bluuebunny/crossref_metadata_2025_split huggingface dataset:
Sara Alert: An enduring national resource to support public health monitoring & disease containment
Authors: Feldman K , Butler M , Hay K , Holmes A , Krautscheid P , Nosal M , Scannell D , Sleeper H , Stoutenburg S , Jarris P 
Published: October 2020

Abstract

Background
Public health agencies had to respond swiftly to the novel coronavirus that emerged in 2019 (COVID-19) to try to contain the virus, which requires early identification of new cases. Monitoring exposed individuals is labor intensive and available tools are often limited. MITRE, a company that operates federally funded research and development centers for the U.S. government, rapidly developed a configurable monitoring tool that allows public health authorities to monitor potentially exposed individuals in their jurisdictions.

Methods
A team, including public health leaders, field epidemiologists, software engineers, and health communication specialists, was quickly assembled to design and develop an open source, disease-independent monitoring tool called Sara Alert. Outreach to key public health stakeholders, including partner organizations and local and state health departments, was conducted early for requirements gathering and to validate assumptions. Public health law experts were consulted regarding data privacy and security.

Results
By four weeks, a minimally viable monitoring tool was available for testing by public health partners. Exposed individuals can be enrolled and reminded daily to enter a temperature and any symptoms by web or mobile interface, SMS messaging or phone. Public health officials monitor and can quickly take action if symptoms consistent with COVID-19 are reported of if there is failure to report within a configurable time frame. Dashboards provide insight into aggregated data appropriate to level of view.

Conclusions
Sara Alert serves as a force multiplier that supports disease containment and allows resources to be directed where they are most needed. Successful development was possible because key stakeholders across public health practice were consulted early. Sara Alert is available, free, to state and local public health departments and serves as an enduring resource easily configured for the next public health emergency.

Key messages
Sara Alert serves as a force multiplier that supports disease containment and allows resources to be directed where they are most needed. Sara Alert serves as an enduring resource easily configured for the next public health emergency.
Effect of area-level factors on heat-associated morbidity and mortality in the Eastern Townships
Authors: Vandal G , Garant M , Cossette B , Pinsonneault L 
Published: October 2020

Abstract

Background
Multiple individual risk factors for morbidity and mortality during heat waves have previously been identified. Based on these, five categories of area-level indicators are used in Quebec, Canada, to identify geographical regions with presumed increased vulnerability: economic, social and biological vulnerability, housing characteristics and urban environment. However, we do not know which indicators correlate with an increase in morbidity and mortality during heat waves. This study evaluated, among 13 different area-level vulnerability factors from these five categories, which ones predict an effect modification of hot temperatures on morbidity and mortality.

Methods
For 2008 to 2018, we first explored the association between average daily temperature and four daily health indicators for the Eastern Townships region in Quebec: all-cause ambulance transports, all-cause emergency department (ED) visits, all-cause mortality and heat-related hospitalizations. We then used Poisson regression linear mixed models to investigate effect modification from the 13 area-level risk factors.

Results
Three vulnerability factors significantly caused positive effect modification between temperature and daily all-cause ambulance counts: the chronic diseases index, the percentage of people aged 65 years or older and the percentage of people aged 65 or older and living alone. For heat-related hospitalizations, four factors caused positive effect modification: the same three as for ambulance counts, plus the proportion of people that spend 30% or more household income on rent. For the ED-temperature association, only the percentage of people with low income caused positive effect modification. There was no significant association between temperature and daily mortality.

Conclusions
This study will help public health officials target preventive interventions to areas with the vulnerability factors that most strongly predict heat-related morbidity.

Key messages
Some, but not all, individual risk factors are useful at the area-level to predict areas with the strongest increases in morbidity associated with hot temperatures. The chronic diseases index and the percentage of people 65 and older living alone both accentuated the association between hot temperatures and ambulance transports or hospitalizations.
8.G. Workshop: Public health systems leadership and capacity building in changing Times
Authors:   Organised by: UK Faculty of Public Health,   Chair persons: Maggie Rae - UK
Published: October 2020

Abstract

Objectives
There is clear need for a diverse public health work force with the training, skills and expertise to provide leadership across health systems. The purpose of the proposed workshop is to share experience and learning on system leadership and capacity building in public health, using the work of the UK Faculty of Public Health as a case study.
The workshop will cover: the nature, key role and the distinguishing features of system leadership in public health;capacity building through competency-based training, adaptive public health curriculum, systematic educational and training activities; and development of multidisciplinary workforce;generation and transfer of knowledge; andthe case for value-driven workforce, systems and leadership.
The Faculty of Public Health is the UK's professional standards body for public health specialists and practitioners, with over 4000 members working around the world. As the professional membership body for public health it has played a leading role in education, training, and assuring an internationally respected public health workforce and development of robust public health systems; promoted public health knowledge; and been powerful advocate for the reduction of inequalities and the very best conditions for health and wellbeing to flourish.
The roundtable workshop will include experienced senior public health practitioners, academics, and leaders who will briefly present from their different perspectives. This will include consideration of the historical perspective and conceptual frameworks around system leadership; the journey towards development of multidisciplinary workforce and recognition of the diversity of the wider workforce; evolution of public health curriculum and education and training activities; knowledge transfer in leadership, advocacy and analysis; and why ethics matters and what can be done about them.
There will be opportunity for reflection and discussion with participants and the panel on system leadership and capacity building, including on the merits and risks of different approaches and implications for policy research and practice.

Key messages
System leadership and capacity building need to be adaptive and shaped by the needs of the times and based on moral mandate of public health. Development of multidisciplinary workforce; effective generation and transfer of knowledge; and value-driven workforce, systems and leadership are key to improving and protecting the public’s health.
Patient-centered approaches applied in inpatient and outpatient TB services in Armenia
Authors: Grigoryan Z , Truzyan N , Petrosyan V 
Published: October 2020

Abstract

Background
Healthcare system performance indicators are common instruments measuring and facilitating quality improvement. The End-TB strategy urges provision of integrated patient-centered (PC) care for all forms of tuberculosis (TB). This study aimed to assess and compare quality of inpatient and outpatient TB services using international standards on specific PC indicators to identify potential targets for improvement.

Methods
Joint Commission International (JCI) accreditation standards, adapted to local needs and context, were used as a basic instrument for qualitative and quantitative data collection. We utilized Patient and Family Right (PFR) and Patient and Family Education (PFE) 15 standards with 49 measurable elements as PC indicators for the nationwide assessment of TB services. A scoring system and a scaling approach were used to convert all-source-data and present the overall performance of services.

Results
We reviewed and analyzed data from 10 legal documents, 34 medical records and 155 interviews and focus group discussions with TB healthcare providers, patients and family members from inpatient and outpatient TB services to define the degree of compliance of their practices and treatment experiences to JCI standards. Outpatient TB services met the PFR and PFE standards at the 51%-level receiving a grading of partially performed and requiring improvements. The inpatient services met the PFR and PFE standards at 39%- and 26%-level respectively, receiving a grading of minimally performed for the JCI standards, showing statistically significantly less patient centeredness compared to the outpatient services (p = 0.007, CI 0.234; 0.4234), and requiring major improvements.

Conclusions
Strengthening interventions towards patient-centeredness are essential in both inpatient and outpatient services, but Armenia needs to put more emphasis on inpatient care to bridge the gap between the existing and recommended practices.
The Netherlands
Authors: Rinaldi C , Bekker M 
Published: October 2020

Abstract

Background
While the literature on the relationship between populist radical right (PRR) parties and public health is still relatively scarce, early evidence suggests that PRR parties and their exclusionary policy agenda could be a threat to population health and health equity. The aim of this case study is to take a closer look at the standpoints and influence of the Dutch Party for Freedom (PVV) on national health and healthcare policies. The PVV is considered the main PRR party in the Netherlands and has been part of the 2010-2012 center-right coalition government.

Methods
This case study was informed by various information sources including academic literature, publicly available data, party manifestos and other statements issued by the PVV, coalition agreements, newspaper articles and interviews.

Results
Two key characteristics of PRR parties can be identified in relation to the PVV's standpoints on health and healthcare: authoritarianism (believing in the value of obeying and valuing authority) and nativism (believing that there is an ethnically united people with a territory). This is, for example, exemplified through strong support for the expansion of home and elderly care, while simultaneously opposing free, non-acute healthcare for refugees and asylum seekers who have not (yet) financially contributed to the healthcare system.

Conclusions
Health and healthcare are generally not priority issues for the PVV, whose political agenda tends to focus on immigration and law and order. While the party takes a leftist position on some aspects of the healthcare system, a nativist rhetoric remains present.
Management of Emergency Services in Lombardy during COVID-19 epidemic using Business Intelligence
Authors: Sechi G M , Migliori M , Dassi G , Pagliosa A , Bonora R , Oradini-Alacreu A , Odone A , Signorelli C , Zoli A 
Published: October 2020

Abstract

Background
In Italy on the 20th of February, the first Italian patient was tested positive for Coronavirus Disease 2019 (COVID-19) in the Lombardy region. The Regional Emergency Medical Services (EMS) Trust (Azienda Regionale Emergenza Urgenza, AREU) of the Lombardy region decided to apply a Business Intelligence (BI) System to take timely decisions on the management of EMS and to monitor the spread of the disease in the region in order to better respond to the outbreak.

Methods
Since the beginning of the COVID-19 outbreak, AREU developed a BI System to track the daily number of first aid requests received from 1.1.2. (Public Safety Answering Point 1). BI evaluates the number of requests that have been classified as respiratory and/or infectious episodes during the telephone dispatch interview. Moreover, BI analyses the pattern of the epidemic, identifying the numerical trend of episodes in each municipality (increasing, stable, decreasing). Currently, AREU is still implementing the BI as the epidemic is still ongoing.

Results
In the Lombardy region on the 20th of February the number of the first aid requests for respiratory and/or infectious episodes were 314. This figure increased sharply during the month of February and March reaching its peak on the 16th of March with 1537 episodes. In the area around Bergamo, this number experienced a greater rise compared to the rest of the Lombardy territory, going from 74 episodes on the 20th of February to 694 on the 13th of March. Therefore, AREU decided to reallocate in the territory the resources (ambulances and human resources) based on the real-time data elaborated by the BI system.

Conclusions
The BI System has been of paramount importance in taking timely decisions on the management of EMS during the COVID-19 outbreak in the Lombardy region. Indeed, BI can be usefully applied to promptly identify the trend of the COVID-19 epidemic and, consequently, make informed decisions to improve the response to the outbreak.

Key messages
The Emergency Medical Services Trust of the Lombardy region applied a Business Intelligence System to promptly respond to the outbreak of COVID-19 and reallocate the resources based on real-time data. AREU used a Business Intelligence System to track the daily number of first aid requests that have been classified as respiratory and/or infectious episodes during the telephone dispatch interview.
Time trend (2008-2016) of food consumption based on the degree of food processing in United Kingdom
Authors: Madruga M F , Martínez Steele E , Levy R B , Rauber F 
Published: October 2020

Abstract

Background
Ultra-processed foods have been rapidly displacing traditional dietary patterns based on unprocessed and minimally processed foods. We assessed the time trend of food consumption based on the degree and purpose of food processing in United Kingdom from 2008 to 2016.

Methods
Cross-sectional data from the National Diet and Nutrition Survey were analysed. Food items collected using a 4-day food diary were classified according to the NOVA system. Linear regression models were used to estimate linear trend of food consumption across years, adjusted for sex, social class occupation, age and region.

Results
From the 2008 to 2016, the dietary contribution of processed culinary ingredients increased from 4.1% to 4.8% (p for trend&lt;0.001), while the contribution of processed foods decreased from 9.5% to 8.4% (p for trend=0.001), respectively. The contribution of unprocessed or minimally processed foods (from 30.4% in 2008 to 30.2% in 2016; p for trend=0.462) and ultra-processed foods (from 56.0% to 56.6%, respectively; p for trend=0.194) across survey years has not appreciably changed. Regarding the subgroups, butter and plain oil (Processed culinary ingredients) increased over time, while beer, food preserved and bread (processed food) decreased. Among ultra-processed foods, pre-prepared meals, biscuits and industrial desserts increased, while reconstituted meat and margarine decreased. Among unprocessed or minimally processed foods, poultry, cereals, eggs and legumes increased, while roots, red meat and fresh fruit juice decreased.

Conclusions
We observed substantial changes in the consumption of processed food and processed culinary ingredients over time. The consumption of ultra-processed food remained unchanged over time, and still account for more than half of total calorie intake in UK. Despite this, substantial changes in some subgroups including ultra-processed, were observed for the four NOVA groups.

Funding
CAPES and FAPESP 2016/14302-7.

Key messages
The consumption of ultra-processed food remained unchanged over time, and still account for more than half of total calorie intake in UK. Actions to mitigate high consumption ultra-processed foods are necessary given that these foods have been strongly associated with obesity and diet-related chronic diseases.
Consumption of ultra-processed foods on free sugar intake of Portuguese infants: The Upper Project
Authors: Costa de Miranda R , Rauber F , Moraes M , Torres D , Lopes C , Rodrigues S , Bertazzi Levy R 
Published: October 2020

Abstract

Background
The dietary share of ultra-processed foods (UPF) has been associated with low diet quality, including high content of free sugar, mainly in adults' populations. We aim to assess the influence of UPF consumption on free sugar intake of Portuguese infants.

Methods
Cross-sectional representative study including 573 infants (6-23 months old) who participated in the 2015-2016 National Food, Nutrition and Physical Activity Survey. Dietary intake was collected by two non-consecutive food diaries (time interval 8-15 days). Food items were classified according food processing degree by the NOVA system. Total energy intake and percentage provided by each NOVA food groups as well as the free sugar content of the overall diet were assessed. Mean free sugar intake was evaluated across quintiles (Q) of UPF consumption by linear regression adjusted for socioeconomic covariates.

Results
Mean energy intake was 935 kcal/day, in which 49.1% was derived from unprocessed/minimally processed foods, 7.2% from processed culinary ingredients, 7.0% from processed foods and 36.6% from UPF. The mean dietary share of UPF ranged from 12.5% (Q1) to 65.5% (Q5) of total energy. Within UPF, infant formulas (19.3%), milk-based drinks (6.7%) and sweet snacks (4.8%) contributed the most to energy intake. Mean free sugar intake in the overall diet accounted for 8.1% of total energy intake, in which 92.5% came from UPF. As the UPF consumption increased, the dietary content of free sugar increased significantly (β = 0.77; p &lt; 0.001). Contribution of free sugar in total energy intake raised from 2.9% to 12.7%, representing an increment of 338% from the lower to the upper quintile of the dietary share of UPF.

Conclusions
Portuguese infants had an important intake of free sugar. Nearly all of this intake came from UPF, which calls for public health efforts to avoid UPF consumption by this population group.

Funding
FAPESP 2018/07391-9, 2019/05972-7 (MCR), 2016/14302-7 (FR); POCI-01-0145-FEDER-032090.

Key messages
Ultra-processed foods contributed with 36.6% of total energy intake and 92.5% of free sugar in the diets of Portuguese infants. As the ultra-processed foods consumption increased, the dietary content of free sugar increased significantly from 2.9% (Q1) to 12.7% (Q5), representing an increment of 338%.
Clinical coordination across care levels according to medical specialty in the Catalan health system
Authors: Campaz D , Esteve-Matalí L , Vargas I , Sitjas E , Plaja P , Sanchez E , Ramon I , Medarde E , Vázquez M L 
Published: October 2020

Abstract

Background
In primary care-based national health systems, cross-level clinical coordination is a priority, as it contributes to quality of care and efficiency. Studies show that clinical coordination may vary depending on doctoŕs specialty. The study's aim was to determine the differences in experience and perception of clinical coordination and their related factors according to the doctor's specialty in the Catalan health system

Methods
Cross-sectional study, based on an on-line survey applying the COORDENA-CAT questionnaire to 1666 secondary care doctors. Descriptive and multivariate analysis were used to compare five groups of specialties (potentially decentralised, hospital-based, internal-medicine/geriatrics, gynaecology, and paediatrics), for experience, perception and factors related to clinical coordination.

Results
Clinical coordination experience was relatively high in all groups, with differences when comparing with decentralised specialties; hospital-based specialties and internal medicine/geriatrics presented lower care consistency and follow up across levels, while gynaecology and paediatrics showed higher accessibility. General perception of coordination was low, being worse in hospital-based specialties (PR:0.80,95%CI0.72-0.89) and better in gynaecology (PR:1.36,95%CI1.18-1.56). Moreover, hospital-based specialties reported lower use of coordination mechanisms and less interaction with doctors from the other level (PR:0.42,95%CI0.23-0.72), than gynaecology (PR:2.04, 95%CI1.22-3.45).

Conclusions
Doctors' experience and perception of clinical coordination was lower among hospital-based specialties and internal medicine/geriatrics and higher in gynaecology and paediatrics. These differences may be explained by complexity, coordination needs, level of specialty decentralisation or related factors. Further research is needed to understand such differences and consider the coordination needs of each specialty to improve cross-level clinical coordination.

Key messages
Differences between specialities might be explain by the complexity, level of specialty decentralisation or factors related to clinical coordination. Clinical coordination needs of each specialty should be deeply explored to improve cross-level clinical coordination.
Scaling-up Packages of Interventions for cardiovascular disease prevention in Europe and Sub-Saharan Africa (SPICES) - implementation evaluation at operational level
Authors: Bastiaens H 
Published: October 2020

Abstract
SPICES focuses on the primary prevention of CVDs in vulnerable populations in Europe and Sub-Saharan Africa by raising awareness regarding CVD and its risk factors and by supporting lifestyle behaviour change in primary care and community settings. It is an implementation project employing a mixed methods evaluation approach. The RE-AIM QuEST and CFIR frameworks are used to guide the evaluation of impact on lifestyle and actual CVD risk and describe implementation barriers and explain how implementation context may influence translation to different settings. The presentation will focus on how these frameworks were used in practice and across settings.
The Scale-Up of Diabetes and Hypertension Care (SCUBY) - large-scale evaluation using routine health information systems
Authors: Buffel V 
Published: October 2020

Abstract
The SCUBY project aims to (1) change the organization of primary health care for diabetes and hypertension in order to (2) improve the outcome of chronic care in three countries (Belgium-Slovenia-Cambodia). These two aims require two types of data, namely data on the organization of care and data on the chronic illness outcomes. It can however be challenging to (1) gather all these data (from various sources) on both the organization and outcomes and (2) create cross-culturally valid datasets. The presentation will present the strategy of SCUBY to gather data and discuss the issues of cross-cultural validity.