bluuebunny/crossref_metadata_2025 huggingface dataset:
Proactive machine-learning-based approaches to vaccine hesitancy for a potential SARS-Cov-2 vaccine
Authors: Oreskovic T , Kujundzic TIljak M
Published: October 2020

Background

Polls in the US and France found a concerning share of respondents (50% and 26%, respectively) stating that they are not committed to receiving or simply saying they would not accept vaccination against SARS-CoV-2[1][2]. In this context, it is worth revisiting machine-learning approaches to predicting vaccine hesitancy - such as the one developed for MMR vaccination at the individual level by Bell et al.[4] amid Europe's recent measles epidemic - as a first step of a proactive policy.

Proposed Methods and Expectations

In the MMR case, using 44K child-healthcare records including vaccination data, a LASSO logistic regression based on a low number of attributes of the child and his or her family and community produced risk scores, making them readily interpretable by healthcare professionals. Since children are regularly the target population for immunization efforts, recent pediatric and school-age records, in concert with other social and medical features, could provide suitable input for algorithms estimating the probability of refusal of a SARS-Cov-2 vaccine for other members of a household. This is contingent upon data on acceptance and refusal being collected and paired with these inputs in areas where the vaccine will first be deployed (if developed), which gives another argument for such timely and organized data collection. Speculating about the future performance of a new model trained on truly “out of sample” data specific to a novel problem should be avoided. Benchmarks for success in terms of measures such as precision and recall, however, have to be set in light of the gravity of the issue and other available methods. Finally, any model trained with the aim of predicting vaccine hesitancy for a SARS-Cov-2 vaccine should be coupled with tailored communication policies tested as part of the first vaccination efforts. Cornwall, Science Mag, Jun 30, 2020Peretti-Watel et al., The Lancet, May 20, 2020Bell et al., IEEE ICHI, 2019

Key messages

Data on acceptance and refusal for the first (potential) SARS-Cov-2 vaccination campaigns should be collected and matched with health records to enable models predicting vaccine hesitancy. The output of machine learning models predicting vaccine hesitancy should be paired with tested policies respectfully communicating reliable information on vaccination.
End-of-life decisions and appropriateness of care in intensive care: a cross-sectional, pilot study
Authors: Cescon F , Monaco E , Gregori D , Martinato M
Published: October 2020

In Intensive Care Units (ICUs) patients can experience severe organ failures. In several cases, failures can be incurable, making many of the treatments inappropriate, according to ethical principles. Based on the current legislation, in ICUs, clinicians proceed to limit life support care in most of the cases described. Despite this, some studies report that in many cases the care provided is inappropriate for the prognosis. The study aims at investigating the type and frequency of healthcare personnel's End of Life Decisions (DEL) and the point of view of patients' family, contributing to the debate.

A non-interventional cross-sectional pilot study was conducted in 3 ICUs in North-Eastern Italy. Two questionnaires were administered: the first investigates DEL and the perception of nurses and physicians regarding the inadequacy of care provided to patients (from the ELDY study), the second focuses on the family's opinions. Data are expressed by frequencies, percentages, means and standard deviations.

In line with most of previous studies, cases identified as DEL are all related to non-treatment decisions (n = 20, 74%), 44% of these are related to having stopped or not started treatments already knowing the possibility of anticipating the end of life of the patient, while 27% had the precise intention of shortening life. The situation has been discussed with patient's relatives only in two cases. The cause of increased inappropriateness (87%) was the perception that other patients would benefit more from intensive care than the patient in charge, and 40% of the healthcare personnel reported that similar situations occur very frequently.

The restriction of treatment has been confirmed as the most frequent DEL, and interruption being more frequent than non-implementation. Given the high rate of inappropriate care, it could be effective to follow adequate guidelines in the management of the DEL and discuss strategies within the team and with patients' family.

Key messages

When severe organ failures are incurable, in ICUs clinicians proceed to limit life support to the patient in charge. Despite this, in many cases the care provided is inappropriate for the prognosis. Given the high rate of inappropriate care, it could be effective to follow adequate guidelines in the management of the DEL and discuss strategies within the team and with patients’ family.
Public Policies for making the right to life effective: The problem of suicide at ‘Third Bridge'
Authors: Maia A C A , Fabriz D C , Motta T A , Zanotelli V F
Published: October 2020

The World Health Organization (WHO) recognizes suicide as a public health priority. According to the same, between 2010 and 2016 the suicide rate in Brazil increased about 7%, in contrast to the world index, wich fell 9,8%. In the state of Espírito Santo - ES (estimated population of 4 million people), the number of suicide events reached 233 in 2018, the highest rate ever recorded by Datasus Mortality Monitoring Panel to the state. Suicides on public venues are noteworthy. According to data from the Rodovia do Sol Concessionaire (Rodosol), in 2018 about 41% of suicides in this state occured in metropolitan region of Vitória (estimated population of 2 million people). In Deputado Darcy Castello de Mendonça bridge, popularly known as Third Bridge, 71 attemps were counted, of wich 7 culminated in suicide. As a point of concern, this bridge, main link between the cities of Vitória and Vila Velha, has a contingency plan for emergency and crisis situations since 2016, in addition to cameras monitored by a prepared team that work together with a firefighter's team allocated near the bridge to intervene at any time of the day. The monitoring of the situation makes it possible to verify that, since 1999, the suicides that have occurred add up to lower rates in relation to the attempts. However, there was an increase of approximately 44% in the number of people who attempted suicide in the period from 2015 to 2018. Knowing that interventions to prevent suicide include reducing access to lethal means, it stands out that in 2019 a plan to build a protection net in Third Bridge was approved by the government. These strategies, combined to provided health care from the State Hospital of Clinical Attention and suicide preventive measures from public healthcare system SUS, are in accordance with Brazilian's public health policies. It is a recognition, by the state, that the life of the individual has a public significance, and should be protected even from the individual itself.

Key messages

Interventions to prevent suicide must include reducing access to lethal means, that is knowingly a highly effective preventive practice and is responsibility of public policies of a country/state. Knowing that life has a public and political dimension, the suicide barrier implementation is necessary for the State to fulfill its duty to protect the life of the citizen.
Migrant carers in Europe: double jeopardy of labour market exploitation and hostile environments
Authors: Kuhlmann E , Burau V , Falkenbach M , Klasa K , Pavolini E
Published: October 2020

Background

Many health systems have responded to growing population needs and expanded long-term care services for older people (LTC). However, no country managed to adequately increase the human resources for health. A large group of transnationally mobile migrant carers fill the gaps and mitigate policy failure. This study aims to explore the connections between health labour markets, migrant care workers and populism and to reveal blind spots in the governance of the LTC workforce.

Methods

An explorative comparative approach was applied, which draws on a rapid review of the literature, public statistics and document analysis. A novel analytical framework was developed, which is informed by transsectoral governance and combines four major dimensions: LTC system (e.g. cash benefits, public responsibility), health labour market situation (supply-demand) in the LTC sector, labour migration policies relevant for LTC, and the role of populist parties. Five EU countries were selected which represent different conditions in LTC: Austria, Denmark, Germany, Italy and Poland.

Results

Typologies of sending and receiving countries are no longer sustainable, but transnational mobility flows still impact differently in healthcare systems and national labour markets. Undersupply coupled with cash-benefits and a culture of family responsibility are predicting high inflows of migrant carers, who are channelled in low-level positions or in the informal care sector. These conditions can often be observed in countries with strong populist movements.

Conclusions

Health labour markets, LTC systems, culture and political factors combine to create a double jeopardy for migrant carers, exploited as labour market subjects and exposed to hostile social environments as individual citizens. Action has to be taken to improve public health advocacy for migrant carers and to establish effective European health labour market regulation and transnational health workforce governance.
Multi-stakeholder engagement
Authors: Gabrijelčič Blenkus M , Kronegger L , Pushkarev N , Robnik M , Sotlar I
Published: October 2020

With the method of the social network analyses, the STOP project is investigating social structures and alliances among stakeholders, by using social theory, network and graph theory. The stakeholder engagement process is an integral component of the project. One of the main aims of this process is to recommend to national authorities and the European Commission a sustainability plan for future stakeholder engagement in the area of childhood obesity. To this end, we would like to better understand stakeholders' views and positions (such as willingness, knowledge and trust for collaboration) and get feedback on the project processes and outcomes.

Analytical results show that following moderated discussions, consensus papers are often the main outputs of the stakeholders’ platforms, and a limited number of organisations dominate the membership of the platforms, with private organisations often having stronger representation.

The aim of the stakeholders’ dialogues is to discuss policies and measures related to childhood obesity and, with the input of different sectors, contribute to identifying possible policy solutions and reflect on the work of the STOP project. Concepts of power; transparency and trust; the importance of evidence and different definitions and perceptions of the evidence; and political will and empowerment all appeared as important in the dialogues. Equity and sustainability issues were also brought in the debate. Non-formal stakeholders are less represented at the EU level, so certain views and approaches are absent from EU debates. Therefore, we plan to explore and identify promising means of the engagement of all different stakeholder groups in a transparent, trustful and constructive approach.
31.C. Workshop: Development and implementation of action plans on health literacy
Authors:   Organised by: Bielefeld University (Germany), GOeG (Austria), EUPHA Health promotion section,   Chair persons: Doris Schaeffer - Germany, Jürgen M Pelikan - Austria
Published: October 2020

Health literacy (HL) has become an important topic in many countries. As HL - meaning the ability to access, understand, appraise and apply health information (Sørensen et al. 2012) - is important to make sound health decisions, to promote health and to take an active part in managing health and illness in everyday life and navigating the health care system. In the modern digital knowledge society, HL is also indispensable for orienting oneself in the abundance of mostly digital health information, including incorrect and false information, for locating reliable information and for assessing the trustworthiness and quality of information. However, available studies show that HL is insufficient in many countries. Low HL has - as many studies show - negative social consequences ranging from unhealthy behaviour, higher risk for diseases, less self-care and deficits in coping with illness and chronicity, to over- and misuse (extensive use) of health care. The promotion of HL is therefore an important public health task. An increasing number of population studies and policy documents currently underline this. The WHO has therefore included HL into many of its strategies, like the declarations of Shanghai (2016) and Astana (2018), and has published several publications focusing on HL, like the Solid Facts (2013), the 57th Health Evidence Network Report (2018) or the Roadmap for Implementing Health Literacy Activities (2019). In many countries, strategies and national action plans to improve HL have been developed in response to the political call for action, e.g. in Scotland, Germany and recently also in Portugal. Other countries and regions are currently working on the development of a HL action plan, e.g. Belgium and the WHO European Region action plan on HL. The development and especially the implementation strategies of action plans in different countries and the experiences gained will be discussed comparatively in the workshop. Following an introduction (10'), two countries, which already have action plans will introduce their implementation strategy in one presentation each: Germany and Portugal (30'). This will be followed by two presentations of countries/regions in which action plans are currently being developed: Belgium and WHO Europe (30'). Afterwards the participants will have the opportunity to ask questions and discuss on the different strategies (20'). The workshop will help other initiatives to successfully develop and implement policy plans and strategies in different fields of public health.

Key messages

Strategies and national action plans to improve HL have been developed in different countries/regions. It is important to reflect on the chosen development and implementation strategies and to discuss their effects, successes and barriers.
Bilateral internal thoracic artery grafting in coronary surgery: 10-year outcomes
Authors: D'Errigo P , Barili F , Rosato S , Biancari F , Cerza F , Cicala S D , Forti M , Badoni G , Seccareccia F
Published: October 2020

Background

The advantages to use the bilateral internal thoracic artery grafting (BITA) technique for coronary artery bypass grafting (CABG) have been recently questioned, but data on long-term follow-up is limited. Using data from the PRIORITY project, this study aims to assess the outcome with the use of BITA grafting and its implications for public health.

Methods

The PRIORITY project was planned to evaluate the long-term outcomes of two prospective multicenter studies on CABG conducted between 2002-2004 and 2007-2008. Data on isolated CABG were linked to administrative data in order to retrieve patients' late outcome. Time-to-event distributions were analyzed accordingly to primary event-type (death, major adverse cardiac events (MACEs)) using the Kaplan-Meier and the Cox proportional hazards methods.

Results

The study population consisted of 11021 patients who underwent isolated CABG. BITA grafting was employed in 24.6% of patients. The median follow-up time was 8.0 years (interquartile range 7.6-10.0 years). After adjustment for potential confounding factors, BITA grafting was significantly associated with better survival (HR 0.85, 95%CI 0.76-0.95, p = 0.003). Moreover, using BITA grafting reduced the incidence of MACE (HR 0.87, 95%CI 0.80-0.94, p = 0.001), showing to be a protective factor for recurrent acute myocardial infarction (HR 0.84, 95%CI 0.71-0.99, p = 0.05) and for rehospitalization for percutaneous cardiac intervention (HR 0.82, 95%CI 0.70-0.96, p = 0.013).

Conclusions

BITA grafting during isolated CABG is associated with survival advantage at 10-year with a significantly reduced incidence of MACE. Being the choice to perform isolated CABG with or without BITA based mainly on operator personal preferences, these findings may have important implications from a public health perspective.

Key messages

The choice to perform CABG with or without BITA grafting is associated to different outcomes. The choice to perform CABG with or without BITA grafting is mainly based on operator preferences and may have important implications in terms of healthcare expenditures.
Joint Action on cancer iPAAC - building on experience and streamlining recommendations for the future
Authors: Jelenc M , Albreht T
Published: October 2020

Background

Policy initiatives, proposals and projects often end up proposing solutions and/or measures that are eventually either not or only partially implemented or they are lacking a system, which would consistently evaluate their implementation and/or impact. Good solutions are often not visible enough to the broader professional community and it is important to identify certain outstanding challenges in cancer control and policy. Driven by the need to better use the outputs from projects on cancer policy, European Commission was trying to address two challenges - one was in solving the problems with the implementation and use of the solutions that have already been proposed and the other one in identifying the outstanding challenges in cancer policy.

Results

We have decided to follow the structure to develop a series of recommendations and examples of good practices at the national level by selected areas. These would be streamlined into a roadmap to support policymakers at the national and EU level in formulating their cancer policies.

Three pairs of targeted recommendations have been identified: Cancer prevention, including health promotion, implementation of the European Code Against Cancer and the reshaping and extension of cancer registriesGenomics and immunotherapy in cancerChallenges in cancer care and governance of cancer control

Conclusions

Multinational collaboration can bring about important consensual solutions, which build on the existing good practices in the countries. This can be combined well with the existing work on specific areas, carried out both internationally and nationally. Consensus building on jointly defined challenges represents a task that appears to be resolved rather pragmatically.

Key message

It is important that advance in cancer care and control are quickly analysed and that policymakers receive up-to-date recommendations to improve their policies on cancer control.
Leadership styles and job satisfaction. Results of a systematic review
Authors: Specchia M L , Cozzolino M R , Carini E , Di Pilla A , Ricciardi W , Damiani G
Published: October 2020

Background

Healthcare organizations are social systems in which human resources are generally the most important factor for the provision of care. In these contexts, leadership plays a key role in providing effective and efficient care and results in positive outcomes for professionals, patients and work environment. The aim of this review was to identify and analyze the knowledge present to date in literature concerning the correlation between leadership styles and nurses' job satisfaction.

Methods

A systematic review of the literature was carried out on Medline and CINAHL databases between June and October 2019 by using a specific search algorithm. The following inclusion criteria were set: focus on the impact of different leadership styles on nurses' job satisfaction; secondary care; nursing setting; full-text available; English or Italian language.

Results

6681 titles, 410 abstracts and 57 full texts were analyzed. The 12 selected studies considered 7 leadership styles: Transformational, Transactional, Passive-Avoidant, Laissez-Faire, Resonant, Authentic and Servant. Four studies (33%) considered only 1 style, 3 studies (25%) 2 styles, 4 studies (33%) 3 styles and only one study (9%) considered 4 styles. Transformational and Transactional styles were the most represented (75% and 67% respectively). Most of the studies conducted (88%) showed a significant correlation, both positive and negative, between the adopted Leadership style and the nurses' job satisfaction.

Conclusions

In a complex and constantly evolving context, healthcare organizations need to guarantee not only technical and professional competence, but also satisfaction as a motivational lever for health workers. It is therefore necessary to identify and fill the gaps in leadership abilities as a present and future objective in order to positively affect health professionals' job satisfaction and therefore healthcare quality indicators.

Key messages

Job satisfaction plays a key role in healthcare and nursing as a motivational lever for health workers. Leadership styles directly impact on nurses' job satisfaction which in turn affects healthcare quality and patient outcomes.
Outcome monitoring of the Austrian health targets
Authors: Griebler R , Winkler P , Antony G
Published: October 2020

Background

The ten Austrian Health Targets, developed in a Health-in-All-Policies process and adopted in 2012 with a time horizon until 2032, are monitored by a series of indicators. The (interim) results are reported regularly.

Methods

Indicators were discussed intensively with experts and defined in advance. The outcome monitoring enables to observe developments over time, to analyse differences by gender, education and region, and comparisons with other EU-countries. For each indicator an overall qualitative assessment is done. This makes monitoring very comprehensive. The challenge is to communicate the monitoring results in an easily understandable way. Therefore, besides reports and presentations further in depth-discussions about communication formats with decision makers were required.

Results

The outcome monitoring shows that there is potential for development in all areas: Between 2006 and 2014 only 25 % of the outcome-indicators developed positively. As far as equal opportunities are concerned, the most improvements were seen in gender differences, significantly less for educational differences and hardly any positive developments in regional differences. In an EU comparison, Austria performs well concerning 15 out of 35 indicators (43 %). However, for some indicators - contrary to the EU trend - no improvements can be observed.

Conclusions

The results confirm the relevance of the ten health targets and identify whole-of-society areas for action. The monitoring provides steering impulses and information enabling decision-making for politics, administration, the health target plenary, and the intersectoral working groups.

Key messages

The monitoring contributes to strategic steering, helps optimising strategy and action plans and enhancing the overall process. Stakeholder involvement is important for development of a format to communicate the results in the best comprehensible way.
Powerful Influencers: Kenyan & Zambia Religious Leaders Advocate for Family Planning
Authors: Bormet M
Published: October 2020

Faith-based organizations (FBOs) provide approximately 40% of healthcare in Kenya and 30% in Zambia. Promoting healthy families is a value at the heart of faith communities. This intervention focused on equipping and encouraging religious leaders (RLs), whose churches own and operate faith-based health facilities, to advocate for family planning (FP) within their congregations, communities, governments. This project included baseline assessments, FP sensitization, and media trainings. Religious leaders were trained through an adaptation of the AFP SMART training by ensuring culturally appropriate messaging for religious audiences were included (i.e. using scripture to discuss and develop messages on families, planning, having children, etc.). Training RLs provides an entree into government fora as culturally respected leaders in positions of power. In order for external advocacy to take place outside of church settings, it is crucial to identify how each church defines FP before meeting with external stakeholders. Creation of low-literacy terms in English and local languages that equipped RLs to interact with community members in-person (i.e. church services, weddings, funerals, community barazas, etc.) and via TV and radio shows was key in addressing myths and misconceptions. Eighty-six religious leaders from 16 denominations in Kenya and Zambia were engaged to sensitize communities and advocate with their Ministries of Health on behalf of the faith community to ensure family planning services reach communities. Equipping RLs in culturally and language appropriate contexts builds stronger advocates for healthy families and communities.

Key messages

To demonstrate how religious leaders in Kenya and Zambia are equipped to advocate for family planning from a faith perspective. Words and definitions and messengers matter in Family Planning Advocacy from a faith perspective.
How to assess health policy impacts of new generation trade agreements
Authors: Koivusalo M
Published: October 2020

Issue

Negotiation of trade agreements has become a key part of current international policy environment with the consequence of increasing concerns over impacts on public health, health protection and policy space for health. Trade agreements represent 'meta-regulation' where key impacts will be on how governments can regulate with different implications depending on existing regulatory framework within a country. Engaging with trade requires understanding how health-related arguments can be made and where they reside.

Results

This presentation discusses where and how public health advocates can engage with trade related decision-making on new generation trade agreements with focus on regulation, services and protection of investment and intellectual property rights. The innovative approach on policy space for health will overcome focus on existing standards and allows discussion on what exceptions and exclusions in trade agreements actually imply. Policy space allows analysis on impacts which may not relate to direct health outcomes, such as issues with privacy, health data, access to new technologies, and pricing of medicines. The presentation will use case examples from European Union trade agreements and will discuss politics of mandate negotiations as well as how diversions, rhetorical/empty claims and circular traps are used in in political decision-making and the extent to which and how these can be counteracted on key public health and health systems -related issues.

Lessons learned

If negotiated agreements will affect how governments can regulate in future rather than existing standards, this requires a different approach for public health researchers and advocates. The lessons learned will provide suggestions on how to approach trade policies as part of Health in All Policies and where limits and opportunities of health and sustainability impact assessments reside.

Key messages

New generation trade agreements impact on regulatory policy space. Assessing impacts of trade agreements need to go beyond impact assessments.
Processed meat eater profile in a Latin-American cohort
Authors: Ruedlinger J , Paredes F , Cid V , Huidobro A , Ferreccio C
Published: October 2020

Background

We aim to describe the prevalence, distribution and factors associated to processed meat (e.g. sausages, bacon) consumption (PMC) in a Chilean population-based cohort. This is the first study to explore this exposure in Chile.

Methods

We studied 7841 participants of the Maule Cohort, 4358 women, 3483 men aged 37 to 77 years, who answered an epidemiological survey (diet, alcohol, health, socioeconomic), had a medical examination, and provided fasting blood. We stratified them in five groups by weekly frequency of PMC from (1) none, (2) <1/week, (3) 1/week, (4) 2-4/week to (5) >5/week. We analyzed MAUCO cohort baseline data in association with PMC. We estimated Prevalence ratios (PR) with Poisson regression (age, schooling & sex adjusted) and with multinomial logistic regression we modelled PMC using group 1 as reference.

Results

High consumers were 8% (7% women, 9% men). Binge drinking was more common among participants in groups 2, 3 & 4 (Relative Risk Ratio, RRR) 1.26, 95% confidence interval (CI) 1.04-1.52; 1.28, CI 1.0-1.55 & 1.32, CI 1.08-1.6). As for diet, participants consuming red meat (>4 /week, 2.79; CI 2.13-3.66), butter/cream (>4 times/week, 2.07; CI 1.62-2.64), sugary snacks/sweets (≥1 time/day, 2.26; 1.81-2.83) and sugary drinks (≥1 time/day, 1.85; CI 1.48-2.31) were more likely to be in the high PMC group. Cardiovascular diseases (1.72, 1.17-2.52) and large waist circumference (1.01, 1.0 - 1.02) were more common in participants in the high PMC group.

Conclusions

High consumption of processed meat is accompanied by other behaviors and risk factors that can potentiate adverse health effects in this population.

Key messages

In Chile, little attention has been given to potential health impacts of processed meat. This work aims to bring focus to this issue. High processed meat consumption was associated with other non-healthy foods, risky alcohol intake and unhealthy weight, all of which can increase the risk of chronic diseases.
Passive suicidal ideation in older adults from 12 European countries
Authors: Lee S
Published: October 2020

Background

Highest rates of suicide in older adults are a major public health hazard in many industrialized societies. The current study aims to provide an overview of demographic, psycho-social, and health-related risks for suicidal ideation among European older adults.

Methods

Study builds on secondary data analysis using data drawn from the Survey of Health, Aging and Retirement in Europe (SHARE) wave 7.0. A total sample of 33,719 older adults, aged 65+, were analyzed. Risk factors included socio-demographic variables, psychological distress, and health conditions. Descriptive statistics and ANOVA were used to provide information about prevalence and demographic correlates of passive suicidal ideation. Standardized significant path coefficients were examined between predicting variables and suicidal ideation.

Results

Suicide ideation was at its highest level among older adults from France, Poland, Spain, Germany, Italy, and Belgium. Highest rates of suicidal ideation were found among widowed, but also married couples, aged between 65 and 70, and older adults living in rural area. Results also reinforced that elderly's suicidal ideation was universally associated with poor health, limited access to activities, a lack of social contact, and worse subjective well-being. The path from depression to suicidal ideation was significant with a larger magnitude.

Conclusions

Passive suicidal ideation is a critical mental health index. In order to diminish the likelihood of suicide thoughts and acts in older adults, national policy should integrate psychological services in elderly care to help older adults better cope with depressive symptoms and long-term health problems. Local government should foster local support groups for elderly and promote suicide prevention-intervention program for those elderly seeking help.
Vaccines in support of globalisation: the current status of coronavirus and future implementation challenges
Authors: Pavlakis G
Published: October 2020

The key aspects to be discussed by this panelist are the role of vaccines in the support of globalization and the life style of global village, and the current status of coronavirus vaccines and future challenges of implementation.

The present pandemic made obvious to the general public the central role of vaccines in the support of modern lifestyle. It also revealed the possibility (or near certainty) of totally new pandemics, for which the world had ample warnings, with AIDS, Ebola, Zika, Lassa, Hendra, SARS, MERS, and many other emerging viruses threatening the world order. We entered a new era of pandemics as the last areas of the planet become members of the global village and due to climate change. Therefore, the world will go through a period of new threats that become more intense due several factors. These include the climate change, the dense co-habitation of large number of humans and their food, the rapid, cheap and universal travel, and the public health rules and traditions. Vaccines and immunotherapies are among the best and most cost-effective ways to address new and established epidemic threats.

Work on a safe and effective coronavirus vaccines progresses with unprecedented speed and substantial resources. Vaccines may be available in a year, and this time could be shortened if emergency approval of a safe but not fully tested vaccine is allowed. Production ability is expected to address the challenge of high demand, but the worrisome signals are that, even under the conditions of a spreading epidemic, a sector of the population is not convinced about the remedies, whether they are public health measures, or preventive vaccines. Addressing the reasons for the denial of scientific method and conclusions is a major priority for everybody involved in the fight of this and other epidemics. Scientific progress and implementation of the results is the only way forward.
Design epistemology as innovation in public health research
Authors: Estany A
Published: October 2020

The idea of design has reached our theories of epistemology: a field that, at first glance, seems to be quite far removed from the analysis of practical situations. However, we should bear in mind that epistemology has shifted from an a priori perspective to a naturalized one, in the sense that we cannot engage in epistemology without taking into account the empirical results of science when it comes to configuring methodological models. The objective is to explore just how far design epistemology (DE) can be adopted as a methodological framework for research in biomedical sciences and in some of their applications as public health. To this end, we will analyze different approaches to DE and related terms and expressions such as “design thinking”, “design theory” and “designedly ways of knowing”. One of the issues that we need to address is precisely the polysemy that exists in the field of design, related to many different concepts. Thus, it seems impossible not to engage in a certain amount of conceptual analysis before we can embark on the study of the role of DE in public health research. Another of the questions that we will consider here is where to place biomedical sciences within the field of academic knowledge and research. The disciplines involved in this field of research range from biology to medicine and also to the applications of these knowledges, as in the case of public health. We will examine some of the definitions provided by international organizations and we will locate public health within the framework of healthcare services and their organization. Finally, we will see how DE can offer proposals and solutions to the challenges that a phenomenon as complex as public health currently faces. That is, we will measure up DE proposals against public health research needs.
Knowledge of stroke and attitude to activate emergency medical services: a cross-sectional study
Authors: Carrossa E , Favaretto A , De Luca C , Boscaro G , Gregori D , Martinato M
Published: October 2020

Introduction

Acute brain stroke is one of the leading causes of death in the world. Translating knowledge of stroke warning signs into appropriate actions is critical to decrease prehospital delay, meaning that the population has a key role in reducing the hospitalization time of affected people.

Objectives

The aim is to understand in which percentage adults (318, without healthcare formation) would react properly by calling emergency medical services (EMS) when presented with hypothetical stroke-related scenarios and how the knowledge of warning signs is related to different factors.

Methods

a population-based online survey was carried out in a random sample of Italian adults in June-July 2019. The STAT (Stroke Action Test) questionnaire included 21 close-ended questions focused on stroke symptoms. The prevalence and distribution of stroke knowledge was examined.

Results

445 subjects were enrolled; the mean age was 36 years. The average score was 10,9/21, and only 21% had an optimal performance. Higher scores are associated with female gender and older age (p < 0,01). When a situation described a single stroke sign, only the 15% recognized the importance to call EMS. The sign/symptom mainly recognized (57%) was “trouble speaking”.

Conclusions

this study provides data describing stroke knowledge among Italian adults; despite its limitations, the study shows that people hesitate to call EMS when stroke signs and symptoms are presented. The knowledge of stroke signs/symptoms remains lower than the heart attack ones. As expected, it would be 'useful to give proper information and training on stroke signs/symptoms' but also it is fundamental to emphasize that stroke is a medical emergency and needs a fast hospital admission.

Key messages

There is a lack of knowledge in stroke emergency shall raise community awareness about the need of education campaigns. It is important to improve stroke's signs and symptoms in order to have better prognosis.
The economic consequences of decriminalizing sex work in Washington, DC
Authors: Srsic A , Dubas-Jakóbczyk K , Kocot E
Published: October 2020

Background

Under repressive policies, sex workers are at disproportionate risk for violence, HIV, and sexually transmitted infections. The decriminalization of sex work between consenting adults provides increased social and health benefits to both sex workers and society at large. Proponents of decriminalization advocate for these added human rights; this is the first research that complements these arguments with a quantifiable economic impact of such a law and a model for future calculations. This research assesses the potential economic consequences of decriminalizing sex work in the District of Columbia (DC) in three areas: (1) income tax revenue, (2) criminal justice system savings, and (3) health sector savings (violence, HIV, gonorrhea, and herpes).

Methods

An economic model is developed and utilized based on a literature review and records from local and federal agencies.

Results

The decriminalization of sex work in DC will generate $5,191.61 per sex worker and $2.49 per client annually, plus an additional $20,118.17 in total criminal justice system savings a year. Per sex worker, $4,906.39 will be gained from income tax revenue, and $285.46 will be generated through health sector savings. Per client, decriminalization will generate $0.05, $2.28, and $0.16 from HIV, gonorrhea, and herpes respectively, or $8,311.67 annually after considering the total number of clients. Estimates are reported in 2019 US dollars.

Conclusions

The potential economic impact of decriminalizing sex work is widespread. In DC, this legislation should be implemented to not only promote the city's human rights but also economic growth. The presented model, in conjunction with a rights-based foundation, should urgently be used by advocates, sex workers, decision-makers, and other researchers.

Key messages

An economic analysis of a policy to decriminalize sex work in DC demonstrates its widespread economic impact across sectors. The economic model generated in this research should be utilized in other regions to strengthen human rights-based arguments in support of these policies.
Can the timing of hospitalization influence the outcomes of childbirth?
Authors: Kundisova L , Nante N , Bardelli S , Lorenzini C , Alaimo L
Published: October 2020

Background

The timing of hospitalization of pregnant females could influence the outcomes of both mother and the baby. The aim of this study was to analyze impact of coming to hospital too early on outcomes of childbirth.

Methods

A cross-sectional study was conducted in the birth center of Siena University hospital (Italy), all women that gave birth between 2017 and 2019 were included. Examined variables were: age, parity, gestational age: GA(weeks), Bishop score at admission: BS (0-13; >9 high possibility of spontaneous delivery), time to delivery:TTD (min), labor duration:LD (min), n°of interventions (induction, amniorhexis, augmentation):NI, type of birth (vaginal/caesarean section: CS/operational birth: OB), laceration, episiotomy, hematic loss: HL (ml), skin to skin:StS and initiation of breastfeeding: BR (yes/no). The females that came too early were identified if TTD >75° percentile. Analysis was performed with Stata 12.

Results

A total of 758 females were analyzed (32.0±5.2years), 55.5% multiparous, average GA was 39.6±1weeks, average BS was 7.2±2.5; 63% had BS <9. Average TTD was 376.7±318.5min; 23% came too early (TTD 865.6±244), more likely primiparous (OR 3.9) and those with higher GA (OR 1.2). A negative correlation between BS and TTD was observed (Rho=-0.6), females with BS <9 had higher probability to have prolonged TTD (OR10.8). Ninety-three% had vaginal birth, 6%CS, 1%OB Average LD was 169.1±145 min, average NI was 0.64±0.93, 78% had lacerations, 7.2% episiotomy. Average HL was 299.3±282.7ml. Females with prolonged TTD had higher NI (1.2 ±1 vs 0.4±0.6), higher probability of CS (OR 3), OB (OR4.5) and episiotomy (OR3.6), lower probability of StS and BR (OR 0.9), prolonged LD (299±184 vs. 120±102) and major HL (347.2±301.8 vs 284.9±275.4).

Conclusions

Our study showed an association between too early arrival to hospital and adverse maternal and fetal outcomes in terms of higher use of medical interventions that can interfere with physiological processes.

Key messages

The risk of arriving too early in hospital for labor was higher in primiparous and in those with higher gestational age. The too early arrival in hospital for labor was associated within increased use of medical interventions, interfering with physiological processes.
Monitoring knowledge translation and the impact of HI in European countries
Authors: Delnord M , Abboud L A , Van Oyen H
Published: October 2020

Background

National health information systems (NHIS) report on the health of populations, the determinants of health and service use within countries. Thus far, the evaluation of HIS has largely focused on data production, and less on their impact in policy and practice. This entails that there is no standardized framework for monitoring the uptake of Health Information (HI) in the healthcare system.

Methods

An international Delphi with public health professionals and policy makers allowed reaching agreement on criteria for monitoring the impact of NHIS, based on four domains: (a) Health information Evidence Quality, (b) HIS Responsiveness, (c) Stakeholder Engagement, and (d) Knowledge Integration. Next, we pretested the Index among participating countries in the European Joint Action on Health Information.

Results

Over 130 public health professionals and policy-makers from 38 countries participated in the Delphi. The panel reached agreement on 30 criteria to monitor the impact of HIS in policy and practice; these constitute the HI-Impact Index. Eight countries participated in pretesting the HI-Impact Index. InfAct country representative found the HIS evaluation tool user friendly and the time needed to fill the evaluation acceptable. They noted however the need to refine the auditing guidelines further as to who shall be responsible for conducting the evaluation (i.e. multistakeholder evaluation vs. single governing body), and which type of population health data sources should be included as part of the evaluation.

Conclusions

Knowledge translation facilitates the implementation of practices that will benefit population health and well-being. The HI-Impact Index addresses a growing demand for more transparency and accountability in the use of HI and scientific evidence within countries. Next steps consist in further piloting the HI-Impact Index for use in specific health areas (i.e. maternal and child health, cancer, antimicrobial resistance).
“Falling off the radar” – uninsured Chinese patients in Austria
Authors: Seidler Y , Novak-Zezula S , Trummer U
Published: October 2020

Background

Even in European welfare states with close to universal health coverage, undocumented migrants often fail to gain access to essential health services, falling “off the radar” of public health policies. Our study aimed to explore the characteristics, health problems and health care needs of undocumented Chinese migrants in Vienna, Austria.

Methods

We analysed anonymized medical records of 74 Chinese migrants utilizing the services of a non-governmental organization (NGO) providing primary care to uninsured people in Vienna during a three-month period. The medical data was then coded using the International Classification of Primary Care, 2nd version.

Results

At present, NGOs in Austria fill major gaps in access to health services that exist in the public system. The most frequently diagnosed health problems in the study sample were cardiovascular and metabolic-related diseases (hypertension and diabetes) and there was a high burden of multiple chronic non-communicable diseases.

Conclusions

NGOs can play a vital role in providing health services to underserved groups, and they can also contribute to public health surveillance and the collection of high-quality data.
The specialised health workforce matters: how to adapt the WHO National Health Workforce Accounts
Authors: Kuhlmann E , Ernst D , Jablonka A
Published: October 2020

Background

The importance of a sustainable health workforce is increasingly recognised. However, the specialised heath workforce remains marginal in health workforce planning, policy and research. This paper aims to improve the integration of small specialised professional groups in health workforce governance and to critically assess existing tools, using Germany and rheumatology physicians as a case study.

Methods

A qualitative explorative approach was applied, which draws on a scoping review of the literature, public statistics and expert information. The National Health Workforce Accounts (NHWA) and the WHO 'AAAQ' framework served as guidance to assess workforce development in rheumatology in Germany.

Results

On average physician density is high in Germany, yet access to specialised care may be seriously delayed and services may not be accessible to all patients; e.g. currently only half of the patients with spondyloarthritis are treated by a rheumatologist which impacts quality of care. An estimated 850 to 1000 additional rheumatologists are needed to ensure early diagnoses and treatment and prevent long-term health damage. However, shortage will even reinforce in future: annual inflow of newly registered rheumatologists over recent years did not exceed 30 to 50 physicians and young rheumatologists more often prefer part-time work.

Conclusions

Specialised health professions with small numbers and long duration of training face specific challenges to create a sustainable workforce. This calls for (1) greater investment in education and training, (2) greater attention to qualitative indicators, such as assess and prevention measurements like early diagnosis, and (3) a dynamic health workforce approach to respond to both new technologies/ treatments and changing preferences of the health professionals, like part-time work.

Key messages

Integrating the specialised health workforce in health workforce governance is important to improve prevention, quality and access to care. NHWA may be aligned to qualitative indicators and prevention policies to respond more effectively to future population needs.