bluuebunny/crossref_metadata_2025_split huggingface dataset:
Tuberculosis contact investigations in congregate settings in Rome, Italy: contribution of migration
Authors: Sane Schepisi M , Miglietta A S , Cerocchi C , Grillo P , Renzi S , Cirilli R , Pavone R , Vaccarello S , Magrelli F , De Angelis G 
Published: November 2019

Abstract

Background
In middle to low incidence countries tuberculosis (TB) is known to concentrate in big cities as national incidence falls: in the last decade TB incidence in Rome metropolitan area and in Lazio region has been higher than the national estimates; TB incidence among foreign born fell by more than half despite remaining higher than among Italian born.
We aimed to describe the current dynamics of TB transmission among residents of our local health unit in Rome metropolitan area in order to drive specific TB control interventions at local level.

Methods
We retrospectively evaluated characteristics of TB cases and results of contact investigations among the residents of ASL Roma 2 in congregate settings over year 2018.

Results
Overall 217 TB cases were notified, of which 70.5% with pulmonary involvement. Male/female ratio was 2.4/1 and age group most affected was 25-44 among foreign born and &gt;65 among natives. During the study period foreign born cases accounted for 65% of the total number of TB cases. 19/141 (13.5%) foreign born patients were hosted in a reception center. 479 exposed close contacts were screened, with no evidence of secondary TB disease transmission. No identifiable links were found among cases occurred in the same immigrant reception center.

Conclusions
Italian guidelines recommend symptom screening for TB and LTBI testing both of new entrants and of long term residents -including second–generation migrants- from high TB burden countries. These findings suggest that local public health efforts should prioritize the identification of reactivations of remotely acquired latent TB rather than of new postarrival infections acquired in the host county through local transmission.

Key messages
City-specific data on TB incidence trends among native and foreign-born residents help understanding the wider interaction between migration and TB. To prevent TB incidents in congregate settings remotely acquired latent TB should be targeted.
Mesothelioma: a rare cancer in the Valencian Region’s Cancer Registry (Spain)
Authors: Cavero Carbonell C , Miguel Marco N , Sabater Gregori X , Esplugues Cebrián A 
Published: November 2019

Abstract

Background
Malignant mesothelioma is a rare type of cancer. The estimated incidence in Spain is 535 cases per year, being more frequent in men and reaching the highest rate of incidence between the ages of 60-70. Objective: to determine the characteristics of those affected by the mesothelioma in the Valencian Region during the period 2005-2016 and identify the temporary evolution.

Methods
A cross-sectional study was performed. Cases were identified through the Valencian Region’s Cancer Registry (VCR), those registered between 2005-2015 were identified by the ICD9-CM (code 163*) and 2016’s by the ICD10 (code C45). Cases were validated through the review of clinical documentation. The incidence and mortality were calculated and a descriptive analysis was developed including clinical, demographic and social characteristics.

Results
379 cases were identified and confirmed. 58.4% of the cases were men and the average age of diagnosis was 67 years. 85.1% were Spanish. 87.3% of cases had died and the average age of death was 70 years. An increasing incidence has been observed, being 11.4/1000000 inhabitants (CI95%:8.4-14.3) in 2016. The malignant mesothelioma morphology distribution was: 45.1% epithelial, 43.8% non-specified, 6.6% fibrous and 4.5% in two-phase. In 90.8% of the cases the assessment used to confirm the diagnosis was the primary tumour’s histology, in 3.7% was a cytology or hematologic analysis, in 2.6% was metastatic tissue histology, in 1.3% were clinical signs, in 0.5% was other clinical test like MRI/CT scan, in 0.3% was a postmortem histology and in 0.8% assessment was unknown.

Conclusions
The data about mesothelioma included in the VCR could be considered solid due to the results obtained through the validation. The mesothelioma’s malignancy it is evident, despite its low incidence, its mortality rate is high. The increasing trend observed is in agreement with those experts who estimate that the highest rate of incidence will be between the years 2020-2040.

Key messages
The data about mesothelioma recorded in the Valencian Region’s Cancer Registry could be considered solid due to the results obtained through the validation of information procedure. The increasing trend of malignant mesothelioma observed is in agreement with those experts who estimate that the highest rate of incidence will be between the years 2020-2040.
Measuring organizational performance. A review of the dimensions of hospital performance indicators
Authors: Carini E , Pezzullo A M , Frisicale E M , Cacciatore P , Pilla A Di , Grossi A , Gabutti I , Cicchetti A , Boccia S , Specchia M L 
Published: November 2019

Abstract

Patients’ increasing needs and expectations demand for an overall assessment of hospital performances. Several Agencies described sets of performance indicators and there is not a unanimous classification. The ImpactHTA Horizon2020 Project wants to address this aspect, developing a toolkit of key indicators to measure hospital organizational performance. The aim of this review is to identify the dimensions of quality in which hospital performance indicators are grouped, and to assess if there has been an evolution over time of the above-mentioned dimensions.
Following the PRISMA statement, PubMed, Ovid and Web of Science databases were queried to perform an umbrella review. Articles focusing on secondary care settings, published January 2000-May 2018 were considered. The study design included was systematic review.
3680 records were screened and 6 systematic reviews ranging 2002-2014 were included. The following dimensions were described in at least 50% of the studies: 6 studies classified efficiency (53 indicators analyzed); 5 studies classified effectiveness (12 indicators), patient centeredness (10 indicators) and safety (8 indicators); 3 studies responsive governance (2 indicators), staff orientation (8 indicators) and timeliness (4 indicators). 3 reviews did not specify the indicators related to the dimensions listed, 1 gave a complete definition of the meaning of each dimension and related indicators.
The research shows steady awareness of the importance of patient centeredness, effectiveness, efficiency, and safety dimensions; apparently, there is still not much attention to sustainability, appropriateness and accessibility in terms of indicators measuring, although those dimensions are described in one of the latest review. Another review described a new dimension, resources and capacity, which focuses on the availability of new technologies, underlining the growing importance of the adoption of digitalization in healthcare.

Key messages
Main dimensions of performance indicators: efficiency, effectiveness, patient centeredness, safety. More emphasis to sustainability and appropriateness to align with today’s healthcare challenges.
Development of the Austrian version of the Hospital Survey on Patient Safety Culture
Authors: Draganović ŠD , Offermanns G O 
Published: November 2019

Abstract

Background
Patient safety culture in hospitals (PSC), as well as its measurement and development, have received plenty of attention in Europe in recent years. Several instruments have been developed for its measurement in European countries. As Austria does not have empirically reviewed questionnaires to measure PSC jet, the research question of this study was: Is the globally admitted American questionnaire “Hospital Survey on Patient Safety Culture (HSOPSC)” (Sorra & Nieva, 2004) suitable for the healthcare system in Austria?

Methods
The HSOPSC contains 42 questions, which constituted twelve factors altogether. The pre-test was done with 101 health professionals. The online survey was conducted in ten public hospitals in 2017. Overall 1525 health professionals participated, which corresponded to a response rate of 23%. A new instrument, namely “Hospital Survey on Patient Safety Culture in Austria (HSPSC-AUT)”, was developed using the Exploratory Factor Analysis (EFA) and the Confirmatory Analysis (CFA).

Results
The factor structure of HSOPSC was not identical to the factor structure of HSPSC-AUT, developed in our study. The study showcased a new tool, HSPSC-AUT, with 30 items altogether, consisting of seven departmental factors, two hospital factors and one outcome factor. This new tool (HSPSC-AUT) showed pleasant results on the model, indicator, and construct level. The results of CFA for HSPSC-AUT (χ2 [360] = 1408.245, p = 0.0001) showed a better model compared to HSOPSC. The absolute and relative fit-indices showed excellent model adjustment (RMSEA = 0.049, SRMR = 0.041, GFI = 0.927, CFI = 0.941, TLI = 0.929).

Conclusions
The study presents a new instrument, HSPSC-AUT, for the measurement of PSC. According to the results, HSPSC-AUT (10-factor structure) has a better model fit than the original HSOPSC. This was confirmed by chi-square test, absolute and relative fit-indices, informational criteria, reliability, and construct validity.

Key messages
The development of an instrument for measuring safety culture is the first step leading to a better PSC. For this reason, HSPSC-AUT is recommended as an instrument to measure the PSC in Austria. Finally, it can be said that the development of a new questionnaire as well as the related measurements of validity and reliability have added value to science and practice.
Knowledge, false myths and beliefs on vaccines among pregnant women: results from NAVIDAD study
Authors: Gualano M R , Olivero E , Voglino G , Rossello P , Quattrocolo F , Bert F , Siliquini R ,   Navidad Collaborating Group
Published: November 2019

Abstract

Background
The diffusion of false myths and vaccine hesitancy are alarming phenomena in European countries and leads to decreasing trends in infant vaccine coverages. Aim of the study was to analyse the level of confidence and correct awareness about immunization, which are crucial for the success of vaccination programs.

Methods
As part of the NAVIDAD multicentre study, we examined vaccination confidence and complacency, among a sample of 1820 pregnant women from 14 Italian cities. The questionnaire assessed the interviewee’s knowledge, beliefs and misconceptions, as well as their socioeconomic status, sources of information about vaccines and confidence in the Italian National Healthcare Service.

Results
Of the participants, only 9% of women completely believed to efficacy, necessity and safety of vaccinations. Almost 20% of them had misconceptions on the majority of the themes. There was a significant difference in level of knowledge considering educational level: women with a high educational level have less probability to obtain a low knowledge score (OR 0.43 [95%CI 0.34-0.54]). The level of knowledge was influenced also by the sources of information: women who got information from General Practitioner and from Institutional Web sites have significantly less chance to have misconceptions (OR 0.74 [95%CI 0.58-0.96]; OR 0.59 [95%CI 0.46-0.74]). Finally, results underlined the influence of trust in healthcare professional information on likelihood of having misconceptions (OR 0.49 [95%CI 0.27-0.89]).

Conclusions
Data suggest the efficacy of healthcare professionals and Institutional Web sites as source of information to contrast misconceptions and underline the importance of confidence in the healthcare system to increase complacency and confidence on vaccines.

Key messages
There is a general lack of knowledge about vaccinations among future mothers. Most of misconceptions regarding vaccinations are related to their safety: this could affect confidence and complacency. To increase vaccine confidence, there is a strong need to inform future mothers: our data show the importance and efficacy of Health Professionals and Institutional Web sites as information sources.
One year update following removal of high sugar sweetened beverages from a university campus
Authors: Fitzpatrick P , O’Connor J , Doyle G , Delaney L , Lades L , Lawlor O , Mullins B , Murrin C 
Published: November 2019

Abstract

Healthy UCD is a health promotion initiative designed to create a sustainable healthy university campus. The aim of the study was to report on student and staff attitudes and provider attitudes to the removal and income from drinks one year following the removal of carbonated sugar sweetened beverages (HSSBs) on a large university campus, University College Dublin (UCD).
In 2018 Healthy UCD, in partnership with the contracted beverage supplier, conducted a seven-week trial where all HSSBs were removed from the main campus and replaced with sugar-free or low-sugar alternatives. This was in advance of a levy on HSSBs to be introduced nationally. During the trial, drinks sales rose by 4%. Following the trial, a survey of students was conducted across the campus which provided the motivation to the University Management Team to approve removal of HSSBs on a permanent basis. Staff and student complaints were monitored over the following year. Drinks sales data was obtained from retail outlets for 2019 and compared to the same sales period for the previous year.
Retail sales for drinks continued to grow despite removal of HSSBs, with 8% growth in the year following removal. A small number of complaints were documented. The most important was a query about those staff and students with diabetes mellitus who might need high sugar energy products and the removal of a particular HSSB which is sold in Ireland. This HSSB had not in fact previously been sold in UCD. The national advice regarding access to high sugar products in the case of hypoglycaemia from Diabetes Ireland was provided satisfactorily for all staff and students.
Removal of HSSBs from a university campus is possible; advice must be provided to those who may feel negatively impacted by the change.

Key messages
Removal of high sugar sweetened drinks from a university campus is possible; advice must be provided to those who may feel negatively impacted by the change. Sales can grow despite health-related changes of the food environment.
The determinants of patients’ opinions about physicians’ services in the Internet-based ranking site
Authors: Smola P , Martuszewska M , Maciak A , Duplaga M 
Published: November 2019

Abstract

Background
The rankings of physicians’ services constructed on the basis of the feedback from patients became a popular form of the appraisal of their work. The main objective of the study was the assessment of predictors of the patients’ satisfaction with services provided by physicians of selected specialities.

Methods
The opinions about physicians of three specialties (paediatricians (P), gynaecologists (G) and family medicine physicians (FM)) who accumulated the highest numbers of opinions, were extracted from the rankinglekarzy.pl website. Only 100 physicians of each specialty who were the most frequently scored were included. Apart from the scores on six individual criteria, the data reflecting the number of opinions (NOO), the type of medical practice (TMP), number of specialties (NS) and PhD title (PhD), as well as the location of the practice (LOP) were collected. The total score was calculated as the sum of scores assigned to individual criteria.

Results
The final data set consisted of 9482 opinions (4234 for P, 2057 for FM, and 3191 for G). The multivariate regression model revealed that odds of obtaining the maximum total score (MTS) depended on S, NOO, LOP, and TMP. G had higher odds of receiving the MTS than P and FM (OR, 95%CI, 0.75, 0.68-0.83, and 0.72, 0.64-0.82, respectively). MTS was less frequently received by physicians practicing in medical centres (0.56, 0.49-0.62) and hospitals (0.55; 0.44-0.70) than in private practices, but not by those practicing in more than one place (3.81, 2.78-4.21). Higher NOO was related to lower odds of receiving MTS (0.992; 0.990-0.995).

Conclusions
There are significant differences in patients’ assessment of services provided by physicians of three analysed specialties. The type of practice has a considerable impact on the satisfaction of patients. Interestingly, it seems also that the number of specialties and PhD title do not influence patients’ opinions about the quality of the medical doctor’s services.

Key messages
Internet-based rankings of physicians may be an important source of information about provided medical services. Key factors influencing patients’ opinions include specialty, the type and the location of medical practice, but not scientific a scientific title and number of specialities.
Umbrella review of strategies to improve uptake of screening programmes
Authors: Hyseni L , Maden M , Boland A , Kypridemos C , Collins B , O’Flaherty M 
Published: November 2019

Abstract

Introduction
High participation rates in screening programmes targeting non-communicable diseases are instrumental in achieving full screening benefits; however, screening programmes remain underused, especially among vulnerable populations. We conducted an umbrella review to assess the type of approaches screening programmes use to maximise uptake, the effectiveness of the approaches and the impact on equity.

Methods
Electronic databases were searched (1999-2019) for systematic reviews on approaches aimed at improving uptake of screening programmes for adults in middle- and high-income countries, with participation rate as the primary outcome. A narrative synthesis was undertaken to present the results by strategy, screening programme and strength of evidence. This study was registered in PROSPERO [CRD42019132087].

Results
In total, 3,059 records were identified, and 82 systematic reviews were included. Preliminary findings suggest contradictory evidence, and effectiveness appears to depend on the disease screened for and specific program implementation. Invitation methods including letters and direct reminders seem to work universally. However, combined approaches using access-enhancing, individual- and system-directed strategies seem to be more effective than single approaches such as invitation methods alone. Few studies evaluated the impact on equity.

Conclusions
Strategies to improve uptake of screening programmes have the potential to be effective. However, there are many components within the system, either at individual, health care professional or health care system level that can influence uptake of screening programmes. Within each screening programme, it is likely that a range of interventions is needed to improve the uptake as opposed to a single intervention.

Key messages
Improving uptake of screening programmes is a complex issue with many factors influencing the process. A range of interventions is favoured over single interventions.
Burden of disease due to nitrogen dioxide exposure in Germany
Authors: Plass D , Tobollik M , Wintermeyer D 
Published: November 2019

Abstract

Background
Numerous studies identified adverse effects of air pollution on health. According to the recent Global Burden of Disease Study about 2.9 million people died prematurely due to the effects of ambient particulate matter (PM) pollution in 2016, which resulted in about 70 million years of life lost (YLL). In addition to PM, a growing body of evidence shows convincing associations between nitrogen dioxide (NO2) with several health outcomes. The case study provides a health risk assessment for NO2 in Germany.

Methods
A systematic review was performed to select health outcomes with strong evidence for an association with NO2 and to derive an updated exposure-response function (ERF). The exposure assessment was performed on a 1x1 km2 grid by combining measured and modelled data (annual means of NO2 background concentration) with population density. Exposure data and the ERF were combined by the population attributable fraction formula. The main analysis was performed using a counterfactual of 10 µg/m3.

Results
Only for cardiovascular mortality the evidence for the association with long-term NO2-exposure was rated as “strong”. Thus, the main analysis merely included this outcome. For the year 2014, 5,966 (95% CI: 2,031-9,893) attributable deaths and 49,726 (95% CI: 16,929-82,456) YLL were estimated. Looking at time trends a decrease of disease burden was observed compared to the year 2007 where 7,832 (95% CI: 2,669-12,973) attributable deaths and 69.244 (95% CI: 23.601-114.690) YLL due to NO2 were calculated.

Conclusions
Our results show a considerable burden due to NO2 in Germany. Compared to previous estimates for PM (ca. 41,100 attributable deaths in 2014) the burden due to NO2 is much lower. However, due to methodological constraints we could not incorporate higher concentrations from traffic hotspots. This, and the fact that we only considered one health outcome in our main analysis, suggests that our results might be an underestimation.
Individual and area-level factors associated with ambulatory care sensitive conditions in Finland
Authors: Satokangas M , Arffman M , Leyland A , Keskimäki I 
Published: November 2019

Abstract

Background
Geographic variation is common in ambulatory care sensitive conditions (ACSCs) - used as a proxy indicator for primary care quality. Its use is debated as it is more strongly associated with individual socioeconomic position (SEP) and health status than factors related to primary care. While most earlier studies have been cross-sectional, this study aims to observe if these associations change over time. Finland offers a good possibility for this due to its extensive registers and unexplained over time convergence of geographic variation in ACSC.

Methods
This observational study obtained ACSCs in 2011-2017 from the Finnish Hospital Discharge Register and divided them into subgroups of acute, chronic and vaccine-preventable causes. In these subgroups we analysed geographic variations with a three-level multilevel logistic regression model - individuals, health centre areas (HC) and hospital districts (HD) - and estimated the proportion of the variance at each level explained by individual SEP and comorbidities, as well as both primary care and hospital supply and spatial access at three time points.

Results
In the preliminary results of the baseline geographic variation in total ACSCs in 2011-2013 - the model with age and sex - the variance between HDs was nearly twice that between HCs. Individual SEP and comorbidities explained 46% of the variance between HDs and 29% between HCs; and area-level proportion of ACSC periods in primary care inpatient wards a further 12% and 5%. This evened out the unexplained variance between HDs and HCs.

Conclusions
Geographic variation in ACSCs was more pronounced in hospital districts than in the smaller health centre areas. The excess variance between HDs was explained by individual SEP and health status as well as by use of primary care inpatient wards. Our findings suggest that not only hospital bed supply, but also the national structure of hospital services affects ACSCs. This challenges international ACSC comparisons.

Key messages
Geographic variation in ACSCs concentrated in larger areas with differing population characteristics. The national structure of hospital services, such as use of primary care inpatient wards, affects ACSCs.