bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prevalence survey of healthcare associated infections in a large teaching hospital
Authors: Castellani F , Barbato D , Angelozzi A , Isonne C , Baccolini V , Migliara G , Marzuillo C , De Vito C , De Giusti M , Villari P 
Published: November 2019

Abstract

Background
Healthcare Associated Infection (HAI) is the most frequent adverse event in healthcare settings. It is associated with an increased mortality and antimicrobial resistance, prolonged hospital stays and consistent financial loss for the healthcare systems. The objective of this study was to estimate the burden of HAIs and antimicrobial use in the Teaching Hospital Policlinico Umberto I (THPUI) of Rome to identify the most critical areas for interventions.

Methods
Data were collected according to the most recent ECDC Point Prevalence Survey protocol in November 2018. Descriptive statistics for all variables were calculated. Univariate analysis was used to assess possible associations between variables and HAIs. Variables with a significance level of p &lt; 0.25 were included in a multiple logistic regression model.

Results
A total of 799 patients were included in the analysis; of these, 13.3% presented at least one HAI. Bloodstream infection was the most common, accounting for 30.9% of the total infections. Globally, 125 microorganisms were isolated, with Enterobacteriaceae being the most frequent (32%). At the time of the survey, 49.1% patients were receiving antimicrobial therapy. The multivariate analysis showed a significant association between HAI and use of medical devices (OR = 34.30,IC95%:3.69-318.66), length of stay (OR = 1.01, IC95%:1.00-1.02) and the exposure to prophylactic antimicrobial therapy (OR = 0.23, IC95%:0.11 -0.47).

Conclusions
Our HAI prevalence was higher than the European standard (6.7%). This highlights the need of implementing targeted measures to prevent and control HAIs and a continuous monitoring to evaluate the effectiveness of such interventions. Another step could be the elaboration of a survey to investigate the knowledge, attitudes and practices of healthcare workers towards HAIs in order to raise awareness, enhance surveillance strategies and promote educational interventions.

Key messages
It was important to quantify the burden of HAIs in the THPUI in order to identify the main areas for interventions. Several activities will be implemented to contain this problem.
MenACWY vaccination decisions in the Netherlands: the role of risk perceptions
Authors: de Vries M , Claassen L , te Wierik M , Coban F , Timmermans D , Timen A 
Published: November 2019

Abstract

Background
The Netherlands experiences an unprecedented increase in meningococcal W infections. A national catch-up menACWY vaccination campaign started in October 2018, covering birth cohorts 2001-2005. To understand menACWY vaccination decisions, our study reports on perceptions of risks and their influence on menACWY vaccination intentions during an ongoing outbreak of meningococcal infections.

Methods
Online surveys were administered in September 2018 among adolescents (AD) targeted for menACWY vaccination (N = 3036) and parents (PA) of these adolescents (N = 3002). Following a mental models approach, survey items addressed knowledge and beliefs of meningococcal disease, the menACWY vaccination and vaccinations in general, and menACWY vaccination intention. Random Forest Analyses were conducted to identify those knowledge and beliefs that strongest predict vaccination intention.

Results
The response was 52.8% (N = 1603) in AD and 57.1% (N = 1784) in PA. 71% Of AD and 83% of PA indicated a positive vaccination intention. Most respondents perceived meningococcal disease as a severe disease with possible deathly consequences and were aware of transmission routes. Some misbeliefs of vaccines were rather strongly represented, with respectively 35% of AD and 45% of PA thinking that each year a number of children dies due to vaccination side effects. Preliminary results indicate that perceptions of vaccines in general, especially concerning the need for and the effectiveness, were the strongest predictors of vaccination intention in both AD and PA.

Conclusions
Adolescents and their parents seemed well informed about meningococcal disease, but less about vaccinations. The belief that vaccines are needed and effective in preventing infectious diseases seems to be of more importance in vaccination decisions than other beliefs of disease and vaccination. Future communications need to address the identified misbeliefs and emphasize the need for and effectiveness of vaccines.

Key messages
MenACWY vaccination intentions are more dependent on beliefs about vaccines in general than on beliefs about meningococcal disease and the menACWY vaccination. The belief that vaccines are needed and effective in preventing infectious diseases is of major importance in menACWY vaccination decisions.
Legionella control in a tertiary care hospital in Italy: adapting solutions to changing scenarios
Authors: Noberasco G , Battaglini A , Grammatico F , Zacconi M , Battistini A , Daturi V , De Florentis D , Borneto A , Morando A , Orsi A 
Published: November 2019

Abstract

Background
Legionella contamination of hospital water distribution system still remains a critical issue in healthcare settings, despite the disputed relationship between environmental legionella and hospital-acquired legionellosis. We report the experience of our 1200-beds hospital, where a new water safety plan (WSP) has been applied since 2017, and the results obtained with the application of different methods to control Legionella water contamination, especially in critical areas.

Methods
Policlinico San Martino is the referral tertiary acute-care university hospital in Liguria region, North-West Italy. It’s made of 21 buildings of different dimensions, 7 of which host high risk patients, according to Italian Guidelines for legionellosis prevention and control. A sampling plan for Legionella detection was implemented in 2017, focusing on the water network critical points. Different secondary disinfection procedures were used, including systemic (chlorine dioxide, monochloramine), focal (point-of-use filtration) and short-term methods (hyperchlorination), the last in case of contamination higher than 10^4 CFU/l.

Results
Respectively, during 2017 and 2018 a total of 201 and 119 hot water samples were collected, distributed among the 7 critical buildings of the hospital. Negative samples raised from 69.7% to 74.8%, while positive samples &gt;10^3 CFU/l (recommended cut-off for acute disinfection according to Italian guidelines) lowered from 21.9% to 9.2% of total samples. Out of 55 positive samples, Legionella sg 3 accounted for 98.2% of the total.

Conclusions
The new WSP determined a significant reduction of Legionella contamination of water distribution networks in our hospital critical buildings. The continuous surveillance of critical water system points provided evidence to elaborate an effective protocol for routine and extraordinary disinfection interventions, as result of a close collaboration between hospital hygiene unit and engineering and technical services.

Key messages
The implementation of an effective water safety plan and different disinfection procedures in hospital critical areas allow us to reduce and control the risk of hospital-acquired Legionella infection. Continuous surveillance cultures of drinking water to detect Legionella are necessary to adapt disinfection methods to local results.
Pediatric vaccination appointment scheduling: experience from an Italian clinic
Authors: Toscano F , Cuccaro C , Ceriale E , Mercone A , Rossi S , Nante N , Messina G , Bagnoli A 
Published: November 2019

Abstract

Issue/problem
Since 2012 pediatric vaccination coverages in Italy have been decreasing. Negative trends have been recorded especially for hexavalent and MMR vaccines. In mid-2017 the Italian government passed an act making ten vaccines compulsory. Most recent data show the act is working, however other aspects of the process should be improved.

Description of the problem
Parents are invited to bring their children to the clinic through letters or telephone calls. Vaccination appointments are scheduled during weekdays, either in the morning, the afternoon, or both. Each session is carried out by a physician and a nurse, with a new patient scheduled every ten minutes. Appointments and vaccinations are registered on the vaccine-specific electronic health record (SISPC).

Results
In March 2019, the vaccination clinic worked 21 days for a total of 29 sessions. 823 appointments were available, 797 of them (96.8%) had a patient scheduled before the session started. 547 (68.6%) attended the vaccination appointment, 98.4% of them were vaccinated (538, 67.5% of the total patients scheduled). Among those who did not attend the scheduled appointment, only 108 (43.2%) agreed to reschedule. Eventually, only 58.3% of these patients attended the rescheduled appointment. No statistically significant differences among those who attended and those who did not attend the appointment were found among the variables retrieved from SISPC: day, time, vaccination planned (type, and if mandatory or not), sex, age.

Lessons
A third of available vaccination appointments in our clinic were lost. Despite the ease through which patients can reschedule an appointment, many choose not to and left their appointments unattended. Although missing a vaccination appointment can be appropriate - e.g. when the child is sick - and great effort should be put to achieve the goal of improving coverages, policymakers should also consider provisions to discourage such behaviors for a better use of resources.

Key messages
A third of available vaccination appointments in our clinic were lost in a month. Keeping in mind the goal of improving coverages, policymakers should aim for the best possible use of resources.
Improving the operational skills of the health personnel working in the emergency departments
Authors: Arnone R , Romano G , Skinner J , Watt S , Poenicke C , Hoestergard D , Chiaramonte G 
Published: November 2019

Abstract

In December 2013 the European Commission approved the project promoted by CEFPAS, The Centre for Training and Research in Public Health within the programme PROGRESS, “Improving the operational skills of health personnel working in the emergency departments. A useful tool to give concrete answers to EU policies on patients’ safety and to create new working opportunities”.
This project aimed to combine the need to find innovative solutions in the field of healthcare with the objective of increasing the safety of patients in emergency departments, while also covering the need to promote worker mobility within the European Union. The key tool for implementing this goal is the exchange of experience and best practices.
The project partners included: the Edinburgh University of Medicine, the Napier University (again in Edinburgh), the Dresden University of Technology, the Herlev Hospital (in Copenhagen) through the DIMS or the Danish Institute for Medical Simulation at the University of Copenhagen, as well as ISMETT and CREAM (the Research Centre of the University of Medicine) in Palermo.
Every partner, during the planning, has provided the know how developed in the area of emergency. Specifically it has been analyzed the possibility to compare and visit the simulation Centres of Edinburgh, Dresden and Palermo, and to study the use, in each country, of innovative methodology during the training of the health personnel.
The partner, during the planning of the project, studied also how to help people to find easier jobs opportunities in the health sector (so they thought to create a specific data base of the emergency departments operating in Italy, Scotland and Germany where to find a job or a chance for an internship).
The project has lasted for one year and has provided research activities and the exchange of experience and best practices.

Key messages
There is a huge difference regarding the way in which the emergency system is organized within single countries around Europe. Comparing high-level organisations we have benefited in terms of ideas, projects and potential objectives to be set in order to improve our work and to improve results for patients.
Recording educational information in medical record: the experience of a Rehabilitation Hospital
Authors: Scarpis E , Poletto M , Guardini I , Londero C , Maestra M R , Tea G P , Zampa A , Lattuada L , Castriotta L , Brusaferro S 
Published: November 2019

Abstract

Issue/Problem
Healthcare organizations have the responsibility to provide education to patients and families so that they have the knowledge to participate in the care process and make decisions. Rehabilitative organizations, on account of the long hospitalization period and the specific care plans, have to organize education resources in the most effective manner, ensuring the registration of what has been done in the medical record (MR).

Description of the problem
During the accreditation process, IMFR (Medical and Physical Rehabilitation Institute - an hospital part of the Udine Healthcare Trust) launched a MR-quality program. A dedicated team of 3 doctors, 4 nurses and 4 therapists changed the way in recording educational information in MR, introducing in April 2018 a specific, independent form, part of the MR, where documenting the achievement of two educational phases: assessment and delivery. The aim of this project is to determine if the introduction of this specific educational form and its sharing process, included in the wider MR-quality program, would improve the recording behavior. Twenty MRs were quarterly analyzed from December 2017 to December 2018, assessing educational forms completeness. Significance (p &lt; 0.01) was assessed by Cochran-Armitage test for trends.

Results
The recording behavior improved significantly from 53% (21/40; Dec-17) to 88% (30/34) in June 2018, after the introduction of the specific education form and remained high also in Sept.2018 (90%, 34/38) and in Dec.2018 (82%, 31/38), with an overall trend of + 29%.

Lessons
Sharing elements in the creation of the specific educational form with a multidisciplinary approach, within a wider MR-quality program, allows to improve the recording behavior of educational information in it. Hopefully this method would help healthcare professionals and organizations to ensure the education needed to patients and families.

Key messages
A multidisciplinary approach is a good model to deal with specific aspects of quality programs. A specific form, part of the MR, allows to improve behavior in recording educational information.
Roma health mediators in Serbia – good example of multisectoral cooperation in health promotion
Authors: Kilibarda B , Vasic M , Knjeginjic V 
Published: November 2019

Abstract

Issue
Within the framework of the JA CHRODIS plus participants of the WP5 worked on identification of factors that contribute to collaboration within healthcare and between the broader health system and other sectors, as well as their enablers and barriers. In Serbia, practice that was identified and elaborated was aimed at improvement of health of Roma population.

Description of the problem
Based on available data, health indicators among Roma population in Serbia were two to three times worse than national averages. In order to tackle this issue, government of the Republic of Serbia, started with implementation of the project of education and inclusion of Roma health mediators in the health system. This project has been implemented in Serbia since 2009. Roma Health mediators (Roma ethical minority females) were trained for fast and efficient provision of support to Roma families.

Results
As a result of the project there was increased number of visits to health institutions and preventive check-ups of target population. Established cooperation between Roma health mediators and other health professionals in centers for primary health care, social care, and local self-government helped them in fulfilling their tasks, but also built capacity of other service providers to work in Roma communities. Through trainings they increase knowledge on various health, social and child care topics.

Lessons
Capacity building and inclusion of memebrs of vulnerable population into health promotion of the own to this population in terms of better acceptance of specific population population is useful to access groups as they can better understand and adapt to the needs of groups they want to reach. They should have opportunity to share their experience and lessons learned with experts involved in planning interventions for other vulberable groups.

Key messages
Building capacity of Roma mediators empowers them for integration into society beyond the scope of the Project. Lessons learned should be used for planning further actions for vulnerable groups.
Early recognition of mental health problems in Croatia
Authors: Stimac D , Pavic Simetin I , Istvanovic A 
Published: November 2019

Abstract

Issue/problem
Mental disorders account for the largest and fastest growing categories of the burden of disease in Croatia. Around 30% of the population has experienced some form of mental illness in the past year. 32% of them had more than one mental health problem. 50% of mental disorders arise by the age of 14. School medical doctors in Croatia are in the position to do early recognition of mental disorders during regular check-ups of school children. It is very important that the health care system helps people to be aware of early signs of mental health problems and enable people to get the timely treatment. According to those facts, Croatian Institute of Public Health starts the preparation for implementing screening for mental health risks of school children. The screening will be implemented by the school medical teams for all students as part of regular yearly check-ups in the 5th and 8th grade of elementary school and 1st grade of secondary school. The screening will be carried out using the YP-CORE questionnaire, which measures the degree of general mental distress. Students at increased risk will be referred to Mental Health Departments in County Public Health Institutes. Mental Health Department’s team of experts, which includes psychiatrist, nurse and psychologist, will carry out further diagnostic and treatment. Education of school staff, which includes teachers, school psychologists, special educators, social workers, nurses who are in direct contact with the children will also take place. Parents also should be educated on early recognition of mental disorders and should be recognized as partners in diagnostics and therapy throughout the child’s life.

Lessons
Early recognition of mental disorders leads to a reduction of psychological distress and increased feelings of control over one’s health.

Key messages
Early recognition of mental disorders leads to a reduction of psychological distress and increased feelings of control over one’s health. School staff and parents should be partners in earliy recognition and treatment of mental disorders of school childrens.
Verbal victimisation and mental health of sexual minority adults in France
Authors: El-Khoury F , Marr K , Melchior M , Héron M ,   Equipe Baromètre Santé 2017
Published: November 2019

Abstract

Objectives
Sexual minority individuals face minority stress, and specific discrimination and abuse that might increase their risk of having mental health problems. We examine associations between sexual orientation, experienced violence in the past year, and mental health outcomes in a representative sample of French adults aged 18 to 75 years.

Methods
Analyses were based on the “Health Barometer” (Baromètre Santé) a nationally representative, cross-sectional survey which recruited 25,198 adults in 2017. Data were weighted to be representative of the French adult population. Four mental health outcomes occurring in the preceding year or currently were examined: a) current depressive symptoms, b) having experienced a major depressive episode, c) suicidal ideation, and d) suicide attempt. We conducted mediation analysis using the counterfactual approach to evaluate the contribution that verbal violence victimisation experience in the preceding year has in the association between sexual orientation and mental health outcomes.

Results
Sexual minority adults were more likely to experience verbal violence in the last year compared to heterosexual individuals (22% vs 11.4%). They were also more likely to have experienced each of the four mental health outcomes. Verbal victimisation in the preceding was found to significantly mediate the association between sexual orientation and mental health outcome with mediated proportions varying between 15 to 22%.

Discussion
Initiatives that aim to structurally reduce stigma and victimisation against sexual minority individuals, but also improve social support and resilience, could have a significant impact on their mental health and well-being.

Key messages
Sexual minority adults are more likely to experience verbal violence, and mental health problems. Verbal victimisation partly explains the increased risk of having mental health problems among sexual minority individuals.
The EMMY Project: Promoting mental wellbeing among the oldest old – The Finnish Case
Authors: Forsman A K , Nordmyr J 
Published: November 2019

Abstract

Background
The European Welfare Models and Mental Wellbeing in Final Years of Life (EMMY, 2017-19) project covers interdisciplinary and mixed method studies on mental wellbeing among the oldest old in Finland, Italy, Norway and Spain. The overarching aim is to strengthen the understanding of how welfare models and related policies could be adapted to support mental wellbeing in the oldest old. Project results will be incorporated in a new tool for assessing the mental wellbeing impact of welfare policies.

Methods
23 focus group interviews were conducted, including 117 participants aged 80 years or older. Six of these were conducted in Finland (N = 28) and the data was analysed using qualitative content analysis. In a policy analysis, relevant national legislation, plans and programmes were identified from the four countries. Five key stakeholders in each country validated the identified policies in interviews. The policy items were systematically coded (N = 42 in Finland), focusing on their correspondence with older adults’ own views on their mental wellbeing and its protective factors.

Results
The findings highlight that although functional status undeniably plays an important role for experienced wellbeing in general, it is not the principal component of the experienced mental wellbeing among the oldest-old. The Finnish policy case pinpoints both promising policy examples, but also development needs such as the inclusion of issues related to e.g. digitalization and social challenges including loneliness.

Conclusions
These findings have significant multi-level implications, showcasing the importance of coordinated actions at societal and individual levels alike. Actions to enhance social participation, especially for individuals with reduced social networks are needed, as well as a more holistic approach in general considering the multi-dimensional nature of experienced mental wellbeing in later life.

Key messages
Results support the exchange of good policies between EU Member States to incorporate a change of focus from mental disorders to mental wellbeing among older people and its protective factors. Country-specific case studies highlight the relevance of context,pinpointing the various pathways to increased mental wellbeing that could be translated into policy.