bluuebunny/crossref_metadata_2025 huggingface dataset:
Obesity Prevalence in Alabama: Trends from 2011 to 2017 and Evaluation of a State Obesity Program
Authors: Dong Z , Pan S W
Published: November 2019

Background

Alabama, one of the southeastern states in the US, suffers from a heavy burden of obesity. In 2014, Alabama launched a state program named ’ALProHealth’, aiming to prevent and reduce obesity prevalence. The objective of this study is to evaluate the potential impact of the ALProHealth Program on the prevalence of obesity in Alabama from 2014 to 2017.

Methods

Data for this study come from the Behavioral Risk Factor Surveillance System (BRFSS). An interrupted time series design was employed. The state obesity prevalence trend for the pre-program period (2011-2014) was estimated and compared with the post-program period (2015-2017). Statistical analyses were conducted using segmented linear regression. Indiana was chosen as the control group in this study.

Results

The obesity prevalence in Alabama significantly increased from 31.8% in 2011 to 36.2% in 2017, increasing by 0.81% on average each year (95% CI: 0.47 to 1.15, p = 0.002). Before the ALProHealth Program, the obesity prevalence increased by 0.59% (p = 0.11) and 0.32% (p = 0.34) in both Alabama and Indiana respectively, though it is not statistically significant. After the program implementation, the slope of obesity prevalence increased by 0.43 (p = 0.45) and 0.03 (p = 0.96) in Alabama and Indiana respectively, though change is not significant. When comparing Alabama and Indiana, the rate of slope change is higher in Alabama (0.73) compared with Indiana (0.093), indicating the rate of slope change in obesity prevalence increased faster in Alabama than Indiana.

Conclusions

To sum up, the study found no evidence that the ALProHealth Program contributed to the decrease of obesity prevalence in Alabama. One possible reason is that there was low program coverage. Future studies should examine the potential effectiveness of other programs using a similar conceptual model as ALProHealth Program.

Key messages

In 2014, Alabama launched a state program named ‘ALProHealth’, aiming to prevent and reduce obesity prevalence. The study found no evidence that the ALProHealth Program contributed to the statewide decrease of obesity prevalence in Alabama, which may attribute to low program coverage.
Transition to health democracy in France: occupational therapy for population-based interventions
Authors: Albuquerque S , Farias L
Published: November 2019

Background

Health promotion stands as a core value of occupational therapy, a client-centred healthcare profession that achieves this goal by enhancing individuals’ ability to engage in activities that they want to, need to, or are expected to do. Yet, occupational therapists in France have not been working in alliance with Public Health funding or programs in the community to reduce possible illnesses leading to chronic conditions and hospitalizations. There is a need to discuss how these professionals can collaborate with Public Health initiatives to move beyond individual interventions and address population-based needs. This study explores occupational therapists opportunities to develop health promotion practices in France.

Methods

A participatory action research was conducted with six co-participants using occupational justice-based frameworks and the French National Public Health report on Health Promotion as a ground for discussion which extended over 3 months. Qualitative content analysis and Kemmis’ practice architecture theory was used to understand how practices are shaped by discursive, economic and socio-political circumstances.

Results

Preliminary results show that occupational justice-based reasoning enables practitioners to shift from an individual to a population needs focus. Yet, the lack of education for this type of practices is evident. The findings highlight prerequisites that need to be fulfilled in order to apply an occupational justice-based approach within health promotion initiatives.

Conclusions

Working on community settings allows practitioners to comprehend the complex interactions between individuals and context. Public Health field provides an interface between society requirements and populations needs in which occupational therapist could enact health promoting interventions. The practice in this field is emerging and therefore it is relevant to discuss the competencies that should be included within occupational therapy education.

Key messages

A healthcare system that does not consider its population’s contextual situation is a failing system. France’s welfare transformation requires all professionals to develop community-based initiatives. The findings will support the development of the first guidelines for health promotion occupational therapy practices in France.
Measuring health promotion in a sports club setting: a modified Delphi study
Authors: Johnson S , Vuillemin A , Geidne S , Kokko S , Epstein J , Van Hoye A
Published: November 2019

Background

The settings-based approach has become an increasing focus in health promotion since the World Health Organization’s 1986 Ottawa Charter. Schools and cities have implemented this approach, but development within sports clubs is limited. Thus, an internationally validated measurement of health promotion within this setting is lacking.

Methods

A modified Delphi study was completed to develop an international evaluation tool grounded in the settings-based approach. Expert panelists from academia, sports and health sectors were invited to participate in 3 online rounds. Items were generated or selected based on 3 prior Delphi-based studies and 2 nationally validated scales. Round one created a collaborative list of items, round two validated items based on relevance, importance and feasibility and the final round classified items into one of four determinants: cultural, social, environmental or economic.

Results

Panelists (69) from 13 countries participated in creating a final list of 62 items at 3 organizational levels. The sports club level included; 5 cultural, 6 social, 6 environmental and 5 economic items. The management level included; 5 cultural, 5 social, 5 environmental and 3 economic items. The coaching level included; 5 cultural, 5 social, 4 environmental and 4 economic items.

Conclusions

This study provides three important innovations; 1- it is rooted in theory through the settings-based approach, 2- the measurement tool includes three levels within sports clubs, capturing a whole club dynamic and 3- all items included in the tool have been validated by an international panel of experts.

Key messages

This 62-item measurement tool allows the comparison of perceptions from participants, coaches and management regarding how health is promoted within their sports club. This information offers insight on the capacity of sports clubs to implement and monitor policies and practices on the promotion of health beyond sports performance within their organization.
Improving health outcomes in Northamptonshire’s Homeless population
Authors: Latif S , Sen A
Published: November 2019

Issue

Homeless people experience inequalities and barriers to accessing healthcare. Northamptonshire had significantly higher number of homeless compared to the England average.

This pilot aimed to provide health screening and interventions for Northampton’s homeless population using an integrated system wide approach. This would inform commissioning and contribute to the database.

Description

The project used a collaborative resource pooling approach by 24 NHS and non-NHS partners. Planning was reliant on information from voluntary sector so budgets were estimated.

Health outreach clinics were planned over 3 months and delivered over 3 weeks at 10 voluntary centres offering blood borne viruses (BBV) and latent tuberculosis screening; basic health checks; and Hepatitis B and seasonal flu vaccinations. Unregistered people were supported to register with a GP. Evaluation will determine how to better collect data and promote and offer such a service.

Results

127 people received basic health checks; 27 were overweight and 20 had high blood pressure. Of the 102 tested for BBVs, 5 were Hep C +ive and 2 were Hep B +ive. A fifth of those tested for LTBI were positive. In total, 67 Hepatitis B and 12 seasonal-flu vaccinations were given. 12 people required GP registrations. Primary and secondary care referrals were made.

Following the pilot, services will provide wrap around care for Northamptonshire’s homeless. Clinics at various times and locations will enable homeless people to engage with health and social services.

Lessons

Difficult to stratify the homeless and identify needs This innovative project was used as a case study by other areas Published data underestimates numbers of homeless Allow Adequate preparation for such events Consider health and safety risk assessment of venues during planning Staff continuity ensures consistent team working Dedicated communications lead support required

Key messages

Wraparound health promoting services are required to enable this cohort of population to engage with and seek health and social care. A multisectoral approach is required to improve and address inequalities of vulnerable groups.
School children’s perspectives on food literacy as competencies – insights from a qualitative study
Authors: Ljungmann C , Stjernqvist N , Bonde A
Published: November 2019

Background

Food literacy (FL) has developed as a relatively new theoretical concept, which according to Benn (2014) captures not only knowledge about healthy food (to know) and cooking skills (to do), but also the sensing of food (to sense), care of others (to care) as well as citizenship involvement in food issues (to want). Empirical studies of the concept are, however, few. The aim was to test the applicability of the 5 theoretical competencies of food literacy in school children aged 12-14 years.

Methods

The operationalisation of the theory into a practical context occurred in three steps using a qualitative approach; 1) Concretizing the domains of the model by defining sub elements to each domain and questions to each sub element. 2) Reviewing questions by a panel of 10 experts in food and education, and subsequently adjusting and reducing according to comments. 3) Conducting participatory observations on a food camp and 4 focus group interviews with a total of 21 school children.

Findings

In practice the competencies are often complementing each other as described by the theory. In relation to the competence ’to know’, the children argued how they achieved more knowledge through hands-on activities. An important element of the competence ’to do’ was getting support from adults when trying new techniques. ’To sense’ was illuminated in the children’s talks about learning to seasoning. ’To care’ was apparent in the children’s appreciation of making food together and the development of cooperation skills while ’to want’ was observed in making of leftovers into “new” dishes and talks on subjects such as food production.

Conclusions

The 5 competencies can be found in everyday practices and are often complementing each other in a learning process. This highlights the need to build on a broad concept of food literacy that addresses more than one competence hence creating broader understandings and practical skills.

Key messages

This study has tested the applicability of a theoretical concept, food literacy, and has found it useful in practice to highlight specific competencies and their interconnectedness. The insights into practical examples of the interconnected competencies can be used to guide future interventions that aims to promote food literacy.
Internalization of rules and risk-behavior among early adolescents and relevance for public health
Authors: Benka J , Orosova O , Bacikova-Sleskova M
Published: November 2019

Introduction

Self-determination theory (SDT) is a macro theory of human behavior and provides a substantial theoretical background for understanding and changing qualitative aspects of behavioral regulation such as the level of internalization in the context of health-related behaviors of individuals and communities. The aim of this study is to use this theory to focus on the internalization of parental rules in early adolescents in Slovakia and examine it in relation to their risk behavior.

Methods

A sample of 581 early adolescents (mean age = 12.5 SD = 0.5; 49% girls) from Slovakia participated in a larger project focusing on health-related behaviors (APVV-0253-11, APVV-15-0662). They completed measures based on SDT addressing the level of internalization or parental rules and the risk behaviors of alcohol use and smoking. These risk behaviors were measured on a dichotomous level (used/ not used). Binary logistic regressions were used to explore the relationship between the level of the internalization of rules with respect to alcohol use and smoking controlling for the relevant variables.

Results

The results of the analyses showed that after controlling for age and gender, internalized parental rules were negatively associated with alcohol use (95%CI=0.918-0.981). Conversely, the extrinsic regulation of parental rules indicated a higher likelihood of using alcohol (95%CI=1.039-1.151). However, this was not observed in smoking which was found to not be associated with rule internalization.

Conclusions

The findings stress the importance and relevance of the internalization process when studying behavioral regulation in the context of health. This was demonstrated in the internalizing of parental rules among early adolescents. However, the findings also suggest that a different approach might be needed with different contexts and different health related behaviors.

Key messages

Acknowledging the importance of the qualitative aspects of self/behavioral regulation such as the level of internalization may improve public health interventions. A different approach might be needed when internalization is considered in different contexts and different health related behaviors.
Survey of nosocomial influenza in South-western Swiss hospitals during two seasonal epidemics
Authors: Hequet D , Qalla-Widmer L , Balmelli C , Clerc O , Fuehrer U , Iten A , Portillo V , Senn L , Troillet N
Published: November 2019

Nosocomial influenza increases morbidity and mortality in hospitalised patients. No multicentre study analysed its impact in Swiss hospitals yet. This study was conducted From November 1st to April 30th in 2016-2017 and 2017-2018 in 27 acute-care public hospitals in South-western Switzerland. It aimed at describing nosocomial cases of seasonal influenza. During these 2 time-periods, every patient hospitalized for >72 hours that was positively screened by RT-PCR or antigen detection for influenza was retrospectively included in the survey. Policies to prevent influenza were collected in each participating hospital. Characteristics of patients included age, sex, and comorbidities. Included patients were followed-up until discharge or death. Complications and administration of anti-neuraminidases and/or antibiotics were registered.

The mean influenza vaccine coverage of healthcare workers (HCW) was 40%. 836 patients were included (98% with a type A influenza virus in 2016-2017; 77% with a type B virus in 2017-2018). Most patients (81%) had an unknown vaccine status. Overall, the incidence of nosocomial influenza was 0.3/100 admissions (0.35/1000 patient-days). The most frequent comorbidities were diabetes (21%), chronic respiratory diseases (18%), and malnutrition (17%). Fever (77%) and cough (66%) were the most frequent symptoms. 70% of patients received anti-neuraminidases, 28% received antibiotics. Infectious complications such as pneumonia were reported in 8%. Overall, the all-cause mortality was 6%.

The occurrence of nosocomial influenza underlines the importance of vaccinating patients and HCW, rapidly recognising community or hospital-acquired cases, and applying adequate additional measures to prevent dissemination, including the timely administration of anti-neuraminidases to avoid antibiotic use (and misuse).

Key messages

Important to encourage patients to be vaccinated against influenza. Apply additional measures in order to prevent influenza dissemination.
Laboratory based Influenza sentinel surveillance in Pakistan At NIC, Islamabad 2007-2017
Authors: Bashir F , Fawad Khan K , Zafar Qureshi S , Khaudaidad F , Sonia R
Published: November 2019

Background

A country-wide lab-based surveillance system for ILI and Severe Acute Respiratory Illness (SARI) with weekly sampling and reporting was established in 2008.This system was necessary for early detection of emerging novel influenza subtypes and timely response for influenza prevention and control.

Objectives

To assess the trends of Influenza-like-Illness(ILI) and to monitor the predominant circulating strains of influenza viruses through Lab based sentinel surveillance.

Methods

A cross-sectional study was conducted based on ten years (2007-2017) influenza surveillance data obtained from National Influenza Central Laboratory Pakistan (NICLP) from January to March 2018.Study was done from the data records and samples of suspected ILI patients and SARI patients received from all seven sentinel sites. An ILI case was defined as sudden onset of fever of ≥ 38 C° and cough, with onset within last 10 days, while patients with sudden onset of fever (>38 °C), cough/sore throat requiring hospital admission within 7 days were termed as SARI. Samples were tested at NICLP for confirmation of virus, typing and subtyping by RT-PCR.

Results

A total of 15885 samples were analyzed during ten years period, out of which 3475(21.9%) were found positive for influenza virus. Among positive samples 26(0.75%) were Influenza-A (H1N1), 550(38%) were A/H3N1,550(15.9%) were A/H3N1,1587(45.7%) were A/H1N1 pdm09and 1312(37.8%) were influenza B. Males were predominant(54%).Influenza Maximum cases were reported from age group 01->12 years(66%).Virus circulation was detected throughout the year along with few cases of seasonal A/H1N1 virus during late winter(January February) and spring(March). Influenza A/H3N2 virus circulation was mainly observed during summer months (August-October).

Conclusions

The findings of this study emphasize the need for continuous and comprehensive influenza surveillance to predict seasonal trends for vaccine development and to further fortify pandemic preparedness.

Key messages

The need for continuous and comprehensive influenza surveillance. Public health importance by pandemic preparedness.
Evaluating latent tuberculosis testing and treatment programme for new migrants in South East England
Authors: Paudyal P , Mason A , Gedi A , Purcell B
Published: November 2019

Background

Tuberculosis (TB) cases in England often originate from high burden TB countries due to ’reactivation’ of the latent TB infection (LTBI), an asymptomatic and non-infectious phase lasting years. 5,137 TB cases were notified in England in 2017, and 71% of these patients were born outside the UK. This mixed-method study evaluated the implementation of the four LTBI testing and treatment programme for new migrants in South East (SE) England.

Methods

A retrospective database (May 2016-Feb 2018) review was undertaken to identify LTBI cases using multiple data sources; LTBI testing laboratories, LTBI programmes, and the national TB team at Public Health England. In addition, a survey questionnaire was emailed to 51 stakeholders (45% response rate) and five in-depth interviews were conducted with LTBI programme leads/TB nurses to explore the challenges of the programme. Quantitative data were analysed using descriptive summary statistics and qualitative interviews were analysed using thematic content analysis.

Results

Of the 5931 eligible patients, 40 % (n = 2391) accepted the LTBI test and 13.4% (n = 321) tested positive. 93.1% (n = 299) of the positive patients were referred for treatment and 63.8% (n = 191) of these accepted the treatment. The programme also picked up 18 active TB cases, an unexpected incidental finding. Results from the survey and the interviews identified laboratory arrangements, workforce, and data collection/management as the greatest challenges for the LTBI programme. Patient focused care, cultural understanding, success in testing/treating migrants, and raising awareness amongst professionals/communities were highlighted as achievements of the programme.

Conclusions

This study found that LTBI programmes in SE England are in line with national expectations and other LTBI programmes in England. The study recognises the achievements and good practice of the LTBI teams in SE England and identifies key barriers to improve the service for the future.

Key messages

Data collection and management is the biggest challenges of the LTBI programmes in SE England. The LTBI programmes in SE England are in line with national expectations.
Analysis of risk factors for occupationally acquired HBV, HCV, HIV infections in Polish paramedics
Authors: Topczewska Katarzyna , Gańczak Maria
Published: November 2019

Background

Paramedics constitute a group of professionals constantly exposed to potentially infectious biological material through close contacts with patients, possibly resulting in occupationally acquired infections.

Objectives

To assess the prevalence and to analyze selected risk factors for occupationally acquired HBV, HCV and HIV infections among Polish paramedics.

Methods

Between December 2018-April 2019 a cross-sectional sero-survey was conducted in 6 randomly selected ambulance stations in the West Pomeranian region of Poland with the use of an anonymous questionnaire. Serum samples were assessed for anti-HBc total, anti-HCV, anti-HIV with the use of 3rd-generation testing methods.

Results

Response rate was 83%; 141 participants (82% males, median age 33 years, median length of practice 11.9 years) agreed to participate. Anti-HBc were found in 7% participants, none of infected individuals was aware of an infection; no anti-HCV/anti-HIV positive paramedics were recognized. Risk factors for occupationally acquired infections were as follows: 5.1% paramedics were not vaccinated against HBV, 18.3% sustained ≥ 1 sharps injury in the preceding year (44.4% of incidents were not reported), 95.6% irregularly used masks/goggles, 6.2% used gloves irregularly (the lack of availability was the most commonly stated reason), 5.1% had never participated in infection control training, 61.6 % did not use safety engineered devices at work, 52.2% reported recapping a needle in the last 12 months. The risk of a single exposure to HBV was correctly defined by 40.2 % of participants, to HCV - by 33.0%, to HIV - by 28.3%.

Conclusions

Most risk factors for occupationally acquired blood-borne infections among Polish paramedics are modifiable. Unsatisfactory knowledge about the occupational exposure risks and poor compliance with infection-control procedures call for better risk recognition and assessment to reduce HBV, HCV and HIV infections in this group of health professionals.

Key messages

Paramedics showed detectable markers of HBV infection; individuals with not recognized occupationally acquired infection could be a source of infection for patients. Existing policies should be reinforced, and better surveillance for occupational risks should be instituted to minimize occupational blood borne infections among paramedics.
How to reach high behavioral riskgroups for HBV-vaccination: combining offline and online strategies
Authors: Urbanus A T , Meiberg A E
Published: November 2019

Issue

Since 2002, the Netherlands started a hepatitis B-vaccination program targeted at high behavioral risk groups in absence of a universal vaccination policy (implemented from 2011 onwards). The Public Health Services (PHS) offer free HBV-vaccination to sexworkers (SW) and men who have sex with men (MSM). In order to increase vaccination coverage and adherence a combination of offline and online strategies was used.

Description

In 2002 the HBV-program started to reach risk groups by offline outreach activities like visiting sauna’s, brothels, festivals etc. In addition targeted campaigns were developed: posters and incentives were used at outreach locations. Gradually, reaching the riskgroups at location became less effective and more costly, therefore online outreach became more important: targeted campaigns are conducted via social media, online dating platforms and commercial sex websites. These campaigns refer to websites with sexual health information, tailored advice and an online module to schedule vaccination appointments.

Results

In 16 years’ time, the program reached over 62,000 MSM and 23,000 SW with a combination of offline and online strategies. Nowadays, PHS nurses organize each year around 70-80 regional (online and offline) outreach actions for MSM and around 30-35 for SW. in 2017-2018 9-13% of the first vaccinations among MSM and SW was facilitated by the online appointment module. In addition, each year PHS are motivated to develop innovative plans in order to increase vaccination coverage such as informative meetings for MSM migrants with a festive touch, and in-depth research in how to reach male and female SW at home.

Lessons

Combining targeted online and offline strategies in order to reach the risk groups for vaccination has been successful over the past 16 years. Each year about 4,000 MSM and 1,000 SW receive their first HBV-vaccination thanks to constant commitment and creativity of enthusiastic health professionals for new approaches.

Key messages

Combining targeted online and offline strategies in order to reach the risk groups for vaccination has been successful. Encouraging innovative plans is succesful in reaching high behavioral risk groups for vaccinations.
Perioperative antibiotic prophylaxis: tools, results and reflections from a 6-year monitoring
Authors: d’Angelo M , Malacarne F , Perri G , Smaniotto C , Battistella C , Brunelli L , Madia A , Arnoldo L , Cocconi R , Brusaferro S
Published: November 2019

Background

Perioperative antimicrobial prophylaxis is a key practice to prevent surgical site infection. The Udine Healthcare and University Integrated Trust has defined its features in a specific procedure, available on the hospital Intranet. Compliance with the procedure has been monitored on a semi-annual basis.

Methods

Between July 2013 and December 2018 15 clinical records per semester for each one of the 16 surgical units were randomly extracted, including ordinary admissions with clean or clean/contaminated surgery. Compliance with the procedure was monitored for all the items considered: drug, dosage, timing of administration, redosing and duration of prophylaxis. A first comparison analysis both between semesters and for longer time frames was performed with the chi-square test; to evaluate the presence of a linear trend all over time (in semestres), the Pearson linear correlation coefficient was calculated; in case of correlation, a simple two-variable linear regression analysis was performed. Statistical significance was assessed for p < 0.05.

Results

A sample of 2775 records was evaluated. Focusing on the first and last semester of monitoring, overall compliance increased in 9 of the 16 units, although there is a drop, when extending the analysis to the whole sample (72% vs 70.8%) with no statistical significance. Otherwise a statistically significant difference is recorded between the first and the last two years of analysis (p <0.007), with an increase of overall compliance from 64.2% (2013-2014) to 69.7% (2017-2018). Finally a strong and significant negative correlation between time and overall compliance to redosing emerges (r = -0.79; p = 0.004).

Conclusions

Compliance with hospital procedure has substantially improved over time reaching a stable performance value. However the linear regression analysis highlights the need to implement new intervention strategies in order to increase overall compliance to redosing.

Key messages

Overall compliance with hospital procedure has improved over time. Results highlight the need to implement new intervention strategies.
Determinants of influenza vaccination uptake among Polish school teachers
Authors: Ganczak M , Biesiada D , Molas-Biesiada A , Topczewska K , Drozd-Dąbrowska M
Published: November 2019

Background

School settings place teachers at risk for influenza infection. Polish National Immunization Program recommends influenza vaccination (IV) for this occupational group. The study objective was to assess teachers’ knowledge and attitudes regarding IV, to determine 2018/2019 uptake and factors influencing the IV receipt; this has never been performed before in Central/Eastern Europe.

Methods

Between March-April 2019 teachers from 5 randomly selected primary schools (2 urban, 3 suburban) in West Pomerania, Poland, were surveyed with the use of the self-administered, anonymous questionnaire.

Results

Response rate was 50.1%. Among 102 respondents (68.6% females, mean age 45.7 years, mean length of practice 20.3 years), 31.4% were chronically ill. Only 4.9% reported getting the 2018/2019 IV, 8.8% were willing to be vaccinated in the next season. Of the respondents getting the 2018/2019 IV, only one also re-ported getting the 2017/2018 vaccine. The most common source of information about the IV were: family doctor (55.9%) and TV (68.6%). Beliefs that the IV was not effective (40.2%%) and concerns about the side effects (19.6%) were the most common reasons for not getting it. Only 44.1% of respondents believed teachers have heightened risk of contracting influenza. Regarding preventive methods, 83.3% teachers pointed at social distancing, 65.7% - at frequent handwash-ing, 65.7% - at vaccination; 38.2% believed that drinking tea with lemon could prevent influenza. More than a third of teachers (38.4%) thought influenza infection is always symptomatic. Older age was the only factor independently associated with IV receipt (p < 0.05).

Conclusions

Influenza vaccination coverage among Polish primary school teachers is disturbingly low. Future education strategies encouraging teachers to immunize themselves against influenza should tackle misconceptions about the IV and increase awareness. Interventions related to maximizing IV uptake should focus especially on younger teachers.

Key messages

This preliminary study showed that influenza vaccination coverage among Polish primary school teachers urgently needs improvement. Teachers should better understand the importance of influenza vaccination as a significant preventive measure and realize their role in infection prevention and transmission at the school setting.
Understanding the complexities of HIV risk among sexual minority men in a global context
Authors: Stojanovski K , King E J
Published: November 2019

Background

Complex systems theory recognizes the intricacy of health issues and inequities, which permits the study of interrelationships across multiple levels of the socioecological model. We interrogated the research to identify upstream and downstream factors, their intersections, and recursive processes to develop a visualization of HIV risk among sexual minority men.

Methods

Using global HIV literature drawn from diverse disciplines and geographies, we elucidated HIV risk factors through a complex systems theory approach. We used thematic analysis to categorize HIV risk factors into different levels of the socioecological model, such as policies, community risk factors, individual behaviors, etc. We also identified the relationships between these risk factors to assess how they shaped HIV risk. The analyses were used to inform the connections between the various factors that lead to HIV risk in order to develop a visualization of the complex system, for which Stella Architecture was used.

Results

The thematic analysis of the literature and complex systems visualization portrays that HIV risk arises from a complex interplay of recursive and reinforcing factors ranging from policies, community factors, healthcare systems, and interpersonal relationships leading to manipulations in individual-level behaviors that put sexual minority men at risk for HIV. This visual representation indicates that HIV risk cannot simply be thought of as an individual-level factor nor simply related to sexual behaviors. Rather, HIV risk arises from upstream societal forces such as stigma, poor mental health, and health systems that relate to a multitude of downstream factors that socially pattern sexual minority men’s HIV risk.

Conclusions

The risk of HIV among sexual minority men stems from numerous intersecting factors across multiple levels of the socioecological model indicating the need to improve structural- and community-oriented approaches to address HIV.

Key messages

HIV risk arises from multiple social determinants. HIV preventions need to encompass multi-level interventions to fully address HIV risk.
Local Tuberculosis Georeference: a tool to define BCG vaccination in high-incidence area in Portugal
Authors: Freire Rodrigues E , Leite A , Cabral M , Duarte G , Marques A P , Cale E , Silva A C
Published: November 2019

Issue

Tuberculosis (TB) incidence in Portugal is < 20/100000 people, with high-incidence municipalities in urban areas such as Amadora. In 2016, the national vaccination programme moved the BCG vaccine from universal to restricted risk groups. Amadora, due to the higher-incidence area, maintained a universal vaccination policy. Recently, it was hypothesized that vaccination could be applied to specific parishes even in high incidence counties.

Description

We aimed to identify specific geographic areas with higher risk of TB to help redefine the local BCG vaccination policy. We proposed to georeference active TB cases between 2015 and 2017, in Amadora, to then assess the incidence per parish and statistical section. We also aimed at identifying geo-clusters and density of cases.

Methods

(1) notified TB cases from 1 January of 2015 to 31 December 2017 were extracted from TB surveillance system; (2) cases of latent TB infection (LTBI), cases out of Amadora’s bounds and without national ID were excluded; (3) ArcGis®Online and associated maps were used to provide populational estimates; (4) cumulative incidence was calculated per year and averaged for the 3-year period; (5) Clusters were determined using distance and simple density of cases was calculated using Kernel algorithm.

Results

Considering the 6 parishes of Amadora, the 3-year cumulative incidence varied from 19.58 to 38.3 per 100000 hab. The highest incidence was found on the parish with the best socio-economic profile. 14 geo-clusters were mapped; 3 matched known deprived neighborhoods. Overall density was higher in these neighborhoods.

Lessons

With this approach we found that deprived neighborhoods had higher levels of case density, but 3-year cumulative incidence was higher on the parish considered to have low occurrence of TB. As such, and due to the intense population flows in Amadora, the local public health unit recommended the persistence of BCG vaccination to all residents of the municipality.

Key messages

Georeferecing supported our recommendation to mantain a universal BCG vaccination policy. Georeferencing associated to surveillance systems is highly useful to ensure evidence based public health practices, even at the local level.
Late presentation of chronic hepatitis B virus in Spain: a country with access to therapy
Authors: Picchio C , Roel E , Buti M , Lens S , Andrade R J , Crespo J , Calleja J L , Simon M A , Lazarus J V
Published: November 2019

Background and aims

Chronic infection with hepatitis B virus (HBV) can progress to liver cirrhosis and lead to complications such as decompensated liver disease, hepatocellular carcinoma and liver-related death. Antiviral agents against HBV are very effective in suppressing viremia and greatly reduce the risk of complications if treatment is initiated before the onset of advanced liver disease. The aim of this study is to assess the prevalence of late presentation in leading hospitals across Spain.

Methods

Retrospective cohort study of patients seeking first time care with a liver specialist at six tertiary Spanish hospitals, with 2018 data. Late presentation (LP) included advanced liver disease (ALD) defined by significant fibrosis (≥ F3 assessed by either APRI score > 1.5, FIB-4 > 3.2, transient elastography (FibroScan) > 9.5 kPa or biopsy ≥ METAVIR stage F3) with no previous antiviral treatment and late-stage liver disease (LSLD) was defined by the presence of decompensated cirrhosis and/or hepatocellular carcinoma. Prevalence of ALD and LSLD at first consultation, demographics, and associated risk factors were analysed.

Results

203 patients chronically infected with HBV were included. Advanced liver disease was detected in 14.8% and late stage liver disease was observed in 6.1% of cases. 57.1% of the cases were male. The majority of those with HBV were non-Spanish (53.7%). The median age was 47 and the median of years from diagnosis to specialist care was 1 (IQR 7). 58.6% of patients were referred from primary care and 3.7% cases had hepatocellular carcinoma upon presentation for care.

Conclusions

Late presentation with HBV is common in Spain, particularly for the foreign-born population, despite full access to antiviral therapy for HBV in the country. In order to rectify this health systems failure, improve outcomes and reach the viral hepatitis elimination goal adopted by WHO in 2016, strategies to reduce late presentation to care are essential.

Key messages

Early diagnosis of HBV is needed in order to rectify the health systems failure of late presentation to care. Interventions targeting foreign-born populations should be implemented to reduce late presentation to HBV care and treatment.
Feedback on the transition to routine use of Connexin, a tool to improve city-hospital cooperation
Authors: Durocher V , Duburcq A , Pamart R
Published: November 2019

Issue

The French national health strategy “Ma Santé 2022” underlines the need to decompartmentalize the organization of care through city-hospital cooperation. The Connexin® platform aims, as part of treatments prescribed in hospitals and delivered in community, to identify all health professionals around the patient, and ensure they communicate and coordinate with each other to improve the coherence and relevance of care within the pathway.

Description of the problem

A pilot phase of deployment of the tool was conducted in two regions to measure the organizational and clinical impact of its use. This evaluation was based on qualitative interviews with the various stakeholders (local pharmacists, hospital teams, institutional partners, etc.). The objective was to assess the adoption and transition phases while identifying its effects and added value for health professionals using it.

Results

Adherence was important: many pharmacists registered, reflection on the service organization in hospital teams. Despite some access problems (codes lost, dual authentication), professionals believe Connexin® facilitates communication between primary care and hospital actors. However, transition was difficult in several hospitals (lack of support from management mainly), insufficient use by pharmacists (hampered by the new missions entrusted to them by law). Support closest to professionals in the tool implementation thus seems crucial to ensure transition to routine use.

Lessons

Connexin® is a secure, intuitive platform adapted to health professionals’ needs for cooperation. Mobilization of the various actors around the platform proves the interest for and the relevance of such a tool to optimize the efficiency of care. However, the organizational impact, no matter how small, is a barrier to the transition to routine use, a finding shared for many tools.

Key messages

While the platform was designed by primary, hospital and institutional health professionals, the study points out the need to set up a project governance and appropriate support during implementation. Any organization impact is an obstacle to the evolution of practices.
How to implement a successful smoking cessation intervention for adolescents?
Authors: Vallata A , Alla F
Published: November 2019

Background

Policies and programs implemented to promote smoking cessation among youth present disparate results. These variations are explained by interventions themselves but also by context, population and implementation characteristics. Our objective was to analyze these factors, related to enrollment and participation in a smoking cessation program, implemented in vocational or technical schools.

Methods

Population factors were studied by a systematic review about determinants of smoking cessation among 10-24 years old, updating a previous one.

Contextual and implementation factors were identified by a qualitative multiple cases study. A smoking cessation program, TABADO, had been implemented in 3 regions in France, in 10 vocational or technical schools (1 school/1 case). Data collection included 51 observations, 46 semi-structured interviews, and 3 interdisciplinary seminars.

Results

The review identified 46 factors probably or possibly related to a successful smoking cessation, both individual (e.g. smoking frequency) and collective (e.g. relationship smoking status, anti-tobacco legislation). The case study allowed us to objectify positive or negative factors that influence the enrollment and the participation in the program (e.g. presence of a referent in the school, combination with the school program). Finally, we identified prerequisites to gather before starting such a program.

Conclusions

This mixt design highlights factors on which we must focus to increase the success of a smoking cessation program for youth. A key factor is to tailor intervention and implementation modalities to the local context. Results enabled us to product a pragmatic guide, TABADO 2, which is now used in a national scaling process. They also will be used to build an intervention theory, which could be used for any smoking cessation intervention for youth.

Acknowledgments: The TABADO IDF study group, Inca, the région Lorraine and the ARS Nouvelle-Aquitaine for their financial support.

Key messages

A smoking cessation program must be a global strategy, considering contextual, population and organizational factors. Instead of trying to strictly apply a protocol, a complex intervention must be tailored to the context in which it is implemented.
Relevance of the health insurance databases to study potentially inappropriate prescriptions
Authors: Jardin M , Banide M C , Saba G , Burlot E , Jozancy F , Guagliardo V , Verger P
Published: November 2019

Issue/problem

Potentially inappropriate prescriptions (PIP) for the elderly constitute a major issue in the quality of ambulatory care. In France, people aged 80 years or older use on average five drugs per day. This polypharmacy is justified in most cases by multimorbidity but it increases the risk of adverse events.

Description of the problem

In order to optimize general practitioners’ (GPs) prescribing practices for the elderly, a project involving the Southeastern Health Regional Observatory (ORS Paca), the Regional Medical Department of Health Insurance Fund (DRSM Paca-Corse) and the Regional Union of Private Practitioners (URPS-ML Paca) was conducted in 2014-2016. Its main objective was to set up a regional mapping tool giving GPs access to drug prescriptions indicators for the elderly in their practice area.

Results

Based on national guidelines and advice of experts in the field, we calculated 7 different indicators of potentially inappropriate prescriptions (PIPs) for people aged 65 years or older, using drug reimbursement data from the Health Insurance Fund. Those indicators were calculated among patient lists of GPs and covered prescriptions of benzodiazepines, non-steroidal anti-inflammatory (NSAI) drugs, new oral anticoagulants, proton pump inhibitors, antiplatelet therapy... PIPs’ prevalence were calculated among GPs’ lists of patients. PIPs prevalence differed between drugs type, GPs and territories: for example, the age standardized prevalence of long-term treatment with NSAI drugs varied in 2014 from 2 to 15% between municipalities and from 0 to 14% in 2017.

Lessons

These results allowed to identify priority areas for intervention, in which continuous medical education sessions with an individual feedback to GPs on their own indicators were implemented, to improve prescribing practices.

Key messages

A substantial proportion of elderly people receive PIPs. Medico-administrative databases can be used to produce indicators of prescription practices to be used to guide public health interventions.
Complexity in managing the blood transfusion process: experience of an Italian Academic Hospital
Authors: Poletto M , Scarpis E , Bianchet B , Ruscio E , Degan S , Farneti F , De Angelis V , Brusaferro S
Published: November 2019

Issue

Blood components transfusion is a high-risk process due to its complexity and possible consequences in case of error. Preventing mistakes and acting promptly if they occur is a duty of healthcare organizations. The Italian Ministry of Health has drafted a specific recommendation with the aim of reducing transfusion errors.

Description of the problem

Following a transfusion error occurred in July 2018, a multidisciplinary group including professionals from Clinical Risk Unit (CRU) and Transfusion Department of the Academic Hospital of Udine, carried out an analysis of the blood components issuing process. The 20 most critical steps were identified and grouped into 3 areas: 1)single samples processed individually, 2)appropriate application compliance, 3)environmental interferences. For each step shared solutions were identified and then implemented as new standard practices. From February to March 2019, CRU randomly observed 23 blood components assignments using tracer methodology, evaluating staff’s compliance with the new recommended practices (NRP).

Results

For the sample processing (area 1, n.10 practices), adherence to all ten NRP was 100% (26/26). For the appropriate application compliance (area 2, n.8 practices), adherence to 7 NRP was 100% (11/11), whereas for one (punctual registration of non-conformities) adherence was 86% (6/7). For the environmental interferences (area 3, n.2 practices), adherence to one practice was 100% (2/2), whereas for the other one (avoid answering to incoming phone calls) adherence was 75% (3/4). Overall, professionals behaviour was consistent with the NRP in the observed period.

Lessons

Identification of critical issues by a multidisciplinary team and measuring the adherence to new practices is crucial in managing the complexity of blood transfusion process.

Tracer methodology, used by CRU to verify adherence to new standard, also allows the hospital to monitor the progress of the achieved performances over time.

Key messages

Multidisciplinary analysis of the blood transfusion process and shared development of new standard by all professionals favours their compliance in the practice. Tracer methodology is a useful tool to evaluate adherence to recommended practices and monitor the complexity of transfusion process over time.