bluuebunny/crossref_metadata_2025_split huggingface dataset:
The recent Italian vaccination law and the role of Local Health Authorities: the case of LHA Roma 1
Authors: Frisicale E M , Miceli M T , Romagnuolo M R , Agostinacchio R , Angelis F De , Gangere F , Giudiceandrea B , Rombolà A M , Spadea A , Goletti M 
Published: November 2019

Abstract

Issue/problem
The increase of vaccine hesitancy is leading to decrease vaccination coverage. In Italy, a new vaccination law was approved in July 2017 to contrast the spread of preventable infections. 10 vaccines became mandatory for children and unaccompanied foreign minors aged 0-16 and provided for free according to the national immunization schedule for each birth cohort. Being vaccinated is now required to attend schools and kindergartens even if a ban for students aged 0-6 or a fine for the other are previewed.

Description of the problem
According to the law, in Lazio Region, a web platform was realized in May 2018 in order to permit schools to update the list of their pupils. Medical doctors from LHAs had to evaluate continuously the updated lists, verifying the vaccination status of each student in order to approve their enrolment at schools or to recall parents providing counseling about vaccination.

Results
From August 2018 to March 2019 schools settled in the area of LHA Roma 1 registered 121.687 pupils (among those 105.720 pupils were also resident in the area of LHA Roma 1). After a preliminary check within data already present in the regional vaccination registry, around 30 healthcare operators, from the 6 healthcare districts of LHA Roma 1, were widely involved in order to evaluate pupils’ vaccination status. The number of evaluations decreases in the same period from 19.634 to 4921, but 4908 out of these 4921 were pupils not found in the regional vaccination registry, probably for errors in the registration of personal data such as the fiscal code. Some students’ families received vaccination counseling.

Lessons
The web platform realization was an innovative way to monitor vaccination status: it facilitates a further collaboration among schools and LHAs in order to guarantee health in community and to increase awareness about vaccinations and their benefits. A great involvement of schools and healthcare operators was observed.

Key messages
Although some problems such as pupils not found in the regional vaccination registry persist, the way of working in a collaborative way addressing community troubles is clearly traced. Technology and information systems help community services in monitoring and improving health outcomes. Their use has to be improved and promoted.
Advancement of hepatic fibrosis among general women with/without NAFLD
Authors: Ibusuki R , Shimoshikiryo I , Shimatani K , Nishimoto D , Maenohara S , Takezaki T 
Published: November 2019

Abstract

Background
Nonalcoholic fatty liver disease (NAFLD) is increasing, being prevalent at 30% of the general population worldwide. A part of NAFLD develops nonalcoholic steatohepatitis (NASH), liver cirrhosis and hepatocellular carcinoma. Hepatic fibrosis plays an important role in their pathogenesis. However, it is unclear how hepatic fibrosis is observed and advanced in NAFLD among general population. To investigate the hepatic fibrosis among general population, we prospectively observed hepatic fibrosis using serum markers.

Methods
The subjects were 228 women who participated as a part of the Japan Multi-Institutional Collaborative Cohort (J-MICC) study in Kagoshima, Japan, and were followed from 2005 to 2014. NAFLD was defined as fatty liver by abdominal ultrasonography; consuming ethanol &lt; 20 g/day; and being none hepatitis B and C carriers. NAFLD were confirmed after two-time consecutive examination, because its disappearance is ambiguous in some cases. Hepatic fibrosis was evaluated using serum M2BPGi and Type IV collagen 7s. The comparison of their changed values between groups was done using the ANOVA adjusted for age. The association between their change and related factors was done using general linear regression model.

Results
The prevalence of NAFLD was 31.6% at baseline. In the 5-year observation, the NAFLD + =&gt; NAFLD + ( ++) group was 23.7%; − +, 2.6%; + −, 7.9%; and - - (control), 65.8%. The values of M2BPGi and Type IV collagen 7s were higher in ++, -+, +- groups than controls at baseline. The change of M2BPGi values was observed in all groups, including controls, and the changed values were higher in ++ and -+ groups. Higher creatinine levels were positively associated with change of M2BPGi values. In contrast, the change of Type IV collagen 7s was not apparent.

Conclusions
This study suggested hepatic fibrosis was advanced with age among general women without NAFLD, and the presence of NAFLD enhanced hepatic fibrosis more.

Key messages
Hepatic fibrosis may be slightly developing with age among general population, and will be enhanced with fatty liver. It is important to prevent fatty liver development to control risk factors, such as obesity and metabolic syndrome, to reduce the risk of NASH, liver cirrhosis and hepatocellular carcinoma.
Risk factors for hazardous drinking in university students from South Africa and Belgium
Authors: Hal G Van , Larivière Y , Inaç Y , Hoque M 
Published: November 2019

Abstract

Background
Previous studies have associated certain risk factors with hazardous drinking in students. However, big cultural and geographical differences exist regarding alcohol use. In this study, we compare the alcohol use and hazardous drinking in Belgian (BE) and South African (SA) university students.

Methods
An online survey assessing alcohol use among university students in South Africa (University of KwaZulu-Natal) and Belgium (University of Antwerp) was conducted, using the shortened version of the Alcohol Use Disorder Identification Test (AUDIT-C). For male students a cut-off point of 5 was used for hazardous drinking and for female students a score of 4. In total, 499 students were included in the study (250 BE and 249 SA students). A comparative analysis between both universities was performed for men and women separately with a Pearson chi-square test or Mann-Whitney U test. Furthermore, the association between hazardous drinking and several exposure variables was explored using multivariable logistic regression analysis.

Results
A significant higher amount of male (94.8%) as well as female (92.4%) BE students drank alcohol in the last year compared to the male (66.2%) and female (67.8%) SA students (p &lt; 0.001). Additionally, a significant higher amount of BE students were hazardous drinkers, compared to the SA students (p &lt; 0.001). Multivariate analysis showed that male BE students were approximately five times more likely to be hazardous drinkers than male SA students (OR = 5.057, 95% CI 1.378-18.556; p = 0.015). Female BE students were over twice more likely to be hazardous drinkers than female SA students (OR = 2.371, 95% CI 0.846-6.644; p = 0.099).

Conclusions
BE students drink significantly more alcohol and a significant higher proportion of BE students were hazardous drinkers compared to SA students. Qualitative research in both groups has been conducted to get more insight into the reasons of these differences and will also be presented at the Conference.

Key messages
When studying alcohol use (disorders) in university students, it is of utmost importance to take into account the socio-cultural context. After finding quantitatively assessed differences in alcohol use (disorder) across different socio-cultural settings, it is evenly important to find out about the reasons why.
Changes in work stress among doctors in Norway from 2010 to 2019: a study based on repeated surveys
Authors: Rosta J , Aasland O G , Rø K Isaksson 
Published: November 2019

Abstract

Background
Changes in the organization of health care can influence the doctors` working conditions, which may in turn impact on doctors` perception of work stress. Since high levels of work stress can affect both the doctors’ own health and the quality of patient care, it is of importance for public health. We studied changes in work stress among Norwegian doctors from 2010 to 2018-19, and the associations of high work stress with job positions, self-rated health and sickness absence in 2018-19.

Methods
The study populations consisted of representative samples of 1,500 to 2,200 doctors working as hospital doctors, general practitioners (GPs), private practice specialists and doctors in academia. Data were drawn from nationwide repeated postal surveys in 2010, 2016 and 2018-19 in Norway. Response rates were between 67%-73%. The main outcome measure was perception of work stress as measured by the validated short form of the Effort-Reward Imbalance Questionnaire (ERI). Linear mixed models, proportions with 95% confidence intervals and logistic regression model were used in the analyses.

Results
From 2010 to 2018-19, the scores on the effort items (time pressure, responsibility, demands) increased significantly and the scores on the reward items (recognition, job stability, promotion prospects, prestige) decreased significantly for GPs, but remained stable for doctors in other positions. The proportion of doctors with high levels of work stress increased significantly for GPs. In 2018-19, high levels of work stress were associated with being a GP as compared with other job positions, younger age groups, average or poor health vs. very good or good health, but not with sickness absence or gender.

Conclusions
During a nine-year-period, work stress increased significantly for GPs, but remained stable for other job positions. This may be partly due to several health care reforms. Less work stress may improve both the doctors` own health and the quality of health care.

Key messages
From 2010 to 2018-19 in Norway, the proportion of GPs with high levels of work stress increased, while it remained stable for doctors in other job positions. This study supports previous findings on the association between high levels of work stress and health.
Teaching medical students multi-disciplinary team work through integrated course
Authors: Khozhamkul R , Kosherbaeva L , Kumar A , Bayildinova K , Sydykova S 
Published: November 2019

Abstract

Healthcare reform in Kazakhstan has created a basis for shift from disease centered approach to person and prevention centered healthcare. In order to embrace that agenda, Kazakh National Medical University has developed and implemented project-based course in General practitioners (GP) training program at the internship level. The objective of the program is to acquire skills on work in multidisciplinary teams for health promotion and research. We used project-based learning pedagogical framework for the course. 6 ECTS course was integrated into curriculum of internship in the track of GP training, at the 7th year, for 1 semester. During the course participants were introduced to the theoretical concepts of health promotion and disease prevention program planning, created and implemented their own project. At the end of the course students were required to do a poster presentation. Main outcomes of educational program were that students will (1) gain understanding of health promotion and disease prevention concepts, (2) would be able to implement research skills, (3) and work in integrated multidisciplinary team. To measure results, we disseminated self-administered online based questionnaire for students after the last class (n = 122). Questionnaire consisted of 4 domains: self-development and team work, teaching, context and clinical practice. There were 17 domains that students assessed with 5-point Likert scale, where 1- strongly disagree, 2- disagree, 3- agree to some extent, 4 - agree, 5 - strongly agree. Questionnaire also included 1 open - ended question for overall comments on the course and demographic questions. The response rate was 68,8% (n = 84), overall satisfaction rate was 77.6% (3.88 out of 5), rate on team work and practical work was 86% (4.3) and 83.6% (4.18). Comments of students showed that there is still not enough understanding on integrated person-centered primary healthcare approach and lack of integrated team work at clinical sites.

Key messages
Education of future general practitioners should include training on teamwork in integrated teams and health promotion. Project based learning helps training multi-disciplinary team work skills not only within students but also in teams at involved sites.
Older Patients in Emergency Departments. Challenges from the health care providers’ perspective
Authors: Deutschbein J , Möckel M , Schenk L 
Published: November 2019

Abstract

Background
Patients aged 65 and above are the fastest growing patient population in Europe. This is one of greatest challenges for almost all health services providers, including acute hospitals and their Emergency Departments (ED). As of today, older patients represent up to 30% of all ED patients, it is estimated. However, it is largely unclear to what degree EDs are currently prepared for older patients and how they need to adjust. This study analyses the present situation from the perspective of health care professionals caring for older ED patients.

Methods
The study was embedded in a mixed methods design using qualitative expert interviews. N = 25 semi-structured, guided interviews were conducted with professional health care providers from 7 Berlin EDs (physicians, nurses), and adjacent health care sectors such as nursing homes, rehabilitation clinics, and medical practices. Interviewees were asked about their daily experiences with older ED patients and their ideas of health care deficits and potentials. Data was analyzed using content analysis and hermeneutics.

Results
Health care providers assess the ED care situation for older patients and the necessity of adjustments in different ways but mostly as deficient. EDs are described as not elderly-friendly and partly as hazardous: older patients are at risk of adverse events such as developing a delirium. Risk factors are prolonged length of stay, the busy and noisy ED setting, and falls hazards. In general, ED staffing is not adequate to care for older patients with complex needs.

Conclusions
Considering demographic change, German Eds need to concentrate on the growing number of oder patients and their specific needs. Further research and development of specific care concepts for older ED patients is strongly needed. Potential adjustments of ED structures and care concepts also need to involve patients’ experiences and subjective needs. However, data on the patient perspective is still missing.

Key messages
Older patients and demographic change represent great challenges for EDs. Care concepts need to be developed to meet older patients needs and to avoid risks of adverse events.
Parents’ socioeconomic position, psychological problems, and emotional neglect in childhood
Authors: Löve J , Mehlig K , Källström Å , Hensing G , Gunnarsdottir H 
Published: November 2019

Abstract

Background
Despite high prevalence and severe consequences for health and wellbeing, emotional neglect (EN) in childhood is a neglected topic in epidemiological research. To enable prevention of neglect knowledge is important about conditions related to EN such as parental individual characteristics and social/economic situation. Aim to investigate the relationship between parental socioeconomic position (SEP), psychological problems, and EN in childhood.

Methods
The sample comprised Swedish women, N = 976, mean age 22. EN was assessed by five indicators: maternal/paternal rejection, maternal/paternal lack of time, and occurrence of domestic violence. The associations between parental SEP/psychological problems and EN were examined by logistic regressions.

Results
The odds of experiencing domestic violence in childhood was higher among women with parents with low (OR 3.1 95% CI 1.1-8.5) or medium SEP (OR 3.4 95% CI 1.7-6.9). Women who reported maternal psychological problems had higher odds of maternal rejection (OR 6.8 95% CI 3.5-13.0), maternal lack of time (OR 2.4 95% CI 1.2-5.0) and paternal rejection (OR 1.9 95% CI 1.1-3.5). Women who reported paternal psychological problems had higher odds of perceiving their father as rejecting (OR 4.0 95% CI 2.1-7.7), not having enough time for them (OR 4.9 95% CI 2.3-10.6), and experiencing domestic violence (OR 4.9 95% CI 2.1-11.6).

Conclusions
Lower SES was not related to EN in form of parental rejection or lack of time but to the occurrence of domestic violence. Parental psychological problems were related to all indicators of EN but differently among mothers and fathers. Public health initiatives aiming at supporting parents should also embrace parental psychological wellbeing.

Key messages
Emotional neglect was clearly related to parental psychological problems but not parental socioeconomic status. Gendered structures need to be considered in studies of emotional neglect.
Gender differences in self-reported health - the significance of inequality in domestic work
Authors: Nyman C Staland , Hensing G 
Published: November 2019

Abstract

Background
Gender difference in health is an important public health issue. Although biological factors contribute, social processes and living conditions create, maintain and exacerbate health differences between women and men. The aim of this study was to examine if lack of equality in domestic work contributes to the explanation of gender differences in self-reported mental well-being, common symptoms and persistent illness.

Methods
Population based questionnaire data on co-habiting women and men in Sweden, aged 19-64 years (n = 2666), was used. Division of planning and performing domestic work, satisfaction with division of domestic work and equality in partner relationship, were analysed in relation to health outcomes using binary logistic regression analysis with adjustments for age, income, country of birth, occupational class, weekly hours in paid work and number of children.

Results
Women, compared to men, showed higher odds (OR) for having low mental well-being, OR 1.35 (1.07-1.70), &gt; 7 common symptoms, OR 1.98 (CI 1.59-2.46) and ≥ 1 persistent illness, OR 1.25 (CI 1.06-1.47). When equal partner relationship and planning and performing domestic work were included in the regression, the ORs for mental well-being and persistent illness slightly weakened and decreased to non-significance when satisfaction with division of domestic work were analysed, OR 1.14 (0.99-1.44) and OR 1.18 (0.99-1.39) respectively. Corresponding ORs for common symptoms were almost unchanged throughout the analysis.

Conclusions
Satisfaction with division of domestic work contributed to explanation of gender differences in persistent illness and notably to differences in mental well-being.

Key messages
Inequality in domestic work could contribute to explanation of gender difference in health. Satisfaction in division of domestic work is of specific relevance in gender difference in mental health.
Promoting health literacy in seniors through self-reliant groups. Results of the GeWinn intervention
Authors: Hassel H , Foitzik E , Klünder C , Langner S , Killenberg A , Neher K , Schimmelpfennig M , Zeiler T , Ladebeck N , Baumgarten K 
Published: November 2019

Abstract

Background
Health literacy (HL) has been demonstrated to be limited among adults aged 65 and over. However, evidence-based HL interventions are lacking. The objective of this study was to develop and test a community-based HL-intervention in the fields of health promotion and self-management of chronic diseases among elderly people.

Methods
A participatory approach was used to develop and implement a 53-weeks program of self-reliant, peer-moderated groups of people aged 60 and over in 14 municipalities in Germany. HL was intended to be improved by promoting of self-management skills, community participation and media literacy. The intervention’s effect on HL was measured by using the HLS-EU-16 questionnaire three times.

Results
Of 183 older adults who completed the HL questionnaire (mean age 69.8, SD 6.74; 20.1% male), 42.3% had intermediate or low levels of HL. A repeated-measures analysis of variance showed statistically significant effects of time on HL scores (F1.91 = 16.948, p ≤ 0.01, eta squared = 0.085) over the one-year period. HL sub-dimensions showed similar results. 87% of the participants would recommend the intervention to other people.

Conclusions
The results indicate that the structure of the intervention is appropriate to involve older adults in self-reliant working groups to improve HL. This is supported by the high acceptance of the intervention the participants showed. As part of the sustained implementation of GeWinn, special attention shall be paid to reaching out to and engaging vulnerable groups (e. g. elderly people with low socio-economic status, older men, migrants).

Key messages
Self-reliant groups in peer-moderation are effective to engage older adults to improve their HL. The intervention improved all HL rates and even doubled the amount of participants with excellent HL.
Evaluation of “Sophia Diabetes”, a diabetic patient support programme, 8 years after its initiation
Authors: Cash R , Cavillon M , Leboucher C , Jouaneton B , Vainchtock A , Aguadé A , Gomez E 
Published: November 2019

Abstract

Background
“Sophia Diabetes” is a personalized diabetic patient support program piloted by French National Health Insurance, launched experimentally in 10 primary health insurance funds in March 2008, extended in 2010 and then generalized to all of France in 2012-2013. A new evaluation was performed in 2018 to determine long-term (2008-2016) improvement of medical follow-up indicators, impact on morbidity, mortality and healthcare expenditure.

Methods
A sample of patients (n = 49,016) eligible for the programme in 2008, but also a sub-group of participating patients (n = 17,007), was matched, using propensity score, with controls randomly selected from the SNDS. Difference in difference method was applied for comparisons at each year of follow-up (Ti) while controlling for differences between populations.

Results
Sophia had a significant positive impact on recommended follow-up indicators, right from the first year. This improvement was maintained for most indicators even if compliance rates remained lower than targets. Sophia Diabetes does not appear to have a major impact on hospitalization rates in either eligible patients or participating patients. However, comparison between participants and controls revealed a less marked increase of hospitalizations for major cardiovascular events at T6 and T7. Compared to their controls, a better use of hospital emergency departments was observed for participants. Ambulatory care expenditure of participants increased more markedly between T4 and T7 (+€105 to €233), related to a better follow-up but in contrast, hospital expenditure increased less markedly during the first year of follow-up (-€139) and the last 2 years (-€360 to -€380).

Conclusions
For the first time in France, a disease management program has been evaluated over a long period. Globally, Sophia programresults in improved patient follow-up, decreased emergency visits, and a less marked increase of hospitalizations for major cardiovascular events at the end of period.

Key messages
First long term evaluation (8 years) of a disease management program in France. Sophia diabetes management program shows a positive impact on some follow-up and morbidity indicators.