bluuebunny/crossref_metadata_2025_split huggingface dataset:
Obstetric interventions among native and migrant women: a survey of episiotomy in Portugal
Authors: Lorthe E , Teixeira C , Rodrigues T , Barros H 
Published: November 2019

Abstract

Introduction
It is unclear whether migrant women experience worse pregnancy outcomes than native women. A better comprehension of obstetric care provision, including controversial interventions such as episiotomy, is important to improve equity of service provision, overall maternal and neonatal health and to support evidence-informed perinatal health policy-making. We aimed to determine if migrant and native women giving birth vaginally have different risks of episiotomy and if the risk differs by migrant sub-groups.

Methods
This study is based on a cross-sectional survey of foreign-born women with a random sample of native women, implemented in 32 public maternity units in mainland Portugal. We included 3583 women with vaginal delivery. Migrant status was defined by the woman’s country of birth (migrants, born abroad, vs natives, born in Portugal), then as subgroups of migrants from Brasil, Portuguese-speaking African countries (PSAC) and non Portuguese-speaking countries vs natives. The association between migrant status and episiotomy was assessed using multilevel logistic regression models, stratified by delivery mode, and adjusted for main risk factors of episiotomy.

Results
The overall frequencies of episiotomy were 52.6% and 48.2% among the 1707 natives and the 1876 migrants, respectively (p = 0.01). With spontaneous delivery, migrant women had decreased odds of having an episiotomy (adjusted OR 0.70 [95% CI 0.58-0.83]), especially those from PSAC (aOR 0.57 [0.46-0.71]). However, with instrumental delivery, migrant women had increased odds of episiotomy (aOR 2.47 [95% CI 1.50-4.07]), especially those from Brasil (aOR 3.24 [1.18-8.92]) and non Portuguese-speaking countries (aOR 3.75 [1.82-7.71]).

Conclusions
These results suggest non-medically justified differential care during childbirth and highlight the importance of developing evidence-based recommendations for episiotomy use, in a country with a high frequency of medical intervention during delivery.

Key messages
Portugal displays a high frequency of medical interventions during delivery, including episiotomy, highlighting the need for developing evidence-based recommendations. Migrant and native women have different risks of episiotomy, suggesting non-medically justified differential care.
Misconceptions and lack of vaccine confidence: even First Responders are not spared
Authors: Riccò M , Vezzosi L , Balzarini F , Mezzoiuso A G , Veronesi L , Colucci M E , Signorelli C 
Published: November 2019

Abstract

Introduction
First Responders (FR) are front-line healthcare workers potentially exposed to different infectious agents. Characterizing their knowledge, attitudes and practices (KAP) towards immunizations has therefore the potential to significantly improve occupational health and safety.

Methods
A questionnaire-based cross-sectional study was performed during October 2018, collecting a convenience sample among FR from the Parma Province. Participants were inquired on 3 recommended vaccinations (i.e. seasonal influenza vaccine, SIV; measles vaccine, MeV; pertussis vaccine, Pa) and for meningococcal vaccines (MEN, not officially recommended in FR). Knowledge status (KS) and Risk Perception (RP) were assessed as percent values. Multivariate odds ratios (mOR) for factors associated with vaccination status were calculated by means of a binary logistic regression analysis.

Results
A total of 161 questionnaires were retrieved (mean age 45.1±14.1 years; seniority 10.8 ± 8.6 years). Internal consistency was good (Cronbach’s alpha = 0.894). KS was unsatisfying (46.5% ± 32.4) with uncertainties on the recommendations for MeV and MEN (39.1% and 34.2% incorrect answers). The majority of respondents were favorable towards MEN (89.4%), MeV (87.5%), Pa (83.0%), while 55.3% exhibited a favorable attitude for SIV, and 28.0% had received SIV 2018 (self-reported lifetime status for MEN 26.1%, MeV 42.2%, Pa 34.8%). RP was unsatisfying, particularly for SIV (33.9% ± 18.4). Interestingly enough, neither KS nor RP were associated with vaccination rates, being the main predictor for SIV 2018 a seniority ≥ 10 years (mOR 3.26, 95%CI 1.35-7.91), and higher educational achievements for both Pa (mOR 3.27, 95%CI 1.29-8.30) and MeV (mOR 2.69, 95%CI 1.09-6.65).

Conclusions
Reasons for vaccination gaps in FR apparently do not find their roots only in FRs’ incomplete KS or RP. However, the very low vaccination rates for SIV, MeV and Pa recommends stronger and more appropriate information campaigns.

Key messages
Main drivers of vaccination status in First Responders are not solely their knowledge status or risk perception. Achieving better vaccination rates in First Responders requires the understanding of a complex interplay of individual factors.
Opinions and beliefs in vaccine hesitant parents in Italy: what makes the difference
Authors: Cocchio S , Bertoncello C , Fonzo M , Zanovello S , Bennici S E , Baldovin T , Buja A , Napoletano G , Russo F , Baldo V 
Published: November 2019

Abstract

Vaccine hesitancy has been defined as the delay of acceptance or refusal of vaccines. Hesitant parents’ (HP) fluctuate between anti-vaccine (AP) and pro-vaccine parents’ (PP) positions. In the light of alarming results from recent Eurobarometer 488, our aim was to identify sensitive topics harbouring the widest opinion gap between HP and PP.
In 2017, an online questionnaire was administered to parents with children aged 3-84 months. Parents were classified as PP, HP or AP based on self-reported vaccine status and timeliness of vaccinations. Agreement with 25 items was assessed with 5-point Likert scale. Items were combined into 8 topics (benefit/risk of vaccines, trust/mistrust in healthcare workers, administration policies, complacency, sense of community, freedom of choice) and scores calculated. Internal consistency was evaluated with Cronbach’s α; t-tests (sig. &lt;.05) were used (Norman G, 2018).
The study included 3,865 parents (64% PP; 32% HP; 4% AP). Cronbach’s α ranged 0.77-0.92. The widest gap concerned the sense of community: HP (2.7/5.0) cared significantly less than PP (4.7) about the usefulness of vaccine in protecting other children and claimed for a complete freedom in decision to vaccinate (3.6) more than PP (1.8). HP were worried (4.1) about current vaccination schedule (PP 2.1): simultaneous administration and age at vaccination (considered too young) were matter of concern. Among HP, mistrust of healthcare workers (3.7) and fear of side effects (3.8) played an important role, but the gap with PP was narrower compared with abovementioned topics; awareness in vaccine benefits reached 3.7. Agreement with complacent attitudes was low (2.2) with the least difference with PP (1.2).
HP showed to partially consider benefits of vaccines on a community scale, claiming for a private nature of this choice. The existence of a consistent opinion gap about the vaccination schedule may suggest the need for a sharper focus on current communication tools and strategies.

Key messages
While hesitant parents share some concerns with pro-vaccine, relevant opinion gaps may serve as warning lights, pointing at topics potentially harbouring the most sensitive drivers of hesitancy. Communication strategies should primarily focus on raising acquaintance of hesitant parents with benefits arising from herd immunity and compliance with the suggested vaccination schedule.
Child living arrangements following separation and mental health of parents in Sweden
Authors: Fritzell S , Gähler M , Fransson E 
Published: November 2019

Abstract

Background
Father involvement and joint physical custody in post-separation families have become increasingly common. In Sweden, 35 percent of the children of separated parents live equally much with both parents. The associations between child living arrangement and parental health may vary between women and men. This study analyzes the association between children’s living arrangement and mental health of parents, and how this interacts with material and social circumstances.

Methods
Drawing on The Swedish Survey of Living Conditions (ULF) 2008-2013, the association between child living arrangements and mental health (worry/anxiety) of parents in four family structures: nuclear, reconstituted, single with joint physical custody, and single with main or sole custody, were analyzed. Data on 9,225 mothers and fathers with resident children aged 0-17 were analyzed by logistic regressions for average marginal effects adjusting for socio-demographic, socio-economic and social factors. Analyses of interaction effects were made using the synergy index.

Results
Substantial family type differences were found in mental health between nuclear family and all other family types for mothers, and nuclear family and single parents for fathers. For the single mothers, the higher risk for worry and anxiety was reduced following controls for socioeconomic factors. Interaction effects were found for the combination of single motherhood and non-employment, causing a higher risk of mental health problems for single mothers, both with joint (SI 5.25 (2.06-13.39)) and sole custody (SI 1.70 (1.11-2.62)), than would be expected from a simple addition of these exposures, indicating that this is a vulnerable group.

Conclusions
The results indicate that joint custody is associated with higher risk for worry and anxiety for the parents, especially for mothers, both re-partnered and single, but also for single fathers.

Key messages
Shared residence is associated with higher risk for worry and anxiety in parents. Single mothers lacking employment is a particularly vulnerable group.
Development of the guideline ‘Challenging behaviour in adults with intellectual disability’
Authors: Kroezen M , Embregts P , Mulder E , Van Bussel C , Van der Nagel J , Van den Akker N , Wolkorte R , Wieland J 
Published: November 2019

Abstract

Background
Challenging Behaviour (CB) is a common problem among people with intellectual disability (ID), leading to a lower quality of life and a negative impact on the emotional well-being of family, staff and fellow clients. Additionally, reduced access to community services and (avoidable) high consumption of specialist care has been reported. This presentation will offer information on the development and content of the Dutch multidisciplinary guideline ‘Challenging behaviour in adults with ID’ that will be published in 2019.

Methods
The guideline was developed on the basis of the methodologic strategy of the AGREE II instrument. Two systematic reviews were conducted. Additionally, healthcare professionals were surveyed through an online questionnaire, interviews (n = 14) and focus groups (n = 6), and interviews were conducted with adults with ID (n = 20) and their family (n = 16). The draft guideline was reviewed by stakeholders and underwent a practice test.

Results
The first module of the guideline describes the assessment of (1) the CB itself, (2) potential factors that contribute to the presence or continuation of CB, and (3) the context in which CB occurs. Implementation will lead to a comprehensive, integrated diagnosis and assessment of the CB, the person and context.
Module 2 enables health professionals to systematically and transparently select and apply interventions to resolve CB, whilst taking into account multiple factors as well as the specific context in which the CB occurs.
Module 3 provides the medical, legal and ethical framework for (off-label) prescription of psychotropics. It explains the process for starting and discontinuing (off-label) psychotropics, the selection of appropriate medication and dosages, and the monitoring and evaluation of effects and side-effects.

Conclusions
The guideline is based on state of the art scientific and practice-based evidence and will contribute to a more structured approach in the care for people with ID and CB.

Key messages
Challenging behaviour is a common problem among people with intellectual disability and can have a negative impact on quality of life and the emotional well-being of family, staff and fellow clients. The development of the multidisciplinary guideline ‘Challenging behaviour in adults with ID’ can help to better understand and treat challenging behaviour in people with ID.
The decomposition of life expectancy for age and cause of death in Tuscany, Italy
Authors: Nante N , Kundisova L , Gori F , Martini A , Battisti F , Giovannetti L , Messina G , Chellini E 
Published: November 2019

Abstract

Introduction
Changing of life expectancy at birth (LE) over time reflects variations of mortality rates of a certain population. Italy is amongst the countries with the highest LE, Tuscany ranks fifth at the national level. The aim of the present work was to evaluate the impact of various causes of death in different age groups on the change in LE in the Tuscany region (Italy) during period 1987-2015.

Material and methods
Mortality data relative to residents that died during the period between 1987/1989 and 2013/2015 were provided by the Tuscan Regional Mortality Registry. The causes of death taken into consideration were cardiovascular (CVS), respiratory (RESP) and infective (INF) diseases and cancer (TUM). The decomposition of LE gain was realized with software Epidat, using the Pollard’s method.

Results
The overall LE gain during the period between two three-years periods was 6.7 years for males, with a major gain between 65-89, and 4.5 years for females, mainly improved between 75-89, &lt;1 year for both sexes. The major gain (2.6 years) was attributable to the reduction of mortality for CVS, followed by TUM (1.76 in males and 0.83 in females) and RESP (0.4 in males; 0.1 in females). The major loss of years of LE was attributable to INF (-0.15 in females; -0.07 in males) and lung cancer in females (-0.13), for which the opposite result was observed for males (gain of 0.62 years of LE).

Conclusions
During the study period (1987-2015) the gain in LE was major for males. To the reduction of mortality for CVS have contributed to the tempestuous treatment of acute CVS events and secondary CVS prevention. For TUM the result is attributable to the adherence of population to oncologic screening programmes. The excess of mortality for INF that lead to the loss of LE can be attributed to the passage from ICD-9 to ICD-10 in 2003 (higher sensibility of ICD-10) and to the diffusion of multi-drug resistant bacteria, which lead to elevated mortality in these years.

Key messages
The gain in LE during the period the 1987-2015 was higher in males. The major contribution to gain in LE was due to a reduction of mortality for CVS diseases.
Solidarity and reciprocity in data governance: information sharing among gamete donors and recipients
Authors: Maia T , Silva S , De Freitas C 
Published: November 2019

Abstract

Background
Decreasing fertility rates have spiralled a growth in demand for assisted reproduction technologies, including reproduction through donated gametes. Gamete donation is grounded on solidaristic practices traditionally focused on the gift of gametes. However, solidarity and reciprocity between donors and recipients may also be enacted through the sharing of other types of information (e.g. donation outcomes, medical and identifying information). Little is known, however, about these stakeholders’ preferences regarding information sharing, which is crucial to promoting people-centred policy for data governance in gamete donation.

Methods
A self-report structured questionnaire was completed by 69 donors and 161 recipients (participation rate: 77.4%) between July 2017 and April 2018 at the Portuguese Public Bank of Gametes. Opinions about access to donation outcomes and medical, extended profile and identifying information about recipients, donors and children were analysed using descriptive statistics.

Results
Most participants considered that recipients should not have access to donors’ identifying (92%) and extended profile (79%) information, but that they should access donors’ medical information (58%). Donors stated more frequently that they should receive information about the outcomes of donation (e.g. pregnancies and births) than recipients (32% vs. 12%). Participants also disagreed with donors’ access to recipients’ medical (83%) and extended profile information (92%) and children’s identifying information (98%).

Conclusions
People-centred policy on data governance in gamete donation should be informed by donor and recipients’ preferences. Sharing donation outcomes with donors and medical information from donors with recipients can foster solidarity and reciprocity between them. This requires the development of a matching mechanism (via consent) to accommodate their preferences.

Key messages
Policy on data governance should be informed by gamete donors and recipients’ preferences. Sharing desired information with donors and recipients can foster solidarity and reciprocity between them.
Introduction to the Environmental Burden of Disease concept – history, methods and selected results
Authors: Plass D , Tobollik M , Wintermeyer D 
Published: November 2019

Abstract

Background
The Environmental Burden of Disease (EBD)-concept was introduced by the World Health Organization to quantify the impacts of environmental risk factors on population health in a comprehensive and comparable way. Since the first Global Burden of Disease (GBD)-study the EBD-methodology was used in numerous global, regional and national assessments.

Methods
In the EBD-concept data from different sources are joined using a standardized framework. To calculate the EBD several steps need to be taken into account. First, the exposure of the selected population towards an environmental risk factor is estimated. In a second step, exposure data and information from an exposure-response-function are combined by using the population attributable fraction formula. In a last step, the attributable fraction (percentage) is multiplied by the disease burden resulting from a selected health outcome to estimate the share of disease burden attributable to the environmental risk factor.

Results
Since the first GBD-study several stakeholders have used the EBD-concept to estimate the disease burden attributable to environmental risk factors. This lead to an increased number of available data sets, which - due to the varying assumptions used in the models - are not ad hoc comparable among each other. Generally, the results of EBD-assessments are presented using disability-adjusted life years (DALY) as the core measure of burden of disease assessments. However, e. g. due to lack of data, assessments also focus on the number of attributable deaths, illnesses or single components of the DALY such as the years of life lost due to premature mortality (YLL).

Conclusions
The EBD-concept allows to compare the impact of environmental risk factors on population health. Though the general concept is widely standardized, assumptions on model parameters can lead to varying results. Therefore, when communicating EBD-results it is necessary to be very transparent about data and model inputs.
Organizational Culture and Readiness for Change in German pediatric outpatient centres
Authors: Georg S , Görig T , Eichinger M , Hoffmann D , Urschitz M S , De Bock F 
Published: November 2019

Abstract

Background
Organizational readiness for implementing change (ORIC) is presumed key for successful change in healthcare settings. At the same time, ORIC is theorized to depend on cultural and other factors of the organizational context. Within the process evaluation of the PART-CHILD intervention in interdisciplinary pediatric outpatient centres (IPOC) for children with chronic health conditions in Germany, we assessed to what extent ORIC is associated with organizational culture and further contextual factors.

Methods
In 2019 data was collected from health care professionals in 12 IPOC, using a questionnaire comprising subjectively perceived ORIC (measure: ORIC, 5-point Likert scale), the organization’s culture (measure: Competing Values Framework, four domains: Group, Developmental, Rational, and Hierarchical Culture) and further contextual factors (e.g., size of the facility, number of patients per year).

Results
In all, responses from 206 health care professionals were included in the analyses (response rate: 47%; preliminary results). Analyses show a moderate ORIC (3,4; SD = 0,6), positively associated with Group Culture (r2=0,178, p = 0,01) and negatively associated with Rational Culture (r2=-0,273, p &lt; 0,001). We found no correlations between ORIC and Developmental or Hierarchical Culture. In congress presentation we report to what extent ORIC depends on further contextual factors (e.g., size of the facility, patients’ demographic characteristics).

Discussion
IPOC with a strong Group Culture show a higher ORIC than those with prevailing Rational Culture. To potentially increase effective implementation of interventions in healthcare facilities in future, a preceding evaluation of the organizational culture might be valuable. Thereby, settings with prevailing Rational Culture could be identified at an early stage and receive additional implementation support, e.g. through enhancing the Group Culture among the health care professionals on-site (e.g, executive coaching).

Key messages
Both organizational readiness for implementing change and organizational culture are presumed to be important for implementing change in healthcare facilities‘ routine care. Assessing both constructs prior to implementing a costly intervention with demanding change processes within healthcare settings could be valuable.
Benefits of performing same day discharge lead and varicose interventions in active patients
Authors: Hamid A , Lamirault G , Gouëffic Y , Meur N Le 
Published: November 2019

Abstract

Background
In France, 90% of varicose vein interventions are performed in ambulatory setting while it concerns 7% of angioplasty for lower extremities arterial disease (LEAD). In this study, we made the hypothesis that such disparities may partly be due to the burden of the post-procedural rehabilitation and its relation to patients’ care-pathway and coordination.

Methods
A retrospective study was conducted on 18 to 65 years old active population who benefited from varicose or LEAD interventions from January 2013 to June 2016 using data from the French National Health Insurance System. Post-procedural rehabilitation measure was the number of cumulated workday break and their renewals within 180 days after intervention. Negative binomial regressions, adjusted for age, gender, and comorbidities, were applied to test associations. The degree of coordination among health care professionals for post-procedural follow-up was tested using the continuity of care and the continuity of prescription indices.

Results
Compared to inpatient care, day interventions decrease the incidence rate ratio (IRR) of cumulated workday breaks by 14% in both varicose vein and LEAD interventions. The decrease in the degree of coordination between care providers increase the IRR of cumulated workday breaks and renewals by 37% and 29% respectively for varicose, and 11% and 9% for LEAD interventions. The increase in the number of work break prescriptions delivered by the same category of providers decreases the IRR of cumulated workday breaks and their renewals in varicose by 25% and 21% but increases them in LEAD interventions by 240% and 106%.

Conclusions
Day interventions have similar impacts on rehabilitations after varicose vein and LEAD interventions. However, coordination is critical. Our results highlight the need to pursue health regulatory agencies and healthcare professionals’ works on multidisciplinary ambulatory care networks for better follow-up of acute day care interventions.

Key messages
Day intervention reduces cumulated workday breaks in endovascular interventions. Multi-specialty coordination of the qualified health care professionals is required in endovascular interventions, especially after angioplasty for LEAD in outpatient settings.