of influenza vaccination coverage year by year. Doctors should be involved more in advocating IV and providing elderly with the necessary information about IV, but that could not be effective without a climate of trust between patients and health care providers.

Key messages

Positive self-experience of older persons with IV may change their perception about it and encourage them to adhere to the vaccine in the future. Elderly should be provided with the necessary information about IV in terms of effectiveness and safety.
Vaccine misinformation - topic-based content analysis on Facebook
Authors: Klimiuk K , Biernacka K , Balwicki Ł
Published: October 2020

Background

Even though vaccinations are referred to as one of the greatest achievements of modern medicine, they are constantly associated with the mood present in part of society denying their sense and effectiveness. The development of technology has moved discussions about vaccinations to the space of the internet. The study aims to analyze the arguments of vaccine-deniers of children use in social media.

Methods

All public comments from the leading Facebook page of opponents of vaccination on Facebook were collected, which were available there between 01/05/2019 and 31/07/2019. Then the comments were stored on a Google spreadsheet and analyzed quantitatively in terms of the content according to the modified method developed by Kata (Kata, 2010).

Results

18685 comments were analyzed, of which 4042 contained content within the adopted criteria: 28.2% concerned conspiracy theories, 19.9% covered misinformation and based on unreliable premises, 14.0% related to the safety and effectiveness of vaccinations, 13.2% to non-compliance with civil rights, 10.9% own experience, 8.5% of morality, religion, and belief, and 5.4% of alternative medicine. There were also 1223 pro-vaccine comments, of which 15.2% were offensive, mocking or non-substantive.

Conclusions

A relatively large amount of content concentrated in terms of conspiracy theories and disinformation may indicate that this is a community characterized by a lack of trust in the scientific achievements of medicine. Surprisingly many comments related to one's own negative experiences with vaccinations, which contrasts with official statistics about side-effects. Vaccination promotion should refer to the arguments of vaccination opponents.

Key messages

The tendency of vaccine-hesitancy is strengthened by 'anti-vaccine' content in social media. To understand the individuals we need to understand what information he daily learns from the internet. It can be hard to maintain herd immunity, due to the prevailing misinformation on vaccination. To overcome this phenomenon, information campaigns must be dependent on the content in social media.
Knowledge and Behavior of Nurses on Childhood Vaccine Refusal in a Hospital of Eastern Turkey
Authors: Boz G , Yigit E , Gokce A , Aslan M , Ozer A
Published: October 2020

Background

Among 10 global problems of 2019 determined by the World Health Organization, vaccine refusal was one of the problems mentioned. In this context, health services and health personnel whose main objectives are to keep individuals healthy and to prevent diseases have major responsibilities. This study aims to analyze knowledge and behavior of nurses working in Malatya Turgut Özal Hospital on childhood vaccine refusal.

Methods

This study, conducted between June-July 2019, is a descriptive cross-sectional study and its universe is composed of 850 nurses working in Turgut Özal hospital. Sample size was calculated to be 263 at a confidence interval of 95% and strength of 80%. In the questionnaire, sociodemographic questions on nurses and children as well as questions determining nurses' knowledge and behavior on childhood vaccine refusal were asked. Chi-square test and Fisher's Exact Test were used in statistical analyses. p < 0.05 was determined to be significant.

Results

31.7% of nurses participating in the study stated that they had concerns on childhood vaccines. Two-thirds of nurses stated that their knowledge on vaccines were from their education, one-thirds of them knew that childhood vaccines were mandatory by law while three out of four stated they knew the vaccination schedule recommended by the Ministry of Health. The level of concern in those agreeing to the fact that vaccines caused autism and infertility, those stating that they did not trust vaccine-producing companies, and those stating that catching the disease was a better immunization method than vaccination was significantly higher than those not agreeing to these and those who were indecisive (p < 0.05).

Conclusions

One-thirds of nurses was proven to have concerns on childhood vaccines and this rate is rather high. Nurses, being both health personnel and the communication channel for guiding parents, should be provided necessary trainings and practices in order to ease their concerns on vaccination.

Key messages

In-service trainings should be given importance in order to reduce nurses’ concern. Due to the fact that the information source for nurses on vaccination was their education, subjects that would eliminate their concerns should be highlighted.
Evaluation of Vaccination Knowledge, Attitudes and Practices and Health Literacy Levels of Adults
Authors: Çam C , Kılınç A , Ünsal A , Arslantaş D , Öztürk Emiral G
Published: October 2020

Background

This study aims to evaluate the vaccination and immunization knowledge, attitudes and practices and health literacy levels of adults living in rural area of Eskisehir City in Turkey.

Methods

The study is a cross-sectional study conducted on individuals aged 18 years and over who live in the rural area of Eskisehir City between November 16 and December 30, 2018. The study group consisted of 955 participants. The survey includes the questions about the evaluation of vaccination and immunization knowledge, attitudes and practices and the questions from the European Health Literacy Scale Short Form (HLS-EU-Q16). The statistical significance value was accepted as p ≤ 0.05.

Results

493 participants (51.6%) of the study group was female. Their ages ranged between 18 and 85 years with a mean (SD) 42.6 (15.6) years. In the study, it was found that 325 people (34.0%) had insufficient knowledge of vaccine and immunization. A positive weak correlation was found between the scores obtained from the information questions about vaccination and immunization and the scores obtained from HLS-EU-Q16 (r = 0.252; p = 0.001). It was found that there was a weak positive correlation between the scores obtained from information questions about vaccination and immunization and the scores obtained from questions about their attitudes and practices towards vaccination and immunization services(r = 0.333; p = 0.001). Being 65 years and older, living in the village having not been vaccinated in the last 10 years and lack of previous information about vaccines, were found to be important risk factors for lack of knowledge level on vaccine and immunization.

Conclusions

In the study, it was observed that one third of the group's vaccine and immunization knowledge levels were insufficient. Determining the factors that affect the level of knowledge about vaccination and immunization may be important in terms of sustaining the effectiveness of vaccination applications and campaigns.

Key messages

Lack of information about vaccines and insufficient knowledge about vaccine-preventable diseases can feed individuals' indecisiveness to vaccination. Health education and information services can be provided to increase the level of vaccination and immunization knowledge.
Impact of a community empowerment programme in disadvantaged UK neighbourhoods: results of a survey
Authors: Bagnall A M , Trigwell J , Heisse C , Quick A , Southby K , Woodward J , South J , Button D
Published: October 2020

Background

A community empowerment programme in the UK aims to enable people to have greater collective control over area-based decision making, improved health and wellbeing and reduce health inequalities, by providing small grants to support residents of deprived neighbourhoods and communities of interest to come together to take action on issues of importance to them.

Methods

A survey was conducted at 4 6-month intervals as part of a mixed methods evaluation, to collect data about participant demographics, level of involvement, opinions of the project, and impacts. The survey was self-completed online or on paper, and distributed by local project leads. Outcome questions were adapted from the UK Government Community Life Survey to facilitate comparison with national statistics. Data were analysed using SPSS to produce descriptive statistics, supported by inferential statistical tests where appropriate. Regression analysis using multi-level modelling was used to estimate the conditional correlation between health outcome and Local People project participation.

Results

1053 people from 29 local areas responded to the survey over the 4 time points; only 93 responded more than once. 43% took part in project activities, 36% were local project committee members and 19% were volunteers. The analysis found positive impacts on confidence, control, friendships, skills, happiness, life satisfaction, feelings of worth (p < 0.05), and that greater length and degree of involvement in the projects were associated with greater positive impacts on all of these outcomes.

Conclusions

The survey provides tentative evidence that participation in a community empowerment initiative may result in improved wellbeing, feelings of power and control, sense of belonging and trust. People who are involved for longer or more deeply involved are more likely to see these impacts. More community-based survey research is needed to gather people's views on neighbourhood initiatives.

Key messages

An evaluation of a community empowerment programme found positive impacts on control, wellbeing, belonging and trust. Greater length or degree of involvement were associated with greater impact.
Healthy settings in an airport planning context: Lessons from the Sydney experience
Authors: Crimeen A , de Leeuw E , Freestone R
Published: October 2020

Issue

Airports provide infrastructure for an industry situated between economic development and environmental detriment. In Western Sydney, a new international airport is being built in an area of sustained population growth. To proactively address the transformation created by the airport, a research hub in South Western Sydney began in 2015 to prepare a health promotion and protection agenda surrounding the airport.

Description

The concept of an airport that proactively addresses social determinants of health (equity) was introduced, and has been met with in-principle positive support from aviation-related stakeholders. However, follow through with demonstrated commitment has been limited. An exploration of the policy domain of the Western Sydney airport region was undertaken to identify the organisations involved and the control they exert over key determinants of health (equity) and their interrelationship. The intent was to gauge urban health professionals' ability to influence change within the airport planning and development process.

Results

The analysis shows that power within airport planning is spread widely vertically and horizontally. Despite having a centralised planning organisation, decision making authority is dispersed across multiple levels of public and private governance within the wider airport region. Organisations are bound by (or defer to) higher level regulatory guidelines or legislation for technical aspects of airport planning. Those with more flexible influence lack incentive to engage with broader public health activities.

Lessons

Lobbying for better public health outcomes has bypassed the complex planning system within airport development settings. Opportunities exist to influence planning through formal and non-formal structures for specific “wins”. However, thinking outside a health box may provide the biggest opportunity for change yet, as shown by the successful legal blocking of the Heathrow runway expansion by climate change activists.

Key messages

Airports as major urban infrastructure sit under complex organisational structures both in their development and management. Public health responses need to be more targeted and innovative in advocacy and engagement.