bluuebunny/crossref_metadata_2025 huggingface dataset:
16.A. Round table: Responding to COVID19 in Europe: politics and policies
Authors:   Organised by: University of Michigan (USA),   Chair persons: Gemma Williams - UK, Scott Greer - USA
Published: October 2020

The COVID-19 virus presented challenges in virtually every area of public heath, from surveillance to research to action. Governments and whole societies faced hard questions: how should they balance containment measures, economic activity, and human rights? How should they communicate effectively and manage disinformation? How should they slow spread of the disease without triggering xenophobia? How should they manage pressures on health care facilities? How should they manage the consequences of social distancing for society as a whole?

This panel addresses the fast-moving events surrounding the virus from the perspective of public health policies and politics. Its goal is to identify and explain the different responses of European countries and the European Union- in other words, why do public health systems act as they do in response to a novel threat? It will contribute to our understanding of how the politics and governance of public health in different countries produce different outcomes, with lessons for the overall organization of European public health and also for immediate responses in what is likely to be an ongoing challenge associated with COVID-19.

Each panellist will discuss a country that had a distinctive experience of the virus and response. The countries were selected for the diversity of their situations as well as the significant differences in the organization of public health and health care systems as well broader political differences. Yves Charpak will discuss France, Michelle Falkenbach will discuss Italy; Thomas Czyprionka will discuss the German speaking countries, Anniek de Ruijter will discuss the European Union's collective responses and coordination, and Elizabeth King will discuss Russia. Each speaker will briefly address the challenges experienced by that country and the actions taken, and focus on explaining why those actions happened. Gemma Williams will chair.

After the panelist's contributions the debate will open up to draw on the experience of everybody in the room. It will be highly interactive, given that many in the audience will have direct experience of managing the responses to the virus in different countries. The chairs will ensure timekeeping and facilitate discussion.

Key messages

COVID19 tested every element of European public health systems. The different responses carry lessons about the policy and politics of public health. We can draw lessons to improve the governance and politics of public health as well responses to COVID19.
The vaccination registry of the local health company (ASL) Roma 4
Authors: Sinopoli M T , Fusillo C , Belfiore G , Galliano E , Quagliariello F , Matera C , Quintavalle G
Published: October 2020

Issue

The regional vaccination of Lazio (AVR) and the ASL vaccination registries(AVA) that feed it, have had to adapt to the directions of national vaccination registry. The ASL Roma 4 added other implementations.

Description of the Problem

L'AVA must, first of all, allow easy search of subjects, defaulters and vaccination coverage for various filters but it can also facilitate the recording and analysis activity.

Results

The provision of barcodes allows the prompt search of subjects, the check of tax code and AIC codes of vaccines. The digital signature of the privacy and consent forms and anamnesis, taken from the “Guide to contraindications to vaccinations” directly available, allows the elimination of the paper. The possibility to go directly to AVR allows the registration of vaccinations made in other ASL. In addition, the AVA allows the compilation of the adverse event reporting form and vaccine management. The link with the portal on the ASL website allows users to download the vaccination certificate. Important is the possibility to send SMS before vaccination deadlines or appointments. The SMART-SMS allows sending videos or photos and manage a short link (http://tiny.cc/XXX) to an information page on ASL website, as well as user response SMS, that can also directly change appointments.

Lessons

The dematerialization of the forms leds to a greater compliance with the procedures, a more accurate anamnesis and the streamling of the vaccination session, the SMS bring greater compliance of users and an increase in vaccination coverage. The use of mobile analytics tools allows monitoring of vaccination campaigns.

Key messages

The dematerialization of the forms in the vaccination registry leds to a greater compliance with the procedures, a more accurate anamnesis and the streamling of the vaccination session. The ability to send SMS through the vaccination registry brings greater compliance of users and an increase in vaccination coverage.
Environmental Effects of the Livestock Industry: Knowledge, Attitudes, and Behavior among Students
Authors: Dopelt K , Radon P
Published: October 2020

Background

The livestock industry has numerous impacts on the environment. The aim of this study is to examine the level of knowledge, awareness and behavior on topics related to environmental pollution caused by industrial animal food production and to determine whether there is a relationship among them.

Methods

Cross-sectional study using an online questionnaire. 361 students were asked about their knowledge, attitudes, and behavior related to the environmental impact caused by livestock industry. The data were analyzed using correlations, t-tests for independent samples, and linear regression models.

Results

Students have almost no knowledge about the environmental impact of livestock industry, their attitudes are moderately pro-environmental, yet they are not strict about them. Students with higher levels of environmental knowledge demonstrated more pro-environmental attitudes and behavior (r = 0.33, p < 0.001; r = 0.36, p < 0.001 respectively); attitudes mediate the relationship between level of knowledge and behavior with respect to environmental pollution caused by the livestock industry (Adj. R2 =0.28, p < 0.001). Significant differences were found between participants who rear animals and participants who don't, in the level of knowledge (t = 3.78, p < 0.001), attitudes (t = 3.04, p < 0.01), and behavior (t = 2.33, p < 0.05).

Conclusions

These findings are in line with other studies, which showed that some consumers are concerned about production of animal foods but their knowledge on this topic is very limited, and most continue to consume animal products without any intention of reducing consumption. There is a need to raise awareness of the environmental and health impacts caused by livestock industry. An introductory course on environmental science should be integrated into different academic study programs. Further research should be conducted among additional population sectors.

Key messages

Students have almost no knowledge about the environmental impacts of the food they consume. There is a need to develop campaigns to raise awareness of environmental impacts of food.
Effects of air pollution exposure on children lung function in three urban areas of São Paulo State
Authors: Braga A L F , Oliveira B B B , Senigalia A , Pestana P R S , Pereira L A A , Martins L C
Published: October 2020

Deleterious effects of air pollution on human health have been observed, including increases in respiratory symptoms and decreases in lung function. Few studies in Brazil have investigated this association in asthmatic children and there is no study in those regions. The aim of this study was evaluating the influence of air pollution on lung function in children.

Methods

Panel study with longitudinal assessment for 12 months of exposure to air pollutants and their effects on lung function in children living in Santos, Cubatão and Presidente Prudente. Data were obtained from monthly spirometry and information on air quality through Environmental Company of the State of São Paulo. Models of equations for generalized estimates were adopted to analyze the effects of the exposure to air pollution on respiratory function, controlled for temperature and humidity.

Results

The concentration of PM10 did not exceed the values established as standard for the state of São Paulo (120μg/m3) during the study. In spirometry, the main parameter for characterization of bronchial obstruction is FEV1/CVF. In Santos, it was observed that the increase of 13.35 μg/m3 of PM10 led to a significant reduction of FEV1/CVF on the day and seven days after exposure, with greatest effect in lag 5 (-21.45% (95% CI: -7.34; -35.56) in asthmatics. In Presidente Prudente it was found a significant reduction of FEV1/CVF on the day and on the seven days after exposure to PM10 (-78.22% (95% CI: 55.68-100.75)). In Cubatão, it was observed a significant reduction of FEV1/CVF on the day, the first, third, fourth and seventh day after exposure of PM10, (lag 4 -54.75% (95% CI: -22.09; -87.41)). In the non-asthmatics group no significant reductions were observed in any of the locations.

Conclusions

Although the pollution levels remained within the air quality standards for the State of São Paulo, children with asthma presented significant reductions in lung function after exposure to the pollutants.

Key messages

Susceptible groups must be the main concern on air pollution adverse health effects studies. Efforts to reduce air pollution in Brazil can not be abandoned, once it remains affecting public health.
Card game as a health education strategy in the learning of schoolchildren about parasites
Authors: Oliveira E S , Gomes S R , Sampaio M G V , Silva M A A , Bezerra C M , Girão S G M , Viana T R F , Oliveira N R
Published: October 2020

Parasitic diseases are a serious public health problem, especially in regions such as the Brazilian Northeast, which despite numerous advances in health still have high rates of morbidity, with regard to intestinal parasitic diseases, especially diarrheal diseases. School-age children are the most affected by this condition, either due to lack of knowledge or poor hygiene habits. The school is a relevant place for the application and development of methods focused on the theme, and knowledge for prevention and control is essential. Thus, the card game aims to facilitate students' understanding of the subject. The contributions of the present work will contribute to prevention and will contribute to children's health programs, through the development and use of a playful tool as a health education strategy for schoolchildren in the prevention of parasites. The game consists of cards that contain parasites, morphology, pathogenesis, diagnosis, forms of prevention, among others, being elaborated based on the literature and made in computer programs, being possible to play individually or in groups. The use of playfulness can provide a better understanding, mainly because it involves children, thus generating curiosity about the theme. Health education carried out in dynamic ways provides and requires attention, leaving them more attentive and curious in view of the above. When applied to schoolchildren, the proportion and impact will be much wider, as it is a very diversified environment, where it will be possible to reach children from different areas, places and realities. When developing the game and applying it to children through health education, the subject will be much more accepted, thus making them more knowledgeable about the theme, which will favor in the prevention of parasites and a better quality of life, as well as well as the dissemination of the importance of the subject.

Key messages

Parasitic diseases do not yet have preventive measures, such as vaccines, and health education is extremely important. The game can bring benefits to public health, in the practice of child health, being used as a form of health education and its dissemination to schools and other learning spaces.
Evaluation of the oral health condition of schoolchildren in the south of Brazil
Authors: Fonseca V , Machado V , Ribeiro S , Alves M , Nacao M
Published: October 2020

In order to subsidize policies, actions and intersectoral strategies for health promotion, protection and recovery, it is important to establish the distribution of oral diseases in the target population. Thus, the present study aims at identifying the oral health condition of students from a network of schools run by a Social Welfare, not-for-profit, non-governmental institution in Brazil's Southern Region. This is a census approved by a competent Research Ethics Committee, carried out in a school environment in 2018, involving 1,243 children, 1,172 of which at 5 years old and 71 at 12 years old. All had impacts on oral health and caries rates (dmf / DMFT), occlusion (Foster & Hamilton and DAI) and fluorosis (Dean) evaluated by properly trained and calibrated dentists.The most prevalent impact on oral health, at both ages, was “difficulty in eating”. Students aged 12 and 5 years old showed, respectively, 0.28 and 1 tooth with caries experience; 5.8% and 5.3% with some need for treatment and a prevalence of malocclusion of 57.7% and 79%. Fluorosis was investigated only within the 12-year-old students and it was present in 26.8% of them. In view of the results, the planning of oral health actions in the schools of the social institution studied must privilege the actions of promotion, protection and recovery in the scope of malocclusions and strengthen those already implemented for caries disease. At the same time, a health surveillance system should be built and implemented for monitoring and assessment.

Key messages

Identifying the epidemiological profile of the target population contributes to the efficient allocation of financial resources and the establishment of assertive strategies to meet their needs. Epidemiological surveys allow us to know the prevalence and severity of the disease, its distribution and treatment needs, allowing health planning and subsidizing the evaluation of services.
Factors associated with women's decision to undergo early mammography contrary to guidelines
Authors: Tur-Sinai A , Shahrabani S
Published: October 2020

Background

For young women, mammography has limited effectiveness and entails exposure to radiation, discomfort and additional costs. As in other countries, the Israel Ministry of Health does not officially recommend mammograms for women under age 50 who do not belong to risk groups. The study identifies factors associated with the willingness to undergo mammography, contrary to the official guidelines.

Methods

Using the Health Belief Model (HBM), we surveyed Israeli women aged 40-51 who are not at high risk for developing breast cancer and who had or had never undergone mammography.

Results

The results show that socio-demographic characteristics, private insurance coverage, out-of-pocket payments to physicians, and two HBM categories-lower levels of perceived barriers to mammography (OR = 0.70, 95% CI = 0.53-0.92) and higher levels of health motivation (OR = 1.65, 95% CI = 1.19-2.29) - are associated with the decision to undergo mammogram. In addition, higher levels of perceived susceptibility to illness (OR = 1.32, 95% CI = 1.00-1.73) and previous experience with mammography (OR = 8.26, 95% CI = 3.71-18.41) are significant predictors of women's intentions to undergo early mammography.

Conclusions

Understanding the factors associated with women's tendency to have mammograms contrary to recommendations can help nurses and healthcare policymakers in creating health-promotive programs targeting this group of women. Taking policy steps to increase women's confidence in Ministry of Health guidelines will reduce the potential damage of cumulative radiation over the lifetime of young women and lower the number of false positives. Preventing unnecessary mammograms might reduce costs to households and HMOs, lessen ineffective use of medical facilities and help relieve the burden on the health system.

Key messages

Taking policy steps to increase women's confidence in Ministry of Health guidelines will reduce the potential damage of cumulative radiation over lifetime and lower the number of false positives. Preventing unnecessary mammograms will reduce costs to households and HMOs, lessen ineffective use of medical facilities and help relieve the burden on the health system.
Regulation EU 2017/745 on medical devices – implementation analysis in Portugal by the distributors
Authors: Vilaça H
Published: October 2020

The Regulation responds to legislation failures in the European regulatory framework on medical devices (MD), which in turn led to public health issues. Two media scandals triggered the final actions on the elaboration of this EU Regulation, which was already being thought off in a context of fast MD development, and on the commitment of member-states to harmonize legislation in order to better manage resources.

This Regulation is expected to address detected gaps, and contribute to the protection of European citizens' health by ensuring high quality and safety of MD, through advocating for more transparency, vigilance, and traceability. A technique to evaluate policies is the implementation analysis, as it links theory and practice. By understanding it, it is possible to ascertain if, in fact, the Regulation will contribute, as proposed, to improve public health. The implementation analysis framework I developed can be used in other countries affected by this Regulation, and may even be extrapolated to other scenarios.

Entry into force 25/05/17.Full application 05/20. This qualitative study uses document analysis and semi-structured interviews to collect data, and literature review to frame the situation and to study implementation analysis. The questions are: identify the facilitators and resistance points of the implementation; explore perceptions of the Portuguese MD distributors; understand the policy implementation pathway; and have a picture of the implementation status in Portugal.

The results can be summarized as: implementers are interested in complying with the Regulation; there is stakeholder involvement in policy making and throughout the implementation process; the main points of resistance, difficulties and the facilitators are identified; and the Regulation is being implemented according to the timelines.

The public health action brought by the policy is that each economic operator is an active actor on vigilance and patient safety across MD lifecycle.

Key messages

If we are interested in the extent to which a particular polity is able to solve the problems with which it is confronted, we need to study the way in which the law is executed in practice. Focus on the effective implementation of the new regulatory framework on medical devices to protect patients and ensure it addresses new and emerging challenges.
Impact of school-based physical activity interventions in primary schools: measuring what matters
Authors: Ram B , Venkatraman T , Foley K , Honeyford K , Ells L , van Sluijs E , Hargreaves D , Greaves F , Viner R , Saxena S
Published: October 2020

Background

A growing number of small studies suggest that school-based physical activity initiatives can help children achieve the recommended 60 minutes of physical activity per day. However, the heterogeneity of outcomes and measures used in small studies prevents pooling of results to demonstrate whether short-term health benefits are sustained. Qualitative studies suggest many benefits that are not represented by outcomes in trials to date. The aim of this study was to generate a list of outcomes that have been studied to develop a core outcome set (COS) acceptable to key stakeholders for future studies evaluating school-based physical activity initiatives.

Methods

We searched six databases (MEDLINE, EMBASE, PsycINFO, CINAHL, CENTRAL and Cochrane Database of Systematic Reviews) systematically for reviews of school-based physical activity interventions, and extracted relevant studies to identify the outcomes and measures used in each paper. A long list was generated from the literature and a previous workshop with stakeholders. This study is registered with COMET (#1322), and with PROSPERO (CRD42019146621).

Results

75/121 cited studies drawn from 53/2409 reviews met our inclusion criteria. We grouped 65 outcomes into 3 domains: (i) physical activity and health (ii) social and emotional health, and (iii) educational attainment. We will conduct two Delphi survey rounds with four stakeholder groups (health professionals, researchers, educators and parents) to rate the importance of each outcome. A core outcome set will be generated from a consensus process.

Conclusions

There is currently a large variation of outcomes and measures studied that precludes evidence synthesis of the impact of school-based physical activity interventions. Consensus methods are needed to focus research on the outcomes that matter the most to key stakeholders and to provide tools for future studies to assess long-term impact.

Key messages

Variations in outcomes studied precludes evidence synthesis of SBPA intervention impacts. A core outcome set is needed to ensure future SBPA interventions measure outcomes that matter the most.
Adoption of local public health plan for better health and quality of life in Belgrade
Authors: Tamburkovski G , Belamarić G , Matijević D , Mladenović Janković S
Published: October 2020

Issue

Development of public health plan for the City of Belgrade, facilitate multisectoral participation and encourage local government to incorporate public health planning into integrated planning framework, including funding.

Description of the Problem

According to Public Health Low, adopted in Serbia in 2016 and Public health strategy (2018), Council for Health, as a professional body of the City government, was obliged to prepare draft of the Plan. Members of the City Council are representatives from different sectors: health care, public health, private sector, child care, education and civil society. Based on data and information from relevant institutions and organizations, situation analysis and health profile of the City have been prepared during 2018.

Results

Public health plan for the City of Belgrade has been drafted for a time period from 2020 to 2026, aligned and within time frame of the National public health strategy. Plan included: mission, vision, objectives, activities, responsible institutions, funding sources and indicators for monitoring. Focus was on health promotion and empowerment of citizens to adopt healthy lifestyle as well on investment in environmental sustainability, poverty and inequalities reduction and minimizing risks to human health and well-being. On December 2019, Belgrade City Assembly adopted this document, with full responsibility for implementation and budgeting specific programs and projects from 2020.

Lessons

Multisectoral working group, with clear defined scope of work, supported by regulations, encouraged and managed by experts in the field, highly motivated to be creator of changes is prerequisite for successful and productive public health planning process.

Key messages

Public health planning enabled communication and cooperation among experts and decision makers and represented a whole-of-local government approach to public health. Document is used as a resource and model for the other cities and municipalities.
A retrospective database analysis of burden of IPD and pneumonia in children <15y in Veneto region
Authors: Barbieri E , Cantarutti A , Porcu G , Hu T , Petigara T , Prandi G M , Alimenti C , Scamarcia A , Cantarutti L , Giaquinto C
Published: October 2020

Background

IPD and pneumonia are associated with high mortality and healthcare resource utilization (HCRU). This analysis assessed incidence, HCRU and costs of IPD and pneumonia following PCV13 introduction in 2010 in Veneto.

Methods

IPD, unspecified invasive disease episodes, outpatient pneumococcal and unspecified pneumonia episodes were identified in Pedianet, a pediatric primary care database from 2010-2017. HCRU includes primary care and specialist visits, antibiotic prescriptions, diagnostics, ER visits and hospitalizations. Incidence rates (IRs) were numbers of episodes/1,000 person-years. Standardized regional incidence rates (SRIRs) were calculated by standardizing IRs with regional population data by age and year. Regional expenditures (€/1,000 person-years) were calculated by multiplying SRIRs with average costs per episode. Interrupted time series (ITS) analyses assessed trends in annual IRs in the early and late PCV13 (2010-2013, 2014-2017) periods.

Results

During 2010-2017, IPD and unspecified invasive disease incidence decreased from 0.40 to 0.31/1,000 person-years. While incidence was numerically lower in 2017 than in 2010, ITS analysis did not detect a significant trend in the early (coef=1.97; p = 0.63) or late PCV13 (coef=0.50; p = 0.90) periods. Average cost per episode was €4206 and average regional expenditure was €171/1,000 person-year. SRIR for outpatient pneumonia decreased from 13.35 to 5.48/1,000 person-year during 2010 to 2017. Pneumonia episodes were associated with 0.29 ER visits and 0.15 short stay and 0.06 long stay hospitalization. Average cost per episode was €345, majority of which was associated with ER visits (€50.8) and hospitalizations (€243.9). Regional expenditures decreased from €12852.31 to €5351.98/1,000 person-year.

Conclusions

IPD and unspecified invasive disease burden did not change significantly following PCV13 introduction, while disease burden declined for outpatient pneumococcal and unspecified pneumonia.

Key messages

IPD and unspecified invasive disease burden did not change significantly following PCV13 introduction. Disease burden declined for outpatient pneumococcal and unspecified pneumonia following PCV13.
Update on adherence to a vaccination protocol for invasive bacterial diseases in HIV patients
Authors: Berghella L , Tancredi S , Cintori C , Kahfian Z , Rovesti S , Bargellini A , Mussini C , Casaletti G
Published: October 2020

HIV+ patients present an increased risk of vaccine-preventable invasive bacterial diseases (IBDs), infections characterized by high lethality and frequency of serious complications. Considering that these patients frequently have to face a complex clinical-care pathway, it has been necessary to design a clear vaccination protocol in order to prevent IBDs and to guarantee adequate patient adherence. In 2013 the Local Health Unit Company of Modena's Public Health Department and the University Hospital of Modena developed a shared vaccination protocol to prevent the most common causes of IBDs: Neisseria meningitidis, Streptococcus pneumoniae and Haemophilus influenzae type B.

The protocol applies to HIV+ patients receiving antiretroviral therapy who have a CD4 + cell count > 200 cells / µL. It provides the following vaccination schedule: administration of PCV13 + MenACWY vaccines; after 15 days administration of MenB + Hib vaccines; after 45 days administration of the MenB vaccine; after at least 60 days, administration of PPSV23 + MenACWY vaccines. The first vaccination counselling is proactively carried out by the Public Health Department healthcare workers and takes place at the Infectious Diseases Division in order to improve patient acceptance and adherence to the protocol.

From October 2013 to January 2020, 503 HIV+ patients (378 males and 125 females) were vaccinated. Among these patients, 338 (67.2%) completed the vaccination schedule; 110 (21.9%) interrupted the schedule, 34 (6.7%) have a vaccination schedule currently underway and 21 (4.2%) never started the planned vaccination protocol. Overall, the percentage of patients who have completed the vaccination schedule or have scheduled appointments is 73.9%. The data analysis shows a high adherence to the protocol thanks to the collaboration between public health and infectious disease specialists, which improves the compliance of patients with a complex clinical-care pathway.

Key messages

HIV patients present an increased risk of IBDs and require a tailor-made vaccination protocol. Collaboration between specialists improves the compliance of patients with a complex clinical-care pathway.
Streptococcus pneumoniae in hospitalized patients with pneumonia: epidemiology and implications
Authors: Dajko M , Poscia A , Posteraro B , Speziale D , Volpe M , Ricciardi W , de Waure C
Published: October 2020

Background

Streptococcus pneumoniae (SP) is a major cause of pneumonia worldwide representing a significant problem from the public health viewpoint. The aim of our study was to assess the frequency of SP in hospitalized patients with pneumonia and investigate its relationship with patients' characteristics.

Methods

A deterministic record linkage of hospital discharge and microbiology laboratory surveillance databases of a teaching hospital in Rome was used to identify all patients over 15 years old (y) with a diagnosis of pneumonia and a microbiological ascertainment between November 2010 and March 2013. Pneumonia ICD-9-CM codes were used to identify the study population. The frequency of SP was assessed with respect to patients' characteristics.

Results

1216 (64% males) of a mean age 65 (SD = 18) y patients with pneumonia were identified. Of them, 707 (58%) had a positive microbiological result. Among the latter, mixed bacterial co-infections were detected in 552 (74%) cases. The most frequently isolated organism was SP in 288 (41%) cases. Nevertheless, SP was the sole isolated agent in only 6 (0.8%) cases. There were no significant differences between men and women with respect to the frequency of SP. Eventually, the frequency of SP among patients with a positive microbiological result was higher in the age group 15-64 y than in 65+ y (45% vs 37%, p = 0.038). When considering only subjects with at least one comorbidity the frequency of SP was higher among the 15-64 y age group (53% vs 44% in 15-64 y and 65+ y respectively, p = 0.040).

Conclusions

Our study revealed that SP was the most frequent isolated pathogen in hospitalized patients with pneumonia. However, the SP coexistence with other pathogens was present in the vast majority of cases. Interestingly, SP was highly frequent among people with comorbidities, in particular in the age group 15-64 y. This emphasizes the importance of vaccination in this group of patients.

Key messages

This study shows that more than 40% of pneumonia with a positive microbiological result are caused by Streptococcus pneumoniae. Preventive strategies to limit Streptococcus pneumoniae infections among adults and individuals affected by comorbidities are needed.
Local solutions by slum communities to deal with summer water scarcity: Learning from Indore, India
Authors: Agarwal S , Verma S , Kothiwal K , Verma N , Vishvakarma K
Published: October 2020

Issue

Government of India's, NITI Aayog reports that 600 million people in India face extreme water stress. Slums and similarly vulnerable urban populations face huge challenges in accessing water for basic needs, increasing in summers. Indore is an extreme water stressed city in India.

Methods

During Urban Health Resource Centre's (UHRC) program work in slums, including women's groups UHRC forms and trains in 2018 we learnt of acute water scarcity in summers. Women in 16 slums were motivated to evolve and implement possible solutions. Most slum dwellers provide services on low wages to the city. With public bore-wells drying-up, in Feb.- May 2019 UHRC helped women's groups' submit community requests, reminders to elected ward representatives and Municipal offices for free water tankers. UHRC motivated slum families to collectively negotiate with private providers to reduce cost, systematise water supply for more families. In 4 peri-urban slums we strengthened water access relationship between farmers and slum dwellers.

Results

During Feb.-May 2019 10 of the 16 slums received free water tankers from Municipal Corporation. More population of 4 peri-urban slums accessed water from farmer's tube-well. Slum families evolved coping mechanisms of storing more general use water in underground tanks or many cans. Families with larger storage shared water with needy families demonstrating social cooperation.

Lessons

Trained and mentored slum women's groups gently negotiating with elected ward-level politicians and municipal officials helps in provision of free water tankers in summers. This strategy to get govt. water supply in slums is adaptable in fast growing Indian cities. Owing to geographical proximity, rural-urban cooperation can help slums in city's fringes obtain water from farmer tube-wells used for irrigation. Fostering community cooperation helps more needy families get water.

Key messages

Slum communities develop local mechanisms to access and store water which need to be understood by civil society organisations and Government to improve solutions for water supply in summer months. Slum women emerge as dynamic actors to improve the lives of both women and men (Sen, 2000). In this case women help negotiate for and foster community cooperation for water, store more water.
What is the healthcare carbon footprint? A collaborative analysis of current literature
Authors: Di Fonzo D , Rivolta S , Mazzolai E , Turatto F , Mammana L , Righini M
Published: October 2020

Background

Climate change (CC) is a public health (PH) issue of growing concern. Health care systems in every country have a significant impact in terms of greenhouse gas emissions (GHGE) causing global warming, but there seems to be a general lack of knowledge about this. As members of the junior study group on CC and PH of the Italian Society of Hygiene (SItI), we launched a project of shared education and literature research about the carbon footprint of healthcare (HCCF). We believe such an effort to be useful in spreading awareness and promoting change both in clinical practice, health care management and at policymaking level.

Objectives

To answer these questions: What is the estimated national and global HCCF?

Which activities contribute to HCCF?

What are the possible actions and policies to reduce HCCF while providing universal health care of good quality in all countries?

From Dec 2019 to Feb 2020 we used databases and backward citation searching to retrieve references which we split among individuals to process, then we shared summaries of the material with the group.

Results

HCCF makes about 4.4% of all GHGE, with important variations among countries. We found estimates on emissions for various activities (e.g. operating theatres) and items (e.g. inhalers), as well as proposed solutions for practitioners, managers, manufacturers and policymakers (e.g. low-impact technologies, advocacy, health promotion to reduce healthcare volumes).

Conclusions

HCCF is complex, attributable to many components and amenable to mitigation through actions at all levels, with additional benefits for efficiency and public health. These conclusions are relevant for all countries as they imply joint international and transversal efforts throughout the world's health care sector.

Key messages

Current data and analysis, available for several services and in many countries, show healthcare carbon footprint is significant. Emissions from health sector can be reduced while granting universal healthcare globally.
Perception of the risk of contamination through feeding in pregnant and breastfeeding women
Authors: Company-Morales M , Fontalba-Navas A , Rubio-Jimenez M F , Gil-Aguilar V , Arrebola J P
Published: October 2020

Introduction

Persistent Toxic Substances (PTS) are substances that are characterized by the cumulative effect at low doses inside the body. Exposure to PTS in pregnant and breastfeeding women, through food consumption, shows various harmful effects on the health of the mother, the fetus and the baby. The objective of this article is to analyze how pregnant and breastfeeding women perceive the presence of chemical substances in food and reflect on the accumulation, transmission and elimination of these substances.

Methodology

Descriptive and interpretive study under the qualitative research paradigm following a phenomenological and ethnographic perspective. As instruments to obtain the primary data we rely on 111 semi-structured interviews with pregnant and breastfeeding women, 4 focused ethnographies, 8 focus groups (63 women), 71 feeding diaries, 71 free listings. To encode the content of the speeches of pregnant and nursing women we rely on the N-Vivo 12 software.

Results

Pregnant and breastfeeding women are concerned about food quality controls. Women trust on local and seasonal foods such as fresh fruits and vegetables from non-extensive crops and close to their home. Foods that produce distrust in women are processed, packaged foods, red meat and large fish. The latter foods promote in women a perception of risk of contamination by chemical substances, manifesting a defenseless situation to maintain a diet without contaminants.

Conclusions

Pregnant and breastfeeding women in Spain have no information on the risk and danger of synthetic chemicals or PTS, with the exception of certain toxic substances such as mercury present in large fish. Women maintain a duality in their own care and that of the fetus or child. This circumstance implies that the women interviewed believe that PTS and synthetic chemicals may have different harmful effects on the mother and the degree of growth of the fetus and, subsequently, of the baby.

Key messages

Future mothers are worried about the type of product they eat, knowing that food influences healthy growth and development of the fetus. Pregnant and breastfeeding women often distrust “processed” or “industrial” foods, which they tend to associate with low quality and large amounts of additives and chemical substances.
Influence of tobacco and e-cig smoke on intestinal microbiota: a systematic review
Authors: Giffi M , Antinozzi M , Sini N , Valeriani F , Gallè F , Romano Spica V , Liguori G , De Vito C , Cattaruzza M S
Published: October 2020

Background

Intestinal microbiota (IM) plays a crucial role in maintaining human body homeostasis, yet it is highly susceptible to lifestyle changes and environmental factors, such as tobacco and e-cig smoking.

This systematic review aims to investigate the relationship between smoking and IM in healthy humans, by assessing abundance of Phyla and species' variability.

Methods

PubMed, Scopus and Web of Science were searched until April 2019. Studies assessing IM of healthy adult tobacco/e-cig smokers, collected on faecal samples and analysed with genome sequencing of rRNA 16 S, were included. Any type of study design, described in English, was considered. Quality assessment was performed with Methodological index for non-randomized studies and Joanna Briggs Institute Critical Appraisal tool for cross-sectional studies.

Results

Eight out of 1,838 studies (one controlled prospective and seven cross-sectional studies) were included. The only controlled prospective study found a signiﬁcant increase in α and β-diversity, an increase in Firmicutes (p = 0.014) and a decrease in Bacteroidetes (p = 0.019) after a smoking cessation intervention. In cross- sectional studies, ﬁve out of seven studies found a statistically signiﬁcant decrease in α-diversity among tobacco/e-cig smokers, while results on β-diversity were more contradictory. One out of two studies evaluating Firmicutes found a signiﬁcant decrease in smokers (p = 0.047). The only study assessing Bacteroidetes found a signiﬁcant increase among smokers (p = 0.015). Five studies analysed genera, three of them found a decrease in Bacteroides and two an increase in Prevotella.

Conclusions

What seems to emerge is a decreasing species’ variability in smokers, yet it is difficult to proﬁle IM in smokers in terms of phyla’s abundance, because of few studies available and some further limitations, such as small sample sizes and lack of adjusted analysis to cope with confounding factors like gender, diet and other lifestyles.

Key messages

There is a decrease in species’ variability among smokers. Further studies are needed to assess abundance of phyla in healthy smokers, taking into account confounding factors.
Depression and lack of physical activity as factors leading to higher health care utilisation
Authors: Dorner T E , Haider S , Grabovac I , Rieder A
Published: October 2020

Background

Depressive symptoms and lack of physical activity (PA) often occur simultaneously, since depression, associated with listlessness can lead to lack of PA, and lack of PA, associated with poor quality of life and health satisfaction can lead to depressive symptoms. Both factors are independent risk factors for a higher health care utilisation. We aimed to assess the effects of the combination of depressive symptoms and lack of aerobic PA on the probability of using in- and outpatient health care services.

Methods

Data from 15.770 people from the nationally representative Austrian Health Interview Survey from 2014 were used for the analysis.

Results

In analysis, adjusted for socio-demographic, health related, and lifestyle-related factors, the combination of depressive symptoms and lack of PA were associated with higher odds of outpatient health care utilisation (OR: 1.43; 95%CI: 0.99-2.07) in men and (OR: 2.02; 95%CI: 1.50-2.73) in women, and with higher odds of inpatient health care utilisation (OR: 1.52; 95%CI: 1.02-2.26) in men and (OR: 1.75; 95%CI: 1.28-2.40) in women. Being affected by depressive symptoms alone showed slightly lower, and being affected by lack of PA alone showed clearly lower OR for health care utilisation compared to the combination of the two factors

Conclusions

Our results show that the combination of depressive symptoms and lack of PA are associated with a higher health care utilisation. Both factors are often neglected health hazards in the health care system and the attendance of affected people could be regarded as opportunity to address those factors properly.

Key messages

The combination of depressive symtoms and lack of physical activity lead to higher health care utilisation. Addressing those factors in the health care system properly would be a good opportunity to address those important health hazards.
Human Centric Lighting: The impact of light on sleep and attention of factory shift workers
Authors: Kindt S , Van de Putte E , Bracke P , Vandevivere L , Ryckaert W
Published: October 2020

Introduction

Increased blue-enriched morning light is often said to support circadian rhythm synchronization. Through a better sleep quality, one's cognitive and emotional functioning can also be enhanced. However, it is unclear which light characteristics (especially illuminance at eye level) are necessary to obtain a wellbeing effect in employees. This field study investigated different lighting conditions in a truck factory.

Methods

71 shift workers participated in the study during their morning shift (6 am - 2 pm). Measurements of sleep (MotionWatch8), attention (D2 attention task, go no-go computer task) and visual comfort (questionnaire) were administered before and after changing the lighting conditions. A Human Centric Lighting-condition (HCL; vertical melanopic equivalent daylight illuminance (MEDI) = 250 lux, CCT=5000 K; N = 33) was compared with a control LED-condition (MEDI = 44 lux, CCT=4000K; N = 38).

Results

Results show that workers in the HCL-condition showed a larger improvement in sleep efficiency (p=.057) and concentration (p=.01) than the control LED-group. No differences were found in visual comfort between groups.

Discussion

Preliminary results are promising and show that 250 MEDI might be a sufficient cut-off to stimulate workers' sleep and cognition. The high illuminance level was not detrimental in the HCL condition for the perceived visual comfort.

Key messages

Blue-enriched morning light supports sleep and concentration in shift workers. High illuminance levels are not detrimental for the perceived visual comfort.
Evidence-based practice competency and its related factors among healthcare students
Authors: Tlili M , Tarchoune S , Aouicha W , Lamine H , Taghouti E , Dhiab M B e n , Chelbi S , Ajmi T , Mallouli M , Ben Rejeb M
Published: October 2020

Background

Evidence-based practice today is a worldwide approach in optimizing quality of healthcare. This approach remains little known among Tunisian future healthcare professionals. This study aimed to describe health sciences students' competencies in Evidence-based practice (attitudes, skills and knowledge) and to determine factors associated with these competencies.

Methods

A descriptive cross-sectional study was conducted from February to March 2018, at the Higher School of Health Sciences and Techniques of Sousse (Tunisia) among health sciences students. Data were collected using the validated Evidence Based Practice Competencies Questionnaire (EBP-COQ) measuring students' knowledge, attitudes and skills in Evidence-based practice. The Statistical Package for Social Sciences (SPSS.20) software was used to analyze data. Independent-Samples T test and One-way ANOVA test were performed to assess the differences between the different subgroups and their association with the Evidence-based practice components.

Results

Altogether, 365 students participated to the study (response rate: 93.11%). The overall Evidence Based Practice Competencies score was 3.26±0.53 out of 5. The attitude, skills and knowledge subscales received 4.04±0.41; 3.05±0.77 and 2.70±0.74 as mean scores respectively. Students' demographic and academic features were significantly associated with their competencies in Evidence-based practice including age (p < 10-6), gender (p < 10-3), academic degree (p < 10-6), English-language reading skills (p < 10-6), students' education in research methodology (p < 10-6) and statistics (p < 10-5), and their familiarity with the term “Evidence-based practice”(p < 10-6).

Conclusions

The reported knowledge and attitudes among the future caregivers is considered below the required competency standards. These findings highlight the urgent need for changes in the current educational strategies to ensure successful implementation of Evidence-based practice in Tunisia.

Key messages

The transition from studentship to a professional health-caring role requires that students are well equipped with EBP competencies to increase their likelihood of utilizing EBP in their future. Understanding the underlying factors that may influence Evidence based practice competencies is useful in developing teaching strategies for effective EBP.
Changing students' knowledge and attitudes towards intimate partner violence
Authors: Papadakaki M , Apostolidou A , Giakoumaki E , Taraktsi S , Chliaoutakis J
Published: October 2020

The need for effective awareness raising interventions for the prevention of intimate partner violence (IPV) has been widely acknowledged, given its frequency among dating relationships. The current intervention study aimed to improve IPV knowledge, attitudes and practices of university students. A pre/post-test design with a control group was employed to compare changes in baseline measures of IPV at post intervention stage. A total of 80 higher education students participated in the study and provided full data; 40 students (intervention group) and 40 students (control group). The awareness raising intervention included: a) a one-day intensive educational seminar, b) reminder and email messages over a 4-week period, and c) demonstration of informational material in public places. Students in the intervention group performed better than those in the control group regarding IPV attitudes (p=.174 and p=.011). No statistically significant improvements were shown in terms of IPV knowledge and self-reported IPV victimization/perpetration. Further studies are necessary to decide on the structure and content of awareness raising interventions that could serve as an IPV prevention measure for young people.

Key messages

Higher education curricula need to incorporate lessons on intimate partner violence management. Longer, practice-based interventions may have a greater effect in changing students' behaviours towards intimate partner violence.