bluuebunny/crossref_metadata_2025 huggingface dataset:
Healthcare-associated infections in a neonatal ICU before and during COVID-19: preliminary results
Authors: Ceparano M , Sciurti A , Isonne C , De Blasiis MR , Imeshtari V , Cammalleri V , Romano A , Bellomo RK , Marzuillo C , Villari P
Published: October 2022

Background

Healthcare-associated infections (HAIs) are a frequent complication in neonatal intensive care units (NICUs). Hospital policies caused by COVID-19 pandemic may have played a role in HAIs development. The aim of this study was to describe and characterize over time the occurrence of HAIs in a NICU at the Policlinico Umberto I in Rome both before and during the COVID-19 pandemic.

Methods

All infants of all birth weight (BW) classes with >2 days in the NICU, admitted from January 2018 to December 2021, were included. To assess the effect of the pandemic, we compared surveillance data from 2018-2019 with those from 2020-2021. Infections were defined using standard Centers for Disease Control and Prevention definitions.

Results

We included 513 infants, 274 admitted in 2018-2019 and 239 between 2020-2021. NICU stay in days was similar in the two periods (14.4 and 15.3 respectively) but the number of patients who died in 2018-2019 (N = 13) was almost double that of 2020-2021 (N = 7). A total of 27 infections were recorded in the post-pandemic period compared to 9 recorded in the previous period, mainly central line-associated bloodstream infections (CLABSI) (7% vs 3.0%, p = 0.043), followed by ventilator-associated pneumonias (VAP) (3.0% vs 0.4%, p = 0.019). The incidence density of device-associated infections was higher in patients with lower BW class in both periods analyzed. Different microorganisms were isolated: in 2018-2019 K. pneumoniae (33.3%) and Serratia marcescens (33.3%) were the most found, while S. aureus (29.0%) and Staphylococci coagulase negative (51.6%) were predominant in the following years.

Conclusions

Results indicate that patient management may have influenced the occurrence of HAIs during the pandemic. This reinforces the importance of the HAI surveillance protocol in the NICU, which monitors microbiologic isolates and medical device use for all classes of infants with BW.

Key messages

• The Covid-19 pandemic has resulted in an increase in healthcare-associated infections occurrence in our neonatal intensive care unit.

• Monitoring device-associated infections in all BW classes of infants is critical to prevent nosocomial infections.
GIS analysis of the relationship between PM2.5 and acute CVD and respiratory hospitalizations
Authors: Slachtova H , Tomaskova H , Polaufova P , Michalik J , Tomasek I , Splichalova A
Published: October 2022

Background and aims

The PM air pollution is a serious concern in northern Moravia in the Czech Republic. The aim is to evaluate the risk of acute hospital admissions for cardiovascular and respiratory causes with the use of the Geographic information system (GIS).

Methods

The data on acute hospital admissions for cardiovascular (I00-99 according to ICD-10) and respiratory (J00-99) causes was assigned based on the information on residence to 77 geographical units (601,299 inhabitants). The annual concentrations of PM2.5 in the period 2013-2019 were assigned to this units according to the respective concentration iso-shapes (step 2 μg.m-3, concentrations ≤29 to ≥ 38 μg.m-3). The Incidence Rate Ratio (IRR) and 95% confidence interval (CI) was calculated for each concentration category. The incidence in the first category with the lowest PM2.5 concentrations (≤29 μg.m-3) was chosen the reference category. The statistical analyses were performed using the SW STATA v.15.

Results

About a half of population (56%) in the year 2013 belonged into the PM2.5 category 34-35 μg.m-3, 26 thousand of inhabitants (4%) live in the PM2.5 concentrations ≥38 μg.m-3. During the analysed period the average concentration values decreased from 30.8 to 21.4 μg.m-3. A statistically significant risk of the acute hospitalization for cardiovascular causes was identified in the categories ≤36 μg.m-3, in the highest interval of PM2.5 the IRR values were 2-3-fold higher comparing with the reference category. As for respiratory causes, the trend is similar, but the statistically significant risk was found already from the interval 34-35 μg.m-3.

Conclusions

With increasing concentrations, the risk of both acute cardiovascular, and respiratory hospitalizations increased.

This presentation was supported by the project TH03030195 of the Technology Agency of the Czech Republic and the project Healthy Aging in the Industrial Environment CZ.02.1.01/0.0/0.0/16_019/0000798 (HAIE).

Key messages

• A statistically significant increase of the IRR for acute cardiovascular and respiratory hospitalizations was found at PM2.5 concentrations ≤34 μg.m-3 compared to the reference category ≤29 μg.m-3.

• Average annual PM2.5 concentration decreased from 30.8 to 21.4 μg.m-3 during the followed period and also the risk of acute hospitalization from cardiovascular and respiratory causes decreased.
Federated learning for describing COVID-19 patients and hospital outcomes: An unCoVer analysis
Authors: Peñalvo JL , Mertens E , Cottam J , Berrozpe-Maldonado V , Fernández-Lobón D , Solarte-Pabón O , Menasalvas E
Published: October 2022

Background

Since the onset of the pandemic, the unCoVer network has been identifying real-world data from EMR of hospitalised patients with COVID-19 across countries. These heterogeneous data are integrated into a multi-user data repository operated through Opal/DataSHIELD, an interoperable open-source server application, providing privacy-preserving access to individual-level information for federated data analyses.

Methods

unCoVer’s federated data platform provided access to EMR collected between 02/2020 - 04/2022 from 6 hospitals in Bosnia and Herzegovina (1), Romania (2), Spain (2), and Turkey (1) for a total of 14,236 patients. Demographics, and co-morbidities at admission, length of hospital stay and intensive care (ICU) needs, are presented according to the patients’ status at discharge.

Results

A total of 11,248 (79.0%) of all patients reviewed recovered from COVID-19 after an average 11.5 (SD 10.8) days hospitalised, with only 4.09% of patients needing ICU. A smaller proportion of patients were transferred (5.93%), and 2143 (15.1%) were considered in-hospital deaths after an average 11.6 (SD 10.5) days in the hospital where most (81.2%) needed ICU. Recovered patients had a mean age of 57.7 (SD 16.3) years old, and gender neutral (51.2% men), in contrast to deceased patients that were 74.2 (SD 12.4) years old (59.7% men). Current smoking was infrequent for both recovered or deceased patients (3.27%, and 2.83%, respectively). Cardiometabolic conditions were less commonly reported among later recovered patients in comparison with deceased patients: obesity (10.7% vs 12.1%), diabetes (15.9% vs 27.4%), hypertension (23.2% vs 42.7%), and CVD (9.33% vs 44.9%). Chronic pulmonary disease was also more frequent among deceased patients (10.3% vs 18.1%).

Conclusions

Characteristics of hospitalised COVID-19 patients differ according to outcomes at discharge with more in-hospital death reported among older, chronic patients across 6 hospitals in 4 countries.

Key messages

• Federated analyses provide unique opportunities for robust results by privacy-preserving accessing individual-level data from heterogeneous data sources.

• The unCoVer network aims to demonstrate the usability of the infrastructure to address research questions related to the COVID-19 while extending the concept to other clinical areas.
The effect of employment services on employment and health among unemployed persons: an IV approach
Authors: Schuring M , Knoef MG , Burdorf A
Published: October 2022

Background

In a large city in the Netherlands, professionals of one department of the municipality focus on rapid return to work, even if that work is not directly in line with education, experience or preference of the client. The first aim was to investigate the effects of this work-first strategy of the municipality on entering paid employment and on health among unemployed persons. The second aim was to determine whether these effects differed between persons, depending on age, sex, education, health, and employment history.

Methods

To identify the effectiveness of employment services of the municipality, a judge leniency instrumental variable (IV) design was used, based on referral behaviour of case workers. In total, 3272 persons who applied for welfare in a large city in the Netherlands in the year 2015, were included in the study. Information on employment services was derived from the municipality. Information on individual characteristics and employment status was derived from register data from Statistics Netherlands. Information on diseases was derived from a medication register. IV regression models and ordinary least squares (OLS) regression models were performed.

Results

The work-first strategy increased the likelihood of entering paid employment by 27% points (b = 0.26, se = 0.07) and had a positive influence on health by 4% points (b = 0.06, se 0.03) of welfare recipients compared to other employment services. Although standard errors were larger for subgroups, the positive effect of the work-first strategy on employment was driven by relatively young (18-30 yrs) and old (45-65 yrs) welfare recipients, with low and intermediate education level.

Conclusions

The instrumental variable approach is a valuable approach to investigate the effect of employment services on entering paid employment and health. To improve health of unemployed persons, it is important to promote entering paid employment.

Key messages

• Active labour market policies, such as the work-first approach, are beneficial for individuals, by increasing employment participation and health, and society, by increasing the employment rate.

• The IV approach is a promising approach to study causal relations in a quasi-experimental study. By using large datasets, differential effects across different groups of participants can be studied.
Sexual harassment, other types of harassment and derogatory treatment in the academy
Authors: Pilgaard F , Agardh A , Östergren P-O , Priebe G
Published: October 2022

Background

Sexual harassment (SH) continues to be a significant public health problem, especially among women. SH and other types of harassment and derogatory treatment/bullying exist at many academic workplaces. The aim of this study is to explore how SH relates to other forms of harassment among staff at a large Swedish university, separated by gender.

Methods

Using data from a web-based survey sent out to all staff in November 2019 (response rate 33%), a multiple logistic regression analysis was performed. Exposure to SH was defined as having experienced at least one of ten defined SH behaviours related to work. Exposure to harassment (other than sexual) was defined as having experienced violation of onés dignity associated with one of the Swedish seven legal grounds for discrimination: sex, transgender identity or expression, ethnicity, religion or other belief, disability, sexual orientation or age. Exposure to derogatory treatment was defined as having experienced undesirable negative behaviours, such as withholding information, derogatory comments or exclusion. All SH, harassment and derogatory treatment took place during the last 12 months.

Results

Preliminary results show a sixfold increased risk among women subjected to SH to also experience harassment, a three times higher risk to experience derogatory treatment and a seven times higher risk to experience multiple forms of harassment (two or more forms of harassment or derogatory treatment) compared to women unexposed to SH. The elevated risk remained after adjusting for relevant background variables. The pattern was similar among men but with lower prevalence of SH, harassment and derogatory treatment.

Conclusions

The results indicate that individuals subjected to SH at work have an increased risk of experiencing other types of harassment or derogatory treatment. This new information is relevant to consider in prevention of SH and harassment in academia.

Key messages

• The results indicate that individuals subjected to sexual harassment at work have an increased risk of experiencing other types of harassment or derogatory treatment.

• Findings indicating a relationship between sexual harassment and other types of harassment or derogatory treatment may be valuable for counteracting the problem.
Predictors of job satisfaction among German teachers during the SARS-CoV-2 pandemic
Authors: Dicks T , Eggert V , Köstner C , Beutel T , Kalo K , Zähme C , Letzel S , Dietz P
Published: October 2022

Background

To contribute the containment of the infections during the SARS-COV-2 pandemic, changes in working conditions occurred worldwide. In the school context, teaching was changed several times to distance learning and teachers were forced to work from home. This increasing spatial separation between work and private life increased the potential for conflicts. Based on the theoretical assumption that stressors worsen job satisfaction and resources increase satisfaction, the aim of our study was to identify the predictors of teachers’ job satisfaction during the pandemic. The focus on job satisfaction is interesting because the concept is often related to health-related aspects from a public health perspective.

Methods

A nationwide cross-sectional survey was conducted among German teachers in March 2021. After data cleaning, 31,089 participants were included in the analyses. The survey consisted of established instruments (e.g., COPSOQ) and self-developed items if necessary. A multiple linear regression was performed to predict teachers’ job satisfaction by stepwise inclusion of sociodemographic, work-related and covid-specific variables.

Results

Overall, the regression revealed that especially work-related variables were strong predictors of job satisfaction. The analyses showed that higher levels of meaning of work, autonomy and predictability of work increased job satisfaction. In contrast, increased emotional stress, feelings of unfair treatment, and work-privacy conflicts deteriorated job satisfaction.

Conclusions

The present study identified important predictors of job satisfaction which may be used to derive specific recommendations for improving teachers’ job satisfaction during the SARS-CoV-2 pandemic. The relevance of job satisfaction for the scientific and public discourse becomes apparent because it was closely related to teachers’ somatic and mental health.

Key messages

• Teachers’ job satisfaction during the pandemic can be further improved by making appropriate adjustments, particularly in work-specific requirements.

• Improving job satisfaction significantly contributes to promoting teachers’ health.
Working re-organisation due to the pandemic may negatively affect workers’ quality of life
Authors: Ghelli F , Bellisario V , Squillacioti G , Panizzolo M , Bono R
Published: October 2022

Background

From the beginning of 2020, the COVID-19 pandemic imposed many changes in the organization of our personal and professional life, allowing a shift to teleworking and hybrid working arrangements worldwide. The persistence of this condition determined the integration of these changes in the daily routine, and our aim was to investigate how these changes could affect workers’ Quality of Life (QOL) in the long run.

Methods

An online questionnaire was administered to 650 workers employed in an Italian company in July 2021. The domains considered were socio-demographic characteristics, QOL (WHOQOL-bref and Healthy Days), lifestyle, health status, physical activity, and work-related factors. Comparisons were performed with non-parametric tests.

Results

Among the 332 respondents (response rate = 51.1%), 79.2% were white-collar workers. The concern for the pandemic affected workers’ QOL, especially in the physical health and the environmental domains (p < 0.001 and p = 0.001, respectively), with lower values in subjects reporting the highest values of concern. A similar effect was found also for healthy days concerning physical and psychological health, and the ability to perform usual activities (p = 0.003, p = 0.003, and p = 0.029, respectively). As well, changes in working arrangements significantly affected the environmental and physical domains (p = 0.023 and p = 0.015, respectively) and the ability to do usual activities (p = 0.011), with lower values in those who interrupted the working activity. Workers whose activity required a shift to teleworking reported higher scores in the physical health domain (p = 0.041) and a higher number of days with good physical health (p = 0.002), while a lower number of days with good psychological health (p = 0.006).

Conclusions

These preliminary data revealed that organizational strategies adopted in working scenarios to contain the spread of COVID-19 may have an impact on workers’ QOL, as well as the concern for the pandemic.

Key messages

• Changes in the working arrangements due to pandemic may negatively affect the workers’ Quality of Life, especially for those who had to interrupt their working activity.

• The shift to telework, even if appearing to be beneficial for physical health perception, seems to negatively affect workers’ psychological health.
Patient experiences of hospital care during the COVID-19 pandemic in Ireland
Authors: Rohde D , Foley C , Murphy R , Kelly M , Drummond L
Published: October 2022

Introduction

The COVID-19 pandemic has greatly impacted healthcare service delivery. This study explored patient experiences of hospital care during the COVID-19 pandemic in Ireland, using National Inpatient Experience Survey (NIES) 2021 data.

Methods

NIES is a repeat cross-sectional survey of inpatient experiences in all public acute hospitals in Ireland. Patients who spent 24+ hours in hospital and were discharged in September 2021 were eligible to participate. 7 questions addressed experiences specific to the pandemic. Comparisons between 2019 and 2021 were conducted using t-tests. Effect sizes (d) are reported. Qualitative data were thematically analysed.

Results

10,743 patients participated (42% response rate). While 68% did not feel at risk of catching COVID-19, 9% felt at risk. 35% reported that staff always helped them to keep in touch with family. There were small, statistically significant differences between 2019 and 2021 ratings, with questions on opportunity for family to talk to a doctor (d=-.328), provision of information to family (d=-.136), and being able to find staff to talk to about worries and fears (d=-.167) recording the biggest decreases. Scores for cleanliness of wards (d = 0.063) and bathrooms (d=.075), and privacy during examination or treatment in the ED (d = 0.085) improved significantly. Patients commented on their appreciation of staff, but missed having visitors, with restrictions posing challenges for those with sensory or physical impairments.

Conclusions

Given the unique challenges experienced by acute healthcare services during the COVID-19 pandemic, comparisons with pre-pandemic patient experiences should be interpreted with caution. Continuing to gather patient feedback during a pandemic presents a unique opportunity to understand the resilience of healthcare systems as they continue to operate under unprecedented pressure, with the potential to inform responses and delivery of care during future pandemics or other emergencies.

Key messages

• Visiting restrictions posed many challenges for patients and affected communication both between patients and their family members, as well as between healthcare staff and patients’ family.

• Gathering patient feedback during a pandemic presents a unique opportunity to inform responses and delivery of care during future pandemics or other emergencies.
The value of uterine oncological surgery in a University Hospital. Results of a break-even analysis
Authors: Specchia ML , Arcuri G , Di Pilla A , La Gatta E , Osti T , Limongelli P , Scambia G , Bellantone RDA
Published: October 2022

Background

Robotic surgery has many clinical advantages but high costs, raising the issue of healthcare sustainability. This study aims to a comparative analysis of the value, in terms of costs and outcomes, of robotic, laparoscopic, and laparotomy surgery for uterine cancer in a University Hospital.

Methods

An observational retrospective study was carried out on hospitalizations between 1 Jan 2019 and 31 Oct 2021 for uterine cancer surgery. DRG amount, costs, economic margins and 30-days readmissions percentage (mean values and 95% CIs) were calculated for robotic, laparoscopic and laparotomy surgery. Student’s t and Chi-square tests were used to assess differences and the break-even point was calculated.

Results

1336 hospitalizations were analyzed, 366 with robotic, 591 with laparoscopic, and 379 with laparotomy surgery. Robotic surgery compared to laparoscopic and laparotomy ones showed a significant difference (p < 0,001) for economic margin, which was largely negative (-1069.18 €; 95%CI: -1240.44 - -897.92 €) mainly due to devices cost (3549.37 €; 95%CI: 3459.32 € - 3639.43 €), and a lower 30-days readmissions percentage (1.4%; 95%CI: 0.2% - 2.6%) with a significant difference only versus laparotomy (p = 0.029). Laparoscopic compared to laparotomy surgery showed a significantly (p < 0,001) more profitable economic margin (1692.21 €; 95%CI: 1531.75 € - 1852.66 €) without a significant difference for 30-days readmissions. The break-even analysis showed that, on average, for every uterine cancer laparoscopic elective surgery, 1.58 elective robotic surgeries are sustainable for the hospital (95% CI: 1.23 - 2.06).

Conclusions

The systematic application of the break-even analysis will allow defining over time the right distribution of robotic, laparoscopic and laparotomy surgeries’ volumes to perform in order to ensure both quality and economic-financial balance and therefore value of uterine oncological surgery in the University Hospital.

Key messages

• The value-based healthcare approach, defined as the measured improvement in a patient’s health outcomes in relation to its cost, finds effective application in uterine cancer surgery.

• The use of the break-even approach allows to promote the value-based view by identifying a useful criterion for the planning and governance of interventions for uterine malignancies.
What kind of patient benefits the most from an intensive physiotherapy after total hip replacement?
Authors: Dionisi L , Accame I , Praino F , Abinova G , Sanguineti I , Gentile AM , Nante N
Published: October 2022

Background

Hip replacement is a common orthopaedic surgery procedure that produces great improvement in the quality of life. Despite this, a globally standardized post-operative physiotherapy protocol still does not exist. The aim of this study is to identify the factors that influence the motor and functional outcome after early, intensive, hospitalized treatment.

Methods

A retrospective study was conducted in 2019 on 509 patients admitted to an Italian private clinic specialized in post-surgery rehabilitation, which applies an original bio-psycho-social-environmental protocol and individual rehabilitation plans. Data regarding each patient were collected from medical records: age, haemoglobin, Body Mass Index (BMI), Cumulative Illness Rating Scale (CIRS), Tinetti scale (TS) and Barthel scale (BS) at admission and discharge. The outcome was measured as the difference (Δ) between the values at discharge and admission of BS (ΔBS) and TS (ΔTS). We performed a univariate linear regression using STATA, to determine which factors influence the outcome. A p < 0.05 was considered statistically significant.

Results

Our sample (57.4% female) was 70.1 ± 10.4 years old. ΔBS was significantly influenced by motor performance at admission (BS: Coef. - 0.708, CI 95% [- 0.743 - - 0.673]; TS: Coef. - 1.697, CI 95% [- 1.849 - - 1.544]), global health conditions (CIRS Severity index: Coef. 4.925, CI 95% [1.037 - 8.814]) and age (Coef. 0.312, CI 95% [0.221 - 0,403]). ΔTS was significantly influenced by the same factors, BS: Coef. - 0.167, CI 95% [- 0.184 - - 0.149]; TS: Coef. - 0.667, CI 95% [- 0.703 - - 0.631]; CIRS Severity index: Coef. 1.254, CI 95% [0.012 - 2.511]; age: Coef. 0.090, CI 95% [0.061 - 0.120]. BMI and haemoglobin did not influence the studied outcomes.

Conclusions

Patients with worse health conditions, advanced age and lower motor performance at admission obtain a higher outcome.

Key messages

• A broader knowledge of rehabilitation influencing factors would provide higher outcomes.

• The diffusion of individual rehabilitation plans would allow the achievement of better results.
Perspectives of clinicians and patients on community-based maintenance care for adults with obesity
Authors: McBride K , Alsultany G , Termaat J , Williams K
Published: October 2022

Background

Tertiary metabolic health services are in high demand as people with severe obesity increase. Once predetermined health goals have been achieved patients must transition to community-based care to urgently free up capacity in tertiary services. Maintenance of successful outcomes achieved via tertiary services is therefore important to limit rates of relapse back to these services.

Methods

This qualitative project explored community-based care needs to help individuals living with obesity maintain health gains. An interview schedule guided one-on-one interviews with patients and staff from metabolic clinics in Sydney, Australia.

Results

We interviewed 22 patients and 13 clinicians. A lack of appropriate and consistent clinical support in the community was identified by patients and clinicians. Most clinicians agreed primary care was key to successful maintenance care. Lack of primary care understanding of appropriate management and support for patients with obesity, lack of bariatric equipment and limited funding for allied health were all seen barriers to appropriate support beyond their clinics. Patients were highly reluctant to transition from tertiary clinics and reluctant to engage with community-based care due to experience of limited clinical/social support and bariatric equipment, demeaning clinical interactions, lack of care coordination and being stigmatised. Support groups outside of the clinic were also identified important in mitigating social isolation and stigma. Both patients and clinicians felt support groups have potential to provide important supplementary help to individuals with obesity outside tertiary settings.

Conclusions

Currently, individuals aiming to maintain their weight are likely to struggle in the context of existing community care provisions. Integrated, community-based and affordable models of care are needed now to allow tertiary metabolic services discharge their patients safely.

Key messages

• Tertiary obesity services are at capacity.

• Subsequent community care for people wth obesity needs to be mote appropriate tp promote weight maintenance.
The COVID – 19 pandemic influence on hospitalizations for ambulatory care-sensitive condition
Authors: Marasovic Šušnjara I
Published: October 2022

Aim

To explore whether the COVID-19 pandemic influenced hospitalizations for ambulatory care-sensitive conditions (ACSCs) during the COVID-19 pandemic in Split-Dalmatia County, Croatia.

Methods

We employed a cross-sectional comparative study using two different time periods, the prepandemic (March 2019 to February 2020) and the pandemic (March 2020 to February 2021) to explore possibilities of COVID-19 pandemic influence on hospitalizations for ambulatory care-sensitive conditions (ACSCs) during the COVID-19 pandemic in Split-Dalmatia County. The research used data from the national information system on hospitalizations from the Clinical Hospital Center Split, University Hospital Split. The ACSCs was classified in the categories of vaccine preventable, chronic and acute disease. The indicators were statistically analysed. The z-score test for two population proportions is used.

Results

During prepandemic (March 2019 to February 2020) there were 48,289 hospitalizations, in the pandemic period (March 2020 to February 2021) there were 37,999 hospitalizations. The ACSCs hospitalizations made 6.4% in the prepandemic and 7.1% in the pandemic period. In the pandemic there was a significantly higher ACSCs hospitalizations compared to the prepandemic (z =-3.9348; p = 0.00008; p < 0), which was supported by a significant increase regarding ACSCs hospitalizations in the category of acute diseases, among women (z=-3.6614; p = 0.00026; p < 0 .05), in age groups 0-19 years (z=-4.0492; p < 0.00001; p < 0.05) and 20-64 years (z= -3.8818; p = 0 .0001; p < 0.05).

Conclusions

The results of the study show that the COVID-19 pandemic contributed to the total number of hospitalizations as well as the hospitalization of the ACSC. One of the reasons for these changes was certainly the changed organization of the work of the entire health system due to the COVID-19 pandemic.

Key messages

• The results of the study show that the COVID-19 pandemic contributed to the total number of hospitalizations as well as the hospitalization of the ACSC.

• One of the reasons for these changes was certainly the changed organization of the work of the entire health system due to the COVID-19 pandemic.
Hospital discharge for stroke patients: Transitional Care is Brain
Authors: Sgueglia AC , Zeduri M , Rissone M , Bertuccio P , Cavallini A , Martignoni A , Muzzi A , Cutti S , Ambrosio AG , Odone A
Published: October 2022

Background

Among cerebrovascular disease, stroke is a life-threatening neurological event and a main cause of serious long-term disability, with relevant healthcare and economic burden. Treatment of stroke is time dependent and organised integrated stroke care enables quick and effective responses to reduce stroke-related death and disability. This study aimed at evaluating the amount of hospital discharge to transitional care facilities for stroke patients to support integrated care models in the city of Pavia (Italy).

Methods

In 2017 in Pavia, Fondazione IRCCS Policlinico San Matteo started a partnership with Fondazione Mondino to build a specific stroke pathway, becoming a leading centre for stroke treatment. We conducted a retrospective chart review (RCR) of patient-centred data to quantify the volume of discharge for stroke patients. Two trained public health residents reviewed medical records with stroke admission diagnosis during 2021, analysing onset (e.g., Emergency Room, other hospital, emergency network), ward, treatment and discharge types (e.g., home, death, transitional care facility).

Results

Our RCR found 669 patients with a stroke diagnosis treated at San Matteo hospital in 2021, the vast majority of which were admitted to the neurology ward (375 patients, 56%). The recanalization rate was 32% (150 on 464 ischemic stroke patients). Regarding the discharge type, 299 patients (45%) were sent home, while 297 patients (44%) needed transfer to rehabilitation or long-term care facilities. About 8% (52 patients) of the overall sample died in hospital.

Conclusions

Our analysis showed that, while most stroke patients were discharged and sent home, more than two-third need to be transferred to continue to get the right healthcare from the right professional. Transitional care facilities should receive the greatest consideration by systems and providers seeking to implement care models to reduce residual neurological disabilities for stroke patients.

Key messages

• A fast and accessible emergency chain is essential to reduce residual neurological disabilities and the related healthcare and economic burden in stroke patients.

• Extending the stroke path model to other time-dependent diseases is increasingly high-priority to shape a strong and resilient healthcare system, ensuring qualified health coverage.
Can the virtual reality intervention VR FestLab improve Danish studentś alcohol competences?
Authors: Guldager J , Kjær SL , Grittner U , Stock C
Published: October 2022

Background

VR FestLab is a newly developed simulated “party” where the player is being offered alcoholic beverages while steering their own party experience in virtual reality. We evaluated the efficacy of VR FestLab on drinking refusal self-efficacy of Danish male and female 15-18-year-old students and tested user satisfaction. Secondary outcomes were drug refusal skills, knowledge/awareness, communication skills, social support willingness, susceptibility to peer pressures, and outcome expectations.

Methods

The intervention consisted of 15 minutes of gameplay and 30 minutes of group/in class discussion. The intervention group played VR FestLab where the control group played the VR game “Oculus Quest - First Steps” (no educational content). In a cluster-randomised controlled trial schools were randomly assigned to the intervention/control group. 13 Danish schools were recruited containing 181 students in intervention/191 in control groups. Students completed a questionnaire before and immediately after the intervention. Data was analysed using mixed linear regression models.

Results

50% of students found VR FestLab to be realistic, 57% would like to explore it further, and 43% would recommend it to friends. We found a small, but non-significant effect on drinking refusal self-efficacy favoring the intervention. No differences between the intervention and control group were observed for the secondary outcomes.

Conclusions

VR FestLab should be used with higher frequency than in this trial and in combination with other evidence-based alcohol prevention interventions adolescents. Further research is needed to improve the effectiveness of VR FestLab.

Key messages

• VR FestLab could be a valuable contribution to school-based alcohol prevention education but cannot stand alone.

• Future research should focus on the dose-effect relationship of the novel tool.
Assessing perceived and functional health literacy among Cypriot parents
Authors: Menikou I , Middleton N , Papastavrou E , Nicolaou C
Published: October 2022

Background

Health literacy (HL) refers to people’s competencies in accessing, understanding, assessing and applying health information to meet demands in healthcare, preventing illness and promoting health. In the case of children, parental HL is important in establishing health-promoting behaviours and better health outcomes.

Methods

A cross-sectional study was conducted among parents of children, aged 6 months to 15 years, in Cyprus with the aim of assessing perceived and functional HL. A convenience sample of parents presenting in pediatric outpatient departments in three Cypriot cities rated their HL using the HLS-EU-Q47 and the NVS (Newest Vital Sign), a performance-based measure of HL. Participants were classified according to the overall and domain-specific scores and associations with socio-demographics were explored.

Results

HLS-EU-Q47 mean score among 416 parents (83.2% female, 83.8% tertiary education) was 35.30 (SD = 7.45). Based on suggested ranges, almost half (42.6%) were classified as having inadequate or problematic HL. Consistently, 62.8% showed high likelihood or significant possibility of limited functional HL, based on the NVS with a mean score of 2.73 (SD = 2.02). Competency of understanding health information was rated higher (37.71, SD = 7.39), whereas assessing health information was rated lower (33.55, SD = 9.05). Among the three domains of the HLS-EU-Q47, the highest mean score was for healthcare (36.16, SD = 7.04) and the lowest score for health promotion (34.60, SD = 8.88). Parental HL was statistically significantly associated with education and financial difficulties.

Conclusions

Moderate-to-low levels of perceived HL appear consistent with a performance-based measure of HL. As a high number of parents may face challenges in assessing and applying health information to improve outcomes for their children, healthcare services should be oriented towards identifying problematic HL, while Public Health interventions are needed to enhance parental HL.

Key messages

• According to both a perceived and a performance-based measure of health literacy, the study suggests that a high proportion of parents in Cyprus may have inadequate or problematic health literacy.

• Health education interventions within clinical settings as well as at Public Health level are needed to enhance parental health literacy, currently not standard practice.
Promoting health literacy during Covid-19 pandemic–valuable partnership with Portuguese pharmacists
Authors: Malcata F , Raposo B , Costa D , de Arriaga MT
Published: October 2022

Issue/Problem

COVID-19 pandemic has amplified the amount of health information available; however, hard-to-reach populations remain and much of the information available is not accurate. Therefore, the use of new proximity approaches in the promotion of health literacy is essential because people face challenges and barriers when trying to find information relevant to them.

Description of the problem

From the beginning of the COVID-19 pandemic in 2020, the Division of Literacy, Health and Wellbeing of the Directorate-General of Health in Portugal developed Social Mobilization and Community Engagement training sessions-which included a presentation and a toolkit of flyers/posters/videos. These sessions had the goal of disseminating public health measures through good practices in health literacy and communication methods/skills to promote efficient communication among people who play an active role (as microinfluencers) in prevention and mitigation of risks associated with COVID-19, as is the case of pharmacists.

Results

A total of 200 Portuguese pharmacists enrolled on the Social mobilization training session in November 2021. More than 150 initiatives were implemented thereafter by those microinfluencers (pharmacists) in the local communities-31% directed to children or young people, 31% to older adults, and 13.8% to migrants or tourists. 70% of the participants considered the materials of the toolkit as adequate and sufficient, and 62.1% answered that people in the community showed interest for those materials available in the pharmacies.

Lessons

This Social mobilization project was important because it assembled and preserved trust- basing the information of the training on reliable sources about COVID-19 virus. It also trained the microinfluencers (pharmacists) in communication strategies. All these approaches were important to prevent and mitigate the impact of COVID-19 via adoption of non-pharmacological measures and promotion of vaccination.

Key messages

• Portugal was pioneer in promoting Social mobilization and community engagement training sessions, maintaining a proximity communication, tailoring the information, and maximizing its impact.

• Within the group of health professionals, pharmacists are a privileged group to promote these communication strategies and social mobilization due to their proximity with the local community.
Measuring the burden of infodemics on health outcomes through harmonized global metrics
Authors: Ishizumi A , Dunn AG , Purnat T , Yau B , Bertrand-Ferrandis C , White B , Briand S , Nguyen T
Published: October 2022

Issue/problem

Infodemics happen when an excess of information makes it difficult for people to discern what they see and hear to make good health decisions. Several challenges limit the usefulness of applying infodemiology research to the practice of managing infodemics including inconsistency in how information exposure is measured and a lack of focus on assessing associations with health behaviors.

Description of the problem

In 2021, WHO partnered with the University of Sydney to develop a study toolkit. We sought to create novel tools for measuring information exposure that can be easily deployed, linked to surveys measuring health behaviors, and implements a standardized study protocol so that data can be directly synthesized into a global analysis of information risk factors associated with health behaviors.

Results

A web-based study platform was developed, comprising tools for capturing information exposures within studies that link to health behavior surveys. The first tool is a smartphone application that asks users to actively record relevant information they see or hear in diary. The second application is a web browser plugin that passively tracks webpages with relevant keywords. Because localized studies follow a standardized protocol and de-identified participant data are recorded in a common format, local study investigators can opt-in to contributing study data to support global surveillance efforts.

Lessons

Through standardization of measurement tools and relevant study protocols, the toolkit can be used to quickly collect and synthesize data for global or regional analysis of infodemics, including in Europe. Validation of the toolkit in the field is needed to inform its open-source release.

Key messages

• A toolkit for measuring information risk factors associated with behavioral outcomes was developed.

• Global collaboration using the toolkit can improve synthesisability of studies investigating infodemic burden of disease.
Health literacy among older adults 77+ in Sweden
Authors: Wångdahl J , Agerholm J , Liljas A , Heap J , Lennartsson C
Published: October 2022

Background

Health literacy (HL) is an essential component of an individual’s ability to gain access to, understand and use information to improve and maintain good health and is an important prerequisite for managing health and care needs. Therefore, knowledge on older people’s HL is vital to meet the care needs of the rapidly aging population efficiently and equitably. Knowledge on HL in the older population is limited, both in an international perspective and in Sweden. Challenges linked to limited HL are expected to increase with advanced age, emphasizing the importance of conducting a study using a nationally representative sample of older adults. The aim of the study was to explore the level of HL in older adults living in Sweden.

Methods

A cross sectional study using data from the Swedish Panel Study of Living Conditions of the Oldest Old (SWEOLD), which is a nationally representative sample of the Swedish population aged 77+ years (N = 1500). SWEOLD covers areas such as health, socioeconomic and social factors. HL is assessed with the communicative and critical health literacy scale. The data was collected through telephone interviews in fall 2021 and spring 2022. Respondents not able to answer themselves were excluded.

Results

Preliminary results show that 49 % of the participating adults aged 77+ have limited HL. HL was significantly associated with age (77-85 years OR: 1.80; 86+ OR: 3.04), education level (OR: 1.76), vision (OR: 2.40) and cognitive ability (OR: 0.88). HL was not significantly associated with sex.

Conclusions

These preliminary results shows that a large proportion of Swedish older people might face difficulties related to accessing, understanding, appraising, and applying health information in ways which promote and maintain good health, and stresses the importance of examining the topic in greater detail.

Key messages

• A high proportion of older adults in Sweden have limited health literacy.

• Health literacy among older adults in Sweden varies with age, level of education, vision and cognitive ability.
Facemasks and Public Health: analysis of bacterial contamination in FFP2 masks
Authors: Papale G , De Palma I , Amodeo D , Messina G
Published: October 2022

Background

Facemasks (FM), due to the Covid-19 pandemic, are extensively used and often worn beyond the recommended time. This has led to questions about the negative impact persistent contamination on FMs might have on public health. The study aims to assess the level of contamination reached in a small cohort of subjects after the recommended use (8 h) of FM.

Methods

This descriptive study was carried out between January and April 2022 on 17 people: 9 women and 8 men aged between 25-45 years. These two groups were divided into two micro-groups: women were selected according to their skincare habits (no skincare and skincare with cosmetics). In contrast, men were selected according to the length of their beards (thick or short beard). The FM was worn for 8 h in a controlled office setting, to avoid possible uncontrolled variables. Then, the FM was cut, placed in a tube with a recovery medium and centrifuged. The supernatant was removed and the pellet resuspended. Aliquots were plated on Petri plates and incubated for 48 h at 36 °C to count the Colony Forming Units (CFU). The statistical analysis was conducted using Stata software, performing the Wilcoxon matched-pairs and setting a significance level of p < 0.05.

Results

Women had higher FM contamination than men (= 4960 vs 3130 CFU/ml). Also, we found more colonies (= 18890 vs 3420 CFU/ml) in the FMs of women without skincare (p = 0.06), while among men, more colonies were reported for those with a thicker beard than for those with a shorter one (= 3300 vs 2960 CFU/ml).

Conclusions

Extensive FM use increases bacterial contamination exponentially. This could lead to changes in the facial microbiome, inducing skin conditions (such as allergic dermatitis and acne). Facial skin conditions are important public health issues for people wearing FMs daily. In addition, responsible handling of this equipment is essential to avoid the spread of SARS-CoV-2 through contact with these items, which can persist for many days.

Key messages

• Gender and physical characteristics may influence the level of contamination present on FFP2 face masks.

• There is a need to increase community awareness on the proper handling of facemasks, prevent health problems for users, and limit the spread of infection to those around them.
Digital Health Literacy during COVID-19: gender differences from a Florentine University experience
Authors: Guida A , Morittu C , Gallinoro V , Ferro Allodola V , Okan O , Dadaczynski K , Lorini C , Lastrucci V , Bonaccorsi G
Published: October 2022

Gender appears to be a strong predictor of online health information-seeking behaviour (OHISB). Gender differences in OHISB have been studied in different countries with different results, but no studies investigated gender-specific behaviour among University students during the COVID-19 pandemic, which has brought with it a consequential infodemic. We sought to investigate any gender differences in OHISB in the period between the first and the second wave of the COVID-19 pandemic. A questionnaire promoted by the COVID-HL network was administered to 2996 students of all the courses at the University of Florence. It included existing validated scales adapted to the COVID-19 pandemic and newly developed scales. Gender differences were tested using the χ2 test or the Mann-Whitney U test, where appropriate. Male students reported a higher score in DHL than females (p < 0.001). However, female students reported using more often different sources for online information seeking (p < 0.05, except for YouTube), searching more corona-related topics (p < 0.05, except for economic and social consequences) and considering ‘‘very important'’ each item in the ‘‘Importance of internet information search'’ section (p < 0.05). Furthermore, female students are more likely to be ‘‘often dissatisfied'’ or ‘‘partly satisfied'’ with information about COVID-19 (p < 0.001) and to search more often for information for themselves and other people. Our study confirmed that gender could affect the way students search for health information on the Internet. Since students, in particular females, have been affected by stress and anxiety during the pandemic, these findings could help institutions to promote gender-specific education programmes to improve students’ DHL and their mental health outcomes, as well as to provide health information that fit specific gender needs.

Key messages

• Gender influences how university students search on the Internet for health information.

• This should guide institutions to better address educational programmes to improve their Digital Health Literacy.