bluuebunny/crossref_metadata_2025_split huggingface dataset:
Klebsiella pneumoniae acquisition in ICUs: patient-based and laboratory-based surveillance
Authors: Barchitta M , Maugeri A , La Mastra C , La Rosa MC , Sessa L , Favara G , Magnano R , Lio S a n , Mattaliano A R , Agodi A ,   Study Group
Published: October 2020

Abstract
Klebsiella pneumoniae - and especially multidrug-resistant K. pneumoniae - represents a global threat for Public Health, due to its high dissemination in Intensive Care Units (ICUs) and its association with mortality. Here, we investigated the molecular epidemiology of multidrug-resistant K. pneumoniae strains in ICUs from Catania, Italy.
We used data and samples from the Italian Nosocomial Infections Surveillance in ICUs - SPIN-UTI project, which has been surveying the epidemiology and the risk of Healthcare-associated infections (HAIs) in Italian ICUs. The SPIN-UTI network adopted the ECDC protocols for patient-based HAI surveillance. In a sample of ICUs the patient-based surveillance was integrated with a laboratory-based surveillance of MDR K. pneumoniae isolates. K. pneumoniae isolates were genotyped by multilocus sequence typing (MLST), and patterns of K. pneumoniae acquisition (i.e. carriage, colonization and infection) were identified using standard definitions.
Our analysis included 155 patients who stayed in two ICUs for a total of 2254 days, from October 2016 to March 2017. Trauma patients were more likely to be infected with K. pneumoniae than other patients (OR = 5.9; 95%CI=2.4-14.8; p = 0.004). A total of 109 K. pneumoniae strains were isolated from different sites of 39 patients, which in turn were defined as 45.2% colonization, 25.8% infection, and 29% carriage. 79.3% K. pneumoniae isolates resistant to carbapenems and 100% resistant to penicillins and cephalosporins. The MLST identified two major clonal groups: the ST395 and the ST37, which represented respectively the 65.6% and the 21.3% of typed isolates.
Surveillance of colonization and infection by high-risk clones might help in implementing appropriate strategies, which are crucial to reduce the spread of K. pneumoniae in ICUs.
*Study Group AOU 'Policlinico-Vittorio Emanuele', Catania, Italy: Patrizia Bellocchi, Giacomo Castiglione, Alida Imbriani, Marinella Astuto, Giuseppa La Camera, Agata Sciacca

Key messages
Multidrug-resistant K. pneumoniae still represents a threat for Public Health in Italy and globally, due to its high dissemination in intensive care units. Surveillance of colonization and infection by high-risk clones might help in reducing the spread of Klebsiella pneumoniae.
Water, sanitation and hygiene in health facilities and how they affect health in European countries
Authors: Grossi V , Shinee E , Schmoll O , Kistemann T 
Published: October 2020

Abstract

Background
Water, sanitation and hygiene (WASH) are human rights as well as important targets of the Sustainable Development Goals and a key component of quality of healthcare. Poor access to safe WASH impacts patients' health as it increases the risk of contracting infectious diseases, mental distress or avoidance of WASH services with additional negative health consequences. Global statistics show that the greatest risk exists in developing countries, while there is little data available from the WHO European Region. Our research aims at gathering an up-to-date overview of WASH data and health consequences on the example of a number of districts from four middle- and high-income countries in the European Region.

Methods
A mixed-methods analysis was conducted, including literature review, one-shot surveys addressing different types of healthcare services and different socio-economical settings, policy analyses, expert interviews and desk-review of health statistics.

Results
Preliminary results show that differences and commonalities are observed with respect to the WASH provision and management in healthcare across the considered areas in the region. While basic drinking-water is widely provided, other aspects, such as sanitation, are in need of attention both at the regulatory and implementation level. Also within countries, local differences are observed. Conditions of WASH services in health care are linked with the spread of (resistant) nosocomial infections through many different pathogens with consequences for patients, mothers and children, and for the broader population, influencing morbidity and mortality.

Conclusions
New insights on the condition of WASH services in healthcare facilities and increasing relevance of WASH-related health outcomes, such as antimicrobial resistance and nosocomial infections, show the need for increased attention to basic services such as sanitation and hygiene in healthcare also in European countries and for locally-targeted interventions.

Key messages
Water, sanitation and hygiene are a critical component of quality of health care and severely affect staff’s performance and patients’ health, with consequences for the population. Water, sanitation and hygiene need more attention in middle- and high-income countries in the WHO European Region, both at the regulatory and implementation level.
Surgical antibiotic prophylaxis adequacy in colorectal cancer surgery in Murcia, Spain
Authors: Monteagudo J F , Pérez-Romero S B , Podio-Martínez M , Aracil-Terrés G V , Arana-Aragón B , Sánchez-Rodríguez D 
Published: October 2020

Abstract

Background
In 2018 an antimicrobial stewardship program (ASP) was established in our Hospital, implementing guidelines for preoperative surgical antibiotic prophylaxis (SAP). Our objective was to describe the adequacy of SAP in colorectal cancer surgery (CCS) in our centre.

Methods
A prospective study was carried out in Hospital General Universitario Reina Sofia, Murcia. Patients subjected to CCS between January 1st and November 30th of 2019 were included. No exclusion criteria were established. Interventions were classified following ECDC Surgical Site Infection Surveillance guidelines. ASP data were obtained from clinical documents and electronic records, evaluated following ASP guidelines and classified as adequate or inadequate. Inadequate SAP was divided into five categories: “Length of administration”, “Antibiotic election”, “Inadequate Timing”, “Antibiotic indication” and “Other”.

Results
A total of 77 interventions were recorded, 75.3% being laparoscopic (LCOL) and 24.7% open (OCOL). All the interventions received SAP, but only 41.5% were adequate. The main causes of inadequacy were inadequate timing (40%) and length of administration (37.7%). Among the LCOL procedures, the main causes were length of administration (42.8%) followed by timing (37.1%). In contrast, the cause of inadequacy in OCOL was inadequate timing (50%) followed by an inadequate antibiotic election (30%)

Conclusions
Despite the implementation of an ASP and diffusion of guidelines among professionals, we found that less than half of colorectal cancer surgeries in our centre received an adequate SAP. Overall, inadequate timing of administration was the main cause, although we found length of administration as the main cause of inadequacy in LCOL. Due to these results, a PDCA cycle was started.

Key messages
Implementation of a program does not always mean compliance. Surveillance is key to monitoring results… and keep improving!
The perspectives of asylum seekers when accessing sexual health services in Cork and Kerry
Authors: Jones M M , Barry F , Davoren M P 
Published: October 2020

Abstract

Background
The World Health Organisation (WHO) states that; “Sexual health is a state of physical, mental and social well-being in relation to sexuality. It requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination and violence.” Asylum seekers are among many vulnerable groups that may face inequalities in terms of sexual health and how sexual health services are accessed. The aim of the present study is to gain an understanding of the experiences of asylum seekers when accessing sexual health services in Cork and Kerry, including the perceived barriers to and factors that facilitate access.

Methods
This is a qualitative study in which data was collected from 14 semi-structured interviews conducted with asylum seekers between May and June 2019. Participants were over the age of 18 and living in direct provision in Cork or Kerry. The present study uses a content analysis to explore the perspectives of asylum seekers when accessing sexual health services in Cork and Kerry.

Results
Participants demonstrated varying levels of understanding around the topic of sexual health and sexual health services. Several barriers and facilitators were identified which can be grouped into socioeconomic, political/legal, systemic, and social/cultural/religious barriers and facilitators.

Conclusions
The findings from this study highlighted several areas for improvement in the provision of information and services in relation to sexual health for asylum seekers living in direct provision and revealed the importance of addressing these issues in order to fulfil the purpose of public health by promoting health, preventing disease and prolonging life for all aspects of society.

Key messages
This study has identified the barriers and facilitators to accessing sexual health services in the context of the direct provision system in the Republic of Ireland. The results of the study reveal the varying ideas and understanding of the topic of sexual health and how this can influence help-seeking behaviour.
Knowledge on sexually transmitted infections and AIDS of women who have sex with women
Authors: Parenti A B H , Ignacio M A O , Buesso T S , Santini M A , Cerqueira A T A R , Nunes H R C , Duarte M T C 
Published: October 2020

Abstract

Introduction
Literature points to a scarcity of studies on sexual health and risk behavior of women who have sex with women (WSW) living in low- and middle-income countries, reporting lack of knowledge, high prevalence of sexually transmitted infections (STI), and low incidence of consistent use of protective barriers.

Objective
Analyze knowledge of WSW on STI and AIDS.

Methods
Cross-sectional study developed in São Paulo state, Brazil. The intentional sample consisted of 182 women (55 WSW and 127 women who have sex only with men - WSM). Data were obtained from April to December 2019 through a questionnaire with questions related to the sociodemographic variables and the validated instrument Sexually Transmitted Disease Knowledge Questionnaire (STD-KQ), which has 28 questions adapted to Brazilian Portuguese in order to assess knowledge on STI/AIDS. The percentage of correct responses in function of sexual orientation, correcting the confounding effects, was adjusted by using a multiple linear regression model. The analyses were performed using the software SPSS 22.0. This research was approved by the ethics committee under protocol number 3.320.951.

Results
Out of the 182 participants, those self-reported as white (79%) and the ones living with their partner (81%) were predominant. The median age was 26 years old (18-48) and the median number of completed years of studies was 14 (1-24). As for their knowledge on STI/AIDS, the average percentage of correct answers was 63%, which on average was 12% lower among WSW compared to WSM.

Conclusions
The data in the present research indicate the importance of implementing public policies concerning the sexual and reproductive health of WSW, especially aiming at knowledge on STI/AIDS and ways to prevent them.

Key messages
Importance of implementing public policies concerning the sexual and reproductive health of women who have sex with women. Scarcity of studies on sexual health and risk behavior of women who have sex with women.
Intercultural and participative strategy for prevention of cervical cancer in indigenous people
Authors: Sarmiento Medina M , Ardila Sierra A , Quintana González E , Vargas Cruz S , Velásquez Jiménez C , Puerto de Amaya M , Fandiño Osorio V 
Published: October 2020

Abstract

Issue
Decline in cervical cancer (CC) worldwide is attributed to coverage of screening programs, but there are barriers to achieve universal care and adherence, such as geographical accessibility, language, lack of knowledge and shame for the procedure.

Description
In indigenous populations barriers are stronger due to beliefs, customs and language. In multi-ethnic countries, it is necessary to use public health strategies that allow approaching communities by respecting their culture. This work proposed a strategy that respects cultures, strengthens community self-management and give sustainability to a CC prevention program. A study of Participatory Action Research with intercultural approach was done with five ethnic groups in a reserve of Colombian Amazon. It was approved by Research Ethics Committee, indigenous authorities and participating women. Indigenous female leaders participated in all phases of the project: 1) Training in qualitative research, ethics and CC; 2)ethnographic research for identifying beliefs and practices on sexuality, gender relations and attitudes towards western medicine and cytology; 3)educational campaign in ancestral languages; 4)training in CC prevention program to promote adherence, sustainability and self-management.

Preliminary Results
No beliefs or practices were found that could be negatively affected by the CC western screening program. Women's attitudes towards cytology are positive as long as it is carried out by female professionals, accompanied by female indigenous leaders and speaking their own languages.

Lessons
Womeńs leadership and reflection on health and prevention of CC were strengthened. Indigenous identity was reinforced and the gap in domination relationships by western culture reduced. A favorable setting for CC screening program was built with a culturally safe practice. In a few months screening campaign will start and it is expected that women feel more interested in their own health and comfortable to attend.

Key messages
Intercultural health prevention programs may be successful when focus on culturally safe practices through the involvement of local indigenous leaders. Cytology perception is positive in indigenous women as long as it is carried out by female professionals, accompanied by female indigenous leaders and speaking their own language.
Mitigating barriers in communication with migrants, results from a survey among health personnel
Authors: Spilker R , Nordström C 
Published: October 2020

Abstract

Background
Ensuring equity in health for migrant is a challenge for society and the health services. This survey map the challenges health personnel face in communication with immigrant patients, and how they wish to mitigate these challenges. Results can be used to inform implementation of measures for health personnel to better meet the needs of their patients.

Methods
In 2017, we conducted a short online survey to map the experiences and needs of health personnel in providing information to patients and relatives with immigrant backgrounds. The questionnaire consisted of six questions with answer options and opportunities to elaborate free-text answers. The survey was distributed through two migrant health networks coordinated by the National Competence Centre for Migration and Health (NAKMI), and by the Norwegian Nurses Organization to different section members. 549 people responded. Most of them nurses (41.5%) and doctors (12.4%) but also other health personnel as midwives, administrative staff, physiotherapists and psychologists.

Results
Nearly 50% of the respondents stated that they experienced weekly or more often communication difficulties with immigrant patients. To overcome communication barriers more than 90% say they would use interpreters when possible, use relatives as interpreters (55%) and/or a multilingual colleague (50%). To mitigate communication challenges, respondents said translated written materials (66%), simple language (43%) or use of pictures, films etc (37%) would be of help. More than 80% believe an electronic resource that gathers advice on how to customize and facilitate information and patient education, overview of translated material and good actions and project experiences will be a good help.

Conclusions
There is a need for increased access to knowledge and resources that can mitigate communication barriers between health personnel and migrant patients.

Key messages
There is a need for a comprehensive system approach to communication barriers in the Norwegian health care system. Health personnel need better access to tools that can help them provide equitable health care to migrants.
Referred morbidity of an African descendant community in the eastern Amazonia
Authors: Castelo-Branco S , Santos R P , Santos B R , Pinnock D D , Silva H P 
Published: October 2020

Abstract

Background
In the Amazon there are several quilombola communities, remnants of the enslaved peoples of African descendant. In Pará/Brazil (Eastern Amazonia) there are over 300 quilombola communities established in rural areas. The aim of this study is to investigate the living conditions and morbidity of individuals aged 18+ years who live in a quilombola community in the city of Ananindeua/Pará.

Methods
A cross-sectional study was done with 132 individuals (71.3% of the population). A household survey and a questionnaire evaluating socioeconomic, life habits and self-reported morbidity were conducted.

Results
Among the participants 90.2% belonged to the D/E economic class, 60.6% were women, the median age was 39.5 years (p = 0.343) and the per capita income was U$41.50/month with no difference between sexes (p = 0.266). 97.0% of the participants self-declared black or brown. Women had more education than men (7x5 years, p = 0.019). Most worked with agriculture and fishing (55.5%). 53.8% of men rated their health status as good while 41.0% of women rated their health as good (p = 0.002). 55.3% had never smoked cigarettes, 25.8% were ex-smokers, and 25.8% were smokers. More men (78.8%) used alcohol regularly than women (43.8%) (p = 0.000), among the users 32.5% reported weekly or daily use. The frequency of self-reported morbidity was as follows: Asthma 21.7%, Hypertension 10.6%, Diabetes 6.8%, Chronic infectious diseases 5.6%, Kidney disease 3.9%, Stroke 3.3%, Angina 3.1%, Liver disease 2.3%, Chronic heart failure 1.5%, with no difference between the sexes. Only 4.0% used medication for diabetes, and 7.6% for hypertension.

Conclusions
The study shows the social vulnerability of this quilombola community, which is similar to others in the region. The rural afro-derived Amazonian populations need to be empowered to help inform policy makers about their main health issues and healthcare needs.

Key messages
There are few studies about health of quilombola communities. This research shows the need for further investigations to produce sensible information and promote the empowerment of these populations. This study shows a high level of vulnerability of this community, similar to others in rural Amazon. Information about their health needs is fundamental to promotion of public policies in the region.
What are the perceptions of Indigenous organisation staff on the utility of the nKPIs?
Authors: Finlay S , Williams M , Judd J , Brown A 
Published: October 2020

Abstract

Background
This presentation will outline the results of five Aboriginal Community Controlled Health Organisation (ACCHO) case studies which sought to understand the impact of national key performance indicators (nKPIs) at the local level. The nKPI framework attempts to collect data to assist the Commonwealth Government to monitor the Closing the Gap Framework and to aid local ACCHOs to monitor and review their service delivery. Understanding how the nKPIs have been implemented and their impact across the various sites is essential to understanding their usefulness.

Methods
A multi-case study approach with a variety of ACCHOs was used. Site recruitment was conducted using a purposive sampling framework with an expression of interest, and/or a direct approach. At each site, several semi-structured interviews were conducted, documents were reviewed, and observations made. Data analysis was conducted using the computer program NVivo.

Results
Case studies (n = 5) were conducted at the five sites between in 2017. Data collection included semi-structured interviews ACCHO staff (n = 24), nKPI site-specific documents (n = 12) and observational. A number of key themes emerged from case studies relating to: • Workforce The usefulness of the nKPIsSelf-determinationWay ForwardACCHO Governance

Conclusions
Across the case studies, it is clear there are a variety perception about the utility of the nKPIs and the barriers/enablers which impact their capacity to report, collect and utilise the nKPIs. All Case Study sites saw the value of data to measure their success and to identify emerging issues among their clients. Their attitudes to the nKPIs varied though, due to issues relating to the design and implementation. The stability and size of the service also influenced their ability to use the data. More work needs to be done by the Commonwealth Government in collaboration with ACCHOs to improve the usability and utility of the nKPIs.

Key messages
Indigenous people need to be involved in the design and implmnetation of monitoring sytems. The nKPIs only report on a small subset of services delivered by Aboriginal Community Controlled Health Organisations.
Access of the LGBTQI+ population from the perspective of community health agents, Brazil
Authors: Souza M H N , Pinho A A , Graever L , Pereira A R , Santana A M S , Junior C J P P , Oliveira J T S , Pereira M E F L , Ferreira N P , Vieira E S 
Published: October 2020

Abstract

Introduction
In Brazil, according to the National Policy for Integral Health for Lesbians, Gays, Bisexuals, Transvestites, Transsexuals, Queers, Intersexuals and other identities (LGBTQI+), it is increasingly necessary to guarantee access to the health system, as well as to train qualified professionals.

Objective
describing the perception of Community Health Agents (CHA) about the approach to and access of LGBTQI+ people to primary health care.

Methods
Quantitative research conducted in October 2019 with 60 community health workers from the municipality of Rio de Janeiro, Brazil. The research was approved by the Ethics and Research Committees of the participating institutions.

Results
it was found that 100% of the CHA have already supported LGBTQI+ people, 19.2% identify prejudiced attitudes and delay in service as barriers to accessing the unit, and 19.2% recognize the presence of group activities in the unit. In the view of the CHA interviewed, LGBTQI+ patients could be approached in groups (50%), individually (19.2%) or both (30.8%). Among the strategies to increase the access of those patients, 61.5% are unaware and 38.5% listed possible strategies to be implemented in the unit. The topics of interest for discussion were: approach to reception, sexual identity, prejudice, psychological support, family, diseases, violence, and rights.

Conclusions
From the perspective of community health agents, the study allowed reflections on how approaching and making access available to LGBTQI+ patients in the primary care network. This evidences stigmas and fragility of professionals in the individual and collective approach to deal with issues regarding guidance sexuality and gender identity of the clientele served. It is important to emphasize permanent education actions among professionals, aiming at a comprehensive health care for the LGBTQI+ population.

Key messages
Welcoming and qualified listening promote comprehensive health care for the LGBTQI+ population. Improvements in the access of the LGBTQI+ population to the primary health care network decrease morbidity and mortality.