bluuebunny/crossref_metadata_2025 huggingface dataset:
Genotoxic damage in workers exposed to pigment-grade titanium dioxide (TiO2) during paint production
Authors: Bonetta S a , Macrì M , Acito M , Bonetta S i , Castrignanò G , Fenoglio I , Bergamaschi E , Carraro E
Published: October 2020

TiO2 is broadly used in a wide range of applications such as photocatalysis, pigments and additives. Despite the promising commercial opportunities, different studies have shown that TiO2 can induce oxidative stress, inflammatory and genotoxic effects. The European Union has classified certain titanium dioxide powders and powder mixtures containing TiO2 as a suspected carcinogen (Category 2) via inhalation. Considering that the information about the potential adverse health effects of TiO2 in occupational environment are still scarce and controversial, the purpose of the study was to investigate the genotoxic effects and oxidative stress in workers exposed to TiO2 during paint production.

Biomarkers of early effect (DNA damage and micronuclei) were evaluated in the buccal cells and salivary leucocytes of 30 workers (15 production workers and 15 controls). To collect information about personal details, occupational history, medication, smoking, diet, physical activity, a questionnaire was administered to all workers. Personal and area monitoring have been carried out to determine airborne inhalable and respirable fraction of TiO2; a NanoTracer was used to monitor the presence of ultrafine particles.

In spite of the low mass concentration and a mild percentage of nanoparticles, filter deposited TiO2 was in sub-micron size, thus accounting for its respirability. Preliminary results on salivary leucocytes show a slight higher DNA damage in the exposed workers as compared to the controls.

Whereas biomarker assessment is still in progress, these preliminary findings show that workers are exposed to low but measurable levels of TiO2 able to induce a mild genotoxic damage. A combined approach using both personal exposure assessment and biomonitoring can improve the risk assessment in occupational settings in which TiO2 is handled. Moreover, this also suggest to take precautionary measure during specific activities and operational phases thus decreasing the risks for worker.

Key messages

The results of the present study may promote effective risk management practices in occupational environments that uses TiO2. The results obtained suggest the introduction of activities and operational phases with lower risks for the worker.
Human factor of The Use Of Robotic Technology In Pediatric neurorehabilitation
Authors: Gilardi F , De Falco F , Casasanta D , Andellini M , Gazzellini S , Petrarca M , Castelli E , Raponi M , Magnavita N , Zaffina S
Published: October 2020

Robotic technology represents a new rehabilitation opportunity that, with an approach similar to a video game, increases the motivation to treat children and seems able to activate brain plasticity, at the basis of the functional recovery due to its interactivity and intensity of the training experience. Literature reports few studies that evaluate the ergonomic aspects of devices for neurorehabilitation, from the point of view of both the operator and the patient. Similar studies in the pediatric field are rare. This study aims to evaluate the response of workers, patients and their parents to this new technology.

The study considered the response of the workers (perception of the workload, satisfaction), that of the patients and their parents (expectations, benefits) by comparing the answers to subjective questionnaires of those who made use of the new technology with those who used the traditional technique. Twelve workers, 46 patients and 47 parents were enrolled in the study.

Significant differences were recorded in the total workload score of operators who use the robotic technology compared to the traditional therapy (p < 0.001). Patients reported a higher quality of life and satisfaction after the use of robotic neurorehabilitation therapy. The parents of patients undergoing robotic therapy have moderately higher expectations and satisfaction than those undergoing traditional therapy. None of the parameters checked was worse in the new therapeutic technique than in the traditional one.

In this pilot study, the robotic neurorehabilitation technique induced an increase in the expectations and satisfaction of patients and their parents. As is frequent in the introduction of new technologies, workers perceived a greater workload. Subsequent studies are needed to verify the results achieved. This study is being developed in an Italian pediatric hospital, with the collaboration and funding of the Italian Ministry of Health, coauthor of this study.

Key messages

Robotic therapy presents a higher workload compared to traditional one. Robotic technique induced an increase in quality of life of patients and in expectations and satisfaction of their parents.
Work absence and multimorbidity in Portugal: results from the 1st National Health Examination Survey
Authors: Matos J , Matias Dias C , Félix A
Published: October 2020

Background

Studies on the impact of patients with multimorbidity in the absence of work indicate that the number and type of chronic diseases may increase absenteeism and that the risk of absence from work is higher in people with two or more chronic diseases. This study analyzed the association between multimorbidity and greater frequency and duration of work absence in the portuguese population between the ages of 25 and 65 during 2015.

Methods

This is an epidemiological, observational, cross-sectional study with an analytical component that has its source of information from the 1st National Health Examination Survey. The study analyzed univariate, bivariate and multivariate variables under study. A multivariate logistic regression model was constructed.

Results

The prevalence of absenteeism was 55,1%. Education showed an association with absence of work (p = 0,0157), as well as professional activity (p = 0,0086). It wasn't possible to verify association between the presence of chronic diseases (p = 0,9358) or the presence of multimorbidity (p = 0,4309) with absence of work. The prevalence of multimorbidity was 31,8%. There was association between age (p < 0,0001), education (p < 0,001) and yield (p = 0,0009) and multimorbidity. There is no increase in the number of days of absence from work due to the increase in the number of chronic diseases. In the optimized logistic regression model the only variables that demonstrated association with the variable labor absence were age (p = 0,0391) and education (0,0089).

Conclusions

The scientific evidence generated will contribute to the current discussion on the need for the health and social security system to develop policies to patients with multimorbidity.

Key messages

The prevalence of absenteeism and multimorbidity in Portugal was respectively 55,1% and 31,8%. In the optimized model age and education demonstrated association with the variable labor absence.
Are the academic institutions of public health in Africa able to prepare graduates for UHC?
Authors: Ledibane N R T , Wolvaardt J E , Voyi K V V
Published: October 2020

Background

Current challenges facing the overburdened health systems warrant a review of public health training and development of the health workforce in Africa within the context of the envisioned global goal of universal health coverage (UHC). The integral components informing the relevance of public health education in the setting of UHC comprises the academic workforce, curriculum and institutional capacity. The aim of the study is to assess the capacity of African academic institutions of public health to address the requirements for UHC and sustainable development goals (SDGs), and to develop an institutional self-evaluation tool as part of an accreditation system.

Methods

Study design: this multi-phase study will employ mixed methods. Study setting: academic institutions of public health at Anglophone, Lusophone, Francophone countries in Africa. Study population: Heads/Deans of Departments/Schools of Public Health, education experts and/or content experts. Various sampling techniques will be employed per study phase. Phase 1 will use an electronic, secure, validated self-administered questionnaire and/or interview schedule to determine the academic workforce demographic characteristics, curriculum characteristics and institutional characteristics. Phase 2 will comprise a Delphi study to determine the items for a self-evaluation tool that will be piloted in Phase 3. STATA version 15 will be used for quantitative analysis and ATLAS.ti software for qualitative analysis.

Conclusions

The study findings are envisaged to produce a self-evaluation tool that can guide these institutions to align academic training and development in pursuit of realising the SDGs and implementation of UHC. Furthermore, the study findings will be shared with the Association of Schools of Public Health in Africa (ASPHA); and used to strengthen the regional institution capacities and networks of public health.

Key messages

Thorough systematic planning and preparation in public health education is vital for the successful implementation of UHC. The African region does not have an accreditation system for academic institutions of public health; and while this role can be fulfilled by ASPHA, evaluation tools are needed.
Implementation of Adolescent and Youth Friendly Health Services in a Rural Region of Tigray, Ethiopia
Authors: Cigliano F , Gebremichael H , Teklay K , Ayele B , Negash D , Gebreslassie F , Gebretnsae H , Hadgu T , Fascendini M
Published: October 2020

Background

The Eastern Zone of the Tigray (Ethiopia) is inhabited by 900,000 people, 34% of whom are adolescents and young people between 10-24 years of age, who are easily influenced by the social and family context and are exposed to significant health risks associated with the earliness of their approach to sexual life. Nonetheless, even if a complete health service is available, the quality is often undermined by the lack of the so-called Youth-Friendly Corners (high confidentiality spaces reserved for young people), promoted internationally by WHO. The aim of the study is to evaluate the effectiveness of the program established in this zone by the Medical Collaboration Committee regarding the creation of friendly health services for adolescent and youth people (AYFHS), especially built for sex education, family planning, abortion, and sexual transmitted infection (STI) prevention.

Methods

The program “#Youths at the centre!” was implemented in 20 rural health centers in the North-East Tigray on April 2018. Data from these AYFHS were collected monthly in aggregated indicators, separated for gender and age class. Use of AYFHS during 2018 and 2019 was assessed using percentage and 95% confidence interval and the period of implementation of the project and centers' characteristics were analyzed to investigate differences in AYFHS utilization.

Results

A monthly mean of 6.04% (6.01% - 6.08%) of adolescents and young people utilized an AYHFS for any of its service; 0.03% accessed for counseling, diagnosis, and treatment of STI, 1.31% for family planning, 1.09% for delivery, and 0.05% for legal abortion. Lower level of utilization was observed in more remote health centers, despite a general increase across the study period.

Conclusions

This project shows the importance of providing friendly facilities dedicated to adolescents and youth in low-income countries, in order to increment the utilization of health services from this population, especially in rural contexts.

Key messages

In rural areas of Africa the risks associated with poor health information of young people and the earliness of the beginning of sexual life remain a Public Health problem. In low income countries the presence of high confidentially spaces for young people in the Health Services could increase their utilization, especially for sex education and family planning.
Experience report about the regional internship of the UFSM's medicine course in Brazil
Authors: Silva M N , Maas M A , Barreto D A , Costa M V P , Vargas D S , Farenzena G J
Published: October 2020

Background

The Regional Internship (RI) is an extension project provided by the Federal University of Santa Maria (Brazil) that gives the medicine students a real experience of how the Primary Health Care (PHC) works, offering them a chance to grow as professionals, gaining self-trust and autonomy while being supervised by the preceptors. The cities where the program operates are small and they suffer with lack of high-quality healthcare professionals, which makes this internship also important for these communities. Worldwide, mainly in developing countries, the deficiency of proper PHC is a problem that can be attenuated by this proposal of introducing updated doctors eager to improve their skills and benefit the society.

Objective

The aim of the present study is to report, through the interns' exposition, how the internship was capable of contributing for the life and formation of the medicine student.

Results

Based on an extension project that gives the students an opportunity of a more embracing experience with the community, it is possible to notice the importance of the extension on the curricular complementation. Moreover, with the interaction between students and community, the knowledge exchange and the experience with different cultures benefit and contribute to the medical formation of these students, as well as in the population health context.

Conclusions

This is a part of the portfolio delivered by an academic: 'At the end of the two months of Regional Internship I have the sensation of mission accomplished and satisfaction. The experience offered by this phase of the course is incomparable, I feel more secure, more autonomous, it's like the growth that was in a constant acceleration before now suffered an exponential improve.'

Key messages

The benefits of Regional Internship cannot be evaluated only by quantitative indicators, but also by the individual experiences lived by interns, preceptors and a general community. After the internship period, academics conclude that they feel more confident and encouraged to face the challenges of medical life.
Is obligation the proper policy to increase immunization coverage? A comparison of 16 OECD countries
Authors: Thomas R , Charrier L , Bo M , Zotti C M
Published: October 2020

Issue

Globally, between 2016 and 2018, low vaccination coverage rates led to an increase of measles cases and related deaths. The WHO European Region reported a total of 83540 measles cases and 74 deaths in 2018, versus the 5273 cases and 13 deaths in 2016, with WHO global estimates reporting 333445 cases. In order to contrast these outbreaks, the European Vaccine Action Plan 2015-2020 states that the ideal immunization coverage for measles must be 95%. Although, this rate is not reached and maintained everywhere, thus one debated solution is to adopt compulsory vaccination plans rather than recommended. Our aim is to analyse if compulsory policies may increase coverage.

Description

Between 2014 and 2018 3 countries (Italy, France and California) changed their measles vaccination policies from recommended to compulsory to fight low immunization. In order to describe the effects of this action, we compared their measles coverage rates in 2014 and 2018 together with other 12 OECD countries rates who adopt both recommendation and obligation, evaluating the trend variations. Data were collected from OECD's, WHO's and Ministries of Health's documents.

Results

After the introduction of obligation, California (91% in 2014; 95% in 2018) and Italy (87% to 94%) coverage rates increased, while France's reduced (91% to 90%). Of other mandatory countries, only Australia showed an increase (94% to 95%); totally, 37.5% mandatory countries showed an increase among the analysed ones. Through the same period, 50% of analysed countries with recommendation maintained rates over 95%, 10% increased, while 40% remained below 95%.

Lessons

Even if mandatory vaccinations can lead to a sharp increase of coverage in a short time in response to emergency situations, the causes and solutions of hesitancy are more complex than law enforcement. Some countries without obligation show rates constantly above 95% throughout the years, demonstrating that other measures can be taken to fight low immunization.

Key messages

Apart from estimates coming from WHO and OECD, it is difficult to find extensive and official information about the application and the effectiveness of vaccination policies in different countries. Low immunization coverage rates rely on different causes (information, religion, personal beliefs, trust), thus the application of mandatory vaccination alone is not sufficient to fight hesitancy.
Eliminating measles: contributions by the Oporto international vaccination centre from 2017 to 2018
Authors: Malcata F , Saldanha G , Henriques M
Published: October 2020

Background

Measles is one of world's most contagious diseases and a growing population mobility has promoted its spreading. Outbreaks have been recorded around the world, despite public health efforts. Measles spreads faster among clusters of unvaccinated people. In 2018, World Health Organization reported 328629 cases worldwide, of which 82596 in Europe and 171 in Portugal- 93% of the latter were imported. Portugal had one of the highest proportions of childhood immunization coverage for Measles-Mumps-Rubella (MMR): 98% for first dose, and 96-98% for second. The main goal of this study was to describe the contribution of the Oporto International Vaccination Centre (OIVC), one of the largest in Portugal, to measles elimination.

Methods

Cross-sectional study, with analysis of vaccination records from travelers vaccinated for MMR at OIVC between January 2017 and December 2018.

Results

OIVC held 5426 pre-travel consultations in 2017, and 6192 in 2018. 535 travelers got the MMR vaccine (57.2% males). Mean age was 44.3±10.9 [1;76] years. Among travelers aged 12 months-18 years (n = 10), 50% were inoculated with the first dose and 50% with the second. Regarding adult travelers (n = 525), 71.6% received the first dose; 24.2% the second; 2.9% the third dose; and 1.3% received both first and second (within > 4 weeks).

Conclusions

The substantial number of inoculated vaccines in OIVC resulted from checking traveler's vaccination immunity status in all pre-travel consultations; this routine practice aimed at reducing the risk of importing/exporting measles. The second dose of MMR was justified by the diversity of travelers who came to OIVC, and to whom such inoculation was indicated: health professionals, humanitarian travelers, and workers in airlines and cruises. The third dose was given due to loss of measles serologic immunity. These measures are important to implement the recommendations of the Measles National Elimination Program, while contributing to global public health.

Key messages

This is an original study on the contribution of international vaccination centers to reduce the number of imported/exported cases and to eliminate measles - which is a global public health issue. At a global level, measles has a large disease burden. Therefore, it is essential to take every opportunity, including pre-travel consultations, to vaccinate people.
Barriers to the access to hepatitis B diagnosis and prevention in Madagascar: a qualitative approach
Authors: Darsot A , Mattern C , Shimakawa Y , Giles-Vernick T , Pourette D
Published: October 2020

Background

The overall seroprevalence of HBsAg is estimated at 6.9% in adults in Madagascar. The most frequently used means of prevention remain screening and vaccination, but their implementation encounters structural and individual difficulties. An anthropological study was conducted in Madagascar in 2018-2019 in order to identify the care pathways of people with chronic HBV infection and the barriers to the vaccination, screening, and care.

Methods

Semi-directive interviews were conducted with twenty patients known to be chronically infected with HBV and three hepato-gastroenterologists at the central hospital in Antananarivo.

Results

None of the patients voluntarily got tested for HBV. Only two patients had known that there is a vaccine against this infection before they got the diagnosis of hepatitis B, and both were medical students. Patients' lack of knowledge about hepatitis B before the diagnosis (name of the disease, modes of transmission, signs, treatment, and prevention) influenced the therapeutic choice. For 16 patients, screening and vaccination of their entourage remained problematic; they do not have the financial resources for the screening and vaccination of their relatives. Moreover, it was difficult for them to make their relatives understand the interest of being screened and vaccinated because patients' entourages do not feel sick. To break the transmission, some patients prefer unofficial prevention methods. The significant costs related to medical follow-up (medical examinations and treatments) are entirely at the patient's own expense.

Conclusions

The low political commitment to hepatitis B in Madagascar leads to the inexistence of care policy and specific actions in terms of prevention. These results underline the urgency of developing a national plan and better communication strategies for the prevention of this infection in Madagascar.

Key messages

This study highlights the lack of knowledge about hepatitis B and the difficulties in access to care and vaccination. Priority is to develop a communication tool to raise the awareness about hepatitis B.
Herd immunity communication counters detrimental effects of selective vaccination mandates
Authors: Sprengholz P , Betsch C
Published: October 2020

Low vaccine uptake results in regular outbreaks of severe diseases, such as measles. Selective mandates, e.g. making measles vaccination mandatory (as currently implemented in Germany), could represent a viable solution to the problem. However, prior research has shown that making only some vaccinations mandatory while leaving the rest to voluntary decisions can result in psychological reactance (anger) and decreased uptake for voluntary vaccines. Since communicating the concept of herd immunity has been shown to increase the willingness to vaccinate, we assessed whether it can buffer such reactance effects. A total of 576 participants completed a preregistered 2 (policy: selective mandate vs. voluntary decision) × 2 (communication: herd immunity explained yes vs. no) factorial online experiment. In a first scenario, the concept of herd immunity was either introduced or not and vaccination was either mandatory or voluntary, depending on condition. The dependent variable was the intention to vaccinate in the second scenario where vaccination was always voluntary. Additionally, we explored the mediating role of anger between policies and intentions. Herd immunity communication generally increased vaccination intentions; selective mandates had no overall effect on intentions, and there was no interaction of the factors. However, selective mandates led to increased anger when herd immunity was not explained. This increased anger led to lower subsequent vaccination intentions. Consequently, explaining herd immunity can counter potential detrimental effects of selective mandates by preventing anger (reactance).

Key messages

When introducing selective mandates, the social benefits of herd immunity should be communicated. Otherwise, the uptake for still voluntary vaccines may decline, putting public health at risk.
Pre-post school educational intervention assessment on HPV vaccination attitudes and willingness
Authors: Costantino C , Restivo V , Trucchi C , Vella C , Sannasardo C E , Caracci F , Scarpitta F , Icardi G , Casuccio A , Vitale F
Published: October 2020

Background

In Italy, vaccination coverage against human Papilloma Virus (HPV) showed a decreasing trend during last years. Different reasons could lead to a decrease in HPV vaccination confidence, such as not taking part to school seminars on HPV infection and vaccination. A pre-post intervention study was conducted in order to assess the improvement of knowledge, attitudes and behavior on HPV-related diseases and willingness on HPV vaccination among secondary school students.

Methods

Two anonymous pre-post intervention questionnaires made up of 25 and 8 items, respectively, were administered to a representative sample of students attending secondary schools of Palermo, Italy. Between the two questionnaire administration, an educational intervention on HPV-related diseases and HPV vaccination, conducted by Public Health medical residents at the University of Palermo, was carried out.

Results

During 2017/2018 and 2018/2019 school years, a sample of 1702 students, attending 18 first-grade secondary schools of the Province of Palermo, was enrolled. Evaluating a 10-scale likert question on the willingness of the children regarding vaccination against HPV, a significant increase of the average score from 8.50 (SD ± 1.79) to 9.01 (SD ± 1.50) (p value <0.001) was observed after intervention. At the multivariate analysis, male students (adjOR 1.76; 95% CI 1.28-2.42) and students attending schools in areas with a high deprivation index (adjOR 1.25; CI 95 % 1.01-1.55), showed a lower increase in HPV vaccination willingness after the educational intervention. In addition, 188 children from 5 schools of more deprived areas, not yet immunized, were vaccinated against HPV.

Conclusions

Standardized educational interventions in the school environment could increase confidence towards HPV and other vaccinations among students. Furthermore, vaccination offer at schools could represent a fundamental strategy to increase vaccination coverage, especially in more deprived areas.

Key messages

The research confirms the effectiveness of school educational interventions in increasing HPV vaccination confidence. Vaccination offer at schools could represent a fundamental strategy to increase vaccination coverage especially in more deprived areas.
Use of Hexyon/Hexacima/Hexaxim in preterm infants in Europe
Authors: Boisnard F , Caracci F , Badzhinerov N , Dhont P , Isnardy B , Kolenc M , Krogh K , Parisi S , Puchilita M , Ralfkiaer L
Published: October 2020

Background

Worldwide 13 million babies born prematurely every year have increased susceptibility to infection and require adequate immunization. Hexavalent vaccines against diphtheria, tetanus, pertussis, poliomyelitis, hepatitis B and Haemophilus influenzae type b are standard of care in pediatric vaccination and are particularly important for preterm infants. Hexyon® is registered in Europe since April 2013.

Methods

Considering birth data from official national databases and only countries with periods of exclusive use of Hexyon from 2013-19, we estimated the total number of preterm infants (<37weeks GA) vaccinated with Hexyon.

Results

Since registration, Hexyon has been used in 23 European countries and exclusively used in the following: Austria, Feb-2017 to present; Belgium, Jul-2014 (Flanders)/Sep-2015 (Overall) to present; Bulgaria, Nov-2014 to Dec-2016; Croatia, Jan-2016 to present; Denmark, Feb-2016 to Apr-2017; Italy, Apr-2016 to present, exclusivity based on Regions; Macedonia, Oct-2015 to present; Norway, Feb-2017 to present; Romania, Apr-2015 to Dec-2017. The estimated total number of preterm infants during these periods of exclusive use is 183 000. Assuming 90% vaccination coverage, ∼164 700 preterm infants received at least 1 dose of this vaccine. From the analysis of the post-marketing safety data available to date, no new risk has been identified in preterm infants.

Conclusions

Hexyon has become a standard for hexavalent immunization in infants, regardless of the gestational age at birth. More than 90 million doses have been administered worldwide, including the estimated 164 000 preterm infants in the 9 European countries considered here. The EU Marketing Authorization granted in 2013 with no contraindication for use in preterm infants, was renewed in 2018 and the black triangle was removed confirming that the safety of Hexyon is well established. The marketing authorization holder continues to support evidence generation for use in preterm infants.

Key messages

Hexyon/Hexacima/Hexaxim has become a standard for hexavalent immunization in infants including for preterm infants (<37weeks GA); around 164 000 preterm infants in 9 European countries received it. The safety of Hexyon/Hexacima/Hexaxim is well established, no new risk has been identified in preterm infants from the analysis of the post-marketing safety data available to date.
Evaluation of vaccine knowledge, attitudes and behaviors and vaccine confidence levels in teachers
Authors: Çam C , Kılınç A , Aydoğan Gedik S , Öznur Muz F N , Önsüz M F , Metintaş S
Published: October 2020

Background

In the study, it was aimed to evaluate the attitudes and behaviors related to vaccine confidence levels of teachers who are a professional group that can lead the community about vaccination in developing countries such as Turkey.

Methods

This is a cross-sectional study conducted on 752 teachers from 21 schools in the city center of Eskisehir in the first semester of the 2020 academic year. The questionnaire included the sociodemographic characteristics, vaccine-related information, attitude and behavior questions, and the Vaccine Confidence Scale(VCS) questions. The total score that can be obtained from the VCS ranges from 0 to 80 and high scores suggests higher confidence level towards the vaccine. The cut-off of the scale was determined by ROC Analysis according to the positive attitude towards the vaccine. It was accepted that those who scored 54 and above had confidence in the vaccine. Chi-square test and logistic regression analysis were used.

Results

Of the participants, 508 (67.6%) were female and their mean age (SD) was 41.7 (8.3) years. Only 6%(45) of the teachers answered 100% of the knowledge questions correctly. 49.6%(373) of the teachers had positive attitudes towards the vaccine. The total score obtained from VCS ranged from 6 to 80, with the mean (SD) of 59 (14.1). In the study group, 43.1%(324) had confidence in the vaccines. In teachers who had paid vaccinations done on their children[OR, 95%CI: 1.96 (1.37-2.81)], answered all of the vaccine knowledge questions correctly[2.27 (1.15-4.49)] and teachers who advocate the opinion that “it is necessary for teachers to take part in the fight against anti-vaccination groups and movements”[1.82 (1.21-2.76)] were more likely to have confidence in the vaccines.

Conclusions

The vaccine knowledge levels of the teachers were low and it was seen that approximately half of them had a positive attitude towards vaccines. Teachers with vaccine confidence constituted less than half of the study group.

Key messages

Increasing the knowledge levels of the individuals may increase the confidence in the vaccines. Health policy makers should organize health education programs to increase teachers' confidence in vaccination considering the fact that they are role models of the communities.
Willingness of healthcare workers to recommend seasonal influenza vaccine to patients- Tunisia, 2019
Authors: Cherif I , Kharroubi G , Bouabid L , Gharbi A , Boukthir A , McCarron M , Ben Alaya N , Ben Salah A , Bettaieb J
Published: October 2020

Background

Most countries of the Eastern Mediterranean Region have low influenza vaccination coverage mainly among high risk groups. Advice to receive the influenza vaccine by healthcare workers (hcws) seems to be an important motivator for vaccine acceptance among patients. In this study, we aimed to describe the willingness of Tunisian hcws to recommend the seasonal influenza vaccine to patients and to assess its determinants.

Methods

A cross-sectional questionnaire-based study was conducted in Tunisian primary and secondary healthcare facilities during the 2018-2019 influenza season. A multivariate logistic regression was used to assess the factors associated with the willingness of hcws to recommend the influenza vaccine to patients.

Results

In the present study, 1231 hcws were included with a mean age of 44.5±9.3 and a sex ratio (Male/Female) equal to 0.25. Among respondents, more than three quarter (79.1%, 95% CI: [76.7-81.3]) declared their willingness to recommend the influenza vaccine to patients if available. In multivariate analysis, belief that influenza vaccine is a severe illness that may lead to death (adj.OR = 2.9, 95% CI: [1.9-4.1]) and previous influenza vaccine uptake among health professionals (adj.OR = 2.4, 95% CI: [1.5-3.9]) were independently associated with the willingness of hcws to recommend the flu vaccine to patients.

Conclusions

This study showed that hcws with a history of influenza immunization and those who were aware of influenza severity were more likely to be willing to recommend the influenza vaccine to patients. These findings should be considered in future educational programs to enhance hcws' recommendation of influenza vaccine.

Key messages

Majority of Tunisian healthcare workers declared their willingness to recommend the influenza vaccine to patients. Healthcare workers’ awareness of influenza severity and history of influenza vaccine uptake were associated with a higher willingness to recommend the flu vaccine.
Systematic review and meta-analysis of determinants associated with HPV vaccination uptake in Europe
Authors: Costantino C , Tabacchi G , Sannasardo C E , Scarpitta F , Vella C , Vitale F , Casuccio A , Restivo V
Published: October 2020

Background

Human papillomavirus (HPV) vaccines are the most important strategy to prevent HPV-related cancers and benign lesions. However, low immunization levels observed in several countries requires a deeper analysis of determinants associated with HPV vaccination uptake. Aim of the research is to identify the main determinants associated with HPV vaccination uptake among European adolescents, through a systematic literature review and meta-analysis.

Methods

The research was conducted on electronic databases including PubMed/MEDLINE and SCOPUS, identifying 1147 studies. Original articles published between 2000 and 2018 were retrieved, with restriction criteria applied to the European region and to the English language. Qualitative and quantitative studies describing the positive and negative determinants underlying vaccination uptake were analyzed. Adjusted and Crude Odds Ratios and their Confidence Intervals were extracted and included in the meta-analysis.

Results

After screening and eligibility processes, 28 articles were included in the meta-analysis. HPV vaccination uptake is significantly associated with correct information given by health-care workers, educational interventions organized at school about HPV and a gynecologist visits. Receiving information from parents and/or friends and a lack of information about HPV are significantly associated with lower vaccination adherence. Moreover, low socio-economic status and religious conviction represent additional barriers to HPV vaccination adherence.

Conclusions

One of the main future challenge for public health authorities will be the increase of HPV vaccination coverage rates. To reach this objective should be necessary to provide an unambiguous communication to general population and to promote educational interventions in the school setting. by all HCWs that play a key role in HPV vaccination recommendation (public health physicians, gynecologists, general practitioners, pediatricians).

Key messages

Health-care professionals play a key role in HPV vaccine recommendation, contributing to vaccination acceptance. Tailored and standardized educational intervention in school settings could improve knowledge and beliefs on HPV vaccines, improving adolescents and parents confidence towards vaccination.
The Knowledge and Behaviours of the Healthcare Staff Regarding Vaccine Rejection
Authors: Gokce A , Ozdemir A T , Boz G , Aslan M , Ozer A
Published: October 2020

Background

Vaccination is a cost-effective method to protect individuals from diseases and complications that might emerge due to diseases. The healthcare staff in primary healthcare services, as the primary body concerned with vaccines, are notably more likely to encounter families who reject vaccines in childhood. This study aimed to investigate the knowledge, attitudes and behaviours of the healthcare staff in primary healthcare services regarding vaccine rejection in childhood.

Methods

Conducted between July and August 2019, this study adopted a descriptive cross-sectional design. The population of the study comprised 392 healthcare staff working in primary healthcare services in Malatya City Centre. The sample size was calculated as 193, considering a 95% confidence interval and 80% power. The survey form used in the study included questions concerning sociodemographic characteristics of individuals, their views on vaccination and the views of parents regarding vaccine rejection according to the perspectives of the healthcare staff. Chi-square test was used in statistical analyses, and the significance level was set as p < 0.05.

Results

In the study group, 25.4% of the healthcare staff stated that they were hesitant about vaccines in childhood. Also, 18.2% of the individuals indicated that they were hesitant about vaccines due to the chemicals in vaccines, 14.4% were hesitant due to the pharmaceutical industry and the relationships based on self-interest and 10.5% were hesitant due to the side effects. The hesitancy level was significantly higher among those whose source of information regarding vaccines in childhood was the internet (37.0%) compared with those whose source was not the internet (21.6%) (p = 0.004).

Conclusions

One-fourth of the healthcare staff, who are supposed to be the most informed group about vaccines, were hesitant about them. Moreover, the inaccurate information acquired from the internet and social media could be increasing the hesitancy level.

Key messages

Vaccination hesitancy is high among the healthcare staff in primary healthcare services. The source of information regarding vaccination influences the hesitancy levels of individuals.
Investigating the Knowledge, Attitudes and Behaviours of Parents Regarding Vaccine Rejection
Authors: Gokce A , Yigit E , Gungor A , Aslan M , Ozer A
Published: October 2020

Background

With an escalating prevalence, vaccine rejection is one of the ten threats to global health as identified by the World Health Organization in 2019. Vaccine rejection and hesitancy can be defined as the hesitancy of individuals to get vaccinated against diseases that can be prevented by vaccination. This study aimed to investigate the knowledge, attitudes and behaviours of parents who use primary healthcare services.

Methods

Conducted between August and September 2019, this study adopted a descriptive cross-sectional design. The sample size of the study was calculated to be 378, considering a 95% confidence interval and 80% power. The survey form, the data collection tool of the study, included questions concerning sociodemographic characteristics of individuals and their knowledge, attitudes and behaviours regarding vaccination. The data were analysed on SPSS 22.0. Chi-square test was used in statistical analyses, and the significance level was set as p < 0.05.

Results

In the study group, 15.5% of the parents stated that they were hesitant about vaccines in childhood, 81.3% stated that their source of information on vaccines was healthcare staff and 28% stated that it was the internet. The hesitancy level was significantly high among those who believed that vaccines led to autism and infertility and those who did not trust pharmaceutical companies (p < 0.05). The hesitancy level regarding vaccines was significantly lower among those whose source of information was healthcare staff, whereas it was significantly higher among those whose source of information was the internet (p < 0.05).

Conclusions

Parents' beliefs that vaccines led to autism and infertility increased their hesitancy levels. The inaccurate information on the internet and social media increased their hesitancy levels. Hesitancy levels were lower among the parents who received information from healthcare staff.

Key messages

Healthcare staff should organise public trainings on vaccines to reduce the hesitancy levels of parents. Anti-vaccination statements on the internet and social media influence individuals’ vaccination behaviours.
#CoveringClimateNow: A social journalism project profiling climate and health
Authors: Williams M , Sweet M , McInerney M , Finlay S
Published: October 2020

Concerns about poor quality media reporting of climate change has led to many initiatives seeking to influence coverage. In 2019/2020, a global media collaboration was established with the aim of generating a sustained media focus on key climate-related events. This paper reports an analysis of an Australian health media organisation's contribution to the collaboration, and the opportunities this provided for public health advocates, Aboriginal and Torres Strait Islander researchers and communities, and the wider community. It presents key reflections from Croakey Health Media's contribution to the global #CoveringClimateNow collaboration, with the aim of providing practical advice to enable further such collaborations and activities in other countries. This project was run on a very small budget, and this presentation is likely to be particularly relevant for low-budget organisations and contexts.

Key messages

Poor quality media coverage of climate change has stimulated innovation. Collaboration locally and globally can convey solutions to climate change.
Urbanization and increased cases of scorpionism in Brazilian cities
Authors: Zanetta S , Germino C , Rodrigues I , Waragaia A
Published: October 2020

Introduction

Scorpionism is a growing problem in Brazil; the hot climate in most of the country makes it suitable for the proliferation in urban and domestic regions alike. The temperatures, low levels of basic sanitation and disorganized urbanization result in an perfect environment for scorpionic accidents.

Objectives

Analyze the urbanization of scorpion accidents in the State of São Paulo - SSP as a public health problem.

Methods

Observational and descriptive study with data from the National System of Notifiable Diseases - SINAN of the Department of Health of Brazil, with direct risk calculation, from the analysis of the incidence of accidents with scorpions in urban areas of SSP, in the period from 1975 to 2019.

Results

In SSP, accidents with scorpions increased 642% between the years 1975 and 2019 in the most densely urbanized nuclei: the cities of São Paulo, Guarulhos, Campinas, São Bernardo do Campo and Santo André. These cases are associated with increased mortality in children and the elderly and corresponded to 56.63% of the total accidents with venomous animals in the SSP. This increase in the occurrence of scorpionic accidents is associated with the behavior of the animal, which finds conditions for its proliferation in the urban environment facilitated by the absence of predators and becomes a relevant public health problem.

Conclusions

Urban areas have become a propitious environment to scorpions' proliferation. Urban dynamics, garbage and other urban waste displacement, human habitation, combined with deficiencies in infrastructure and basic sanitation, created the conditions for the emergence of accidents with scorpions in urban areas as a relevant public health problem with significant mortality numbers, especially vulnerable groups of elderly people and children, in the large urban centers of SSP, Brazil.

Key messages

Discuss the synanthropy and proliferation of venomous animals in urban centers. New public health challenges with the change of accidents with venomous animals from rural to urban areas.
Distribution of breast cancer and the relationship with contaminated areas in Brazil
Authors: Montanha D , Martins L , Braga A
Published: October 2020

Introduction

Breast cancer is a worldwide public health issue. The distribution of the disease presents different behavior depending on the region. In Brazil, for the triennium 2020/2022, approximately 66.28 per 100,000 new cases are expected each year, with the highest incidence in the southeast region 81.06 per 100,000. The region of this study has high mortality rates from the disease and several environmental contaminants classified as carcinogenic.

Methodology

A spatial and temporal ecological study of the breast cancer distribution in the municipalities of the Baixada Santista with secondary data from 2000 to 2011, in women 20 years or older. The cancer data of 3,233 cases were provided by the Oncocentro Foundation of São Paulo, of the contaminated areas were provided by the Technology of Environmental Sanitation Company, and the population at risk were provided by the State Data Analysis System. Standardized coefficients of annual breast cancer rates for each municipality, to characterize exposure, an indicator of contamination per municipality was constructed. Pearson's correlation was used to analyze breast cancer rates and environmental contamination rates. Cartographic sequencing to analyze the distribution and spatiotemporal evolution of outcome and exposure. Trend analysis used linear regression.

Results

The municipality of Santos presented the highest rates of the disease. Pearson's correlation was positive, with r = 0.7 (p = 0.036). Spatially, the most contaminated areas had the highest rates of breast cancer, except in one municipality. Trend analysis in eight of the nine municipalities in the region signaled an increased number of cases.

Conclusions

The study confirmed that environmental contamination interferes with the distribution of breast cancer and the temporal trend signaled an increase in the disease in eight of the nine municipalities in the region.

Key messages

Environmental Contamination. Breast Cancer.