bluuebunny/crossref_metadata_2025 huggingface dataset:
Key drivers for and requisites to harness digital tools for personalized healthcare
Authors: Boccia S , Pastorino R
Published: October 2020

The technologies that allow for a deeper understanding of the human 'omic infrastructure are creating unprecedented opportunities for disease prevention, diagnosis, and treatment and for disease monitoring on a personalised basis, both within the health system and beyond. As all the new technologies and their applications advance, they are likely to play an integral role in shaping healthcare and the ways in which citizens manage and optimise their health. The 'omic profiling have the potential to be considered a useful component of health management since birth, but the extent to which it really represents an added value in terms of improved outcomes and quality of life needs additional evidences. The use of PRS in health subjects is an important area of development for public health and warrants close attention, but there is still a good deal to learn about how to maximise benefits for population health. When it comes to digitalization, we can anticipate that its impact on health, health care delivery and health systems will be profound. It will likely (further) affect the different phases of health care delivery, including health promotion, prevention, primary care, specialised care, long term care, social care, and self-care. In this context, a key challenge is to ensure that all people enjoy the benefits of digital technologies for everyone. Establishing the critical digital infrastructure, training the workforce, improve citizens awareness, and secure safeguarded systems to protect data as a central issue to fostering patients and citizens trust in data sharing, are key aspects that we need to address now. Additionally, we must make sure that all the innovation and technologies helps to reduce the inequities in our world, instead of becoming another reason people are left behind.
Health and wellness tourism in Sicily: development and enhancement
Authors: Arnone R , Bue S L , Parenti I
Published: October 2020

Background

The Health Counselor of Sicily in Italy, appointed the “Forum Meridiano Sanità” 2020 dedicated to Health Tourism (HT). Sicily is a member of the Italian network “Mattone internazionale salute” that focus the development of Health Tourism aiming at: Establish the state of art on HT;Defining a strategy to give visibility of the services targeting health tourists;Defining joint actions/projects to strengthen Italy's attractiveness and the action plan to promote/valorize health performances and the touristic services offered.

Sicily, making use of its cultural/environmental characteristics, landscapes, climate, food traditions and its Mediterranean diet, wants to be accounted for a destination on health/wellness tourism. Target groups are seniors, disabled people and people affected by particular pathologies Contribution of Sicilian Region (Sicilian Health Government and CEFPAS) and of the European program 2021-2027 are promoting in Sicily the implementation of such in the development of the “Health and Wellness Tourism”. In order for this to be integrated in a broader framework a discussion on the first European Charter on Health Tourism will be developed with participants.

Results

The “working table” has elaborated a document “Framework on health and tourism - the interregional point of view” containing the definitions of Health tourism, a state of art of the national/European legislative framework and a mapping of the touristic flow and the needs of seniors. The Regional Health Government is also starting articulations with other Regional Governments (e.g. Tourism/Environment). Strategic alliances/resources able to transform the tourism sector, should focus a strategic policy agenda for health prevention/promotion linked to a wider concept of general wellness.

Key message

Promote health/wellness tourism targeting seniors and people with disabilities/pathologic diseases is considered worth the investment.
Impact of Immediate ART Initiation and Patient Health Expenditures: A Stepped-Wedge Randomised Trial
Authors: Steinert J I , Geldsetzer P
Published: October 2020

Background

Healthcare expenditures for HIV care pose a major economic burden on households in sub-Saharan Africa. While immediate initiation of antiretroviral therapy (ART) for all HIV-positive patients has important health benefits, it is unknown how this profound change in HIV care provision will affect patients' healthcare expenditures. This study, therefore, aims to determine the causal impact of immediate ART initiation on patients' healthcare expenditures in Eswatini.

Methods

This stepped-wedge cluster-randomised controlled trial enrolled fourteen public-sector healthcare facilities in rural and semi-urban Eswatini. Facilities were randomly assigned to transition at one of seven time points from the standard of care (ART eligibility at CD4 counts of < 500 cells/mm3) to the immediate ART for all intervention (EAAA). The primary outcome was total patient-borne healthcare expenditures during the preceding 12 months. We used mixed-effects negative binomial regressions adjusted for secular trends and clustering at the facility level.

Results

2261 participants were interviewed over the study period. Participants in the EAAA phase reported a 45% decrease (RR: 0.55, 95% CI: 0.39, 0.77, p < 0.001) in their total past-year healthcare expenditures compared to the standard-of-care phase. Patients' healthcare expenditures for private and traditional healthcare providers were 93% (RR 0.07, 95% CI: 0.01, 0.77, p < 0.001) lower in the EAAA than the standard of care phase. Self-reported health status was similar between study phases.

Conclusions

Despite a higher frequency of HIV care visits for newly initiated ART patients, immediate ART initiation lowered patients' healthcare expenditures because they sought less care from private and traditional healthcare providers. This study adds an important economic argument to the World Health Organisation's recommendation for countries to abolish CD4-count-based eligibility thresholds for ART.

Key messages

This is the first experimental study to examine the impact of immediate ART initiation on patients’ healthcare expenditures and thus obtain a causal estimate of the economic benefits of immediate ART. Immediate ART initiation in Eswatini reduced HIV patients’ healthcare expenditures, at least partially through decreasing care-seeking from traditional and private healthcare providers.
Artificial Intelligence in Drug-Resistant Tuberculosis Diagnosis. Systematic Review & Meta Analysis
Authors: Herman B , Sirichokchatcawan W , Pongpanich S , Nantasenamat C
Published: October 2020

Background

Artificial Intelligence (AI) models possess potential screening or diagnosing Drug-Resistant Tuberculosis. This meta-analysis aimed to elaborate on the performance of AI models in predicting drug-resistant TB compared to the gold standard.

Methods

A systematic search of full-paper articles from Pubmed/MEDLINE and SCOPUS published between January 2005 and April 2020 was conducted. Studies involving whole-genome sequencing or human subject data that used drug-susceptibility test results as a reference standard were retrieved. Hierarchical summary receiver-operating characteristic (HSROC) and bivariate model were performed to calculate pooled sensitivity and specificity. Heterogeneity and publication bias were also assessed.

Results

25 Models form four genome-based studies, four radiology-based studies, and two clinical and demographic-based studies were included. The radiology-based models, mainly built with the Convolutional Neural Network (CNN), possessed pooled sensitivity of 58% (95%CI 50%-65%), and a pooled specificity of 75% (95% CI 47%-91%) for detecting MDR-TB. Genome-based models outperformed other models despite developed with simpler classifiers (CART/GBT/LR). The genome-based studies reached pooled sensitivity of 92% (95%CI 90-93%), pooled specificity of 98 (95% CI 96%-98%) in predicting isoniazid resistance. For predicting rifampicin resistance, the pooled sensitivity and specificity were 93% (95%CI 90%-94%) and 98% (95% CI 96%-98%) respectively. The Artificial Neural Network (ANN) demonstrated superiority rather than the Classification and Regression Tree (CART), and logistic regression (LR) on the clinical and demographic model in predicting drug-resistant TB.

Conclusions

Simple classifier performs better in genomic data whereas the CNN model works best in high-dimensional data, such as radiology images. The ANN model indicates a preferred model for data obtained from clinical and demographic parameters. (PROSPERO number CRD42020167439)

Key messages

Artificial Intelligence model through machine learning and deep learning possess a good diagnostic performance for drug-resistant tuberculosis. Artificial Neural Network model outperforms other technique. The model built from genomic data shows the best performance, followed by model from patient-based data and radiology/imaging data.
The association of nurses’ informatics competence with distress and information system-related stress
Authors: Laukka E , Kaihlanen A-M , Gluschkoff K , Virtanen L , Heponiemi T
Published: October 2020

Background

Ability to use information systems is a crucial part of nurses' competence, but evidence on whether this competence is associated with stress among nurses is lacking. As part of the 'Towards socially inclusive digital society: Transforming service culture' (DigiIN, funded by the Strategic Research Council, project 327145), we examined the associations of registered nurses' informatics competence with distress and information systems related stress.

Methods

The data was collected in Finland with an electronic survey at the end of 2018. The sample comprised 1639 nurses. Analyses of covariance were used to examine whether the nurses' informatics competence was associated with distress and information system-related stress. In addition to overall informatics competence, we also examined the associations of four dimensions of informatics competence (terminology based documentation; e-documentation according to structured national headings; general IT competency; patient-related digital work) with dependent variables. Models were adjusted for age, gender and employment sector.

Results

Nurses' overall informatics competence was associated with lower distress (F = 9.90 p = 0.002), but not with information system-related stress. The analyses with four competence dimensions showed that patient-related digital work competence was associated both with lower distress (F = 3.95 p = 0.047) and information system-related stress (F = 4.63 p = 0.032). In addition, general IT competency was associated with information system-related stress (F = 12.6 p < 0.001).

Conclusions

Especially lack of patient-related digital work competence seems to stress nurses. Supporting nurses in patient-related digital work and improving nurses' general IT competency by training could decrease their stress related to information systems and improve their wellbeing.

Key messages

Nurses should be supported more in patient-related digital work. Nurses’ high IT competency is associated with lower stress, and thus, healthcare organizations may benefit from providing more IT training for nurses to decrease their stress levels.
Data-driven chronic care delivery pathways visualization Methods: protocol for a systematic review
Authors: Siqueira do Prado L , Allemann S , Viprey M , Schott A-M , Dediu D , Dima A L
Published: October 2020

Background

Faced with increasing illness burden and costs, healthcare systems are working towards integrated care to streamline services and improve efficiency, especially for chronic conditions. Routine care delivery data stored in various electronic healthcare databases (EHD) has the potential to support chronic care coordination if information is integrated and accessible at the point of care. Care delivery pathways (CDPs) can be constructed by linking multiple data sources and extracting time-stamped healthcare utilization events and other medical data related to individual or groups of patients over specific time periods; CDPs may facilitate communication on current practice and ways of improving it. We aim to identify and describe the methods proposed to quantify and visualize CDPs.

Methods

A literature search was performed in PubMed (MEDLINE), Scopus, IEEE, CINAHL and EMBASE, without date restrictions. We will describe CPDs methods from 3 perspectives relevant for EHD use in long-term care: (1) clinical (what clinical information is used and how was it considered relevant?), (2) data science (how was the method developed and implemented?), and (3) behavioral (which behaviors and interactions are promoted among users and how?). Data extraction will be performed via deductive content analysis using selected frameworks, and inductive analysis to identify additional relevant features. We will compare these characteristics to identify common, infrequent, or missing features, and extract recommendations for future initiatives.

Results

The literature search identified 2349 entries, currently under title and abstract selection by 4 coders. This study will produce a comparison and synthesis of clinical, data, and behavioral features of CDPs methods and derive recommendations for CDP construction.

Conclusions

This review works towards a common basis for visualizing and quantifying CDPs across healthcare systems, an essential prerequisite for interoperable digital health.

Key messages

Visual feedback on health care trajectories, especially for chronic conditions, may support informed decisions and planning future care episodes to advance towards person-centered integrated care. We describe and compare technical and clinical characteristics of visual feedback methods available for care pathways, and behaviors they may promote in care planning, to inform future initiatives.
Factors contributing to physicians’ use and satisfaction with Electronic Health Records in Kuwait
Authors: Alotaibi J , Tolma E , Alali W , Alhuwail D , Aljunid S
Published: October 2020

Introduction

Electronic Health Records (EHR) help physicians make effective decisions in patient care. With limited research in this area in Kuwait, we sought to identify the factors that contribute to the current use and satisfaction of EHR in Kuwait.

Methods

This cross-sectional study took place in a public hospital in 2019. Three-hundred ten physicians were recruited through convenience sampling (response rate: 95%). The survey which was translated into Arabic, was self-administered and it contained 48 statements. The Technology Acceptance Model was used as the theoretical framework. The dependent variables were satisfaction with EHR and current use of EHR. The main independent variables were barriers of using the EHR, perceived level of ease for using EHR, and effect of EHR on the physicians' work. Descriptive analysis, followed by bivariate, multivariate linear regression adjusted for demographics were conducted.

Results

The study sample consisted of predominantly males (82%), non-Kuwaiti (84%), and of young age (42% were 30-39 years old). The majority of the participants (76%) were currently using the EHR system. The physicians' satisfaction with use of EHR system was moderate (Mean: 3.47, SD: 0.81, range 1.33-5). The EHR effect on the physicians' work was the most significant predictor of satisfaction (β = 0.491, p = 0.000), followed by the level of ease (β = 0.274, p = 0.000), and length of use of EHR (β = 0.100, p = 0.006). Perceptions of barriers was the strongest predictor of current use of EHR (β=-0. 417, p = 0.000), followed by level of ease (β = 0.227, p = 0.000) and quality of a related training (β = 0.195, p = 0.000).

Conclusions

In the promotion of EHR use and related satisfaction, making the use of EHR functions (e.g. registration of clinical notes) as easy as possible seems to be a key factor. Other factors to consider are removing the barriers physicians face, making the benefits of use of EHR visible, and ensuring a high quality related training.

Key messages

Most physicians in a Kuwaiti public hospital use the EHR system. Perceived barriers, effect of EHR on the physicians’ work, and user-friendly application of EHR are associated with satisfaction and EHR use.
Prevalence of amputations amongst people with type 2 diabetes enrolled in primary care in England
Authors: Meza-Torres B , Heiss C , Cunningham S , Carinci F , de Lusignan S
Published: October 2020

Background

Different patterns of co-morbidities observed among people with type 2 diabetes (T2D) and lower extremity amputations (LEA) compared with those without may provide insights into the quality of care provided by general practitioners in England. We analysed routinely recorded clinical data to build predictive models for benchmarking and continuous improvement.

Methods

A cross-sectional computerized data extraction of clinical records from the Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) database of people with T2D in England. Key target cases were defined as adults with T2D and a record of major/minor LEA between 2008-2019 vs all subjects with T2D without amputation. Quality of care was assessed in terms of percentage of patients treated with optimal medical therapy and diagnostic procedures and referred to specialized care according to their clinical profile. The association between quality of care and outcomes was explored using a logistic regression model, adjusting for case-mix.

Results

During the last decade, in a sample covering approximately 7.4% of all general practitioners in England, a total of 1,052 subjects out of 127,100 adults with T2D had a LEA (832 per 100,000). The median time since amputation was 3.4 years. Only 410 (38%) patients had a recorded DFU diagnosis prior to the amputation, with a median of 2 years from diagnosis to amputation. Major LEA was recorded in 280 (27%) cases. People with a record of retinopathy, peripheral arterial disease, renal disease, neuropathy and DFU had a higher risk of amputations. Quality of care was heterogeneous between patients with and without LEA.

Conclusions

People with T2D and LEA have a distinct pattern of co-morbidities some of which may be sensitive to improved primary care management, and differential quality of care. Models built using this national database can routinely monitor amputations in England. Variation in treatment should be properly investigated.

Key messages

The automated extraction of clinical cases from a national database may help shed light on clinical patterns among people with diabetes at high risk of amputations, based on evidence-based criteria. Variation in treatment and quality of care among amputated vs non-amputated subjects can be rapidly explored using a cross-sectional analysis of current records.
The implementation of a mobile application to support community-based health workers
Authors: Martins A C F , Pereira P L , Mafra A C C N , Miraglia J L , Monteiro C N , Silva J R , Almeida E S , Oliveira J S , Santos V S , Borges L M
Published: October 2020

Issue

Real-time access to up-to-date population information is essential to the strategic planning of primary health care (PHC). In the Brazilian public health system community-based health workers (CHWs), working as part of PHC teams, collect health, demographic and socio-economic data from individuals mainly through paper-based forms that are later entered manually into electronic information systems. Mobile applications could help to improve the quality and speed of this process facilitating the CHWs day-to-day work while improving the access to the collected information.

Description of the Problem

During September of 2019, a mobile application installed in tablets for the collection of health, demographic and socio-economic data was deployed for 432 CHWs of 87 PHC teams in the southern region of São Paulo, Brazil, serving a total population of 283,324 individuals. During implementation, the acceptability and challenges faced by CHWs were evaluated and the time taken to complete data entry.

Results

Seventy-two hours of training were offered to CHWs and other 139 professionals including managers, nurses and administrative staff (AS). Some CHWs reported concerns about the process change and fear of not being able to operate the application, especially those unfamiliar to the technology. With training and team support, fear was transformed into satisfaction with the realization of the benefits of the system. The main infrastructure challenge was the need for installation of Wi-Fi routers in some health care units, in addition to the replacement 4.4% of damaged tablets. In four months 97.6% of the total population was registered in the application.

Lessons

A WhatsApp group was created to clarify AS doubts, receive suggestions and disseminate guidelines. AS remained as the reference point at healthcare units and data completeness still needs to be reinforced.

Key messages

A mobile application was well-accepted by CHWs and could facilitate the collection of population data. A tablet app proved to be a useful tool to generate information for the PHC teams.
Validation of the CASUS score in Tunisian patients: a quality management tool in intensive care units
Authors: Besbes T , Mleyhi S , Sahli J , Messai M , Ziadi J , Ghedira F , Ajmi N , Denguir R
Published: October 2020

Background

Early prediction of patients at highest risk of a poor outcome after cardiovascular surgery, including death can aid medical decision making, and adapt health care management in order to improve prognosis. In this context, we conducted this study to validate the CASUS severity score after cardiac surgery in the Tunisian population.

Methods

This is a retrospective cohort study conducted among patients who underwent cardiac surgery under extracorporeal circulation during the year 2018 at the Cardiovascular Surgery Department of La Rabta University Hospital in Tunisia. Data were collected from the patients hospitalization records. The discrimination of the score was assessed using the ROC curve and the calibration using the Hosmer-Lemeshow goodness of fit test and then by constructing the calibration curve. Overall correct classification was also obtained.

Results

In our study, the observed mortality rate was 10.52% among the 95 included patients. The discriminating power of the CASUS score was estimated by the area under the ROC curve (AUC), this scoring system had a good discrimination with AUC greater than 0.9 from postoperative Day 0 to Day 5.From postoperative day 0 to day 5, the Hosmer-Lemeshow's test gave a value of chi square test statistic ranging from 1.474 to 8.42 and a value of level of significance ranging from 0.39 to 0.99 indicating a good calibration. The overall correct classification rate from postoperative day 0 to day 5 ranged from 84.4% to 92.4%.

Conclusions

Despite the differences in the profile of the risk factors between the Tunisian population and the population constituting the database used to develop the CASUS score, we can say that this risk model presents acceptable performances in our population, attested by adequate discrimination and calibration. Prospective and especially multicentre studies on larger samples are needed before definitively conclude on the performance of this model in our country.

Key messages

The casus score seems to be valid to predict mortality among patients undergoing cardiac surgery. Multicenter study on larger sample is needed to derive and validate models able to predict in-hospitals mortality.
The Situation Room as a management tool: the case of the Municipal Health Secretariat of Salvador
Authors: Pereira M , Santos dos , Alves H , Lima Vieira , Carvalho Cerqueira S , Almeida A , Jure F , Rosemberg R , de Fernandes Oliveira
Published: October 2020

Problem

The Salvador Municipal Health Secretariat (MHS) utilizes health data to elaborate technical documents to manage and respond to instances requiring internal or external control. In answer to demands for the modernization and transparency of municipal management, the constitution of a Health Situation Room (HSR) was included in the political agenda of the Secretary, thereby guaranteeing political, technical and operational support for its implementation.

Description of the Problem

To describe the process of construction of the HSR in the Salvador MHS in 2020. The HSR is a physical, virtual and collective space for the analysis of information, which begins with a data search which allows to understand the information flow, identifying the solicitor and the constructor of the information, the data source and the informational object itself.

Results

130 technicians and managers were interviewed, and their responses then categorized into 161 indicators across different themes. The results point out the need to define a spatial analysis unit to be adopted, and to communicate with external actors who demand information, as well as to develop a communication plan for the HSR.

Lessons

To develop an informational culture oriented by local and central protagonism, generating evidence for decision-making and information transparency for the whole of society.

Key messages

The Health Situation Room reduces the time between information-decision-action. The Health Situation Room prioritizes interdisciplinary collaboration and increases the efficiency of the health system.
A GDPR-compliant information system to improve community primary care in a middle income country
Authors: Oliveira V A , David R B , Mota L G , Barral-Netto M , Carreiro R P , Botelho D F
Published: October 2020

Background

A strong primary health care (PHC) is associated to better overall health system results. Brazil has good results in PHC in the last decades, integrating 260,000 community health workers (CHW) in 43,000 family health teams (FHT), assisting 90 million people and delivering 500 million health activities yearly, such as home visits, consultations, colposcopy, etc. We address the challenges of incorporating CHA-produced data to official electronic health records, automate its analysis and promote information use by FHT to plan activities & prioritize individuals considering social determinants of health, clinical data and treatment plans. Our study developed a general data protection regulation (GDPR) compliant information system to improve community health agents and family health teams coordination of care in order to address this challenge.

Methods

The intervention was developed using UX techniques and combines Apps and Web dashboards, issuing digital alerts to the FHT and municipal health manager, regarding individual health status and pending care for each covered individual. The research used the “Monitoring and Evaluating Digital Health Interventions” toolbox by World Health Organization (WHO), and GDPR compliance was attained by terms of use acceptance, pseudonymisation and anonymization procedures.

Results

Stage 1 and Stage 2 Maturity tests with doctors, nurses and CHA showed good feasibility, usability and user satisfaction of the solution. UX and Qualitative Assessment are reported separately.

Conclusions

Results so far point that the solution is viable and acknowledged as useful by health professionals. Stage 3 (Pilot) will run in September 2020 in two different cities to test efficacy and health system adherence in real world setting. Digital health interventions are powerful tool to improve health care system performance, particularly in Primary Health Care.

Key messages

Digital Health Intervention are viable in Primary Care as long as they reduce health profesisonal burden and increase service quality. Brazil is a promising environment for Digital Health. Careful planning, development and deployment are essential in the process.
UX Research applied to digital transformation of primary care in Brazil
Authors: Mota L G , David R B , Botelho D F , Oliveira V A
Published: October 2020

Background

Digital are powerful tools to improve the work and quality of information of primary care teams (PHC) in Brazil has been encouraged through the institution of the e-SUS Primary Care strategy (e-SUS AB). Digital tools were developed to optimize the PHC work process in collecting data on the health of the Brazilian population. The e-SUS AB application was one of those tools developed by the Ministry of Health. This simplified collection of population data. Despite technological updates, since 2015 there were updates regarding the usability of the application.

Objective

Aim to report on the use of UX research tools to identify changes needed in the e-SUS AB application and to propose solutions aligned with the concepts of usability.

Methods

For the UX Research, we used focus groups and field monitoring. As a result, we produced personas, empathy map, user journey, and user history documents. The Heuristic User Interface Design, proposed by Nielsen, was used for the application analysis. The World Health Organization's MEDHI (Monitoring and Evaluating Digital Health Interventions) protocol was used for designing solution proposals for UX Design.

Results

In the design process, we produced navigation sketching's flow and high-fidelity prototypes for improvement proposals. It was necessary to correlate Nielsen's 10 heuristic principles with the needs inherent to public health applications. Problems related to the freedom of control and use by the health professional and the flexibility and efficiency of use were the most significant finds. We also identified underutilization of data collected.

Conclusions

Based on the results found, an aesthetic reformulation was proposed to solve the heuristic problems. It was also proposed to include a new functionality: a checklist for specific conditions, thus optimizing the use of data collected for primary health care. The proposals are currently undergoing usability testing in a municipality in northeastern Brazil.

Key messages

We need to plan health digital tools with UX knowledge to improve analysis and decision making capabilities to pointing out strategies to face health issues in the territories. Digital tools are powerful tools to improve health care system performance.
Reviewing Effective Contents for a Gamification Approach to Foster Wellbeing among Adolescents
Authors: Thiele A , Tolks D , Sailer M , Dadaczynski K , Lampert C , Paulus P
Published: October 2020

Background

Ample evidence exists that wellbeing is critical during teenage years. Therefore, options for implementing wellbeing among adolescents are needed. To fulfill this need, gamification promises to be a suitable method. Gamification uses game design elements from a game context (points, leaderboards) and game elements (randomness, tension) in a real life context to reach life goals such as behavioral changes. Recent studies indicate that gamification only produces long-term effects when filled with stimulating content. To categorize the content of the adventures and other game design elements within the gamification concept, the “5 ways to wellbeing” have been a suitable evidence-based approach among adult interventions: connect, give, take notice, keep learning and be active. This research aims at filling the framework of gamification with the most opportune content to foster wellbeing among adolescents.

Methods

71 interventions of fostering wellbeing among adolescents could be identified in a scoping review from Pubmed. Eligible interventions had to focus on adolescents and had to have outcomes on wellbeing. Interventions that covered a more specific target group, such as cancer survivors, were excluded from this research.

Results

Adolescent interventions' contents, which had a positive outcome on wellbeing, mostly dealt with physical activity (13) and health promotion (11), followed by psychological training interventions (9). 11 interventions did not have a positive outcome on wellbeing.

Discussion

The many positive outcomes in above categories result from the amount of interventions. To further investigate the effect of the five ways to wellbeing within a gamification framework for adolescents, we develop an intervention application (ONYA) which will be applied among adolescents in German middle schools.

ONYA is funded by the German Federal Ministry of Health Education.

Key messages

Research on suitable content for gamification frameworks on wellbeing is rare. Wellbeing interventions are underrepresented in the categories of the 5 ways to wellbeing.
Promoting education on the health effects of climate change for nurses in Finland
Authors: Tiitta I , McDermott-Levy R , Jaakkola J J K , Turunen H , Kuosmanen L
Published: October 2020

Background

Climate change has a direct and indirect impact on human health that include health impacts from rising temperatures and poor air quality. Without changes in our greenhouse gas emissions, it is estimated that by the end of this century average temperatures will rise from two to four degrees Celsius worldwide. In Finland, this rise in temperature is estimated to be 1.5-2 times higher than other regions of the world. During the heatwaves in Finland in the 2000s, the mortality rate among the elderly increased by 21%. Nurses should be aware of these health effects and the patients who are particularly vulnerable to the health impacts caused by climate change.

Purpose

The purpose of the study was to identify the health issues that Finnish nurses associate with climate change. The purpose was also to find out how prepared nurses are to deal with the health effects of climate change.

Methods

A qualitative descriptive study was conducted in November 2018 using focus group interviews to collect data.

Results

Interviews revealed that nurses have seen much of the health damage caused by climate change in their patients. However, they had not linked their observed changes in patients' health to climate change. Nurses interviewed felt unaware of the health effects of climate change. In addition, nurses felt that climate change was not adequately addressed in basic and in-service training.

Conclusions

Education could strengthen the competence of nurses in helping their patients prevent and reduce the health impacts caused by climate change. It is therefore important to include climate change and its impact on human health in the nursing curriculum.

Key messages

Nursing organizations can influence nurses’ understanding of climate change in their practice. Nurses' understanding can be used leverage their role in reaching nurses for new and emerging health conditions that influence public health.
Urbanization and greenness in HBSC survey: association with life satisfaction and health complaints
Authors: Gintoli I , Bellisario V , Squillacioti G , Caputo M , Borraccino A , Dalmasso P , Bono R , Lemma P
Published: October 2020

Background

Several studies have shown that neighborhood greenness is associated with lower problematic behaviors in children and better perceived well being. While urbanization showed opposite results. The aim of the study was to assess the relationship between urbanization and greenness levels with perceived health, life satisfaction and health complaints on adolescents.

Methods

The study is based on data from 2018 Health Behavior in School-aged Children in the region of Piedmont(Italy), which involved 3022 11-,13-,15-year olds, sampled in 122 schools across the region. Every school was georeferenced. Greenneess was measured by Normalised Difference Vegetation Index (NDVI-satellite images) and urbanization by population density, traffic intensity (satellite measurements) and air pollution concentration (sampling stations). Health complaints were evaluated with a set of 8 psychosomatic symptoms(reported more than once a week). Life Satisfaction (LS) was measured by using the Cantril scale (low LS < 5, high LS > =6). Self-Rated Health was measured by means of a four points scale (fair or poor, good or excellent).

Results

More than 66% of adolescents reported frequent health complaints; 11% declared low life-satisfaction and 9% of adolescents scored poor or fair self-rated health. The proportion of the three variables increased with age in both genders, and was higher among girls. Gender differences increased from 11- to 15-years of age. Preliminary results showed a positive association between greenness and life satisfaction, urbanization and health complaints.

Conclusions

In times of increasing urbanization and reduced availability of green areas, characterizing the association between urbanization, greenness and perceived health is revealed to be the challenge for Public Health. Redefine the urban spaces accordingly requires collaboration between different disciplines. Coherently with the recent studies, communities can be actively involved through qualitative approaches.

Key messages

The topic of urban nature is becoming central for healthy and sustainable urban planning, not the least for population groups like adolescents and children. The relation between urbanization, with decreasing access to green spaces, and the impact on physical as well as mental health presents an important issue and a big challenge for Public Health.
Role of different wastewater treatment plants in antibiotic resistance spreading
Authors: Bonetta S , Pignata C , Bonetta S a , Gasparro E , Lorenzi E , De Ceglia M , Gilli G , Carraro E
Published: October 2020

The global action plan on antimicrobial resistance reports the necessity to develop standards and guidance for the presence of antimicrobial agents in the environment, especially in wastewater, highlighting its possible role in the antibiotic resistance spreading. In addition, the New European One Health Action Plan against Antimicrobial Resistance underlines the need to support research into knowledge gaps on the release of resistant microorganisms into the environment and their dissemination. The aim of this study was to evaluate the presence of Antibiotic Resistance Bacteria (ARB) and Antibiotic Resistance Genes (ARG) in wastewater treatment plants (WWTPs). At this scope, untreated sewage and treated effluents of three different WWTPs (A, B and C) were sampled for one year. Sample dilutions were plated on R2Agar added/not-added with 4 different antibiotics (ampicillin 32mg/L; tetracycline 16 mg/L; chloramphenicol 32 mg/L; sulfamethoxazole 50,4 mg/L) to evaluate the percentage of antibiotic resistant bacteria and their WWTPs removal rate (%). DNA extraction on the filter used to concentrate the wastewater samples was performed to reveal the ARG presence; subsequently specific PCRs for ARG (blaTEM, tetA, sul II, sul III) were carried out. ARB were detected in all samples analysed. The highest antibiotic resistance percentage was revealed in the sewage (mean 21,7%±4,8) and effluent (mean 21,1%±3,0) of the three wastewater treatment plants for sulfamethoxazole. Moreover, sul II was the most present gene in the samples (81% of all samples, 89 % of sewages and 72% of effluents). The lower WWTPs removal was recovered in the plant B for the tetracycline (95, 7%). The results obtained underlines the need to monitor WWTP as critical hot spot for the antibiotic resistance spreading also considering the One Health approach. Furthermore, the results obtained could suggest interventions to reduce the spread of the antibiotic resistance in the integrated urban water cycle.

Key messages

The information obtained could provide usefulness information about the role of wastewater treatment plant in the antibiotic resistance spreading. The results could contribute to suggest the interventions targeted to reduce the antibiotic resistance phenomenon in the integrated urban water cycle.
E-cigarettes from the perspective of teenagers – results of focus studies
Authors: Pluta K , Balwicki Ł
Published: October 2020

Research shows that over 80% of smokers start their habit under the age of 18. A few years ago young people undertook risky behaviors related to nicotine initiation mainly by smoking cigarettes. Today, next to traditional tobacco products, electronic cigarettes are becoming more and more popular. Due to the prevalence of new forms of nicotine addiction, modification of anti-tobacco prevention programs is required. The purpose of the research was exploration - learning the opinions and attitudes of young people towards e-cigarettes.

The qualitative study was conducted using the FGI method (focus group interview). The meetings were modereted by specially trained psychologists. 48 students participated in the meetings of six focus groups, divided by gender and smoking status (smokers/non-smokers). The participants are young people aged 15-19, attending high schools in Warsaw, Kielce and Lublin. In conversations, young people emphasized the impact of e-cigarettes in smoking initiation - it usually occurs at the age of 12-14. E-cigarettes are perceived as cigarettes “for younger”, non-addictive, less serious, providing more entertainment. 'Cloud chasing' is particularly popular. They perform social functions - they are helpful in establishing relationships. Teenagers do not see the harmfulness of e-cigarettes.

Participants mentioned their advantages over traditional tobacco products - they can be smoked everywhere and do not leave an unpleasant smell. Some of the respondents admit to the simultaneous use of electronic and traditional cigarettes. Moreover, many parents allow children to smoke electronic cigarettes.

Vaping have become a natural way to relaxation and socialization for adolescents. E-cigarettes do not have such a negative connotation as traditional tobacco products. Young people do not see them as harmful, which is a challenge for effective preventive measures.

Key messages

Adolescents do not see e-cigarettes as harmful, which is a challenge for effective preventive measures. Vaping have become more and more popular - it's natural way to relaxation and socialization for young people.
Children with deficit in executive abilities have risk for emerging weakness in grammar understanding
Authors: Kiselev S
Published: October 2020

Background

Children with specific language impairment have difficulties producing and understanding language (Bishop, 1997). Specifically, these children have deficit in grammar understanding. The goal of this research was to examine the hypothesis that children at the age of 5-6 with deficit in executive abilities have a risk for emerging weakness in grammar understanding at the age of 8-9.

Methods

136 children at the age of 5-6 were assessed using 5 subtests from NEPSY (Tower, Auditory Attention and Response Set, Visual Attention, Statue, Design Fluency), which are designed to assess executive abilities in children. We have revealed 27 children with deficit in executive abilities. These children were included in the experimental group. The control group included 27 children with no deficit in executive abilities. In the framework of longitudinal research children at the age of 8-9 from both groups were assessed by Grammar Understanding Test from Luria's neuropsychological assessment technique.

Results

One-way ANOVA has revealed significant differences (p<.05) between groups for scores in Grammar Understanding Test. Children from experimental group had low level of grammar understanding.

Conclusions

This research has shown that deficit in executive abilities can predict the delay in development of grammar understanding in children. These results provided insight into cognitive mechanisms in typically developing and the underlying nature of specific language impairments, helping to elucidate the nature of impaired mechanism in this disorder. It can be assumed that deficit in executive abilities is one of the risk factors for emerging weakness in grammar understanding in children.

Key messages

Deficit in executive abilities is one of the risk factors for emerging weakness in grammar understanding in children. There is relationship between grammar understanding and executive abilities in children.
Cost-effectiveness of an indicated preventive intervention for depression in adolescents
Authors: Ssegonja R , Sampaio F , Alaie I , Philipson A , Hagberg L , Murray K , Sarkadi A , Langenskiöld S , Jonsson U , Feldman I
Published: October 2020

Background

Adolescent depression has negative health and economic outcomes in the short- and long-term. Indicated preventive interventions, in particular group based cognitive behavioural therapy (GB-CBT), are effective in preventing depression in adolescents with subsyndromal depression. However, little is known about the cost-effectiveness of these interventions.

Methods

A Markov cohort model was used to conduct cost-effectiveness analyses comparing a GB-CBT indicated preventive intervention for depression, to a no-intervention option. Taking a time horizon of 5- and 10 years, incremental differences in societal costs and health benefits expressed as cases of depression prevented, and as quality adjusted life years (QALYs) gained were estimated. Through univariate and probabilistic sensitivity analyses, the robustness of the results was explored. Costs, presented in 2018 USD, and effects were discounted at a yearly rate of 3%.

Results

The base-case analysis showed that GB-CBT indicated preventive intervention incurred lower costs, prevented more cases of depression and generated higher QALYs compared to the no-intervention option for both time horizons. Offering the intervention was even a cost saving strategy and demonstrated a probability of being cost-effective of over 95%. In the sensitivity analyses, these results were robust to the modelling assumptions. Limitations: The study considered a homogeneous cohort and assumed a constant annual decay rate of the relative treatment effect.

Conclusions

GB-CBT indicated preventive interventions for depression in adolescence can generate good value for money compared to leaving adolescents with subsyndromal depression untreated.

Key messages

Indicated preventive interventions for depression are cost-saving and can generate substantial health benefits. Indicated preventive interventions can be adopted as cost-effective preventive strategies for depression.