bluuebunny/crossref_metadata_2025 huggingface dataset:
Barriers and facilitators of adherence for cervical cancer prevention in low-income women in Colombia
Authors: Bermúdez Jaramillo PC , Arrivillaga Quintero M , Torres Poveda K J , Castrillón Libreros D M , Neira Acevedo D , Cuartas Arroyabe D , Castillo Castillo L E
Published: October 2020

Introduction

In Colombian women, cervical cancer screening coverage in 2017, 48.2 % of women were able to pay and 34.3% were not able to.

Objective

To determine the barriers and facilitators of screening adherence to preventive program for cervical cancer prevention, in women were not able to pay affiliated to a public network of primary health care in Cali, Colombia, during the years 2014-2018.

Methods

Sequential mixed study, quantitative initial phase and second qualitative phase. We analyzed information from 32,001 insured women and 7,691 users of the program. The quantitative design was cross-cutting, observational and analytical; we also incorporate a qualitative case study; we conduct focus groups, in-depth interviews with users, health care services and administrative staff.

Results

47.5% of women were adherents to the program; women over 50 (OR = 0,82; 95% CI = 0,73-0,92), who lived further away from the health care site, (OR = 0,78; 95% CI = 0,62-0,97), had worse adherence to the program; women most often from medical consultations had increased adherence (OR = 3; 95% CI = 2,66-3,42). The qualitative case study showed similar barriers to other populations, living conditions, shame and fears of the procedure itself. We found as facilitators, agile attention, the ease of consulting services, and having some social support.

Conclusions

Despite the efforts of the public network of primary health care, the personnel staff consider a great barrier, the lack of updated information of women, which prevents recruitment and monitoring.

Key messages

In low-income women, it is necessary to generate interventions in groups of poor non-adherent women, as well as women with low adherence. Adherence depends on women’s beliefs and knowledge. Lack of interaction with a healthcare provider, increasing age and living far away from the health care site continue to be barriers.
Hospital management of patients with acute coronary syndrome: influence of age and gender
Authors: D'Errigo P , Rosato S , Mureddu G F , Badoni G , Cerza F , Cicala S D , Forti M , Seccareccia F
Published: October 2020

Background

Although the improvement of therapeutic strategies is leading to a dramatic decline of in-hospital acute coronary syndrome (ACS) death rates, differences in care and prognosis of ACS patients exist when age, gender and admission department are considered.

Methods

The national administrative hospital discharge record (HDR) system was used. Only data recorded from January 1, 2017 to Dicember 31, 2018 were analyzed. This approach allowed to identify 205775 patients reporting ACS as primary or secondary diagnosis: 122812 with non-ST-elevation ACS (NSTE-ACS) and 82963 with ST-elevation ACS (STEMI). The ACS cohort was stratified by age (<75 and ≥75 years) and gender. The proportion of STEMI patients treated in general medicine or cardiology departments requiring a coronary procedure or extensive investigations were analyzed.

Results

Among the 205775 patients hospitalized for ACS, 6% of STEMI and 8.3% of NSTE-ACS patients have been treated only in a general medicine ward and have never passed through a specific cardiology ward. For STEMI patients, the proportion becomes 4% when males are considered, increases up to 10% for females and up to 13% for elderly patients (≥75 years). During the index hospitalization, about 25% of female and more than 30% of elderly patients with STEMI do not undergo a coronary procedure or other extensive investigations; the same happens only in about 10% of male and 6% of younger patients. The proportion of improperly managed patients reaches 35% for women aged ≥75 years.

Conclusions

In-hospital management of women and elderly patients with ST-elevation ACS does not completely comply with the recommended guidelines and exposes them to unfavourable prognosis.

Key messages

Women and elderly STEMI patients are markedly less intensively investigated and treated in cardiologic departments. This medical policy could lead to unfavourable prognosis.
Trajectories of cognitive performance over 5 years in a cohort of breast cancer patients (NEON-BC)
Authors: Araujo N , Lopes-Conceição L , Fontes F , Severo M , Dias T , Tedim-Cruz V , Ruano L , Pereira S , Lunet N
Published: October 2020

Purpose

Cancer-related cognitive impairment may affect 30-70% of cancer patients, either at baseline or during and after treatment. We aimed to identify trajectories of cognitive performance, from before any treatment to 5 years later, in a cohort of breast cancer (BCa) patients.

Methods

BCa women admitted to the Portuguese Institute of Oncology, Porto, were included in the NEON-BC study during 2012. They were evaluated with the Montreal Cognitive Assessment (MoCA) before any treatment, and after 1, 3 and 5 years (N = 506, 503, 475 and 466, respectively). Nlme R package was used to fit a mixed-effect model of the trends in MoCA scores over time, with age and education as fixed effect. Coefficients of this model were retrieved to calculate an age- and education-modified MoCA score (mMoCA). Mclust was used to obtain clusters of trajectories of mMoCA.

Results

Two trajectories were identified, one with higher scores and increasing over time, and the other showing a continuous decline (25.9% of the participants and 84% of the women with cognitive impairment confirmed by neuropsychological tests and clinical examination by neurologist at the 5 year follow-up). Each trajectory was split into 2, according to scoring above or below to the median value of mMoCA at baseline to account for the possibility of patients being in a declining pathway before treatment. In addition to trajectories characterized by the highest and lowest scores, respectively, relatively stable over time, two trajectories with middle-range scores were observed, one increasing over time and the other decreasing (12.7% of the participants); being older than 65 years, suffering from anxiety, depression or poor sleep after treatment were more frequent among the latter.

Conclusions

One quarter of the 5-year breast cancer survivors had a declining trajectory in cognitive performance. Anxiety, depression and sleep quality should be considered as targets for preventive or curative interventions of cognitive decline.

Key messages

Cognitive decline occurs during breast cancer care, affecting one quarter of the patients. Anxiety, depression and sleep quality should be considered as targets for preventive or curative interventions of cognitive decline.
Multimorbidities associated with bruxism: a population-based study. Campinas- Brazil
Authors: Kelly Fehlberg B , Guimarães Lima M , Alvarenga Santini P , Berti de Azevedo Barros M
Published: October 2020

Background

Bruxism is a relevant topic in public health, as it represents an increasingly frequent parafunctional activity and also for presenting musculoskeletal and dental effects affecting the health and well-being of the affected population. The reviewed literature shows that bruxism is associated with some health problems, but with multimorbidities has not yet been investigated.

Objective

To identify the association of bruxism with a multimorbidity pattern.

Methods

A population-based cross-sectional study was conducted with a sample composed of 1986 adults (≥20 years of age). This study used data from the Third Health Survey of the City of Campinas conducted in 2014 and 2015 (ISACamp 2014/15). A principal component analysis was performed to identify in which multimorbidity pattern, present in the population, bruxism is included. From this pattern, the variable number of diseases was created (0; 1; 2 to 4; 5 or more). The prevalence of bruxism was established according to this variable and associations were tested using the Rao-Scott chi-square test and Poisson regression.

Results

The factor analysis revealed three relevant patterns of multimorbidity in the population of Campinas. Bruxism was part of the pattern also composed of: asthma, rhinitis, sinusitis, allergy, migraine/headache, emotional/mental problem, dizziness/vertigo and back pain. The prevalence of bruxism increased more than fivefold in the concomitant presence of five or more of these conditions (PR = 5.35;95%CI:3.35 to 8.45).

Conclusions

Knowledge about the association of bruxism with a pattern of multimorbidities can show the direction of health actions in multidisciplinary teamwork, prioritizing the reduction in harm caused by the simultaneous presence of health problems associated with bruxism. We also emphasize the possible role of bruxism as an indicator of multimorbidities, especially those associated with the pattern found.

Key messages

Bruxism was more associated with multimorbidities of the pattern composed of asthma, rhinitis, sinusitis, dizziness/vertigo, migraine/headache, emotional/mental problem, back pain and allergy. The concomitant presence these conditions increased the prevalence of bruxism up to fivefold.
Burden of cardiovascular diseases in the region of Monastir (Tunisia)
Authors: Abroug H , Kacem M , Ben fredj M , Zemni I , Bennasrallah C , Dhouib W , Sriha A
Published: October 2020

Background

Cardiovascular disease (CVD) is the leading cause of death in Tunisia. The aim of this study was to analyze CVD burden from 2002 to 2013 in the region of Monastir.

Methods

Using the Global Burden of Disease methodology, cardiovascular disease mortality and disability-adjusted life years (DALYs) were analyzed by age group and sex for all admissions at the university hospital of Monastir, using standardized approaches for data processing and statistical modeling. Data were retrieved from the regional register of hospital morbidity in Monastir and were analyzed from January 2002 to December 2013.

Results

CVDs caused 519 in-hospital deaths during the study period, accounting for 43.3 % (CI 95%: 40.6-46.1%) of all in-hospital non-communicable diseases-related mortality (n = 1197). The crude mortality rate of CVDs was 8.81 per 100,000 inh. The highest rate was recorded among patients aged ≥ 60 years-old. The age-standardized mortality rate was 11/100,000 PY (14 in men and 8 in women). CVD DALY per 100,000 was 176.4 (199.4 in men and 152.7 in women). The highest CVD DALY was in the age groupe of 60 years and older (929.7/100,000). The leading causes of DALYs for both sexes are coronary heart diseases and stroke with DALY rate of 112.6 and 47.4 per 100,000 inh, respectively.

Conclusions

The CVD burden was heavy in the study population, in particular in the elderly and in men. Prevention and control of modifiable risk factors should be taken actively to improve health for Tunisian adults.

Key messages

CVD burden was heavy in the region of Monastir. More efforts are needed to improve cardiovascular health in Tunisian adults.
Diabetes and education: analysis of the consequences on the school and academic careers of diabetics
Authors: Matchika Megaptché M , Wamba A
Published: October 2020

Background

Diabetes management is a very critical time for many people as they have to make a new life with the disease on a daily basis. However, the effect of the school environment on this management remains poorly understood, and most existing studies neglect the role of teachers and students in preventing or triggering a possible diabetic crisis.

Objective/Methods

Based on the ethnography of the subjective experience of 6 young diabetics aged 15 to 20 years attending school in Yaoundé, the study combines life stories examining how teachers and students modify the markers of preventive management of diabetes in the classroom, and observations analysing how these markers vary according to the level of their knowledge of the constraints related to the disease and the consequences it generates in the young diabetic's school and social life.

Results

Managing diabetes in the school setting results in a double handicap. Firstly relational: it creates latent or open conflicts between the diabetic and his peers and with certain teachers, due to the constraints of treatment and the social perceptions/representations they send back to the young diabetic. Second, pedagogical: some young diabetics are denied access to PSE courses, for example, while others choose to drop out of certain courses because of conflicts with the teacher or drop out of school permanently. Finally, others are denied access to certain training schools of their choice, which limits their possibilities of developing a socio-professional project compatible with their real aspirations and adapted to their state of health.

Conclusions

The study suggests the need to develop a school diabetes support programme that takes into account this dual educational and relational handicap; and that educates teachers and peers about the medical constraints and socio-educational consequences of the disease.

Key messages

The management of diabetes in the school and academic environment produces in young diabetics a double relational and pedagogical handicap. The study suggests developing a school-based diabetes support program that takes into account this double handicap and educates teachers and peers about the constraints and consequences of the disease.
Factors that influence the response time in STEMI patients in Lisbon 2017
Authors: Gil M , Garcia M , Aguiar P
Published: October 2020

The success of the ST-segment elevation myocardial infarction (STEMI) approach is based on early diagnosis and on the institution of timely reperfusion therapy, with response times remaining variable. The objective of this study was to determine which factors influenced the response time to patients with STEMI until the treatment with coronary reperfusion from the prehospital service or the emergency room in three hospitals in the greater Lisbon area in 2017. An epidemiological, cross-sectional, retrospective, descriptive study with an analytical component was performed, with data from the National Institute of Medical Emergency (INEM) and clinical trials of patients. Patients who were not referred to these hospitals were excluded. Univariate statistical analysis was performed, as well as c2 tests, t-student and logistic regression model (r < 0.05). The population included 95 patients, the majority being male (67.4%), and with a mean age of 63.8 years. 61.1% were hypertensive and the majority (87.4%) had no signs of previous heart failure. The mean door-to-balloon time was 159 minutes, with 57.4% showing time greater than 120 minutes. In patients in whom the INEM Coronary Greenway was activated, mean door-to-balloon time was 99 minutes. Diagnostic, symptom-admission and transport times showed a statistically significant association with the door-to-balloon time in the bivariate analysis. The times are fulfilled in the prehospital service, but in the hospital, services can be improved through the early accomplishment of electrocardiogram and the optimization of interhospital transport.

Key messages

Reducing ECG time and inter-hospital transport time improves STEMI response and outcome. Time is muscle is the main message for de concern of identifying influence factors of STEMI response time.
Pepper mild mottle virus in different water matrices
Authors: Ferraro G Bonanno , Suffredini E , Mancini P , Veneri C , Iaconelli M , Bonadonna L , Montagna M T , De Giglio O , La Rosa G
Published: October 2020

Background

Pepper mild mottle virus (PMMoV), a plant virus belonging to Virgoviridae, has recently been suggested as a potential viral indicator for faecal pollution in aquatic environments, since it has been found to be abundantly excreted from healthy human subjects.

Methods

The occurrence, amount and diversity of PMMoV was investigated in water environments by nested RT-PCR and TaqMan based quantitative PCR. During 2017-2019, 251 water samples (92 urban wastewaters, 32 treated effluents, 16 surface water samples, 9 estuarine samples, 20 seawater samples, 67 groundwater samples, and 15 drinking waters) were analysed.

Results

PMMoV was detected in 73/92 (79%) wastewater samples, 22/32 (69%) treated sewages, 11/16 (69%) river samples, 6/9 (67%) estuarine samples, 5/20 (25%) bathing waters, and 9/67 (13%) groundwaters, whilst drinking water samples tested always negative. Mean viral concentrations (genome copies/L) were: raw sewage 4.2 × 106, treated sewage 7.4 × 105, river 3.2 × 103, estuarine waters 9.6 × 102, seawaters 3.0 × 102, groundwaters 7.7 × 101.

Conclusions

This study highlights the significant occurrence of PMMoV in aquatic environment in Italy, and a clear gradient of viral prevalence and concentrations from polluted to clean waters (wastewaters to drinking waters).

Key messages

PMMoV is ubiquitous throughout the water cycle in Italy with different concentrations. Studies are needed to evaluate the suitability of PMMoV as a viral indicator for human fecal pollution in waters.
A gendered typology of tobacco use among college students
Authors: Igboanugo T
Published: October 2020

Background

Smoking habits initiated during the adolescent period often persist into adulthood leading to tobacco and nicotine dependence with associated morbidity and premature mortality. Parental smoking has been associated with early tobacco dependence on their children. An understanding of students' smoking patterns in relationship to parents' smoking habits is crucial to informing the establishing of a smoking reduction intervention in students.

Methods

Latent Class Analysis (LCA) was used to characterize the different patterns of smoking among 361 Irish university students. The participants were enrolled in this cross-sectional study by inviting them to complete an online survey.

Results

Three groups were identified: (1) Chain smokers (n = 92, 25.52%). (2) Moderate tobacco users (n = 124, 34.60%). (3) Experimenters (n = 145, 40.16%). The predominantly male 'chain-smokers' groups (class 1) has a higher probability of using tobacco several times a day, have both parents as tobacco users and both parents smoking in the home compared to the 'moderate tobacco users' group (class 2) and 'experimenters' groups (class 3) which are both predominantly females. The majority (70.40%) of the chain smokers source their tobacco from family members (either parents or an older sibling); moderate tobacco users (84.74%), from friends and experimenters (100%) buy themselves.

Conclusions

This study reveals the predictors of tobacco use patterns among students and can inform smoking reduction intervention and strategies among students.

Key messages

Regulating tobacco access will checkmate use among teens/young adults. Understanding how parenteral smoking habits and tobacco access influences use and abuse among students is crucial to instituting intervention strategies.
Efficacy of electronic cigarettes for tobacco smoking cessation: An adapted systematic review
Authors: O'Dowd T
Published: October 2020

Background

Worldwide smoking remains the leading cause of preventable morbidity and mortality. Electronic cigarettes (ECs) are increasingly used by tobacco smokers as an aid to smoking cessation; however, their efficacy remains uncertain.

Methods

Electronic databases, clinical trial registries and grey literature sources were searched. The aim was to examine randomised controlled trials or prospective cohort studies, published since the 2016 Cochrane review on this topic, that assessed the efficacy of ECs in achieving smoking cessation among current smokers.

Results

Two RCTs and five cohort studies, including a total of 16,460 participants, were eligible for inclusion. One RCT found sustained 1-year abstinence of 18.0% in the EC group versus 9.9% in the nicotine replacement therapy group (RR: 1.83; 95% CI 1.30 to 2.58; P < 0.001). The second RCT did not find a statistically significant difference in abstinence rates between EC users and non-users (RR 0.71). Of the five included cohort studies, four reported statistically significant RRs. Two found a positive association (RRs of 1.45 and 1.84) between EC use and smoking cessation but two studies showed EC use was associated with reduced smoking cessation (RRs of 0.25 and 0.35). Due to significant heterogeneity between the studies the data were deemed unsuitable for pooling into a meta-analysis. All trials assessing smoking reduction reported higher rates of reduction among EC users. No serious adverse events were reported with EC use. Follow-up periods of included trials ranged from one to four years, with an average of 1.6 years.

Conclusions

There is limited, low-quality evidence that ECs are an effective intervention for smoking cessation and smoking reduction. The overall quality of evidence is low as it is based on a small number of studies with inconsistent and imprecise results. Due to the short follow-up periods of the included trials, the long-term safety of ECs is unclear from this review.

Key messages

Limited evidence that electronic cigarettes are an effective smoking cessation intervention. Further well-designed randomised controlled trials are required to investigate the efficacy of ECs for smoking cessation.
Unveiling barriers and facilitators to physical activity participation among urban Indian men
Authors: Rathi N , Kulkarni M
Published: October 2020

Purpose

Regular participation in physical activity is critical for nurturing optimum health and well-being. It also prevents the onset of obesity and associated non-communicable diseases. Indeed, urban Indian men are more prone to these chronic illnesses as most of them lead a very sedentary lifestyle. Thus, a public health priority is to increase physical activity levels among sedentary urban Indian men. With this objective in mind, an exploratory study was designed to understand men's perspective of physical activity and the factors influencing physical activity participation.

Methods

Five focus group discussions (FGDs) were conducted with adult men (n = 26; age: 20-60 years) between August and November 2019. The participants were recruited from Mumbai Metropolitan Area through snowballing. All the FGDs were audio-recorded and conducted in both Hindi and English. The audio recordings were transcribed and translated. Content analysis was used to obtain frequencies of different barriers and facilitators. Thematic analysis was applied to cluster responses, identify themes in the data, and build an explanation from the FGDs.

Results

All the participants perceived the need to participate in physical activity as it was associated with a better quality of life. Commonly identified facilitators were health benefits, physical appearance, and adequate facilities in the neighbourhood to engage in physical activity. Self-reported barriers included lack of time because of hectic work schedules and commuting, laziness, physical activity not viewed as a priority, and engagement with mobile phones.

Conclusions

The emerging findings can inform the development of a physical activity intervention to support behaviour change as well as ensure its sustainability among inactive urban Indian men. This qualitative inquiry contributes to the body of knowledge on physical activity in a culture that is relatively underrepresented in the current literature.

Key messages

Physical activity was influenced by multiple factors at multiple levels i.e. intrapersonal level, interpersonal level, and community level. There is a need to design effective public health interventions to increase physical activity and thereby control the prevailing disease burden.
Fractured lives in fractured cities: towards a critical Public Health approach to urban violence
Authors: Borde E
Published: October 2020

Background

43 of the 50 cities with the highest homicide rates worldwide are Latin American. Although the mechanisms through which urban violence is (re-)produced are complex, the inequalities that shape fragmented Latin American urban landscapes and define the patterns of urban violence have been forged by sociopolitical processes including market-driven urban restructuring processes in the realm of “actually existing” neoliberalism. The comparative case study on two neighborhoods in Bogotá and Rio de Janeiro seeks to contribute to the development of a critical Public Health approach to urban violence that moves beyond the description of death registries and the association of discrete risk factors.

Methods

The case studies are based on qualitative analyses of 4 focus groups and 46 semi-structured interviews with residents and specialists (2016 and 2019) using the Framework Method as well as comprehensive literature reviews.

Results

Both cases reveal nuanced processes through which urban violence is produced and reproduced by different actors and suggest that violence is inherent in the market-driven territorial making and un-making of increasingly “fragmented” cities. The cases suggest that violence is implied in threats of eviction, “necropolitical” police/military interventions and in the silent imposition of a “slow death” on urban infrastructure and entire neighborhoods, which bring about health consequences that include injuries but also shape other health problems. Both cases provide evidence to suggest selective and contradictory state presence that implies, admits or reinforces violence.

Conclusions

The cases combat simplistic readings of Latin American urban violence as a phenomenon exclusively related to confrontations between rival drug gangs and the police or aggressive individuals by revealing a great variety of actors and processes involved in (re-)producing urban violence that have serious implications for life and health in Latin American cities.

Key messages

Need for a critical Public Health approach to urban violence that moves beyond the description of death registries and the association of discrete risk factors. A great variety of actors and processes is involved in (re-) producing urban violence that have serious implications for life and health in Latin American cities.
Biomass combustions and biomonitoring of airborne particulate: suggestions for preventive actions?
Authors: Gea M , Bonetta S , Marangon D , Fontana M , Schilirò T
Published: October 2020

Biomass combustions generated by both forest fires and home heating in urban centers produce a huge amount of pollutants which can be adsorbed on the particulate matter (PM) and subsequently carried within the human respiratory system. Moreover the occurrence of forest fires is growing due to climate change and it poses a great risk both to environment and to human health.

The aim of this study was to investigate different biological effects of PM collected during a big forest fires phenomenon that occurred in Piedmont (Northern Italy) in autumn 2017. PM2.5 and PM10 were collected near the forest fires and in three other areas of Piedmont (two urban and one rural areas). Mutagenicity of organic extracts was assessed on different strains of Salmonella typhimurium using Ames assay while cytotoxicity (WST-1 and LDH assays) and genotoxicity (Comet assay) were evaluated on human bronchial epithelial cells (BEAS-2B). The estrogenic activity of organic extracts was estimated through a gene reporter assay on MELN cells, in order to analyse the presence of endocrine disruptors adsorbed on PM.

The contribution of fires to urban mutagenicity was low moreover samples did not induce any significant cytotoxic or genotoxic effect. A slight increase in estrogenic activity was detected in samples from urban and rural areas, while an anti-estrogenic effect was induced by forest fires samples. The biological effects induced by extracts were low respect to what is normally observed in urban sites but are probably due to the tested concentrations, which are closer to realistic human exposure but are insufficient to show differences among areas.

These findings may be helpful for public health policies, suggesting to include in the monitoring of traditional parameters the contribution of biomass combustion to the air quality. Finally the PM biomonitoring could improve the air quality assessment, which is essential to plan strategies focused on environment and health protection.

Key messages

The PM biomonitoring could improve the air quality assessment, which is essential to plan strategies focused on environment and health protection. Public health policies should consider the contribution of biomass combustion to the air quality in monitoring plans.
Factors affecting medication assisted treatment success for opioid use disorder
Authors: DeLellis N , Mitchell M , Frederick A , Schachman K
Published: October 2020

Background

In the United States (US) when opioid use disorder (OUD) is treated with medication assisted treatment (MAT), many patients in MAT will relapse into active opioid use during the recovery process. About 23% drop out of treatment within 3 months, and 40-50% drop out within 6 months of MAT start. Using the Anderson and Newman (2005) Framework for Health Services Utilization, 27 variables reflecting predisposing, enabling, and need factors were used to examine the impact on the number of days patients were retained in treatment.

Methods

One MAT clinic in rural Michigan used random sample of archival records (n = 390) OUD patients (DSM-V-TR code 304.00, ICD-10 code F11.20) between Jan. 1, 2014 and Nov. 21, 2018 with prescribed buprenorphine as part of MAT program. The first set of linear regressions (backward elimination) defined significant variables for each factor, and the final model included significant variables to predict length of retention in MAT.

Results

The first step identified legal issues (predisposing), MSHN insurance, distance to clinic, ability to drive, mental health diagnosis, and homelessness (enabling factors); Zung self-reporting depression score, starting dose, past suicide attempt, Hep-C status, and method of use (needs factor) as statistically significant to be used in the final model, controlling for age and gender. Starting dose (unstandardized b = 136.8, 95%CI 98.0, 175.6), driving license (b = 68.3, CI 13.2, 123.4), distance to clinic (b=-1.1, CI -2.2, -0.5) had statistical impact on the length of stay in MAT.

Discussion

This case study identified enabling factors (starting dose and access to clinic) affecting length of participation in MAT. Other factors warranting provider attention were identified for rural OUD patients.

Conclusions

Evidence based guidelines for starting doses are needed to increase MAT effectiveness. MAT services should consider distance to clinic as a factor of successful treatment.

Key messages

Evidence based guidelines for starting doses are needed to increase MAT effectiveness. Opiood treatment services should consider distance to clinic as a factor of successful treatment.
Workplace violence and all-cause mortality
Authors: Högnäs R , Magnusson Hanson L
Published: October 2020

Background

Research suggests that workplace violence (WPV) increases the risk of psychological and physical health problems (e.g., type 2 diabetes). Research further suggests that WPV may affect long-term health; however, there are few studies and it is unclear whether WPV is associated with mortality. This study extends the literature by examining the association between WPV and all-cause mortality and whether workplace support moderates the association.

Methods

Cox models were estimated using data from the Swedish Work Environment Survey and Swedish registers (≈ N = 82,400). WPV was measured in terms of the frequency of exposure during the previous twelve months. Workplace social support was measured in terms of perceptions of social support from co-workers and/or superiors when work becomes troublesome. All-cause mortality includes death for any reason by the year of 2017.

Results

Adjusting for demographic and health factors (e.g., sex, education, chronic pain) and workplace support, exposure to WPV more than once per week increased significantly the risk of all-cause mortality. There did not appear to be an increased risk for those exposed less than once per week. While workplace support moderated the association between WPV and all-cause mortality, this was only the case for females who perceived support from superiors.

Discussion

Increased attention to workplace violence and threats of violence is warranted given the prevalence of these negative social behaviors in the workplace and associated long-term health risks. Our results suggest that workplace social support may buffer the negative health effects of WPV, at least for females. This suggests that policies aimed at reducing exposure to WPV, which simultaneously encourage workplace support, are worth exploring.

Key messages

Frequent exposure to workplace violence increases the risk of all-cause mortality. Support from superiors may buffer against some of the risk of all-cause mortality among females exposed to violence in the workplace.
Tunisian Nurses experiences of their humanitarian mission in the ''Choucha” Refugee Camp
Authors: Limam M , Jomaa S , Mellouli M , Ben Kacem M , Sahli J , Ghardallou M , Zedini C , Ajmi T
Published: October 2020

Background

Participation in a humanitarian mission can be considered as a heroic work especially for health professionals. In 2011, a refugee camp was set up in southern Tunisia. The objective of this study was to describe and better understand the experience of Tunisian nurses in the Choucha refugee campbased on the Meleis transition theory.

Methods

We conducted a qualitative, phenomenological study among 14 nurses using an interview guide. Data analysis was carried out according to the method of Giorgi, from which 5 core themes and 28 sub-themes had emerged.

Results

This studydescribed the experience of nurses as a passage between 4 different phases: before, during, after the passage to the refugee camp and the memory.Five core themes emerged from our research:1) Trigger events: 3 sub-themes were evoked for the reason of participation: motivation, commitment and expectations; 2) Professional and interpersonal relationships marked the integration of the interviewees despite some misunderstandings, 3) Coping, 4) The impacts are mostly positive, and 5) Feelings that expressed emotions and nostalgia. For the transition, the last stage, which is the appreciation of the past moments, indicated the passage from an unbalanced state to stability.

Conclusions

Looking at the lived experience of the nurses and the transition experience described by the participants, this study found that the lack of training of the nurses previous to the humanitarian mission was the major barrier to making a healthy transition. These findings can contribute to raise the awareness, preparation and education of nurses to improve the experiences of future caregivers who will participate in humanitarian missions.

Key messages

It seems essential to set up training program focusing on preparation and debriefing of nurses to support them in achieving a healthy transition in their humanitarian mission in refugee camps. Training health care professionals before their participation to humanitarian mission in refugee camps can be among the factors that enhance the quality of care provided to refugee populations.
Student's attitudes towards induced abortion and its associated factors
Authors: Tapia Pulido E A , Cosgalla González R I , Alemán Pérez I A , Cervantes Gómez K C , Márquez Celedonio F G , Villegas Domínguez J E
Published: October 2020

Background

At present, the legal status of abortion worldwide is maintained heterogeneously. In Mexico, its practice is allowed within the capital of the country and one more state, provided that it is before the 12th week, however in the rest of the country it is still classified as illegal. Research question: What are the factors associated with the modification of attitudes towards abortion?

Methods

An observational, prospective, cross-sectional and analytical study was conducted in Veracruz, Mexico between December 2019 and March 2020. University students from public and private schools were included, from the city of Veracruz-Boca del Río, selecting the participants through a non-probabilistic sampling. The Attitudes Abortion Questionnaire was applied to assess the attitudes provided, pro-selection, reproductive rights, health risk and legalization. The surveys were conducted through Google Forms® and were answered on that same platform. The results were collected and analyzed with the SPSS Statistic® program.

Results

517 students were included. Private school students showed differences in pro-election attitudes when compared to public, students from urban areas had more pro-election attitudes and in favor of reproductive law compared to those from rural areas, having active sex life and having someone known to having performed induced abortion favors the attitude of pro-choice, reproductive rights and the legalization of abortion as a means of solution for its complications, and detracts from the position provided, in both situations (p < 0.05). The strong religioside is the one who has the main differences showing less points in the pro-election, reproductive law and legalization as a solution and more in being provided. (p < 0.001)

Conclusions

The social context still manifests itself uneven at the moment of having a posture and attitude with the legalization of induced abortion, being strong, independent of religion strong beliefs in a god.

Key messages

University students are in different positions before abortion according to their social and cultural context. The regulation of the abortion policy will have to contemplate the particular Mexican situation taking into account its social fabric and the moment in which it lives.
Has the impact of heatwaves on mortality changed in Slovenia? A study of the heatwaves, 2014-2018
Authors: Percic S , Cegnar T , Hojs A
Published: October 2020

Background

Heat waves are associated with increased mortality. In the last years the decreasing trend has been observed.

Methods

We estimated relative risks for number of deaths, for the observed diagnoses, sex and age, as well as 95% confidence intervals and excess deaths associated with heat waves occurring in the years from 2014 to 2018.

Results

Statistically significant were: in 2014, all, all causes (RR 1.26 (95% CI, 1.14-1.40); male, all causes (1.26 (1.09-1.45)); female, all causes (1.27 (1.11-1.44)); 5-74 years, all causes (1.26 (1.07-1.49)): 75+ years, all causes (1.27 (1.12-1.43)); all, circulatory system (1.24 (1.06-1.45)): female, circulatory system (1.27 (1.04-1.55)); 75+ years, circulatory system (1.3 (1.1-1.55)); female, 75+ years, circulatory system (1.33 (1.08-1.64)) and all, neoplasms (1.33 (1.11-1.59)), in 2015, 75+ years, all causes (1.11 (1.00-1.22)); all, circulatory system (1.14 (1.01-1.3)) and 75+ years, circulatory system (1.17 (1.01-1.34)), in 2016, 5-74 years, circulatory system (1.17 (1.01-1.34)) and male, 5-74 years, circulatory system (1.41 (1.01-1.99)), in 2017 and 2018 no statistically significance appeared.

Conclusions

Despite increasing heat load in observed years, we did not notice a statistically significant association between heat waves and the number of deaths in the last observed years 2017 and 2018. The results indirectly indicate that we are on the right track with public health efforts to raise awareness among Slovenes about the danger of heatwaves and appropriate measures.

Key messages

Heat waves will become more frequent, more intense and will last longer in the future, Due to these facts public health efforts are continously needed. The population is growing old and chronical noncommunicating diseases increases, so the burden of heatwaves will continue for voulnerable groups.
Public Health Consortia and potentiation of the collective action on the process of regionalization
Authors: Andrade S K , Mendonça F F , Bento L C , Baduy R S
Published: October 2020

The regionalization is one of the biggest Brazilian challengers on public system of health since its decentralization and, once consolidated, turns possible the structuration of a regional scale, which can potentiates the territories. Among the organizational arrangements on health region, the public health consortium is one of the participants on public politics. Considering that the consortium must deal not only with the sum of individuals, but with a joint project, a collective action, this study aims to investigate the perception of health managers about the consortium they are part of, its role and performance on regionalization process. The research had a qualitative and exploratory approach and it was submitted to the ethics committee approval process. Data collection was done through interviews and focus groups, with semi-structured scripts. The participants were health manager or a team member from counties of the region, state and ministry of health. The analysis methodology adopted was the discourse analysis. The results were classified on conditions that limit the consolidation of regionalization through consortium and the conditions that favor it. The conditions that limit were the insufficient knowledge about consortia's role followed by its inappropriate uses and prevail of distinct and individual interests among federative entities on decision making. Otherwise, the conditions with favour regionalization among consortium are the representatively of collective interests and the collaboration character on the consortia action. In the studied territory, the public health consortia was positioned as a strategic tool, its coherent performance is revealed on the perception of the study subjects, unveiling new perspectives for strengthen the regionalization. Concluding, public health consortia can be configured as an innovative role in territorial priorities and in the midst of needs of the entities, which can be replied around the world.

Key messages

The regionalization turns possible the structuration of a regional scale, which potentiates the territories and one of its arrangements is the public consortium. Public health consortia can be configured as an innovative role in territorial priorities and in the midst of needs of the entities, which can be replied around de world.
Words Counts: Family Planning Advocacy in a US Context
Authors: Bormet M , Noziglia B
Published: October 2020

Words, and the emotions they elicit, matter. This is especially true when dealing with a subject that inflames passionate emotions like family planning (FP). Despite the benefits gained from FP, such as improved maternal and child health, many remain skeptical, especially with questions of abortion's place in discussing women's sexual and reproductive health.

Language to talk about FP with US government (USG) policymakers and faith-based organizations (FBOs), especially from a conservative perspective, was tested through focus groups, one-on-one interviews with FBOs and 18 Congressional offices. Overall results were clear that defining what terms mean is crucial to buy-in, helped identify which terms are most palatable to faith audiences in the US and understanding the context of when and how to use terms and definitions is essential when advocating to USG audiences on such a sensitive topic.

Despite the benefits gained from family planning (reduce poverty, reduce risk of HIV/AIDS, improve maternal and child health) some policy makers remain skeptical. Many of these reservations come from questions of abortion's place in discussing women's sexual and reproductive health. However, FP services reduce abortions, by preventing unplanned pregnancies and empower families to grow in safe and healthy ways. Highlighting initiatives supported by local faith leaders, reinforcing messages from health care professionals, can reduce the skepticism of FP services. This allows policy makers to make decisions impacting family planning based on facts and data, not conjecture.

Key messages

Explain what language is most palatable and culturally appropriate to use and be understood by faith-based organizations and conservative policy makers in the United States on family planning. Discuss others experiences in speaking with conservative policy makers in the United States regarding family planning.
Ban on electronic cigarettes in Brazil: a policy in favor of human rights
Authors: Maia A C A , Fabriz D C , Motta T A , Zanotelli V F , Zamprogno B
Published: October 2020

This research aims to study the prohibition of electronic cigarettes' commerce in Brazil and to demonstrate its relevance in the realization of freedom and health, especially considering the impact of these devices worldwide. Also known as Electronic Nicotine Delivery Systems (Ends) and e-cigarettes it is a type of product designed to deliver nicotine, derived from tobacco leaf, in the form of an aerosol, some of which are also sold without nicotine.

It is necessary to analyze, using rhetoric as method, as well as the science of statistics, the conflicting principles of freedom and life involved in the citizen's right to choose and public health, to answer the question: Is a complete ban on e-cigs the correct policy from the government? The commercialization, importation and advertising of electronic cigarettes was prohibited by the Brazilian Health Regulatory Agency (ANVISA) in 2009, thus banning, at least legally, access to the devices inside the country. Despite this prohibition, the trade in vaporizers and their fluids, which contains nicotine, is easily achieved on the internet, informally. It must be noted that, even considering the benefits of vaping for chronic smokers, there is the concern of secondhand smokers and the upsurge of young people taking on vaping to consider.

The conclusion is that, although both individual freedom and health are constitutional rights, in this conflict between them, the suppression of individual freedom is needed, since health is a public concern, and it stands to reason that, even considering the lesser impact vaping has on people, compared to combustion cigarettes, there are two factors in play: First, nobody has the right to expose people to any chance of ill effects, negating the argument of reduced risks when compared to cigarettes. Secondly, there are no long-term studies to support the claims of safety in this practice. The ban, therefore, represents public health and respect regarding Human Rights.

Key messages

The conflict between individual freedom and health must prevent, in this situation, the possibility of affecting the health of new generations and nonsmokers. There are no long-term studies proving the safety of electronic cigarettes, therefore the law banning the product is a preventive act in the name of public health.