bluuebunny/crossref_metadata_2025 huggingface dataset:
Assessment of the nutritional status in patients with acute diverticulitis
Authors: Giorgetti G , Fabiocchi F , D'Avino A , Tursi A , Brandimarte MA , Paoloni A , Meucci T , Parrocchia S , Brandimarte G , Nasi G
Published: October 2021

Background

The study evaluated the implementation of a screening strategy on all hospitalizations for diverticular disease (DD) of the colon with particular reference to acute diverticulitis (AD) regarding nutritional status.

Methods

The Nutritional Risk Security (NRS2002) system, was used, preselecting those with AD by the nurses of the nutrition team on the same day of admission from 1/01 to 31/12/2017 at the S. Eugenio Hospital in Rome. Patients (pts) with positive pre-screening were referred for additional evaluation performed by a dietician.

Results

AD was observed in 133 pts, 58% women, out of a total sample of 4667. The NRS2002 was applied to all, finding a positive screening test in 97 (72.9%) pts of whom a severely compromised nutritional status (NRS2002 score>3) in 61 pts (62.9%). Each patient tested positive was given initial nutritional support: oral supplements (17 pts, 17.52%), enteral nutrition (22 pts 22.68%), total parenteral nutrition (58 pts 59.8%). The mean length of hospital stay was 6.9 days, although was significantly longer for pts with NRS2002 positive (mean of 18 day). NRS2002 score can be a significant predictor of disease severity and outcome, operating independently of BMI, since a total score ≥3 can predict length of hospital stay.

Conclusions

The study confirmed that NRS2002 is a useful screening tool for identifying nutritional risk AD pts in hospital wards and allowed to select pts who needed a more careful monitoring program, diet therapy and possibly nutrition artificial. Furthermore, it showed an increasing and underestimated risk of malnutrition in a large number of pts hospitalized and that NRS2002 screening is a good predictor of some socio-health indicators such as hospital stay.

Key messages

There is an increasing and underestimated risk of malnutrition in a large number of patients hospitalized. NRS2002 is a useful screening tool for identifying nutritional risk and a good predictor of some socio-health indicators such as hospital stay.
Environmental Factors Affecting Cognitive Function Among Community-dwelling Older Adults
Authors: Motohiro A , Abe T , Okuyama K , Kumakura S
Published: October 2021

Background

Although neighborhood environmental factors have been found to be associated with cognitive decline, few longitudinal studies have focused on their effect among older adults living in rural areas. This longitudinal study aimed to investigate the effect of neighborhood environmental factors on cognitive decline among rural older adults.

Methods

The data of 503 older adults aged > 60 years who were living in Unnan City in Japan and had participated in two surveys conducted between 2014 and 2018 were analyzed. Cognitive function was assessed using the Cognitive Assessment for Dementia, iPad version 2. Elevation, hilliness, residential density, and proximity to a community center were measured using geographic information system. Logistic regression examined the effect of each neighborhood environmental factor (in quartiles: Q1-Q4) on cognitive decline.

Results

A total of 57 (11.3%) participants demonstrated a decrease in cognitive function at follow up. Elevation (Odds ratio (OR): 3.37, 95% Confidence Interval (CI): 1.11-10.20 for Q3 vs. Q1; OR: 5.43, 95% CI: 1.89-15.56 for Q4 vs. Q1) and hilliness (OR: 3.45, 95% CI: 1.46-8.11 for Q4 vs. Q1) were associated with a higher likelihood of cognitive decline. Residential density and distance to a community center were not associated with cognitive decline.

Conclusions

Elevated and hilly environments may increase risk of cognitive decline among rural older adults.

Key messages

Residents in mountainous regions tend to have limited accessibility to various living centers. Those who live in elevated and hilly areas within the mountainous regions may have further limited accessibility and availability of locations where they can interact with others.
Rewilding European urban spaces
Authors: Evans M
Published: October 2021

Background

In the context of global climate change, deforestation, biodiversity loss, and the impact of urban living on public health, the rewilding of urban areas and surrounding spaces may offer a host of benefits for physical and mental health as well as improvements to environmental and planetary health. This review offers a contemporary appraisal of the role and impact of rewilding urban areas within Europe, considering the success of existing policies and offering suggestions for future projects.

Findings

Rewilding projects across Europe vary in scale and intensity. Given ongoing urbanisation across much of Europe, there is increasing need for green and natural spaces. Protection and enhancement of natural spaces, development of newly rewilded areas, and increased connectedness of natural spaces represent ways to increase prevalence and access to such spaces. Rewilding offers a number of potential benefits to human health, including restoration of biodiversity which may support food security, and sequestration of carbon dioxide which plays an important role in reducing climate change. Green spaces in cities counteract heat island effects and help to maintain temperatures. There are also documented benefits to mental health and faster recovery times from illness.

Lessons

There is scope to improve rewilding projects to enhance their success across Europe. Current limitations to rewilding projects include:

The lack of a clear definition of rewilding and the broad scope of projects that fall under this concept. Challenges in monitoring and evaluation, and the need for a clear framework for effective evaluation of such projects. Increased and improved communication and advocacy.

Key messages

Rewilding offers a range of potential benefits to human and planetary health, and there is increasing interest in such projects. There are limitations to rewilding projects that must be overcome in order to improve policy and practice in this area.
Staying active during Covid-19 crisis: why it would have been important to keep public parks opened
Authors: Porcherie M , Roué Le Gall A , Thomas MF , Montiège Q , Faure E , Rican S , Vaillant Z , Simos J , Cantoreggi N
Published: October 2021

Background

In 2020, the Covid 19 pandemic and associated restrictions, including limited access to public urban green space (UGS), have led to a decrease in the ability of city dwellers to engage in physical activity. In France, more than 52% people reported being physically active in urban parks. Based on the GREENH-City research carried out in cities of the French network of WHO healthy cities, this presentation aims to show that UGS, depending on different drivers, can support a wide variety of physical activities, but also offer multiple other functions that contribute more or less directly to the health of the population.

Methods

A qualitative survey was conducted among users of 3 different parks in each of the 6 selected cities with both observations and semi-directive interviews and a thematic analyzes were performed. Observed activities were classified into 8 groups including physical activity (non-sport, sports). Interview's analysis aimed to describe the reasons for coming and the type of activity made.

Results

186 observations and 591 recorded and unrecorded interviews with individuals or groups were conducted in the 18 parks. 24 types of physical activity have been described as possible uses of UGS. The most important, regardless of UGS location, is children activities in playgrounds. The most common activities are walking (with a social function) and jogging (individual function). Proximity and the accessibility are two reasons for use.

Conclusions

UGS are an open access amenity for physical activities. From a social justice perspective, policy makers should ensure that every neighborhood is sufficiently close to an UGS. In addition to promoting physical activity, UGS also serve an important social function and impact the collective physical and mental health of the population in many other ways (e.g., as environmental risk regulators). Their coping role during crisis for population would worth to be studied further.

Key messages

Proximity and accessibility should shape local policies related to UGS renewal towards more equity. Different typologies of urban parks at the city level can offer multiple functions, including facilitation of physical activity that contribute to the health of the population.
Gender-linked determinants for utilization of long-term care in community-dwelling adults in Germany
Authors: Steinbeisser K , Schwarzkopf L , Grill E , Schwettmann L , Peters A , Seidl H
Published: October 2021

Background

The number of people using long-term care (LTC) is increasing steadily worldwide. Hence, demand for adequate services is rising. The purpose of this exploratory study was to identify relevant gender-linked determinants for utilization of LTC in community-dwelling older adults.

Methods

We examined 4077 females (52.7%) and males ≥ 65 years old (range: 65-97) between 2011/12 (t1) and 2016 (t2). Data originated from the population-based Cooperative Health Research in the Region of Augsburg (KORA)-Age study in Germany. A descriptive analysis assessed the amount of LTC used. Cross-sectional generalized estimating equation logistic models identified determinants for utilization of (in)formal LTC. Determinants for transition to LTC between t1 and t2 were examined using a longitudinal logistic regression model. Potential determinants were chosen according to Andersen's Behavioral Model of Health Services Use.

Results

At t2, 820 (20.1%) were LTC users with 527 (64.3%) being female. The average amount of informal LTC was higher in males (158.0 minutes/day (m/d) (SD: 270.5) vs. 70.1 m/d (SD: 152.8)), whereas the amount of formal LTC was higher in females (89.7 m/d (SD: 224.7) vs. 28.5 m/d (SD: 23.3)). In both genders, higher age, multimorbidity, and disability were associated with utilization of and transition to LTC. Living alone was significantly associated with utilization of (formal) LTC in both genders, but its effect was almost two times stronger in males (men: OR: 3.48 (CI: 2.05-5.90) vs females: OR: 1.83 (CI: 1.25-2.69)). Thus, ‘living alone' is considered the essential gender-linked determinant.

Conclusions

Gender-linked determinants must be considered when establishing demand-oriented policies. Future health programs should specifically target older individuals, especially males, living alone to improve their capabilities in activities of daily living to allow them to remain living longer and more independently within community settings.

Key messages

Older individuals, especially men, living alone should be targeted in future health programs. Females tend to use a higher amount of formal long-term care than males.
Changes in the prevalence of MetS and its components between 2011 and 2018 in the Roma Population
Authors: Piko P , Dioszegi J , Kosa Zs , Sandor J , Adany R
Published: October 2021

Background

Metabolic syndrome (MetS) is a worldwide problem with severe health consequences, which are further exacerbated by the current COVID-19 pandemic. In this study, we examine the changes in the prevalence of MetS and its components among the Roma (one of the most vulnerable ethnic group in Europe) in two disadvantaged counties of North-eastern Hungary in the period between 2011 and 2018.

Methods

Two health examination surveys were performed in the Hungarian Roma population aged 20-64 years in 2011 (n = 458) and in 2018 (n = 374). The data from these surveys were used to examine how the prevalence of MetS and its components and the prevalence of relevant preventive medication changed during the study period.

Results

The increase in the prevalence of MetS itself in the whole Roma population was not found to be significant in the period examined (although it increased from 40.0% up to 46.0%, p = 0.080); however, there was a significant increase in the prevalence of central obesity (from 62.7% to 73.3%, p = 0.001) and raised blood pressure (BP) or treated hypertension (from 45.2% to 54.5%, p = 0.007). These changes were mainly observed in the younger age groups, so the risk for MetS increased significantly in the 20-34 (OR = 1.10, p = 0.038) and 35-49 (OR = 1.07, p = 0.048) year-old groups in the 2018 study population compared to the 2011 one. A favourable non-significant decrease was observed in the prevalence of raised fasting plasma glucose concentration (from 29.0% to 24.1%, p = 0.107) and reduced HDL-C levels (from 60.3% to 55.6%) over the study period.

Conclusions

The increasing prevalence of hidden hypertension and, consequently, the number of untreated individuals with raised BP (from 29.6% to 43.5%, p = 0.014) among women is quite alarming; therefore, a targeted public health strategy and targeted interventions are desperately needed to prevent further worsening of the current situation.

Key messages

Among Roma women, the prevalence of hidden hypertension and, consequently, of elevated blood pressure increased significantly over the study period. Stopping the increasing trend of MetS would require interventions which focus on the increasing prevalence of central obesity and hypertension in the Roma population.
The burden of seasonal influenza-associated complications in Italy: a systematic review
Authors: Giacchetta I , Primieri C , Cavalieri R , Domnich A , de Waure C
Published: October 2021

Background

Influenza is the infectious disease with the highest impact on population health in the European Union in terms of disability-adjusted life years. Reliable country-specific influenza-associated burden estimates play a crucial role in informing prevention and control measures to minimize the health and economic burden of the disease. Our purpose was to provide a comprehensive summary of available scientific literature on the burden of seasonal influenza on the Italian population.

Methods

We performed a systematic literature review of articles published until 31 July 2020. PubMed, Embase and Web of Science were searched. The search strategy included a combination of search terms related to burden, influenza and Italian population. We included studies investigating seasonal influenza-related complications and/or mortality in Italy. A meta-analysis of data was not pre-planned because of the expected heterogeneity in study populations and outcomes.

Results

A total of 16 studies were included in the qualitative synthesis, out of an original yield of 9,268 articles. Ten (62.5%) and 8 (50%) studies analyzed influenza-related complications and hospitalizations, respectively, while 8 (50%) assessed influenza-related deaths. Only 3 studies (19.7%) concerned pediatric age. The synthesis of results showed that patients with chronic conditions might have an increased risk for complications up to almost 3 times as compared to healthy people. Hospitalization due to influenza can occur from less than 1% to more than 5% according to the study setting (general practice or emergency room). Excess deaths rates were estimated to be over 6-fold higher for the elderly than for the rest of population.

Conclusions

Although there are still gaps in existing data, there is evidence of the significant burden that influenza places each year especially on high-risk groups. Summaries of the available data may inform decision-making in regard to vaccine strategies and public health policies.

Key messages

Existing data show evidence of significant burden of influenza on Italian population, especially on high-risk groups. Summaries of country-specific influenza-related burden are crucial in informing vaccine strategies.
The impact of age when screening for latent tuberculosis infection - is it a problem?
Authors: Almeida Santos J , Duarte R , Nunes C
Published: October 2021

Background

Older population in developed countries represents a large reservoir of tuberculosis (TB) infection. Knowledge if age can contribute to false negative results in the immunological tests available for screening latent TB infections (LTBI) is critical to improve their usefulness in Public Health strategies for TB control. The aim of this study was to ascertain whether age was a risk factor for false negative (FN) results in the tuberculin skin test (TST) and in an interferon gamma release assay (IGRA).

Methods

Retrospective cohort study carried out using data from the Portuguese National Tuberculosis Surveillance system (2008-2015). Were included all active pulmonary TB cases with an IGRA (n = 597) and/or TST (n = 6185) result. TST outcomes were interpreted using a 5mm (TST-5mm) and 10mm (TST-10mm) cutoff. Logistic regression analysis crude and sex-adjusted was used to evaluate the association of age to the risk of FN results.

Results

Patients with a TST result presented a mean age of 42.7 years and patients with an IGRA result presented a median age of 45.5 years. TST-5mm, TST-10mm and IGRA had 36.5%, 43.9% and 24.5% FN results, respectively. Older patients presented a statistically significant association with the risk of FN TST results, regardless of using a 5mm [71-80years: OR 2.209; >80years: OR 2.491; p < 0.001] or 10mm [71-80years: OR 1.986; >80years: OR 2.308; p < 0.001] cut-off. Age was not a predictive factor for FN IGRA results. However, older patients presented a significant association with indeterminate IGRA results [71-80years: OR 3.808; >80years: OR 5.214; p < 0.001].

Conclusions

When using TST as part of the Public Health strategies for screening elderly patients, healthcare professionals should bear in mind that there is an increased risk of obtaining a FN result. On the other hand, age did not show an association with the occurrence of FN IGRA results, which suggests that this test could perform better when screening for LTBI in older patients.

Key messages

TST in elderly people is associated with false negative results thus, when using this test for screening for LTBI, a negative result should be interpreted with caution. IGRA was not associated with false negative results in elderly people, however indeterminate results can occur more frequently, thus performing better in this population group.
Background exposure to polychlorobiphenyls and mortality: A systematic review and meta-analysis
Authors: Fiolet T , Mahamat-Saleh Y , Frenoy P , Kvaskoff M , Romana-Mancini F
Published: October 2021

Polychlorinated biphenyls (PCBs) are a family of 209 congeners known to be highly persistent in the environment and with long-range transport leading to a ubiquitous pollution. This group of persistent organic pollutants is known to be carcinogenic and to have endocrine-disrupting properties. Due to bioaccumulation along the food chain, the main route of exposure in general population is through diet. High level toxicity was well characterized with mass poisoning episodes and occupational cohort but the association with PCBs exposure at low doses with mortality in general population is uncertain. We conducted a systematic review and meta-analysis to assess whether background exposure levels of PCBs increase all-cause and cancer- and cardiovascular-specific mortality risk in the general population, following the National Toxicology Program/Office of Health Assessment and Translation framework. Studies were identified by searching PubMed, Embase and Web of Science up to 1st of January, 2021. Random-effects meta-analysis was used to estimate summary relative risks (SRRs). Eight prospective cohort studies met our inclusion criteria, leading to 72,852 participants including 17,805 deaths. Overall exposure to PCBs was not statistically significantly associated with all-cause mortality (SRR=1.13, 95% CI = 0.90-1.41, n = 7 studies, low certainty); however, dietary exposure to PCBs was associated with an increased risk of cardiovascular-specific mortality (SRR=1.38, 95% CI = 1.14-1.66, n = 3 studies, moderate certainty), while no association was found with cancer-specific mortality. Bayesian meta-analysis and subgroup analyses confirmed these findings. Our meta-analysis suggests that background exposure to PCBs is associated with an increased risk of cardiovascular-specific mortality in the general population with a “moderate” level of evidence. This should be interpreted with caution given the small number of studies on mortality in the general population.

Key messages

This meta-analysis fails to highlight any clear association between background level of PCB exposure and all-cause and cancer-specific mortality, probably due to the limited number of studies. This study brings new evidence of an increased risk of cardiovascular-specific mortality associated with a higher exposure to PCBs in the general population, with a moderate level of certainty.
Energy and macronutrients intake in an Italian infants cohort at 24 months of age
Authors: Valdi G , Moretti V , Concina F , Pani P , Carletti C , Ronfani L , Parpinel M
Published: October 2021

Background

Dietary habits during infancy and early childhood could have short and long-term health effects and could influence future adults' dietary habits. Acting during this sensitive period of life could be crucial. In 2006 a prospective infants cohort study was established at the Maternal and Child Institute - Burlo Garofolo in Trieste, Italy (Trieste Infant Feeding Cohort - TIF cohort) to assess energy and nutrients intake during the first three years of infants' life. This nutritional analysis focused on dietary habits of infants at 24 months of age.

Methods

Dietary data were collected using a 3-day dietary record (3-d DR) and data were analysed using a nutritional software containing the Italian Food Composition database and integrated with data from nutritional labels and literature. Energy and macronutrients intake were compared with the Italian Dietary Reference Values (DRV) and the WHO recommendation. Differences by sex were also assessed.

Results

3d-DR was filled for 157 infants. Available carbohydrates (CHO) and starch intakes were significantly significant higher in males (p < 0.05). The percentage contribution of CHO to total energy intake was in line with DRV (75.8% of infants within the reference interval (RI)) similarly 75.2% of infants are within the RI for fats. Proteins' contribution to energy intake, instead, was above the RI for 53.5% of infants over the RI and the daily protein intake was greater than the estimated DRV (median 43.9 g/d, IQR of 16.2 g/d vs median DRV 10.3 g/d, IQR 1.3 g/d).

Conclusions

The results show a substantial adherence with recommendations for macronutrient intakes except for the excess protein intake. Elevated protein intake play a role in developing long-term health consequences and seems linked to overweight and obesity. Further evaluation of protein intake should be desirable.

Key messages

Nutritional studies are essential tools to assess dietary habits in infants and allow to contribute of reference recommendations evolution. Macronutrients analysis, with a particular focus on proteins intake, can help to evaluate children’ dietary patterns, to intercept and possibly correct unhealthy habits.
Outcomes and predictive factors of weight loss: an evaluative retrospective study in Tunisia
Authors: Ayedi Y , Harizi C , Abdessalem H , Skhiri A , Fakhfakh R
Published: October 2021

Introduction

Morbid over-weight is associated with adverse health outcomes such as cardio-vascular diseases, diabetes, hyperlipidemia, hypertension… Obesity treatment needs special and personalized care. Moderate loss weight from 5% to 10% is beneficial for primary reduction of these disorders.

Aim

Identify predictive factors of weight loss of at least 5% of baseline weight and describe improvement of metabolic syndrome

Methods

We performed a retrospective evaluative study in Obesity Research Unit in the National Institute of Nutrition of Tunis from October 2016 to March 2018. We included adult women, whose BMI was > =30 kg/m2. Anthropometric and biological parameters were taken in the first consultation (T0). Then, adequate and personalized care (diet, physical activity, and psychological support) was received. Monthly check-ups were done to detect eventual diet errors. Evaluations were done in 3 and 6 months (T1) and (T2). We performed univariate and then, logistic regression to determine predictive factors of successful loss weight by at least 5%.

Results

We included 73 obese women. Mean age was 42.63 +/- 11.8 yo. One third of the patients were in menopause. At T0: 83.1% have had a weak physical activity while mean BMI was 39.98 +/- 6.47 kg/m2. Fourteen patients had had hypertriglyceridemia and 43 had hypo-HDLemia. Eighteen were hypertensive. Eighteen were diabetic. At T2: mean weight loss was 5.92 +/- 4.34 kg. Fifty-seven percent of patients have successfully lose more than 5% of their baseline weight. Mean BMI was 37.59 +/- 6.51 Kg/m2. A significant improvement of rates of cholesterol and triglycerides was found. Logistic regression found that predictive factors to weight loss were successful loss weight at 1 month, diminution of TSH hormone and augmentation of Phosphorus intake.

Conclusions

A large proportion of obese women may be sensitive to moderate weight loss but a further effort is necessary to maintain effective weight loss on long term.

Key messages

Moderate weight loss is beneficial for health. Personnalized care is required to help obese women.
The HTA of genomic applications in Italy: methodological and organisational preparedness
Authors: Migliara G , Pitini E , Baccolini V , Isonne C , Mazzalai E , Salerno C , Turatto F , De Vito C , Marzuillo C , Villari P
Published: October 2021

Background

The formal process to determine the value of a health technology is Health Technology Assessment (HTA). Two key components are required to implement the HTA of genomic applications: the development of a specific methodology and an adequate network. This work aims to review the state of HTA in Italy and to assess its preparedness for genomic applications, both at a national and regional level.

Methods

For the national level, a narrative review of the policy documents regulating the HTA process was conducted. For the regional level, an update of a previous survey on the topic (SIHTA/AGENAS 2016) was performed through the search and analysis of regional websites, and grey and scientific literature.

Results

Various national centres share a role in the governance of the HTA process and/or in the production of reports, such as the National Agency for Regional Healthcare Services (since 2006), the Steering Committee of the Italian National HTA Program for Medical Devices and the National centre for HTA (since 2017). 76% of the Regions has specific regulations for the HTA process. Of these, 68.8% regulate the reporting phase, 62.5% the priority setting, 81.3% the assessment, 50% the appraisal, and 43.8% the dissemination. The following dimensions were assessed: “technical characteristics”, “health problem and current use”, “cost and economic effectiveness” by 62.5% of the Regions; “efficacy”, “safety”, “organizational aspects” by 56.3%; “ethical aspects” by 25%; “social aspects”, and “legal aspects” by 18.8%.

Conclusions

The HTA is specifically addressed at a National level, but there is an overlap of institutional roles in its governance. At regional level, while most Regions have HTA specific regulations, there is great heterogeneity among them in the phases regulated and in the dimensions evaluated. Moreover, there is a lack in evaluation of dimensions essential for a comprehensive assessment of genomic applications, like ethical, social and legal aspects”.

Key messages

Policy documents on HTA are well developed and integrated in the governance of the NHS. However, there seems to be a dispersion of value with various centres partially overlapping in their functions. There is a lack of evaluation in dimensions fundamental for genomic tests, due to the implications of privacy violations, impact on quality of life and abuses that can follow these tests.
Deprescribing for community-dwelling elderly: A systematic review of economic evaluations
Authors: Romano S , Figueira D , Teixeira I , Perelman J
Published: October 2021

Background

Multimorbidity among the elderly represents a serious challenge for health systems. Older adults are often exposed to polypharmacy and inappropriate medication, which are associated with adverse events and increased healthcare use. This study aims to identify and synthetize the economic evidence of deprescribing interventions among community-dwelling elderly.

Methods

Literature was systematically reviewed on the cost and effectiveness of deprescribing interventions in adults aged ≥65 years living in the community. MEDLINE, EconLit, Scopus, Web of Science, CEA-TUFTS, CRD York and Google Scholar databases were searched from inception to February 2021. Grey literature was also explored. Titles and abstracts, and subsequently full-text articles were screened according to inclusion and exclusion criteria. Studies' quality was appraised using the extended Consensus on Health Economics Criteria list.

Results

A total of 6,154 articles were identified, of which 89 were retrieved for full-text review, yielding 14 studies. Most were conducted in Europe (n = 9), followed by North (n = 3) and South America (n = 1), and China (n = 1). Settings included community pharmacies, primary care/general practices and patientś homes. Most deprescribing interventions were delivered within a pharmacist-doctor collaboration. Twelve studies were trial-based economic evaluations with a time horizon varying from 2 to 12 months. Cost-effectiveness ranged from dominant to an incremental cost-effectiveness ratio of $112,932/QALY. Nine studies scored >80% (good) and two scored ≤50% (low) on critical quality appraisal.

Conclusions

There are few economic evaluations of deprescribing interventions focused on community-dwelling elderly. Although results varied across settings, time horizon and intervention complexity, most interventions were cost-effective according to the WHO threshold. Deprescribing interventions are promising from an economic viewpoint, but more studies are needed.

Key messages

There is a paucity of economic evaluation studies conducted on deprescribing interventions of community-dwelling elderly. Research suggests that most interventions are cost-effective or even dominant compared to usual care.
Healthcare waste management processes and transition towards a circular economy
Authors: Mokra J , Loosova J
Published: October 2021

The new Waste Directive 2018/851/EU strengthens the role of waste prevention and emphasizes recycling to facilitate the transition to a circular economy. So far, it has not been legislatively necessary for the Czech Republic to look at waste from a broader perspective, especially in healthcare, where the waste management is perceived as a separate process suitable for outsourcing. With the new directive and the transition to a circular economy, the waste management process becomes part of strategic management processes. These processes are partially systematically covered by the standards of the environmental management system, used mainly in the industrial sector. The optimal solution is a reassessment of the entire waste management of the medical facility and the inclusion of the principle of waste prevention in the decision to purchase a product or service. The necessary condition for the successful implementation of the circular economy is to minimize negative impacts on health and the environment while maintaining the economic sustainability of such a solution. Setting up generally sustainable management of medical facilities thus goes beyond current clinical practice. The health technology assessment model provides several domains that complement life cycle analysis and health impact assessment, including a health risk assessment method. The outputs of the above analyzes and evaluations cover the maximum scope of public interest in healthcare. A practical approach is developing a system of methodologies based on the methods mentioned above, which respect the whole chain of strategic processes of healthcare facilities and involve maximum stakeholders in the evaluation process. We test the approach on a pilot facility in the project SS01010276 ‘Sustainable healthcare waste management: economically feasible minimization of impacts on health and environment' supported by the Technology Agency of the Czech Republic within the Environment for Life Program.

Key messages

The approach aims to add value to traditional waste management approaches and integrate the long-term interests of key stakeholders using the overlapping outcomes of respective assessments. A sustainable approach to healthcare waste management must be developed with the involvement of all key stakeholders and concerning their interests within their position in the assessment process.
A software package for monitoring and managing occupational health risks for industrial workers
Authors: Izdenov AK , Zharylkassyn ZhZh , Otarov YZh , Alexeyev AV , Tilemissov MK , Izdenova NR
Published: October 2021

At the present stage of development of any state, an important aspect of occupational health and public health is undoubtedly the protection of workers' health. In view of this, we have developed an automated system and algorithm for the approach to assessing professional risks. It is proposed to implement a campaign to manage occupational health risks for workers through the automated system “Software complex for monitoring and managing occupational health risks for workers at an industrial enterprise” developed in the Republic of Kazakhstan. This complex performs the necessary actions to create the foundations for making management decisions, it consists of the following components, which were analyzed and used at the industrial enterprise Joint Stock Company ‘Kostanay Minerals' in the Republic of Kazakhstan: 1) analysis of current information based on the definition and systematization of the information bases of the enterprise. Such databases include data on employees, working conditions, cases of injuries, morbidity, medical examinations, occupational morbidity and personal protective equipment;

2) the analytical component, carried out on the basis of statistical data, mathematical methods of information processing, conducts an analysis of professional risk both for each worker and for each enterprise.

The analysis of the data is presented by the system in the form of reports received by the interested person of the enterprise by specifying a sample of data in any form, with the specification of the conditions for sampling from the stored data in the database of the automated system. The developed and implemented approach to occupational risk management is aimed at the practical implementation of a comprehensive risk assessment at workplaces, allowing not only to identify risks, but also to manage them during the work shift, throughout the entire work experience, which is the basis for ensuring the safety and health of industrial workers.

Key messages

The introduction of new technologies in industry will lead to a sharp decrease in the intensity of production factors and occupational pathology and to conduct a correct assessment of health risks. Professional risk monitoring consists in informing employees, employers, the public, administrative authorities about the risk factors at work and the necessary and applied measures to reduce it.
Evaluation of Mixed reality in undergraduate nursing education. A systematic review
Authors: Aguinaga-Ontoso I , Guillen-Aguinaga L , Guillen-Aguinaga S
Published: October 2021

Background

Mixed Reality is becoming more widespread in the training of nursing students because it allows students to face situations that are difficult to manage or that rarely occur in their practice, but for which they must be prepared. Our objective is to evaluate whether mixed reality improves nursing students' learning outcomes and satisfaction compared to simulation.

Material and methods

This systematic review was performed according to the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) The generic keywords used were “(nurses OR nurse OR nursing) AND mixed reality AND simulation”. The literature search was carried out in the PubMed and CINAHL databases between 2011 and 2021. After the review, 4 references were selected. Based on the study title and abstract, two independent authors selected potential. Whenever a study meets the inclusion criteria, the authors access the full text. To assess potential bias, all studies included in the review were evaluated with the Newcastle-Ottawa Quality Assessment Scale

Results

The search produced 54 papers but after reviewing only 4 were selected. Two studies were pretest post-test with a control group, while the other 2 were post-test only with no control group. Mixed reality was used in several settings (Maternal Health, Mental Health, CPR, and hospital ward) to increase the realism of simulations, increase confidence, reduce anxiety and stress of students in clinical situations. The results of the studies are contradictory, with poor quality studies showing positive effects, while studies with better quality and design showed poorer results.

Conclusions

Mixed reality is a very recent technique in nursing education. It is necessary to carry out well-designed studies of adequate size to evaluate in which contexts it is effective.

Key messages

Mixed reality is an emerging technology in education, but very few evaluations have been conducted. It is necessary to carry out well-designed studies to evaluateif Mixed reality it is effective in nursing education.
Training of employers and employees in workplace health promotion in Bulgaria – 7-year experience
Authors: Georgieva S
Published: October 2021

Issue

Health of working population is a question of present interest because of a number of reasons: aging workforce, globalization of the labour market, new and increasing risks at working environment etc. Workplace Health Promotion (WHP) become increasingly relevant field of action for public health improvement all over the world. According to the Bulgarian legislation annual trainings on health and safety at work are obligatory for employers and employees.

Description

By this paper 7-year experience in training of employers and employees in WHP was shared. Generally, 9 employers/organizations and 120 employees in three focus groups were included in the training. Questions of the project are: a) how to enhance employers' capability to plan and put into practice health promotion programs; b) how to increase employees' interest for active participation in these programs. Training have been conducted both at workplace and at special meetings outside of work environment, organized by Occupational Health Service in collaboration with health promotion experts of Medical University - Pleven.

Results

At the beginning (2014), about 2/3 of participants distrust of the proposed approaches. To adapt the training to needs of the audience, a study on the barriers and difficulties in carrying out health promotion activities at workplace was made. Participants were also asked about aspects of WHP that they interested in. During the following meetings (every year from 2014 until now), interest to the WHP and approaches of its implementation have been increasing. Participants improved their activity in discussions, interactive approaches for teaching and training get preferable.

Lessons

Lack of knowledge about health promotion concept and its principles predispose to distrust of its potential for public health improvement. Positive attitude to the concept could be established by increasing knowledge and skills in this area and by providing examples of good practices and results.

Key messages

Workplace Health Promotion become increasingly relevant field of action because of aging workforce and new occupational hazards, but there are some barriers and difficulties in its implementation. Annual training of employers and employees in Workplace health promotion improve the capability for implementation of the concept and for utilization its potential for better health of working people.
Wind of change: better air for microbial environmental control
Authors: Messina G , Taddeini F , Amodeo D , Petri C , De Palma I , Puccio A , Cevenini G
Published: October 2021

Background

COVID19 outbreak highlighted air disinfection's importance. All bacteria and viruses tested to date (including various coronaviruses) respond to UV-C disinfection. This study aims to assess the effectiveness of an UVC disinfection system for air in a real working context.

Methods

This descriptive study was carried out in November 2020 in an office of the Department of Molecular and Developmental Medicine at the University of Siena. The disinfecting air system, Cleaning Air T12, produced by Italia Iso Group, has 12 lamps of 6.9 Watt of UVC/each, two inlet grills in its bottom and 2 outlet grills in the superior part. The volume of air that the system treat is of 210m3/h. The experiments were run over several days during the activities of 3-5 subjects working for several hours. Real time microbial air samplings were run during the tests switching the system ON and OFF. To verify microbial time variation, initial samplings (phase 1) had the system OFF, then ON (phase 2) and finally OFF again (phase 3). Petri dishes were incubated at 36 and 22 C°. Statistical analysis was executed with Stata 16. Significance level was set at p < 0.05.

Results

The longest test highlighted that during phase 2, after 8 minutes from the end of phase 1, the system acted significantly (p = 0.001) on the reduction of environmental contamination up to a mean of 70 (95% C.I. 64 - 77) CFU/500 liters (about 70% at 22 °C) and 50% at 36 °C. In phase 3 the mean values became 171 (144 - 198) CFU/500 liters at 22C° and 259 (228-291) at 36 °C.

Conclusions

The system was able to significantly reduce the environmental contamination in real time. The experimental tests show how, as soon as the device is turned OFF after at least half an hour of operation, air healthiness drops dramatically within 10 minutes, bringing the levels of microbial contamination (induced by the presence of the operators in the room) to levels even higher than 150%.

Key messages

In order to convey a correct and truthful message about the disinfection capabilities of an air purification system, testing the device under real operating would be necessary. Testing the device under real operating conditions, with and without the presence of people in controlled environments, would be necessary before the final product is placed on the market.
Genetic testing in the context of familial hypercholesterolaemia: organisational and ethical aspects
Authors: Strohmaier C , Walter M
Published: October 2021

Background

Molecular genetic diagnostics (GDx) is an increasingly used tool in the so-called ‘precision medicine'. For a structured implementation of GDx in screening programmes (SP), organisational and ethical implications must be considered. Our research report addresses implementation aspects of GDx in different health care systems and ethical considerations in the context of familial hypercholesterolaemia (FH)-a malfunction of the lipid metabolism.

Methods

The overview of (inter-)national FH test strategies, characteristics, and ethical aspects of (predictive) GDx is based on an iterative manual literature search in the G-I-N Library and the Trip-Database, followed by a search on health specific web pages. A revision of the Socratic approach by Hofmann et al. assists in analysing ethical aspects.

Results

We selected nine countries for a detailed comparison. Important components in FH treatment are the detection method, clinical criteria indicating a diagnosis, diagnostic tools, implementation, recommendations concerning cascade screening, genetic counselling, registries, and awareness programmes. Detection and diagnosis of index patients comprise of opportunistic approaches or organised systematic screenings in non-specialized or specialized settings. The use of GDx is most often recommended after a clinical diagnosis. In the course of cascade screening of at-risk family members, GDx is partly recommended in existing strategies. Ethical issues especially concern autonomy, informed consent and privacy (addressed during the process of genetic counselling). As a diagnosis by GDx impacts at risk family members, increased risk for intra-familial conflicts arise, e.g. disclosure of test results.

Conclusions

Implementing GDx results in a number of organisational and ethical challenges. Especially, investing in professional and well-trained genetic counsellors seems to be paramount, as the numerous ethical questions require sensitive communication.

Key messages

Our report provides a basis for decision makers to resolve implementation issues of molecular genetic diagnostics in the context of familial hypercholesterolaemia beyond (cost-) effectiveness/safety. In our report we discuss important ethical aspects of molecular genetic diagnostics in the context of familial hypercholesterolaemia that need to be considered by healthcare decision makers.
Geospatial analysis of access to healthcare: child development needs and available care
Authors: Grueebler E , Gruebner O , von Rhein M
Published: October 2021

Developmental delay (DD) is one of the most frequent disorders in early childhood affecting 10-15% of all preschool children. Early identification of children with DD is critical to ensure appropriate therapeutic interventions, to support the families, and finally to prevent chronic, life-long health, educational, and social consequences. It is widely acknowledged that early intervention (EI) programs are both ethically mandatory and cost-effective for a society on a long-term perspective. However, data shows that many cases are missed in early childhood. Although research has identified potential risk factors for under-utilization of EI, the spatial distribution of children in need, referring doctors, and therapeutic places have been neglected in many research studies so far. Consequently, we do not know much about the spatial variation in EI, and knowledge on potential influencing factors for spatial variation in referral and utilization is lacking. Therefore, we aimed to quantify accessibility of care in the Canton of Zurich, Switzerland. To do so, a comprehensive data set from all children (age 0-4) admitted to the two Units of Special Needs Education (USNE) in the Canton of Zurich in 2017 (n = 1971) was used and analyzed with the Floating Catchment Area (FCA) set of methods. Our results show major differences between rural and urban regions and better accessibility closer to greater therapy institutions. Our findings highlight spatial inequalities between healthcare needs and services. Our research contributes to a better understanding of spatial access to healthcare and informs healthcare policy to help increase accessibility to EI for children with DD.

Key messages

The Canton of Zurich shows regional inequalities between EI needs and services. Spatial analyses are a valuable tool to find areas of high and low accessibility and understand spatial access to healthcare.