bluuebunny/crossref_metadata_2025 huggingface dataset:
Acceptability and utilization of evidence for decision-making: helminth control, sub-Saharan Africa
Authors: Pearson G , D’Souza B , Fergus C
Published: November 2019

Background

Public health practitioners are part of a larger global health system, responsible for the implementation of disease-specific health interventions, largely financed by external actors through a variety of mechanisms. Emphasis on the need for evidence-informed decision-making often includes rhetoric for the localization of this approach to assist practitioners in resource allocation. In practice its realisation is challenging. This research addresses the following: what are the evidence needs of local public health practitioners? How acceptable are, for example, modeled disease estimates? What decision-making processes occur for implementation? How do evidence and decision-making processes interact?

Methods

Examining mass drug administration (MDA) for schistosomiasis and soil-transmitted helminths (STH) in the African Great Lakes region (Kenya, Malawi, Tanzania and Uganda), we use qualitative approaches to collect data, including a series of 4 workshops with district- and national-level MoH personnel, key informant interviews and e-survey questionnaires from a sample of relevant local and global organisations including NGOs. Coded data are analysed thematically.

Results

Preliminary results provide important insights into the sources, types and format of evidence which local public health practitioners find acceptable and useful for decision-making when implementing disease control measures.

Conclusions

A variety of factors influence local level decision-making with implications for policy aimed at disease control, such as MDA for schistosomiasis and STH, and global health policy and practice more broadly. First, processes of decision-making at different localities are heterogenous and evidence needs of local practitioners are not well understood. Second, evidence development and knowledge synthesis on health interventions are rarely linked in ways that feedback and respond to local implementation, decision-making practices and public health practitioners.

Key messages

Evidence needs of local public health practitioners need to be accounted for when producing and synthesising evidence. Multiple factors influence local level decision-making with implications for public health disease control policy.
The impact of social media misused and behavior problems among adolescent in Thailand
Authors: O-ium P
Published: November 2019

Introduction

Recent increased in the prevalence of behavioral problems among young adults has coincided with the raised of popularity of Internet usage including handheld technologies, electronic game and social media among adolescent. However, these information in Thailand is limited. Therefore, this study aim to investigate the association between social media misused and behavioral problems among adolescent in Thailand.

Materials and methods

The cross-sectional was conducted at 7 public schools located in Central of Thailand in December 2018. The behavioral problems were assessed by using the Strengths and Difficulties Questionnaire (SDQ). Multiple logistic regression analysis was used to identify the risk factors associated with the behavioral problems.

Results

The total of 1,118 were enrolled into the study. The prevalence of the social media misused and behavioral problems were 85% and 18.5%, respectively. The prevalence of the subscale behavioral problems were peer problem (21%), emotional problem (19%), hyperactivities (10%) and conduct problem (4%). The independent factors associated with behavioral problems were include sleep problem (OR = 3.3, 95%CI = 2.1-5.1), prosocial behavior (OR = 0.4, 95%CI =0.3-0.6), social media misused (OR = 2.5, 95%CI =1.7-3.8), Facebook addiction (OR = 1.8, 95%CI = 1.1-3.0) and Line addiction (OR = 2.8, 95%CI = 1.5-5.1).

Conclusions

This study highlight the association between the social media misused and high prevalence of behavioral problems among adolescent in Thailand. The information of the potential risk factors should be inform to all stakeholders for develop and implement the effective intervention for young adults in Thailand.

Key messages

The association between the social media misused and high prevalence of behavioral problems among adolescent in Thailand. The information of the potential risk factors should be informed to develop and implement the effective intervention for young adults in Thailand.
Association of maternal developmental disorder traits with child maltreatment
Authors: Fujiwara T
Published: November 2019

Objective

Maternal mental disorders are known risk factors for child mistreatment. However, little is known about the involvement of maternal developmental disorder traits. The aim of this study was to examine maternal traits related to Pervasive Developmental Disorder (PDD) and Attention Deficit Hyperactivity Disorder (ADHD), and their possible association with child maltreatment.

Methods

Maternal PDD and ADHD were assessed through a self-administered questionnaire (N = 846) during mid-pregnancy using the Pervasive Developmental Disorders Autism Society Japan Rating Scale (PARS) and Adult ADHD Self-Report Scale (ASRS). The mothers completed another questionnaire on child mistreatment when the offspring was approximately 18 months of age. The associations between maternal PDD and ADHD traits and child maltreatment score were analyzed using linear regression models adjusted for covariates.

Results

Mothers who exhibited stronger PDD traits showed significantly higher child maltreatment score, even after adjustment for maternal characteristics at baseline and ADHD traits. At the same time, ADHD traits were significantly associated with child maltreatment after adjustment of covariates, although the association became non-significant after adjustment of PDD traits.

Conclusions

Mothers who showed PDD and ADHD traits during pregnancy were more likely to maltreat their children. It is essential to educate mothers with such traits with appropriate, easy-to-follow childcare instructions, preferably in simple language combined with pictorial aids.

Key messages

Maternal developmental disorder traits are risk factor of child maltreatment. Specific parenting training intervention for mothers with developmental disorders are needed.
Finding alternative roles for Traditional Birth Attendants: an experience from the south of Angola
Authors: Fattorini M , Raguzzoni G , Cuccaro C , Nante N , Quercioli C , Ileni F , Kaunawoye M C , Caresia C , Putoto G
Published: November 2019

Background

Reduction of maternal mortality ratio (MMR), a key indicator contained in the Sustainable Development Goals (SDGs), is strictly related to maternal empowerment and to an increasing access to skilled care in pregnancy, childbirth and postpartum. The WHO recommends to define alternative roles for Traditional Birth Attendants (TBAs) in the transition from birth with TBAs to birth with Skilled Birth Attendants (SBAs), in particular in countries where maternal care services still do not meet recommended standards.

Objectives

In 2018, the Italian Non-Governmental Organization Doctors with Africa CUAMM and the District Health Department of Ombadja (a 350000 inhabitants district in Cunene province, south of Angola) started a three-year multifaceted project to support and strengthen local health services. Aim of this work is to describe the first six months of an implemented activity involving 120 local TBAs, identified and trained to perform basic educational talks in the district territory regarding topical issues of mother and child health. TBAs were also engaged in the referral of pregnant women to health facilities with SBAs.

Results

From June to November 2018, TBAs performed 2272 talks about maternal and child health issues: healthy pregnancy (551 talks, 24.3%), nutrition (404, 17.8%) and malaria (370, 16.3%) were the most debated topics. The total of women’s presences during these educational talks was 57504, and 15379 of them (26.7%) were pregnant. TBAs referred to health facilities 226 pregnant women for a delivery assisted by SBAs.

Conclusions

Angolan estimated MMR in 2015 was 477/100000 live births: therefore, more efforts should be made to contribute to the achievement of 2030 SDGs target of 70/100000 globally. Moreover, the country percentage of deliveries assisted by SBAs is less than 50%. Promoting alternative roles for TBAs into the mother and child health framework could represent an effective way to improve maternal and neonatal outcomes.

Key messages

According to the World Health Organization, defining alternative roles for traditional birth attendants could represent an effective way to support the health of women and children. Traditional Birth Attendants can play an important role in providing basic health education and in the “referral chain” of pregnant women to health facilities with skilled birth attendants.
Cosmetics and pregnancy: perception of health risk by health professionals and pregnant women
Authors: Sauvant-Rochat M , Kouamé N G L , Fradet M R , Marie C , Bernard L , Maquinghen S , Lémery D , Vendittelli F
Published: November 2019

Contex

During pregnancy, the International Federation of Gyneco-Obstetrics (FIGO) advocates limiting exposure to chemicals present in everyday products, including cosmetics. However, both pregnant women (PW) and perinatal health professionals (PHP) know still poorly this source of exposure. AIMS: The PERICOS-Quali Study aims to identify the perception of the risk associated with the use of cosmetics during pregnancy by PHP and PW.

Methodology

A qualitative survey was conducted among PHP and PW in Auvergne (France). The data were collected by semi-structured interviews with the PHP and by focus group with the PW, until saturation of the speeches, by an experienced investigator, with an interview guide. The interviews were recorded, the verbatim was transcribed and subjected to a thematic analysis with the N-VIVO v11 software.

Results

12 PHP (5 midwives, 2 general practitioners and 5 obstetricians) and 24 PW were interviewed. PHP and PW considered cosmetics as wellness and body-care products. Furthermore PHP noted that during pregnancy women used more often organic products, moisturizers or anti-stretch marks, and reduced the use of perfumes, deodorants. In the absence of recommandations based on Evidence-Based Medecine, PHP and PW considered the risk related to cosmetics as not major. The PHP (especially midwives) reported giving advice to comfort the pregnant women; their positioning was not to prohibit the use of cosmetics during pregnancy. PW did not identify PHP as reliable sources of information about cosmetics.

Conclusions

PHP are seeking for tools to help them to better advice PW. And PW would like also to have pertinent advices about cosmetics to make a reasoned choice.

Key messages

Health education about use of cosmetics during pregnancy is necessary. Pregnant women and health professionals don’t perceive health risk linked to cosmetics.
Evaluation of the oral health of pregnant women in prenatal consultations in Côte d’Ivoire
Authors: Meless G D , Guinan J C , Sangaré A D , Traoré M , Amangoua A A , Danho-Da V , Datté A S , Samba M , Bakayoko-Ly R
Published: November 2019

Background

Despite the proven links between oral health status and adverse pregnancy outcomes, oral examination is not systematically integrated into prenatal examinations in Côte d’Ivoire. In addition, there are no prevention messages specifically targeted at pregnant women. Objective: To assess the oral health of pregnant women in Côte d’Ivoire.

Methods

A cross-sectional survey was conducted at the Maternal and Child Health Department of the National Public Health Institute in Abidjan. The data collected were: age, education level, marital status, source of income, trimester of pregnancy, gestational age, oral hygiene habits and the fact that they whether or not received oral health information. A clinical examination was conducted to assess oral hygiene (OHIS index), periodontal condition (CPI index), dental condition (DMFT index), as well as the presence of epulis, erosion or dental mobility. Frequencies and counts were calculated for the different variables in the study.

Results

A total of 207 women were observed. The age range was 15 to 44 years with 14.0% under 19 years old. The majority were in couple (76.8%), multi-gesture (77.3%), and more than half had no education (52.2%) or source of income (56.0%); 50.7% snacked between meals and 33.3% had vomiting. They brushed their teeth at least twice a day (70.0%) and had not changed their oral hygiene habits (77.3%) during this pregnancy. Only 3.4% had information on oral health conditions during pregnancy. The frequency of caries was 75.4%, dental erosions 13.0%, gingivitis 57.0%, periodontitis 6.8% and epulis 3.4%.

Conclusions

The results suggest the integration of systematic dental consultation into prenatal consultations in order permit the sensitization of these women, screening and management of their oral conditions.

Key messages

Oral diseases of pregnant women are a reality without their knowledge in Côte d’Ivoire. A systematic dental visit is essential during prenatal consultations in Côte d’Ivoire.
Participatory research in the field of early childhood interventions - how can this be achieved?
Authors: Weigl M , Marbler C , Haas S , Laskowski W
Published: November 2019

The Austrian early childhood interventions programme (“Frühe Hilfen”) is an overall concept of health promotion measures, aiming to support families depending on their individual needs to create good conditions for raising their children. This should contribute to long-term health of the children. The manifold effects of this complex intervention on the families are to be investigated in the future. To do so, a research concept shall be developed using a participatory research approach. A selective literature search was carried out to identify concrete recommendations for participatory research and previous experiences on the participation of parents. Based on these results, semi-structured interviews and group discussions with families were carried out. According to literature, parents have rarely been used as co-researchers. Our experiences show that access to families in burdened life circumstances is possible via the low-threshold structures of our early childhood interventions programme. In 2018, 21 families participated in interviews and group discussions. The latter method is particularly well suited for obtaining targeted information from families and building trust for long-term cooperation. Still, the stressful family situations make it difficult to participate in research activities. Therefore, specific conditions are required. At present, it is clear that it is feasible to involve families and test research methods together. The next step, an equal cooperation of families and researchers, shall be achieved by the use of a research group. A small group started in Spring 2019, eventually being involved in the implementation of some methods during fall 2019. Whether families are willing to participate continuously for a long time in research activities remains unclear, so far.

Key messages

Participatory research with families in stressful situations needs time and patience as well as specific conditions, but it is possible. Participation of the target group in the planning phase of further research can lead to relevant insights for programme improvements.
Maternal characteristics in childhood and smoking at age of 15: Findings from the Czech Republic
Authors: Pikhartova J , Andryskova L , Pikhart H
Published: November 2019

Objective

Maternal employment has been shown to influence child’s health, cognitive and behavioural outcomes. There is only a limited number of studies in Central Europe investigating the impact of parental employment on the uptake of smoking in children. The aim of this work is to look at the influence of maternal employment over the whole period of childhood of their children, and other maternal social and behavioural characteristics on the uptake of smoking among children aged 15 in the Czech part of European Longitudinal Study of Pregnancy and Childhood (ELSPAC).

Methods

There were 971 individuals with complete data on smoking behaviour at age of 15, pattern of maternal employment between child ages 3 and 15, and other covariates including gender, maternal age, maternal education and marital status, household income, and maternal smoking. Logistic regression was used to analyse the association between maternal employment and smoking in their children.

Results

37% of adolescents aged 15 years reported trying cigarette more than once. Preliminary results suggest that those whose mothers were in paid work were more likely to be smoking at age 15. When stratified by maternal education, the association between maternal employment and smoking was particularly strong among university educated mothers. Those whose mothers were never employed were 4-times more likely to smoke than those whose mothers were continuously employed between ages 3 and 15. The association between maternal employment and smoking was weaker in other strata of maternal education.

Conclusions

Although maternal employment might have only a limited role in development of smoking behaviour of young adolescents, the association between maternal employment during childhood and young adolescents’ smoking does exist and is particularly strong among those with university educated mothers.

Key messages

More than one third of Czech adolescents self-reported repeated attempt to smoke cigarettes or cigars or pipe at the beginning of new Millennium. Data suggest that adolescents whose mothers had not been employed were more likely to smoke than those of employed mothers.
Vaccination of classmates for an immunosuppressed child’s protection in a school in the LHA Roma 1
Authors: Marino M , Spadea A , Furia G , Frisicale E M , Michelazzo M B , Valentini F , Consoli C , Forte U , Bracci S , Goletti M
Published: November 2019

Issue/problem

One of the duty of a State is to guarantee the protection of the health of all citizens, both safeguarding the sick individual needing care and protecting the healthy individual. An important objective of the vaccination prevention programs is to protect people most at risk of contracting infections because of their health conditions.

Description of the problem

In April 2019 the District 14 of Local Health Autority Roma 1 was asked by a father of an immunosuppressed child (6 years old), worried about infectious diseases, to verify the safeness of his child school attendance (the first class of primary school). First, a list of the class mates was asked to the school, in order to check their vaccination status by interrogating the web based regional vaccination register. Then, the District asked to the school to plan a meeting with classmates’ parents and teachers, in order to inform about the importance of a complete immunization both for the classmates and the immunosuppressed child protection.

Results

Preliminary results show that, among 18 classmates, 77.8% had full vaccination coverage for the second dose measles and fourth dose whooping cough (not mandatory for children aged less than 7 years), 22.2% were immunized for chicken pox. Among the parents attending the meeting, 15 agreed to complete their children vaccination cycle, all the teachers agreed to undergo whooping cough and chicken pox vaccination in order to allow a safe school attendance to the immunosuppressed child. Parents and teachers were given an appointment in a vaccination center for the week following the meeting.

Lessons

It is important to promote a real ’vaccination culture’ starting from the school, in order to develop greater citizenship awareness about the potential of vaccinations and to contrast fake news and ignorance leading to dangerous prejudices.

Key messages

The active collaboration between institutions (sanitary and school) allows, through the integration between different competences, to achieve health objectives to protect the community. Talking to pupils’ parents about infectious diseases and their prevention makes it possible to increase knowledge and therefore awareness of the importance of adult and children health protection.
Identifying binge-eating disorders in obese young people living in vulnerable areas of Marseille
Authors: Pinto S , Rotily M , Dany L , Négre V , Galinier A
Published: November 2019

Background

While anxiety, depression and self-esteem have been identified as contributors to obesity, binge-eating disorder (BED) also requires attention to avoid worsening obesity. However, handling obese young people living in vulnerable neighbourhoods is rather difficult both in terms of psychosocial representations of obesity and the poor care offer. The objective of our exploratory research is to study the impact of a dedicated multidisciplinary management program on anxiety and depression of obese young adolescents presenting with, or not, a binge-eating disorder.

Methods

Twelve patients (7 girls, 5 boys; mean age: 12.8 +/-1.3 years, range: 11-17) participated so far in this ongoing study. The mean body mass index was 36.5 +/- 7.2 (range: 27-53.4) for the group. They were all residents of vulnerable neighbourhoods of Marseille (France). They were evaluated at inclusion and 3 months after the 6-weeks program with the following self-questionnaires: Adolescent Binge Eating Disorder scale (ADO-BEDS), Hospital Anxiety Depression (HAD), 6-item Kutcher Adolescent Depression Scale (KADS-6), Self-esteem Measurement Scale for Adolescent (EMESA).

Results

So far, only 3 patients were evaluated pre- and post-management. For two patients with ADO-BEDS scores at inclusion and post-management showing the presence of a BED, the KADS-6 and EMESA (general and physical appearance items) scores improved at 3 months. The remaining patient, without any depression signs at both inclusion and after 3 months, experienced a decreased self-esteem while a BED, not assessed at inclusion, was clearly revealed at 3 months. BMI did not change from pre- to post-management.

Conclusions

Our clinical impression is that participating to the management program failed, at least for our first patients, to make them engage in a psychiatric/psychological therapy. Nevertheless, the program contributed to provide a motivating support system allowing them and their parents to become involved in their care.

Key messages

A multidisciplinary management program could potentially have a beneficial impact on depression and self-esteem in obese young adolescents presenting with a binge-eating disorder. The management program seemed to provide a motivating support system allowing obese young adolescents living in vulnerable neighbourhoods, and their parents, to become involved in their care.
Trends in physical activity and overweight among adolescents and their parents in Russian population
Authors: Denisova D , Scherbakova L , Berezovikova I
Published: November 2019

Background

Unhealthy lifestyle, including physical inactivity and overweight, typically begins in adolescence. Familial aggregation of the factors aggravates the predictive risk. During the 1990s Russian population has been exposed to major political, economic and social changes.

Methods

Seven cross-sectional surveys of representative samples of school children aged 14-18 in 1989-2019 were carried out in Novosibirsk. Total sample was 4677 (45% males). To define overweight in adolescents the sex- and age-specific BMI cut-offs of the IOTF were used. Information about parents physical activity (<150 min/week), height and weight was obtained by mail questionnaire. Parents overweight registered if BMI≥25.

Results

Levels of low physical activity in adolescents were stably high during all the period in boys (49-55%) and girls (83-73%) with a rising trend in recent years. In 2009 average amounts of weekly screen time were 18 hours in boys and 15 hours in girls, In 2019 - 35 and 33 hours respectively. Their parents had low levels of physical activity: 2,5 hrs/w in men and 1,5 hrs/w in women without any trends. The prevalence of overweight among adolescents during the 30-year period showed U-curve characteristic with significant decreasing (4,0%) at the end of 90s and rising since 2003 particularly in boys (17.6% in 2019, P < 0,01). Overweight prevalence among parents was high: from 25% in 1989 to 38% in 2019 (P < 0,05) and from 32% in 1989 to 28% in 2019 among fathers and mothers respectively. Familial associations between parents and children were found for overweight but not for levels of physical activity.

Conclusions

Levels of physical activity in Siberian adolescents and their parents were low during 30-year period. Trends in the prevalence of overweight in this groups were differed. Familial aggregation of overweight indicates necessity of preventive actions at a family level.

Supported by grant No. 19-013-00800 of RFBR.

Key messages

Levels of physical activity in Siberian adolescents and their parents were low during 30-year period. Trends in the prevalence of overweight in adolescents and their parents were differed: the shaped curve in children and linear - in parents. However familial associations of overweight were found.
Beyond the diabetes epidemic – a public health challenge
Authors: Cuschieri S , Mamo J
Published: November 2019

Introduction

Various factors pertain to the development of type 2 diabetes (T2DM). While exploring the risk factors and links to T2DM at a population level, certain unexpected relationships were identified in a cross-sectional study representative of adults in Malta (2014-6).

Methods

A health examination study was conducted among a representative sample of adults in Malta (18-70 years). Validated medical data was collected for fasting glucose (FBG) and lipid profiles. Self-reported Diabetes (T2DM) and a fasting glucose level(FBG) >7mmol/L were labelled as T2DM. Regression analysis explored T2DM and components of the lipid profile while adjusting for confounding factors (age, gender, residing locality, education level, employment status, use of statins). Separate analysis compared non-diabetic and metabolically healthy sub-populations as a reference to T2DM population respectively.

Results

A negative association was found between an increase in LDL-C (OR: 0.76 CI 95% 0.65 - 0.89, p = <0.01) and a diagnosis of T2DM when the non-diabetic sub-population was the reference category. A negative association was also present for total cholesterol (OR: 0.79 CI 95% 0.69 - 0.91, p = <0.01). On the contrary, a positive relationship with T2DM was present for both parameters (LDL-C OR: 4.15 CI 95%: 2.79 - 6.17, p = <0.01 and Total cholesterol OR: 2.45 CI 95%: 1.84 - 3.33, p = <0.01) when the metabolic healthy sub-population was the reference category. Similar results were present after adjusting for confounders.

Conclusions

Individuals without an established diagnosis of T2DM but with a biochemical and/or anthropometric abnormality are still at metabolic risk. Hence, preventive policies targeting metabolically at-risk persons at the community level need to be explored in order to target the health inequalities gap.

Key messages

Health inequalities are present in individuals with normoglycemia but with biochemical and/or anthropometric abnormality. Preventive policies need to target metabolically unhealthy population irrelevant of their glucose status.
Lifestyle related risk factors of coronary artery disease patients in Nepal
Authors: Gaudel P , Kaunonen M , Neupane S , Joronen K , Koivisto A M , Rantanen A
Published: November 2019

Background

Coronary Artery Disease (CAD) is a leading cause of morbidity and mortality and serious health problem worldwide. It is important to observe lifestyle related risk factors in patients with CAD for effective planning and implementation of secondary prevention strategies. The aim of this study is to describe the prevalence of lifestyle related risk factor habits among the patients with CAD.

Methods

A cross-sectional study was conducted among CAD patients in a tertiary care national heart center in Kathmandu, Nepal. Six lifestyle related factors (dietary habit, smoking, alcohol consumption, stress, physical activity and adherence to medication) and Body Mass Index were used as the risk factors of CAD in this study. Individual face-to-face structured interview was conducted using culturally validated standard instruments. The descriptive characteristics were presented as frequencies and percentages for categorical variables and as mean ± standard deviation (SD) or median and interquartile range (IQR) otherwise.

Results

In total study population, the mean age of the patients was 59.9 years and 76% were male. Patients having any three risk factors out of seven were the most common (36%) followed by two risk factors (25%) and four risk factors (22%). About 32% of study population were current smokers, whereas 29% were former smokers. Likewise, 31% of the total were physically inactive. Majority of the patients 95% had perceived moderate stress.

Conclusions

The prevalence of lifestyle related risk factors is high among CAD patients in study population. Combination of any three lifestyle related risk factors were the most common among patients. Therefore, studies focusing on lifestyle risk factor modification intervention on particular groups is recommended.

Key messages

Need to improve awareness about lifestyle related risk factors among CAD patients. Highlight the importance of lifestyle counselling.
Ketoacidosis admission rate in type 2 diabetes mellitus patients from 2006 to 2015 in Abruzzo, Italy
Authors: Meo F , Di Giovanni P , Cedrone F , Di Martino G , Scampoli P , Staniscia T
Published: November 2019

Background

Diabetic ketoacidosis (DKA) is a potentially life-threatening but largely preventable complication of diabetes and is associated with significant health care utilization and expenditure. Whereas DKA is mostly related to type 1 diabetes, over recent years an increasing number of hospital admissions for DKA have been reported in adult subjects with type 2 diabetes. The aim of this study was to assess the trend of hospitalizations for DKA in adult patients with type 2 diabetes and its associated factors.

Methods

A retrospective cross-sectional study was performed from 2006 to 2015 in Abruzzo region. Data were collected from hospital discharge records (HDRs) of type 2 diabetes adult patients with either primary or secondary diagnosis for DKA. Age-adjusted hospitalization rates were computed by gender and standardized on the regional population in 2006. A logistic regression model was implemented using the presence of DKA as dependent variable.

Results

We identified 160,366 HDRs with type 2 diabetes. Out of them, 1611 (1.00%) were due to DKA. The hospitalization rates for DKA increased both for male +115.9 and female +142.8%, from 2006 to 2015. Associated factors of DKA were age ranging from 18 to 44 (adjOR=4.17; 95%CI:3.27-4.31), uncontrolled diabetes (adjOR=1.79; 95%CI:1.60-2.01), trauma (adjOR=1.38; 95%CI:1.13-1.68), any infection (adjOR=1.68; 95%CI:1.22-.2.33), liver disease (adjOR=1.29; 95%CI:1.09-1.53), fluid and electrolyte disorders (adjOR=2.09; 95%CI:1.09-1.53), psychosis (adjOR=1.69; 95%CI:1.25-2.30).

Conclusions

Hospitalization trends for DKA in adult patients with type 2 diabetes have been increasing and are associated with some comorbidities. Early screening, appropriate patients, families and communities education remain an important aspect of preventing an acute diabetic complication such as DKA. Moreover, multimorbidity complicates the disease management and remains an open challenge for public health.

Key messages

This study addresses hospitalizations for DKA in adult patients with type 2 diabetes, an occurrence increasing worldwide for unclear reasons. For preventing DKA in type 2 diabetes patients, it is useful taking into consideration the known trigger factors, but it is also worthwhile improving the management of comorbidities in outpatients.
Management of COPD in Anhui Province: compliance with GOLD guidelines
Authors: He S , Zha L , Li Y , Yang G , Zhou Y , Villanueva E V
Published: November 2019

Background

COPD is a major public health concern of global scope, especially in China. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines are international and national recommendations to manage COPD. Little is known about level of adherence of COPD management among exacerbated COPD inpatients to GOLD guidelines in China. The current study aimed to compare COPD management (vaccination and treatment of COPD exacerbation) among hospitalized patients in Anhui Province with GOLD guidelines and identify risk factors influencing vaccination coverage and guideline-compliant care.

Methods

A retrospective clinical audit of medical records was conducted in a hospital in Anhui Province in China, involving 1132 patients hospitalized with exacerbated COPD within 2016-2017. Descriptive analysis was conducted to evaluate compliance to GOLD recommendations (version 2017). Logistic regression was conducted to detect the association between guideline-consistent care and variables.

Results

Extreme deficiency in the vaccination coverage (0%) was found. Regarding pharmacological management, some adherence to prescribing short-acting bronchodilators timely (43.5%) and prescribing long-acting bronchodilators (55.0%) was observed; nonetheless, only 26.1% of patients received systemic corticosteroids or antibiotics for the recommended duration (<7 days) and only 17.0% did not receive methylxanthines. Age, education level, occupational status and disease severity were independently associated with guideline-consistent treatment.

Conclusions

The implementation of GOLD recommendations in Anhui Province was unsatisfactory. Interventions to increase the vaccination coverage among COPD patients and to optimize the treatment of COPD exacerbation are imperative, requiring efforts at the hospital and policy levels.

Key messages

This is the first clinical audit study investigating the COPD management among hospitalized COPD patients in China. The implementation of GOLD recommendations in Anhui Province was unsatisfactory.
The analytic hierarchy process as a holistic model for the assessment of dialysis centres
Authors: Kaziuk M B , Kosiba W
Published: November 2019

Introduction

Haemodialysis is one of the methods of renal replacement therapy which is most frequently used in Poland and in the world in patients with chronic and acute renal failure. Purpose: An attempt was made to have patients undergoing regular haemodialysis assess the results of activity of dialysis centres.

Methods

64 patients (30 women, 34 men, age: 50.2 +/- 11.9 years) undergoing dialysis therapy in three selected dialysis centres in Poland were included in the study. A questionnaire correlated with the analytic hierarchy process (AHP) was employed for the assessment. The dialysis centres were assessed by the patients in the context of availability of services, communication between the medical staff and the patient and the treatment used. Two sub-criteria were connected with each criterion, for which significance (priorities) indicating a dependent impact on the assessment of the quality of dialysis centres was calculated.

Results

From amongst four domains of the assessment of dialysis centres, the patients rated medical care and nursing care the highest (w = 0.386), where medical care had significance equal to 0.455, and nursing care had significance equal to = 0.545. The next important part of the assessment of dialysis centres was communication between the medical staff and the patient (w = 0.321) and the treatment used (haemodialysis) (w = 0.155). Availability of services had the lowest significance (w = 0.138), including performance of examinations for kidney transplant and medical transport for haemodialysis.

Conclusions

The assessment of dialysis centres using the AHP method should be part of the therapeutic process where one needs to emphasise the role of the patient in chronic nephrological care which translates into the quality of services provided by dialysis centres.

Key messages

The assessment of dialysis centres using the AHP method should be part of the therapeutic process. The patient’s role and its good assessment in the treatment process is very important.
Nutritional and Rehabilitation goals in Acquired Brain Injury patients: a new decannulation protocol
Authors: d’Angelo M , Michelutti A , Biasutti E , Quattrin R , Brusaferro S
Published: November 2019

Background

One of the first goals for the rehabilitation of patients with Acquired Brain Injury (ABI) is the removal of the tracheocannula: the aim is not only to allow respiration by airways and reduce respiratory complications but also to obtain rehabilitation of dysphagia and verbal communication: for this purpose from July 2017 the ABI unit of the Institute of Physical and Rehabilitation Medicine ’Gervasutta” adopted a new decannulation protocol, recommended by the Italian Society of Physical Medicine and Rehabilitation (SIMFER).

Methods

Clinical data of ABI patients with tracheal cannula from May 2014 were collected as both process and outcome indicators associated with the adoption of the new protocol were defined. ABI patients were therefore divided into two groups depending on whether they were treated with or without the new procedure. Data have been processed with “Simple Interactive Statistical Analysis” (SISA) software.

Results

A sample of 141 patients with tracheocannula was analyzed; among these 57 (40.4%) were treated with the new decannulation protocol. No statistical significant differences were found between the two groups in terms of systemic or respiratory complications, Functional Independence Measure (FIM) or Level of Cognitive Functioning (LCF) at the entrance as well as for both the time (days) between entry or tracheotomy and decannulation. However decannulation rate is significantly higher when the new protocol is applied (OR = 1.8; 95% CI = 1.2- 9.8; p = 0.01) as the time (days) between entry and oral feeding resumption (p < 0.001; 95% CI = -10 - -34 days).

Conclusions

The introduction of the new protocol has allowed the achievement of both nutritional and rehabilitation goals with a significantly faster oral feeding resumption and an increase of decannulation rate and. Further efforts are needed to support its use in the future, with the aim of further improving of either process or outcome performances.

Key messages

Promising prospects for the decannulation of patients with acquired brain injury. Achievement of nutritional and rehabilitation goals.
Factors associated with patient activation in a Turkish population with diabetes and/or hypertension
Authors: Sakarya S , Kulak E , Gorcin Karaketir S , Dogan E , Akman M , Cifcili S , Gunes E D , Ormeci L
Published: November 2019

Background

Patient activation (PA), which is known to improve health outcomes, describes the knowledge, skills and confidence a person has in managing their own health care. We investigated the extent of PA and associated factors in adults with diabetes (DM) and/or hypertension (HT). This study is the first in Turkey evaluating PA, using the Patient Activation Measure (PAM) scale. The results of the study provide practitioners with information on the characteristics of patients who need support to increase their activation.

Methods

We conducted this cross-sectional study in 14 Family Health Centers in Istanbul. The participants were DM and/or HT patients. A questionnaire including the PAM, questions on patient characteristics, life style behaviors, healthcare utilization and health status was applied to 431 patients. Based on PAM score, patients were classified into two activation levels: level 1-2 (poor activation) and level 3-4 (good activation). χ2, t-test and logistic regression (LR) analysis were used. LR analysis was performed for all participants and for women and men separately.

Results

Of 431 patients (mean age: 63.6), 65% were women; 45% had a poor activation level (PAL). Based on LR analysis; low socioeconomic status (SES) (OR = 1.6; 95% CI:1.01-2.5), being illiterate (OR = 3.9, 95% CI: 1.5-10.7), being primary school graduate (OR = 2.1, 95% CI:1.1-4.2), lack of adult vaccination (OR = 1.9, 95% CI:1.1-3.1), higher BMI (OR = 1.1, 95% CI: 1.09-1.13) and worse self-reported health (OR = 1.2, 95% CI: 1.1-1.3) were factors associated with low PAL. The latter was associated with low PAL for both sexes; high BMI was an associated factor only among women, while low SES and lack of vaccination were factors only in men.

Conclusions

Almost half of the patients had low activation level in our sample. Associated factors may serve as the basis for the development of interventions needed to enhance activation for patients with DM/HT.

Key messages

Low patient activation is associated with low level of education, low SES, high BMI, lack of vaccination and worse self-reported health. The factors associated with patient activation vary by gender. A qualitative study with patients having different levels of activation would be useful to understand the underlying motivations.
Breast Cancer burden in Tunisia: situation in 2017 and projections by 2030
Authors: Cherif A , Dhaouadi S , Osman M , Hsairi M
Published: November 2019

Introduction

Despite advances in diagnostic and treatment of cancer, burden of this disease is increasing worldwide. Breast Cancer is one of the leading cancers and major causes of death among female worldwide. The aim of this study was to describe the breast cancer burden in Tunisia in terms of disability adjusted life years (DALY) in 2017 and to perform projections by 2030.

Methods

DALYs for cancer are the sum of years of potential life lost due to premature mortality (Years Life Lost (YLL) and the years lived with disability (YLD). We used epidemiological data (incidence rate, death rate, DALY, YLL and YLD) estimated by the Institute for Health Metrics and Evaluation (IHME). Demographic data were provided by the National institute of statistics. The projection of DALYs for breast cancer through 2030 was performed by a Poisson Regression analysis with Age -Period -Cohort (APC) using SPSS software while using IHME estimated data for the period 1990-2017.

Results

In 2017, breast cancer incidence and mortality rate among females in Tunisia were 50.17/100000 persons years and 14.04/100000 persons years respectively. Breast cancer DALY values were 25145 (438 /100000 persons years). The percentage of YLL in DALYS was 92.4%. Without effective interventions, the number of DALYs due to breast cancer would reach 40071 in 2030 with a standardized rate of 507/100000 persons years (IC 95% = [501/100000 to 514/100000]. The number of YLL predicted will attain 36457 with a standardized rate of 461/100000 persons years.

Conclusions

The burden of breast cancer among Tunisian women in 2017 is relatively high mainly due to the lack of screening program. There is an urgent need of a strong plan of early detection and appropriate care.

Key messages

Burden of breast cancer among women in 2017 is high and will rise in 2030. Renforcing screening program is urgent.
High resolution data to estimate effects of pollution and temperatures in Italy: The BEEP project
Authors: Cernigliaro A , Stafoggia M , Gariazzo C , Viegi G , de’ Donato F , Scondotto S
Published: November 2019

Introduction

The BEEP (Big data in Environmental and occupational Epidemiology) project aims to estimate the health effects of several environmental risk factors on the Italian population at municipal level. Specific focus is being devoted to the risk of hospitalizations and mortality at the national level and within the major metropolitan areas and the risk of occupational injuries.

Results

Particulate matter concentrations and mean air temperatures (1x1km) were estimated using satellite data, land use data and observed data from monitoring networks for the Italian domain for 5 yrs. The short-term effects of PM and air temperature on morbidity and mortality only in Sicily, Lazio, Puglia, Emilia Romagna and Piedmont, were assessed. The preliminary results show: an increased risk of natural mortality, cardiovascular and respiratory hospitalizations in subjects exposed to PM, as well as higher effects in the older age on respiratory admissions in males. Associations were found also in the municipalities of medium and low level of urbanization; a non-linear relationship was found with increased risk of hospitalizations and mortality for high and low temperatures. Effects of heat were observed on respiratory hospital admissions, and effects of cold temperature were found on both cardiovascular and respiratory admissions. Larger effects of heat and cold were estimated in the elderly and in municipalities at a higher urbanization; a larger risk of occupational accidents in the construction industry for hot temperatures and in the transport sector for cold temperatures were evidenced.

Conclusions

Results of the BEEP project provide innovative findings on the health risks of environmental exposures in both urban and rural settings and provide decision makers with important information for the definition of prevention measures.

Acknowledgement: The BEEP project is supported by INAIL and is described in the website: www.progettobeep.it.

Key messages

Using Big Data (environmental and Health) is possible estimate the effect of pollution and temperature on mortality and morbidity among the residents in cities or rural areas. Pollutant increase the risk on natural mortality and cardiovascular and respiratory hospitalizations.
Implementation of a nationwide Waterborne disease outbreak surveillance system in France
Authors: Mouly D , Pouey J , Galey C , Chesneau J , Jones G , De Valk H
Published: November 2019

Issue/Problem

Waterborne disease outbreaks (WBDOs) remain a public health issue in developed countries, but to date the surveillance of WBDOs in France, mainly based on the voluntary reporting of clusters of acute gastrointestinal infections (AGIs) by general practitioners to health authorities, is characterized by low sensitivity. In this context an integrated and automatized approach to detect WBDO relying on the identification of clusters of medicalized AGI cases sharing a same drinking water networks (DWN) was developed, evaluated in a simulation study and tested in a pilot study by the French National Public Health Agency.

Description of the problem

Two national big databases support the detection process of potential WBDO: health insurance database for AGI, ministry of health database for drinking water system information. Each detected outbreak has to be investigated regarding environmental criteria during the days before the onset of the outbreak: results on bacterial water monitoring, weather (e.g. heavy rain), technical incidents in the drinking water system (e.g. chlorination breakdown, alarm malfunction). To evaluate the strength of association with drinking water, four levels are proposed based on epidemiological and environmental criteria (strong, probable, possible and undetermined).

Results

The WBDO surveillance system has been implemented in all french departments since start of 2019 and support by the ministry of health. A web-application, named “EpiGEH”, was also developed to support the surveillance system. A retrospective study between 2010 and 2017 has detected almost 300 to 550 potential WBDO per year while voluntary reporting identified 2 to 3 WBDO each year during the same period.

Lessons

Such a specific surveillance system should help health authorities to formulate recommendations regarding the management of drinking water systems and propose appropriate preventive measures, in accordance with the water safety plans.

Key messages

The WBDO surveillance system based from health insurance databases constitutes a daily surveillance system of drinking water quality. The WBDO surveillance system should drastically improve the detection sensitivity by a factor 100 to 200 compared to voluntary reporting.