bluuebunny/crossref_metadata_2025_split huggingface dataset:
An individual care plan for a high risk elderly population in the Local Health Authority of Bologna
Authors: Ciotti E , Catalani F , Martino F , Camplone I , Valisella C , Petroni M , Randazzo C 
Published: October 2020

Abstract

Issue
Fragility is a major challenge that demand a comprehensive public health response, since a high rate of population is aging and becoming vulnerable.

Description of the Problem
The Local Health Authority of Bologna, about 850,000 inhabitants, has implemented a new qualitative and quantitative Project on fragile patients. Frailty was measured by the “Risk Profile of the Emilia-Romagna region,”, an algorithm that provides a risk index, based on patients'record, which divide population in risk categories (high/very high, moderate and low risk) of hospitalization. The 585 General Practitioners (GPs) have enrolled their fragile patients with high and very high risk (about 6% of the population). GPs and other healthcare professionals are asked to define an Individualized Care Plan (ICP) according to an integrated and multi-professional management perspective. Patients' and healthcare professionals' subjective experience was collected throughout a structured interview.

Results
From October 2018 to April 2019, 260 patients were included in the project and they received a ICP which included different interventions such as: integrated nursing care (105), nursing care in chronic ambulatory (55), community hospital care (9), social assistance (92), physiotherapy (88), specialist activities (114). Qualitative data highlighted high level of satisfaction both in patients and clinicians. The strengths of the Project are: 1) an integrated management (with a multi- professional team) of frailty population, 2) proactive and individualized treatment plan. Limitations are: 1) different approaches among clinicians in the Local Health Authority of Bologna with possible inequalities of accessibility to the treatment; 2) difficulties in the relationships among clinicians.
The early recognition and the specialistic management of the fragile population have to be considered a priority in health practice in order to provide effective medical intervention.

Key messages
Individualized Care Plan (ICP) and integrated and multi-professional management. Importance of fragility early recognition.
Institutional strengthening for evidence-based health policies in the DR Congo (RIPSEC): Impact
Authors: Mwembo-Tambwe A , Chenge F , Criel B 
Published: October 2020

Abstract

Issue
In the DRC, the need to strengthen the health system for a more equitable charge of the health of the population in a perspective of universal health coverage proves to be relevant. Develop a culture that promotes decision-making based on scientific evidence, essential to improve the overall performance of the health system from this perspective

Description of the Problem
The RIPSEC program aims to (i) develop the capacity to manage health knowledge in the DRC through the creation of a Health Knowledge Center in the DRC, (CCSC- Asbl); to strengthen the scientific capacity of the Public Health Schools and the National Institute of Biomedical Research in health systems research and education and to strengthen the training capacity of the Public Health Schools by Development of Learning and Research Health Districts (LRHD). We assess the level of achievement of the results of this program.

Results
The majority of objectives have been reached.The CCSC-Asbl, created is an autonomous institution with legal personality. It produces scientific evidence and support for decision-making. The Ministry of Health has been strengthened and diversified. Institutional capacities and visibility have been strengthened through continuing education and the publication of scientific articles. But, no doctorals theses has been completed yet. Establishment of a consultation framework for health science training institutes: online training, short-term joint training on health system research. The third component concerns the development of LHRD; Transformation processes in the district went through a strengthening of the capacity of the district health teams and via a process of action-research.

Lessons
The RIPSEC program is increasingly becoming part of the Congolese health system as a strong partner.

Key messages
This experience can be used elsewhere in different contexts This program could be continued to perpetuate these fragile achievements. It corresponds to the felt needs and the priority of the health education system in the DRC or elsewhere.
Drugs in the environment: Do we know the risks?
Authors: Caminada S L , Caminada M L , Bocchiglieri M M , da Silva Paganini W 
Published: October 2020

Abstract
The occurrence of residual drugs in sewage and natural waters is an important international topic. The behavior of compounds in the environment and sewage treatment plants (ETEs) is influenced by their physicochemical properties, which govern partition in water, soil or biota.
The present study aims to identify the presence of clonazepan, simvastatin, paracetamol, atenolol, carbamazepine and fluoxetine drugs in biosolid from TEE before and after the composting process.
Based on the Environmental Protection Agency's Structure-Activity Relationship Model (ECOSAR) Program (EPA), and according to ZAGATTO (2006), the octanol/water partition coefficient (Kow) observed for ibuprofen drugs, fluoxetine and sinvastanin was 3.97, 3.82 and 4.68, respectively, denoting its bioaccumulation potential, which does not happen with the other compounds, as they present logKow &lt; 3, being log kow = 0.03 for atenolol; 2.3 for carbamazepine; 0.49 for paracetamol and 2.53 for clorazepam.
AQUINO, 2013, mentions that drugs with logKow &lt; 2.5 have high hydrophylycity and low absorption trend in biomass and lipid fractions of suspended solids. For Log Kow values between 2.5 and 4.0, there is a moderate tendency of absorption in these matrices.
Data on ecotoxicity, provided by the ECOSAR program, indicate the effects observed in fish, at the concentration of 30 μg/L for Sinvastatin and 20 μg/L for Fluoxetine.
The agricultural use of biosolids is a controversial subject due to the potential adverse impacts on human health. In the name of safety, strict standards, high quality criteria and restrictions on use are imposed, and standards should be based on risk assessment, but there is a lack of data on the subject, and there is still no clarity as to what constitutes tolerable risk in the brazilian context for the composition of a pattern.

Key messages
According to the results obtained, it is verified that the studied compounds have the potential to cause deleterious effects on the evaluated organisms, according to the ECOSAR model. Considering the little information available on the subject, especially in relation to the incidence and persistence of drugs in the environment, the continuity of studies is necessary.
Policy framework for building integrated care for TB patients in Romania: setting up the scene
Authors: Furtunescu F , Serban A , Mahler B , Munteanu I 
Published: October 2020

Abstract

Problem
Romania put many efforts for TB control, but despite a constant decreasing trend since almost two decades, TB remained a public health concern, due to the notification rate (highest in EU), the number of resistant cases and the mortality. A national strategy for TB control has been issues for 2015-2020, but its implementation was fragmentary.

Description of the Problem
Benefiting for a series of programs financed by the Global Fund to Fight AIDS, Tuberculosis and Malaria, Romania performed a detailed analysis of the national context, on four pillars (governance and accountability, service delivery, organizational capacity, resources). Quantitative data collected through routine systems were combined to interviews with key informers and focus groups with medical staff, patients and NGOs active in supporting key vulnerable population.

Results
A national framework for strengthening the implementation of the strategy was set up under a Tailored to Transition Global Fund Grant. This framework put together the policy and the technical levels and the civil society sector. Main interventions aimed to strengthen the governance, to improve the procurement and supply mechanism, to develop the ambulatory patient-centered model of care and to create tools for improving the access of key vulnerable population to basic integrated medical and social services.

Lessons
Translating the good practice models developed by the NGO sector to permanent (governmental) structures was difficult due to more rigorous legislative framework for public systems.

Key messages
Multisectoral approach is essential for building integrated care for TB patients. Integration of services should focus not only to complex medical needs, but also to the social ones.
Experience report on strategy design for effective public health policies in the Piauí, Brazil, 2020
Authors: Vilarinho L , Amorim A , Fé C , Cardoso O 
Published: October 2020

Abstract

Aim
Report of the ascending, collective and participative process of construction of the Strategic Action Plan of the State Secretariat of Health of Piauí for the period from 2020 to 2023 and its compatibility with the Planning and Management Instrument of the State of Piauí - PPA (Plano Pluri Yearly). Action developed for the Institutional Development Program of SUS. We sought consistency and compatibility for health needs and Government priorities, implementing public health policies, technical, operational and financial feasibility and feasibility, impact and improvement in living conditions and health of the population, reducing inequalities, expanding the access to inclusive health policies, increase in citizen's life expectancy and life expectancy at birth.

Methods
Workshops, with technical staff from the Health Secretariat and the State Planning Secretariat, using the Situational Strategic Planning-PES, in addition to the Balanced Scorecard, and the SWOT Matrix. The SESAPI Strategic Map was previously built, with priorities for the identification of plans and results oriented to the goals.

Results
The SWOT Matrix focused on analyzing the environment or scenarios, internal and external, with strategies to maintain strengths, reduce the intensity of weaknesses, use opportunities and protect against threats. The technical health priorities were legitimized and made compatible with the State Planning Secretariat, in Workshops with Social Representations of the 12 Regional Development Territories of the State.

Conclusions
The prioritized strategic actions embodied the definition of Budgetary Actions for the health area that conform to the LOA- Annual Budget Law, linking the estimated amounts to a set of indicators and desired and possible results to be achieved in the established period. The entire process was technically monitored and submitted to analysis and approval by the Social Control bodies in compliance with the provisions of the legislation in force.

Key messages
The prioritized strategic actions embodied the definition of Budgetary Actions for the health area and linked the estimated amounts to a set of indicators. All production has generated the formation of a government staff with managerial capacity to strategic planning and evaluation as part of training teams trained by the government.
Mortality of youth in changing socio-economic situation in the Russia
Authors: Sabgayda T P , Semyonova V G , Zubko A V 
Published: October 2020

Abstract

The past three decades in Russia (from 1989 to 2018) are characterized by significant changes in the socio-economic situation with corresponding fluctuations in death rate. Mortality of children (under 15 years of age) reflects a steady decline without pronounced ups; the dynamics of youth mortality (aged 15-29 years) shows three peaks (in 1995, 2000 and 2005), while in the mortality dynamics of people aged 30 years and over there were two peaks (in 1994 and 2003).
We analyzed what determines the uniqueness of the dynamics of young mortality. We revealed the next 8 specifics. The growth rate of youth mortality before reaching the first death rate (1995) as well as the rate of decline in mortality after the last peak (2005) are higher than in other population groups (1994 and 2003, respectively).Gender differences in youth mortality are more pronounced: among young people, male mortality decreased significantly faster than female mortality; in 2018, the ratio of male to female mortality was 1.3, 2.7, and 2.0 for age groups respectively 1-14, 15-29 and 30+ years old.Youth mortality is determined mainly by avoidable causes.Avoidable mortality of young people is more determined by living conditions and lifestyle.The quality of medical care has a more pronounced effect on the mortality of young men.There is a large variation in the avoidable mortality levels among youth for the analyzed period.For the analyzed period, the unavoidable mortality of young people increased to a greater extent than in the age group 5-64 (for which as a rule avoidable mortality was determined by the end of the last century).In youth mortality, the contributions of external death causes and infection diseases are greater than in older age group.
Conclusion. The regularities found allow us to conclude that the death rate of youth, which responding faster and more clearly to changes in socio-economic situation, can serve as quick indicator of avoidable population losses.

Key messages
The youth mortality, which responding faster and more clearly to changes in socio-economic situation, can serve as quick indicator of avoidable population losses. For period 1989-2018, the unavoidable mortality of young people increased to a greater extent than in the age group 5-64.
Adults with young children are more satisfied with their lives than other adults
Authors: Haapala E , Peltomäki H , Jääskeläinen T , Koponen P , Mäntymaa P , Lundqvist A 
Published: October 2020

Abstract

Background
Limited research exists on the differences in the wellbeing of adults with young children and those without. The aim of this study was to compare the well-being of adults with and without young children.

Methods
The study is based on the FinHealth 2017 Study of a nationally representative sample on adults aged 18-50-years (n = 4764, 58% participated). Information on wellbeing was collected through self-administered questionnaires. Adults living in a household with young children (under 7-years old, n = 762) were compared to adults living in a household without young children (n = 1864). Inverse probability weights were used in the analysis to correct for the effects of non-response and different sampling probabilities.

Results
Nearly 90 % of adults with young children rated their quality of life as good or very good and were more satisfied with their family life (women 84% vs. 76%, men 87 % vs. 78%) and life achievements (women 82% vs. 69%, men 78% vs. 58%) compared to other adults. No difference was observed in satisfaction with the financial situation. Differences in the experience of psychological distress (Mental Health Inventory, MHI-5 score ≤52) were statistically insignificant. 6% of women and 7% of men with young children experienced psychological distress while the equivalent percentage of other adults was 9% in both sexes. Differences in symptoms of depression (Beck Depression Inventory, 6 item score &gt;4) were also statistically insignificant, although the prevalence was somewhat lower for those with children (women 12% vs. 15%, men 6% vs. 12%). Adults with young children reported sufficient sleep less often compared to other adults (women 64% vs. 76%, men 67% vs. 77%).

Conclusions
Most parents of young children have a good quality of life and are satisfied with their life. Getting sufficient sleep is one of the main challenges of adults with young children.

Key messages
Adults with young children are more satisfied with their life compared to other adults. There is still a need for holistic lifestyle guidance, especially to promote mental well-being and sufficient sleep of adults with young children.
MisuMedPT - Morbi-mortality consequences of misuse of psychoactive prescription drugs in Portugal
Authors: Araújo A , Bulhosa C , Goulão J , Martins A P 
Published: October 2020

Abstract

Background
In Portugal, there are no published data on the health-related consequences of prescription drug misuse, which is therefore a public health issue of unknown dimension in our country. Poison control centres and other pharmacoepidemiological sources can be part of a surveillance system for monitoring medicine's use and misuse.

Methods
Retrospective observational study of intentional exposures to opioid analgesics, antiepileptics, antidepressants, anxiolytics, hypnotics and sedatives reported to the Portuguese Poison Information Centre (CIAV) between 2014 and 2018. Variables studied were demographic characteristics of individuals, geographic distribution of calls, co-exposure to alcohol or illicit drugs, call origin, case evaluation and guidance.

Results
CIAV received 24624 calls reporting 34203 intentional exposures to any medicine, 31169 (91.1%) of which involving one of the studied psychoactive medicines and 20906 exposures having emergency room advice or effective hospitalisation. The most frequently involved medicines were benzodiazepines (62.0%) - alprazolam (15.4%) and diazepam (12.0%) - with trazodone ranking fifth (6.0%). Combination with non-medicinal products was seen in 2169 calls (9.4%), 2052 (94.6%) of which with alcohol.

Conclusions
There is female predominance in the poisonings reported involving any of the medicines studied. Benzodiazepines and antidepressants are the top classes reported. The rate of intentional exposures to psychoactive medicines is higher in Coimbra district, whose significant university student population requires further analysis of data. To adjust for the variability in the level of medicines' use in the population, work is undergoing to include rates of intentional poisonings in patients prescribed the studied medicines. To better characterise the potential consequences of misuse of psychoactive prescription drugs in Portugal, additional data on deaths involving these medicines will also be included in the project.

Key messages
First published Portuguese data on prescription drug poisoning reported to CIAV. First Portuguese project to analyse prescription drug poisoning, forensic and hospitalisation data.
Assessment of the attractiveness of robotic-assisted radical prostatectomy in the hospitals in Milan
Authors: Greco M , Mosillo M , Papa M T , Zanardi S , Tinaglia V , Nicolosi D 
Published: October 2020

Abstract

Background
Robotic-Assisted Radical Prostatectomy (RARP) performed in the hospitals of the Health Protection Agency (ATS) of Milan increased from 302 in 2011 to 1275 in 2019. On the contrary, Traditional Radical Prostatectomy (TRP) remained essentially unchanged (919 hospitalization in 2011, 937 in 2019). The increase in RARP occurred both for Lombardy (L) (223,7%) and particularly for out-of-Lombardy residents (EL) (565,5%). In 2011 66.5% of all EL treated with Radical Prostatectomy (RP) (RARP + TRP) in the ATS area were enrolled in hospitals equipped with robots, while in 2019 this percentage rose to 97.5%. In view of this important increase and considering the high density of hospitals with robots in Milan, it was analyzed if the reason for the EL displacement could be due to the possibility of performing a RARP.

Methods
The Hospital Discharge Cards (SDO) database was used for the analysis. Admissions to be considered were identified through the main diagnosis of localized malignant prostatic cancer and the surgical intervention of RP. The other urological interventions were identified through the discharge ward. The “residency” field allowed to separate L from EL.

Results
Considering the four hospitals where robot technology was already available in 2011, the percentage changes in hospitalizations were compared for: only RP interventions, all urological interventions excluding RP, total hospital production distinguishing between L and EL. RP increased by about 5 percentage points in EL (from 43.5% in 2011 to 48.7% in 2019). For other urological surgeries excluding RP, the increase was about 11 pp (from 16.1% in 2011 to 27.3% in 2019), as well as for general procedures (15.5% in 2011, 26, 2% in 2019).

Conclusions
The increase in EL for RP is lower than the increase observed for other urological surgeries and on all hospital production. It can be concluded that it is not the RARP technique itself that is attractive to EL, but rather the reputation of the hospital.

Key messages
In 2019 the number of robotic-assisted radical prostatectomy increased 4,2 times compared to 2011. R-assisted radical prostatectomy is not a determining factor for health mobility towards Lombardy.
Acute gastroenteritis outbreak: epidemiology at the core of investigation
Authors: Carvalho Sousa S , Fernandes S , Novais L , Verne M , Areias R , Dourado F , Ribeiro M 
Published: October 2020

Abstract

Background
At 28th February 2020, local public health authorities were notified that an occupational activity center headed to adult individuals with disabilities, in Guimarães (Portugal), had several cases of users vomiting or with diarrhea during that week, requesting control measures.

Methods
An outbreak investigation was carried out, with case definition being someone with nausea, vomiting and/or diarrhea. An epidemic curve was made with the number of cases per date of symptoms onset. Attack rate was calculated as the number of cases in the occupational activity center divided by the number of people in the same center.

Results
Mild, self-limited acute symptoms of nausea, vomiting and/or diarrhea were identified in 18 individuals that attended the occupational activity center. The first case developed symptoms on 24th February (day 0); the second case appeared about 24 hours after; the peak occurred at day 4 with seven cases. Attack rate was 27% among users and 15% among monitors. The mean age was 40 years. Two cases went to the emergency department and were clinically diagnosed with acute viral gastroenteritis, no further care needed. Meals were served at a neighbor building, shared with another rehabilitation institution. The rehabilitation institution reported zero cases. Additionally, Hazard Analysis and Critical Control Point process was fully accomplished.

Conclusions
Clinical and epidemiological findings suggest a probable viral outbreak with person-to-person transmission. The incubation period is consistent with norovirus, the most common agent of viral gastroenteritis. No biological samples were collected, because symptoms were mild and there was no chance to do it. Environmental samples were not collected. Preventive hygiene measures were immediatly enhanced, namely hand washing, appropriate disinfection of contaminated surfaces and isolation if symptomatic. These measures are highly efficient breaking the chain of infection and that was obtained.

Key messages
Epidemiological findings are at the core of an outbreak investigation and support immediate implemention of effective control measures. Although laboratory results are important, they are not always available for outbreak investigation.