bluuebunny/crossref_metadata_2025_split huggingface dataset:
Intravenous iron therapy and the cardiovascular system: risks and benefits
Authors: Del Vecchio Lucia , Ekart Robert , Ferro Charles J , Malyszko Jolanta , Mark Patrick B , Ortiz Alberto , Sarafidis Pantelis , Valdivielso Jose M , Mallamaci Francesca ,   for the ERA-EDTA European Renal and Cardiovascular Medicine Working (EURECA-m) Group
Published: October 2020

Abstract

Anaemia is a common complication of chronic kidney disease (CKD). In this setting, iron deficiency is frequent because of the combination of increased iron needs to sustain erythropoiesis with increased iron losses. Over the years, evidence has accumulated on the involvement of iron in influencing pulmonary vascular resistance, endothelial function, atherosclerosis progression and infection risk. For decades, iron therapy has been the mainstay of therapy for renal anaemia together with erythropoiesis-stimulating agents (ESAs). Despite its long-standing use, grey areas still surround the use of iron therapy in CKD. In particular, the right balance between either iron repletion with adequate therapy and the avoidance of iron overload and its possible negative effects is still a matter of debate. This is particularly true in patients having functional iron deficiency. The recent Proactive IV Iron Therapy in Haemodialysis Patients trial supports the use of intravenous (IV) iron therapy until a ferritin upper limit of 700 ng/mL is reached in haemodialysis patients on ESA therapy, with short dialysis vintage and minimal signs of inflammation. IV iron therapy has also been proven to be effective in the setting of heart failure (HF), where it improves exercise capacity and quality of life and possibly reduces the risk of HF hospitalizations and cardiovascular deaths. In this review we discuss the risks of functional iron deficiency and the possible benefits and risks of iron therapy for the cardiovascular system in the light of old and new evidence.
A Trust Framework Utilization in Cloud Computing Environment Based on Multi-criteria Decision-Making Methods
Authors: Trabay Doaa Wagdy , El-Henawy Ibrahim , Gharibi Wajeb 
Published: October 2020

Abstract
Cloud computing (CC) is a complete online system of specialized technical resources for data computing and storage management. Many organizations, including small and start-ups, have recommended using CC technology rather than building their own high-costed data centers. Due to the diversity of cloud service providers, identifying appropriate cloud services that can meet users’ and organizations’ requirements, including trust, is a major challenge. In this paper, we propose a trust framework utilization to evaluate cloud services trust using multi-criteria decision-making and fuzzy logic techniques from different perspectives based on performance, agility, finance, security and usability criteria. The comparison of obtained results with related ones shows that ours are efficient and promising decisions for cloud users and organizations as well.
Docendo discimus: Forwarding Seeing the Patient as a Person to the Future Generation of Physicians
Authors: Greenbrook J T V , Ioannou M 
Published: October 2020

Abstract

Background
Forwarding the finest traditions of a calling, and upholding core components of the Hippocratic Oath, requires forwarding seeing each patient as a unique and autonomous person to future generations of physicians. Whilst clinical teaching is paramount in fostering this ethical perspective in applied contexts, limited empirical research has addressed how and why clinical teachers forward seeing the patient as a person in teaching. The present study endeavored to address this gap.

Methods
Qualitative semi-structured interviews were conducted with 17 randomly sampled clinical teachers, from two major university hospitals in Sweden. Data was analyzed through the phenomenological method.

Results
Two themes emerged: (1) Forwarding seeing the patient as a person by conveying the perspective, including the categories highlighting practical benefits in context, displaying humility and rendering the abstract salient, awareness of clinical teachers' impact on pathway development, and protecting core Hippocratic values in medical education; and (2) the need for active engagement in fostering the perspective, including the categories observing own development on a continuum, requiring constant reminders in applied contexts, finding inspiration through interaction, and the need for dedication and resolve.

Conclusions
Emblematic of the Latin proverb docendo discimus [by teaching, we learn], exemplifying the Hippocratic Oath in applied contexts further fueled and fostered the clinical teacher's own ethical perspective. This observed process accents how focus in teaching is contingent on, and promoting of, clinical teachers' own development and further engagement with the human dimensions of care. Cumulatively, past and present exemplars shape clinical teachers' professional identity and ability to engage with seeing the patient as a person, in turn enhancing the dedication needed to lead by example and revive the core components of the Hippocratic Oath in clinical teaching.

Key messages
Forwarding seeing the patient as a person in teaching is contingent on, and promoting of, clinical teachers’ own development and further engagement with the human dimensions of care. “Docendo discimus [By teaching, we learn]” – The reciprocal effect of fostering the ethical perspective in teaching requires seeking exemplars, to serve both as reminders and sources of inspiration.
BRaVE Project: processing an evidence-based tool to develop and evaluate vaccination strategies
Authors: Carini E , Calabrò G E , Tognetto A , Mancinelli S , Sarnari L , Colamesta V , Ricciardi W , de Waure C 
Published: October 2020

Abstract

Introduction
Deaths and epidemics due to vaccine-preventable diseases still occur even though there are effective vaccines available. Albeit recommendations released by the Italian Ministry of Health, vaccination coverages remain unsatisfactory. An improvement is therefore needed and new strategies are deserved in order to increase coverage. Nevertheless, neither a validated tool nor an institutional guideline to plan and/or evaluate vaccination strategies are available. The aim of BRaVE project was to build an evidence-based tool to develop and assess them.

Methods
In May 2019, a scoping review in MEDLINE and a search of ECDC and WHO websites were performed to look for validated tools to plan and/or evaluate vaccination strategies. The results of the search and the four phases of the Deming cycle (Plan, Do, Check, Act) were used to develop a grid. A multiprofessional panel of 7 experts validated the items included in the grid through a Delphi process followed by a face-to-face meeting.

Results
The original grid submitted to the panel of experts included 30 items (13 planning, 7 implementation, 4 check, 4 act, 2 other). The first round of Delphi led to the suggestion of 11 additional items and to the amendment of 4 out of 30 original items. During the second round of the Delphi the 41 items proposed were approved. At the end of the face-to-face meeting, 1 item was split. Seven items belonging to “Planning” (Plan) and “Implementation” (Do) were labelled as requisites for launching a vaccination strategy and the remaining 35 as items to be considered in their evaluation (15 planning, 11 implementation, 8 check, 4 act, 4 other).

Conclusions
Despite its importance, vaccination coverage is low. Evidence shows possible improvement in coverage, if innovative vaccination strategies are put in place. The developed grid is proposed as an organizational instrument which could improve and standardize vaccination strategies fostering their success and transferability.

Key messages
Novel organizational strategies could be a useful answer to improve vaccination coverage. The proposed grid could be used for the development and assessment of vaccination strategies.
Forecasting the extent of future public health challenges using the Scottish Burden of Disease study
Authors: Wyper G M A , Fletcher E , Grant I , McCartney G , Stockton D L 
Published: October 2020

Abstract

Background
Over the next 25 years in Scotland there is expected to be negative natural change in population growth in a rapidly ageing population. Recent evidence has highlighted the slowing of life expectancy gains and worsening trends in self-assessed general health. We have adapted the Scottish Burden of Disease study to forecast how demographic and health trends will shape future public health challenges. This is important in order to inform policy, service and workforce planning to meet anticipated needs.

Methods
For a baseline period of 2014-16 Disability-Adjusted Life Years (DALYs) were estimated for 132 causes of burden using routine data sources and patient-level record linkage techniques. Disability weights and disease models used to calculate Years Lived with Disability (YLD) were largely based on those from the Global Burden of Disease study, with life tables used to facilitate calculations of Years of Life Lost (YLL). The leading 20 causes were identified and trends in the occurrence of morbidity and mortality are currently being estimated up until 2019, and forecast to 2040, using age-period-cohort modelling. Crude and age-standardised rates will be used to monitor changes due to demography and exposure to the wider social determinants of health.

Results
In 2014-16, the leading causes of burden were ischaemic heart disease, neck and low back pain, depression, lung cancer and cerebrovascular disease. The leading 20 causes represented 68% of all-cause DALYs with ill-health and disability causing almost half of the burden.

Conclusions
Insights of the future trajectory of population health equip us with strong evidence to influence the need for a strong policy response on prevention. Estimates of the future occurrence of morbidities can be embedded in planning to ensure that services and the care workforce are proportionately designed to meet the increasing needs of a vulnerable ageing population.

Key messages
The most recent assessment highlighted that non-fatal and fatal health states approximately contribute equally to the overall disease burden in Scotland. Evidencing how future demographic and population health trends interact allows us to ensure that policy responses, care services and the care workforce can be designed based on anticipated needs.
The Danish implementation study on response to pregnancy complications, MAMAACT
Authors: Villadsen S , Johnsen H , Rasmussen T D , Sørensen J , Christensen U , Nybo Andersen A M 
Published: October 2020

Abstract
Differential incidence and severity of pregnancy complications are likely important contributing factors to the increased risk of poor pregnancy outcomes among ethnic minority women in Europe. To address this issue, the MAMAACT trial has been developed based on a thorough mixed methods needs assessment and co-creation process, feasibility tested, now implemented in a nationwide complex intervention. The overall aim of the Danish MAMAACT trial is to reduce ethnic and social disparity in stillbirth and newborns' health by improved management of pregnancy complications. The overall target group is all pregnant women, and the specific target group is women of non-Western origin. The hypothesis of MAMAACT is that improved communication between pregnant women and midwives regarding body symptoms that need prompt reaction will improve perinatal health among these vulnerable groups. The intervention consists of postgraduate training of midwives in intercultural communication and a smart phone application and a leaflet, both in six different languages. The app and leaflet target the women and explain the most serious warning signs of pregnancy complications and how to respond to them.
MAMAACT is implemented and evaluated in a randomized controlled cluster trial and 10 maternity wards consist the intervention groups, while nine maternity wards are the control groups. The evaluation is a mixed method evaluation focusing on understanding the mechanisms of change, how context at both maternity ward level as well as in the everyday life of women affects the implementation, and finally if effects on health literacy of the women and perinatal health of the children can be documented.
Implementation of systematic fall risk screening in primary care: barriers and facilitators
Authors: Meekes W M A , Leemrijse C J , Korevaar J C , van de Goor L A M 
Published: October 2020

Abstract

Background
Falls are a major problem among older people. Healthcare professionals are often unaware of the high fall risk of their patients because systematic screening does not take place. In the primary care setting systematic implementation of fall risk screening and referral to fall prevention interventions is lacking. This study aims to evaluate the implementation of a systematic and targeted fall risk screening among independently living frail older people in the primary care setting.

Methods
The implementation strategy used in this study consists of the provision of tools to screen for fall risk and identify the underlying causes, and services by physio- and exercise therapists who offer evidence-based interventions. The Theoretical Domains Framework of Huijg et al., (2014) is applied to identify barriers and facilitators of the implementation process. Online focus groups and informal interviews are conducted with the healthcare professionals involved.

Preliminary results
Participating GPs, practice nurses and district nurses acknowledged that fall prevention is part of their job, meaningful, and that they have the knowledge and skills to offer fall prevention. They also highlighted that the underlying causes of falls differ across patients, so personalized care is required. Experienced barriers are the complexity of diagnosing and treating high fall risk adequately versus lack of time, limited reimbursement, and patient's shame or limited motivation. Experienced facilitators are a good professional network, collaboration between GP practices and homecare providers, a motivated practice nurse, and adequate communication and support within the GP practice.

Conclusions
Identifying main barriers and facilitators offers opportunities for improving systematic fall prevention for older people. Hence, fall prevention can become more structurally available, reducing a major threat for the quality of life of older people living independently.

Key messages
Primary care professionals acknowledged systematic screening and fall prevention as meaningful and part of their job. Main facilitators are a good network of professionals, a motivated practice nurse, and adequate communication and support within the GP practice.
Participation, equity and health policies at the local level: tools for their implementation
Authors: Peiro Perez R , Mas Pons R , Ocana Ortiz A , Barona Vilar C , Legaz Sanchez E , Paredes Carbonell J , Pérez Sanz E 
Published: October 2020

Abstract

Issue/problem
In the Valencian Community, (a Spanish region with 5,000,000 inhabitants and 520 municipalities) a network of municipalities for health has been launched. Near 200 municipalities (70% population) have committed themselves to work taking into account health and equity in all policies that has to be decide and implemented in a participatory and intersectoral way. Each municipality organized a group formed by the councilors, technicians, and citizen associations related to the local policies. In order to help and guide in this policy process 2 tools were translated, adapted and tested in various municipalities.

Description of the problem
Describe the usefulness of two tools, the “Place standard” to analyse the participatory form the situation of health determinants and their prioritization, and the adaptation of a 'Fem Salut?' of evaluation of impact on health and equity to be used at the local level. Both were adapted during 2018 and used by a set of municipalities. These processes were made by groups of experts and citizens and after a pilot studies to test it was carried out.

Results
Two municipalities use the “place standard” tool and 6 “Fem salut?”. With the first tool, 8 community groups and 2 community days were organized in each municipality in order to present the tool and analysed the health situation looking at the health determinants and equity aspect. Public transport was the policy prioritize. “Fem salut” was modified using qualitative methodology. The use of support questions and examples was very useful to facilitate the incorporation of equity approach guiding on how each initiative could influence.

Lessons learned
The ease use and understanding by politicians, the technicians and by community of the results obtained promote the participation and also facilitate the participation of vulnerable population in all parts of the process. This experience could be useful to be transferred to other local territories.
Child sleep: assessment of the knowledge of parents of children aged zero to two years
Authors: Oliveira E S , Oliveira L M , Oliveira D T , Viana T R F , Silva L K C , Bezerra C M , Cardoso MVLML 
Published: October 2020

Abstract
Changes in sleep behavior are considered a public health problem, since they interfere with the health of the individual, especially in early childhood, and can impair growth and development. The objective of this study was to evaluate the knowledge about children's sleep in parents of children aged 0 to 24 months. Quasi-experimental study, of the type before and after, with a single group, developed in a pediatric outpatient clinic in northeastern Brazil. Convenience sample of 60 parents of children discharged from the neonatal unit, who represent preliminary data from a larger study. Data collected between November / 2019 and January / 2020, using the CAP survey (Knowledge, Attitude and Practice). A child sleep instrument was used in the pre-test (first time with the parents) and post-test (15 days after the first application). After the pre-test, the parents read an educational booklet containing the information to which they were asked. The knowledge about sleep was assessed including, time, place and sleeping clothes, position in the crib, prevention of sudden infant death syndrome and total sleep time. Scores ≤ 3 represented inadequate knowledge; 4-7 adequate knowledge. Only 5 parents had inadequate knowledge in the pre-test. In the post-test, everyone demonstrated adequate knowledge. The average of points in the pre-test was 4.3, median of 4. In the post-test, the average of points (6.15), median (6). In the pre-test, less correct questions were total sleep time, adequate sleeping position, with 12 and 20 errors, respectively. After the application of the booklet, the question regarding the total sleep time remained with an equal number of errors, however only 7 parents were wrong about the position of the child at the time of sleep. It is concluded that there is a need for guidance to parents on sleep, and it is pertinent to evaluate their previous knowledge, contributing to the strengthening of public policies aimed at children's sleep.

Key messages
Parents should receive guidance on infant sleep hygiene. Strengthening the promotion of children's sleep by health professionals.
Varicella vaccination as useful strategy for reducing the risk of varicella-related hospitalizations
Authors: Marrella A , Casuccio A , Amodio E , Vitale F 
Published: October 2020

Abstract

Introduction
The present study summarizes evidences of the impact of varicella vaccination (VV) on hospitalization rates attributable to this infectious disease in Italy.

Methods
We have carried out a retrospective observational study that analysed hospital discharge records and VV coverage at 24 months collected from 2003 to 2018 by the Italian Health Ministry. All hospitalizations with the presence of an ICD-9 CM 059.X code in the principal diagnosis or in any of the five secondary diagnoses were considered as related to varicella. The hospitalization rate reduction was evaluated by calculating average annual percent change (AAPC) through joint-point analysis.

Results
Hospitalization rates showed a decreasing risk by age: children aged &lt;1 year were the most affected age group in each region (42.56/100,000 per year), whereas lower incidence rates were found in older age groups (23.76/100,000 in 1 to 5 years age group and &lt;4/100,000 in the following groups).
Varicella hospitalization rates decreased significantly after the introduction of VV (3.42 vs. 2.67 per 100,000; P &lt; 0.001). During the first five years after vaccination introduction hospitalization rates showed a statistically significant decrease especially for infants aged &lt;1 year (AAPC -34.98%; p &lt; 0.001) and 1 to 5 years old (AAPC -35.22%; P &lt; 0.01). VV coverage was strongly correlated with hospitalization rates decrease over each paediatric age group (R-squared 0.38 in aged &lt;1 year, p &lt; 0.001; 0.71 in 1 to 5 years old, p &lt; 0.001; 0.93 in 6 to 14 years old, p &lt; 0.0001).

Conclusions
All the previously reported findings confirm that hospitalization rates are strictly related to both the number of years since vaccination introduction and the vaccination coverage. VV confirms to be an important step in public health strategies and the introduction of universal vaccination, with high vaccination coverage, should be considered as an extremely powerful tool for reducing the risk of complications.

Key messages
This study adds update findings to the literature and shows that varicella hospitalizations in Italy, from 2003 to 2018, have reduced their burden, that was high in years before varicella vaccination. Varicella vaccination introduction and high coverage are powerful tools for reducing the risk of varicella complications and related hospitalizations in the general population.
Data inputs and assumptions in calculating the non-fatal burden in burden of disease studies
Authors: Haagsma J , Wyper G , Devleesschauwer B 
Published: October 2020

Abstract
Years Lived with Disability (YLD) is a component of the Disability-Adjusted Life Year (DALY), and measures the healthy time that is lost because of living with a disease or disability. YLDs are calculated by multiplying the prevalence and/or incidence of a disorder by the short- or long-term loss of health associated with that disability (the disability weight) and disease severity (severity distribution).
The process of calculating a YLD involves several components and in this presentation each step will be highlighted through a sequential walk through for each step in the YLD calculation, including counting disease occurrencethe relationship between disability weights, health states and severity distributionsadjusting for comorbiditiesdealing with uncertainty
The aim of this presentation is to provide a simple step by step guide on the key components in the YLD calculation. Using the real-life example of cerebrovascular disease, the presentation will outline the key choices and assumptions that underline each data input in the YLD calculation. Participants in this session will also be provided with links to resources to help facilitate this decision-making process. The workshop will end with an interactive session where the presenters will discuss the implications of the different methodological choices with the audience.