bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prevalence of endoparasitors in rural communities in Central Brazil: a cross-sectional study
Authors: Souza Rocha B , Alves Guimarães R , Sérgio Scalize P , Pagotto V , Souza Fiaccadori F , Fatima C , Rosso Weirich , Ribeiro N , Teixeira Bezerra , do Espírito Santo Filho K 
Published: October 2020

Abstract

Background
Studies show that the magnitude is high in regions lacking basic sanitation, such as rural areas. Despite this, there is little evidence on the prevalence of endoparasitosis in rural communities in developing countries. The aim of this study was to estimate the prevalence of endoparasitosis in residents of rural communities in Central Brazil.

Methods
Cross-sectional study conducted within the scope of the Sanrural Project that aims to assess the health and sanitation conditions of rural communities in 2019. The target population of this study consisted of residents of 17 settlements, 24 quilombola and 7 riverside communities in Central Brazil. By listing the total number of residents of each household in the communities, residents were selected by simple random probability sampling. Then, stool samples were collected in sterile plastic containers and identified. After collection, the samples were transported for analysis by direct examination of the feces. The descriptive analysis was made. The study was approved by the Research Ethics Committee of the Federal University of Goiás.

Results
Data from 680 individuals (children and adults) who had stool samples collected were analyzed. The prevalence's of the endoparasites found were: Entamoeba coli (13.5%; 90%CI: 11.5-15.8%); Giardia lamblia (2.8%; 90%CI: 1.9-4.4); Ascaris lumbricoides (1.5%; 90%CI: 0.9-2.4); Ancyslotoma (0.9%; 90%CI: 0.5-1.7); Enterobius vermicularis (0.7%; 90%CI: 0.4-1.5%); Taenia (0.6%; 90%CI: 0.3-1.3); Hymenolepis nana (0.6%; 90%CI: 0.3-1,3); Itamoeba (0.4; 90%CI: 0.2-1.1); Hymenolepis diminuta (0.3%; 90%CI: 0.1-0.9), Strongiloides (0.0%); Trichuris (0.0%) and, Schistosoma mansoni (0.0%).

Conclusions
An intermediate prevalence for principal endoparasites was observed. This result may suggest the persistence of precarious sanitation conditions. Thus, the implications of the study include the need for systematic action by managers and health professionals in improving sanitation conditions.

Key messages
A current diagnosis will be made on the health and sanitation situation of rural communities in Goiás, based on the analysis of clinical samples and water quality, among other conditions. Based on this diagnosis, together with the community, we will seek solutions for sanitation and health through a Rural Sanitation Security Plan (PSSR).
Hand hygiene: are WHO Framework scores consistent with hand rub consumption data? A regional study
Authors: Garlasco J , Vicentini C , Emelurumonye I N , Quattrocolo F , D'Alessandro G , Zotti C M 
Published: October 2020

Abstract

Background
Hand hygiene represents one of the most effective measures to prevent infection transmission in healthcare facilities and may reduce healthcare-associated infections by up to 15-30%. In Piedmont (a region in North-West Italy), hand hygiene compliance is routinely monitored through the WHO Hand Hygiene Self-Assessment Framework (HHSAF) and each hospital is also required to provide data about alcohol-based hand rub (ABHR) consumption as part of the regional performance indicator surveillance system. The aim of this study is to assess whether these two systems yield consistent results, i.e. whether numerical data matches the self-reported status of hand hygiene compliance.

Methods
For the years 2015-2018, data on ABHR consumption (in millilitres per patient-day, ml/PD) were collected annually at a facility level (40 hospitals) and then aggregated according to the corresponding local health unit/hospital unit, whereas the HHSAF scores were collected at a health/hospital unit level (18 units). The analysis was performed through logistic regression, by taking the WHO HHSAF score (continuous variable) as predictor and ABHR consumption as response variable, dichotomously considered as “low” or “high” (respectively below or above the 20 ml/PD threshold commonly accepted for good practice in hand hygiene).

Results
This study found that a high level of ABHR consumption is more likely to be observed in hospitals/health units with higher HHSAF scores, with a 1.14-fold increase in the odds for every 10-point increase in the HHSAF score. Despite the limited number of observations due to data aggregation, the result reached borderline statistical significance (p = 0.05).

Conclusions
The ABHR consumption surveillance provides feedback heading in the same direction as the results of the HHSAF, therefore the two surveillance systems are consistent. These findings provide further support for the validity of the HHSAF score as a reasonable predictor of hand hygiene compliance.

Key messages
The WHO Hand Hygiene Self-Assessment Framework score is a reliable predictor of hand hygiene compliance, as a high hand rub consumption is more likely to occur in hospitals with higher HHSAF score. Surveillance through the WHO HHSAF should be encouraged, along with alcohol-based hand rub (ABHR) measurement, and these results should be used to guide action plans to promote hand hygiene.
Appropriateness of antibiotics for medical prophylaxis: evaluation of data from the Italian PPS-2
Authors: Cremona A , Garlasco J , Gintoli I , D'Ambrosio A , Quattrocolo F , Vicentini C , Zotti C M 
Published: October 2020

Abstract

Background
Antibiotics (AB) are administered for medical prophylaxis (MP) to prevent infectious complications. The second national point prevalence survey (PPS) of healthcare-associated infections and AB use was conducted in Italy in 2016-2017. The survey found MP accounted for nearly 25% of all registered ABs, more than twice the EU/EEA proportion. The aim of this study was to evaluate how many ABs were administered for MP and how frequently general indications were followed.

Methods
Data from the PPS were used to evaluate the prevalence of indications for MP over the total number of ABs, the proportion - among these indications - of those justified by a motivation in the patients' charts, and the prevalence of ABs considered appropriate for MP. The evaluation was made in 12 hospitals out of 14 participating in the PPS in Piedmont, chosen on the basis of patient traceability. According to national guidelines, the indications for MP that were considered appropriate in this study were: Trimethoprim/sulfamethoxazole for P. carinii pneumonia, Rifaximin for diverticulitis, Penicillin for Streptococcal infections and for splenectomized patients, and Rifampin for TB infections.

Results
1844 AB prescriptions were registered among 1334 traceable inpatients in Piedmont. The prevalence of indications for MP was 16.2% and 253 ABs (84.6%) were prescribed with a motivation. Only 3% of ABs registered as MP were appropriate for this indication: Bactrim 2%, Rifaximin 0.3%, Penicillin 0.2% and Rifampin 0.4%.

Conclusions
This study found an extremely high rate of inappropriate ABs for MP, that will be further investigated through qualitative analysis of medical records to evaluate whether a misunderstanding of the PPS protocol occurred and empirical therapy was confused with MP. Nevertheless, this study highlighted the need for interventions to improve prescribing appropriateness for MP.

Key messages
This study found that only 2.98% of ABs registered as MP among traceable patients in Piedmont were appropriate for this indication. 15.38% of prescriptions for MP were not justified by a motivation. Interventions to improve prescribing appropriateness for MP could lead to a considerable reduction in inappropriate use of ABs, which is crucial in a country facing hyperendemic levels of AMR.
Epidemiology of Carbapenemase-Producing Klebsiella pneumoniae in a Portuguese Tertiary Hospital
Authors: Peres D , Pereira-Rocha N , Alves C , Correia S 
Published: October 2020

Abstract

Background
Carbapenemase-producing Klebsiella pneumoniae (CPKp) are considered a public health problem. To manage this multidrug-resistant organism (MDRO), it is important to identify individuals at higher risk. We describe risk factors for CPKp among a population who acquired this MDRO, in a tertiary hospital Center (THC), from 2017 to 2019.

Methods
Descriptive study, with data from medical record, in a 1100 bed THC, with active surveillance (high risk population at admission and CPKp direct contacts). Participants: patients &gt; =18 years old, with length of stay (LOS) &gt;48 hours, in which CPKp was identified in clinical samples &gt; =48 h after admission and without previous history of this MDRO.

Results
Incidence rate increased from 0.031 (2017) to 0.090 (2018) cases per 1000 patient-days and was 0.081 in 2019 (p = 0.004). Evolution of CPKp proportion was 1.6%, 3.9% and 4.1%, respectively. In 2019, 12 patients (40.0%) were at intensive care when this MDRO was detected. During these 3 years, CPKp was more frequently identified in urine (31.3 - 54.5%) and respiratory products (13.3 - 36.4%). The median LOS until CPKp isolation was 10.0 to 24.0 days and, until discharge, 15.0 to 25.5 days. Fatal outcome occurred in 8 (25.0%) and 7 (23.3%) patients in 2018 and 2019, respectively. Most cases were exposed to antibiotics (81.8 - 90.6%), had a urinary catheter (63.6 - 75.0%) and were dependent for hygiene activities (63.6 - 66.7%). Many had a central line (21.9 - 43.3%), previous surgery (45.5 - 63.3%) and hospital admission in the previous 6 months (27.3 - 40.6%). Along these 3 years, none of these variations was statistically significant.

Conclusions
In this THC, CPKp increased from 2017 to 2018 and remained stable afterwards. It affected mostly male patients, exposed to antibiotics, with urinary catheter and dependent in their hygiene activities. In order to have an adequate CPKp containment strategy it is essential to know the population who acquired this MDRO.

Key messages
CPKp increased from 2017 to 2018 and remained stable afterwards, affecting mostly male patients, exposed to antibiotics, with urinary catheter and dependent in their hygiene activities. In order to have an adequate CPKp containment strategy it is essential to know the population who acquired this MDRO during their stay.
Physical illnesses associated with childhood homelessness - a literature review
Authors: Strashun S , D'Sa S , Foley D , Hannon J , Murphy A M , O'Gorman C S 
Published: October 2020

Abstract

Background and aims
Childhood homelessness is a growing concern in Ireland creating a Pediatric subpopulation at increased risk of physical illnesses, many with life-long consequences. Our aim was to identify and categorize the physical morbidities prevalent in homeless children.

Methods
A review of the English-language literature on physical morbidities affecting homeless children (defined as &lt; 18 years of age), published from 1999-2019 was conducted. A total of 1194 articles were identified, 33 articles of which met our inclusion criteria.

Results
Respiratory issues were the most commonly cited illnesses affecting homeless children; including asthma, upper respiratory tract infections, and chronic cough. Homeless children were described as being at increased risk of contracting infectious diseases, many studies placing emphasis on STI and HIV/AIDS transmission. Dermatologic concerns comprised of scabies and head lice infestation, dermatitis, and abrasions. Malnutrition manifested as a range of physical morbidities; including childhood obesity, iron deficiency anemia, and stunted growth. Studies found a higher prevalence of poor dental and ocular health in this population as well. Many articles also commented on the risk factors predisposing homeless children to these physical health concerns, which can broadly be categorized as limited access to health care, poor living conditions, and lack of education.

Conclusions
This literature review summarized the physical illnesses prevalent among homeless children and the contributing factors leading to them. Gaps in the literature were also identified, and included a dearth of studies focusing on younger children compared to adolescents. We believe that the current issue of child homelessness is socially and medically unacceptable and that homelessness occurring today will be one of the scandals of the next generation. Further research into prevention and intervention programs for this vulnerable population is urgently needed.

Key messages
This literature review shows that homeless children are at an increased risk of several physical morbidities and identified the common themes among them. Based on this literature review, it is recommended that more research be done into developing appropriate intervention and prevention strategies to help this vulnerable population.
Own migration experience is not a risk factor for incident cardiovascular disease – a cohort study
Authors: Krist L , Dornquast C , Reinhold T , Solak S , Durak M , Icke K , Danquah I , Becher H , Willich S N , Keil T 
Published: October 2020

Abstract

Background
Studies have shown differences regarding prevalence and incidence of chronic diseases among first (own migration experience) compared to second (born in host country) generation migrants. The aim of this study was therefore to investigate the incidence of cardiovascular diseases (CVD) among persons of Turkish descent with and without migration experience living in Berlin, Germany.

Methods
In 2012-2013, Berliners with a Turkish migration background were recruited, examined, and contacted again 5 years later via postal mail. Incidence of diagnosed CVD (myocardial infarction, stroke, coronary heart disease, heart failure, cardiac arrhythmia, intermittent claudicatio or transient ischaemic attack) was assessed via self-report. Incidence of any CVD is presented as number and percentages. Associations between the incidence of any CVD and having an own migration experience were investigated with uni- and multivariable regression analyses. Results are presented as odds ratios with a 95%-confidence interval (OR, 95%-CI).

Results
Data of 234 persons of Turkish descent (62.8% women) with a mean age±standard deviation of 44±12.4 years were included in the analyses. Out of these, 79.9% were first generation migrants. First compared to second generation participants differed regarding CVD incidence (any CVD 16.6% vs. 4.3%, respectively; p = 0.03), socio-demographic, and lifestyle factors. After adjusting for these factors, multivariable analysis showed that only BMI (OR 1.12 per BMI point, 95%CI [1.02;1.24], and having a diagnosis of dyslipidemia (OR 4.0, 95%CI [1.45;12.05]), were independently associated with CVD incidence.

Conclusions
In a cohort study with Berliners of Turkish descent, CVD incidence was associated with increasing BMI and dyslipidemia, but not with own migration experience. Future migration-related public health research needs to focus on the prevention of harmful health behaviours to avoid the progression of overweight/obesity and dyslipidemia.

Key messages
CVD incidence is higher in persons with migration experience compared to those without. Migration experience is not associated with CVD incidence after adjusting for confounders (e.g. age, BMI).
Loss to follow up among men who have sex with men and heterosexual men living with HIV in Haiti
Authors: Dunbar W , Sohler N , Coppieters Y 
Published: October 2020

Abstract

Background
Despite the benefits of adherence in HIV medication, health systems are struggling to keep all categories of patients in care due to loss to follow up (LTFU). Men who have sex with men (MSM) are at higher risk of HIV infection and also face several barriers to reach treatment, it is hypothesized that they may also have higher incidence of dropping-off. This study aims to determine whether MSM living with HIV have a greater risk of LTFU compared with heterosexual men and to identify the risk factors for the two groups.

Methods
A retrospective matched cohort study of electronic medical record data from 554 patients living with HIV and enrolled in care between 2015 and 2018 at a Port-au-Prince-based HIV clinic was performed. The 125 MSM and 429 heterosexual patients were matched on gender age and enrolment date. The primary outcome was LTFU defined as not refilling an ART prescription for a period of 90 days. MSM and heterosexual men was compared using t-tests and chi-square tests. The Kaplan-Meier technique was used to estimate time to LTFU after initiation of ART and the Cox Proportional Hazards regression model was used to determine predictors of LTFU.

Results
The sample had a mean age of 31.1 years (SD 8.0) for MSM and 32.4 years (SD 7.7) for heterosexual men. LTFU was significantly more common among the MSM group than the heterosexual group (MSM 48.8%, heterosexual men 34.7%; p = 0.012). Factors associated with LTFU were greater amongst younger patients, with lower educational and economic level. The median time to LTFU for MSM was 679 days and 1110 days for heterosexual men. The log rank test showed that this is statistically significant at p = 0.001.

Conclusions
This study showed that the risk of LTFU is significantly higher and the time to LTFU is significantly shorter for MSM relative to heterosexual men. Identifying predictors to LTFU in HIV clinical settings and providing appropriate services and supports are important steps in addressing this issue.

Key messages
Men who have sex with men continue to face barriers to effective HIV treatment in Haiti. Adapted interventions are needed to improve HIV care for Men who have sex with Men in Haiti.
Ending female genital mutilation – a city’s coordinated effort
Authors: Paixão M , Carmona A , Capelão H , Calé E , Silva A 
Published: October 2020

Abstract
Female genital mutilation (FGM) has short and long-term impacts on the health of girls/women. In Portugal, an estimated 5246 women were subjected to it, with 568 of them residing in the city of Amadora, in the metropolitan area of the capital Lisbon. As such, Amadora was considered a priority area for developing strategies to prevent female genital mutilation, under the coordination of the local public health unit.
Our aim was to capacitate professionals to recognise and act on risk/danger and on minimising potential health impacts of FGM on the local institutions these girls/women might come into contact with.
We created a task force that held meetings with different local actors: hospital, teams at the primary healthcare facility, city hall of Amadora, child protection services, a school, social inclusion projects, representatives of the justice system and a non-governmental organisation. We designed different scenarios for the different needs and entry points of these girls/women in the system and created appropriate procedures for all these actors. Within the primary healthcare facility, we created guidelines specifying criteria for referral to other specialties. This led to the development of a county protocol targeting FGM during the summer of 2019.
We trained 160 healthcare professionals. In addition, we created a booklet for schools and held sessions in school groups targeting teachers, psychologists and operational assistants with a focus on risk and danger indicators and on how to proceed. Overall, 360 school professionals received training. During these sessions, we also presented resources on how to integrate FGM in discussions with students regarding gender violence and human rights.
This intervention will be evaluated after one year (summer of 2020) through mixed-methods to understand the impact on the practice of the professionals in Amadora. We will conduct interviews and apply questionnaires to capture the implementation of this city-wide protocol.

Key messages
Given the complexity of FGM a wide societal and multidisciplinary approach should be used with a public health team coordinating the intervention. In Portugal there is a need for an organised and systematic response by professionals regarding FGM; our county-specific protocol aimed to create that response.
Language barriers in HRQOL assessment: development of a picture-based questionnaire (PictoQOL)
Authors: Erdsiek F , Aksakal T , Dyck M , Padberg D , Yilmaz-Aslan Y , Brzoska P 
Published: October 2020

Abstract

Background
Translations and adaptations of standardized HRQOL questionnaires (e.g., SF-8) are available for many large population groups. For smaller groups, like certain migrant communities, whose language use can differ from the respective population in their countries of origin, often no adequate adaptations are available. Nonverbal, picture-based questionnaires could address these challenges. The present study provides insights into the development of such a measure (PictoQOL) for HRQOL assessment.

Methods
We used a qualitative design. We conducted 6 focus group discussions with a total of 18 adults from different cultural backgrounds to identify suitable visual cues based on the the dimensions of the SF-8 and WHOQOL-BREF and to create drafts of visual representations for different items. Subsequently, we developed a draft of the questionnaire and further revised it according to findings from 45 cognitive interviews, based on a think aloud and verbal probing approach.

Results
Preferred visual representations and understanding of pictorial elements differed between participants from different cultural backgrounds. Simpler concepts were considered easier to understand than compounded concepts. Preferences in element style and composition were similar between the groups. In addition, using a recurring character was considered helpful for identification.

Conclusions
In the development of the PictoQOL, decisions concerning style and composition of pictorial elements were culture-independent. In contrast, preferences of visual representations of abstract concepts were strongly dependent on cultural aspects, confirming the need of a participatory approach to develop the measure. The PictoQOL is likely to be comprehensible cross-culturally without further need of adaptation.

Key messages
To ensure cross-cultural comprehensibility development of a picture-based questionnaire, a participatory approach to development is necessary. The PictoQOL is suitable to measure health-related quality of life in understudied, culturally diverse populations.