bluuebunny/crossref_metadata_2025 huggingface dataset:
Effectiveness of e-cigarettes in smoking cessation: a systematic review and meta-analysis
Authors: Oberndorfer M , Grabovac I , Haider S , Dorner T E
Published: October 2020

Background

Reports of the effectiveness of e-cigarettes (ECs) for smoking cessation vary across different studies making implementation recommendations hard to attain. We performed a systematic review and meta-analysis to synthesise the current evidence regarding the effectiveness of ECs for smoking cessation.

Methods

PubMed, PsycInfo and Embase databases were searched for randomized controlled trials comparing nicotine ECs with non-nicotine ECs or with established smoking cessation interventions (nicotine replacement therapy (NRT) and or counselling) published between 01/01/2014 and 01/05/2019. Data from eligible studies were extracted and used for random-effects meta-analyses.

Results

Our literature review yielded 13190 publications with 10 studies being identified as eligible for systematic review, covering 8362 participants, and 8 for meta-analyses (n = 30 - 6006). Using the last follow-up of eligible studies, the proportion of smokers achieving abstinence was 1.67 [95CI:0.99 - 2.81] times higher in nicotine EC users compared to non-nicotine EC users. The proportion of abstinent smokers was 1.69 [95CI:1.25 - 2.27] times higher in EC users compared to participants receiving NRT. EC users showed a 2.70 [95CI:1.15 - 6.30] times higher proportion of abstinent smokers in comparison to participants solely receiving counselling.

Conclusions

Our analysis showed modest effects of nicotine-ECs compared to non-nicotine ECs. When compared to NRT or counselling, results suggest that nicotine EC may be more effective for smoking cessation. As ECs also help maintaining routinized behaviour and social aspects of smoking, we hypothesise that this may explain their advantage as a tool for smoking cessation. However, given the small number of included studies, different populations, heterogeneous designs, and the overall moderate to low quality of evidence, it is not possible to offer clear recommendations. More comparable data is needed to strengthen confidence in the quality of evidence.

Key messages

The number of previous studies assessing the effectiveness of ECs for smoking cessation is limited. Further, comparability of these studies is restricted, weakening the quality of evidence. Although current evidence on the effectiveness of ECs for smoking cessation is inconclusive, our meta-analyses suggest that ECs could be a promising alternative tool in attempts to achieve abstinence.
Meaningful patient and public involvement to advance healthcare equity, quality and accessibility
Authors: Warner G , Lampa E , Tökés A , Osman F , Sarkadi A
Published: October 2020

Background

A large part of public health is promoting healthcare equity, quality and accessibility. Patient and public involvement (PPI) is a powerful tool to support this goal. It can lead to a richer understanding of public health research topics, improve data quality and analysis, increase trust in and dissemination of research findings, and ultimately achieve health services that are useful, useable and desirable. However, this all relies on PPI being conducted in a meaningful, respectful and inclusive way. Guidance is available on how to conduct, report and evaluate PPI activities. However, evaluative data are often brief, narrative descriptions, which reflects the lack of robust tools specifically developed to assess PPI. The purpose of this study was to develop and pilot tools to objectively assess PPI in the context of research project meetings.

Methods

PPI and group dynamics literature was used to guide the construction of an observation protocol and questionnaire. The research tools were piloted within a randomised trial of a community intervention for refugee children reporting symptoms of posttraumatic stress.

Results

The Active Involvement of Users in Research Observation Schedule is a semi-structured observation protocol, which consists of 12 observable behaviours relating to the interpersonal relations between researchers and PPI advisors; the nature of advisor contributions; and how the advisors guide research development. Each category consists of positive and negative behaviours. There is an accompanying paper-based assessment form that allows attendees to independently and anonymously grade the meeting on a list of items that correspond to those on the observation pro-forma. Preliminary inter-rater reliability for the observation protocol is good (ICC=0.833; 95% CI: 0.569-0.947).

Conclusions

Although the research tools require further refinement and validation, the methodological approach offers a promising, rigorous way to evaluate PPI.

Key messages

A large part of public health is promoting healthcare equity, quality and accessibility. Patient and public involvement (PPI) is a powerful tool to support this goal. The Active Involvement of Users in Research Observation Schedule and Questionnaire offer a promising, rigorous way to evaluate PPI and promote meaningful involvement to advance public health research.
Sustainable public health partnerships: Results from 41 European, Asian and American regions
Authors: Ese J , Ihlebak C
Published: October 2020

Background

Public health problems often constitute so called “wicked problems”, and the importance of involving multiple stakeholders in order to address such problems is acknowledged, for instance through the SDG17 guidelines. Partnerships between academia and the public sector have been deemed especially promising. However, sustainable partnerships might be difficult due to divergent understandings and interests. Although there is a substantial research literature on academic-public partnerships in general, partnerships addressing public health specifically are less investigated. The aim of the project was therefore to identify enablers for sustainable public health partnerships between academia and the public sector.

Methods

A mixed methods design was used. A survey regarding partnerships was sent to 41 European, Asian and American regions, with a response rate of 72 %. Based on survey data, an interview guide was developed and four best cases (Canada, Bulgaria, the Netherlands and Norway) were identified. Site visits and group interviews with representatives from stakeholders of the partnerships were conducted. Interview data and answers to open ended questions from questionnaires were analysed.

Results

Three main findings became apparent through the analysis. Important enablers were: 1) person-to-person fit between individuals, 2) national incentive schemes for collaboration, and 3) formal partnership agreements that provided a framework that allowed for manoeuvring. The enablers identified are on a macro, miso and micro level. Furthermore, they can be categorised as political, organisational, and social.

Conclusions

The data support the notion that partnerships are complex social structures that need to be initiated and managed on different levels and with different measures. At the same time, data demonstrate that across different geographical, political, and social contexts the same enablers are reappearing as important for sustaining public health partnerships.

Key messages

Similar enablers for sustaining public health partnerships are found across geographical, political, and social contexts. Important enablers for partnerships are person-to-person fit, national incentive schemes, and formal agreements.
Corporations in global health: an investigation of food industry political activity at the WHO
Authors: Lauber K , Rutter H , McGee D , Gilmore A B
Published: October 2020

Background

With over ten million annual deaths now attributable to unhealthy diets, there is an urgent need for action, yet, political progress is too slow. Policy interference by major corporations is well documented in the area of tobacco control. Evidence shows similar behaviours by the food industry at country level, but global-level policymaking remains under-researched. Thus, this study explores how food industry actors seek to influence dietary non-communicable disease (NCD) policy at the World Health Organization (WHO).

Methods

We identified relevant industry documents from the Food Industry Documents Library and academic articles, using these initial findings and an existing model of corporate political activity as the basis for sixteen key informant interviews. Key industry strategies were identified in an iterative process of qualitative thematic coding. Additionally, food industry responses to five WHO consultations on NCD policy and governance (2015-2018) were analysed to explore how evidence was used.

Results

Food industry actors have substantial access to the WHO through formal routes. These interactions largely take place through business associations rather than individual companies, owing at least partly to the agency's own guidelines. Food industry actors can also access global-level policymaking indirectly, for example, by lobbying national political actors to adopt favourable positions in member state-led WHO decision-making, or by co-opting civil society. In consultation responses, the majority of evidence cited by commercial actors was either industry-linked or industry-funded, and less than half was peer-reviewed.

Conclusions

Focusing on the WHO's NCD agenda, we provide new insights into the ways food industry actors seek to influence global public health policy. Although their political behaviour bears similarities with that of the tobacco industry, multinational food companies are, in contrast, widely treated as part of the solution.

Key messages

By mapping how food industry actors seek to shape WHO policy, this research adds to evidence from national contexts and highlights a need for better safeguards across levels of governance. While the tobacco industry is prohibited from engagement with global NCD policy, multinational food corporations enjoy significant access and legitimacy, despite similarities in political behaviour.
The relevance of an experienced computerized procedure regarding asbestos remediation
Authors: Chellini E , Angelini A
Published: October 2020

Problem

Asbestos removal is very complex and bureaucratically demanding activity according to the Italian asbestos ban law 257/92. Each remediation of Asbestos Containing Materials requires the drafting of a Work Plan containing generic and specific information that entails an administrative commitment and correspondence between companies and Health and Safety Units of the public Regional Health System. Same problems are encountered for the annual report to be sent to the Regional Health System according to the article 9 of the cited law.

Description of the Problem

The Tuscan Health System developed a computerized procedure that allows direct contact between companies and Health and Safety Units, and at the same time a better monitoring of the entire remediation process without producing documentation on paper.

Results

After one year experimentation involving 50 companies, the procedure underwent a regional regulatory provision. From year 2016 the procedure went to operation and companies had to upload all data on the regional web site. To date 590 companies used it registering 113749 Work Plans on remediation works. The procedure allows to compile automatically the annual report summarizing the work done during the previous year: approximately 250 reports arrive per year. The procedure is now slowly spreading over the national territory.

Lessons

Through a computerized procedure, companies and Health and Safety Units are facilitated in carrying out Asbestos Containing Material remediation works in complete safety for workers and environment, as well as savings time and costs. It could be used in other countries considering that the asbestos remediation is widespread throughout Europe and beyond.

Key messages

The computerized procedure guarantees great economic savings for companies and the Health and Safety Units. It allows a control of the remediation process, countering illegal activities on these wastes.
Rethinking policies and possibilities of sustainable solid waste management system of Dhaka City
Authors: Jerin D , Sara H , Hasan T , Quayyum Z
Published: October 2020

Issues

Solid waste management is one of the biggest concerns in Bangladesh, particularly in Dhaka city at present. This paper aims to find the gaps and challenges in solid waste management policies and implementations and thus, gives an insight towards sustainable solid waste management system in the country.

Description of the Problem

Improper solid waste management is adversely impacting environmental protection, public health and the control of carbon emissions in Bangladesh. As a result solid waste has become a major area of public policy with growing concern.

Lessons

Bangladesh has been experiencing changes in solid waste management since 1983 with the introduction of Dhaka City Corporation Ordinance and later the promulgation of National 3R Policy in 2010. With few exceptions, the overall waste management system cannot be termed as an efficient sequential process of waste minimization, recycling, and disposal based on global standards. Many initiatives are being implemented as part of independent projects by the non-governmental organizations (NGOs) and not always supported by policies. Though the establishment of several secondary transfer stations (STSs) has improved the environmental conditions and cleanliness of the cities, the waste segregation and recycling practices in the pathways from households to landfill do not adhere to the 3R Policy. Both the recyclable and non-recyclable waste are collected and dumped all together at different levels of waste management, i.e. collection from households, dumping at STSs, and later in the landfill without any formal procedures of sorting and recycling. Lack of coordination between implementing agencies is another problem.

Conclusions

Absence of sustainable solid waste management policy and proper execution agency are the main obstacles towards a proper waste management system. This problem is huge and should be addressed immediately to protect the environment and ensure better health of the city population.

Key messages

Even though the formation of STSs is one of the significant changes in the system nowadays, it is not evaluated or monitored under any specific policy or ordinance. In order to implement the existing policies, adequate funding and monitoring bodies should be introduced to the waste management sector.
Decentralization Process in Portugal: impact in the health care system
Authors: Sequeira R , Quinaz Romana G , Campos Fernandes A , Pinho M , Freire Rodrigues E , Isoppo C , Sousa P
Published: October 2020

Problem

Different countries have incorporated models of decentralization in their health reforms to achieve efficiency, by increasing the training of local governments, responsibility and gains in areas such as quality, costs and equity. In Portugal, the 21st government program established the autonomy of local authorities and the democratic decentralization of public administration. Accordingly, a decentralization law was approved and local governments have now a crucial role on health policies.

Description of the Problem

For this framework, a situational diagnosis and an intersectoral approach to policies are needed. This is an observational, analytical and cross-sectional study developed at council level in two Portuguese municipalities. This study aims to: Adjust responses to health needs at the local level; Set priorities by taking into account installed capacity and responses to populations; Promote the articulation between entities; Strengthen the focus on health promotion and healthy lifestyles; Strengthen health interventions in educational communities; Promote the creation of programs at local level, in conjunction with the national level, to reduce inequalities.

Results

The preliminary results in health, social and economic indicators show that this framework, while taking in consideration population characteristics, allows the development of local strategies regarding health services coverage, health services type and medication. At council level, the preliminary results also show a lack of data on healthy lifestyles and social indicators.

Lessons

The implementation of a decentralization process involves a broad range of requirements such as a situational diagnosis, strategies development and a periodic update of quality life and health indicators. Those are needed to assess council level priorities, which allow the development of public policies and interventions, in line with population characteristics, to tackle health inequalities and inequities.

Key messages

Performance improvement of health system is linked to the implementation of local citizen centred policies. These are actions which promote quality of life through health-friendly ecosystems. The local health intervention has contributed to promote inequalities reduction, increasing equity and dynamize new frameworks of organization with individual and community participation.
Policy implementation evaluation: a stakeholder-centred approach
Authors: Scheller D , Wendt J , Müller-Stierlin A , Flechtner-Mors M , Steinacker J M
Published: October 2020

Work Package 4, Policy Evaluation Network, JPI “A Healthy Diet for a Healthy Life”, Germany
Analysis of the political process of Denmark’s hospital reform
Authors: Reichebner C , Berger E , Eriksen A
Published: October 2020

Background

The German hospital landscape is characterized by a decentralization of the range of services provided, low levels of specialization and significant overcapacity. This leads to over-, under- and misuse of hospital care, which is not least evidenced by wide variation in quality in the system. In Denmark, since the early 2000s, a continuous restructuring of the hospital landscape has been undertaken. Among other things, hospitals have been rebuilt, many smaller hospitals have closed and the number of emergency rooms has been halved. The aim of the project K:IDD (Hospital: Impulses for Germany from Denmark) is to examine the conditions that have to be created to be able to incorporate parts of the Danish reform into German hospital care, and to leverage these for improved patient care. To learn from the case of Denmark, it is important to understand which circumstances facilitated the reform.

Methods

To analyse the political process behind Denmark's hospital reform using two different sources will be used: (1) A qualitative content analysis of 17 semi-structured expert interviews with political scientists, journalists, politicians, among others and (2) an analysis of the literature about the reform. Kingdon's (1994) multiple stream framework as well as Tsebelis' (1995) Veto-player theory will be used.

Results

The key success factors encouraging to the reform will be presented. In addition potential Veto-Players and institutional settings enabling or hindering the reform will be described. The final assessment of the policy process and comparison to the German context will lead to implementation guidance and recommendations for the German context. Further, alternative courses of action will be presented.

Conclusions

The findings from this analysis can provide important and practical recommendations for the necessary reform of the hospital landscape in Germany, thereby improving hospital care in the long term.

Key messages

The hospital reform in Denmark was possible due to the interaction of different social currents, which ultimately opened a window of opportunity. This could be used as role model for decision-makers, professionals and researchers strive for change in other countries.
Rethinking MS in Europe: Prioritizing integrated services for people with multiple sclerosis
Authors: Battaglia M A , Pugliatti M , Soelberg Sørensen P , Tiu C , Carrascal P , Quoidbach V
Published: October 2020

Background

Multiple sclerosis (MS) is a chronic disease of the central nervous system. Over 750,000 people are affected across Europe. The European Brain Council initiated in 2018 a project RETHINKING MS, calling for change in MS care.

Methods

The research framework included desk research data mapping and expert interviews. A series of clinical and patient-oriented benchmarks along the care process were developed. Data were analysed in collaboration with experts from across Europe to build an interdisciplinary consensus around practical and sustainable policy responses to MS in Europe.

Results

Results indicate that a timely diagnosis is important to enable a prompt initiation of specific drugs and symptomatic treatment which, in turn, can prevent potentially irreversible disability. Care must be individualised to each person and their specific symptoms and needs. Regular monitoring is key to personalise care and provide adequate support but there are often delays to diagnosis and limitations to treatment personalisation due to inadequate access to diagnostic facilities and MS specialists. Access to therapies can also be extremely challenging. The interdisciplinary approach is essential; disease management includes aspects of lifestyle modification, as many 'brain healthy' lifestyle factors may delay progression and relapses. Finally, social care can greatly improve quality of life for people with MS, social workers and occupational therapists can also support people with MS in their professional and daily lives.

Conclusions

Conclusions link timely diagnosis and coordinated care, long-term adaptable support to better quality of life. Primary prevention modification of lifestyle factors

Key messages

Policies for multiple sclerosis in Europe have to be changed. Primary and secondary prevention are possible.
Renewing primary care: the bottom-up experience of an Italian health professional movement
Authors: Sessa G , Milani C , Occhini G , Marini G , Sarro A
Published: October 2020

Sustainability of the National Health Systems (NHS) has been facing different challenges. A community-oriented Comprehensive Primary Health Care (CommOr C-PHC) could help its survival. Such a framework, focused on health promotion, primary prevention, not communicable disease management, requires new capabilities among health professionals. Considering teamwork and interprofessional collaboration (IPC) as PHC core elements, there is growing recognition of the need of interprofessional education (IPE). Nevertheless, italian medical education is distant from other disciplines and mainly based on hospital care settings. Since this situation represents an obstacle to implement a CommOr C-PHC model of health service, new ways of training students and retraining actual health workers should be developed.

The aim of the project is to design IPE programs and to improve IPC within the C-PHC framework, shared learning environments placed in the community were developed.

At the end of 2017 a group of young italian health professionals (public health resident, young general practitioner, social assistant, nurse, medical anthropologist, etc) founded the Campaign “2018 Primary Health care: Now or never”, a cultural movement of public health advocacy. Its goals are: The creation of a common cultural background through the study of PHC evidence and best italian and international practices. Organization of workshops all over Italy: peer education training session, site-visits, lectures with Italian and foreigner health professionals, based on need assessment methods.

Individuation of learning environments placed in the community and in a primary care setting where students can apprehend social determinants of health, exercise critical thinking and develop transprofessional knowledge.

Key messages

Young health professionals from Italy, starting from the need for a different educational framework, based on IPE, created a movement to defend the NHS and promote PHC principles. The success and large participation of a national campaign sustaining PHC and aimed at promoting interprofessional education shows the need for a change in the medical education field.
Liquid biopsy in lung cancer: tertiary prevention potential
Authors: Rubba F , Pepe F , Martello R , Egidio R , De Pascale T , Loperto I , Iervolino A , Malapelle U , Triassi M , Troncone G
Published: October 2020

Background

In the era of personalized therapy liquid biopsy is considered an important diagnostic tool in the clinical management of cancer patients. Tissue specimen represents “gold standard” for molecular evaluation of specific gene targets alterations that lead cancer patients to benefit of a “tailed therapy” based on molecular features of the tumor. This innovative source of nucleic acids was introduced in clinical setting only for NSCLC patients to test Epidermal Grow Factor Receptor (EGFR) mutations when tissue is not available or to monitor acquired resistance mutation after a first line of treatment. The study aimed at assessing the diagnostic potential of liquid biopsy in balanced tertiary screening modeling.

Methods

The cases relating to 5 years of activity regarding to molecular diagnostics performed on liquid biopsy specimens in the Predictive Diagnostic laboratory of AOU Federico II were reviewed. Laboratory data were collected in SPSS. Non parametric analysis were performed in order to test the differences between patients WILD TYPE or not. A multivariate logistic model was performed in order to assess the effect of mutation, age and sex, on the tumor progression. The results of the revision concern 515 total cases (almost of all plasma or peripheral blood) allowed to evaluate the liquid biopsies for women and men. The average age of the Patients is 66.3 years, and the 25 percentile is 59 years.

Results

The cases are 221 basal and 294 by progression. The cases with mutation, as expected, have an OR 4,15 compared to the basal to have a tumor progression (95% IC: 2,7 - 6,3) regardless of sex and age. The mutations detected were 131 from different types of pulmonary carcinomas.

Conclusions

Working on case data, specifying the characteristics of the Patients with mutations will drive a further estimate in tertiary prevention screening designs.

Key messages

In the last five years, the liquid biopsy has been used for different purposes in oncology. To specify the characteristics of the Patients with mutations will drive a further estimate in tertiary prevention screening designs.
Cryptosporidium oocysts: are they still a risk for human population? A case study in Italy
Authors: Pignata C , Bonetta S i , Bonetta S a , Cacciò S M , Sannella A R , Gilli G , Carraro E
Published: October 2020

Over the past decade, several outbreaks of cryptosporidiosis have been reported in many EU countries in association with the consumption of contaminated drinking water, recreational waters, food consumption and contact with animals. The aim of this study was to evaluate the occurrence of Cryptosporidium oocysts in a drinking water treatment plant (DWTP) located in a rural area of northern Italy. Influent and effluent samples at the DWTP, together with tap water samples from a public fountain were collected for three years (2013-2016). All samples were analysed for the presence of Cryptosporidium spp. oocysts by the EPA Method 1623 based on immunomagnetic separation (IMS)/immunofluorescence assay (IFA), complemented by 4,6-diamidino-2-phenylindole (DAPI) staining. The detection has been implemented with a reverse transcriptase-PCR (RT-PCR) protocol to evaluate the oocyst viability. The results highlighted a high variability of oocyst concentrations in all samples (mean 4.3 - 5.8/100 L) and a high percentage variability of the DAPI-positive specimens (mean 48.2% - 40.3%). Conversely, RT-PCR did not reveal the presence of any viable C. parvum and C. hominis oocysts. A nested PCR targeting Cryptosporidium 18S ribosomal DNA was carried out in two water samples to deepen the understanding of the obtained results. This test revealed the presence of a particular Cryptosporidium genotype associated with wild animals in the river and in tap water. Although the recovered Cryptosporidium genotype is not a human pathogen, its presence demonstrates the existence of a potential pathogen Cryptosporidium spp. contamination risk. Moreover, these results underline the importance of considering unconventional (not bacterial) biological contaminations (protozoa) in water resources in rural areas, including those of developed countries.

Key messages

The supply source and the drinking water treatment plant examined represent a classic example of a system that requires continuous monitoring to guarantee population health. Cryptosporidium oocysts may still be a Public Health problem even in industrialized countries, especially in rural and mountain areas.
Assessing the implementation of population based cervical cancer screening in Amadora, Portugal
Authors: Leite A , Pereira S , Vaz D , Smet T , Portilheiro C , Calé E , Morgado P
Published: October 2020

Background

Population-based cervical cancer screening (CCS) are deemed to be more cost-effective than opportunistic screening and to reduce inequalities. Implementation in Portugal has been heterogeneous, at the regional level. In Amadora healthcare cluster (Lisbon area), implementation started in April 2018 in a pilot unit and was scaled-up. We aimed to assess population-based CCS implementation in Amadora.

Methods

Population-based CCS targets women aged 30-65, and utilises liquid-based cytology with partial HPV genotyping (HPV16/18 and other high-risk HPV - hrHPV). Samples positive for other hrHPV undergo a cytology. HPV16/18+ and other hrHPV+ with ≥ASCUS (atypical squamous cells of undetermined significance) are referred to colposcopy. We assessed implementation according to key indicators extracted from our information system: geographic coverage, number of tests, positive results, positive predictive value of referral (number of cervical intraepithelial neoplasia-CIN/number colposcopies).

Results

As of 30 August 2019, CCS were in place in 4 of the 9 units, potentially covering 20904 women (48.4% of the target population). 1797 womem performed screening within the programme. Invitation for screening is currently implemented in 1 of the 4 units. Screening results were available for 1702 women, 11,1% were HPV+. From these, 26,5% were HPV 16/18+ and 86.2% positive for other hrHPV. Among the latter, 63.2% were negative for intraepithelial lesion and 36.8% were ≥ASCUS. Overall, of these 189 women, 51.3% (n = 97) were referred for colposcopy. Colposcopy results were available for 37 women, of which 13 had a CIN. PPV of referral was 35.1% (95%confidence interval: 20.7;52.6).

Conclusions

Despite being a population-based screening most tests are still opportunistic. There is still a limited number of colposcopies results but the current PPV of referral is low and requires further investigation. Implementation towards a full population-based screening in Amadora should continue.

Key messages

Implementation of a population-based cervical cancer screening in Amadora, Portugal is underway but most screening tests are still applied in an opportunistic manner. A limited number of results is avaliable to estimate positive predictive value of referral to colposcopy. Results available indicate a value of 35.1%, which requires further investigation.
Tobacco industry tactics in response to extensive tobacco control legislation in Israel
Authors: Bar-Zeev Y , Berg C , Kislev S , Geva H , Godinger E , Abroms L , Levine H
Published: October 2020

Issue

Tobacco control in Israel has been lagging, and smoking rates have remained stable in the last decade (∼20%). In 2018, landmark legislation was passed to go into effect during 2019- 2020. The tobacco and vaping industry employed several tactics to circumvent and test the ability to enforce the new legislation. Examining industry responses to legislative reform in Israel may inform policy and enforcement internationally.

Description of the Problem

Resulting from strong political will, supportive media, and a strong coalition of tobacco control advocates, the legislation involves: 1) advertising bans in all media, excluding print press; 2) point-of-sales display bans; 3) plain packaging with textual health warning labels; and 4) extending the legislation to include also vaping products. Industry tactics to circumvent/test this legislation were communicated through an active social media group of tobacco control coalition members who shared information regarding such tactics in all geographical areas in Israel and via different media outlets.

Results

Various measures employed by the industry included, for example, print media advertisements with branded elements in the background (prohibited by law); new signs and display boxes for heated tobacco products and e-cigarettes, at the point-of-sale, that say “An alternative to cigarettes”; distributing branded tin cases for cigarettes; Highlighting different brands online and in print media using colors and fonts that are not allowed as part of plain packaging, and including branded elements inside the cigarette package

Lessons

Anything not specifically covered or detailed or verbiage that is open to interpretation provides an opening for the industry to circumvent the legislation intentions. It is crucial that legislation be as specific and detailed as possible, anticipate industry efforts to identify such 'loopholes', and compel industry compliance through efficient enforcement.

Key messages

In response to extensive tobacco control legislation in Israel, the tobacco industry employed various tactics to bypass legislative efforts. Tobacco control legislation and regulation need to use detailed wording to prevent alternative interpretations by the tobacco industry.
Health care network for chronic conditions: an intervention and evaluation in the health system
Authors: Cardoso C S , Baldoni N R , Melo C F , Rezende L O , Noronha K , Oliveira C D L , Quintino N D , D`Alessandro T A L , Andrade M V
Published: October 2020

Background

Health assessments are necessary for the (re) formulation of effective public policies and to guarantee the quality of care offered. This study aim to evaluate the perception of health professionals concerning the institutional capacity of the health system to care for Chronic Conditions (CC) after intervention in a medium-sized municipality in Minas Gerais, Brazil.

Methods

It is a panel study with evaluation before, during and after an intervention in the health system with a focus on three CC, i.e., i) diabetes; ii) hypertension; and iii) pregnant women. Health care professionals from primary and specialized care units were interviewed using the Assessment of Chronic Illness Care (ACIC) scale, which was applied in nine focal groups organized by health care unit.

Results

A total of 240 professionals participated of this evaluation, being 94, 63 and 82 participants in 2013, 2015 and 2018 respectively. The ACIC scores showed an positive evolution in the capacity of the health system to care for CC over the years. In the first wave the global score was 5.40 (basic capacity), while in the third wave the score was 9.38 (optimal capacity), with a significant increase in the scores (p < 0.01).

Conclusions

An important gain in the institutional capacity of the municipality was evidenced for the care of chronic conditions after intervention in the health system. Such an enhancement of the health system to operate in the CC might be sustainable over the time. Furthermore, its impact may directly reflect on the health indicators of the population.

Key messages

The results showed a strengthening of the local health system. These findings can subsidize other municipalities with a similar reality in the organization of the health care network and, consequently improve the care provided to chronic conditions.
Screening for senile asthenia syndrome
Authors: Sabgayda T P , Edeleva A N , Zubko A V , Semyonova V G
Published: October 2020

Life expectancy of the Russian population lags behind countries with similar socio-economic development by several years. Significant reserve for reducing population losses is associated with measures to ensure healthy aging. In Russia, patients with high probability of senile asthenia (presence of three from seven geriatric syndromes) are identified among persons aged 75 years and older. However, with high mortality, screening for senile asthenia may need to be started at a younger age.

Purpose

to analyze the average age of occurrence and the conjugations of geriatric syndromes in outpatients of different age groups living in the same area of the city.

619 outpatients older than working age (men 60 years and older, women 55 years and older) were interviewed. Two and four geriatric syndromes are more common than three syndromes: 21.6% and 26.0% versus 11.8%, respectively (p < 0.0001). The number of geriatric syndromes increases with age, however, is not strictly proportionally. In the patterns of geriatric syndromes distribution, differences are observed between groups of outpatients with two and three syndromes. Marked weight loss does not occur in people with three syndromes, while a tenth of people with two syndromes notice it. On average, sensory limitations and depressive mood appear earlier than other syndromes and their simultaneous presence greatly increases the risk of others. In women, compared with men, sarcopenia appears early. The opposite situation is observed for falls. Cognitive impairment significantly increase the likelihood of all other geriatric syndromes.

It is advisable to screen for geriatric syndromes in people aged 60 years and older in countries with high mortality. When detecting sensory impairment syndrome, the prevention of depressive syndrome and cognitive impairment should be carried out. The depressive mood of the population due to the difficult social situation is apparently one of the factors of insufficient life expectancy in Russia.

Key messages

When detecting sensory impairment syndrome, the prevention of depressive syndrome and cognitive impairment should be primarily carried out. It is advisable to screen for geriatric syndromes in people aged 60 years and older in countries with high mortality and old population.
Prevalence of hyperoxemia in hospitals of southern Tamaulipas, Mexico during the period Aug-Oct 2019
Authors: Reynaga M A R H , Castañeda E D C P , Correa L A C M , Zamarrón E I Z L
Published: October 2020

Background

Assisted ventilation represents high benefits for patients that cańt breathe normally or had suffered lung damage. The problem begins when there is an excessive assisted ventilation, that could lead to partial pression of the oxygen that cause hyperoxia and the result is oxygen poisoning [Hyperoxemia]. Reports have shown that cells, connective tissue, and organs can be affected by the hyperoxia. Our research consists in identifying hyperoxemia prevalence in Intensive Care Unit [ICU] at hospitals, so they can develop a better oxygen treatment.

Methods

The method we use in this investigation were: Nonexperimental, quantitative, retrospective, and transversal research, with the variable data PAO2, PCO2, SO2, age and gender. The subjects were distributed in normoxia and hyperoxemia. The population sample was of 19 patients from the Hospital A, B, and C in the south of Tamaulipas, Mexico, during the August-September 2019 period. The analytic technique used was the statistical average, which was of 137.9% in ICU.

Results

From 19 patients [100%], 15 patients with hyperoxemia [79%] and 4 patients with normoxemia [21.05%]. There was a difference between hyperoxemia: 10 male patients [52.63%] and 5 female patients [26.31%]. In the ICU, oxygen average saturation was 96.7%, and partial pressure of oxygen was 137.9%

Conclusions

We recommend performing a blood gas test in each patient with assisted ventilation, this with the purpose of regulate the administration of the oxygen inspiratory rate [FiO2]. Develop a clinic practice manual to regulate the administration of the oxygen inspiratory rate [FiO2] with assisted ventilation patients, with specifications and parameters to use it according each patient's characteristics and noted the consequences of a bad management on this. From 100% of patients [19], 79% [15] had hyperoxemia, which denotes that it is missing health surveillance to look after patient's health in the future.

Key messages

There are no beneficial effects of hyperoxemia in critical patients clearly demonstrated in clinical trials. The use of elevated FiO2 can produce a direct toxic effect on lung cells, with phenomena of cell destruction and alteration of defense mechanisms.
Gender equity in scientific publishing: Analysis of publications in the Journal of Health Monitoring
Authors: Seeling S , Rabenberg M , Saß A C , Ziese T
Published: October 2020

Background

The importance of gender- and sex-sensitive reporting and communication in science has been widely acknowledged in the past years. At the same time, a 'gendered system' of scientific publishing is increasingly discussed, given the underrepresentation of women as first and last authors, reviewers, on editorial boards and in editorial key positions. Against this background, the Journal of Health Monitoring (JoHM) - a scientific online journal published by the Federal Health Reporting at the Robert Koch Institute, Germany's national public health institute - took stock of the proportion of women among authors and reviewers.

Methods

Articles published in the JoHM between its founding in 2016 and the last issue in 2019 were included. Descriptive analysis was performed on the proportion of women in first and last authorship, stratified by publication format, and the proportion of peer reviews performed by women.

Results

A total of 145 articles were included in the analysis, comprising the categories Focus, Fact sheet, Concepts & Methods, Proceedings, Abstract and Editorial. The percentage of articles with first authorship by women was 66% (95/145), ranging from 53% for Focus articles (n = 16/30) to all of the Editorials (n = 6/6). 49% of last authors were female (n = 66/135). Overall, 42% of all reviews were performed by women (n = 96/233).

Conclusions

With almost two third of the publications analysed, first authorship of women in the JoHM is high. However, the proportion of female last authors and reviewers is lower in comparison. Next to professional qualification, gender should be taken into account when editors select reviewers. Overall, discussion should be stimulated on adequate representation of women in all areas of scientific publishing, given the relevance of visible merits in publishing for the building of scientific careers.

Key messages

Publications in the Journal of Health Monitoring have a high percentage of female first authors; in comparison, the percentage of last authorship and peer reviews by women is lower. An adequate representation of women in all areas of scientific publishing is essential, given the significance of publishing for merit in science and research.
“Patiently waiting”: a multivariate logistic regression analysis to understand waiting times
Authors: Rossi M , Da Re N R , Forni G , Campanelli E , Balconi R , Bergamaschi W
Published: October 2020

Background

Outpatient visits waiting time poses a significant challenge in countries facing rising health demands, particularly those that have universal access to public health care. In Italy, despite major improvements, many patients still experience extensive delays accessing specialist care. Our study describes waiting times for the 14 most critical specialist “first” visits provided by the national health care system in the Milan Health Protection Agency territory (3,48 million inhabitants) and investigates whether specific patient, prescription and hospital variables are associated to an increased risk of delay in waiting time.

Methods

A multivariate logistic regression analysis of the relationship between specialty, age, sex, priority class, exemption from prescription charges, hospital organization, patient region, and Hospital district was performed to investigate whether specific variables are associated to the odds ratios (OR) for having to wait more than the maximum time limit.

Results

Out of the 1,174,283 visits performed in 2019, 90% were provided within the maximum waiting time. Visits were provided beyond maximum time in 20% (median delay=2 days) of priority class 1 visits, 24% (median delay=7 days) of class 2, 22% (median delay=37 days) of class 3, and 4% (median delay=65 days) of class 4. All analysed variables were significantly correlated (p < 0.001) to the OR for having to wait beyond the priority class specific limit. In particular: female sex (OR = 1.074), residing outside Lombardy (OR = 0.696), class 1 priority (OR = 4.939), exemption from prescription charges (OR = 1.107), research Hospital (private: OR = 5.937, public: OR = 5.156) and ophthalmology (OR = 8.822).

Conclusions

Our results show that most visits were provided within the time limits. However, waiting times seem to be a major issue when assessing certain specialties, hospitals, and priority classes. This data should guide health policy makers interested in tackling the waiting time issue.

Key messages

This study highlights the importance of monitoring outpatient waiting times. Strategies and policies to tackle the problem of waiting times should be made upon reliable data and transparent criteria in order to meet patients’ needs.
Diabetes: awareness and management. Data of Passi and Passi d’Argento surveillance in Lazio, Italy
Authors: Paradiso F , Agosti G , Prencipe G P , Trinito M O , Iacovacci S , Contoli B , Minardi V , Masocco M
Published: October 2020

Background

Diabetes is a health emergency: in Italy over 3 million people are diabetics. In Lazio region a high percentage of population is affected by diabetes. Data are collected from two Italian population surveillance systems, Passi during 2015-18 and Passi d'Argento (PdA) during 2016-2018; this trasversal study was conducted to investigate diabetes awareness and clinical management in Lazio.

Methods

Passi and PdA collect representative data providing a telephone interview with a standardized questionnaire to a representing sample (18-69 and over 65 aged respectively), randomly selected and sex-and-age stratified. In both questionnaires a diabetes section assesses diagnosis, knowledge of HbA1c, health setting and number of annual checks. Data refer to whom affirm to be diagnosed with diabetes. Results are shown by prevalence and 95% CI.

Results

Diabetes prevalence grows with age, it does not reach 1% in people under 50 years, it is 9% for the age group 50-69 years and 20% in over 75. Serious economic difficulties and low education level are related to higher prevalence. Among diabetics, 18.7% (15.42-22.46) from Passi and 24.2% (20.29- 28.61) from PdA ignore HbA1c. About clinical management, 1.5% (0.73-2.90) in Passi do not receive any care from doctor; the whole sample of PdA receives medical care. Most of the respondents in both surveillance are managed by diabetes care team (43.76% in Passi - 39.87% in PdA), reporting to receive care about three times a year on average. No significant differences are observed between economic and education levels.

Conclusions

High percentage of diabetics, not knowing HbA1c, are not aware about disease. Patient empowerment is necessary to gain control over disease and increases capacity to act on it. Health education should be improved and diagnostic and therapeutic pathways, recently introduced in Lazio Region, should be better structured. Population surveillances allow to plan and evaluate programs and interventions.

Key messages

Fight the lack of awareness with patient empowerment to gain control over diabetes. Population surveillances are valuable tools to plan and evaluate programs and interventions in Public Health.