bluuebunny/crossref_metadata_2025_split huggingface dataset:
Capture-recapture study to estimate the true incidence of tuberculosis in Portugal, 2018
Authors: Perez Duque M , Hansen L , Antunes D , Sá Machado R 
Published: October 2020

Abstract
Accurate estimation of the true number of cases of an infectious disease is essential to plan and efficiently allocate available resources. This study aims to improve the Portuguese surveillance system for tuberculosis (TB) by identifying gaps in TB epidemiological surveillance at the national level. We estimated annual TB incidence using a capture-recapture method to assess the sensitivity of national TB surveillance.
Using probabilistic record linkage between two data sources, the National Epidemiological Surveillance System (SINAVE) and National Tuberculosis Program Surveillance System (SVIG-TB), we extracted TB diagnosed cases data for calendar year 2018. All reported TB cases were included, classified as confirmed, probable or possible. A two-source capture-recapture analysis using a log-linear model was performed to estimate the number of unobserved TB cases in Portugal and of the proportion identified by the current TB surveillance system.
Between the two datasets, we found 896 TB cases (of a total of 2170 cases) that could not be matched (37.5% SINAVE only, 62.5% SVIG only). Based on the log-linear model, it was estimated that there were 148 unobserved TB cases (95% confidence interval 127.96 - 171.31). Therefore, the estimated true number of TB cases in 2018 is 2318, so current surveillance has a sensitivity of 93.6%. Based on these findings, the TB incidence in Portugal is estimated to be 22.55 cases per 100 000 inhabitants.
Capture-recapture methods are useful in estimating annual TB incidence in high-resource settings. Although the two TB surveillance systems capture the majority of TB cases in Portugal, we might still be underestimating the true number of TB cases. Because TB is a high impact infectious disease, precise incidence estimates are crucial to allocate treatment and prevention resources and guide health policies.

Key messages
CRC method showed that Portugal is a TB low incidence country. Epidemiological surveillance systems should have a high sensitivity in order to allocate efficiently resources available.
Cost-effectiveness of targeted screening for active pulmonary tuberculosis among asylum-seekers
Authors: Wahedi K , Biddle L , Bozorgmehr K 
Published: October 2020

Abstract

Background
Screening asylum-seekers for active pulmonary tuberculosis is common practice among many European countries with low incidence of tuberculosis. The reported yields vary substantially, partly due to the heterogeneous and dynamic nature of asylum-seeking populations. Some countries apply targeted screening measures based on the incidence of tuberculosis in the country of origin. Evaluations of such approaches with respect to (cost)-effectiveness is scarce.

Methods
Using screening data from a large German state over 14 years (2002-2015), we evaluate the cost-effectiveness of targeted screening based on WHO-reported incidence of tuberculosis in country of origins (from thresholds of 50 to 250/100,000 inhabitants). Incremental cost-effectiveness is measured as cost per case found and cost per case prevented.

Results
Incremental cost-effectiveness ratios (ICERs) of screening asylum-seekers from countries with an incidence of 50 to 250/100,000 range between 15,000€ and 17,000€ per additional case found when compared to lower thresholds. The ICER for additional screening of asylum-seekers from countries with an incidence &lt;50/100,000 is 112,000€ per additional case found. Costs per case prevented show a similar increase in costs.

Conclusions
The high cost per case found or case prevented in the &lt;50/100,000 threshold scenario suggests this threshold to be a sensible cut-off for targeted screening. Acknowledging that no screening measure can find all cases of tuberculosis, and that reactivation of latent infections makes up a large proportion of foreign-born cases, targeting asylum-seekers from countries with an incidence above 50/100,000 is likely to be a more reasonable screening measure for the prevention and control of tuberculosis than indiscriminate screening measures.

Key messages
We challenge the widespread belief that indiscriminate tuberculosis screening programmes are placed at an acceptable balance between costs and benefits. Targeting asylum-seekers from countries with an incidence above 50/100,000 is likely to be a reasonable screening measure for the prevention and control of tuberculosis.
Industry funding of patient groups: a systematic review
Authors: Fabbri A , Parker L , Colombo C , Mosconi P , Barbara G , Lau E , Kroeger C M , Lunny C , Salzwedel D M , Mintzes B 
Published: October 2020

Abstract

Background
Patient groups play an important role in health care and policy. Concerns have been raised about the financial ties between the pharmaceutical industry and patient groups, because of potential threats to the groups' independence. We conducted a systematic review to synthesise studies that explored pharmaceutical or medical device industry funding of patient groups.

Methods
We searched Medline, Embase, Web of Science, Scopus and Google Scholar (from inception to January 2018). We included observational studies reporting at least one of the following outcomes: prevalence of industry funding; proportion of industry funded patient groups which disclosed information about this funding; association between industry funding and organisational positions on health and policy issues. We carried out duplicate independent data extraction and assessed study quality.

Results
26 cross-sectional studies were included. Fifteen studies assessed the prevalence of industry funding, which ranged from 20% (12/61) to 83% (86/104). The proportion of patient groups which disclosed funding information on their websites was low (27% [95% CI: 24%-31%]). Few patient groups had formal policies governing corporate sponsorship (range from 2% (2/125) to 64% (175/274)). Among the few studies examining funding status versus organisational position, industry sponsored groups tend to hold positions consistent with sponsors' interests.

Conclusions
We found widespread indications of industry funding of patient groups. Transparency of funding is inadequate and the prevalence of policies governing corporate sponsorship is low. Research on policy impact is still limited. Considering the important role that patient groups play in health, strategies to prevent biases that may favour commercial interests above those of patients need to be implemented.

Key messages
Industry funding of patient groups is common in high income countries. Transparency of funding is inadequate and the prevalence of policies governing corporate sponsorship is low. Considering the important role that patient groups play in health care and policy, strategies to prevent biases that may favour commercial interests above those of patients need to be implemented.
Cardiovascular diseases burden in Italy, 1990–2017: the Global Burden of Disease Study
Authors: Fornari C , Cortesi P A , Madotto F , Conti S , Crotti G , Mazzaglia G , Monasta L , Giampaoli S , Mantovani L G ,   on behalf of the GBD 2017 Italy CVDs Collaborators
Published: October 2020

Abstract

Background
Cardiovascular diseases (CVDs) are still the leading cause of mortality, morbidity and disability in Europe. Consequently, an exhaustive estimation of CVDs burden and cardiovascular risk factors impact is crucial for healthcare planning and resource allocation. In Italy, data on CVDs burden are sparse. This study aims to assess the global Italian CVDs burden and to analyze time changes from 1990 to 2017 within the country and in comparison to other European states.

Methods
We used data from the 2017 Global Burden of Diseases (GBD) study to estimate CVDs prevalence, mortality and disability-adjusted life-years (DALYs) in Italy from 1990 to 2017. We also analyzed burden attributable to CVDs-related risk factors. Finally, Italian estimations were compared to those of the other 28 European Union countries.

Results
CVDs were still the first cause of death (34.8% of total mortality) in Italy in 2017. A significant decrease in CVDs burden was observed since 1990: age-standardized prevalence (-12.7%), mortality rate (-53.75%), and DALYs rate (-55.54%) all decreased. Similar patterns were observed also in the majority of European countries. Despite these trends, all-ages CVDs prevalent cases increased from 5.75 million to 7.49 million. More than 80% of CVDs burden could be attributed to known modifiable risk factors such as high systolic blood pressure, dietary risks, high LDL cholesterol, and impaired kidney function.

Conclusions
Data showed a decline in cardiovascular mortality and DALYs, which reflects the success in terms of reducing disability, premature death and early incidence of CVDs. However, the burden of CVDs is still high, as population aging and the increased prevalent cases require more access to care and generate more years lived with disability, which in turn leads to higher costs for the National Health Service and society. More efficient prevention strategies at community and individual level are needed.

Key messages
Despite decreasing trends in CVDs mortality and DALYs, the burden of CVDs is still high in Italy. A joined approach of the National Health System stakeholders is needed to keep reducing the CVDs burden.
Infections in diabetics: a ten-year analysis on hospital discharge records in an Italian region
Authors: Meo F , Di Giovanni P , Cedrone F , D'Addezio M , Di Martino G , Masciarelli M , Scampoli P , Staniscia T 
Published: October 2020

Abstract

Background
Patients with diabetes mellitus (DM) have increased risk of developing infections and complications from infections that require hospitalization and greater healthcare utilization. This study aimed to analyze hospitalizations in DM patients with a diagnosis of infection and to assess the burden of infections on the regional healthcare system in terms of length of stay and in-hospital mortality.

Methods
A retrospective cross-sectional study was performed from 2006 to 2015 in Abruzzo, an Italian region. Data were collected from hospital discharge records (HDRs) of patients with a diagnosis of DM. All the admissions with an ICD-9 infection diagnostic code were identified. Logistic regression models were implemented to evaluate the association between infections and the study outcomes.

Results
A total of 182,709 HDRs of DM patients were identified, 12,381 (6.78%) of which related to an infectious disease. The number of admissions with a diagnosis of infection increased during the study period (+4.0%). Respiratory infections were the most common (69.8%), followed by sepsis (9%), and skin and soft tissue infections (8.7%). Factors associated with the infection were age&lt;18 (aOR=1.88; 95%CI:1.42-2.47), age≥65 (aOR=1.29; 95%CI:1.23-1.35), and DM type 2 (aOR=1.19; 95%CI:1.12-1.26). Diabetic patients with an infectious disease had a longer median length of stay (days:10; IQR:6-16) than those without infections (days:7; IQR:3-12) (p &lt; 0.001), and showed higher in-hospital mortality (aOR=2.67; 95% CI:2.5-2.8).

Conclusions
Over the study period, hospitalizations related to infections among diabetics rose. The increase was registered mostly among the youngest and the oldest subjects. Infectious disease diagnosis was associated with longer length of stay and higher in-hospital mortality. Cost-effective strategies for infection prevention in patients with DM are needed in order to reduce morbidity and the impact of these conditions on the healthcare system.

Key messages
Patients with diabetes have increased risk of developing infections. In our study, infectious disease diagnosis was associated with longer length of stay and higher in-hospital mortality. Cost-effective strategies for infection prevention in patients with diabetes are needed in order to reduce morbidity and the impact of these conditions on the healthcare system.
Depression, suicidal ideation and stress among Italian medical students: PRIMES multicentre study
Authors: Lo Moro G , Bert F , Corradi A , Gualano M R , Leombruni P , Siliquini R , PRIMES Collaborating Group  
Published: October 2020

Abstract

Background
Depression represents a public health priority and a major contributor to suicide worldwide. Medical students (MS) have been reported as a high-risk group and data are required to implement action plans. This study aimed to investigate depressive symptoms (DS), suicidal ideation (SI) and perceived stress (PS), and analyse factors that may impact on such conditions.

Methods
In 2018, a multicentre cross-sectional study (PRIMES) was carried out in 12 Medical Schools, reaching 2513 MS throughout Italy. Socio-demographic data and psychometric tests were collected. Main outcomes were measured by Beck Depression Inventory-II (DS and SI) and Perceived Stress Scale (PS). Mostly, multivariable logistic and linear regressions were run (p &lt; 0.05 as significant).

Results
The prevalence of DS and SI was 29.5% and 14%. The mean PS score was 18.6 (SD = 7.8), within a range to 0 from 40. Preliminary results showed that the variables associated with a higher risk of reporting all outcomes (DS, SI, PS, respectively) were: increasing age (p = 0.004, p = 0.016, p = 0.003), bisexuality (p = 0.002, p &lt; 0.001, p &lt; 0.001), poor economic status (p = 0.010, p = 0.014, p &lt; 0.001), psychiatric family history (p = 0.007, p = 0.003, p = 0.029), negative judgment about medical school choice (all p &lt; 0.001), unsatisfying classmates' friendships (p = 0.027, p &lt; 0.001, p &lt; 0.001) and classmates' climate competitive and hostile (all p &lt; 0.001). An excellent family bond reduced the odds instead (all p &lt; 0.001). Other socio-demographic and university-related items resulted associated to the outcomes in different ways.

Conclusions
PRIMES showed a high prevalence of DS and SI among MS, with alarming PS levels. Since this issue seems common worldwide, further analyses to understand the determinants are needed and a population-based approach pertaining to public health must be addressed, e.g. to increase resilience. Universities must realize interventions, offer counselling and improve modifiable factors, such as learning climate.

Key messages
Italian medical students reported a prevalence of depressive symptoms and suicidal ideation of 29.5% and 14% respectively, both higher than the prevalence among same-aged general population. Depression, suicidal ideation and stress were mainly influenced by age, sexuality, finances, psychiatric family history, judgment on medical school, family bond, classmates’ friendships and climate.
Assessing the digital health transformation with the SCIROCCO Exchange tool in Puglia Region
Authors: Mingolla S , Pantzartzis E , Graps E A 
Published: October 2020

Abstract
Have we progressed integrated care in Europe? The EU Health Programme funded project, SCIROCCO Exchange addresses this question by providing online self-assessment tool for integrated care. Among the project partners, Puglia Region and the Strategic Regional Agency for Health and Social Care (AReSS), assessed the integrated care maturity level of the six Puglia' Local Health Authorities.
The SCIROCCO Exchange project provides a 12-dimensions online tool for European regions to assess their maturity in the provision of integrated care, including identification of strengths, weaknesses and areas for improvement. The methodology provides the following steps: 1) selection of key stakeholders participating in the assessment; 2) conducting the individual assessments; 3) building the consensus among the involved stakeholders. The outcomes of the assessment were captured in the form of spider diagrams, highlighting Puglia' strengths and weaknesses in integrated care.
The research has provided a multi-dimensional representation of the integrated care maturity level of the Puglia' Local Health Authorities. With reference to the SCIROCCO Exchange tool dimensions, major strengths include: Digital Infrastructure; Population Approach; Process Co-ordination; and Citizen Empowerment. Among the areas for improvement: Finance & Funding; Removal of Inhibitors; and Evaluation Methods were identified.
The experience of using the SCIROCCO Exchange Tool have demonstrated benefits and added value of the Tool in guiding involved stakeholders towards the implementation of integrated care in Puglia and in stimulating multi-stakeholders discussions and participants' engagement. The assessment results will be used to orient an Action Plan to facilitate much more effective and tailored knowledge transfer process and provide better digital care services in Puglia.
Dietary and lifestyle behaviours in the preconception period
Authors: Schoenaker D 
Published: October 2020

Abstract
Observational studies have shown strong associations of preconception nutrition and lifestyle behaviours with maternal and child health outcomes; however, awareness of these links among lay people, policy makers and health professionals is very limited. Poor nutrition and obesity are common among women of reproductive age, and the preconception period therefore has underutilised potential as a point of intervention. Intervention studies to improve dietary intake and physical activity during pregnancy have not been successful in reducing adverse maternal and newborn health outcomes, but relatively few interventions have examined effects of modifying diet and lifestyle prior to pregnancy. Despite limited evidence from human clinical trials, increasing evidence from observational studies and from animal trials for the benefits of optimal preconception health suggests public health efforts to increase awareness and improve preconception health behaviours are needed as strategies for disease prevention across generations. This presentation will provide an overview of the evidence for the impact of nutrition and lifestyle behaviours on short and long-term maternal and child health outcomes. This will provide workshop participants with an understanding of health behaviours across the life course that should be considered when building preconception care into existing health services.
Spatial analysis of vaccination coverage in Paraíba in 2016
Authors: Martins L , Cunha N , Baebieri C , Pamplona Y , Loureiro N , Olinda R , Moschini L 
Published: October 2020

Abstract

Introduction
Immunization is a human right, being considered an action of the most successful and cost-effective in public health. In Brazil, it is an action that is linked to primary health care, In Brazil, the National Immunization Program (PNI), created in 1973, is recognized as a world reference of public health policy, as it offers all vaccines recommended by the World Organization health care in its national vaccination calendar.

Objective
Spatial analysis of vaccination coverage of children aged 0 to 11 months in Paraíba in 2016.

Methods
Cross-sectional study, with information on doses applied to children under 1 year of age obtained at the PNI, by municipality of Paraíba. Live birth data from the Live Birth information system (SINASC). Descriptive analysis, chi-square test, spatial analysis.

Results
In Paraíba, 54.3% of the municipalities had adequate vaccination coverage, for BCG we have 68%, Hepatitis B (34.5%), Hib and DTP (35%), Polio (29.6%), pneumococcal (46.6%) and meningococcal (42.6%). The sertão paraibano is the mesoregion with the largest number of municipalities in the state with adequate vaccination coverage (p &lt; 0.01), the paraiba forest is the region with the highest number of municipalities with very low coverage (p &lt; 0.01).

Conclusions
Thus, Paraíba does not present a homogeneous vaccination coverage, not having 'herd immunity'. This fact leaves the state vulnerable to the return of immunopreventable diseases and thus at risk of raising infant morbidity and mortality, constituting an important public health problem.

Key messages
Immunization is a human right, being considered an action of the most successful and cost-effective in public health. Paraíba does not present a homogeneous vaccination coverage, not having 'herd immunity'.
Child drowning mortality in the Sundarbans, India: Applying the Community Knowledge Approach
Authors: Gupta M , Bhaumik S , Roy S , Panda R , Peden M , Jagnoor J 
Published: October 2020

Abstract

Background
The Sundarbans in India is a rural, forested region where children are exposed to a high risk of drowning due to its waterlogged geography. Current data collection systems capture few drowning deaths in this region due to its remoteness and poor coverage of health and police systems. Household methodology was found to be resource and time intensive, and so a Community Knowledge Approach was used and applied to calculate injury mortality for the first time.

Methods
A community-based survey was conducted in the Sundarbans to determine the drowning mortality rate for 1-4 and 5-9 year old children. A Community Knowledge Approach was applied. Meetings were held with law community residents and key informants to identify drowning deaths in the population. Identified deaths were verified by the child's household through a structured survey, inquiring on the circumstances around the drowning death.

Results
The drowning mortality rate for children aged 1-4 years old was 243.8 per 100,000 children and 38.8 per 100,000 children for 5-9-year olds. 58.0% of deaths were of 1-2-year-old children. Most children drowned in ponds within 50 metres of their homes. Children were usually unaccompanied with their primary caretaker engaged in household work. Only one third of deaths were reported to hospitals or civil registration systems. Of deaths listed by community members, 63.0% were identified by both residents and by at least one key informant, 25.6% by key informants only, and 11.4% (n = 79) by community residents only.

Conclusions
Drowning is a major cause of death among children in the Sundarbans, particularly those aged 1-4 years old. The results illustrate how routine data collection systems grossly underestimate drowning deaths, emphasising the importance of community-based in rural low-and middle-income country contexts.

Key messages
Drowning is likely the largest killer of 1-9 year old children in the Sundarbans region, emphasising the need to better understanding drowning epidemiology in similar rural LMICs contexts. The Community Knowledge Approach provides a low-resource, valid method for capturing injury mortality data.