bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Public Health Workforce in Portugal in 2019
Authors: Moreira de Sousa A , Moreira M , Cabral M 
Published: October 2020

Abstract
While the slogan of a fit for purpose workforce pushes us to consider qualitative aspects, there are still quantitative aspects that need further consideration. In some planning and forecast processes, greater quantitative detail should be considered. We use an example from Portugal to explore this matter in the Public Health workforce (PHW). In 2019, for the first time, all Public Health Units (PHU) were supposed to fill in a plan of action on a public online platform. This included some self-reported data on their PHW.
We have used this data to explore which and how many professionals were available in each of the PHU, also having in mind their percentage of work hours dedicated to the PHU and their gender. For this analysis, we have used Microsoft Office Excel 365, R 3.6.1, RStudio 1.2.5033, and ArcMap 10.7.1.
Of the 55 PHU in Portugal, 12 (21,8%) did not publish their Plan, 2 (3,6%) were released without being correctly filled, and 3 (5,4%) with substantial data regarding their human resources being incomplete. In total, the plans identified 220 public health medical specialists, 130 medical residents, 184 nurses, 136 secretaries, and 314 other professionals. From the reported data, there was an average of the percentage of week hours dedicated to the PHU of 82,8% for medical specialists, 71,8% for nurses, 89,8% for secretaries, and 92,1% for other professionals. In what concerns gender distribution, women represented 60,9% of medical specialists, but only 52,6% of PHU coordinators, 55,5% of medical residents, 86,4% of nurses, 83,7% of secretaries, and 77,7% of the remaining professionals. There were considerable differences between PHU in these results.
These results might differ from formal administrative data. However, due to being reported from the PHU themselves might portrait a more realistic picture of the local public health workforce. These results underline the importance of the hours dedicated to the PHU in the planning and forecasting of the PHW.

Key messages
The % of time PH professionals dedicate to their Unit should be included in Workforce planning. Greater adherence to the Portuguese public platform for action plans is needed.
Task shifting and health professionals: a European policy analysis
Authors: De Caro W , Corvo E 
Published: October 2020

Abstract

Issue
There is now a growing interest by public health and health policy leader worldwide in task shifting within health professionals. Nurses represent the largest health workforce. Research has displayed that higher level of nursing competencies leads to better outcomes for patients and for the organization. Advanced and specialistic nursing and prescribing nurses is common in anglophone countries but is still in development in other countries and do not have a stable legislative recognition.

Methodology
We carry out a review of policy documents, models, and frameworks at European level to identify best practices to implement within the Italian context, with particular attention to nursing task shifting in order to set up Advanced Practice Nursing. Following the EU taxonomy, the analysis was carried out in order to classify the different approaches under the three main areas: enhancement, substitution/delegation and innovation.

Results
There are a number of reports and policy documents suggesting that task shifting is a way to improve health management, however to a mixed extent. Results show that task shifting has a domino effect. It impacts on the whole organization in terms of social and financial sustainability, quality of care, and general strength of the health systems. According to the results, Task shifting could potentially play a big role in the crucial transformation of health systems worldwide, however, it is still strongly influenced by a medically centered approach.

Conclusions
In the light of the results, there is an overall lack of clarity and well-developed policy approach by policymakers about task shifting competencies. Recent occurrences in terms of overwhelmed hospitals and health systems in general has clearly displayed the need to a major transformation and update of traditional models and regulatory frameworks of delivery of care and cure.

Key messages
Task shifting for health professionals is the future. task shifting is crucial in emergency and primary care.
Delays in the diagnosis of pulmonary tuberculosis in critical and non-critical areas in Portugal
Authors: Leite A , Soares P , Santos J , Nunes C 
Published: October 2020

Abstract

Background
Delays in diagnosing tuberculosis lead to longer infectious periods, posing a challenge in tuberculosis control. This is particularly relevant in high incidence areas (critical). Thus, the objectives of this work were to characterize tuberculosis diagnosis delay and its components (patient delay and health delay) in incidence critical and non-critical areas in Portugal, as well as associated factors.

Methods
Notified cases of pulmonary tuberculosis diagnosed due to symptoms (passive screening) in the Portuguese Tuberculosis Surveillance System were analysed (2008-2017). Patient, health and overall delays were calculated. Factors associated with each delays' components were identified utilising Cox regression, while adjusting for sex, age and education level. Analyses were stratified by area type (critical and non-critical).

Results
Median (1st-3rd quartile - Q1-Q3) delays in patient, health and overall delay in critical areas were: 40 (Q1-Q3: 21-76), 8 (Q1-Q3:1-31), and 65 (Q1-Q3: 40-105) days, respectively; similar delays in non-critical areas were 32 (Q1-Q3:16-63); 9 (Q1-Q3: 1-34) and 58 (Q1-Q3: 35-98), respectively. More recent cases, adults younger than 65 years and alcoholic presented longer patient delays (both areas); healthcare professionals and patients with HIV infection presented shorter patient delays (only critical areas). Tuberculosis high-risk groups (males, alcohol dependency, homelessness, community residency) presented shorter health delays in both areas; drug use also presented shorter health delays but only in critical areas. Existing comorbidities was associated with longer health delays in both areas.

Conclusions
Patient delays increased between 2008 and 2017. Groups with longer/shorter delays differed between delay type and area type. Intervening in tuberculosis diagnosis delays requires different action for critical and non-critical areas, targeting health literacy from the general population and training of healthcare professionals.

Key messages
Delays in diagnosing in Portugal are mainly driven by delays in patient seeking care and are longer in areas of higher tuberculosis incidence. Intervening in tuberculosis diagnosis delays in Portugal requires different action in different areas, targeting health literacy in the general population and training of professionals.
Selectively permeable national borders: An ethnographic study of a pre-entry TB screening centre
Authors: Potter J L 
Published: October 2020

Abstract

Background
The securitisation of borders against the threat of invading microbes, carried by immigrant bodies, is not a new phenomenon. Tuberculosis (TB), transmitted through coughing, has been a core member of the infectious diseases deemed important to control for more than a century. Following evidence suggesting airport screening for TB using chest x-rays was ad hoc, ineffective and costly, the UK - following in the footsteps of other high-income, low TB-burden countries - moved to pre-entry screening of migrants for TB. Thus the 'biosecuritisation' of immigrant bodies was shifted off-shore. Since 2014, pre-entry screening for TB has been a mandatory part of the visa application system for those moving to the UK for a period of 6 months or longer from high-incidence countries. This ethnographic study explores how pre-entry screening is experienced by migrants.

Methods
Data was drawn from a project exploring migrants' experiences of accessing healthcare. This involved a focused ethnography, comprising 180 hours of field work over four weeks including interviews with clients and staff, in a pre-entry TB screening centre in India in 2017. During this time over 1000 individuals were screened for active pulmonary TB as part of their visa application. In addition, 14 in-depth interviews were conducted with migrants diagnosed with TB in the UK. Foucault's concept 'governmentality' and sociological theories of bordering were used alongside thematic analysis to analyse the data.

Results
This study reveals the previously undocumented harms experienced by individuals who are required to undergo pre-entry screening for TB. Through the 'biosecuritisation' of some, but not all, off-shore bodies; some, but not all, off-shore TB; some, but not all, infectious diseases; pre-entry screening becomes a border force, reinforcing global inequities and racialised hierarchies. In this context, I argue pre-entry screening makes UK citizens live while letting 'others' die.

Key messages
Pre-entry screening marks migrants as ‘other’ in a global, racialised, hierarchy of TB risk that ignores intra-country heterogeneity, obfuscating solutions that might reduce inter-country inequities. The global health security agenda must consider the experiences of those caught up in its policies and practices in order to ensure disease control does not do more harm than good.
Pulmonary tuberculosis incidence, trends and predictions in Monastir, Tunisia (2000-2030)
Authors: Ben Nasrallah C , Zemni I , Kacem M , Dhouib W , Bannour R , Grira S , Ben fredj M , Abroug H , Belguith Sriha A 
Published: October 2020

Abstract

Background
Tuberculosis (TB) continues to be one of the infectious diseases with the highest morbidity worldwide. The lung is the most commonly involved organ, but lesions can occur in other body systems. This study aimed to describe incidence and trends of pulmonary tuberculosis (PTB) over a period of 18 years in Monastir and to estimate predictions for 2030.

Methods
We carried out an observational study from 2000 to 2017. Data were collected by the regional direction of primary health care. Incidence was estimated by the crude incidence rate (CIR) and the age standardized rate (ASR). Poisson regression model was used to calculate the slope 'b' in order to describe trends and was performed to estimate incidence projection for 2030. Data were verified and analyzed using IBM SPSS Statistics version 22.0 software.

Results
A total of 997 patients were recorded with 486 cases of PTB (48.95%). Sex ratio was 2.85. The median age was 40.5 [IQR 28-56] years old. PTB ASR was 5.71/100,000 inhabitants (inh). CIR was the highest among the eldest cohort aged more than 60 years (12.65/100,000 inh) and the lowest among youth aged less than 19 years (1.01/100,000 inh). We established a negative trend of PTB over 18 years (b= -0.032; p &lt; 10-4) in all age cohorts. PTB would be decreasing by 2030 with an estimate incidence rate of 1.83/100,000 inh.

Conclusions
The decline of PTB may be a sign of TB control program effectiveness in Monastir. Thus, the challenges for the future are to maintain PTB towards decreasing.

Key messages
Our study highlighted the impact of TB control strategies in Tunisia. Our findings play a key role in estimating whether the WHO’s End TB strategy targets can be achieved by 2030.
Electronic cigarettes and respiratory diseases in Russian Tobacco Control Policy evaluation survey
Authors: Gambaryan M H , Popovich M V , Starovoytov M L , Drapkina O M 
Published: October 2020

Abstract

Background
Though electronic cigarettes (EC) and heated tobacco products (HTP) are marketed as harm reduction products, the evidence is that like smoking, their use is dangerous for the lung health.

Aim
To explore the associations between EC and HTP use and major respiratory diseases (RD).

Methods
Cross-sectional data of adult representative sample from Russian Tobacco Control Policy Evaluation Survey are analysed, based on multistage sampling in 10 Russian regions in 2017-2018, stratified by smoking status: n = 11625: 6569 smokers, 2377 former smokers, 2679 never smokers. Self-reported formerly diagnosed RD as outcome indicators were analysed in relation with ever EC and HTP use, and current EC use, including HTP. Multiple logistic regression is employed; odds ratios (OR) with 95% CI adjusted by smoking status and socio-demographic factors.

Results
Chronic bronchitis (CB) was reported by 14% respondents, COPD-by 4.3%, asthma-by 3.1%, emphysema-1.5%, lung cancer-1.1%, tuberculosis (TB)-1.3%. Ever EC use was prevalent in 9.3%, HTP use-in 3.3%, and current EC use-in 2.5% of population. The prevalence of ever EC and HTP use and current EC use was higher among current smokers (13%,4.4%,3.5%), compared to former smokers (7.4%,3.4%,3.5%) and never smokers: 2.2%, 0.7% and 0.6% respectively, (p&lt;.001). Ever HTP users had 2.5 times higher chances of CB: OR 2.52(95%CI 1.9-3.3), and 4 times higher chances of COPD: OR3.97(95%CI 2.8-5.7). The risk is even greater in case of dual EC and tobacco use in current smokers: OR 3.0(95%CI 2.2-4.1) and 4.2(95%CI 2.8-6.3) respectively. Current EC use was significantly associated with asthma: OR 2.9(95%CI 1.5-5.8) and OR 5.0(95%CI 2.6-11.3) in current smokers, lung cancer: OR 4.9(95%CI 1.6-14.8) and 7.2(95%CI 1.9-27.4); and TB:OR4.1(95%CI 1.7-11.6) and 5.4(95%CI 1.6-17.9) respectively.

Conclusions
EC and HTP use independent from smoking may increase the risk for major RD, combined with tobacco smoking the risk of RD is even greater.

Key messages
The use of Electronic cigarettes and heated tobacco products, independent from smoking, may increase the risk for major respiratory diseases. Prevalence of EC and HTP use is higher among smokers, compared to former and never smokers; combination of EC and HTP use with tobacco smoking makes the risk of respiratory diseases even greater.
Impact of clinical symptoms on the disability of patients with schizophrenia (Bulgaria, 2018-2019)
Authors: Veleva I , Yankulovska S , Velikova K , Valkova M , Grancharova G 
Published: October 2020

Abstract

Background
According to Global Burden of Disease Studies (1990-2017), schizophrenia causes globally 1.1% of DALYs (disability-adjusted life years) and 2.8% of YLDs (years lived with disability). It is the 8th leading cause of DALYs in 15-44 years of age (WHR 2001). The aim of the study was to assess the impact of clinical symptoms on disability in hospitalised patients with paranoid schizophrenia (PS).

Methods
The study includes 108 patients treated in Psychiatric Clinic of Pleven University Hospital: 66 males and 42 females, mean age 38.9±10.0, duration of disease 12.8±8.2 years; mean onset of disease at 24 years (Me = 25 and Mo = 22). The research protocol was approved by University Ethical Committee. The disease burden was assessed by Positive and Negative Syndrome Scale (Ð ANSS), and level of disability - by 36-item self-administered WHO Disability Assessment Schedule 2.0. Pierson's r. was used for the relationship between both variables. Data processing was performed by IBM SPSS v.24.

Results
The average burden of disease based on Ð ANSS was 71,8±5,1. The increase of symptoms' burden leads to worsening in “participation in society” (r = 0.561), “life activities-household” (r = 0.554), “getting along with people” (r = 0.539). Positive symptoms correlate higher with “getting along with people” (r = 0.549), “life activities-household” (r = 0.578), “participation in society” (r = 0.623), and negative symptoms - with “participation in society” (r = 0.526) and “life activities-household” (r = 0.476). Symptoms of disorganisation have highest impact on “life activities-household” (r = 0.807),”getting along with people”(r = 0.556), and “participation in society” (r = 0.649. All correlations were significant at p = 0.0001. “Getting around” has no relation with disease burden.

Conclusions
Disorganisation symptoms and negative symptoms strongly affect the overall psychosocial functioning, while positive symptoms have less impact on it.

Key messages
Appropriate treatment schemes directed to negative symptoms would contribute to decrease of disability level in patients with paranoid schizophrenia. Prevention and rehabilitation in PS patients should emphasise promotion of professional and personal development for minimising of disease impact on overall social functioning.
Education as a contradictory determinant of mental health between migrant and national adulthood
Authors: Sesti F , Minardi V , Baglio G , Bell R , Goldblatt P , Marceca M , Masocco M , Carrozzi G , Fateh-Moghadam P , Marmot M 
Published: October 2020

Abstract
The Social Determinants of Health (SDHs) are well known for their interaction on health outcomes and they can have a stronger impact on migrant health whom have higher probability to live in precarious living and working conditions compared to the hosting population. Migrant health is a public health issue which has to be considered taking into account the SDHs and complementary, including cultural issues is fundamental for addressing health equity in the society as a whole. Recognising this challenge, this study aims to evaluate the interactions between education and mental health of resident population in Italy, including Italians and immigrants.
This study examined the respondents in 2014-17 to the Italian “Progressi delle Aziende Sanitarie per la Salute in Italia” (PASSI) surveillance system. The sample of 118,639 respondents is composed by the residing working adults aged 25-69 with Italian citizenship (n = 112,345) and foreign citizenship (n = 6,294). Looking at SDHs, if for Italians high level of education appears to be a protective factor of mental health in accordance with the international evidence (adjPR: tertiary education 0,87 95%IC 079-0,97), among immigrants higher level of education it is more associated with the presence of depressive symptoms (adjPR: tertiary education: 1.77 95%IC: 1.19-2.63). Longer the length of stay in Italy for PFPM immigrants higher the risk of depressive symptoms: adjPR for 10+ years: 5.1 95%IC: 1.29-4.3.
The data show that high education could represent a risk factor for mental health of immigrants. Considering that health is related to the nature of society as well as to access to technical solutions, multicultural societies require culturally oriented interventions for tackling health inequities. This means developing evidence-based policies in order to tackle health inequalities in the population as a whole, including culturally oriented measures in the larger framework of developing diversity sensitive services.

Key messages
For some groups of population, such as migrants, high education could represent a risk factor for mental health. Developing diverse sensitive policies is needed in order to tackle health inequities in the population as a whole.
Monitoring the implementation of national climate action plans (NDCs) using the WHO CaRBonH tool
Authors: Spadaro J V , Mudu P , Kendrovski V 
Published: October 2020

Abstract
One crucial area of work of the WHO European Centre for Environment and Health has been the assessment of the health effects associated with the use of fossil fuels, both directly through the generation of local air pollution and indirectly by contributing to global environmental and climate change. The WHO European Centre for Environmental Health in Bonn has developed various decision support tools to calculate both the health burdens of local pollutants and the benefits of selected interventions. A key outcome has been the recent development of a simplified calculation tool, Carbon Reduction Benefits on Health (CaRBonH), capable of estimating the health, carbon and economic benefits of selected mitigation interventions. CaRBonH allows quantification of the physical and economic consequences on human health achieved through improvements in country-level air quality from domestic carbon reductions, specifically the policy mitigation actions and measures as reported in the NDCs submitted by the Conference of the Parties to the UNFCCC in support of the objectives as set out in Article 2 of the Convention. The work of improving and updating the CaRBonH tool, based on feedback from users, and the process of extending the geographical scope of the tool to account for countries outside the WHO EURO region, will be discussed in this session.
Gender responsive health promotion and NCD prevention – challenges and solutions in Kyrgyzstan
Authors: Graeser S , Djamangulova T , Aidaralie R , Matovic-Miljanovic S 
Published: October 2020

Abstract
Reaching men is one of the challenges related to targeted health promotion. Societal factors, concepts of masculinities, and gender norms have a strong influence on preventive and health behavior of men. Targeted health promotion and prevention has to consider gender-specific differences in language and information sources to spread preventive messages but often fail to be effective. In Kyrgyzstan, non-communicable diseases account for 80% of mortality, including cardiovascular diseases, and raised blood pressure is the second most common disease for men. The NCD prevention and control project in Kyrgyzstan, funded by the Swiss Agency for Development and Cooperation (SDC), aims to facilitate behavioral change towards healthier lifestyles by taking a gender-responsive approach to support the utilization of NCD related primary health care services for men. The gender-responsive intervention considers gender roles, norms, and inequalities, understands men's health needs, and pattern of preventive behavior to develop interventions. Data from project studies yielded that for men family members were the primary source of information about NCDs, risk factors and prevention. An assets-based approach is taken, building on the male role in a life-course perspective and a positive approach to the role of men as fathers. In 2019, an intervention, combining a school competition for children with a voucher system for preventive services for fathers and male relatives was conducted. In total, 80,416 males were reached and visited primary health facilities for preventive services (which averaged 20% of the male population over 18 years old); 18,364 (23%) men were newly detected with high blood pressure. Medical workers were made available during special hours to provide men with a consultation. During their visits, all men were screened for risk factors and received a consultation based on PEN protocol 1 and 2. Lessons on gender sensitivity have been learned from this experience.