bluuebunny/crossref_metadata_2025_split huggingface dataset:
Change in fertility rates in southern Ethiopia: Findings from Dale-Wonsho surveillance system site
Authors: Areru H , Dangiso M , Lindtjorn B 
Published: October 2020

Abstract

Background
Even though the fertility in Africa has started to decline, there was no demographic study done in southern Ethiopia except a census done more than a decade ago. Understanding the population dynamics can help policymakers forecasting future health needs. The objective of this study is to investigate the population characteristics in Sidama with an emphasis on fertility estimates, age, and death reporting.

Methods
This is a mixed-method cross-sectional study, conducted in Sidama in southern Ethiopia, using baseline data of the newly established Dale-Wonsho Health and Demographic Surveillance System site in 2018. We used quantitative data of 5179 randomly selected households having 25,144 individuals. We also collected information on deaths in the same study period and from the same population from the traditional burial associations (Iddir). Qualitative data were collected using focus group discussions, and in-depth interviews. Life tables, age reliability indices and logistic regression were used to analyse the data.

Results
The total fertility rate was 2.9 children/woman, the crude birth rate was 22.8/1000 population and the crude death rate was 5.2/1000 population. The dependency ratio was 66/100 working-age population. Urban residents had higher birth rates(OR = 1.4 (95% CL: 1.05-1.78), and women with basic education had lower birth rates(OR = 0.6 (95% CL: 0.46-0.78). The Whipple's, Myer's, and United Nations Joint Score indices showed unreliable age reporting. As the number of deaths increased from 29 to 132 when we included deaths registered at the Iddirs, and as there was an under-reporting of neonatal and deaths of young children; the expected life expectancy became lower to 48-55 years.

Conclusions
The fertility rate in Sidama is lower than previously reported and is affected by age, residence and education. As we have identified important measurement and reporting errors, future demographic surveillance sites should consider these limitations.

Key messages
The reduction in fertility is an important indicator of demographic transition. Age and vital events reporting system are crucial for demographic surveillance.
Patients’ expectations on medicines information
Authors: Sevikyan A , Kazaryan I 
Published: October 2020

Abstract

Background
Medicines information is important for patients as it assists them in achieving more safe and effective use of pharmaceuticals. Many patients seek information from community pharmacies' staff. The objectives of this study were to identify specific topics of medicines information which patients expect to receive at community pharmacies.

Methods
Face-to-face interviews were conducted with 1059 visitors of community pharmacies in Armenia. Previously developed questionnaire was used for interviewing patients. Data were analysed with the SPSS statistical software.

Results
Most of participants acknowledged importance of receiving from community pharmacies' staff information on therapeutic indications of medicines (91.1%), dosage and method of administration (90.8%), the duration of treatment (86.3%), expiry date (85.7%), adverse reactions (85.0%), contraindications (84.6%), storage conditions (77.5%) and type of activity (76.0%). Importance of receiving information on some specific topics depends on patients' age. Participants' acknowledgement of information on interaction with other medicines, certain categories of users, and potential effects on the ability to drive is decreasing with patients' age increasing (p &lt; 0.001). The opposite trend was observed with attitude to receiving information on medicine price that was mostly valued by elderly patients (p = 0.046). The number of patients who trust the information provided was higher among those who more often received comprehensive responses from pharmacists and pharmacy assistants (p &lt; 0.001).

Conclusions
Receiving medicines information from the staff of community pharmacies is important for patients, and the majority of them trust to information received. Patients are mainly provided with comprehensive responses to their questions about medicines, and there was dependence between a frequency of receiving comprehensive responses and a level of patients' trust the information provided by pharmacy staff.

Key messages
Increasing patients’ awareness on their right to get medicines information can be beneficial. Comprehensive responses increase patients trust medicines information provided by pharmacists.
Hospital stay frequency of patients with cancer diseases in Rhodes Island, Greece
Authors: Katsaros E , Kitsou K S , Bakola M , Jelastopulu E 
Published: October 2020

Abstract

Background
Cancer is the second leading cause of death globally and a major public health problem that poses a threat to human development. The aim of this study was to investigate the number of hospital stays of cancer patients in Rhodes island in Greece.

Methods
A retrospective study was conducted to examine the parameters of frequency (case numbers) of inpatient hospital stays for a 4-year period of 2015-2018 at the General Hospital of Rhodes (GHR).

Results
In total, 1838 cancer cases were hospitalized during the study period, with an average age of 66.5 years and a male-to-female ratio of 1.9:1. (1199 vs 639). The most frequent diagnosis was urological cancer (incl. prostate cancer, 32.2%), followed by skin cancer (15.6%), gastrointestinal cancer (incl. colorectal cancer, 14.4%), hematological cancer (10.7%), breast cancer (8.9%), gynecologic cancer (5.3%), thyroid cancer (5%), lung cancer (4.1%), ear-nose-throat cancer (2.1%) and connective and soft tissue cancer (2, 0.1%). Surgery was the most common treatment (57.5%), whereas 250 patients (13.6%) received no treatment at the GHR. Most of the patients (66.6%) received one type of drug therapy, whereas the rest received a combination of drug therapies. Due to the lack of an Oncology Department, the therapy was given by other health personnel (e.g. hematologists) according the guidelines/recommendations of oncology-health-care-professionals in tertiary-care-hospitals at the mainland.

Conclusions
Our results do not follow the percentages of hospitalized cancer cases as seen in other developed countries. The island of Rhodes does not have the specialized staff and the means to treat all kinds of cancer, thus the patients with other types of cancer (e.g. lung and breast cancer) were referred to receive tertiary care cancer treatment in mainland Greece. Our results yield information to guide future actions in order to improve health and quality of life in people in remote/island areas

Key messages
An oncology department should be created in the GHR in order patients with common cancers, like lung and breast cancer to be treated in the island of Rhodes.
Federative relation and the process of regionalization in Brazil: strength to resist
Authors: Andrade S K , Mendonça F F 
Published: October 2020

Abstract
The federative relation is an essential tool to face the current challenges in Brazil and defends the public health system, threatened by measures of totalitarianism and individualism. Some of the barriers to promote an effective federative relation on the regional territories based on collective action are the devaluation of the deliberation spaces, the verticalization in making-decision process and marks of submission on federative relation. In this sense, one of the most important factors to structure democratic spaces is the regionalization, what subsidizes the construction of a regional identity, through dialogical strategies. In order to consolidate the regionalization, is important to characterize and apply instruments and strategies of negotiation, agreement and cooperative relations, by the entities. This study aims to identify and understand cooperation strategies, if present or potential on the counties of region practices and propose its sharing and implementation between them. The research has a qualitative, exploratory and interventional approach and it was submitted to the ethics committee approval process. The methodology way contemplates the collect of dates by questionnaires applied during a sixty-hour extension course. The participants are counties managers and supporters of their teams from the five regions of health on the north of the state of Parana, organized on small groups. After this, some individuals are invited for complementary interviews with semi-structured scripts. The adopted methodology for the analysis of the results is the discourse analysis. After identified and categorized the initiatives, they are shared among the participants through some workshops. In this way, the expected results of the study is to allow the strengthening of regionalization process in the territories and contribute for the establishment of a new order on the federative relation, boosting a democratic process of decision-making, cooperation and solidarity.

Key messages
The current challenges in political scenario on Brazilian health system requires new strategies to boost a democratic, cooperative e solidary process of decision-making and federative relation. One of the most important factors to structure democratic spaces on Brazil is the regionalization, which can be strengthened by federative relation based on cooperation and solidariety.
Impact assessment of the public health product tax in Hungary
Authors: Zámbó L , Bakacs M , Illés É , Varga A , Sarkadi Nagy E , Zentai A , Feigl E , Biró K 
Published: October 2020

Abstract
Many countries apply fiscal policies to promote healthy diets to reduce the risk factors of NCDs. In 2011, a public health product tax (PHPT) was introduced in Hungary, taxing non-staple food products that carry proven health risks when consumed. The objectives of PHPT were to promote healthier eating habits by increasing the availability of healthy choices; to encourage reformulation; and to increase revenues for public health. With the purpose of evaluating the social and economic effects of PHPT, impact assessments (IAs) were conducted in 2012, 2014, and in 2018. The IA in 2018 was conducted within the framework of an EU-cofunded development project. To measure the awareness of the population on the law; to assess the population's attitude towards PHPT; to map the consumption patterns and to examine the major factors influencing food choices were fundamental parts of the IAs. We aim to present the findings of the latest IA and compare them to the results of the previous studies. Population surveys with questionnaires including the same questions were applied in the three assessments, hence changes during the 6 years could be detected. A sample of the adult population was involved in form of personal interviews in each IA. Based on the results, the awareness of PHPT was less (66%) in 2018 than in 2012 (72%). The adult population's consumption of the taxed products increased in all categories between 2012 and 2018 (except for salty condiments). Sociodemographic factors and awareness of the law correlated with the consumption of certain PHPT products. Taste was the primary determinant of food choice both in 2012 and 2018. The role of the price and the energy content in food choices were decreased significantly by 2018. A higher proportion of people identified the aims of PHPT correctly and agreed with them in 2018. The results draw attention to the importance of further interventions and the need of targeted health communication.

Key messages
The impact of the PHPT should continue to be monitored and evaluated. To achieve the aims of PHPT in the long term, it is needed to use more effective health communication, furthermore harmonized intersectoral actions should be also implied to promote healthy diet.
Implementation level of best practice policies by Italian government for healthier food environments
Authors: Zace D , Specchia M L , Di Pilla A , Carini E , Cacciatore P , Frisicale E , Silano M , Ricciardi W , Sassi F 
Published: October 2020

Abstract

Background
Government actions play a critical role in shaping healthy food environments, which can improve population's diet and decrease the burden of disease. This study aims to determine and compare the level of policy implementation for healthy food environments in Italy with reference to international benchmarks and make prioritized recommendations based on the identified implementation gaps.

Methods
The Healthy Food Environment Policy Index (Food-EPI) tool from the International Network for Food and Obesity/NCDs Research, Monitoring and Action Support (INFORMAS) was adapted for the Italian context. This tool includes two components, thirteen domains and fifty good practice indicators, which were verified with experts from National Health Institute (NHI). Evidence for implementation was gathered and summarized for all fifty indicators from data sources such as governmental websites, non-government organizations publications and websites and via direct contact with government officials. After collecting all evidence, experts from the NHI verified the completeness and accuracy of it. The evidence document will be presented to stakeholders, aiming to seek consensus on the priority actions to be implemented by the Italian Government to improve food environments.

Results
The evidence for policy implementation concerning Italy varied among domains and indicators. We found the highest level of evidence within three domains: Food Composition (2/2 indicators), Food Labelling (3/4 indicators) and Food Promotion (4/5 indicators). The domains with less identified evidence were Food Prices (1/4 indicators), Food Retail (0/4 indicators), Food Trade and Investment (0/2 indicators) and Platforms and Interaction (1/4 indicators).

Conclusions
The evidence summarization and the upcoming stakeholders' meeting to rate the level of implementation for each indicator in Italy, have the potential to improve government commitment to shape healthier food environments.

Key messages
Food environment policies, implemented by the government, play a key role in the health of the population, decreasing the burden of disease. Several food environment policies have been implemented and supported by the Italian government but there are still some priority actions to be taken towards healthier food environments.
Italian multiple sclerosis register as the basis for post-authorization safety studies
Authors: Ponzio M , Trojano M , Capobianco M , Pugliatti M , Ulivelli M , Mosconi P , Patti F , Zaratin P , Lepore V , Battaglia M A 
Published: October 2020

Abstract
While the safety and efficacy of Disease Modifying Therapy (DMT) in multiple sclerosis (MS) are assessed in clinical trials, these are of relatively short duration and always confined to highly selected patient groups. The evaluation of real-world data such as patient registries, is vital as it offers long-term data collection and is patient rather than product-focused during the lifetime of MS, and allows to document a patient's treatment history throughout the disease course. Patient registries can play an important role in monitoring the safety of drus. Regulators and the pharmaceutical industry have shown interest in complementing or even replacing phase 4 clinical studies with data from MS registries.
The Italian MS Register (IMSR), in collaboration with the Big MS Data initiative, that also includes the national MS registries of Denmark, France, and Sweden and the international database network MSBase, came together with industry to conduct studies on post-authorization safety (PASS) and treatment effectiveness. The IMSR includes the clinical history of approximately 55,000 patients, or approximatively 45% of the estimated cases of MS in Italy. More than 10,000 patients have a follow-up duration of over 10 years.
A Core Protocol outlining principles of PASS projects was created in which aggregated results made available to sponsors and health authorities. The Core Protocol specifies variables, emphasizes improved capture of adverse events, in particular cancer, non-melanoma skin cancers and immunosuppression-related infections, all MedDRA-coded. EUROCAT codes for pregnancy outcomes are also documented.
Regulators, the pharmaceutical industry and national-level registries have jointly identified a format of collaboration on PASS for DMT in MS to benefit patients and the larger society. In this way, we hope to contribute to a framework that will include emerging and existing registries with the common goal of contributing to the advancement of knowledge in MS.

Key messages
The real-world data can contribute to understanding of the impact of disease-modifying therapy on long term. A format of collaboration among clinical research, regulators and pharmaceutical industry could be a winning framework to improve the knowledge on safety and treatment effectiveness in MS.
Appropriate admission to rehabilitation: definition of a set of criteria through the Delphi Method
Authors: Principi N , Carnevali D , Grimoldi L , Merlo A , Rodà F , Auxilia F , Lombardi F , Maini M , Brianti R , Castaldi S 
Published: October 2020

Abstract

Background
Controlling inappropriateness of care, a widespread phenomenon, should be a global target in order to improve the quality of care, save money and ensure system sustainability. Inappropriateness is a relevant issue in public health and in rehabilitation medicine specifically. In fact, admitting a patient to a rehabilitation hospital or unit is a complex decision also due to the absence of shared and objective admission criteria. Aim of this study is to define clinical admission criteria and rules in rehabilitation medicine.

Methods
A three-round Delphi survey was conducted on a sample of rehabilitation medicine experts skilled in both rehabilitation and healthcare organization. The two initial rounds consisted of an electronic online questionnaire concerning appropriateness of admission to intensive rehabilitation while in the third one a report of the results was provided to the participants. The experts had to score their agreement with each item in the questionnaires, based on either a Likert scale or a dichotomous statement. Consensus between the experts was assessed.

Results
A total of 53 health professionals completed the Delphi survey. 19 out of 20 Italian regions were represented. The first round consisted of 8 multiple-choice questions questionnaire. The second round was designed thanks to the suggestions provided by the panelists in the previous one and consisted of a twelve items questionnaire. At the end of the survey, eight criteria of appropriateness of admission to rehabilitation were identified and five rules defining an appropriate admission to a rehabilitation facility were elaborated.

Conclusions
This study represents an attempt to create a worthwhile and reliable tool for a more conscious clinical practice in admission to rehabilitation, based on a set of shared criteria and rules.

Key messages
Improving appropriateness in healthcare delivery must be a primary goal in public health and in rehabilitation medicine specifically. Delphi method was applied to define shared clinical admission criteria and rules in rehabilitation.
The determinants of non-smokers’ opinions about increased health insurance rates for smokers
Authors: Szulc K , Duplaga M 
Published: October 2020

Abstract

Background
The rates of obligatory health insurance available to Polish citizens do not depend on their health behaviours. However, there are opinions suggesting that the rates should be increased for those who show risky health behaviours. This study aimed at the assessment of determinants of non-smokers' opinions about the introduction of increased health insurance rates for smokers.

Methods
The analysis was carried out on the data originating from the telephone-based survey on the representative sample of 1000 adult Polish citizens. Responses from non-smokers in the moment of the study were retrieved from the data set. A dichotomised variable derived from the item asking about the opinion about increased insurance rates for smokers was used as a dependent variable in uni- and multivariate logistic regression models. Sociodemographic characteristics, health status, prior use of health care resources, and history of smoking were included as independent variables.

Results
The study sample included 779 respondents; of them 60.1% (n = 471) never and 0.39.9% (n = 308) smoked in the past. There were 45.0% and 34.4% of supporters of higher rates in these subgroups. Increased insurance rates were supported by older respondents (OR, 95%CI: 1.01,1,001-1.03) and those with higher income (2.17, 1.27-3.70, and 2.23, 1.34-3.71, for the comparisons of two higher income categories with referential category of net income &lt;1500 PLN). Past smokers (0.51, 0.36-0.74), Internet users (0.49, 0.27-0.90), respondents admitted to hospital in preceding year (0.57, 0.36-0.91), and those who reached higher levels of education (0.49, 0.29-0.84, and 0.50, 0.28-0.90 for comparisons between persons with higher levels of education with those with the lowest level) expressed an opposite view.

Conclusions
Not only earlier experience of tobacco smoking but also higher education level, prior hospital admission and Internet use are related to lack of the acceptance for increased health insurance rates.

Key messages
Determinants of opinions about increased insurance rates may be counterintuitive. The use of health services or higher education levels are not associated with the support of higher rates for smokers.
Changes in walkability in three urban neighborhoods of the city of Rome: a comparison 2009-2019
Authors: Appolloni L , Barbaliscia M , D'Alessandro D 
Published: October 2020

Abstract

Introduction
Scientific evidence stresses that more walkable neighborhoods are linked to increased physical activity. Walking Suitability Index of the territory (T-WSI) is an easy method, already validated, to evaluate the walkability on the basis of direct observation. Aim of the study is to compare the walkability indices obtained in three urban neighborhoods of the city of Rome in 2009 and 2019, to evaluate whether the urban redevelopment interventions, performed in the decade, do really promote walkability.

Methods
An audit, through T-WSI, is carried out for each street of a neighborhood. T-WSI audit evaluates 12 indicators subdivided into 4 categories: practicability, safety, urbanity, pleasurableness. The weighted analysis of these indicators gives an overall score of the actual usability of the neighborhood. In this study, 2 different trained surveyors, evaluated T-WSI in three neighborhoods of Rome (San Saba, Sacco Pastore and Tufello-Val Melaina), which differ in socio-economic conditions. Average scores have been compared using t-student.

Results
A considerable improvement was observed in the Sacco Pastore neighborhood final weighted scores (T-WSI scores: from 53.6 in 2009 to 68.3 in 2019, with an increase of 14.7% (p &lt; 0.005). All categories improved, although Safety (T-WSI scores: from 35.0 to 59.3; increase of 24.3% - p &lt; 0.005) and Pleasurableness (T-WSI scores: from 48.5 to 61.4; increase of 12.9% - p &lt; 0.005) show the greatest improvements. It is mainly due to redevelopment works carried out in the neighborhood in the last 10 years, mainly aimed to increase citizen's perceived safety (e.g. signs, crossing protection devices, traffic lights, greenery management) and to remove architectural barriers.

Conclusions
The results show T-WSI is a useful tool in order to measure the effectiveness of the interventions already realized at local level, but it could also contribute to making decisions to develop regeneration projects for degraded areas of the cities.

Key messages
Physical Activity must become a priority and part of a daily routine. Healthy cities, healthy people.