bluuebunny/crossref_metadata_2025 huggingface dataset:
Sick leave and disability pension before and after breast cancer diagnosis: a Swedish cohort study
Authors: Chen L C , Alexanderson K A
Published: November 2019

Background

Most working-aged women are, after diagnosed with breast cancer (BC), on some sickness absence and/or disability pension (SADP). We aimed to explore possible trajectories of their previous and subsequent SADP days and risk factors for consistently high levels of future SADP.

Methods

In a longitudinal cohort study of all 3536 women in Sweden aged 19-64 with a first BC diagnosis in 2010, we calculated their annual SADP net days from two years before to three years after BC diagnosis date. A group-based trajectory model was applied to depict SADP patterns. Logistic regressions were used to calculate odds ratios (OR) with 95% confidence intervals (CI) for having >90 or > 180 SADP days/year in the three postdiagnostic years.

Results

Three trajectories of SADP days/month over the five years were identified: “high” (30% of all)”, “increase only around diagnosis” (61%), and ’constant very high’ (9%). Across the study period, the risk factors associated with constantly high levels of SADP days (>90 or > 180 days/year) were similar. Particularly, factors significantly associated with having annual SADP >90 days during all the three postdiagnostic years were: stage II cancer (OR = 4.59; 95% CI 2.98-7.07), stage III+IV (OR = 26.57; 13.52-52.22), prediagnosis SA 1-30 days (OR = 2.73; 1.30-5.70), prediagnosis SA > 90 days (OR = 24.52; 12.25-49.08), and prediagnosis DP (OR = 659.97; 292.52->999.99).

Conclusions

When diagnosed with BC, SADP increased significantly postdiagnosis, however, decreased with time and the absolute majority had no SADP the third year after BC diagnosis. Advanced cancer stage and previous high SADP were the highest risk factors for later SADP.

Key messages

Most breast cancer survivors’ work capacity (sickness absence (SA) and disability pension (DP) is only affected shortly post-diagnosis. Prior SADP and high cancer stage were strongest risk factors. Register-based information on breast cancer patients and their sickness absence and disability pension before and after diagnosis are useful to identify different types of return-to-work patterns.
Work disability before and after incident myocardial infarction and subsequent common mental disorder
Authors: Bokenberger K , Rahman S , Wang M , Vaez M , Dorner T E , Helgesson M , Ivert T , Mittendorfer-Rutz E
Published: November 2019

Background

This study investigated the extent to which work-disability patterns including sickness absence and disability pension (SA/DP) before and after acute myocardial infarction (AMI) were associated with subsequent common mental disorders (CMDs) such as depression and anxiety in AMI patients without previous CMD.

Methods

A cohort of 11,493 patients aged 26-64 years without previous CMD with incident AMI during 2008-2010 were followed up for CMD measured as antidepressant prescription through 2013. Four SA/DP trajectory groups during the 3 years pre-AMI and 1 year post-AMI were identified. Hazard ratios (HR) and 95% confidence intervals (CI) were estimated in Cox models.

Results

Higher pre-AMI SA/DP levels (>1-12 months/year), compared to the majority of patients (78%) following low increasing annual levels (increasing up to 1 month/year) of pre-AMI SA/DP, were associated with a 40-60% increased CMD rate. Regarding post-AMI findings, constant high (∼25-30 days/month) and steeply decreasing SA/DP levels within the first 3 months were associated with a 76% and 35% higher CMD rate, respectively, compared to constant low (<1 days/month) levels. Conversely, a gradually decreasing pattern of post-AMI SA/DP over a 12-month period suggested protective influences for CMD (HR = 0.80), even after adjusting for sociodemographic and medical factors.

Conclusions

This is the first study to demonstrate that pre- and post-AMI work disability patterns are associated with subsequent CMD risk in AMI patients. Work disability patterns should be considered in clinical practice as an indicator of AMI prognosis in terms of CMD risk.

Key messages

Increasing and high persistent levels of pre-AMI work disability are associated with higher risk of subsequent CMD, while gradually decreasing post-AMI work disability has a favourable CMD prognosis. Pre- and post-AMI patterns of work disability (sickness absence and disability pension) can be a useful marker in terms of CMD prognosis.
Gender and psychological distress: contribution of work-family balance
Authors: Viertiö S , Kiviruusu O , Piirtola M , Kaprio J , Korhonen T , Marttunen M , Suvisaari J
Published: November 2019

Background

Women suffer from psychological distress more often than men. Our aim was to investigate the potential contribution of work-family balance to this gender difference.

Methods

Questionnaire data from the nationally representative 2013 Finnish Regional Health and Well-being Study (target population all adults aged 20 years or over, n = 88 377, response rate 53%), was restricted in the current analysis to those who were working and who had minor children (n = 26 442). Psychological distress was assessed using the Mental Health Index (MHI-5, cut off value < =52). Participants answered six questions on balancing work and family demands (yes/no). We used logistic regression adjusted for age, education and marital status.

Results

Women reported more distress than men (12.4% and 10.2% respectively, p = 0.000). We found statistically significant interactions between gender and two work-family demands (both p = 0.010): “I sometimes neglect my family when I am wholly absorbed in my work” was associated with distress in women (OR = 1.29, 95%CI 1.11-1.49), but not in men (OR = 0.95, 95%CI 0.79-1.14). “I feel inadequacy as a parent” had stronger association with distress in men (OR = 3.07, 95%CI 2.56-3.69) than in women (OR = 2.31, 95%CI 2.00-2.65). Both men and women had less psychological distress if they reported stopping thinking about their work at home or having more energy to be with the children when they also went to work. Correspondingly, they had more psychological distress if they felt they were neglecting home issues because of work or found hard to concentrate on work because of home issues. Common-law marriage was associated with psychological distress in women (OR = 1.43, 95%CI 1.22-1.68), but not in men (OR = 1.11, 95%CI 0.91-1.36).

Conclusions

Women felt distress about neglecting family due to being absorbed in their work while men did not. Feelings of inadequacy as a parent were associated with distress more in men.

Key messages

Both women and men struggle to coordinate work and family, but expectations how job is divided may differ by gender. Actions to improve coordination between working life and family life are needed, both within families and by political decisions.
Preterm delivery is associated with long-term risk of maternal renal disease
Authors: Barrett P , McCarthy F P , Evans M , Kublickas M , Perry I J , Stenvinkel P , Kublickiene K , Khashan A S
Published: November 2019

Background

Preterm delivery is an independent risk factor for maternal cardiovascular disease. Little is known about the association between preterm delivery and maternal renal function, and whether any association is independent of preeclampsia or intra-uterine growth restriction. This study aimed to examine the association between gestational age and long-term maternal chronic kidney disease (CKD) and end-stage kidney disease (ESKD).

Methods

Using data from the Swedish Medical Birth Register, singleton live births from 1973-2012 were identified and linked to data from the Swedish Renal Register and National Patient Register (up to 2013). Women with pre-pregnancy CKD/ESKD, cardiovascular disease, diabetes, hypertension, systemic lupus erythematosus were excluded. Gestational age at delivery was the main exposure, treated as a time-dependent variable. Primary outcomes were maternal CKD or ESKD. Cox regression was used, adjusting for maternal age, year of delivery, country of origin, education, parity, interpregnancy interval, smoking, BMI, gestational diabetes. Models were stratified by exposure to preeclampsia or small for gestational age (SGA).

Results

There were 3,847,694 pregnancies among 1,990,273 unique women. Nine percent of women (n = 172,915) had at least one preterm delivery (<37 weeks). Exposure to preterm delivery was associated with higher risk of CKD (aHR 1.48, 95%CI 1.41-1.54) and ESKD (aHR 2.52, 95%CI 2.17-2.92). Earlier gestational age at delivery was associated with increasing risk of CKD and ESKD. Women with spontaneous preterm delivery were at higher risk of CKD (vs. normal term, aHR 1.33, 95% CI 1.26-1.40) and ESKD (aHR 2.02, 95%CI 1.69-2.40) independently of preeclampsia/SGA. Associations persisted after excluding women who developed postpartum cardiovascular disease, hypertension or diabetes.

Conclusions

Women who gave birth at earlier gestation were at higher risk of later CKD and ESKD. This association persisted independently of preeclampsia and SGA.

Key messages

Preterm delivery is an independent predictor of long-term maternal renal disease. Obstetric history should be considered as part of overall risk stratification for chronic kidney disease in women.
Breastfeeding and Birth mode: comparative analysis between elective and in-labor caesarean section
Authors: Napolitani M , Lorenzini C , Kundisova L , Crescenzo F , Alaimo L , Nante N
Published: November 2019

Introduction

Evidence in literature suggests that the outcomes of children born by in-labor non-emergency caesarean section (CS) are better if compared to those born by programmed CS. The aim of this work was to evaluate impact of type of CS on neonatal outcomes and breastfeeding.

Materials and methods

The cross-sectional study was performed in the Siena province (hospital of Siena and Poggibonsi) during the period January-December 2015. All females that gave birth by CS were included, except those that had emergency CS from severe medical indication (pre-eclampsia/eclampsia, fetal distress, intrauterine growth retardation, etc) or due to multiple pregnancy.

The sample was divided in two groups (programmed CS/CS in the presence of labor). The outcome variables were: necessity of hospitalization in neonatal intensive therapy unit (NITU) or resuscitation; weight loss after birth (%), hours passed between birth and first attack to the breast, type of breastfeeding at discharge (exclusive/mixed). The statistical analysis was performed with Stata 12.

Results

In total 446 females were included (53.6% programmed CS). Any association between the type of CS and admission to NITU or resuscitation was observed.

Among the newborns born by CS in the presence of labor, there was a greater proportion of babies who attached to the breast immediately after birth (82% vs. 71%; p < 0.05) and also those exclusively breastfed at the moment of discharge (71% vs. 60%; p < 0.05).

The weight loss was lower in babies born by CS in the presence of labor (8%±1.8; 95% CI 7.7%-8.2% vs. 8.53%±1.7%; 95% CI: 8.3%-8.8%; p < 0.05).

Conclusions

Our study confirmed the negative impact of the CS in the absence of labor on the breastfeeding initiation, probably due to incomplete activation of neuroendocrine mechanisms (release of oxytocin; etc). The CS in the presence of labor is more stressful from the organizational point of view, but it helps promotion of health through the facilitation of breastfeeding.

Key messages

In-labor non-emergency caesarean section is more physiological and helps to initiate and maintain breastfeeding. The CS in the presence of labor is more stressful from the organizational point of view, but it helps promotion of health through the facilitation of breastfeeding.
Maternal obesity and severe preeclampsia among immigrant women: a mediation analysis
Authors: Siddiqui A , Deneux-Tharaux C , Luton D , Schmitz T , Mandelbrot L , Estellat C , Howell E A , Khoshnood B , Bertille N , Azria E
Published: November 2019

Background

Severe preeclampsia is known to be associated with both maternal place of birth and obesity. However, the role of prepregnancy obesity has not been well elucidated on the causal pathway between maternal origin and severe preeclampsia. We aimed to test for and quantify a mediation effect of obesity in this association.

Methods

A secondary analysis of the PreCARE prospective French cohort of pregnant women (n = 9,579). Adjusted path analysis logistic regression models tested for a mediation effect of obesity in the association between maternal place of birth and severe preeclampsia. Adjusted odds ratios and 95% confidence intervals for the total exposure-outcome association and for the direct and indirect/obesity-mediated components were calculated in addition to an estimate of the indirect/obesity-mediated effect.

Results

95 (0.99%) women developed severe preeclampsia: 47.6% were non-European immigrants, 16.3% were born in Sub-Saharan Africa, and 12.6% were obese. Obesity was both associated with Sub-Saharan African place of birth and severe preeclampsia. Women from Sub-Saharan Africa had an increased risk of severe preeclampsia compared to European-born mothers (aOR 2.53, 95% CI 1.39-4.58). The obesity-mediated effect of the association was 18% (aOR 1.18, 95%CI 1.03-1.35).

Conclusions

Sub-Saharan African immigrant women have a two-fold higher risk of developing severe preeclampsia as compared to European-born women, one-fifth of which is mediated by prepregnancy obesity. Our results provide estimates of the benefit of decreasing obesity among at-risk women.

Key messages

Obesity, a modifiable risk factor, is a target for interventions to prevent severe preeclampsia among immigrant women from Sub-Saharan Africa. Future investigations should focus on better elucidating the role of other modifiable mediators such as interaction with the health care system and quality of prenatal care.
Combined effect of adverse childhood experiences and young age on self-harm ideation after birth
Authors: Doi S , Fujiwara T
Published: November 2019

Background

Suicide among postpartum women is a new and emerging issue in developed countries. However, little is known about the combined effect of risk factors on self-harm ideation, although various risk factors have been found. The aim of this study is to examine the combined effect of maternal adverse childhood experiences and maternal age on self-harm ideation among postpartum women.

Methods

The study comprised a cross-sectional study of 8,074 mothers participating in a 3-month health checkup between September 2013 and August 2014 in City A, Prefecture A, Japan. Main outcome was self-harm ideation assessed using the Edinburgh Postnatal Depression Scale (EPDS), item 10. Possible risk factors were maternal adverse childhood experiences (ACEs), maternal characteristics, relationship with husband/partner (e.g., feelings when pregnancy was confirmed), household characteristics, child characteristics (e.g., age, sex, birth weight), and postpartum characteristics, and postpartum depression status other than self-harm ideation.

Results

Postpartum women with 3 or more ACEs and younger age (<25 years old) were 10.3 times more likely than those with no ACEs and older age to have self-harm ideation (95%CI=5.3-20.2). This combined effect was also found in first-time mothers (OR = 7.6, 95%CI=3.2-17.9).

Conclusions

Postpartum women with 3 or more ACEs and who were younger than 25 years old were at a high risk for self-harm ideation. Providing prevention strategies aimed at mothers with multiple risk factors, especially younger age and ACEs, is warranted.

Key messages

Mothers with 3 or more ACEs and younger age had a high self-harm ideation risk. Providing prevention strategies for mothers with multiple risk factors is warranted.
Maternal dietary patterns during early pregnancy and birth weight in Japan
Authors: Yamashita T , Yonezawa Y , Obara T , Ishikuro M , Usuzaki T , Murakami K , Noda A , Ueno F , Suganuma H , Kuriyama S
Published: November 2019

Background

The average birth weight in Japan has decreased by 200 g in the last 40 years. Only three studies were reported for the association between maternal dietary patterns and birth weight in East Asia, whose results were inconsistent. We examined what maternal dietary patterns were associated with the birth weight in Japan.

Methods

Totally 22,493 pregnant women were recruited between July 2013 and September 2016 into the Tohoku Medical Megabank Project Birth and Three-Generation Cohort Study. We included 17,287 women who had a full-term single healthy baby into the analysis. Consumption of food and beverage items was evaluated based on food frequency questionnaire at the first-trimester. Dietary patterns were analyzed using a machine learning method of k-means clustering algorithm. Birth weight was obtained from the medical record. The association between dietary patterns and birth weight was analyzed using multiple liner regression model adjusted for potential confounders with multiple imputation method for missing values.

Results

Dietary patterns were classified into seven groups by cluster analysis: “high in rice (reference) (n = 8046)”, “middle in vegetables, beans, mushrooms, seaweeds and miso-soup (n = 4842)”, “high in fruits (n = 1176)”, “high in bread, dairy and alcohol (n = 1091)”, “high in meat and fish (n = 1049)”, “high in coffee, black tea, soft drinks and confections (high in coffee) (n = 585)”, and “high in vegetables, beans, mushrooms, seaweeds and miso-soup (n = 498)” groups. In multiple liner regression models, birth weight was 22.6 g (95%CI: 0.1 to 45.2 g) heavier in “high in fruits” group than in reference group and 39.4 g (95%CI: 8.6 to 70.3 g) lighter in “high in coffee” group than in reference group. The other groups were not statistically significant.

Conclusions

High consumption of fruits and high consumption of coffee, black tea, soft drinks and confections during early pregnancy were associated with increased and decreased birth weight, respectively.

Key messages

We found maternal dietary patterns during early pregnancy using a machine learning method of k-means clustering algorithm. We found maternal dietary patterns which associated with the birth weight in Japan.
Breastfeeding-related social media: an online survey of UK mothers’ perceptions
Authors: Visram S , Hunter T
Published: November 2019

Background

Breastfeeding is beneficial for both maternal and infant health, contributing to reduced risk of infections and chronic disease. Despite public health efforts, just 1% of mother-infant dyads in the UK meet international recommendations to breastfeed exclusively until six months. Numerous studies have investigated the influences on suboptimal breastfeeding rates, exposing a myriad of interconnected physiological, psychological and social barriers. Conversely, social support has been shown to be positively associated with breastfeeding duration. The objective of this study was to determine whether and how UK mothers use social media to access breastfeeding advice and support.

Methods

An online survey was developed, piloted and distributed via social media using a snowball sampling approach. Responses to closed questions were analysed using SPSS and appropriate statistical tests performed. Free-text responses were analysed manually using thematic analysis.

Results

The survey was completed by 1012 mothers, with 992 (98%) reporting use of social media for breastfeeding advice and/or support. Responses revealed a largely positive perception of breastfeeding-related social media. Supportive peer networks and easily accessible information were highlighted as unique features that help to encourage and normalise breastfeeding. Non-university educated mothers were significantly more likely to report this support as “very influential” with regard to how comfortable they felt breastfeeding in public (p = 0.006). Peer-led groups were preferentially used over professional-led groups, particularly by younger women (p = 0.007).

Conclusions

There is growing interest in social media as a health platform, particularly in light of recent funding cuts impacting on access to formal support services. By supporting mothers and normalising breastfeeding, social media may help to increase UK breastfeeding rates and reduce health inequalities.

Key messages

Many mothers successfully use breastfeeding-related social media for information and support, with a preference for peer-led as opposed to professional-led groups. Future research should explore how public health services can update their practice to better harness these platforms for breastfeeding promotion.
Monitoring air pollution effects on children for supporting public health policies (MAPEC_LIFE study)
Authors: Ceretti E , Donato F , Feretti D , Carducci A , Moretti M , Donno A De , Carraro E , Biggeri A , Gelatti U
Published: November 2019

Background

Children are at high risk of suffering health consequences of air pollution and childhood exposure can increase the risk of developing chronic diseases in adulthood. The MAPEC_LIFE project, funded by EU Life+ Programme (LIFE12 ENV/IT/000614), aimed to evaluate the association between air pollution exposure and biomarkers of early effect in children and to propose guidance for implementing environmental policies.

Methods

The study was carried out on 6-8-year-old children. Micronucleus (MN) frequency was investigated in buccal cells of children and its association with air pollution exposure was assessed applying multiple Poisson regression mixed models, including socio-demographic and lifestyle factors as confounders. We also dichotomize air pollutants concentration according to the EU Ambient Air Quality Directives and WHO Air Quality Guidelines in all Poisson regression models to assess their risk predictive capacity.

Results

The project involved 1149 children providing buccal cells in winter and spring. 2139 biological samples were included in the analysis (1093 collected in winter, 1046 in spring). The analysis of the association between MN frequency and air quality parameters found positive associations for PM10, PM2.5, benzene, SO2 and ozone. Considering EU Directives, an association was found between MN frequency and PM10 exposure higher than the annual limit value, with an increase of the risk of 17.9% (95%CIs: 0.6-38.1%). Considering WHO Guidelines, the exposures to levels of PM10, benzene and BaP higher than the annual limits were associated with MN frequency, with a risk increase of 22.5%, 27.8% and 59.8% (95%CIs: 3.9-44.3%, 3.8-57.3%, 21.0-111.1%), respectively.

Conclusions

The analyses conducted showed an association between MN frequency in buccal cells of children and levels of some air pollutants, even at concentration below EU and WHO thresholds, which hence seemed to be insufficient for protecting children from this type of damage.

Key messages

Air pollution exposure induced chromosomal damage in buccal cells of children, even at concentration below the law limits. Early biological damage detected might be predictive of the occurrence of future harmful effects in humans, at a population level.
Unpaid carer inequalities: a public health concern
Authors: Carr S , Woklowski A , Parkinson M
Published: November 2019

The number of unpaid carers is rising globally and is anticipated to grow given predictions on life expectancy, morbidities and limitations on care alternatives. The estimated number in England is 5.5 million. Significant international evidence exists of potential negative impact on employment, health and wellbeing which have individual and societal consequences. This presents a major public health concern, especially as much of the experience and health consequences remain a largely hidden issue.

Drawing on two doctoral studies undertaken in the UK we expose the potential for significant health and social inequalities to be experienced by unpaid carers and offer models to enhance understanding and potentially more effective responses. The presenting author provided supervision and continues to research the topic.

Both studies were set in a translational paradigm to maximise timely utility. The experiences of the participants were privileged while attempting to ensure that the clinical, education and policy potential of the research was incorporated. Study participants were care givers for family members with life limiting illnesses, principally cancers and dementia. Qualitative methodologies were employed in both studies; one drawing significantly on realist approaches and the other on grounded theory.

There is generally a lack of consensus concerning when and how carers can best be supported. Although some support interventions were valued there are some fundamental tensions in service models which limit their potential. Specifically the centrality of the relationship is needs to be acknowledged and nurtured. Often, professionals often predominately draw on a medical model as the default intervention position when attempt to tackle carers’ health inequalities. These findings suggest that greater attention should be afforded to the potential of social coping strategies to create a more enabling rather than burden dominated perspective.

Key messages

unpaid (family)carers are at risk of being exposed to a range of health inequalities which can have individual and societal consequences. Interventions that acknowledge the relationship and draw on social dimensions may off coping may offer effective ways forward.
Shifting the Gravity of Spending: Assessing the impact of PHE’s Prioritisation Framework
Authors: Maniatopoulos G , Hunter D J , Gray J
Published: November 2019

Background

Findings are presented from the evaluation of Public Health England’s (PHE) new Prioritisation Framework (PF) conducted between September 2017 and December 2018 aimed to help local authority commissioners with their public health investment and disinvestment decisions. The study explored the take up of the PF in three early adopter local authority settings.

Methods

Data collection was based on semi-structured interviews (n = 30) across three local authorities supplemented by participant observation of workshops and data concerning the implementation process as well as spend and outcomes both before and, where possible, after using the PF.

Results

Participants acknowledged that the PF provided a systematic way to guide prioritisation decisions and one that encouraged transparency over investment and disinvestment decisions. The role performed by PHE and its regional teams in facilitating the process was especially welcomed and considered to be critical to the adoption process. However, uptake of the PF required a significant investment of time and commitment from public health teams at a time when resources were stretched. The impact of the political environment in local government was a major factor determining the likely uptake of the PF. Ensuring committed leadership and engagement from senior politicians and officers was regarded as critical to success.

Conclusions

The study assessed the value of the PF and the processes surrounding its implementation and use. Further research could further explore the value of the tool in aiding investment and disinvestment decisions and its impact on spending.

Key messages

The PF provides a platform for engaged and informed deliberation about priorities and does so in an open, structured and transparent manner. Organisational and political context in which prioritisation occur shape the adoption of the PF tool.
Are midwives ready to fight vaccine hesitancy? First results from an Italian cross-sectional study
Authors: Massimi A , Rosso A , De Vito C , Marzuillo C , Baccolini V , Pitini E , Barbato D , Villari P
Published: November 2019

Background

Pregnancy is widely recognized as a ’teachable moment’ since attitudes and beliefs about childhood vaccines are not completely structured. Among healthcare workers (HCWs), midwives play a pivotal role in the maternal care pathway and should have a key role also in promoting opportunities of discussion and correct information about vaccinations.

Methods

We conducted a cross-sectional survey to assess knowledge and attitudes of a sample of Italian midwives towards vaccinations. A questionnaire was designed ad hoc and sent electronically to midwives members of the professional register of Rome.

Results

Preliminary results on data collected from 140 midwives (mean age 37.32, DS ± 11.61; mean years on the job: 11.94 DS ± 12.78) who completed the survey showed a heterogeneous level of knowledge: only 50% of the sample indicated the correct threshold of vaccination coverage for herd immunity, while safety of multiple shots and of the additives contained in vaccines was reported by 61% and 31% of respondents, respectively. Only 41% of midwives had identified the pertussis vaccine as one of the vaccinations recommended during pregnancy. Attitudes were generally positive: 84% of respondents recognized recommended vaccines as effective and 86% as one of the safest health interventions. However, vaccinations against MMR and Varicella were perceived as useful by 86% and 71% of the midwives, while 89% and 77%, respectively, would recommend them to parents (compared to 96% in case of hexavalent). Globally, 79% of respondents would agree with the introduction of mandatory vaccinations for HCWs in maternity wards.

Conclusions

Midwives show some gaps in the knowledge on vaccinations. The final results of this study will be used to build specific and tailored training programs directed to midwives involved in pregnancy management. This may help them to transfer the correct vaccination information for the empowerment and the growth of vaccine literacy.

Key messages

Pregnancy is a strategic teachable moment to influence attitudes regarding childhood vaccinations and healthcare professionals must be trained to be the vehicle of the most accurate information. Specific under- and post-graduate training courses on vaccinations directed to midwives are strongly needed to ensure good level of knowledge on this topic.
Impact of hepatitis B vaccine in Tunisia 20 years after its introduction
Authors: Lahchaichi A , Hadj M Ben , Bouguerra H , Talmoudi K , Bahrini A , Bahri O , Letaief H , Hazgui O , Hannachi N , Bouafif N Ben Alaya
Published: November 2019

Introduction

Vaccination against hepatitis B represents the most effective preventive measure to reduce the global impact of this infection. In Tunisia hepatitis B vaccination was introduced for health professionals in 1992 and for the general population in 1995. The objectives of this study were to evaluate the impact of vaccination twenty years after its introduction.

Methods

It was a descriptive study of data provided by the national survey of prevalence of Hepatitis B in Tunisia, which was a household-based study conducted in 2015. Blood samples sent to the reference laboratory to test markers of hepatitis B virus infection. The Vaccine effectiveness rate was calculated using the following formula: VE = 1 - Odds-ratio (OR), where OR = ratio of odds of being vaccinated among subjects with positive HBsAg test results to the odds of being vaccinated among subjects with negative HBsAg test results.

Results

Approximately a quarter of our population reported having been vaccinated against HBV, a coverage rate of 26.9%. Among subjects above 20 years of age, this rate was 85.3%. Besides, 83.7% of vaccinated subjects had received the three required doses of the HBV vaccine. Analysis of vaccination status by great regions of the country showed that the vaccination coverage rate was higher in the southern region. Regarding HBsAg prevalence, the rate was significantly higher among unvaccinated subjects 0.3% vs 2.2% in those vaccinated (OR = 0.11 [0.07-0.18]). We found that among vaccinated subjects, the serologic response rate at vaccination was only 63.2% which represented 16.2% of the total population. The vaccine effectiveness indicated that vaccination reduced by 88.6% the risk of HBV infection.

Conclusions

These results demonstrate that vaccination against hepatitis B introduced in the national immunization schedule since 1995 has reduced the infection although the vaccination coverage rate remains below 90%.

Key messages

Importance of vaccination that reduced by 88.6% the risk of HBV infection. More effort required to raise awareness about vaccination against HBV.
Serologic antibody response to quadrivalent influenza vaccination in Polish elderly patients
Authors: Dubiel P , Ganczak M , Drozd-Dąbrowska M , Hallmann-Szelińska E , Szymański K , Brydak L B
Published: November 2019

Background

The effectiveness of immunization with subunit inactivated quadrivalent influenza vaccine (QIV) in the elderly has not been sufficiently estimated. The study objective was to evaluate QIV-induced antibody response and influencing determinants in Polish elderly patients.

Methods

Consecutive patients ≥55 years old attending the Primary Care Clinic in Gryfino, Poland, received QIV (A/Michigan/45/2015 [A/H1N1/pdm09], A/Singapore/INFIMH-16-0019/2016 [A/H3N2/], B/Colorado/06/2017 [Victoria lineage], B/Phuket/3073/2013 [Yamagata lineage]) between October-December 2018. Hemagglutination-inhibition assays measured antibody response to vaccine strains before/after vaccination. Geometric mean titer (GMT)/titers ratio (GMTR), protection (PR) and response (RR) rates were calculated.

Results

Among 108 participants (45.4% females; age 55-85, median 67 years) the highest GMTR after vaccination was observed for A/H3N2/(61.5-fold) followed by Victoria lineage (10.3-fold), A/H1N1/pdm09 (8.4-fold) and Yamagata lineage (3.0-fold). Most participants had a post-QIV protection for A/H3N2/and Yamagata lineage vaccine strains (64.8%, 70.4% respectively); lower PR were observed for Victoria lineage (57.4%) and A/H1N1/pdm09 (41.8%). The RR was high for A/H3N2/(91.7%) and Victoria lineage (68.5%), however, not satisfactory for A/H1N1/pdm09 and Yamagata lineage (59.3%, 52.8% respectively). Patients who received influenza vaccination in the previous year presented lower response to the both B strains compared to those who did not (p < 0.0001 and p = 0.03 respectively).

Conclusions

Although vaccine-induced antibody response in the elderly Polish population was more effective against A/H3N2/and B Victoria, this introductory study supports the use of QIV. Prior season vaccination was associated with lower antibody response to the current vaccination; this was not consistent to vaccine strains. Further research to better investigate QIV effectiveness determinants in the elderly would be of value.

Key messages

Subunit inactivated quadrivalent influenza vaccine (QIV) is effective in elderly people and should be used. The response to vaccination is not consistent and depends on the strain of influenza virus.
Improving access to post-exposure prophylaxis for Lyme disease: a role for community pharmacists
Authors: Baron G , Pinsonneault L , Binet A , Philie C-A , Bonapace-Potvin M , Lio S
Published: November 2019

Issue

Virtually non-existent in Eastern Townships (ET) before 2010, Lyme disease incidence rate reached 52 confirmed cases per 100 000 in some districts in 2018, leading to post-exposure prophylaxis (PEP) recommendation by public health. To improve access to PEP, community pharmacists can now screen and initiate PEP under a collaborative practice agreement (CPA) with the regional Medical Officer of Health. Knowledge, attitudes and practices of pharmacists regarding Lyme disease PEP were surveyed after implementation of this measure.

Description of the problem

312 community pharmacists practicing in ET were invited, in October 2018, to complete an online survey, based on Godin’s integrative model (2012), with questions on professional characteristics, knowledge of CPA, attitudes about PEP, and facilitators and barriers to the use of CPA. Pharmacist’s practices were evaluated using 8 clinical vignettes. Vignette-specific and a global score were calculated. Bivariate analyses were done to test the association between global score and knowledge, attitudes, facilitators and barriers.

Results

Response rate was 13.8%. Most pharmacists knew (97.4%) and were in favor (93.1%) of the CPA, and believed it was effective to prevent Lyme disease (96.4%). The main barriers reported to using the CPA were related to the assessment of PEP criteria. With regards to practice, pharmacists answered correctly for clients presenting all criteria for PEP (80.6%), aged < 8 y.o. (51.6%), who had their tick removed for >72 hrs (67.7%), already presenting with symptoms (32.3%) or who had exposure in a non-endemic area (38.7%). Finally, none of the variables studied were associated with the global score.

Lessons

This measure has now been expanded in other endemic regions in Quebec and a provincial CPA is under development. These results will help guide the development of the provincial CPA, specifically to better consider and to provide guidance regarding PEP contraindications.

Key messages

Pharmacist-initiated PEP is an innovative approach to increase timely population access to an essential preventive measure in the fight against Lyme disease in endemic districts. Additional guidance is required for pharmacists with regards to assessment of PEP criteria in future CPAs.
Treatment of the opioid use disorder in the primary health care in The City of Zagreb
Authors: Margreitner M , Grbic D Stimac , Manzin O Santini , Lang V Bralic
Published: November 2019

Issue/problem

Management of patients with opioid use disorder commonly includes opioid agonist therapy as a part of an integrated treatment plan. These interventions are associated with proven benefits to the individual and society. Treatment choices in opioid use disorder pharmacotherapy should be based on the needs of the individual and characteristics of medications.

Description of the problem

The aim was to present the use of pharmacotherapy in the treatment of opioid use disorder in family medicine practice in Zagreb. We collected data from 30 family physician practices, on patients treated for opioid use disorder. We analyzed the epidemiological characteristics of the patient, the diagnosis according to ICD X rev., as well as the frequency of the medication use and the duration of the treatment.

Results

Data about 100 patients treated for opioid use disorder were obtained, (88% men and 12% women). The average age of the patients was 37.9 years. From all patients, 31% had dg. F.60, 22% had dg. F19, 15% had dg. F32, 3% had dg. F29. 19% of patients was HCV positive. 62%of patients were treated with buprenorphine and 38% with methadone. In 5% of patients buprenorphine was only medication in therapy. 53% of patients with buprenorphine use diazepam, 30% use buprenorphine with antidepressant, and 12% use diazepam and antidepressant with buprenorphine. All patients who are on methadone therapy are using some other medication in therapy. Methadone is commonly prescribed in combination with diazepam and antidepressant (55%). The following combination is methadone and diazepam (34%), a combination of methadone, antipsychotics and pregabalin (7%) and a combination of methadone, antidepressants and antipsychotics (4%). The average duration of treatment for opiate addicts is 11.9 years.

Lessons

Patients who use buprenorphine in the treatment of opioid use disorder have less need for additional medication in therapy than patients who use methadone.

Key messages

Patients who use buprenorphine in the treatment of opioid use disorder have less need for additional medication in therapy than patients who use methadone. Treatment choices in opioid use disorder pharmacotherapy should be based on the needs of the individual and characteristics of medications.
Delegation of medical services to specially trained medical practice assistants
Authors: Jedro C , Holmberg C , Kuhlmey A , Tille F , Stumm J , Schnitzer S
Published: November 2019

Background

Germany is one of the countries most affected by demographic change. Meaning the shift towards the population being older is growing. At the same time, the number of doctors is declining. In order to ensure adequate care in Germany, the delegation of medical services to specially trained medical practice assistants (MPAs) is currently discussed. The aim of this study was to assess the attitudes of the German population towards medical delegation.

Methods

The analysis was based on a population survey of 6.105 German-speaking residents aged 18 years and over. Associations between respondents’ attitudes towards the delegation and social determinants (age, gender, education, employment status, region, self-rated health) were assessed using standardised questionnaires. Bi- and multivariate (logistic regression) analyses were performed.

Results

In case of a chronic disease half of the German-speaking population (51. 8%) would accept getting treated by a MPA. More older participants (65 years and above) than younger participants (18 to 34 years old) (OR: 1,64; KI [1,24-2,18]), more lower than higher educated participants (OR: 1,20; KI [1,04-1,39]) and more non-German than German participants (OR: 1,61; KI [1,24-2,10]) are significantly more likely to not accept medical delegation in case of a chronic disease. Discussion: In the debate on delegation models the present results should be taken into account in order to be able to address relevant target-groups. Further qualitative studies that investigate the reasons for the critical view on delegation are recommended.

Key messages

Approximately 50% of the German-speaking study population would accept treatment by a MPA for chronic disease. Especially older study participants, lower educated people and non-German participants would not accept medical delegation in case of a chronic disease.
Early socioeconomic circumstances and adverse childhood experiences in 10-year-old children
Authors: Peres F Soares , Soares S , Barros H , Santos A C , Fraga S
Published: November 2019

Background

Evidence showed that adverse childhood experiences (ACEs) are associated with the development of disease later in life and premature death. Examining the occurrence of these experiences at early ages would contribute to intervene and therefore to reduce health inequalities. This study aimed to assess the prevalence of ACEs among 10-year-children and to examine its association with early socioeconomic circumstances.

Methods

At the fourth wave of the population-based birth cohort Generation XXI, from Porto, Portugal, 5153 children completed a self-report questionnaire on 9 experiences related to household dysfunction and physical and emotional abuse. Socioeconomic circumstances included household income, maternal and paternal education, and history of parental unemployment. Logistic regression was performed to calculate the Odds Ratios (OR) and 95% Confidence Intervals (95%CI).

Results

A high prevalence of physical and emotional abuse was reported by children from low socioeconomic circumstances. A graded relationship between socioeconomic circumstances and cumulative ACEs was observed, for instance, low household income was associated with increased number of ACEs (one event [OR = 1.10; 95%CI: 0.89-1.36], two events [OR = 1.41; 95%CI: 1.15-1.73], three events [OR = 1.67; 95%CI: 1.34-2.06], and four or more events [OR = 2.05; 95%CI: 1.64-2.55]). Also, living with one parent or none of them increased the likelihood of reporting multiple ACEs (OR = 5.50; 95%CI: 4.23-7.13).

Conclusions

Children from low socioeconomic circumstances were more likely to report multiple adverse experiences in the first decade of life. These findings support that children from less advantaged environments might be at a higher risk of co-occurrence of adverse experiences during their childhood.

Key messages

Prevalence of ACEs is high among 10-year-old children and is associated with low socioeconomic circumstances. Social inequalities in children should be prioritized by public health policy.
Spatial analysis and mapping of child malnutrition in Burkina Faso
Authors: Chuang Y
Published: November 2019

Background

Approximately 45% of all child deaths are associated with malnutrition in sub-Saharan Africa. However, information on the geographical variations of child malnutrition in Burkina Faso is limited. This study examined the geographical distribution and the community characteristics associated with child malnutrition in Burkina Faso using spatial regression analysis.

Methods

Data from the 2011 Burkina Faso Demographic Health Survey were analyzed. A representative sample of 572 communities and 6,120 children under age of five were in the survey. A general Kriging interpolation method was used to generate spatial malnutrition patterns. The Local Indicator of Spatial Autocorrelation was used to identify particular communities clustering with high and low child malnutrition scores. In the spatial regression analysis, we used a two-step procedure combining generalized estimating equation models (GEE) and spatial lag modeling techniques.

Results

The average rates of stunting and wasting were 32.48%, and 15.05%, respectively. Stunting hotspots were observed to be in the eastern and northeastern part of Burkina Faso (i.e. Oudolan, Séno), while high rates of wasting were observed in the central-north part. The results of the spatial regression analysis revealed lower stunting rates in communities with a higher percentage of households with improved sanitation. Communities with higher rates of professionally assisted births were associated with low wasting rates while communities with higher rates of households with low wealth index reported higher rates of wasting. Spatial lag models appeared to estimate the relationship between community-level risk factors and stunting and wasting more accurately than the ordinary least squares models.

Conclusions

This study revealed significant geographical patterns and community factors associated with childhood malnutrition. These factors should be considered for future programs aiming at reducing child malnutrition in Burkina Faso.

Key messages

The study identifies spatial trends and contextual factors associated with child malnutrition in Burkina Faso. Public health programs should focus on the regions identified as hot spots of child malnutrition in Burkina Faso.