bluuebunny/crossref_metadata_2025_split huggingface dataset:
Bringing greater transparency to health workforce planning in Tajikistan: using the WISN approach
Authors: Prytherch H , Kasymova Z , Lechthaler F , Kiefer S , Yarbaeva S , Hojimatova Z , Farrukhzoda A , Wyss K 
Published: November 2019

Abstract

Background
For many countries, overcoming problems related to human resources is critical for progress towards Universal Health Coverage. Planning the workforce means to make decisions on required number, qualification and distribution of health workers. In Tajikistan, despite significant reforms, the health workforce is unequally distributed with physicians being mainly specialized and concentrated in urban areas.

Description
Using the Tajik case, we present a first comprehensive assessment of the Primary Health Care (PHC) staffing situation in a Central Asian setting applying and critically discussing the Workload Indicators of Staffing Need (WISN) method developed by the World Health Organization. Staffing requirements were derived using annual service statistics, obtained from a re-count of monthly routine data from registration books at facility level in the year 2016. Available health cadres in PHC at district and facility level were compared to the according staffing needs. Sensitivity analysis was performed to test the robustness of the predictions, and to identify the main contributors to uncertainty in the predicted staff requirements.

Results
For doctors performing general tasks in the PHC, there is currently an excess of full time equivalents. Moreover, health centres are overstaffed in terms of nurse positions. If the various speciality doctors currently working at rural health centres are not included, there is a shortage of family doctors in place. Sensitivity analysis revealed that staffing requirements in the PHC sector in Tajikistan are most importantly influenced by antenatal care visits.

Lessons
The present study concludes that there is an oversupply of doctors and nurses at PHC and a shortage of family doctors working at the level of health centres. Consequently, a more rational health workforce planning based on well-grounded methodology such as WISN has potential to contribute to more efficient and effective health service delivery in Tajikistan.

Key messages
Countries shifting towards a family medicine model face challenges like an oversupply of specialists performing general medical tasks and a lack of general/family doctors in the transition phase. To identify staffing requirements a transparent and reproducible approach, such as the WISN methodology, is required to steer future staffing needs and possible re-training of current staff.
Patient safety incidents in ambulatory care in Germany
Authors: Geraedts M , Krause S , Schneider M , Leinert J , de Cruppé W 
Published: November 2019

Abstract

Background
In contrast to the inpatient sector, reliable data on the epidemiology and public health impact of patient safety incidents (PSI) are hardly found in the outpatient sector. Thus, this study focusses on the incidence of PSI; the distribution among the various specialist groups; the harmful consequences; the causes and how affected patients deal with PSI in Germany.

Methods
We conducted a cross-sectional study using a newly developed computer-assisted-telephone-interview survey tool. Based on random telephone numbers, citizens &gt;39 years were asked to report whether they had experienced a PSI in the last year or since their 40th birthday; whereby the PSI happened, what consequences the PSI had for them and if they reported the PSI back to their physician. We performed descriptive and multivariate analyses and extrapolated the results to the total population &gt;39 years in Germany.

Results
10037 citizens were surveyed (response rate 13%): 8841 had an outpatient visit last year, of whom 1570 (18%) had experienced at least one PSI. In total, 2832 PSI were reported. General practitioners caused 43% of PSI. Among specialists (54%), most PSI were found among orthopedists (15%) and internists (9%) and arose in connection with anamnesis and clinical examination (61%) as well as drug prescriptions (15%). 72% of the PSI caused health related harm. The most frequent harm was a deterioration in health (23%) and persistent pain (22%). 54% of those affected described the harm as severe or very severe. 27% considered doctors’ stress and lack of time or poor communication (18%) as causes for PSI. 32% of PSI were reported back to the treating physician.

Discussion
Extrapolated to the total population &gt;39 years in Germany (47.2 million), an incidence of 12 million PSI per year must be expected with around 6.6 million affected outpatients. Thus, PSI in the outpatient sector are of immense public health importance in Germany.

Key messages
Patient safety incidents (PSI) often happen in the German outpatient sector. Outpatient PSI can also be accompanied by severe harm for patients.
The use of ICT to increase vaccination uptake: state of the evidence from experimental studies
Authors: Odone A , Balzarini F , Frascella B , Oradini Alacreu A , Signorelli C 
Published: November 2019

Abstract

Background
Information and communication technology has a great potential to improve vaccine uptake by increasing the demand of vaccines and the supply of life-course immunization services. The EUVIS (EUrope Vaccines ICT Strategies) project aims at assessing the current use of ICT in European countries’ immunization programs to inform the planning and implementation of ICT-based intervention models to increase vaccine uptake. Here we present the output of Part I of the EUVIS Project, the state of the evidence from experimental studies at the global and regional level.

Methods
We conducted a systematic review following the PRISMA guidelines to analyze the available evidence from experimental studies on the impact of ICT-based interventions to improve: i) vaccine uptake (primary outcome), and other associated outcomes, including knowledge and attitudes towards immunization in infants, adolescents, adults, elder populations and at risk groups.

Results
We included 68 RCTs. Informative websites significantly increased vaccination uptake among adolescents. Among young adults, none of the assessed interventions was successful in increasing vaccination uptake. The tools targeting parents that increased uptake were SMS, automated phone calls or messages, websites and online decision aid platforms. For pregnant women, combinations of more types of ICT were more effective in increasing uptake. In the adult population, both SMS and videos proved to be successful, while in elder populations and at-risk groups, the use of more traditional methods as short phone calls proved to be more efficient than ICTs.

Conclusions
Technological innovations have made significant contributions to healthcare, but our results shows that the interventions must be tailored to target populations’ specific characteristics and needs. These data are of crucial importance to identify which ICT-based interventions are more effective in each target group, to plan and implement immunization programs.

Key messages
Information and Communication Technology-based interventions to increase vaccine uptake are more successful when planned tailoring target populations’ specific characteristics and needs. ICT can significantly improve healthcare delivery but its role to increase vaccine uptake is controversial. Results from this systematic review are fundamental to plan tailored ICT-based interventions.
Flu vaccination coverage in a large Italian teaching hospital: the example of the leaders
Authors: Pumpo M Di , Barbara A , La Milia D I , Tamburrano A , Vallone D , Gentili A , Cavalieri S , Viora C , Berloco F , Laurenti P 
Published: November 2019

Abstract

Annual flu vaccination among healthcare workers (HCWs) is recommended to prevent influenza and to avoid its transmission especially to frail patients. In our teaching hospital, flu vaccination rate among HCWs has been growing during last 3 years. The aim of this study was therefore to describe the flu vaccination coverage across the past 3 years and to analyze which factors lead to such increase. We performed a cross-sectional study on all HCWs of Fondazione Policlinico Universitario “A. Gemelli” (FPG) hospital of Rome (Italy) to determine the flu vaccination coverage. Socio-demographic and occupational data were collected from hospital personnel records and included age, gender, previous flu vaccination, profession and workplace unit. On site vaccination plus academic detailing involving leaders have been the main strategies adopted in this last 3 years that have already proved to be effective in increasing vaccination coverage among HCWs. During the 2018-2019 season, we analyzed how the flu vaccination coverage among leaders (nurse coordinators and head physicians) could affect all HCWs coverage rate. Flu vaccination rate increased from 9.57% in the 2016-17 to 14.24% in the 2017-18 and to 22.38% in 2018-2019. A total of 4035 HCWs employed in the FPG were included in 2018-19. Concerning the role played by vaccination of leaders in increasing general vaccination coverage during the 2018-2019, the group of HCWs with a vaccinated leader showed a higher coverage rate (28.65%) than the group with a non-vaccinated leader (16.22%) (p &lt; 0.0001). The results are preliminary. Flu vaccination coverage of HCWs in our hospital during the last 3 years has been increasingly higher. Vaccination of the leaders, in addition to previously implemented effective strategies, resulted to be a key factor in increasing flu vaccination coverage among all HCWs. Socio-demographic and occupational variables can significantly influence the coverage rate as well.

Key messages
Annual flu vaccination among healthcare workers (HCWs) is recommended to prevent influenza and to avoid its transmission especially to frail patients. This study shows the growing flu vaccination coverage rate in our teaching hospital and the effectiveness of the example given by the vaccinated leaders in increasing the coverage among all HCWs.
Monitoring of obesity in the Italian adult population: preliminary results of 1998-2018 trend
Authors: Donfrancesco C , Noce C Lo , Profumo E , Minutoli D , Lonardo A Di , Buttari B , Bellisario P , Vanuzzo D , Giampaoli S , Palmieri L 
Published: November 2019

Abstract

Background
Obesity is a risk factor for the majority of non-communicable diseases-NCDs. In the Italian country profile, the NCD Risk Factor Collaboration estimated the 2010 obesity prevalence at 19.0% (95% confidence interval - C.I. 15.7-22.7) in women aged 18 years and over and 18.5% (95% C.I. 15.1-22.0) in men, with a very low probability (2-9%) of halting the increase of obesity by 2025 (WHO global obesity target). This preliminary analysis aims to assess 20 years trend of BMI and obesity in the Italian general adult population using the data collected within the CUORE Project.

Methods
Mean of BMI and prevalence of obesity (BMI &gt; =30 kg/m2) in random samples of resident population in 6 Italian Regions, aged 35-74 years, stratified by age and sex, were assessed in an on-going survey started in 2018 (men 612; women 649), and compared to those assessed in the same Regions in 1998-2002 (men 1933, women 1926) and in 2008-2012 (men 1306; women 1318). Weight and height were measured using standardized methodologies. Surveys were partly funded by the Italian Ministry of Health-CCM and approved by the National Institute of Health ethical committee.

Results
In men, mean values of BMI resulted 26.6 kg/m2 (95% C.I. 26.4-26.8) in 1998 survey, 27.5 (27.2-27.7) in 2008 and 26.5 (26.1-26.8) in 2018; prevalence of obesity was 16.8% (95% C.I. 15.1-18.4) in 1998, 23.5% (21.2-25.8) in 2008 and 17.3% (14.4-20.4) in 2018. In women mean values of BMI were 26.1 kg/m2 (95% C.I.: 25.9-26.4) in 1998, 26.4 (26.1-26.7) in 2008 and 25.5 (25.1-25.9) in 2018; prevalence of obesity was 20.7% (95% C.I.: 18.9-22.5), 21.9% (19.7-24.2) and 19.0% (15.9-22.0) respectively.

Conclusions
Preliminary data of first 6 Regions (out of 10 to be examined in the on-going survey) suggest that mean BMI and prevalence of obesity in Italian adult population are still very high; if confirmed, in the last ten years a reduction seems to be occurred increasing the probability of meeting the WHO obesity target by 2025.

Key messages
Mean BMI and prevalence of obesity in Italian adult population are still high. If confirmed, in the last ten years a reduction of mean BMI and prevalence of obesity in Italian adult population seems to be occurred.
Variants in Neuromedin U pathway genes and risk of cardiovascular disease in an Italian population
Authors: Gianfagna F , Marotta A , Noro F , Gialluisi A , Izzi B , Costanzo S , Castelnuovo A Di , Cerletti C , Donati M B , Iacoviello L ,   on behalf of Moli-Sani Study Investigators
Published: November 2019

Abstract

Background
Neuromedin U (NMU) is a hypothalamic neuropeptide with several functions, considered to be a potential therapeutic target for diabetes mellitus. The aim of this study was to analyse the association between genetic variants in NMU pathway genes and cardiovascular risk, in Italian adults from the general population recruited for the Moli-sani study.

Methods
A total of 4,039 participants (mean age 55.8±12.1 SD; men 46.1%) were randomly selected from the whole study population (N = 24,325; recruitment years 2005-2010). DNA from blood samples stored in the Moli-sani biobank were genotyped for 14 single nucleotide polymorphisms (SNPs) in the genes encoding for NMU, Neuromedin S (NMS) and their receptors NMUR1 and NMUR2. Cox regression analysis (age, sex, BMI, blood pressure, glucose and lipid levels as covariates) was performed to estimate the associations between SNPs and fatal or non-fatal CVD events (validated myocardial infarction or stroke), identified from death certificates and electronic records during a median follow-up of 4.5 years. A genetic score was then computed.

Results
CVD events (N = 93) were associated with mutant alleles in the NMU SNP rs55796004 (HR = 1.94; 95%CI:1.08-3.48) and rs4856020 (HR = 0.52; 95%CI: 0.29-0.94) and in the NMS SNP rs12474526 (HR = 0.48, 95%CI:0.28-0.81), independently from CVD risk factors. A SNP in NMUR1 showed a borderline association (rs6754952, HR = 0.74; 95%CI:0.54-1.00). The derived genetic score was associated with CVD incidence with a HR of 1.57 (95%CI:1.25-1.96, per 1 score SD). A HR of 7.33 (95%CI:1.68-32.01) was found comparing the last vs the 1st decile of the genetic score.

Conclusions
Italian adults carrying variants in NMU pathway genes are at increased CVD risk. Intermediate phenotypes, mediating this association independent of classical risk factors, are unknown and should be investigated. Once confirmed, these results could be useful to improve CVD risk assessment and to plan cost-effective interventions.

Key messages
Polymorphisms in NMU pathway genes are associated with CVD risk independently of classical CVD risk factors, suggesting a potential clinical utility in CVD prediction when added to CVD risk algorithms. The unknown phenotype mediating the association between NMU genes polymorphisms and CVD development could be the neglected CVD risk factor potentially explaining the unpredicted CVD fraction.
Burden of disease of heavy metals in population clusters: towards targeted public health strategies
Authors: Thomsen S T , Herrera J A R , Jakobsen L , Fagt S , Pires S M 
Published: November 2019

Abstract

Background
Humans are exposed to heavy metals from certain foods, thus specific dietary patterns may lead to high burden of disease (BoD). By identifying diet, lifestyle and socio-demographic characteristics of population groups with highest BoD, targeted preventive strategies can be developed. We aimed at identifying clusters and characteristics of Danish individuals with highest BoD due to food exposure to three heavy metals: methylmercury (MeHg), cadmium and inorganic arsenic.

Methods
We collected diet, lifestyle and socio-demographic information of 3,946 individuals in the Danish National Survey of Diet and Physical Activity. Occurrence of heavy metals in food was obtained from Danish food monitoring. We applied machine learning self-organizing maps to group individuals according to similarities in diet, lifestyle and socio-demographics, and estimated BoD due to metal exposure in terms of Disease-Adjusted Life Years (DALY). We will present calculation steps of our approach in a tutorial-like way and demonstrate its applicability to other cases.

Results
We identified 13 population subgroups with distinct dietary and lifestyle characteristics. The estimated BoD varied largely between subgroups, with five subgroups experiencing a BoD &gt; 10 DALY/100,000. The cluster bearing the highest BoD (26.2 (95% uncertainty interval (UI): 10.3, 50.6) DALY/100,000) was significantly different from the cluster with the lowest BoD (5.1 (95% UI: 2.5, 9.2) DALY/100,000) (preliminary). BoD was higher in subgroups with diet and lifestyle considered healthy. Most of the BoD was due to MeHg, particularly in female-dominant subgroups.

Conclusions
Linking machine learning, exposure assessment and burden of disease metrics, this novel approach identified population subgroups with higher BoD due to exposure to three heavy metals. It can be expanded to estimate BoD of other chemicals, and used to develop targeted preventive strategies to reduce BoD in more affected subgroups.
Characteristics and outcomes of clusters of multimorbid patients in UK general practice
Authors: Zhu Y , Edwards D , Kiddle S , Payne R 
Published: November 2019

Abstract

Background
Current clinical specialities, guidelines and quality of care metrics are organised around single diseases and treatments of multiple conditions are rarely coordinated, resulting in insufficient or even conflicting care. This study uses large scale English general practice (GP) records to identify and characterise clusters of patients based on their multimorbidity to allow better design of health services and highlight groups that require additional interventions.

Methods
This is a retrospective cohort study that includes multimorbid adult patients (N = 113,211), from a random sample of 391,669 English patients with valid GP records in 2012 where 38 long-term conditions were defined. Latent class analysis, stratified by age groups, was used to identify multimorbidity clusters. Class solutions are validated and associations between multimorbidity clusters, patient characteristics, public health service utilisation and mortality are assessed.

Results
Poor socioeconomic status is associated with clusters with higher service use and mortality risk. Physical-mental health co-morbidity is a major component of multimorbidity across all age strata. The clusters with highest age-stratified mortality risk in under 65 year olds were linked to alcohol and substance misuse, whereas in over 65 year olds they were linked to cardiovascular disease. The largest cluster in the 85+ years strata (58%) has the lowest number of morbidities, a low degree of service use and mortality. Consistency was seen across identification and validation data.

Conclusions
We find a clear distinction between morbidity clusters, both in the prevalence of long term conditions within them, and in their associations with outcomes (service use and mortality). Specific health services and interventions might be more effective when targeted on the distinct types of multimorbidity we have identified, with a particular focus on the morbidity clusters associated with the worst patient outcomes.

Key messages
The first study to derive age stratified multimorbidity clusters from a large GP record system, whose patients are representative of the English population. Knowledge about particularly dangerous clusters of multimorbidity, such as those involving alcohol and drug use in 18–64 years old, and cardiovascular disease in those 65 years or older.
The health of people in prison in Europe
Authors: O’Moore E , Sturup-Toft S 
Published: November 2019

Abstract
This presentation will explore the rationale behind a public health approach to prison health covering aspects such as the socio-demographic composition of the prison population in Europe, its health status and main health needs, based on the current sources of data. The link between the prison population and the wider community will be analyzed alongside the concept of community dividend, defined as the benefit of prison-related intervention for general population health.
Countering anti-vaccination trends and changing online opinion
Authors: Signorelli C , Odone A 
Published: November 2019

Abstract
We reported the case study of Professor Roberto Burioni, a medical microbiologist and virologist who, in 2015, started a personal social media campaign to contrast anti-vaccinists, using Facebook and other social media to disseminate the science behind vaccines and disseminating scientific data to refute rumors about their dangers. With over 500,000 people following his Facebook profile, Burioni has become a popular role model and influencer in the field of vaccines, openly criticizing vaccines’ refusers and fighting fake news. He used a rather aggressive tone, claiming they are ignorant and that “science is not a matter of democracy”. Although it is methodologically difficult to quantitatively estimate the so-called ‘Burioni effect’ in influencing vaccines’ confidence, we report a drastic rebalance of the number of Italian social media pages supporting vaccines after 2015 suggesting his action on the web has been successful. In fact in 2015 Fakebook pages with the highest amount of contacts were anti-vax, while in 2018 pages with the highest number of contacts were those of supporting the scientific rationale of immunization. We are studying this phenomenon inside a project considering areas of Italy with high prevalence of no-vaxxers and hesitants.
The real inequalities
Authors: Bambra C , Reeves A 
Published: November 2019

Abstract

Background
The ‘greedy geezer’ and ‘poor elderly’ narratives both assume that the older population are homogeneous and that the experiences of older people are universal. This ignores the fact that there are significant health inequalities (i) amongst the older population and (ii) in terms of who gets to be ‘old’ (and for how long). Further, the focus on intergenerational inequality is a deliberate distraction from the far more significant health inequalities that exist in terms of gender, geography, ethnicity, socio-economic status etc across the whole population - regardless of age.

Methods
Health inequalities amongst the older population and inequalities in terms of who gets to be ‘old’ will be examined through health inequalities across the population by gender, geography, ethnicity, socio-economic status etc.

Results
Given, for example, that total intergenerational transfers incorporating private transfers are from the older to the younger, it is quite possible that if we reduce public intergenerational transfers (working age to older) then all we are doing is increasing inherited inequality.

Conclusions
Policy focused on ‘intergenerational equity’ and ‘intergenerational accounting’ will often exacerbate inequalities within generations, to the benefit of the wealthiest and the detriment of much of the population. Win-win solutions only emerge if there is a focus on addressing the many and more profound health inequalities that cross-cut generations.