bluuebunny/crossref_metadata_2025 huggingface dataset:
Predictors of Healthcare Associated Infections and Their Role on Mortality in an Intensive Care Unit
Authors: Migliara G , Baccolini V , Salvatori L M , Angelozzi A , Isonne C , Nardi A , Prencipe G P , Marzuillo C , De Vito C , Villari P
Published: October 2020

Background

Healthcare associated Infections (HAIs) represent a significant burden in terms of mortality, morbidity, length of stay and costs for patients in intensive care units (ICUs). In this study, we analyzed the predictors of HAIs development and assessed the HAIs association with mortality. Data were retrieved from a general ICU active surveillance system of a large teaching hospital in Rome.

Methods

Logistic regression models were built to quantify the association between demographic and clinical factors and the development of HAIs, device-related HAIs and Multi Drug Resistant (MDR)-associated HAIs. The HAIs independent predictors were used to create propensity scores (PS) specific for each model, that was subsequently used to adjust the association between these conditions and mortality in logistic regression models.

Results

From May 2016 to September 2019, 864 patients were included in the surveillance system, 236 (27.3%) of which had at least one HAI during their hospitalization. Specifically, 162 (18.8%) patients had at least a device-related HAI and the overall mortality rate was 34.3%. Factors associated with the HAIs and the device-related HAIs were mechanical ventilation and admission for trauma. The PS-adjusted logistic models showed an association between HAI and device-related HAI and mortality (OR 1.82, 95%CI 1.30-2.54; OR 2.03, 95%CI 1.40-2.95, respectively). MDR-associated HAIs had a significant association with diabetes mellitus; however, these infections weren't associated with mortality (OR 1.42, 95%CI 0.98-2.08), even in the subgroup of infected patients (OR 0.99, 95%CI 0.56-1.73).

Conclusions

The study confirms the association between HAIs and device-related HAIs with mortality in ICUs. Apparently, MDR-associated infection subset appears not having a specific association with mortality. However, given the extra effort that these infections require to be managed, they should be adequately surveilled and contrasted.

Key messages

Healthcare associated infections are strongly associated with mortality in ICU. MDR-associated infections do not seem to give a specific drawback in our setting.
Effect of ClO2 on the distribution of Legionella pneumophila serogroups in a Teaching Hospital
Authors: Vincenti S , La Milia D I , Boninti F , Marchetti E , Wachocka M , Laurenti P
Published: October 2020

The prevention of Legionella colonization of water systems is one of the goals of hospital management. Among chemical disinfection methods, chlorine dioxide (ClO2) has been largely used to control Legionella in water systems. We analysed the distribution of Legionella pneumophila serogroups (sg) and Legionella other spp before (PRE) and after (POST) installation of chlorine dioxide (ClO2) continuous disinfection systems in a Teaching Hospital in Rome.

According to the Italian National Guidelines, our surveillance plan involved a systematic sampling of the water system. The sampling was performed from Jan. 2010 to Dec. 2019. From 2011 to 2019, ClO2 continuous disinfection systems were installed in all hot water system of the hospital, and maintained at a concentration of 0.25 mg/l at the end point. The isolated strains of Legionella were first serotyped using a kit that identifies sg1, other species and that discriminate sg from 2 to 15.

1505 hot water samples were collected from the Hospital and analysed. 363 samples are PRE and 1142 are POST activation of ClO2. Only the 16.74% of monitored sampling points were colonized by Legionella during the study period. This percentage decrease from 31.40% of PRE samples, to 12.08% of POST samples (p ≤ 0.000). The sg isolated were: sg3 (60.31%), sg8 (17.12%), sg1 (16.73%), sg6 (1.95%) and other species (3.89%). Comparing the distribution of sg between the PRE and POST samples, the sg8 showed a high increase (+136.84%) and the sg3 a slight decrease (-17.94%). These variations were statistically significative.

The results showed a predominance of Legionella pneumophila sg3, compared to what was observed in a multicenter study conducted between different hospitals of various regions of Italy, where sg6 was the major isolate. The ClO2 affect the distribution of sg, in particular for sg8. This interesting result will be further investigated.

Key messages

Our data deriving from an environmental monitoring plan, show that the ClO2 affects the distribution of Legionella’s serogroups. The ClO2 reduces the percentage of samples colonized by Legionella. The ClO2 reduces the percentage of samples colonized by Legionella.
Burden of Healthcare-Associated Infections in Italy: Disability-Adjusted Life Years
Authors: Bordino V , Vicentini C , D'Ambrosio A , Quattrocolo F , Zotti C M
Published: October 2020

Background

Healthcare-Associated Infections (HAIs) significantly increase adverse clinical outcomes and healthcare costs. In 2016 Italy participated in the second European Centre for Disease Prevention and Control (ECDC) Point Prevalence Survey (PPS) of HAIs and antimicrobial use in acute care hospitals. The aim of this study was to estimate the burden of the 5 most common HAIs in Italy, by evaluating incidence, attributable deaths, Years of Life Lost (YLL), Years Lived with Disability (YLD) and Disability-Adjusted Life-Years (DALYs).

Methods

National PPS data were used to establish sex- and age-specific incidence of Healthcare-associated Pneumonia (HAP), HA Urinary tract infections (HA UTI), HA Bloodstream Infections (HA BSI) excluding neonatal BSI, Surgical Site Infections (SSI), HA Clostridium Difficile infections (HA CDI). Patients' life expectancy was adjusted according to the severity of underlying conditions using the McCabe score. Following the methodology from the Burden of Communicable Diseases in Europe (BCoDE)-project, an adapted version of the disease models of the BCoDE toolkit was used.

Results

An overall yearly incidence of 643434 new cases of HAI in Italy was estimated. The aggregate burden of the 5 HAIs was 426411.98 DALYs (86731.03 YLD + 339680.96 YLL), corresponding to 702.53 DALYs per 100000 total population. HA BSI and HAP had the highest burden with respectively 253868.22? and 126038.26 DALYs. The population strata with the highest burden were the ones with McCabe Score 1 for every considered HAI. The age groups with the highest burden were 70-74 for male and 45-49 for female patients. In total, 56% of DALYs were attributable to men and 44% to women.

Conclusions

This nation-wide study found a significant burden of disease due to HAIs in Italy. Results of this study could be used to guide policy-makers in the implementation of measures aiming to reduce the impact of HAIs.

Key messages

This study estimated the burden of 5 HAIs in Italy was 426411.98 DALYs (86731.03 YLD + 339680.96 YLL according to 2016 PPS data. Considering the significant burden of HAIs found in this study, infection prevention and control measures should be a Public Health priority in Italy.
FRESHER and RARE 2030: scanning the horizon emerging trends in health and healthcare
Authors: Giuffre G , Sisti L G , Ricci A
Published: October 2020

Background

Health and healthcare are facing novel challenges ranging from broad, shifting trends to emerging innovative technologies and social practices. Foresight methodology aims to analyse emerging trends, building different future scenarios and identifying policy options to support the policy dialogue.

Methods

FRESHER and RARE 2030 are two EU-H2020 projects. FRESHER- FoRESight for hEalth policy development and Regulation (2016-2018) aimed at representing long term alternative health Scenarios testing future policies to tackle the burden of Non-Communicable Diseases. A micro-simulation model, specifically enhanced by the project, also computed the health outcomes of the different four Scenarios. Rare 2030-Foresight in Rare Diseases Policy (2019-2020) uses a participatory approach to identify the most relevant trends, anticipate their influence over the next decade and propose policy recommendations that could lead to a better future for people living with Rare Diseases. Different in scope, these projects share common features. Both follow a four steps foresight methodology: horizon scanning, trends identification and ranking, scenarios building, back-casting and policy elaboration. Taking a participatory approach, these studies apply structured qualitative tools, involve a wide range of stakeholders and include regional case studies.

Results

20 trends emerged as key for the future of health and healthcare, among them: demographic change, rise of inequality, urbanisation, climate change and low carbon development, innovation in medicine, citizens empowerment and the potential for big data and Artificial Intelligence application.

Conclusions

The 20 trends analysed offering a litmus test for future proofing current health and healthcare policies. Foresight has proven to be a valid methodology to gather collective intelligence for identifying emerging trends and scenarios, evaluating risks and opportunities, setting long term goals and helping the decision making in health.

Key messages

To promote a transition toward better health policies, it is crucial supporting the collaborative attitude and ensuring a greater involvement of citizens and patients in the decision making. The importance and unpredictability recognized to the equity trend in both projects reveals the need for urgent actions to ensure the future access to better health and care to all European citizens.
A new tool to assess community-level evidence to inform public health decision making
Authors: Clark E , Snelling S , Beyers J , Howarth C , Neil-Sztramko S , Dobbins M
Published: October 2020

Background

As public health responds to evolving challenges around the globe, it is critical to draw on community-level evidence to inform decisions on emerging needs. There are existing tools for assessing the quality of research evidence, but none that explicitly focus on quality assessment of evidence from community sources, including local health status and ever-changing community and political preferences and actions.

Methods

The National Collaborating Centre for Methods and Tools (NCCMT) in Canada has developed new tools, called Quality Assessment of Community Evidence (QACE), to help public health decision makers assess the quality of community evidence. The QACE tools were drafted through extensive review of existing frameworks, tools and measures for appraising population health and community evidence, and diverse key informants. We identified three consistent themes that became the core dimensions in these tools. By using the QACE tools, practitioners can answer the question: “Is the quality of this evidence about local context, community needs and political preferences good enough to influence decision making?”

Results

The QACE tools provide probing questions for each of three dimensions: relevant, trustworthy and equity-informed. Supplementary resources help users delve more deeply into different aspects of quality assessment. The QACE tools are intended for public health practitioners who provide and use evidence to support or make decisions about public health practice and policy, including public health practitioners, senior leaders, policy makers and funders.

Conclusions

The QACE tool is a new addition to the public health toolbox for evidence-informed decision making, providing questions to ask about evidence from community sources. By using the tool as part of a decision-making process, public health practitioners can be assured that their decisions are based on the best-available evidence for their communities.

Key messages

The new Quality Assessment of Community Evidence (QACE) tools fill the gap in assessing quality of community-level evidence for public health decision-makers. Community evidence, including local health status and needs and community and political preferences and actions, should be assessed for quality in three critical domains.
Incident reporting digitalization: the experience of an Italian academic hospital, 2019
Authors: Ruscio E , Bianchet B , Scarpis E , Del Pin M , Degan S , De Corti D , Bellomo F , Farneti F , Cocconi R , Brusaferro S
Published: October 2020

Issue

Incident reporting (IR) is an important tool to assess potential or current problems within health care facilities. To increase the number of IR should be an important issue of the risk manager. In the academic hospital Santa Maria della Misericordia (SMM) of Udine, in North-east of Italy, IR were anonymous paper forms handwritten by health-care workers (HCW) and sent to Clinical Risk Management by internal mail. Digitalization was carried out aiming to increase IR, making it simpler, more direct and perceived as more anonymous by HCW.

Description of the problem

January 1st 2019 the digitized system was initialized, between January and March two training sessions for HCW were carried out and from the 1st April HCW began to send IR with the new application which was installed on every hospital's PC. The objectives were to push HCW to report more, mostly on their own wards' incidents, and to receive complete IR through the insertion of some mandatory information fields.

Results

Comparison between the period from 1st April to 31th December 2018 and from 1st April to 31th December 2019 showed an increase of 22,6% of IR (from 678 to 831), an increase of 11,2% (from 331 to 368) of IR regarding problems with other wards or services and an increase of 33,4% (from 347 to 463) of IR regarding their own wards' incidents.

Lessons

Digitalization seems to be appreciated by HCW despite they are forced to give more information due to the mandatory fields. This could be explained considering that a direct incident reporting system ensures privacy of the HCW which feels more warded also when he reports an internal problem of his own ward. Finally, mandatory fields facilitate risk management work giving all the relevant information about the incident.

Key messages

Digital reporting seems appreciated by HCW and could be a mean to increase the number of incident reporting. To guarantee the anonimity of incident reporting should be a priority and every way to make the HCW feel anonymous seems to be appreciated.
Differential susceptibility to allostatic load and educational inequalities in coronary heart disease
Authors: Hicks B , Veronesi G , Ferrario M , Cesana G , Iacoviello L , Palmieri L , Kuulasmaa K , Soderberg S , Sans S , Kee F
Published: October 2020

Background

Differential exposure to lifestyle factors may mediate the association between education and cardiovascular disease (CVD). However, differential susceptibility (the effect of exposure to the same “dose” of risk factors differs across groups) may also elevate CVD risk but the causal pathways remain unclear. Allostatic Load (AL) is a marker of cumulative biological burden resulting from mal-adaptation to chronic stressors. We aimed to examine the role of differential exposure and susceptibility to AL and other factors in coronary heart disease (CHD) educational gradients in Europe.

Methods

51,328 35-74-year-old participants originally free of CVD from 21 European cohorts in the BiomarCaRE consortium were identified and followed for a median of 10 years to their first CHD event. We defined an AL score as the sum of z-scores of 8 markers from the cardiovascular, metabolic, and inflammatory systems. To investigate the mediating role of AL (and smoking, alcohol and BMI) on educational differences in CHD incidence we applied marginal structural models and three-way decomposition on gender-specific additive hazards models.

Results

AL was a significant mediator of the association between educational status and CHD. The highest proportion mediated was observed in women, with 28% (95%CI 20% to 44%) attributable to differential exposure and 8% (95%CI 0% to 16%) to differential susceptibility. In men, AL mediated 16% of the increased CHD risk in the less educated, with 2% (95%CI 0%-6%) attributable to differential susceptibility. The effects of smoking, alcohol and BMI were relatively small for men and women, with a limited role of differential susceptibility.

Conclusions

While we found evidence of differential susceptibility to AL on CHD, effects were modest and the mediating effect of AL (and other lifestyle factors) was predominately via differential exposure. Controlling disproportionate exposure to AL may help reduce CHD morbidity among those with lower education.

Key messages

Educational inequalities in coronary heart disease in Europe were predominantly driven by differential exposure rather than susceptibility to allostatic load and other lifestyle factors. Controlling disproportionate exposure to AL may help reduce coronary heart disease morbidity among those with lower education.
Psychological distress among elderly in Bangladesh
Authors: Sara H
Published: October 2020

Multimorbidity is a major public health problem in most developing countries including Bangladesh, where the population is moving towards aging. Elderly with chronic conditions may suffer from psychological distress which often goes unrecognized. Since psychological distress is curable, it is important to identify it at the earliest to enhance recovery. Thus the objective of the study is to examine the association between psychological distress and multimorbidity among hospitalized elderly.

This hospital-based cross-sectional study is followed by a two-stage stratified sampling method and all hospitalized elderly aged 60 and above are the target population. Data were collected from April 2017-June 2017 by a structured questionnaire through face to face interview. The level of psychological distress was measured with the Kessler 10 items scale K (10). SPSS version 23.0 was used for data analysis.

The internal consistency of the Kessler Psychological Distress Scale (K10) was good (Cronbach's a = 0.96). The average mean of psychological distress measured with K (10) was 29.18. The level of psychological distress increased by no chronic diseases. Findings show that 88 percent of respondents have severe mental disorders who were suffering from 3 chronic diseases while 45 percent reported for no psychological distress with single diseases. And among multimorbid respondents, elderly women reported a higher level of Psychological distress than male. Similarly, middle-old and old-old respondents have higher psychological distress than Young-old. Urban and currently married people reported for lower psychological distress. Respondents engaged in work have higher psychological distress than unemployed respondents.

Building sufficient systems of long-term care ensuring an appropriate setting that includes both formal and informal care to improve the psychological well-being of elderly people with chronic medical conditions is regarded as crucial.

Key messages

Psychological distress is significantly affected by chronic medical conditions. As many older people remain in hospital inappropriately with psychological distress, a number of measures can be applied to allow for more treatments out of the hospital.
Psychological resilience and cardiovascular disease? A systematic review of the literature
Authors: Ghulam A , Bonaccio M , Gialluisi A , Gianfagna F , Iacoviello L
Published: October 2020

Background

Psychosocial resilience is the capacity of responding positively to stressful events in life. We performed a systematic review of the literature to find whether resilience has any protective effect on cardiovascular disease (CVD) or mortality.

Methods

We searched Pubmed and Prospero systematic Review Registry using terms resilience, psychological or resiliency or resilience or resilient or hardiness, cardiovascular or stroke or or myocardial infarction or CVD or mortality or hospitalization. The references of each included paper were also searched for relevant studies. Longitudinal studies conducted on all populations, in English, with no time restriction were searched. They were included in the review if they examined resilience as primary exposition, and mortality for all causes, mortality for CVD, CVD events and hospitalization as outcomes and if they were longitudinal.

Results

The search identified 1,471 studies, of which only 8 were retained and fully examined based on the study design reported in the abstract, and 3 met all the inclusion criteria. Two studies on 237,879 young Swedish men showed that lower resilience compared with the highest (scores from an interview) resulted associated with both coronary heart disease (HR = 2.61, 95%CI:2.52-2.70) and stroke risk (HR = 1.54, 1.40-1.70) in adulthood (follow up 23 yrs). A third study on 2,765 postmenopausal Afro-American women showed that a modified Brief Resilience Scale was not associated with CVDs (lowest vs highest quartile, HR = 0.95, 95%CI:0.63-1.42; follow up 12.5 yrs).

Conclusions

There is not sufficient evidence of a protective attitude of resilience towards CVD: only 3 studies were eligible, with heterogeneity in sample size, exposures to stressors and scales used to measure resilience, and with resilience data available only at baseline. Further studies are necessary, since resilience is a powerful concept, and, if proved protective, might be improved in populations to ameliorate CV health.

Key messages

No clear association between resilience and CVD risk has been shown in literature. This is the first systematic review on the topic and further research is needed to broaden our understanding of the relation between resilience and CVD.
Prevalence of type 2 diabetes and associated risk factors among Saharawi refugees in Algeria
Authors: Henjum S , Kjollesdal M K R , Flaaten M O , Andersen E , Hjellset V T , Morseth M S
Published: October 2020

Background

The Saharawi refugees have been living in refugee camps in the Algerian desert since 1975 and are dependent on food aid. A double burden of malnutrition by the coexistence of undernutrition among children and overweight and obesity among adults has been observed in the Saharawi refugee camps. Limited knowledge about the prevalence of type 2 diabetes (T2D) and associated risk factors exists in this population. The aim of this study was, therefore, to address this gap in the literature.

Methods

A cross-sectional survey was carried out in five Saharawi refugee camps in Algeria in 2014. A total of 180 women and 175 men were included. HbA1c was used to assess the prevalence of T2D and prediabetes. The Finnish Diabetes Risk Score (FINDRISC) was used to estimate the risk of developing T2D. Multiple logistic regressions were performed to assess risk factors associated with T2D and prediabetes.

Results

Median (min, max) HbA1c among the Saharawi refugees was 35 (4, 135) mmol/mol. The prevalence of T2D and prediabetes was 7% and 10%, respectively. The prevalence of overweight and obesity combined was 45%, and higher in women than in men. According to FINDRISC, 9% of participants had high risk of developing diabetes and 10% had moderate risk. In adjusted models, significant predictors for T2D were age, waist circumference and having a first-degree relative with T2D. Significant predictors for prediabetes were age, body mass index (BMI), waist circumference and a history of high blood glucose.

Conclusions

We found moderate prevalence of diabetes and prediabetes and a relatively high prevalence of overweight and obesity among the Saharawi refugees, especially the women. Given the fragility of the Saharawi health care system, screening for diabetes should be conducted in a cost-effective manner and high-risk individuals should receive advice about lifestyle changes (e.g. diet and physical activity).

Key messages

We found moderate prevalence of diabetes and pre-diabetes among the Saharawi refugees, and a high proportion were classified as overweight or obese. In light of this, the rates of T2D are likely to increase in the near future. The Saharawi health authorities should pay attention to the increased risk of diabetes in this vulnerable population.
Screening in health impact assessment: issues and practice in France
Authors: Jabot F , Dardier G
Published: October 2020

Background

Health impact assessment (HIA) is a method aimed at anticipating the potential effects of proposals on health prior to their implementation in order to include health issues in decisions made outside the health sector. It is structured in several steps. The first one (screening), aimed to decide if a full assessment is required or not, is poorly documented. In France, the interest shown for HIA has led to a growing number of experiments, which questions the quality of practices linked to this step and its capacity to fulfil its purpose. This study describes how screening is implemented, explores the main issues at this stage, the decision-making process and to what extent it conditions the HIA's success.

Methods

All HIAs undertaken between 2011 and 2019 were listed in order to provide a picture of the process. Then, we focused on the 3 most involved regions to describe the screening process (reports, interviews, observation). Drawing on quality standards and literature review, we built an analytical framework to analyze practices, the interface with other approaches, the influence of the local context and the HIA's success factors.

Results

59 HIAs were identified. Among them, 54 have gone beyond screening. HIAs are applied to land use planning (72%,) policies (19%), equipments (9%) and are carried out by public organisations (37%), private firms (35%), universities (15%), municipalities (13%). 11 regions (out of 18) conducted at least one HIA and practice varies significantly across regions. Case studies in 3 regions (36 HIAs) show that screening length and depth vary greatly. Its features depend on political commitment to HIA, advocacy for HIA, guidance, relationship with local authorities, technical skills. Overall, screening is more dedicated to promote HIA and select a pilot project than to study the HIA's relevance and feasibility.

Conclusions

Since screening is methodologically poorly underpinned, it weakens HIA's quality and efficiency whatever its duration.

Key messages

Screening step is key to raise decision-makers’ awareness of the consequences of their engagement in HIA. Screening allows to ensure that HIA is the relevant method for the project and the conditions are met to gain its utility.
Success story in technical cooperation among countries of the south
Authors: Alsheikh G , Al Darazi F
Published: October 2020

The policy paper aims at sharing experience in medical education between Tunisia and Djibouti through technical support from WHO EMRO. Djibouti, a francophone country located in the English-speaking horn of Africa, could not rely on neighboring countries to help in establishing a badly needed medical school. Djibouti a low middle-income country, with around one million population has a low density in medical professionals. Most of them were trained in France or other francophone countries and the rate of return to practice. WHO EMRO was requested to support in establishing a medical school.

A feasibility study to develop a problem based and community oriented medical school was carried out by experts from WHO EMRO and from senior medical professors from Lebanon and Tunisia. A plan was designed to establish the medical school with support from WHO EMRO and technical cooperation from Tunisia using the same approach in establishing the medical school of Nouakchott in Mauritania. Initial funding was provided from WHO EMRO to support acquisition of education materials and laboratories and by a 600,000 $ grant from the African Bank to secure travel and accommodation of visiting professors from Tunisia and from other francophone countries from the region. More than 300 physicians were trained locally and efforts are being made to train Djiboutian residents in various specialties and to train future teachers.

The objectives of the paper are to: To share a success story in south to south cooperation with technical support from WHOTo harness solidarity mechanisms among countries of the southTo highlight the positive role played by WHO in facilitating technical cooperation and in mobilizing financial resources from development bank to support medical education

Key messages

need to harness solidarity among countries of the south in human resource development. highlight the facilitating role of WHO In technical cooperation and in fund raising.
eConsultation between health care professionals in primary health care and specialized medical care
Authors: Seppänen M , Hämäläinen T , Joffe G , Mäkitie L
Published: October 2020

The synchronous eConsultation is provided by a specialist in a hospital to a GP appointment either by pre-set request or without scheduling. The patient participates in the session. The eConsultation employs video or chat and the program integrated into Health Village service platform enables also sharing x-rays, still photos and other EHR material. Health Village delivers public health services for general public, digital care pathways for patients with specific diagnoses and digital tools for professionals.

The eConsultation project started in 2018, after interviewing the member municipalities (n = 24, 1 600 000 inhabitants) of the Hospital District of Helsinki and Uusimaa (HUS) in Finland. The municipalities gave a high priority to eConsultation as a way of further integration of service chains and dissemination of common practices between and within the specialized and primary health care services.

Funded by the HUS and supported by the HUS IT Department eHealth Services, eConsultation pilots started in 2018 in close collaboration between the public specialized and primary health care organizations in neurology, orthopedics and wound treatment. The pilots indicated that eConsultation are more efficient than traditional consultation methods (e.g., the time used by a neurologist in eConsultation dropped by 87% vs. a face-to-face consultation visit). Almost all of patients and 84% of primary care professionals reported high level of satisfaction. The consultants found that the presence of a patient fostered, if needed, additional clinical interview and diagnostic procedures by proxy, as well as assessment of individual needs of a GP. The primary care professionals appreciated queue-free response (45 seconds in eConsultation with no pre-set appointment time) and augmented educational validity.

Scaling of eConsultation across the whole hospital district and more specialties is going on. eConsultation will be explored in depth in two starting scientific studies.

Key messages

Synchronous eConsultation. more efficient than traditional consultation methods.
XarxaSalut, network of municipalities for health, Valencia Region (Spain): policy process evaluation
Authors: Peiró Pérez R , Pérez Sanz E , Legaz Sanchez E , Quiles Izquierdo J , XarxaSalut Grupo
Published: October 2020

“XarxaSalut” started in 2017, with the municipalities that have taken the commitment to boost the Promotion of Health (HP) at the local level through community participation, intersectorality and equity perspective. The objective is to present a policy process evaluation (2'5 years) of the implementation of XarxaSalut.

Different approaches have been used; a questionnaire addressed to the municipalities at the time of adhesion including data on intersectorality, participation, HP actions and open questions; description of instruments that Regional Public Health Authorities (RPHA) has mobilized and an analysis of barriers and strengths made by the coordination office.

In 2017, 17 municipalities were joined, being 197 in February 2020 (70% of the population). 65% are in a process of an organizational change through the intersectoral, decision making and participative working group. 35% are doing analysis of determinants and /or health situation, assets maps and a prioritization of HP actions. The main barriers identified by municipalities are lack of economic and personal resources, and difficulties in achieve citizen participation. The main benefits were the optimization of resources, the exchange of experiences, training, or economic support from the RPHA. Some support instruments develop for RPHA are a collection of guides for community development, funds that the municipalities can apply to support actions related with training, HP action on vulnerable population, on asset maps, participation processes, vulnerable neighborhoods, etc.; Community actions have been included in the “Health Observatory” to give visibility and social support to XarxaSalut. Interdisciplinary training processes with health and municipal professionals have been made in order to develop a common language and strength the competences for HP.

Lesson learned: The need to improve coordination and a common language between different types of participants and professionals

Key messages

The decision makers and professionals in the municipalities understand the impact in health of the policies developed at local level but needs guide and support to deal with it. The coordination between different administrations and primary health at local level and the misunderstandings about health and their determinants are the main aspect to reinforce.
Elements of the built environment that can promote physical activity in elderly: an umbrella review
Authors: Manzi F , Del Riccio M , Naldi E , Setola N , Dellisanti C , Lorini C , Bonaccorsi G
Published: October 2020

Background

All healthy adults aged 65 years and above, unless specific medical conditions, benefit from physical activity. The built environment can support and encourage physical activity. The aim of this study is to establish which specific elements of the built environment can contribute to improve the physical activity of self-sufficient, non-institutionalized and living in the city adults > 65 years.

Methods

An extensive literature search was conducted in several database. Umbrella review methodology was used to include the systematic reviews that presented a sufficient methodological quality. Data from reviews were undergone to critical appraisal, data extraction and synthesis.

Results

Eleven reviews were included. The elements positively associated with physical activity in the elderly resulted: walkability; residential density/urbanisation; street connectivity; access/availability of services and destinations (land-use mix destination diversity and access, public transit, recreational facilities, parks and open spaces); pedestrian/cycling infrastructures and streetscapes (footpaths presence and quality, infrastructures for walking or cycling, easy access to building entrance, benches and sitting facilities, street lights); greenery and aesthetically pleasing scenery; safety and traffic (crime, personal and general safety, traffic and pedestrian safety, human or motorised traffic volume). The elements that resulted as negatively associated with physical activity were: the presence of slopes or hilliness; presence of barriers to walking/cycling; littering/vandalism/decay/vacant buildings; pollution (air, noise, sewer).

Conclusions

Evidences show that specific elements of the built environment can contribute to promoting elderly people's physical activity. The city restructuring plans should take into consideration these evidences in order to implement the design of interventions aimed at promoting physical activity of elderly people.

Key messages

Evidences show that specific elements of the built environment can contribute to promoting elderly people’s physical activity. The city restructuring plans should take into consideration these evidences in order to implement the design of interventions aimed at promoting physical activity of elderly people.
The spatial epidemiology of alcohol-related mortality among the Czech adult population
Authors: Kazmer L , Kulhanova I , Lustigova M
Published: October 2020

Background

In Czechia, alcohol-induced deaths account for a significant portion of preventable mortality. As inequalities in health are both socially and spatially determined, the paper aims at the detailed examination of socio-geographic inequalities of this phenomenon.

Methods

The 2011-2015 annual data on both ICD-10 cause-specific deaths (K70; F10; X45/64; Y15) and mid-year population were obtained from the official Czech registries - the data were cross-classified by gender, 5-year age-groups, and permanent residence (N = 6,302 small area spatial units). The selected socio-demographic indicators (education, unemployment, religious population) from the Czech 2011 Census were spatially merged to the mortality dataset. From the data on education and unemployment, composite deprivation index (DI) was derived. In the adult population aged 25+, the age-standardised mortality ratios (SMR) were computed for each of the spatial units, separately by genders. The SMRs were spatially modelled by the Besag-York-Mollié (BYM) autoregressive approach, applying a fully bayesian framework integrated within the INLA R-package. The study applied cross-sectional design and employed ecological regression conducted on observational data.

Results

Compared to the Czech average, the highest SMRs were located in the historical regions of Moravia [SMR=1.15; 95%CI: 1.11-1.19] and Silesia [SMR=1.59; 95%CI: 1.52-1.66]. The SMRs were significantly correlated with DI among males [Rel.Risk=1.15; 95%CI: 1.11-1.19], and with religiousness rate among females [Rel.Risk=0.83; 95%CI: 0.77-0.90].

Conclusions

Significant socio-geographic inequalities were detected, particularly with respect to the Czech historical regions. Among males, higher mortality was associated with a structural deprivation. Among females, protective effect of religiousness rate was found to be significant. The results highlight an importance of both socially and spatially integrated efforts for public health promotion.

Key messages

The inequalities in health are both socially and spatially contextualised. The paper presents robust empirical evidence in favour of the proposition, as examined on alcohol-related mortality data. The health determinants may be gender sensitive. Males might be more responsive to a structural disadvantage. Among females, cultural factors related to a local community might be more relevant.
Education and alcohol use in adolescence – The role of social causation and health-related selection
Authors: Schmengler H , Peeters M , Kunst A E , Oldehinkel A J , Vollebergh W A M
Published: October 2020

Background

Both social causation and health-related selection may influence educational gradients in alcohol use in adolescence. From past studies it is unclear which of these mechanisms predominates, as drinking may be both a cause and consequence of low educational attainment. Furthermore, gradients in alcohol use may reflect 'third variables' already present in childhood, such as parental socioeconomic status (SES), effortful control, and IQ. We investigated social causation and health-related selection in the development of educational gradients in alcohol use.

Methods

We used data from a Dutch population-based cohort (TRAILS Study; n = 2,229), including measurements of educational level and drinking at ages around 14, 16, 19, 22, and 26 years. First, we evaluated the directionality in longitudinal associations between education and alcohol use with cross-lagged panel models, with and without adjusting for pre-existing individual differences using fixed effects. Second, we assessed the role of childhood characteristics around age 11, i.e. IQ, effortful control, and parental SES, both as confounders in these longitudinal associations, and as predictors of educational level and drinking around age 14.

Results

In fixed effects models, lower education at age 14 strongly predicted increases in drinking at 16. From age 19 onward, we found a non-significant tendency towards opposite associations, with higher education predicting increases in alcohol use. Alcohol use was not associated with subsequent changes in education. All childhood characteristics strongly predicted education around age 14 and, to a lesser extent, early drinking.

Conclusions

We found conclusive evidence for social causation from education to alcohol use in early adolescence only, and no evidence for selection attributable to alcohol use. By determining initial educational level, childhood characteristics also predict subsequent trajectories in alcohol use.

Key messages

Our findings illustrate the importance of social causation in relation to alcohol use in early adolescence, while no support was found for health-related selection from alcohol use to education. Parental SES, effortful control, and IQ in childhood strongly predicted educational level in early adolescence, which subsequently predicted trajectories in alcohol use during adolescence.
How effective is a social norms programme in changing perceived injunctive norms about drug use?
Authors: Stock C , Vallentin-Holbech l
Published: October 2020

Social norm theory suggests that students often overestimate the frequency and quantity of drug use among their peers (descriptive norms) as well as how acceptable their peers feel these risky behaviours to be (injunctive norms) and tend to match their own behaviour to this incorrect perception. This study aims to investigate whether a Danish social norms based intervention (The GOOD Life) using both descriptive and injunctive normative information may change students perception of peers' attitudes towards smoking, drinking and using cannabis.

In total 38 schools were included in a cluster-randomised controlled trial and allocated to either intervention (n = 641) or control group (n = 714) during 2015/2016. Students (aged 13-17 years) from both groups completed an online survey before the intervention and 3 months after baseline. The GOOD Life intervention provided normative feedback tailored for each school-grade using three communication channels: classroom sessions, posters and web application. Outcome measures were perception of peers' attitude towards: smoking, drinking alcohol, getting drunk and using cannabis. All with five response options from 'never okay' (1) to 'okay' (5). Intervention effects at follow-up were examined using ordinal logistic regression models and marginal effect-estimates.

Students in the intervention group were less likely to perceive peers to approve of smoking (Coef: -0.22, p = 0.04, 95%CI [-0.43; -0.01]). The marginal effect estimates showed that compared to the control group, students in the intervention group were 5% more likely to perceive that peers think it is never okay to smoke, 3% less likely to perceive that peers think it is okay to smoke occasionally and 1% less likely to perceive that peers think it is okay to smoke frequently. No significant effects were found for injunctive norms regarding alcohol consumption and cannabis use.

Key messages

The intervention The GOOD life has potential to produce change in perceived injunctive norms among Danish adolescents. Prevention programmes should thoroughly consider how to incorporate injunctive normative feedback.
Barriers and facilitators to catch-up vaccination in migrant populations: defining effective and cost-effective implementation strategies
Authors: De Vito E
Published: October 2020

In this talk, EdV will discuss barriers and facilitators to vaccination uptake in a range of diverse migrant groups in Europe, explore the role of vaccine hesitancy in vaccine uptake in migrant populations, and define effective and cost-effective strategies to improve coverage.
Perspectives of asylum seekers, refugees, and other migrant groups on approaches to catch-up vaccination on arrival to Europe
Authors: Louka C
Published: October 2020

Very few research studies to date have explored the views and concerns of the broad range of migrants residing in Europe around vaccination in general, vaccine hesitancy, and approaches to catch-up vaccination on arrival. In this talk, CL will discuss the current research in this area, and implications for policy and practice.
The experience of the Italian Global Burden of Disease Initiative
Authors: Monasta L
Published: October 2020

In 2007, two groups of Italian researchers started collaborating with the Institute for Health Metrics and Evaluation (IHME) to contribute to the generation of the first GBD 2010 estimates, published in 2012 in The Lancet.

Early 2016, the Italian GBD collaborators, 12 at that time, decided to work together, to strengthen the exchange with IHME and gain ownership on the Italian estimates. The group aimed to: 1) exchange experiences, and coordinate activities related to the production and revision of Italian GBD estimates and for specific areas of expertise; 2) disseminate GBD estimates at national and regional level, and foster the active participation of health planners; 3) intensify the sharing of data and information with IHME and reach an agreement for the production of sub-national estimates; and 4) elaborate joint research projects to cover data gaps.

In October 2018, IHME agreed to generate sub-national estimates for Italy, which are now being reviewed and will be officially published in May 2021. A thorough analysis of the epidemiological situation in Italy, using GBD 2017, was published in November 2019 in The Lancet Public Health. Other articles are currently being submitted. Researchers are structured in thematic working groups (Core Groups) while Regional Health Authorities are gradually becoming involved, gaining confidence in the use of GBD metrics and contributing to the sub-national revisions.

The Italian GBD Initiative held a two-day meeting in Rome in January 2020, to discuss preliminary sub-national estimates. The Core Groups revised the estimates and identified data sources that could further improve the estimates. The results were then discussed with IHME in March 2020.

The Italian group can now count on 75 collaborators from 30 research institutes.

The Italian bottom-up approach, involving researchers and research institutes without a national political mandate, has shown both positive and negative aspects, as will be discussed during the workshop.
New population health methods require innovative health information business models
Authors: Lisbon L , Tijhuis M
Published: October 2020

Background

InfAct is tackling the European Health Information (HI) sustainability. New population HI methods should be designed to be sustainable European-wide. Internet and digital health developments have also creating the need for innovative business model for the HI-RI that provides value to all involved stakeholders.

Methods

Leveraging from previous work and from a SWOT analysis, covering both market environment and health data opportunities, a set of health information services was designed. The evaluation of these services was done using Business Model Canvas (BMC), a strategic management template for developing new and innovative business models. Its visual chart was used for describing the services value proposition, infrastructure, customers, and finances. The usefulness of resources is paramount in healthcare. Therefore, it is important to assess the actual benefits obtained with the services.

Results

The SWOT analysis has shown the importance of addressing innovative HI business models to tackle the challenge of a healthcare sector more and more driven by information. Four main services were selected to support a European health information strategy: One-stop Shop, Innovation Research in HI (e.g. access to more updated HI), Capacity Building in HI (e.g., training support), and Knowledge translation research for decision-making (e.g., support policies with evidence-based). BMC analysis contributed to the identification of services value and innovative approach to the health data market.

Moreover, from this analysis proper access to services required sophisticated HI infrastructure that should be able to brokering information in a competitive way.

Conclusions

Novel HI requires innovative business models services based on priority and planning for the next stages grounded on a sustainable roadmap towards the construction of a HI platform. BMC analysis provided the support for the prioritizations and helped designing the HI marketing and adoption strategy.