bluuebunny/crossref_metadata_2025_split huggingface dataset:
National health insurance impact on malnutrition in under-five years old children in Indonesia
Authors: Herman B , Pongpanich S , Viwattanakulvanid P 
Published: October 2020

Abstract

Background
The premium-based National Health Insurance Program under Jaminan Kesehatan Nasional (JKN), has been launched in 2014, although it lacks evaluation of the benefits, particularly on clinical outcomes-based. This study aimed to assess the impact of JKN possession on nutrition status among under-five years old children.

Methods
A Cross-Sectional Study was conducted during January-September 2019 in Balikpapan, Indonesia to assess the impact of JKN in the nutrition status of this specific group. Primary data (socio-demographic, feeding pattern, basic knowledge of nutrition and Health Insurance ownership) has retrieved through validated questionnaires from the parents and/or the guardian, followed by anthropometry measurement (Weight per Age Z-Score) to determine the nutrition status. Bivariate analysis was conducted to identify the confounder. Binary Logistic Regression was performed to determine the impact of JKN health insurance on the nutrition status among the target population

Results
As 62 from 312 (19.87%) children fall &lt;-2 Z-Score (Underweight) whereas 5 children were overweight (&gt;2 Zscore) and 2 children were obese (&gt;3 Z Score). Only 77 (24.68%) children have JKN. The education of both parents was associated with nutrition status but no difference in knowledge regarding nutrition and identifying nutritional disease. Various feeding patterns (Breastfeeding status, vitamin A status, and snack intake) were not potential confounders. Adjusted by birth weight and history of disease within 6 months, child who possess Health Insurance (JKN) tend to have a normal weight child up to 1.998 times (AOR = 1.998, 95% CI 1.056-3.780 p = 0.033) compared to underweight, but no significant finding was found between Health Insurance and children with normal and overweight/obese children, adjusted by birthweight (AOR = 3.091, 95% CI 0.639-14.692 p = 0.161)

Conclusions
This study illustrated the significant benefit of JKN to prevent undernourished event but not overnutrition.

Key messages
National Health Insurance Coverage provides benefit on malnutrition prevention in under-five years old children. Children covered with National Health Insurance will unlikely get undernourished but no significant finding in overnourished prevention.
Perceived treatment and unmet need for medical care among people of foreign origin in Finland
Authors: Somersalo L , Kankkunen P , Kuusio H 
Published: October 2020

Abstract

Background
Previous international studies show that perceived unjust treatment is relatively common among people with foreign background (PFB) in medical services. This study examines the association between unjust treatment in medical settings and unmet need for general practitioner's (GP) services among PFB in Finland.

Methods
The data for this study were drawn from Survey on work and well-being among people of foreign origin (UTH) (N = 5449, response rate 66%), conducted in 2014-2015. Respondent characteristics were weighted and summarized, and multivariable logistic regressions were performed to assess the adjusted odds ratios (OR) of association between self-assessed unjust treatment and unmet need for medical care. The analyses were conducted in a three-step process where the first model tested the association between unjust treatment in medical care settings and unmet need for GP services, second model adjusted this association by sociodemographic factors, and the third model further adjusted the previous models by migration related factors.

Results
PFB reporting unjust treatment were significantly more likely to experience unmet need for GP services, even after controlling for other tested factors (OR = 8.73, 95% CI 6.18-12.33, p&lt;.001). Besides unjust treatment, only employment status was associated with unmet need for GP services (OR = 1.43, 95% CI 1.08-1.89, p = 0.123) in the final model. Immigration related factors were not associated with unmet need for care in this model.

Conclusions
Perceived unjust treatment in medical settings is strongly associated with unmet need for GP services.

Key messages
Cultural sensitive treatment could affect the inequities in unmet need for GP services between PFB and overall population. Ensuring cultural competence throughout organizational structures, and not just for individual employees, could create an environment to promote equal treatment of all clients.
A retrospective database analysis to estimate the burden of AOM 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
Acute Otitis Media (AOM) causes substantial healthcare resource utilization (HCRU) in children. This analysis assessed AOM HCRU and costs following PCV13 introduction in 2010 in Veneto.

Methods
AOM episodes in children &lt;15 years residing in Veneto were identified in Pedianet, a pediatric primary care, database from 2010-2017. Recurrent AOM was defined as at least three episodes in 6 months, or four or more episodes in 12 months. HCRU includes primary care visits, antibiotic prescriptions, diagnostic tests, specialist visits, emergency room (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 cost per episode.

Results
Simple AOM episodes were associated with 1.03 primary care visits and 1.52 antibiotic prescriptions on average. Only 2.4% and 0.18% of simple AOM episodes included an ER visit, and a hospitalization respectively. Recurrent AOM episodes were associated with 1.06 primary care visits and 1.62 antibiotic prescriptions. Annual costs per episode were €50 for simple AOM and €54.2 for recurrent AOM, majority of which were associated with primary care visits and antibiotic prescriptions. Average antibiotic prescription costs were €14.2 for simple AOM and €16 for recurrent AOM. During 2010 and 2017, SRIRs declined from 100 to 72/1000 person-year for simple AOM and from 13 to 11/1,000 person-year for recurrent AOM. Regional expenditures decreased from €4702.7 to €3358.5/1,000 person-year for simple AOM and from €672.4 to €572.6/1000 person-year for recurrent AOM.

Conclusions
SRIRs and regional expenditures declined for simple and recurrent AOM after PCV13 introduction. Primary care visits and antibiotic prescriptions account for the majority of expenditures.

Key messages
SRIRs and regional expenditures declined for simple and recurrent AOM after PCV13 introduction. Primary care visits and antibiotic prescriptions account for the majority of expenditures.
AEFIs active surveillance projects as vaccinovigilance traineeship: Puglia (Italy) experience
Authors: Stefanizzi P , Bavaro V , Spinelli G , Anona D , Stella P , Tafuri S 
Published: October 2020

Abstract
Surveillance of Adverse Events Following Immunization (AEFIs) is a crucial part of vaccination strategies because the most important concern of “No-vax group” is the safety of vaccination. According to UE laws, in Italy a passive surveillance system of AEFIs is established by law and managed by National Drug Authority (AIFA) and Regional Health Governments. The performance of surveillance system is different in the 21 Italian Regions and in some Region, such as Puglia, the AEFIs reporting rate has been, for several years, lower than National figure. The implementation of AEFIs active surveillance projects could increase the performance of AEFIs surveillance system, also after the end of the project.
In Puglia, since 2017, May to 2018, November, an active surveillance of AEFIs has been established, focused on MMRV vaccine. In this study, we analysed the AEFIs general picture in Puglia in 2016 and 2019, before and after active surveillance project. The source of data is the AIFA database; data were reported as number of AEFI and rate for Puglia population (reporting rate RR). The AEFIs were classified as serious, not serious and unclassifiable and causality assessment was performed according to WHO recommendations.
The number of AEFIs detected by the passive surveillance system is 91 for 2016 (RR 2,2 per 100.000 people), and 168 for 2019 (RR 4,2 per 100.000 people). The percentage of serious AEFIs was 23.1% (21/91) in 2016 and 31% (52/168) in 2019 and unclassifiable AEFIs were 22% (20/91) in 2016 and 0 in 2019. The percentage of serious AEFIs for which the result of causality assessment was “consistent” is 23,8% (5/21) in 2016 and 55,8% (29/52) in 2019.
The experience of AEFIs active surveillance project increase the performance of AEFIs surveillance system. From 2016 (pre-project time) to 2019 (post-project time) the number of AEFIs detected was doubled, the number of unclassifiable AEFIs (proxy of poor reliability of the system) was reduced to zero.

Key messages
AEFIs passive surveillance system could be affected by underreporting and lack of quality. The AEFIs active surveillance project are an important occasion of traineeship for vaccinovigilance system, that could increase the sensibility and the reliability.
Modelling the global impact of the 13-valent pneumococcal vaccine on antibiotic use for otitis media
Authors: Moffatt M , Wasserman M 
Published: October 2020

Abstract

Background
Antimicrobial resistance (AMR) is a critical issue in global health causing approximately 1 million annual deaths. Vaccines are essential in addressing AMR as they reduce resistant strains and prevent development of resistance by preventing spread of disease and resulting antimicrobial use. This analysis evaluates the impact the 13-valent pneumococcal conjugate vaccine (PCV13) has had on dispensed antibiotic prescriptions (DAP) due to otitis media (OM), one of the largest drivers of DAP globally.

Methods
An Excel-based model was developed to estimate number of infants vaccinated with PCV13, and the associated reduction in OM cases in children &lt;5 since 2010. OM cases averted were based on a global meta-analysis and estimated cases averted were applied to infants vaccinated by country. DAP avoided were estimated assuming 90% of OM cases were prescribed an antibiotic. We then compared our modelled estimates to metrics measuring number needed to vaccinate to prevent DAP from any outcome.

Results
Over the past 10 years, we estimated 286,54m infants were vaccinated with PCV13, with 158,33m OM cases and as many as 142,49m DAP avoided globally. By WHO region, reductions in OM rates and DAP respectively are estimated to have been; Africa and Eastern Mediterranean (103,05m; 92,74m), South-East Asia and Western Pacific (8,82m; 7,94m), Europe (20,70m; 18,63m) and Americas (25,76m; 23,18m). Using rates from the literature of 0,20 to 1,79 total DAP avoided per child vaccinated, results ranged from to 71,63m to 511,68m.

Conclusions
PCV13 use has resulted in substantial reductions in OM and DAP. As we focus on OM in children &lt;5, results underestimate the full impact of PCV13 on DAP as vaccine impact on other pneumococcal diseases and adults through herd effect are not included. Recognition of the role of vaccination in addressing AMR burden is an opportunity to encourage patients, providers and healthcare systems to continually prioritize vaccination in public health efforts.

Key messages
Over the past 10 years, PCV13 has led to considerable reductions in dispensed antibiotic prescriptions globally, highlighting the importance of prioritizing vaccination in global healthcare systems. Our findings illustrate how vaccines can play an essential role in reducing the global burden of antimicrobial resistance through reduction of antibiotic use.
Influenza immunization among Tunisian health care workers in the 2018-2019 influenza season
Authors: Cherif I , Kharroubi G , Bouabid L , Gharbi A , Boukthir A , McCarron M , Ben Alaya N , Ben Salah A , Bettaieb J 
Published: October 2020

Abstract

Background
Given the nature of their activities, health care workers (hcws) are at higher risk of contracting influenza and transmitting the disease to their patients. Influenza vaccine (IV) remains the most effective way to prevent influenza and its complications. To the best of our knowledge, no national data on IV coverage among hcws is available in Tunisia. The present study aimed to assess the flu vaccination coverage among Tunisian hcws in the 2018-2019 influenza season and factors associated with IV uptake through a study of knowledge and attitudes related to influenza vaccination.

Methods
A cross sectional study was conducted in Tunisian primary and secondary health care facilities from March to May 2019. Hcws with direct patient contact were recruited according to a self-weighted multistage sampling. Survey data collection was based on a face to face questionnaire containing both open and closed questions.

Results
A total of 1231 hcws were enrolled in this study. Among respondents, 15.3% (95% CI: [12.3-17.2]) were vaccinated against influenza during the 2018-2019 influenza season. High confidence regarding vaccine efficacy (OR = 3.5, 95%CI: 2.5-4.8), belief that hcws' influenza immunization may decrease illness and deaths among patients (OR = 1.7, 95% CI: 1.2-2.3) and belief that influenza vaccination can reduce work absenteeism (OR = 1.7, 95% CI: 1.2-2.4) were associated with a higher IV uptake among hcws. In addition, participants who mentioned hcws as a target group for influenza vaccination (OR = 2.0, 95% CI: 1.5-2.8) and who were agree that IV is indicated annually for hcws (OR = 3.1, 95% CI: 1.9-4.9) were more likely to receive the IV.

Conclusions
Influenza vaccination coverage among Tunisian health professionals in 2018-2019 was low. Our findings suggest that knowledge and attitudes regarding influenza vaccine influence vaccine compliance among hcws and should thus be targeted by vaccination campaigns to promote flu vaccine uptake in the health community.

Key messages
Vaccination coverage among Tunisian healthcare workers was low in the 2018-2019 influenza season. Our findings suggest that knowledge and attitudes regarding influenza vaccine influence vaccine uptake among Tunisian health care workers.
The new public health imposed and its missing links - people, cultures, anthropology, health for all
Authors: Špoljar Vržina S 
Published: October 2020

Abstract
Critical medical anthropology has been active throughout the decades (Baer, Susser, Singer 1986; Lock, Nichter, 2002; Lupton, 1995. 2000, 2015) in proving that public health is not only an addition to equations of equity in health care but rooted in cultures of people globally (Špoljar Vržina 2003, 2007, 2008; 2011, 2013, 2021; Špoljar Vržina, Rudan, 2009). Italian anthropologist codified the postmodern 'doing good only in states of emergencies' (Pandolfi, 2010). In times of Corona Covid 19 -2020 epidemiological freights we are urged to take this further into account, especially since witnessing racial stigmatizing on the basis of ethnicity and nationality. Paradoxically, Italy as one of the cradles of quarantines is facing the potential permanent closure of neighbouring borders rather than experiencing a historically practiced cooperation, as in the case with Croatia, over centuries (Blažina, Blažina 2015). If there should be a New Public Health (Baum 2016, 2019; Lupton 1997, 2000) it should be recalibrated by anthropological findings that re- focus towards the good of people, cultures and their cooperation. The work of this paper presents this urgent challenge. This anthropological research is a long-term follow up of Croatian medicine system dismantling (Špoljar Vržina, 2008 onwards) through a continuous analyses of micro (people), intermediary (governmental) and macro (international) changes (Bear et al. 1986), departures from functioning for the benefit of people and finding entry points for ethical corrective interventions. The analysis proved an existing switch of the public health paradigm from global health into states of neoliberal sickness, with clear possibilities of returning to 'health for all' if disengaging from the politics of culture/public health. Public health enhancements need to be based on the recalibration towards knowledges of populational and cultural realities.

Key messages
Reintroducing the ‘innovative’ wisdom of doing good for all regardless of emergencies is the core of a new public health agenda. The new public health agenda is based on recognizing cultures as pillars of communities and global societies that matter.
Management of Food and Feed Safety Alerts in ATS VAL PADANA (Italy)
Authors: Troiano G , Chiesa M , Ghisetti M , Gelpi A , Meggiorini A , Firmi A M , Clasadonte V 
Published: October 2020

Abstract

Issue
The rapid alert system is a procedure codified in the European Community, designed to guarantee the speed of communications and consequent measures, that should be adopted if a food or feed represents a serious risk for health.

Description of the Problem
ATS Val Padana implements several measures in cases of food or feed that don't satisfy safety requirements, imported, produced, processed, or distributed by companies located in its area of competence. ATS checks the completeness and effectiveness of the actions undertaken/planned by the food/feed industry operator. The checks are focused on: - Preparation of the distribution list Activation of withdrawal/recall procedures;information provided to consumers;management of the withdrawn products;adoption of measures to prevent the placement of product on the marketAdoption of the traceability systemNotification to the authorities

Results
In November 2018-November 2019, 205 alerts were registered (11 in 2018, 191 in 2019) and specifically: - Alert notifications (risk requiring rapid action in another country): 154 Information notifications for follow-up (product present or that could be placed on the market in another Member State): 22Information notifications for attention (product present only in the Notifier country or has not been placed on the market or is no longer on the market): 29
The notifications concerned: the Department of Veterinary and Safety of Animal Origin Food(89), the Department of Hygiene and Health Prevention (89), both departments jointly (27). ATS Val Padana has managed the alerts and closed them on average within 7.59 days (DS 5.80, range 0-42). In one case the alert was closed after a month.

Lessons
The effectiveness of the Alert System depends first of the communications speed, as well as of the guarantee of rapid times to analyze sampled matrices. Our results demonstrate how ATS Val Padana operates ensuring the maximum effectiveness of the Alert System.

Key messages
The rapid alert system is a codified procedure in the European Community, designed to guarantee the speed of communications and consequent measures. The effectiveness of the Alert System depends primarily on the speed of communications.
Wild mushrooms poisoning: a public health challenge
Authors: Troiano G , Firmi A M , Adorni C , Porro R , Aroldi E , Mazzurini E , Pizzacani R , Pedrazzani S , Lopopolo F , Clasadonte V 
Published: October 2020

Abstract

Issue
Mushrooms are considered as ingredient of gourmet cuisine across the globe and mushroom poisonings can occur because of misidentification of a poisonous species as edible. Of the vast number of mushroom species, approximately 100 are toxic(**).

Description of the Problem
Mushroom poisoning is a public health problem. People should be educated about this poison as often there are no guidelines about the treatment of mushroom toxicity. Despite treatment, the prognosis can be mortal. In the Department of Hygiene and Health Prevention (ATS Val Padana, Italy) expert mycologists offer their consultation free of charge to people who pick mushrooms and register, for each consultation, quantity and toxicity of collected mushrooms.

Results
In 2018-19, 279 consultations were offered: 124(44.44%) in 2018, 155 (55.56%) in 2019. 58.42% of mushrooms were considered not dangerous for human health, without any difference among the two considered years (p = 0.167). 233.7 kg mushrooms were considered edible (mean 2.71, SD 16.44), 92.95 kg were considered dangerous and destroyed (mean 1.39, SD 6.99). The most identified species were: Agrocybe aegerita (11.47%), Armillaria Mellea (29.75%), Boletus edulis (6.45%), Macrolepiota venenata** (1.43%, N = 4), Xerocomus badius (2.51%), Lyophillum loricatum (1.79%), Agaricus Xanthodermus** (3.23%, N = 9). Intoxications occurred among people who did not refer to our mycology unit.

Conclusions
Mushroom poisoning represents a major health risk and as it's often consequence of misidentification, a free of charge consultation offered by experts is fundamental to avoid intoxications or deaths.

Key messages
Mushroom poisoning presents a major health risk. A free of charge consultation offered by experts is fundamental to avoid intoxications or deaths.
Children’s experience of using a smartphone application to promote healthy eating behaviour
Authors: Rageliene T , Grønhøj A 
Published: October 2020

Abstract

Background
Childhood obesity continues to grow in industrialized and developing countries becoming one of the major public health crises worldwide. This, in turn, causes short and long term financial and psychosocial burden to individuals and society. However, obesity can be prevented and reversed by changing one's diet. Previous studies showed that children who have a balanced diet rich in a variety of fruits and vegetables are less likely to be overweight and obese. Smartphone apps could be a useful tool for encouraging healthy eating behaviour and hinder obesity. The aim of this study was to evaluate children's experience of using a smartphone app designed to encourage healthy eating among 9-13 years old children.

Methods
According to dietary recommendations a smartphone app “Food Boss” was developed. The app consists of several different parts designed to promote healthy eating habits and knowledge about a balanced diet. A food diary, games, and the possibility to interact with peers were included. Children were asked to test the app for 2 weeks. Afterwards, two gender-specific focus groups were conducted.

Results
Children found the app easy to use and expressed a positive attitude to the user interface design. The app was perceived as being useful for learning about healthy eating and remember to eat more fruits and vegetables. User's engagement, interest and general satisfaction of using the app varied among the children, boys being more positive about their experience than girls. Though children asserted using the app in the future and recommending it to their friends. Suggestions for further app improvement was also disclosed.

Conclusions
Children's overall experience of using the app was overall positive and they found it useful for learning about healthy eating.

Key messages
Childhood obesity can be prevented and reversed by changing one’s diet. The “Food Boss” app can be an attractive way of reaching children and useful in encouraging healthy eating among children. Children’s overall experience of using the app was overall positive and they found it useful for learning about healthy eating.