bluuebunny/crossref_metadata_2025_split huggingface dataset:
Challenges of health workforce in the next decade in Bulgaria
Authors: Vladimirova M , Kostadinova K r , Velikova D , Tzolova G , Kamel I 
Published: October 2020

Abstract

Issue
The sustainable development of human resources is essential for the effective functioning of the health system and the quality of health services. The analysis of the human resources available in the European region proves serious problems in this area, which requires the adoption of strategic documents with measures to overcome the negative tendencies

Description
The solution of the existing and expected and future shortage of health professionals is essential to protect the health of the population globally. In this regard, the international migration of health professionals and the shortage of skilled health workforce, as well as the growing disparity between population needs, health care supply and demand, is a topical problem for health systems.

Results
The mobility and shortage of highly qualified specialists are characteristic of the top of the pyramid. There is a significant shortage in the medium and low levels of the pyramid of healthcare professionals and some non-medical majors. In both cases, there are internal and external imbalances, most often caused by increased migration to economic centers in the country or countries with a high standard of living. A severe shortage of nursing professionals -Bulgaria has the second-lowest ratio of nurses to population and the lowest nurse to physician ratio among all member states. (1:1,2 compared to 1:2,3). The emigration of young doctors and nurses and the ageing of all health professionals - especially well pronounced with nurses and general practitioners - is a threat to the health system.

Lessons
The research of Human Resources in Healthcare is necessary to diagnose the managerial, financial and socioeconomic problems that arise in their formation and development. A key point - changing the system of postgraduate training. The regulatory standards and limits introduced in outpatient and hospital care and the specialization system do not help to link the incomes of medical staff to the quantity and quality of work.

Key messages
By the number of medical specialists, Bulgaria still holds positions well above the EU average. However, the age structure of workers implies increasing deficits in the future. Bulgaria should invest and support investments in the development of human capital in the health care system.
Who manages health workforce in the States of India: Profile, knowledge and perceptions of the team
Authors: Khurana S , Roy S , Gupta M 
Published: October 2020

Abstract

Problem
Human resources in the public health sector is of prime importance in a limited resource setting country, who at times work in a high-pressure, limited resource environment and where skilled staff continue to remain in short supply. The role of Human Resource for Health (HRH) team responsible for managing this health workforce is crucial. They play an important role in improving the human resource practices and creating an enabling organizational culture for optimal resource utilization. The paper explores the profile of the HRH teams of the states of India, their knowledge levels, and perceptions of their role.

Methods
The participants were HR Managers from 29 states of India who look after HRH in National Health Mission and State Health Departments. Cross-sectional survey tool was used for data collection. Quantitative data analysis included univariate and bivariate analysis. One Way ANOVA test of significance and post-hoc tests using Tukey's method was used to ascertain the groups with significant difference.

Results
Most of the HRH team members are postgraduates or have management background. Their experience varies from &lt;1year to &gt; 25 years. Mostly of them perceive their role to be limited to implementing bare essential HRM practices, mostly administrative. The educational qualification of the members did not have any significant bearing on their technical knowledge related to HRM practices; but their experience in public health sector showed a significant association.

Lessons
This study lends evidence to the principle that professionals who have been in the system for long, know about HRH and the associated policies better, and hence may be better equipped to handle HRH and establish good HR Management (HRM) systems. Better role clarity among the HRH teams, expansion of their current scope of work to include advanced practices of HRM and continuous capacity building mechanisms are needed to help strengthen the development and management of HRH.

Key messages
This study, a first of its kind in the country, lend evidence related to the principle for deciding the profile of team who should be entrusted with managing and development of HRH. The Study gives evidence to focus on the role clarity of HRH to zero down their knowledge and skills gaps and enhance their competencies through better capacity building.
GH:ADT Project: developing a framework of Global Health concepts and a learning objectives catalogue
Authors: Stratil J , Rehfuess E A , Geffert K 
Published: October 2020

Abstract

Background
Global Health (GH) is receiving increasing attention, in Germany, Europe and internationally. Despite an increased demand, teaching on GH remains fragmented and heterogeneous in the university landscape in German-speaking countries. Moreover, there is a lack of common understanding of GH and interpretations range from GH as tropical medicine to GH as everything related to health. This project aims to develop (A) a framework of different GH concepts, as a basis for (B) a set of GH learning objectives for German-speaking countries.

Methods
A review of publications providing GH definitions was carried out. Following a concept analysis approach, we developed a general framework of different and partially overlapping GH understandings. Building on these results we conducted an overview of reviews on learning objectives and curricula for GH to develop a set of learning objectives.

Results
The general framework distinguishes between GH concepts describing GH as (1)a set of global health issues (e.g. COVID-19), (2) a global ideal to strive for, (3 + 4) any activities relating to said global health issues or ideals (e.g. all activities contributing to health equity), and (5) sets of activities meeting various characteristics (e.g. being transdisciplinary and transnational). Within each concept, multiple sets of axes allow a more granular distinction of the concepts (e.g. regarding the relation to public health and tropical medicine). The list of key learning objectives shows considerable overlap with widely accepted public health core competencies. Differences include e.g. a (stronger) emphasis on intercultural and interdisciplinary collaboration, globalisation and transnational determinants of health.

Conclusions
A systematic reflection on commonalities and differences in the understanding of GH is important for a shared understanding. Based on the GH learning objectives we will develop core competencies for GH, including through an online survey of GH experts.

Key messages
The GH:ADT framework of global health concepts supports a systematic reflection on and recognition of the multi-dimensional nature of Global Health. The learning objectives identified in the GH:ADT project can be a valuable tool for curriculum development.
Emerging cross-disciplinary profiles: The Geomatic Epidemiologist
Authors: Recchioni M , Castello V , Del Vecchio S , Ciaccio V , Donia A M , Fabiani L 
Published: October 2020

Abstract

Issue
Geographic information systems (GIS) and remote sensing technologies are increasingly used in Public Health epidemiology, showing a great potential in anticipating and responding to actual and future challenges for the public health system and in improving health services' excellence. According to the evidences collected within a wide meta-research carried on of relevant literature (”GIS geographic information system” and “GIS geographic information system and training” on Pubmed; “epidemiologist use of GIS and training” and “epidemiologist use of gis” on Google Scholar),GIS and new sensing technologies are mostly used to: map air and water pollution, map diseases prevalence, predict infection diseases and vector-spread diseases in big areas, study health service coverage and preparedness in emergencies, map cities and study urban health, study climate changes for decision making.

Description of the Problem
Specific skills and training are required to address the use of GIS and new sensing technologies.The specific aim of our study is to identify the professional profile of a new figure, called 'Geomatic Epidemiologist' and to define its professional and educational standards, as well as the relevant training programs.

Results
Data collection and analysis of INAPP and ESCO databases about existing professional profiles (starting from 2016) has allowed drafting a first qualification schema and profile. The profile has been defined according to the 4C model (elaborated by Univaq) distinguishing between Hard Skills (technical knowledge and skills),Soft Skills (cognitive, individual and social) and interpersonal behaviors.

Conclusions
Profile will be validated with relevant stakeholders and Public Health professionals in order to deepen the understanding of the main competences required to study health issues with GIS and related technologies; to this extent, a questionnaire has been elaborated to evaluate relevance, frequency and complexity of each component of the profile

Key messages
Developing cross-disciplinary profiles, (i.e. the Geomatic Epidemiologist) integrating clusters of competences (holistic approach). Public health research challenges and excellence.
Do long-term care services meet the minimal requirements for the elderly?
Authors: Gomes F A , Lopes D G , Cunha I , Duarte S , Pereira M B , Moreira A , Gil M M , Esteves H 
Published: October 2020

Abstract

Background
As the percentage of elderly people (aged over 65) is expected to rise, from 16.0% of the population in 2010 to 29.3% in 2060 in Europe, a quality long-term care system is of increasing priority for governments. The aim of this study is to analyse long-term care services (LTCS) in the geographical area of the group of primary healthcare centres of Loures-Odivelas.

Methods
A retrospective, observational, descriptive study comprising data from public health inspections to LTCS between 2015 and 2019. Variables included were the number of residents, nurses, orderly, cooks, kitchen helpers and medical doctors; licensing status, public health inspection results and the presence of air conditioning. Descriptive analysis was performed for all variables.

Results
Between 2015 and 2019, a total of 200 public health inspections were carried out in 106 LTCS. Only 41 (38.7%) LTCS were licensed. The total number of residents was 2,803, 168 (6.0%) of which were bedridden. Concerning the staff ratio, 79 (74.5%) LTCS fulfilled the ratio of nurse to resident of 1:40 and 67 (63.2%) the ratio of orderly to resident of 1:8. On the first inspection, 11 LTCS (10.4%) complied with the minimal requirements for health care, hygiene, food preparation and facilities conditions. After the implementation of corrective measures proposed by the Public Health Unit, the number of LTCS which had complied for the same criteria was 64 (60.4%).

Conclusions
Society needs to adapt to a growing ageing population. LCTS, while part of the solution, still have deficiencies. In this sample, the majority were illegal and lacked the appropriate conditions. Public Health interventions can contribute to improving these services.

Key messages
In an ageing society, long-term care services are essential but the majority lack the appropriate conditions. Public Health intervention is crucial in implementing corrective measures that will result in better conditions for the elderly.
Antibiotic consumption and healthcare associated infection in a third level Italian hospital
Authors: Gori F , Vonci N , Tinturini A , Basagni C , Messina G , De Marco F 
Published: October 2020

Abstract

Background
The extended length of stay (LoS) is one of the main causes of hospital infections (HAI), followed by an increase in antibiotics consumption. The final step is the development of multiresistant microorganisms, with a consequent increase in costs for the national healthcare system. Aim of this study is to evaluate the prevalence of HAI and to analyze ATB consumption in a teaching hospital

Methods
Between 17-21 June 2019 the infection control team collected the clinical records of 425 patients to perform a point of prevalence analysis (PPA). Eligible patients were hospitalized in surgical and medical wards of the teaching Hospital (615 beds) in Siena, Italy. For each patients according to guidelines of European Centers for Disease Control and Prevention (ECDC 4.2) we searched for evidence of HAI and for all indication of ATB consumption. Data were processed using Stata12

Results
Overall 425 patients have been analyzed (48.24% female), mean age was 60.88 (SD 26.11) years, mean LoS 8.37 (min 1 max 86) days. Patients were admitted mostly in General Medicine wards (48.94%); 34% underwent surgery. 63.8% of patients had Peripheral Venous Catheter, 20% Central Venous Catheter and 31.06% Urinary Catheter. Twenty-nine HAI were discovered (PPA 6.82%); the higher prevalence (19.23%) was in Intensive Care Unit. LoS (OR:1.07;IC95%1.04-1.1) and devices (OR:2.17;IC95%1.39-3.37) were the two variables that significantly influenced the infection risk. Forty-six percent of all patients received ATB, the most used were third generation Cephalosporines (26,18%), followed by Penicillines (24,73%). The main use was to treat community infections (62.12%), followed by medical prophylaxis (30.81%)

Conclusions
PPA of HAI was 6.82%, comparable to 2017 national PPA (6.5%); prolonged LoS is probably the main cause of this result. Our analysis showed that ATB consumption was quite high, in agreement with the Italian prevalence (44.9%), but the percentage of medical prophylaxis was still high.

Key messages
The way to achieve the health care infection control is still long, the length of the hospitalization could be a field to be improved. High consumption of antibiotics for prophylaxis is still the main point to fight in the battle against the multiresistant microorganisms.
Surveillance and control of M. chimaera infections in the Tuscany Region, Italy
Authors: Casini B , Tuvo B , Totaro M , Baggiani A , Privitera G 
Published: October 2020

Abstract

Background
Disseminated M. chimaera infections among patients who underwent open-chest surgery with cardiopulmonary bypass have been associated with the contamination of heater-cooler devices (HCDs). The Tuscany region in the Decree 3822/2019 issued recommendations for the surveillance and control of M. chimaera infections.

Methods
In three Tuscan cardiac surgery centers, the case finding was carried out through evaluation and testing of patients with a history of HCD exposure (past 6 years) was performed. Water and aerosol samples were analyzed from each HCDs to determine the microbiological parameters required by the Directive 98/83/CE and to assess the presence of non-tuberculous mycobacteria (NTMs), according to the regional protocol.

Results
M. chimaera infection was not found in any patient and all clinical specimens tested negative. 22 HCDs were sampled (n.12 LivaNova, n.1 Terumo and n.9 Maquet) for a total of 114 samples (45, 8, 2 and 59 respectively). All the microbiological parameters were compliant, excepted for total microbial count at 36 °C that exceeded 100 CFU/ml in 50% (57/114) of samples and for the presence of P.aeruginosa in 10% (12/114). NTMs were detected in 16% (18/114) of HCDs: M. chimaera was identified in 11% (13/114) of samples and in 4% (5/114) M. gordonae. All aerosol samples were negative for NTMs, but in the HCDs Maquet, B.cereus were detected in 7% (4/59) of the samples, K.oxytoca in 2% (1/59), B.ursincola in 2% (1/59) and S. paucimobilis in 3% (2/59). Only S. paucimobilis was isolated also in the same HCD water sample.

Conclusions
The implementation of maintenance and disinfection procedures of HCDs was able to reduce the risk of contamination and aerosolization by NTMs but not of other microorganisms.

Key messages
Further strategies should be put in place for the cases finding. Moreover, reliable decontamination and identification of agents that can disrupt biofilms and increase chlorine susceptibility of mycobacteria are required.
Know your enemy, fight the outbreak: an Italian experience
Authors: Cuccaro C , Tarroni M , Tinturini A , Cresti S , Basagni C , Nante N , Messina G , De Marco F M 
Published: October 2020

Abstract

Issue
The New Delhi-Enterobateriaceae producing metallo-beta-lactamase NDM, resistant to carbapenems, are responsible of hospital outbreaks. The European Centre for disease prevention and control has published a report about the NDM outbreaks in Italy. Knowledge and application of all types of precautions is necessary to obtain adequate control.

Description
Between June and August 2019 an outbreak of Klebsiella pneumoniae producing NDM-1 occurred in an acute cardiac surgery setting from medium to high intensity, in a third level-hospital in Italy. Every patient with at least one positive typing test for NDM in clinical specimens was defined as a case. The infection control team sought patient 0, reviewed patients' daily records and created a timeline to control movements, verifying risk factors and time to positivity. The correct application of isolation and standard precautions was assessed. Auditing and training sessions were carried out. Our aim is to verify if these actions sufficed to control and halt the outbreak.

Results
Fourteen cases were identified, mean age=66.28 (SD = 13.55), 71.43% of them had a previous negative test. Positivity was found in samples from 13 rectal swabs (prevalence 12.38%), 7 lung aspirates, 3 urine cultures, 2 blood cultures and 2 wound swabs. Eight patients were positive in multiple body districts, 5 have been admitted to the same hospital within the year before, 3 came from other hospitals. The patient 0 has been moved in from a medical ward. After auditing, a training class was given to healthcare staff. The class concerned NDM phenotype, hand hygiene, isolation and personal protective equipment, with further observation in wards. In the following three months no new cases were registered.

Lessons
A continuous high-level adherence to standard precautions and hand hygiene by healthcare staff should be supported by adequate training. This is confirmed to be a strong action to prevent or stop cross-contamination.

Key messages
Colonization of multiresistant germs in healthcare due to cross-contamination has to be tackled promptly. Auditing and training actions should be taken into serious account in order to ensure an effective reaction from healthcare staff.
Simulated operating room aerodynamics to improve air quality and prevent surgical site infections
Authors: Messina G , Spataro G , Tarroni M , Cevenini G 
Published: October 2020

Abstract

Background
Proper operating room (OR) ventilation and air filtration are important measures to prevent infection of the surgical site and consequently reduce hospital stay and healthcare costs. In order to identify how changes in the air system can affect air quality, tailor-made researches need to be conducted in ORs. The aim of the study is to verify how a mobile air filtration system can affect the air quality of ORs when placed in different positions.

Methods
This is a descriptive study conducted during April and May 2018 in the University Hospital of Siena, Italy. We measured air flows through the vents of both the OR air system and a mobile novel air system unit, which includes a patented crystalline ultraviolet C reactor and an HEPA filter. Using a CAD 3D simulation software (SolidWorks 2017) the air flows interactions were simulated in the replicated OR.

Results
The device influenced the original airflows generated by the integrated OR ventilation system. Simulations have shown that when the device is positioned close to the wall with its intake beside the entrance and its outlet towards the operating table, air from outside can enter the room because the air intake from the device prevails over the internal pressure of the OR, increasing contamination. If the device is placed near the OR centre with its suction towards the operating table and its outlet towards the OR entrance, if the door is opened, airflows towards the outside of the room prevail, improving ability to retain outgoing contaminants.

Conclusions
The different positioning of mobile devices that generate clean air flows within ORs can have a significant impact on aerodynamics, which can turn can affect critical aspects of the surgical outcome. In order to achieve an effective device placement and orientation, OR-specific environmental measurements should be carried out.

Key messages
Movable devices may help boosting the performance of air systems in operating rooms. Every operating room needs a speciﬁc study in order to obtain the best proﬁt.
Results of screening for emergent highly resistant bacteria in Tunisian intensive care units
Authors: Ben Rejeb M , Ben Cheikh A , Bhiri S , Ghali H , Kahloul M , Khefacha-Aissa S , Hmouda H , Bouallegue O , Said-Latiri H 
Published: October 2020

Abstract

Background
The infections caused by emergent highly resistant bacteria (eHBR) that develop in intensive care units (ICUs) may result in significant patient illnesses and deaths, extend the duration of hospital stays and generate added costs. Facing this problem, the screening that emphasizes early identification of colonized patients, reduces the prevalence and incidence of infection, improves patient outcomes and reduces healthcare costs. In this context, we have implemented a screening for eHBR in ICUs of Sahloul university hospital of Sousse (Tunisia), which we report in this study the first six-months outcomes.

Methods
Rectal swab cultures were collected to detect Vancomycin resistant enterococcus (VRE) and Carbapenemase producing Enterobacteriaceae (CPE) among patients admitted in six ICUs of Sahloul university hospital of Sousse (Tunisia) and more than three times, at least one week apart, between 1 June and 31 December 2018.

Results
During the study period 174 patients were screened. Of them, 69.5% were male and 73.6% were admitted in surgical ICU. In total, 161 and 152 samples were realized respectively for the detection of CPE and VRE. These samples were positive in 15% and 8.5% respectively for CPE and VRE. Klebsiella pneumoniae OXA 48 was the most isolated CPE (80%).

Conclusions
Our screening program helped us in infection control by early identification of patients, thereby facilitating an informed decision about infection prevention interventions. Moreover, these results encouraged us to improve and generalize this program throughout the hospital.

Key messages
eHRB screening becomes an important axis in the prevention of eHRB infections in our facilities. eHRB screening allows the reinforcement of the basic infection prevention and control measures.