bluuebunny/crossref_metadata_2025_split huggingface dataset:
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

Abstract

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

Abstract

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

Abstract

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 &gt; 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

Abstract

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

Abstract
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

Abstract

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 &lt;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

Abstract

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 (&lt;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 (&lt;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

Abstract

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

Abstract

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

Abstract

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.