bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effects of air pollution exposure on children lung function in three urban areas of São Paulo State
Authors: Braga A L F , Oliveira B B B , Senigalia A , Pestana P R S , Pereira L A A , Martins L C 
Published: October 2020

Abstract
Deleterious effects of air pollution on human health have been observed, including increases in respiratory symptoms and decreases in lung function. Few studies in Brazil have investigated this association in asthmatic children and there is no study in those regions. The aim of this study was evaluating the influence of air pollution on lung function in children.

Methods
Panel study with longitudinal assessment for 12 months of exposure to air pollutants and their effects on lung function in children living in Santos, Cubatão and Presidente Prudente. Data were obtained from monthly spirometry and information on air quality through Environmental Company of the State of São Paulo. Models of equations for generalized estimates were adopted to analyze the effects of the exposure to air pollution on respiratory function, controlled for temperature and humidity.

Results
The concentration of PM10 did not exceed the values established as standard for the state of São Paulo (120μg/m3) during the study. In spirometry, the main parameter for characterization of bronchial obstruction is FEV1/CVF. In Santos, it was observed that the increase of 13.35 μg/m3 of PM10 led to a significant reduction of FEV1/CVF on the day and seven days after exposure, with greatest effect in lag 5 (-21.45% (95% CI: -7.34; -35.56) in asthmatics. In Presidente Prudente it was found a significant reduction of FEV1/CVF on the day and on the seven days after exposure to PM10 (-78.22% (95% CI: 55.68-100.75)). In Cubatão, it was observed a significant reduction of FEV1/CVF on the day, the first, third, fourth and seventh day after exposure of PM10, (lag 4 -54.75% (95% CI: -22.09; -87.41)). In the non-asthmatics group no significant reductions were observed in any of the locations.

Conclusions
Although the pollution levels remained within the air quality standards for the State of São Paulo, children with asthma presented significant reductions in lung function after exposure to the pollutants.

Key messages
Susceptible groups must be the main concern on air pollution adverse health effects studies. Efforts to reduce air pollution in Brazil can not be abandoned, once it remains affecting public health.
Card game as a health education strategy in the learning of schoolchildren about parasites
Authors: Oliveira E S , Gomes S R , Sampaio M G V , Silva M A A , Bezerra C M , Girão S G M , Viana T R F , Oliveira N R 
Published: October 2020

Abstract
Parasitic diseases are a serious public health problem, especially in regions such as the Brazilian Northeast, which despite numerous advances in health still have high rates of morbidity, with regard to intestinal parasitic diseases, especially diarrheal diseases. School-age children are the most affected by this condition, either due to lack of knowledge or poor hygiene habits. The school is a relevant place for the application and development of methods focused on the theme, and knowledge for prevention and control is essential. Thus, the card game aims to facilitate students' understanding of the subject. The contributions of the present work will contribute to prevention and will contribute to children's health programs, through the development and use of a playful tool as a health education strategy for schoolchildren in the prevention of parasites. The game consists of cards that contain parasites, morphology, pathogenesis, diagnosis, forms of prevention, among others, being elaborated based on the literature and made in computer programs, being possible to play individually or in groups. The use of playfulness can provide a better understanding, mainly because it involves children, thus generating curiosity about the theme. Health education carried out in dynamic ways provides and requires attention, leaving them more attentive and curious in view of the above. When applied to schoolchildren, the proportion and impact will be much wider, as it is a very diversified environment, where it will be possible to reach children from different areas, places and realities. When developing the game and applying it to children through health education, the subject will be much more accepted, thus making them more knowledgeable about the theme, which will favor in the prevention of parasites and a better quality of life, as well as well as the dissemination of the importance of the subject.

Key messages
Parasitic diseases do not yet have preventive measures, such as vaccines, and health education is extremely important. The game can bring benefits to public health, in the practice of child health, being used as a form of health education and its dissemination to schools and other learning spaces.
Evaluation of the oral health condition of schoolchildren in the south of Brazil
Authors: Fonseca V , Machado V , Ribeiro S , Alves M , Nacao M 
Published: October 2020

Abstract
In order to subsidize policies, actions and intersectoral strategies for health promotion, protection and recovery, it is important to establish the distribution of oral diseases in the target population. Thus, the present study aims at identifying the oral health condition of students from a network of schools run by a Social Welfare, not-for-profit, non-governmental institution in Brazil's Southern Region. This is a census approved by a competent Research Ethics Committee, carried out in a school environment in 2018, involving 1,243 children, 1,172 of which at 5 years old and 71 at 12 years old. All had impacts on oral health and caries rates (dmf / DMFT), occlusion (Foster & Hamilton and DAI) and fluorosis (Dean) evaluated by properly trained and calibrated dentists.The most prevalent impact on oral health, at both ages, was “difficulty in eating”. Students aged 12 and 5 years old showed, respectively, 0.28 and 1 tooth with caries experience; 5.8% and 5.3% with some need for treatment and a prevalence of malocclusion of 57.7% and 79%. Fluorosis was investigated only within the 12-year-old students and it was present in 26.8% of them. In view of the results, the planning of oral health actions in the schools of the social institution studied must privilege the actions of promotion, protection and recovery in the scope of malocclusions and strengthen those already implemented for caries disease. At the same time, a health surveillance system should be built and implemented for monitoring and assessment.

Key messages
Identifying the epidemiological profile of the target population contributes to the efficient allocation of financial resources and the establishment of assertive strategies to meet their needs. Epidemiological surveys allow us to know the prevalence and severity of the disease, its distribution and treatment needs, allowing health planning and subsidizing the evaluation of services.
Factors associated with women's decision to undergo early mammography contrary to guidelines
Authors: Tur-Sinai A , Shahrabani S 
Published: October 2020

Abstract

Background
For young women, mammography has limited effectiveness and entails exposure to radiation, discomfort and additional costs. As in other countries, the Israel Ministry of Health does not officially recommend mammograms for women under age 50 who do not belong to risk groups. The study identifies factors associated with the willingness to undergo mammography, contrary to the official guidelines.

Methods
Using the Health Belief Model (HBM), we surveyed Israeli women aged 40-51 who are not at high risk for developing breast cancer and who had or had never undergone mammography.

Results
The results show that socio-demographic characteristics, private insurance coverage, out-of-pocket payments to physicians, and two HBM categories-lower levels of perceived barriers to mammography (OR = 0.70, 95% CI = 0.53-0.92) and higher levels of health motivation (OR = 1.65, 95% CI = 1.19-2.29) - are associated with the decision to undergo mammogram. In addition, higher levels of perceived susceptibility to illness (OR = 1.32, 95% CI = 1.00-1.73) and previous experience with mammography (OR = 8.26, 95% CI = 3.71-18.41) are significant predictors of women's intentions to undergo early mammography.

Conclusions
Understanding the factors associated with women's tendency to have mammograms contrary to recommendations can help nurses and healthcare policymakers in creating health-promotive programs targeting this group of women. Taking policy steps to increase women's confidence in Ministry of Health guidelines will reduce the potential damage of cumulative radiation over the lifetime of young women and lower the number of false positives. Preventing unnecessary mammograms might reduce costs to households and HMOs, lessen ineffective use of medical facilities and help relieve the burden on the health system.

Key messages
Taking policy steps to increase women's confidence in Ministry of Health guidelines will reduce the potential damage of cumulative radiation over lifetime and lower the number of false positives. Preventing unnecessary mammograms will reduce costs to households and HMOs, lessen ineffective use of medical facilities and help relieve the burden on the health system.
Regulation EU 2017/745 on medical devices – implementation analysis in Portugal by the distributors
Authors: Vilaça H 
Published: October 2020

Abstract
The Regulation responds to legislation failures in the European regulatory framework on medical devices (MD), which in turn led to public health issues. Two media scandals triggered the final actions on the elaboration of this EU Regulation, which was already being thought off in a context of fast MD development, and on the commitment of member-states to harmonize legislation in order to better manage resources.
This Regulation is expected to address detected gaps, and contribute to the protection of European citizens' health by ensuring high quality and safety of MD, through advocating for more transparency, vigilance, and traceability. A technique to evaluate policies is the implementation analysis, as it links theory and practice. By understanding it, it is possible to ascertain if, in fact, the Regulation will contribute, as proposed, to improve public health. The implementation analysis framework I developed can be used in other countries affected by this Regulation, and may even be extrapolated to other scenarios.
Entry into force 25/05/17.Full application 05/20. This qualitative study uses document analysis and semi-structured interviews to collect data, and literature review to frame the situation and to study implementation analysis. The questions are: identify the facilitators and resistance points of the implementation; explore perceptions of the Portuguese MD distributors; understand the policy implementation pathway; and have a picture of the implementation status in Portugal.
The results can be summarized as: implementers are interested in complying with the Regulation; there is stakeholder involvement in policy making and throughout the implementation process; the main points of resistance, difficulties and the facilitators are identified; and the Regulation is being implemented according to the timelines.
The public health action brought by the policy is that each economic operator is an active actor on vigilance and patient safety across MD lifecycle.

Key messages
If we are interested in the extent to which a particular polity is able to solve the problems with which it is confronted, we need to study the way in which the law is executed in practice. Focus on the effective implementation of the new regulatory framework on medical devices to protect patients and ensure it addresses new and emerging challenges.
Impact of school-based physical activity interventions in primary schools: measuring what matters
Authors: Ram B , Venkatraman T , Foley K , Honeyford K , Ells L , van Sluijs E , Hargreaves D , Greaves F , Viner R , Saxena S 
Published: October 2020

Abstract

Background
A growing number of small studies suggest that school-based physical activity initiatives can help children achieve the recommended 60 minutes of physical activity per day. However, the heterogeneity of outcomes and measures used in small studies prevents pooling of results to demonstrate whether short-term health benefits are sustained. Qualitative studies suggest many benefits that are not represented by outcomes in trials to date. The aim of this study was to generate a list of outcomes that have been studied to develop a core outcome set (COS) acceptable to key stakeholders for future studies evaluating school-based physical activity initiatives.

Methods
We searched six databases (MEDLINE, EMBASE, PsycINFO, CINAHL, CENTRAL and Cochrane Database of Systematic Reviews) systematically for reviews of school-based physical activity interventions, and extracted relevant studies to identify the outcomes and measures used in each paper. A long list was generated from the literature and a previous workshop with stakeholders. This study is registered with COMET (#1322), and with PROSPERO (CRD42019146621).

Results
75/121 cited studies drawn from 53/2409 reviews met our inclusion criteria. We grouped 65 outcomes into 3 domains: (i) physical activity and health (ii) social and emotional health, and (iii) educational attainment. We will conduct two Delphi survey rounds with four stakeholder groups (health professionals, researchers, educators and parents) to rate the importance of each outcome. A core outcome set will be generated from a consensus process.

Conclusions
There is currently a large variation of outcomes and measures studied that precludes evidence synthesis of the impact of school-based physical activity interventions. Consensus methods are needed to focus research on the outcomes that matter the most to key stakeholders and to provide tools for future studies to assess long-term impact.

Key messages
Variations in outcomes studied precludes evidence synthesis of SBPA intervention impacts. A core outcome set is needed to ensure future SBPA interventions measure outcomes that matter the most.
Adoption of local public health plan for better health and quality of life in Belgrade
Authors: Tamburkovski G , Belamarić G , Matijević D , Mladenović Janković S 
Published: October 2020

Abstract

Issue
Development of public health plan for the City of Belgrade, facilitate multisectoral participation and encourage local government to incorporate public health planning into integrated planning framework, including funding.

Description of the Problem
According to Public Health Low, adopted in Serbia in 2016 and Public health strategy (2018), Council for Health, as a professional body of the City government, was obliged to prepare draft of the Plan. Members of the City Council are representatives from different sectors: health care, public health, private sector, child care, education and civil society. Based on data and information from relevant institutions and organizations, situation analysis and health profile of the City have been prepared during 2018.

Results
Public health plan for the City of Belgrade has been drafted for a time period from 2020 to 2026, aligned and within time frame of the National public health strategy. Plan included: mission, vision, objectives, activities, responsible institutions, funding sources and indicators for monitoring. Focus was on health promotion and empowerment of citizens to adopt healthy lifestyle as well on investment in environmental sustainability, poverty and inequalities reduction and minimizing risks to human health and well-being. On December 2019, Belgrade City Assembly adopted this document, with full responsibility for implementation and budgeting specific programs and projects from 2020.

Lessons
Multisectoral working group, with clear defined scope of work, supported by regulations, encouraged and managed by experts in the field, highly motivated to be creator of changes is prerequisite for successful and productive public health planning process.

Key messages
Public health planning enabled communication and cooperation among experts and decision makers and represented a whole-of-local government approach to public health. Document is used as a resource and model for the other cities and municipalities.
A retrospective database analysis of burden of IPD and pneumonia in children &lt;15y in Veneto region
Authors: Barbieri E , Cantarutti A , Porcu G , Hu T , Petigara T , Prandi G M , Alimenti C , Scamarcia A , Cantarutti L , Giaquinto C 
Published: October 2020

Abstract

Background
IPD and pneumonia are associated with high mortality and healthcare resource utilization (HCRU). This analysis assessed incidence, HCRU and costs of IPD and pneumonia following PCV13 introduction in 2010 in Veneto.

Methods
IPD, unspecified invasive disease episodes, outpatient pneumococcal and unspecified pneumonia episodes were identified in Pedianet, a pediatric primary care database from 2010-2017. HCRU includes primary care and specialist visits, antibiotic prescriptions, diagnostics, ER visits and hospitalizations. Incidence rates (IRs) were numbers of episodes/1,000 person-years. Standardized regional incidence rates (SRIRs) were calculated by standardizing IRs with regional population data by age and year. Regional expenditures (€/1,000 person-years) were calculated by multiplying SRIRs with average costs per episode. Interrupted time series (ITS) analyses assessed trends in annual IRs in the early and late PCV13 (2010-2013, 2014-2017) periods.

Results
During 2010-2017, IPD and unspecified invasive disease incidence decreased from 0.40 to 0.31/1,000 person-years. While incidence was numerically lower in 2017 than in 2010, ITS analysis did not detect a significant trend in the early (coef=1.97; p = 0.63) or late PCV13 (coef=0.50; p = 0.90) periods. Average cost per episode was €4206 and average regional expenditure was €171/1,000 person-year. SRIR for outpatient pneumonia decreased from 13.35 to 5.48/1,000 person-year during 2010 to 2017. Pneumonia episodes were associated with 0.29 ER visits and 0.15 short stay and 0.06 long stay hospitalization. Average cost per episode was €345, majority of which was associated with ER visits (€50.8) and hospitalizations (€243.9). Regional expenditures decreased from €12852.31 to €5351.98/1,000 person-year.

Conclusions
IPD and unspecified invasive disease burden did not change significantly following PCV13 introduction, while disease burden declined for outpatient pneumococcal and unspecified pneumonia.

Key messages
IPD and unspecified invasive disease burden did not change significantly following PCV13 introduction. Disease burden declined for outpatient pneumococcal and unspecified pneumonia following PCV13.
Update on adherence to a vaccination protocol for invasive bacterial diseases in HIV patients
Authors: Berghella L , Tancredi S , Cintori C , Kahfian Z , Rovesti S , Bargellini A , Mussini C , Casaletti G 
Published: October 2020

Abstract
HIV+ patients present an increased risk of vaccine-preventable invasive bacterial diseases (IBDs), infections characterized by high lethality and frequency of serious complications. Considering that these patients frequently have to face a complex clinical-care pathway, it has been necessary to design a clear vaccination protocol in order to prevent IBDs and to guarantee adequate patient adherence. In 2013 the Local Health Unit Company of Modena's Public Health Department and the University Hospital of Modena developed a shared vaccination protocol to prevent the most common causes of IBDs: Neisseria meningitidis, Streptococcus pneumoniae and Haemophilus influenzae type B.
The protocol applies to HIV+ patients receiving antiretroviral therapy who have a CD4 + cell count &gt; 200 cells / µL. It provides the following vaccination schedule: administration of PCV13 + MenACWY vaccines; after 15 days administration of MenB + Hib vaccines; after 45 days administration of the MenB vaccine; after at least 60 days, administration of PPSV23 + MenACWY vaccines. The first vaccination counselling is proactively carried out by the Public Health Department healthcare workers and takes place at the Infectious Diseases Division in order to improve patient acceptance and adherence to the protocol.
From October 2013 to January 2020, 503 HIV+ patients (378 males and 125 females) were vaccinated. Among these patients, 338 (67.2%) completed the vaccination schedule; 110 (21.9%) interrupted the schedule, 34 (6.7%) have a vaccination schedule currently underway and 21 (4.2%) never started the planned vaccination protocol. Overall, the percentage of patients who have completed the vaccination schedule or have scheduled appointments is 73.9%. The data analysis shows a high adherence to the protocol thanks to the collaboration between public health and infectious disease specialists, which improves the compliance of patients with a complex clinical-care pathway.

Key messages
HIV patients present an increased risk of IBDs and require a tailor-made vaccination protocol. Collaboration between specialists improves the compliance of patients with a complex clinical-care pathway.
Streptococcus pneumoniae in hospitalized patients with pneumonia: epidemiology and implications
Authors: Dajko M , Poscia A , Posteraro B , Speziale D , Volpe M , Ricciardi W , de Waure C 
Published: October 2020

Abstract

Background
Streptococcus pneumoniae (SP) is a major cause of pneumonia worldwide representing a significant problem from the public health viewpoint. The aim of our study was to assess the frequency of SP in hospitalized patients with pneumonia and investigate its relationship with patients' characteristics.

Methods
A deterministic record linkage of hospital discharge and microbiology laboratory surveillance databases of a teaching hospital in Rome was used to identify all patients over 15 years old (y) with a diagnosis of pneumonia and a microbiological ascertainment between November 2010 and March 2013. Pneumonia ICD-9-CM codes were used to identify the study population. The frequency of SP was assessed with respect to patients' characteristics.

Results
1216 (64% males) of a mean age 65 (SD = 18) y patients with pneumonia were identified. Of them, 707 (58%) had a positive microbiological result. Among the latter, mixed bacterial co-infections were detected in 552 (74%) cases. The most frequently isolated organism was SP in 288 (41%) cases. Nevertheless, SP was the sole isolated agent in only 6 (0.8%) cases. There were no significant differences between men and women with respect to the frequency of SP. Eventually, the frequency of SP among patients with a positive microbiological result was higher in the age group 15-64 y than in 65+ y (45% vs 37%, p = 0.038). When considering only subjects with at least one comorbidity the frequency of SP was higher among the 15-64 y age group (53% vs 44% in 15-64 y and 65+ y respectively, p = 0.040).

Conclusions
Our study revealed that SP was the most frequent isolated pathogen in hospitalized patients with pneumonia. However, the SP coexistence with other pathogens was present in the vast majority of cases. Interestingly, SP was highly frequent among people with comorbidities, in particular in the age group 15-64 y. This emphasizes the importance of vaccination in this group of patients.

Key messages
This study shows that more than 40% of pneumonia with a positive microbiological result are caused by Streptococcus pneumoniae. Preventive strategies to limit Streptococcus pneumoniae infections among adults and individuals affected by comorbidities are needed.