bluuebunny/crossref_metadata_2025 huggingface dataset:
Computerized prescription order entry and adverse drug events in pediatrics: a systematic review
Authors: Lambert Passos S , Barbosa N O , Mayon Neves L A A , Motta P A , dos Santos J L B , de Sousa F M , Cavalini L T
Published: October 2020

Background

Potentially harmful errors occur in pediatric patients at a rate three times higher than in adults, mainly due to dosage calculations. Objective. To evaluate the effect of Computerized Prescription Order Entry (CPOE) and Decision Support Systems (DSS) on Adverse Drug Events (ADE) in pediatrics. Method. Systematic review updated up to December 2019 in the PubMed, Scopus, Web of Science and Embase, Lilacs and cross-references, recorded in Prospero CRD 42019126590. Observational and pre- and post-implementation CPOE studies were included. in any language. A scale was used for methodological evaluation of the studies. Relative risk (RR), attributable risk (AR) or number needed to treat (NNT) with 95% CIs were computed for comparing the incidence of total, actual, preventable and potentially harmful ADE.

Results

Starting with 203 retrieved abstracts, 12 articles were included - eight interventional and four observational studies. Five articles evaluated CPOE and seven CPOE plus DSS. Settings for eleven studies were hospitals and one an outpatient facility. Sample sizes ranged from 514 to 45,615 totaling 112,187 patients. The number of prescriptions ranged from 724 to 92,398, totaling 182,803. A reduction in total ADE was observed in two studies. The risk reduction of preventable ADE ranged from 24% RR 0.76 (0.59 - 0.97) to 47% RR 0.53 (0.29-0.91) in four articles. Potentially harmful ADE (ADE ph) in five studies were reduced from 76% RR = 0.24 (0.09-0.68) to 44% (RR 0.56 (0.46 - 0.70), with an AR variyng from 1.8 to 0.9%. One of the articles stated that 64 (95% CI 25-100) patients would need to be using CPOE in order to avoid one potentially harmful ADE. Studies identified reductions in ADE in various settings- two in wards, one in wards and Pediatric Intensive Care Unit (PICU), the others in PICU and Neonatal Intensive Care Units.

Conclusions

Implementation of CPOE plus DSS reduces EADs in pediatric settings.

Key messages

Accumulated evidence favors implementation of CPOE plus DSS as important for prevention of ADE in pediatric settings. Potentially harmful and preventable errors can be avoided by implementing electronic prescribing systems in pediatrics. Its use should be encouraged in countries in low-income countries.
Human centered AI design for clinical monitoring and data management
Authors: Adnan H S , Matthews S , Hackl M , Das P P , Manaswini M , Gadamsetti S , Filali M , Owoyele B , Santuber J , Edelman J
Published: October 2020

Background

In clinical settings, significant resources are spent on data collection and monitoring patients' health parameters to improve decision-making and provide better care. With increased digitization, the healthcare sector is shifting towards implementing digital technologies for data management and in administration. New technologies offer better treatment opportunities and streamline clinical workflow, but the complexity can cause ineffectiveness, frustration, and errors. To address this, we believe digital solutions alone are not sufficient. Therefore, we take a human-centred design approach for AI development, and apply systems engineering methods to identify system leverage points. We demonstrate how automation enables monitoring clinical parameters, using existing non-intrusive sensor technology, resulting in more resources toward patient care. Furthermore, we provide a framework on digitization of clinical data for integration with data management.

Methods

Activities of Daily Living (ADLs) are essential parameters, necessary for evaluating patients in mental health wards. Ideally logging the parameters should take place at hourly intervals; however, time constraints and lack of resources restrict the nursing staff to consolidating the overall impression during the day, relying on what they recall. Using design methods, sensors (e.g. infrared, proximity, pressure) are used to automate the acquisition of data for machine learning that correspond to the ADLs, considering privacy and other medical requirements.

Results

We present a concept of a room with sensors that can be deployed in clinical settings. Sensor data log ADLs, and provide machine learning data. A theoretical framework demonstrates how collected data can be used in electronic/medical health records.

Conclusions

Data acquisition of the ADLs with automation enable variable specificity and sensitivity on-demand. It further facilitates interoperability and provides data for machine learning.

Key messages

Our research demonstrates automated data acquisition techniques for clinical monitoring. Human centered AI design approach enables on-demand analysis of ADLs for mental health treatment.
Information system in the context of the use of electronic patient record in Burundi
Authors: Munezero F , Sossa C , Bazira L
Published: October 2020

Objective

The Information System is an essential catalyst for the performance of a hospital. In order to strengthen the hospital information system, the patient record computerization project has been initiated since 2014. Our objective was to assess the hospital information system in the context of using the electronic patient record to highlight the factors to be strengthened.

Methods

This is a cross-sectional survey using the Health Metrics Network assessment tool. Eleven hospitals were included in the study, including 4 computerized in 2015 and 7 computerized in 2017. We carried out an evaluation of the hospital information system as a whole and an evaluation of the level of filling of patient files. In each hospital, the director of care, the chief nursing officer and the data manager were surveyed. Data collection was done in October 2019.

Results

This evaluation showed that 4 components (resources, indicators, information product and the use of information) were satisfactory with a score varying from 55% to 67% while 2 components (data source and data management) were present but not satisfactory. The score was 61% for resources, 60% for indicators, 41% for data sources, 43% for data management, 55% for information product and 67% for dissemination and use of information. The proportion of files with the main diagnosis at discharge was 61% before computerization, while it was 81% when using EPR (p < 10-4). It was also noted that the electronic patient record had 2.73 [1.83 - 4.07; p < 10-4] times more likely to report the main diagnosis on exit than the paper file.

Conclusions

the source components of the data and data management have shortcomings. Corrective strategies should be considered to support the ongoing hospital information system strengthening reforms

Key messages

The health metric network tool for evaluating the health information system adapted to the national level can also be used to assess the hospital information system. The computerization of the patient record is not enough to make the hospital information system efficient.
Economic arguments for population interventions to reduce alcohol consumption in Russian population
Authors: Myrzamatova A , Kontsevaya A , Mukaneeva D , Balanova Y u , Khudyakov M , Drapkina O
Published: October 2020

Aim

To get economic arguments for population-based interventions to reducing the consumption of alcohol in the Russian Federation.

Material and Methods

Studies of international practice on the implementation of population-based preventive measures to reducing alcohol consumption was carried out in order to identify interventions with proven effectiveness. We used the official statistics data collected by Ministry of health on the number of patients, health care resources utilization. Directs nonmedical costs included disability payments. Indirect costs included decreased productivity due to premature mortality and disability.

Results

Russian Federation has on the moment rather strong legislation in the area of alcohol regulation, but still there is a potential for further improvement. Increase in the price for alcoholic beverages by 10% in the Russian Federation can potentially prevent 7 477 potential years of life lost, the prognosed economic effect due to premature deaths reduction will be 42 002 523€ for 5 years. Increase in the minimum age for alcohol sales from 18years to 21years can save 48 920 potential years of life lost in Russian population, and the economic effect will be 279 912 075€ for 3 years. Reducing the permissible limit of blood alcohol concentration in vehicle drivers to 0.03mg/ml will allow to gain 8 834 673€ of economic effect for 3years.The deprivation of driving license for longer period after drinking and driving will give economic 916 809€ for 1 year due to prevent 217fatal accidents in alcohol intoxicated condition. And the effect of a complete ban on advertising alcoholic beverages in all media will give potential impact of 678 437 773€ for 10years

Conclusions

There are still potential for improvement the legislation in the area of alcohol control in Russian Federation. Described interventions demonstrate substantial potential economic effect. These data can be used as an argument for policy makers to justify the investments in these interventions

Key messages

The main results obtained in the simulation demonstrated the possibility of improving the prognosis of mortality and morbidity from NCDs associated with alcohol consumption. These data can be used as an argument for policy makers to justify the investments in these interventions.
Are Danish adolescents’ internalizing and externalizing symptoms associated with their substance use?
Authors: Vallentin-Holbech L , Thomsen K R , Stock C
Published: October 2020

Background

Several studies have found that externalizing symptoms are associated with harmful substance use. Also, findings suggest that girls are more likely to report internalizing symptoms compared to boys. This study assessed the association between internalizing and externalizing symptoms (independent variables) and substance use and alcohol-related harms (dependent variables). Furthermore, it was investigated whether associations differentiate among boys and girls.

Methods

Data from Danish students aged 13-17 years (N = 2601) were collected using online self-administrated questionnaires measuring demographics, substance use (drunkenness, binge drinking, smoking, cannabis use and other illicit drug use) and alcohol-related harms. Externalizing and internalizing symptoms were measured using the Strength and Difficulties Questionnaire. To test associations multilevel logistic regressions were applied for each dependent variable including both internalizing and externalizing symptoms. Gender differences were tested separately.

Results

The study population comprised of 1235 boys (47%) and 1366 girls (53%) from 42 schools in the region of Southern Denmark. Strong positive associations between externalizing symptoms and substance use were found for both boys and girls. When internalizing symptoms were present, boys demonstrated a negative association with binge drinking (OR: 0.90, p < 0.001), drunkenness (OR: 0.91, p = 0.001) and alcohol-related harms (OR: 0.91, p = 0.006). Among girls, a negative association was only found for binge drinking (OR: 0.94, p = 0.009).

Conclusions

This study demonstrated strong positive associations between externalizing symptoms and substance use both among boys and girls and showed that internalizing problems protect particularly boys from harmful alcohol use. The findings suggest that Danish girls should be considered equally to Danish boys regarding externalizing symptoms and substance use.

Key messages

Boys with internalizing problems are more protected against harmful alcohol use compared to girls. Targeting gender-specific risk factors should be considered when developing prevention programmes.
Moving towards or away from universal health coverage in the EU-8 countries
Authors: Tambor M , Klich J , Domagała A
Published: October 2020

Background

The transformation of health care systems in Central and Eastern European (CEE) countries after the fall of communism resulted in increased household out-of-pocket payments for health and a deterioration of equity in health care. Since then, CEE countries have been struggling to ensure sufficient public resources for health and improve universal health coverage.

Methods

We evaluated the progress in achieving universal health care coverage made over the last two decades in eight European Union countries (EU-8): Czechia, Estonia, Hungary, Latvia, Lithuania, Poland, Slovakia, and Slovenia. A desk research method was applied (2019) to collect and analyze quantitative data on health care expenditure and qualitative data on health care coverage (population coverage, service coverage, patient cost-sharing, and quality of care).

Results

The results show an increased priority on the part of governments to fund health care in the EU-8 countries. Nevertheless, public resources have not been sufficient to significantly reduce the role of out-of-pocket expenditure. Out-of-pocket payments in the analyzed countries result from the explicit decision to shift costs to households (patient cost-sharing for medicines, excluding dental care) or implicit rationing (long waiting times for specialist services). Despite some common features, there is a great diversity across the EU-8 with some countries (Latvia) marked with significant gaps in health care coverage, and others (Czechia, Slovenia) providing universal health care with relatively low out-of-pocket payments.

Conclusions

There is room for reducing out-of-pocket payments in the EU-8 through further budget prioritization. A systematic and evidence-based approach to establish a benefit basket and patient cost-sharing obligations might help to improve universal health coverage in these countries.

Key messages

In the last two decades, the EU-8 countries have made moderate progress in achieving universal health coverage. Despite governments’ increased priority for health, significant gaps in service and cost coverage, as well as quality of care, persist in some EU-8 countries.
Vaccination on the move for asylum seekers and refugees: evidence, policies and practicalities
Authors: Campos-Matos I
Published: October 2020

Public Health England works alongside the International Organization for Migration to provide migration health assessments and a travel service to refugees entering the UK through the Gateway Resettlement Programme. As part of this programme, catch-up vaccination is offered to align these migrants with the UK schedule. IC-M will describe current UK approaches to improving vaccination coverage in migrants both to and within the country, and highlight lessons learned for European health systems.
Key developments and results from the Australian Burden of Disease Study
Authors: Gourley M , Juckes R , Moon L
Published: October 2020

Australia has been at the forefront of national burden of disease study development for more than 20 years. Australia's 1996 national burden of disease study was one of the first in the world and updates have continued over the following two decades with the fifth study now underway. The studies adapt the global framework most recently implemented by the Global Burden of Disease Study to suit Australia's specific needs, producing estimates of fatal and non-fatal burden via the Disability-Adjusted-Life-Year metric, as well as attribution of the burden to many risk factors.

Detailed Australian data are used from a range of sources (e.g. death registrations, population surveys, disease registers, hospitalisations and linked health data) with minimal reliance on modelling to fill data gaps. Comprehensive burden of disease estimates are produced, including for the Indigenous population, for each of the eight states and territories, the five remoteness areas and five socioeconomic quintiles.

A number of method developments have been made as part of these studies, including redistribution of deaths data and a detailed quality framework for describing the robustness of the underlying data and methods. Data and methods continue to be refined as part of the studies, and developments in global studies and other national studies are incorporated where appropriate.

This presentation will describe the history of burden of disease work in Australia, including some of the key method developments made, challenges faced over the years and lessons learned. It will also present some key results from the latest Australian Burden of Disease Study (2015) and how these estimates are being used for population health monitoring, health policy and research in Australia.
Substance use, mental health, and life satisfaction in Czech straight and sexual-minority population
Authors: Pitonak M , Chomynová P , Mravčík V
Published: October 2020

Background

Evidence shows that sexual minorities are more vulnerable to substance use and psychological distress as a result of minority stress compared with heterosexuals. So far, research conducted outside North America or Western Europe has been underrepresented. This research compares for the first time the substance use, quality of mental health and life satisfaction between the sexual minority people and heterosexuals using a nationally representative probability sample in the Czech population.

Methods

Sample of the general population aged 15+ years surveyed within the National Survey on Substance Use in 2016 in randomly selected households (N = 3,601, F2F interviews). Prevalence of licit and illicit substance use, psychological distress (MHI-5 scale) and life satisfaction (SWLS scale) were analyzed by respondents' self-reported sexual identity and behaviors. Logistic regressions were applied to evaluate the differences between groups. Adjustment for basic sociodemographic characteristics was performed.

Results

2.8% of adults identified as sexual minorities, including 0.5% lesbians or gays and 2.3% bisexuals. Sexual minorities were more likely to experiment with (illicit) substance use in the last 12 months (OR = 1.74, 95% CI: 1.03-2.94), more often experience psychological distress (OR = 2.56, 95% CI: 1.50-4.38), and were slightly less often satisfied with their lives (OR = 0.79, 95% CI: 0.46-1.37) compared to heterosexuals. Sexual minority status was not found as a significant predictor for daily tobacco smoking nor for frequent excessive/binge alcohol consumption.

Conclusions

In accordance with international evidence, sexual minorities represent a vulnerable group from the perspective of substance use and psychological distress. Factors influencing life satisfaction of sexual minority people living in geographically underrepresented regions need to be further investigated using measures more sensitive to local cultural circumstances.
Clean air policy challenges in Europe: achieving air standards that prevent disease
Authors: Stauffer A , Perroud S
Published: October 2020

Despite a large regulatory framework on clean air, air pollution in the European Union continues to be the top environmental threat to health, leading to approx. 400,000 early deaths annually and high health costs. Over 20 of the 27 EU countries fail to keep air quality standards, which for key pollutants are already less strict than what the World Health Organization (WHO) recommends.

In the EU Green Deal Communication, the European Commission has pledged to align current standards more closely with WHO. At the same time, the latest science underlines that there is no safe level of air pollution, and WHO is reviewing current guidelines. In EU neighbouring countries, the need to act on clean air standards is even more pressing. During the COVID-19 lockdown, many countries have witness a drop in air pollution, especially in cities. As transport and economic activities kick in again, pollution is on the rebound, making the need for long-term clean air even more apparent.

The presentation/paper will showcase ongoing policy opportunities at EU and national level, and discuss how the health sector can become engaged to prevent chronic disease from poor air quality, especially as part of a healthy, green and just recovery.
Multidrug-resistant organism infections and mortality: estimates from a large Italian hospital
Authors: Moro M , Vigezzi G P , Callari E , Biancardi A , Nizzero P , Cichero P , Signorelli C , Odone A
Published: October 2020

Background

Multidrug-resistant organisms (MDRO) are one of the most critical public health concerns, particularly in hospital settings. Nearly 8% of hospitalized patients develop healthcare-associated infections (HAI), 20% of which is caused by MDRO.

Aim of the study was to estimate nosocomial infection-associated in-hospital mortality, by different MDRO, in a large Italian teaching hospital.

Methods

We conducted a retrospective cohort study on patients hospitalized at San Raffaele Hospital, Milan, from 2016 to 2018. Two existing datasets were merged: hospital discharge records and MDRO surveillance data. Exposure was defined as any HAI caused by MDRO, and main outcome variable was in-hospital mortality from all causes.

Results

A total of 78,795 patients were studied (mean age 59.3 y, age range 18-105 y). 1,345 patients with at least one MDRO had mean age of 68 y, mean length of stay (LOS) of 32.8 days and mean DRG weight of 3.8. 77,450 patients without MDRO isolation had mean age of 59 y, mean LOS of 7.2 days and mean DRG weight of 1.6. Risk of in-hospital mortality is 3.4 times higher in patients with at least one MDRO isolation (OR 3.4; 95% CI 2.8-4.2). Enterococci (OR 2.6; 95% CI 1.1-6.3), A. baumannii (OR 3.5; 95% CI 1.4-8.6), P. aeruginosa (OR 1.8; 95% CI 0.8-4.2), MRSA (OR 3.4; 95% CI 2.1-5.4), ESBL-producing (OR 1.9; 95% CI 1.4-2.7) and carbapenem-resistant bacteria (OR 3.8; 95% CI 2.5-5.7), and carbapenem-resistant K. pneumoniae (OR 5.5; 95% CI 3.2-9.2) isolations were risk factors for nosocomial mortality.

Conclusions

Patients with MDRO isolations were older, more complex and had 5 times longer LOS than ones without MDRO. Deceased patients were 18% among MDRO cohort against only 2% among others.

Bacteria included in WHO list of priority pathogens with antibiotic resistance were associated with a significantly higher risk of death. These results prove the urgency of controlling MDROs' spread that threatens global public health and available treatments of infections.

Key messages

Nosocomial MDRO isolation is a significant risk factor for in-hospital mortality from all causes. Infection prevention and control measures, and antibiotic stewardship are key strategies in order to prevent MDRO transmission and HAI, AR spreading and their burden of related deaths.
Italy on gaining official parliamentary recognition that obesity is a chronic disease
Authors: Serra F , Lenzi A , Pella R , Spinato C , Fatati G , Carruba M , Caretto A , Sbraccia P , Busetto L , Zani I
Published: October 2020

Obesity places a significant burden on people affected, increasing their risk of unintended health consequences and reducing their life expectancy. Rising obesity levels have also had an adverse effect on society and economic prosperity, causing a decrease in economic activity through loss of productive life years, and by placing increasing demands on healthcare systems.

Despite the scientific community recognising obesity as a multifactorial chronic disease which requires long-term management, it is often considered to be the responsibility of the individual by governments, healthcare systems and even people with obesity. Obesity is not recognition as disease in Italy, but it has a relevant impact on heath policy, clinical, social and economic.

On November 13th 2019, the Chamber of Deputies of the Italian Parliament voted unanimously to approve a motion that recognises obesity as a chronic disease and asks the Government to implement specific actions to promote and improve obesity prevention and management. Among the various commitments there is also a national plan that harmonises the activities in the field of prevention and the fight against obesity; full access to the diagnostic procedures for comorbidities, to dietary-food treatments in the most serious cases, access to second-level centres to evaluate psychological, pharmacological and surgical approaches; guidelines concerning the “first 1,000 days of life” of the child and programs for the prevention of childhood obesity.

Obesity now recognised as a chronic disease in Italy. The collaborative, multi-stakeholder effort was long in the making and includes a Charter of Human Rights for People Living with Obesity. The document enumerates actions necessary for the protection of health for obesity prevention and treatment of people living with obesity. The process implemented as a typical policy domino game.

Key messages

Obesity now recognised as a chronic disease. Policy domino game.
The kids are not alright: Lessons from the advocacy pursuit of restrictions on food marketing
Authors: James L , Arango M , Lawrence S
Published: October 2020

Issue

Poor nutrition is a leading contributor to ill health worldwide. WHO recommends restrictions on the marketing of unhealthy food to children to reduce intakes of energy-dense, nutrient-poor foods. In Canada, the government made this a mandate commitment. This provides an opportunity for other countries pursuing public health nutrition policy to better understand and overcome commercial interests when trying to advance public health.

Background

Heart & Stroke Foundation (H&S) advocated for over a decade (2008-2019) to secure government policies to restrict food marketing to youth in Canada. The inclusion of such policy in the government's 2015 mandate was promising and the associated bill was one of the strongest in the world - well received by public health advocates worldwide, positioning Canada as global leader. However, the commercial interests of various stakeholders including food and marketing industries created concerns among policy makers. Public health advocates underestimated the influence, power and opposition of industry.

Results

In order to counter industry opposition, the public health community worked in coalitions and employed a range of innovative tactics to mitigate policy concerns. This included public engagement on social media, evidence generation, celebrity endorsement, as well as calling out industry practices and political blockers. Despite the innovative and collaborative approach of public health, the policy failed to be adopted.

Lessons

Food industry will use a range of concerns including economic, environmental, and health issues to generate skepticism among policy makers. Public health advocates working in nutrition need to be proactive and prepared with insightful counter arguments and evidence to dispel myths and re-frame the issue.

Key messages

Public health progress on nutrition policy is at an early stage and we need to learn lessons from successes and failures. There is a strong amount of food industry opposition to public health nutrition policy.
National level wealth inequality and socioeconomic inequality in adolescent mental wellbeing
Authors: Dierckens M , Weinberg D , Huang Y , Elgar F , Moor I , Augustine L , Lyyra N , De Clercq B , Stevens G W J M , Currie C
Published: October 2020

Background

Previous research established a positive association between national income inequality and socioeconomic inequalities in adolescent health, but little is known about the extent to which national level inequalities in accumulated financial resources (i.e. wealth) are associated with these health inequalities. Therefore, we examined the association between national wealth inequality and income inequality and socioeconomic inequalities in adolescent mental wellbeing.

Methods

Data were from 17 countries participating in three successive waves (2010, 2014 and 2018) of the cross-sectional Health Behaviour in School-aged Children (HBSC) study. We combined individual-level data on adolescents' life satisfaction, psychological and somatic symptoms and socioeconomic status (SES) with country-level data on income and wealth inequality (n = 244771). We performed time-series analysis on a pooled sample of 48 country/year groups.

Results

Higher levels of national wealth inequality were associated with fewer average psychological and somatic symptoms, while higher levels of national income inequality were associated with more psychological and somatic symptoms. No associations between either national wealth inequality or income inequality and life satisfaction were found. Smaller differences in somatic symptoms between higher and lower SES groups were found in countries with higher levels of national wealth inequality. In contrast, larger differences in psychological symptoms and life satisfaction (but not somatic symptoms) between higher and lower SES groups were found in countries with higher levels of national income inequality.

Conclusions

Although both national wealth and income inequality are associated with (socioeconomic inequalities in) adolescent mental wellbeing, associations are in opposite directions. Further research is warranted to gain better understanding in the role of national wealth inequality on (socioeconomic inequalities in) adolescent health.

Key messages

This is one of the first studies to examine if socioeconomic inequalities in adolescent mental wellbeing are associated with national wealth inequality independently from national income inequality. Opposing effects of national wealth inequality and income inequality on socioeconomic inequalities in adolescents’ mental wellbeing warrant further research before policy recommendations can be made.
Undocumented migrants’ right to health care: Physicians’ rejection of law in their gatekeeper roles
Authors: Greenbrook J T V
Published: October 2020

Background

Legal consciousness theory acknowledges the known gap between law in writing and law in its everyday practical application in society. Limited research has explored legal consciousness in medical contexts, and limited knowledge exists surrounding how the intrusion of law in medical authority impacts applied medical ethics. Conflicts between law and medical ethics can be saliently observed in Sweden, where current law forcibly places physicians in a gatekeeper role in satisfying undocumented migrants' right to health care access, relying on physicians' assessments of whether patients without legal residency status should be provided 'care that cannot be deferred'.

Methods

In this context, the present phenomenological study sought to explore how legal terminology is experienced, understood, and applied by physicians, contextualising the perceived meaning ascribed to the imposed gatekeeper role. Qualitative interviews were conducted with 42 physicians from five major Swedish hospitals, and analysed through the lens of legal consciousness theory.

Results

Participants actively rejected law by taking a firm, and often collective, stance against its intrusion in their work. Rejection of law was constructed through: rejecting legal hegemony and government imposed non-medical responsibilities; perceiving professional authority and medical ethics as empowering; considering repercussions of legal non-compliance unthreatening; believing increased legal knowledge would not influence their professions' foundational role.

Conclusions

The study produced novel findings, contributing to the limited body of work exploring legal consciousness in medicine. Regardless of legal knowledge held, when law conflicted with foundational medical ethics, the intrusion of law in the medical profession lead to the explicit rejection of law. Findings accent the need for laws addressing healthcare access to be compatible with foundational medical ethics and principles of non-discrimination.

Key messages

Regardless of legal knowledge held, when law conflicted with foundational medical ethics, the intrusion of law in the medical profession lead to the explicit rejection of law. Findings accent the need for laws addressing healthcare access to be compatible with foundational medical ethics and principles of non-discrimination.
Characteristics of discharged patients from hospitals - Georgian descriptive study
Authors: Skhvitaridze N , Gamkrelidze A , Kereselidze M , Gambashidze K , Kandelaki L , Grdzelidze N , Manjavidze T
Published: October 2020

COVID-19, the disease caused by the novel coronavirus, started spreading rapidly across the world. Although, many aspects of disease is still under the observation. Therefore, in this study retrospectively was investigated the data on patients discharged from Georgian hospitals between February and June.

According to Georgian regulation, all patients with confirmed COVID-19 should be hospitalized. The data sources were hospitalization registry and the standardized case report forms. In this descriptive study, epidemiological characteristics of 500 COVID-19 cases confirmed with PCR tests were analyzed. Among variables were: gender, age and geographic distribution, disease characteristics, underlying health conditions, test-related features, etc.

Majority of patients (72.0%) were admitted to hospitals by the ambulance. The mean age of the patients was 43 years. The sex distribution was merely the same for both genders (49.4% male and 50.6% female). The most common symptoms were fever (82.4%, 95% CI 78.4-85.9), fatigue (49.6%, 95% CI 44.7-54.5), and cough (38.3%, 95% CI 33.6-43.1). The proportion of asymptomatic cases during the PCR testing were 16.6%. More than one symptom was observed in 57.6% of patients. Most common underlying health conditions were cardiovascular diseases (21.8%), diabetes (7.6%), kidney disease (3.6%), chronic lung disease (2.4%), cancer (2.2%), and chronic hepatitis (1.8%). Disease severity significantly differ among cases. Of those without comorbidity conditions, 94% had mild severity. However, among those with comorbidity conditions 35% were sever or critical. 50% of patients were reported as obese. The proportion of severe or critical patients was higher with BMI-18.5-24.9 and BMI ≥30. The case-fatality rate was 2.6%, with majority of deaths among aged ≥70.

The severity of illness was strongly associated with comorbidity conditions and BMI. These findings are important to contribute and improve evidence-based knowledge for the novel coronavirus.

Key messages

Hospitalization of all COVID-19 cases, despite their severity, improving positive outcome of patients. Follow-up for discharged patients is necessary to control medium and long-term impact of COVID-19.
Building intersectoral networks: the role of health brokers in a community health promotion program
Authors: de Jong M
Published: October 2020

Background

In community health promotion programs (HPP) aiming to improve health and reduce health inequities, health brokers can have a crucial role in building and sustaining intersectoral networks. These networks are pivotal for developing and implementing the HPP. However, the role of health brokers is new and there is little insight into the changes in the networks' size and composition over time and the processes that facilitate brokers' networks. The aim of this study was to map the brokers' network in detail and unravel the barriers and facilitators in network building.

Methods

To study the brokers' networks in a HPP in a Dutch socioeconomically deprived city district, in October 2017 and November 2019 the Composed Network Analysis (CNA) and the Coordinated Action Checklist (CAC) were used, as part of the action research accompanying the HPP. The CNA provides insight into the size and composition of the network and the CAC explores facilitators and barriers in network building and sustaining. Focus groups with the core network members (n = 6) were held to discuss and interpret results.

Results

The health brokers' network had expanded from an average of 100 contacts in 2017 to about 140 contacts in 2019. Existing contacts (e.g. social work, welfare work) had been strengthened and new partners, e.g. general practitioners and volunteers joined the network. This resulted in an increased attention for health on the agenda of these organizations and several joint activities as part of the HPP. Facilitators were working on a small scale, informal and formal, and frequent personal contacts. The most important barrier was change of partners.

Conclusions

The health brokers have been successful in and expanding their networks, putting health on the agenda of network partners and supporting activities. As such, the broker is essential in connecting a diverse range of partners and organizations in an intersectoral network in the city district.

Key messages

Working on a small scale, and with frequent personal, formal and informal contacts facilitated the health brokers network building and sustaining. A health brokers’ role, being initiator, facilitator and connector is essential for continuation of the community health promotion approach.
Real-time immunization trends in under-2 children in Pakistan: insights from big data analysis
Authors: Siddiqi D A , Mirza A , Abdullah S , Dharma V K , Shah M T , Akhter M A , Habib A , Khan A J , Chandir S
Published: October 2020

Background

Despite the provision of free-of-cost vaccines in Pakistan, fully immunized child (FIC) coverage in Sindh province remains low at 49%. In 2012, we developed and piloted the Zindagi Mehfooz (Safe Life; ZM) Digital Immunization Registry, an Android-based platform that enables vaccinators to enroll and track child level immunization data of children in the catchment population. In 2017, ZM was scaled-up across Sindh province and is currently being used by 2,284 vaccinators across 1,526 facilities serving >48 million (m) population.

Methods

All children under-2 years of age visiting EPI centers are enrolled. At enrollment, caregiver and child bio-data and child immunization history are recorded, and the child is provided with a unique Quick Response (QR) code for identification. For follow-up immunization visits, 3 SMS reminders are sent to caregivers, and upon immunization, child history is retrieved by scanning the QR code and vaccination record updated. ZM allows real-time access to data and generation of monitoring reports. Data from ZM was used to calculate coverage rates, timeliness, and trends for immunization coverage in Sindh.

Results

From Oct'17 to Dec'19, more than 2.4m children and 0.8m women were enrolled in the Registry, while >17m immunizations were administered. The FIC coverage in 12-23 months old children has increased from 49% (at baseline) to 57% for children enrolled in ZM. Additionally, pentavalent-3 coverage increased from 59% to 68%.

Discussion

ZM demonstrates the potential of DIRs to improve immunization outcomes within low-resource settings by enabling better child tracking and a higher retention rate. Additionally, the big dataset provides the opportunity to identify real-time trends and provides actionable data for evidence-based decision making.

Key messages

ZM Immunization Registry has strengthened the current EPI program through increased FIC coverage and timeliness through better tracking of children and increased retention. Big Data from ZM can be used to analyze immunization trends of global relevance, and guide strategic policy decisions for improving immunization coverage and equity, based on actionable data insights.
Participation in data generation and information sharing: are patients and carers willing to engage?
Authors: De Freitas C , Silva S , Leão Teles E , Maia T , Amorim M
Published: October 2020

Background

Health systems are moving towards a personalisation of care. Personalised care relies on data-intensive research, which depends on active participation by citizens in data generation and information sharing. Collecting and sharing one's data for research can deliver several benefits. However, it also comes at a cost in time and effort that may burden different population subsets to varying degrees. This study aimed to assess patients' and carers' willingness to generate and share health data, and its associated factors, to inform the design of inclusive engagement strategies.

Methods

A cross-sectional study was performed with 157 patients and 487 carers (participation rate=89.3%) followed at 2 rare diseases reference centres in Portugal (06/2019-01/2020). Participants were asked about willingness to collect their health data. Those who responded yes/maybe also reported, from 0 (not willing) to 4 (always willing), on willingness to share it for the following purposes: diagnosis/treatment, non-profit research and for-profit research related to their disease and to other diseases. Data were analysed using descriptive and inferential statistics.

Results

From 567 respondents, 42.7% are willing to collect their health data, 34.7% are unsure and 22.6% do not want to participate in data generation. More educated participants, with white-collar occupations, satisfied/very satisfied with their health and those with higher social trust levels are significantly more willing to engage in data collection (p < 0.05). Participants are less prone to share information for for-profit research on their disease (Median[P25-P75]: 3.0[2.0-4.0]) or others (Median[P25-P75]: 2.0[1.0-3.0]), in particular carers (p < 0.05).

Conclusions

Participants are more willing to share information for diagnosis/treatment and non-profit research. Efforts to engage people in data generation and sharing should be directed towards disadvantaged groups to reduce biases related to skewed populations.

Key messages

Willingness to participate in data generation and sharing is influenced by social indicators. Engagement by less advantaged groups should be promoted to avoid biases related to skewed populations.
Australia’s 2020 summer shows our changed climate future - a public health preparedness challenge
Authors: Hanna L
Published: October 2020

Background

Humans have wandered this planet for hundreds of thousands of years, yet in the last 160 years we have dramatically disrupted planetary systems upon which we depend. Humanity has polluted the oceans, rivers, air and soils. Our persistent burning of fossil fuels to power opulent lifestyles is now perilously close to permanently disrupting global climatic systems.

Problem

It is clear. The problem is us. Australia's summer of horrors provides a terrifying glimpse into our collective future. This rich and exquisitely advantaged nation has voted for governments that have ignored fragile ecosystems, dismantled environmental protection laws, ignored climate science and expanded its fossil fuel exploration, extraction, consumption and exportation. It has systematically silenced science, ignored its duty of care to protect its present and future citizenry.

Evidence

The 2019-2020 summer brought unprecedented disasters to a country familiar with disasters. After the hottest and driest year on record came the world's largest bushfire, which started in winter, and burned uncontainable for 7 months across 5 states. Billions of animals perished, thousands of homes & businesses destroyed, 33 people burned alive. Continental-wide temperatures of 42oC. Smoke levels exceeded hazardous levels by a factor of 25, lingered 6weeks in the national capital, circumnavigated the southern hemisphere. 80% of Australians were affected by the fires in some way, and the nation fell into a deep grief.

The public health challenge

As the world faces new climate regimes, the associated health challenges are elevating to unheralded and unforeseen levels. Public health preparedness for past situations will inevitably fail. Events are no longer singular, short lived or readily managed. Today's events are multifaceted, expansive and protracted. Their sheer magnitude and scale prevent response activities, interrupt transport and supply chains and shut down power and communications.

Key messages

Unfettered human development has degraded planetary systems upon which humanity depends for survival and flourishing. Climate change is disrupting all our key environmental determinants of health. Environmental degradation and climate change now present a rapidly intensifying health emergency. Australia’s summer of disasters demonstrates we need an explosion of public health preparedness.
Psychological impacts of the 2019 Quebec floods: findings from a large population-based study
Authors: Genereux M , Maltais D , Lansard A L , Gachon P
Published: October 2020

Background

During Spring 2019, many regions in Quebec (Canada) experienced severe floods. As much as 5,245 households were flooded and 7,452 persons were evacuated, causing extensive material and human damages. A large population-based study was therefore conducted to examine medium-term effects of this natural disaster on health and well-being.

Methods

Six to eight months post-floods, households located in the flooded zones (in one of the 6 Quebec regions the most severely affected) were randomly invited to participate to a telephone or a web-based survey (response rate=15.3%). Several psychological health outcomes were examined, including psychological distress (based on the 6-item Kessler Scale, score 0-24) and post-traumatic stress (based on the 15-item Impact of Event Scale, score 0-75). These outcomes were compared among 3 levels of exposure using Chi-square test: flooded (floodwater in ≥ 1 liveable room), disrupted (floodwater in non-liveable areas, loss of utilities, loss of access to services, or evacuation), and unaffected.

Results

Of the 3,437 participating households, 349 (10.2%) were flooded and 1230 (35.8%) were disrupted (but not flooded) during the 2019 floods. A steep gradient was observed for moderate/severe symptoms of post-traumatic stress (score ≥ 26) according to the level of exposure to flooding (unaffected: 3.0%; disrupted: 14.6%; flooded: 44.1%; p < 0.0005). For psychological distress (score ≥ 7), the baseline level (i.e. unaffected group) was 7.3% while it reached 15.0% and 38.4% in the disrupted and the flooded groups, respectively (p < 0.0005).

Conclusions

This study is among the largest to examine the psychological impacts of flooding. The magnitude of effects observed in flooded households is consistent with the literature and calls for stronger social and economic measures to support flood victims. Such support should help coping with initial stress, but also alleviating secondary stressors classically observed in post-flood settings.

Key messages

Psychological impacts of floods may persist for several months and may be observed in both flooded and disrupted people. Stronger social and economic measures are needed to better support flood victims, not only in the short but also in the longer term.