bluuebunny/crossref_metadata_2025_split huggingface dataset:
Survival and prognostic factors of patients with breast cancer in the state of São Paulo
Authors: Almeida R J , Luizaga C T M , Eluf-Neto J , Pessoa E C , Chiarotti A M M , Souza R A , Murta-Nascimento C 
Published: October 2020

Abstract

Introduction
Breast cancer is a public health problem worldwide, being the most common malignant neoplasm in the female population.

Objectives
To estimate 5- and 10-year breast cancer-specific survival probabilities of patients included in the hospital-based cancer registry (HBCR) of the Fundação Oncocentro de São Paulo (FOSP, in Portuguese) and to assess the prognostic factors for this neoplasm.

Methods
Historical cohort study that included women with breast cancer included in HBCR-FOSP and diagnosed between 2002 and 2012. The event of interest was breast cancer-specific mortality. Living cases at the end of follow-up (December 31, 2017), loss to follow-up and death other than that due to breast cancer were considered censored on the date of the last contact or date of death. Descriptive analysis and survival analysis were performed using the Kaplan-Meyer method. Survival curves were compared using the log-rank test. Hazard ratios (HR) and their 95%CI were estimated using Cox's proportional hazards model. The study was approved by the Human Research Ethics Committee of the Botucatu Medical School, São Paulo State University, Brazil.

Results
53,146 cases of invasive breast cancer were registered at HBCR-FOSP between 2002-2012. The median age at diagnosis was 55.9 years. By the end of the follow-up, 20,683 patients died, and 71.4% were due to breast cancer. The 5- and 10-year breast cancer-specific survival for the entire cohort was 76.1% (95%CI 75.7-76.5%) and 64.8% (95% CI 64.2-65.3%), respectively. In the multivariate analysis, the factors associated with prognosis were age at diagnosis, year of diagnosis, educational level, clinical stage, and histological type.

Conclusions
These findings may contribute to the development of policies for the identification of breast tumors at earlier stages.

Key messages
Breast cancer is an important public health problem in Brazil and worldwide. The findings of this study may contribute to the development of public policies for the control of breast cancer in the state of São Paulo.
Personal experiences of medical school education: methods to evaluate competency and ways to improve
Authors: Khan H , Fundano N , Ghazal Asswad A , Holm S , Petráková A 
Published: October 2020

Abstract
Personal experiences of medical school education and the manner in which it is delivered will be discussed. Examples of approaches used for student evaluation of different competencies and the methods to track their progress and development were identified. They were appraised, with their strengths and weaknesses discussed. Ideas to improve the approaches for competencies assessment in medical students were also explored.
Integrated approaches for the assessment of health impacts of environmental chemicals: our experience in the GraMo cohort study
Authors: Arebola J P , Martin-Olmedo P , Pérez-Carrascosa F M , León J , Echeverría R , Salcedo-Bellido I , Gomez-Peña C 
Published: October 2020

Abstract
The assessment of the health implications of human exposure to low doses of multiple environmental chemical pollutants represents an important challenge for environmental epidemiology. Current studies must go beyond simple exposure-disease associations and need further characterization of a complete exposure disease continuum, including exposure routes, adverse outcome pathways, potential subclinical effects, interactions between chemicals, and intra-individual susceptibility. This needs an effective synergism with basic sciences, which can enrich epidemiologic findings with very detailed information at a molecular level, but also with clinicians, who would help to provide accurate diagnoses and interpretation in a real-world scenario.
On the other hand, environmental exposures can affect the general population at different levels, including economic and social dimensions, which have been frequently overlooked. These approaches would require specific methodologies that are relatively novel in the field of environmental epidemiology, such as cost-benefit analyses and qualitative techniques.
Public health campaigns can clearly benefit from these mixed approaches.
Continuing online education to health workforce: elderly’s health care training experience
Authors: Savassi L C M , dosSantos A O , Gasque K C S , Lemos A F , Alves L D S , Vilaça J P V , Hoffmann M C C L , Campos N V P , Amstalden A L F 
Published: October 2020

Abstract

Background
The Open University of the Unified Health System (UNA-SUS) was created in 2010 to promote continuing professional education using online distance education (ODE) to Brazilian health workforce - mainly primary care – spread over 8.5 million kilometers. It comprehends a 34-universities network developing free open technology-enhanced courses and has more than 3 million enrollments and 1 million single learners, covering 98% of the country's cities.

Objectives
Elderly's Health Care Educational Program aims to improve professional education for public health workers, focused on aged people's care, based in 5 independent microlearning courses developed in the past 2 years. It follows “action mapping” design, in which the action objectives and practice demands are defined before content, meeting real-world demands, intending to improve completion rates (CR) as well as modeling continuing education in world's health systems.

Results
These ODE courses were available for 18 months (2018-2019), with 66,655 enrollments and 36,714(55%) certificated; CR ranged from 46.4% to 70.5% among 15 health professions and “students”, being higher for Community Health Agents (70.5%) and Nursing Technicians (65,4%). Enrollments were from all 5 Brazilian regions, mean age was 32.6 years, 81.6% were female.

Conclusions
Instructional design allowed professionals to learn according to specific gaps; microlearning strategy promoted higher CR compared to traditional ODE courses. High school and technical educational levels also had higher CR suggesting that ODE can be adequate to this target audience, who possibly have less educational opportunities than graduated ones. Considering the success obtained in a continental-size country, this model could be reproduced worldwide.

Key messages
Continuing ODE is a worldwide demand. Initiatives that use information technology to improve learning process of health professionals, including healthcare technicians, should be considered.
Total worker health® is the future of worker safety, health, and well-being
Authors: Tamers S 
Published: October 2020

Abstract
The future of work is being shaped by rapid changes in the workplace, work, and workforce. Driven by advances in industry, this movement is marked by the accelerated pace of developments connecting people, places, and things. All these advances and developments have implications for worker safety, health, and well-being and require innovative occupational safety and health strategies.
Because of these new realities, the U.S. Centers for Disease Control and Prevention's (CDC) National Institute for Occupational Safety and Health (NIOSH) recently launched the Future of Work (FOW) Initiative. This Initiative is a collaborative effort of multidisciplinary research, communication, and partnerships throughout NIOSH, other agencies, and organizations that aims to identify novel research solutions, practical approaches, and partnership opportunities to address the future of work. To more broadly address worker safety, health, and well-being, the FOW Initiative applies the Total Worker Health® (TWH) framework. TWH is defined as policies, programs, and practices that integrate protection from work-related safety and health hazards with promotion of injury and illness prevention efforts to advance worker well-being. The TWH approach prioritizes changes to improve physical, organizational, and psychosocial factors that present possible risks in the work environment for today's and tomorrow's workforce.
This presentation will first introduce CDC/NIOSH's FOW Initiative. Next, the TWH integrated approach will be defined and described. Centering on CDC/NIOSH's future of work priority topics in the areas of workplace (organizational design, technological displacement, work arrangements), work (artificial intelligence, robotics, technologies), and workforce (demographics, economic security, skills), the presenter will then provide evidence-based solutions to address future of work issues and related outcomes, using the TWH approach.

Key messages
The future of work has world-wide implications for the workplace, work, workforce. The Total Worker Health framework is a transdisciplinary approach by which to view and address the future of work. Public health professionals and other stakeholders must take a proactive approach to address worker safety, health, and well-being issues impacted by the future of work.
Predictors of Healthcare Associated Infections and Their Role on Mortality in an Intensive Care Unit
Authors: Migliara G , Baccolini V , Salvatori L M , Angelozzi A , Isonne C , Nardi A , Prencipe G P , Marzuillo C , De Vito C , Villari P 
Published: October 2020

Abstract

Background
Healthcare associated Infections (HAIs) represent a significant burden in terms of mortality, morbidity, length of stay and costs for patients in intensive care units (ICUs). In this study, we analyzed the predictors of HAIs development and assessed the HAIs association with mortality. Data were retrieved from a general ICU active surveillance system of a large teaching hospital in Rome.

Methods
Logistic regression models were built to quantify the association between demographic and clinical factors and the development of HAIs, device-related HAIs and Multi Drug Resistant (MDR)-associated HAIs. The HAIs independent predictors were used to create propensity scores (PS) specific for each model, that was subsequently used to adjust the association between these conditions and mortality in logistic regression models.

Results
From May 2016 to September 2019, 864 patients were included in the surveillance system, 236 (27.3%) of which had at least one HAI during their hospitalization. Specifically, 162 (18.8%) patients had at least a device-related HAI and the overall mortality rate was 34.3%. Factors associated with the HAIs and the device-related HAIs were mechanical ventilation and admission for trauma. The PS-adjusted logistic models showed an association between HAI and device-related HAI and mortality (OR 1.82, 95%CI 1.30-2.54; OR 2.03, 95%CI 1.40-2.95, respectively). MDR-associated HAIs had a significant association with diabetes mellitus; however, these infections weren't associated with mortality (OR 1.42, 95%CI 0.98-2.08), even in the subgroup of infected patients (OR 0.99, 95%CI 0.56-1.73).

Conclusions
The study confirms the association between HAIs and device-related HAIs with mortality in ICUs. Apparently, MDR-associated infection subset appears not having a specific association with mortality. However, given the extra effort that these infections require to be managed, they should be adequately surveilled and contrasted.

Key messages
Healthcare associated infections are strongly associated with mortality in ICU. MDR-associated infections do not seem to give a specific drawback in our setting.
Effect of ClO2 on the distribution of Legionella pneumophila serogroups in a Teaching Hospital
Authors: Vincenti S , La Milia D I , Boninti F , Marchetti E , Wachocka M , Laurenti P 
Published: October 2020

Abstract
The prevention of Legionella colonization of water systems is one of the goals of hospital management. Among chemical disinfection methods, chlorine dioxide (ClO2) has been largely used to control Legionella in water systems. We analysed the distribution of Legionella pneumophila serogroups (sg) and Legionella other spp before (PRE) and after (POST) installation of chlorine dioxide (ClO2) continuous disinfection systems in a Teaching Hospital in Rome.
According to the Italian National Guidelines, our surveillance plan involved a systematic sampling of the water system. The sampling was performed from Jan. 2010 to Dec. 2019. From 2011 to 2019, ClO2 continuous disinfection systems were installed in all hot water system of the hospital, and maintained at a concentration of 0.25 mg/l at the end point. The isolated strains of Legionella were first serotyped using a kit that identifies sg1, other species and that discriminate sg from 2 to 15.
1505 hot water samples were collected from the Hospital and analysed. 363 samples are PRE and 1142 are POST activation of ClO2. Only the 16.74% of monitored sampling points were colonized by Legionella during the study period. This percentage decrease from 31.40% of PRE samples, to 12.08% of POST samples (p ≤ 0.000). The sg isolated were: sg3 (60.31%), sg8 (17.12%), sg1 (16.73%), sg6 (1.95%) and other species (3.89%). Comparing the distribution of sg between the PRE and POST samples, the sg8 showed a high increase (+136.84%) and the sg3 a slight decrease (-17.94%). These variations were statistically significative.
The results showed a predominance of Legionella pneumophila sg3, compared to what was observed in a multicenter study conducted between different hospitals of various regions of Italy, where sg6 was the major isolate. The ClO2 affect the distribution of sg, in particular for sg8. This interesting result will be further investigated.

Key messages
Our data deriving from an environmental monitoring plan, show that the ClO2 affects the distribution of Legionella’s serogroups. The ClO2 reduces the percentage of samples colonized by Legionella. The ClO2 reduces the percentage of samples colonized by Legionella.
Burden of Healthcare-Associated Infections in Italy: Disability-Adjusted Life Years
Authors: Bordino V , Vicentini C , D'Ambrosio A , Quattrocolo F , Zotti C M 
Published: October 2020

Abstract

Background
Healthcare-Associated Infections (HAIs) significantly increase adverse clinical outcomes and healthcare costs. In 2016 Italy participated in the second European Centre for Disease Prevention and Control (ECDC) Point Prevalence Survey (PPS) of HAIs and antimicrobial use in acute care hospitals. The aim of this study was to estimate the burden of the 5 most common HAIs in Italy, by evaluating incidence, attributable deaths, Years of Life Lost (YLL), Years Lived with Disability (YLD) and Disability-Adjusted Life-Years (DALYs).

Methods
National PPS data were used to establish sex- and age-specific incidence of Healthcare-associated Pneumonia (HAP), HA Urinary tract infections (HA UTI), HA Bloodstream Infections (HA BSI) excluding neonatal BSI, Surgical Site Infections (SSI), HA Clostridium Difficile infections (HA CDI). Patients' life expectancy was adjusted according to the severity of underlying conditions using the McCabe score. Following the methodology from the Burden of Communicable Diseases in Europe (BCoDE)-project, an adapted version of the disease models of the BCoDE toolkit was used.

Results
An overall yearly incidence of 643434 new cases of HAI in Italy was estimated. The aggregate burden of the 5 HAIs was 426411.98 DALYs (86731.03 YLD + 339680.96 YLL), corresponding to 702.53 DALYs per 100000 total population. HA BSI and HAP had the highest burden with respectively 253868.22? and 126038.26 DALYs. The population strata with the highest burden were the ones with McCabe Score 1 for every considered HAI. The age groups with the highest burden were 70-74 for male and 45-49 for female patients. In total, 56% of DALYs were attributable to men and 44% to women.

Conclusions
This nation-wide study found a significant burden of disease due to HAIs in Italy. Results of this study could be used to guide policy-makers in the implementation of measures aiming to reduce the impact of HAIs.

Key messages
This study estimated the burden of 5 HAIs in Italy was 426411.98 DALYs (86731.03 YLD + 339680.96 YLL according to 2016 PPS data. Considering the significant burden of HAIs found in this study, infection prevention and control measures should be a Public Health priority in Italy.
FRESHER and RARE 2030: scanning the horizon emerging trends in health and healthcare
Authors: Giuffre G , Sisti L G , Ricci A 
Published: October 2020

Abstract

Background
Health and healthcare are facing novel challenges ranging from broad, shifting trends to emerging innovative technologies and social practices. Foresight methodology aims to analyse emerging trends, building different future scenarios and identifying policy options to support the policy dialogue.

Methods
FRESHER and RARE 2030 are two EU-H2020 projects. FRESHER- FoRESight for hEalth policy development and Regulation (2016-2018) aimed at representing long term alternative health Scenarios testing future policies to tackle the burden of Non-Communicable Diseases. A micro-simulation model, specifically enhanced by the project, also computed the health outcomes of the different four Scenarios. Rare 2030-Foresight in Rare Diseases Policy (2019-2020) uses a participatory approach to identify the most relevant trends, anticipate their influence over the next decade and propose policy recommendations that could lead to a better future for people living with Rare Diseases. Different in scope, these projects share common features. Both follow a four steps foresight methodology: horizon scanning, trends identification and ranking, scenarios building, back-casting and policy elaboration. Taking a participatory approach, these studies apply structured qualitative tools, involve a wide range of stakeholders and include regional case studies.

Results
20 trends emerged as key for the future of health and healthcare, among them: demographic change, rise of inequality, urbanisation, climate change and low carbon development, innovation in medicine, citizens empowerment and the potential for big data and Artificial Intelligence application.

Conclusions
The 20 trends analysed offering a litmus test for future proofing current health and healthcare policies. Foresight has proven to be a valid methodology to gather collective intelligence for identifying emerging trends and scenarios, evaluating risks and opportunities, setting long term goals and helping the decision making in health.

Key messages
To promote a transition toward better health policies, it is crucial supporting the collaborative attitude and ensuring a greater involvement of citizens and patients in the decision making. The importance and unpredictability recognized to the equity trend in both projects reveals the need for urgent actions to ensure the future access to better health and care to all European citizens.
A new tool to assess community-level evidence to inform public health decision making
Authors: Clark E , Snelling S , Beyers J , Howarth C , Neil-Sztramko S , Dobbins M 
Published: October 2020

Abstract

Background
As public health responds to evolving challenges around the globe, it is critical to draw on community-level evidence to inform decisions on emerging needs. There are existing tools for assessing the quality of research evidence, but none that explicitly focus on quality assessment of evidence from community sources, including local health status and ever-changing community and political preferences and actions.

Methods
The National Collaborating Centre for Methods and Tools (NCCMT) in Canada has developed new tools, called Quality Assessment of Community Evidence (QACE), to help public health decision makers assess the quality of community evidence. The QACE tools were drafted through extensive review of existing frameworks, tools and measures for appraising population health and community evidence, and diverse key informants. We identified three consistent themes that became the core dimensions in these tools. By using the QACE tools, practitioners can answer the question: “Is the quality of this evidence about local context, community needs and political preferences good enough to influence decision making?”

Results
The QACE tools provide probing questions for each of three dimensions: relevant, trustworthy and equity-informed. Supplementary resources help users delve more deeply into different aspects of quality assessment. The QACE tools are intended for public health practitioners who provide and use evidence to support or make decisions about public health practice and policy, including public health practitioners, senior leaders, policy makers and funders.

Conclusions
The QACE tool is a new addition to the public health toolbox for evidence-informed decision making, providing questions to ask about evidence from community sources. By using the tool as part of a decision-making process, public health practitioners can be assured that their decisions are based on the best-available evidence for their communities.

Key messages
The new Quality Assessment of Community Evidence (QACE) tools fill the gap in assessing quality of community-level evidence for public health decision-makers. Community evidence, including local health status and needs and community and political preferences and actions, should be assessed for quality in three critical domains.
Incident reporting digitalization: the experience of an Italian academic hospital, 2019
Authors: Ruscio E , Bianchet B , Scarpis E , Del Pin M , Degan S , De Corti D , Bellomo F , Farneti F , Cocconi R , Brusaferro S 
Published: October 2020

Abstract

Issue
Incident reporting (IR) is an important tool to assess potential or current problems within health care facilities. To increase the number of IR should be an important issue of the risk manager. In the academic hospital Santa Maria della Misericordia (SMM) of Udine, in North-east of Italy, IR were anonymous paper forms handwritten by health-care workers (HCW) and sent to Clinical Risk Management by internal mail. Digitalization was carried out aiming to increase IR, making it simpler, more direct and perceived as more anonymous by HCW.

Description of the problem
January 1st 2019 the digitized system was initialized, between January and March two training sessions for HCW were carried out and from the 1st April HCW began to send IR with the new application which was installed on every hospital's PC. The objectives were to push HCW to report more, mostly on their own wards' incidents, and to receive complete IR through the insertion of some mandatory information fields.

Results
Comparison between the period from 1st April to 31th December 2018 and from 1st April to 31th December 2019 showed an increase of 22,6% of IR (from 678 to 831), an increase of 11,2% (from 331 to 368) of IR regarding problems with other wards or services and an increase of 33,4% (from 347 to 463) of IR regarding their own wards' incidents.

Lessons
Digitalization seems to be appreciated by HCW despite they are forced to give more information due to the mandatory fields. This could be explained considering that a direct incident reporting system ensures privacy of the HCW which feels more warded also when he reports an internal problem of his own ward. Finally, mandatory fields facilitate risk management work giving all the relevant information about the incident.

Key messages
Digital reporting seems appreciated by HCW and could be a mean to increase the number of incident reporting. To guarantee the anonimity of incident reporting should be a priority and every way to make the HCW feel anonymous seems to be appreciated.