bluuebunny/crossref_metadata_2025_split huggingface dataset:
Tuberous Sclerosis: a disease systematically monitored by the Rare Diseases Registries in Spain
Authors: Cavero Carbonell C , De La Natividad Palomares M , Botella P , Zurriaga O , Guardiola Vilarroig S 
Published: October 2020

Abstract

Background
Tuberous Sclerosis (TS) is a rare genetic disease that causes hamartomas and neuropsychiatric disorders.

Objective
to determine the prevalence and its evolution in the Valencian Region in the period 2010-2017.

Methods
Through the information sources used by the Rare Disease Population-based Registry of the Valencian Region, possible cases of TS were identified with codes 759.5 (International Classification of Diseases -ICD- 9th Revision Clinical Modification version) and Q85.1 (ICD10th Revision, ICD10th Spanish version and ICD10th British Paediatric Association version). Prevalence and mortality rates per year were obtained (by the direct method, using the European Standard Population 2013) and a descriptive analysis of the sociodemographic variables of the confirmed cases was performed.

Results
158 possible cases of TS were obtained, which 139 were confirmed (54.7% women and 45.3% men). The lowest prevalence was in the year 2010 with 16.0/1,000,000 (95%CI: 12.7-20.0) and the highest in 2017 with 26.5/1,000,000 (95%CI: 22.0-31.7), identifying an increasing trend along the period. Prevalence in women was higher than in men throughout the period, being in the year 2017 in women (30.3/1,000,000 (95%CI: 23.5-38.4)) and in men (22.7/1,000,000 (95%CI: 17.0-30.0)).The province with the highest prevalence was Castellón (in the north), 34.8/1,000,000 (95%CI: 20.9-55.0) in the year 2017. The median age at diagnosis was 7.2 years. The mortality rate over the period was 0.4/1,000,000 (95%CI: 0.2-0.7), being higher in men (0.5/1,000,000 (95%CI: 0.2-1.0)) than in women (0.3/1,000,000 (95%CI: 0.1-0.7)).

Conclusions
The prevalence obtained is lower than that estimated by Orphanet, the rare diseases reference portal, (100-500/1,000,000), being in this study the first time it is identified in the Valencian Region. The increasing trend in prevalence may be due to the low mortality of TS and it is being chronic, as well as a good healthcare management of the disease.

Key messages
The Tuberous Sclerosis is one of the 20 rare diseases systematically monitored by the Rare Disease IPopulation-based Registry of the Valencian Region and in the Spanish Rare Disease Registry. The obtained prevalence and mortality could be used to increase the knowledge of the Tuberous Sclerosis and as a basis for health programs and research.
Adequacy of hospitals in Rome to an unconventional event (CBRNe): TTX simulation and HTA
Authors: Rosiello F , Desideri E , Vinci A , Zelinotti L 
Published: October 2020

Abstract

Background
Rome hosts thousands of sensible targets. Healthcare reaction has been guaranteed by 6 advanced Emergency Departments (EDs) and 7 basic ones. Everyday Rome hosts 6 millions of people/die, ± 2 million in particular occasions. About National Stockpile Antidotes (SNA), Rome hosts 3 warehouses. In case of events, stockpiles are activated with a long-time call; then stockpiles are charged in delivering trucks.

Methods
Study analyzes PEIMAF (State of emergency plans for massive influx of injures) of advanced EDs in Rome and their adequacy in a possible CBRNe attack. Hypothesis of C/N attack on Saint Peter's Square during Angelus on Wednesday (at 12.00 AM) or E attack in Trastevere on Saturday (at 9.00 PM). Analysis of activation of SNA and travel times between SNA warehouse and EDs. Comparison with French EDs during Paris attacks.

Results
EDs are chronically undermanned in ordinary conditions already, and would have issues in hosting a very large number of critical patients all at once. Some hospitals do not inform their workers about PEIMAF or they do not consider CBRNe emergencies in their PEIMAF, and even if it has been considered, hardly any simulation/exercitation is ever performed. Moreover, news of the CBRNe attack may not reach immediately the healthcare personal already at work in EDs; this is extremely problematic since they could be at major risk of contamination in case of CBRNe attacks. Furthermore, without a standardize protocol active in the whole city, no cross-hospital organization can be performed.

Conclusions
All data point towards the weakness and fragmentation of actual organizative system. Time of activation and charging are crucials for first aid efficacy and efficiency; a smart call system can reduce the activation time of SNA. A better organization of SNA in major Rome hospitals can reduce delivering time and help save more lives.

Key messages
Basing on our experience, we can say that all the resilience health strategies, especially when connected to terrorist/CBRNe events, should be managed by the National Government. the capability to face up these kind of events should be up to time-dependent networks, especially considering those hospitals with medium-high intensity healthcare.
Countering COVID-19: A European survey on acceptability of and commitment to preventive measures
Authors: Sabat I , Elsem Varghese N , Neuman-Böhme S , Pita Barros P , Brouwer W , van Exel J , Schreyögg J , Stargardt T 
Published: October 2020

Abstract
To understand the public sentiment toward the measures used by policymakers for COVID-19 containment, a survey among representative samples of the population in seven European countries was carried out in the first two weeks of April 2020. The study addressed people's support for containment policies, worries about COVID-19 consequences, and trust in sources of information. Citizens were overall satisfied with their government's response to the pandemic; however, the extent of approval differed across countries and policy measures. A north-south divide in public opinion was noticeable across the European states. It was particularly pronounced for intrusive policy measures, such as mobile data use for movement tracking, economic concerns, and trust in the information from the national government. Considerable differences in people's attitudes were noticed within countries, especially across individual regions and age groups. The findings suggest that the epidemic acts as a stressor, causing health and economic anxieties even in households that were not directly affected by the virus. At the same time, the burden of stress was unequally distributed across regions and age groups. Based on the data collected, we draw lessons from the containment stage and identify several insights that can facilitate the design of lockdown exit strategies and future containment policies so that a high level of compliance can be expected.

Key messages
Citizens were overall satisfied with their government's response to the COVID-19 outbreak. A north-south pattern in public opinion was observed across the European states.
Support to academic education in view of the consolidation of the universal health system in Brazil
Authors: Ribeiro Bizuti M , Eneida de Almeida M , Roberto Barbato P , Savi Geremia D , Inácio Andrioli A , Rossetto M 
Published: October 2020

Abstract
The Federal University of Fronteira Sul (UFFS) is the first higher-level institution in Brazil to emerge from the processes of social and political participation of social movements and networks of civil associations. Its objective is to ensure access to higher education for the entire population of the region named Fronteira Sul, historically excluded, in order to contribute to the resolution of local and regional problems. Its public and popular character is structural, with a historical aspect of a struggle of more than forty years of various social movements for the federal university, in defense of society and its ideas: democracy, equality, respect for diversity, citizenship, right to free public education, sustainability and social justice. The center of political action at UFFS is in direction of universal human rights, equality and the reduction of social inequality, being one of the structuring axes, the strengthening of Policies and Practices for the Promotion of Public Health, since society has presented its demands guided by the concerns with health care in the region. CEBES is a national entity created in 1976, whose historical mission is the struggle for the democratization of society and the defense of social rights, in particular the universal right to health. As a supraparty plural space, it brings together activists, leaders, researchers, teachers, professionals and students, together with other entities in the fight for health. It was responsible for founding the Brazilian Sanitary Reform Movement, by producing and disseminating information, knowledge and critical analyzes aimed at strengthening subjects through the expansion of critical thinking and health awareness, essential elements for political practice and action. The Chapecó nucleus was created to contribute to academic education in the health field by respecting the founding principles of social justice that are in the Federal Constitution of 1988, universality, equity and integrality.

Key messages
Present the Chapecó nucleus created to contribute to academic education in the health field, while respecting the founding principles of social justice and democracy. To present UFFS as an important institution for universal human rights and its commitment to the reduction of social inequality in the strengthening of Public Health Promotion Policies and Practices.
Prevalence of burnout among operating room professionals in the district of Sousse
Authors: Aouicha W , Tlili M A , Sahli J , Hlaoui A , Chniti A , Chelbi S , Said Latiri H , Ajmi T , Ben Rejeb M , Mallouli M 
Published: October 2020

Abstract

Background
The Operating Room (OR) is a complex, stressful and potentially dangerous environment. In fact, the professionals practicing in these units suffer from a continuous exposure to multiple stressors that can, eventually, lead to a state of Burnout. The aim of this study was to estimate the prevalence of burnout in the OR and to determine the possible associated factors with this syndrome.

Methods
This is a cross-sectional study that was carried out among surgeons and paramedical staff in twelve ORs in the teaching hospitals in Sousse, Tunisia, using an auto-administred questionnaire. It was spread over a 4-month period; from January 1st to April 30th 2018. Data was entered and analyzed using SPSS 20.0. Also, all confidentiality and anonymity measures were respected.

Results
A total of 225 OR professionals participated with a response rate of 76.8%. The medical profession was represented by 46 surgeons and the female gender, overall, was predominant and accounted for 60.9% of the participants. Our study showed that the prevalence of burnout was very high (82.6%). Actually, more than half of our population (65.3%) had a high level of emotional exhaustion, 34.2% had a high level of depersonalization and 40.4% represented a high level of low self efficacy. In fact, several factors have been found to promote the occurrence of the burnout syndrome. Indeed, there was a link between burnout and dissatisfaction of work conditions (P = 0.001), high workload (P = 0.001) and altered relationship with the hierarchical superiors (P = 10-6).

Conclusions
In light of these results, the burnout syndrome is a reality in the ORs. It represents a public health problem whose consequences do not only affect the health of caregivers but, also, the quality of care provided. Thus, it is essential to plan awareness-raising and prevention actions to combat this phenomenon.

Key messages
A high prevalence of Burnout was recorded among operating rooms professionals. Dissatisfaction and an altered relationship with superiors were found to be associated with the occurrence of Burnout.
Both soap and ozone more effective and better tolerated than alcohol hand disinfection?
Authors: Breidablik H , Johannessen L , Andersen J , Lysebo D , Skare Å , Kleiven O T 
Published: October 2020

Abstract

Background
Preventing the transfer of virulent microorganisms is an essential part of infection control programs and clinical practice. Hand disinfection using alcohol from dispensers has become a standard practice worldwide; however, consequent skin irritation is frequently reported. Thus, alternative methods for hand sanitization are needed.

Objectives
We used a modified European Standard procedure (EN 1500:2013) with the aim of comparing the efficiency of alcohol, ozonated water and soap for eradicating transient Escherichia coli from artificially contaminated hands.

Methods
We applied a crossover design for testing alcohol and ozone (20 participants/product; 40 participants in total). The participants were mostly nursing students. We have merged the results from two separate crossover studies with altogether 35 participants, and also included 20 non-crossover participants for soap washing.

Results
Both ozonated tap water and soap & water were more effective than alcohol disinfection; and washing hands with soap the most effective. In some participants, disinfection with alcohol seemed to fail at eradicating transient E. coli from the hands, particularly from one side. The pre-test CFU/mL values were ≥30,000 in 52 of 55 participants. After disinfection of both the hands with 85% alcohol, 0.8 ppm ozonated tap water and soap & water, the mean/median (range) values were 2330/300 (14,000), 538/250 (3450) and 98/50 (450), respectively. The majority of the participants (66%) stated that they would prefer using ozonated tap water if the disinfection effect was the same as that of other agents.

Conclusions
We hypothesize that hand disinfection with alcohol is more difficult, and that the flow rate of water may play a pivotal role in eradicating microorganisms in addition to the choice of disinfectant. Ozonated tap water had no adverse effects on the skin and was preferred by most participants.

Key messages
Ozonized water as hand disinfection. Alcohol hand disinfection problems.
Risk assessment in hematology ward renovation, a FMEA example in a tertiary hospital in Italy
Authors: Battaglini A , Orsi A , Icardi G , Vyshka S , Casabona F , Orengo G 
Published: October 2020

Abstract

Background
Hospital construction and renovation works cause derangement, increasing mistake rate in healthcare workers and resulting in dust contamination and dispersal of fungal spores that could improve morbidity and mortality in severely immune suppressed patients. The necessary renovation of hematology ward at IRCCS Policlinico San Martino in Genoa, scheduled for February 2020 required a risk assessment to avoid logistical, organizational and clinical problems. Two possible scenarios were proposed: (1) displacement of patients in another building previously used as hematological unit or (2) department split in 2 sections to carry out renovation works in different periods. Risk management of the choice relies on failure mode and effects analysis (FMEA) method, a proactive tool based on risk priority number (RPN) that ranks failure modes in terms of occurrence, severity and detection. Aim of this work is to analyze and compare the two scenarios; a team of experts in Public health with specific skills in risk management and hospital governance used FMEA to single out failure modes and to compute RPN.

Methods
Thirteen failure modes were combined together in four major possible risks: (a) lengthening waiting times and delay haematopoietic stem cell transplant procedures, (b) exposure to airborne contamination, (c) cross contamination and water contamination, (d) wrong behaviors. RPN was computed for each failure mode.

Results
Relevant failure modes were: reduction of bedsides in both scenarios (7 bedsides lost in first scenario RPN1 540 vs 9 bedsides lost in second scenario RPN2 630), less air exchange/hour in the first scenario (4/h RPN1 500 vs 6/h RPN2 400) balanced by closeness to the work site in the second scenario(RPN2 500). First scenario total RPN was 2430, second scenario was 3250.

Conclusions
Using FMEA, we assessed the different risks profile of two scenarios. Although some residual risks persisted, the first scenario shows a lower risk profile for all major risks.

Key messages
Risk assessment is a key element to better understand hospital problems and improve environmental health in healthcare setting FMEA represents a useful tool to guide hospital manager in difficult choices concerning severely immune suppressed patients.
The emerging issue of cognitive disorders and dementia among migrants
Authors: Canevelli M , Lacorte E , Cova I , Cascini S , Bargagli A M , Giusti A , Pomati S , Pantoni L , Vanacore N 
Published: October 2020

Abstract

Background
Due to population aging, people with a migration background are (and will be) increasingly exposed to the burden of chronic, age-related diseases. Specifically, the occurrence of dementia and cognitive disorders in this population of individuals can assume special clinical and public health relevance. The ImmiDem project (GR-2016-02364975) is aimed at characterizing the emerging phenomenon of cognitive disorders in migrants in Italy.

Methods
The number of dementia and mild cognitive impairment (MCI) cases among migrants living in the extended European Union was calculated by applying the age- and gender-specific prevalence rates of these conditions to the population data of international migrants provided by Eurostat. A pilot survey was addressed to a representative sample of Italian centers for cognitive disorders and dementia (CCDDs) with the aim of collecting information on the number of migrants attending these services, the adopted diagnostic, and the possible barriers and resources in the provision of care.

Results
Nearly 700,000 cases of dementia and 680,000 cases of MCI can be estimated in the migrant population living in Europe in 2018. Nevertheless, the number of migrants referred to the surveyed CCDDs was very low and was considered as stable over the last 5 years. Most of CCDDs reported the possibility of contacting cultural mediators and/or interpreters, while only a few reported the availability and regular use of translated and/or cross-cultural cognitive assessment tools.

Conclusions
The data produced by the ImmiDem project allow a preliminary characterization of the emerging phenomenon of cognitive disturbances in the migrant population. The survey will be extended to all Italian dementia services (CDCD, day centers, residential structures). Activities aimed at identifying and promoting dedicated care pathways or good practices will also be conducted.

Key messages
The clinical and epidemiological characterization of cognitive disorders occurring in migrants represent an emerging public health matter for Western countries. The onset of dementia in migrants can result in important clinical-diagnostic and healthcare complexities.
Early risk factors of obesity in 5-year-old boys and girls in Finland
Authors: Laitinen U , Lehtinen-Jacks S , Lundqvist A 
Published: October 2020

Abstract

Background
Several potential early-life risk factors for childhood overweight and obesity have been identified. Yet results regarding early risk factors and obesity (BMI-for-age ≥30 kg/m2) at pre-school age are mixed and boys and girls have rarely been studied separately. Our aim was to study whether pre- and perinatal factors predict obesity in 5-year-old boys and girls.

Methods
National register data was used to identify children born in Finland between 2007 and 2014 with data available on pre- and perinatal factors as well as on height and weight at 5 years of age (n = 131,818). Multivariable logistic regression models were used to analyze sex-specific associations between pre- and perinatal factors (e.g. maternal age, parity, pre-pregnancy BMI, smoking, diabetes, delivery method, gestational-age-adjusted birth weight) and offspring obesity.

Results
Five percent of boys (n = 3,551) and 3% of girls (n = 1,949) had obesity. Adjusted for potential confounders, the strongest predictor of subsequent obesity at 5 years of age was severe maternal obesity (BMI ≥35 kg/m2) (boys: OR 6.5, 95% CI 5.8-7.4; girls: OR 7.5, 95% CI 6.4-8.8) followed by maternal obesity (BMI 30.0-34.9 kg/m²) (boys: OR 3.9, 95% CI 3.5-4.4; girls: OR 5.5, 95% CI 4.8-6.2) and maternal overweight (BMI 25.0-29.9 kg/m²) (boys: OR 2.3, 95% CI 2.1-2.5; girls: OR 2.6, 95% CI 2.3-3.0). Other factors associated with child obesity were maternal smoking during pregnancy (boys: OR 1.8, 95% CI 1.6-1.9; girls: OR 2.0, 95% CI 1.8-2.2) and being born large for gestational age (boys: OR 1.9, 95% CI 1.6-2.2; girls: OR 2.1, 95% CI 1.8-2.6).

Conclusions
These findings indicate that childhood obesity may partly originate before conception, gestation and birth. As prevention of obesity may be economically and socially more sustainable than treatment of its consequences, emphasis should be put on early interventions. Particular attention should be paid on preventing maternal overweight and obesity.

Key messages
Maternal obesity was the strongest predictor of child obesity at 5 years of age. Investing in maternal health from as early as before conception may help prevent offspring obesity.
Lactational exposure to phthalate monoesters among breastfed infants in Italy
Authors: Arletti M , Maione D , Fioretti E , Panciroli G , Predieri G , Pinetti D , Bargellini A , Facchinetti F , Fantuzzi G , Righi E 
Published: October 2020

Abstract

Background
Phthalates are chemicals widely used as additives in plastics, cosmetics and medical devices. Due to their endocrine disrupting action and ubiquitous environmental presence, the detection of their levels in breast milk is a crucial public health issue. However, up to date limited information exists on lactational exposure to phthalates in Italy. We aimed to determine the levels of 6 phthalate monoesters in breast milk of women living in Modena (Italy), to investigate the potential sources of exposure and to calculate the Estimated Daily Intake (EDI) for breastfed infants.

Methods
In this cross-sectional study 201 women (19-45 years) living in Modena (Northern Italy) provided a sample of breast milk (30-40 days postpartum) and filled in a questionnaire on personal data and on potential sources of exposure to phthalates. Samples were analyzed by triple Quad LC/MS Mass Spectrometry. Phthalates levels were used to calculate newborns' EDIs that were compared with the Tolerable Daily Intake (TDI) set up by the European Food Safety Authority (EFSA).

Results
Monoethyl phthalate (MEP) and monoisononyl phthalate (MiNP) were detected in most samples, respectively, in 173 (86%; mean: 14.50±80.88; range: 0.03-674 μg/l) and 160 samples (80%; mean: 1.41±2.48; range: 0.04-18.40 μg/l). Levels appeared higher in women more frequently consuming food and beverages preserved in plastic containers or using cosmetics, although differences were not significant. The EDI levels for MEP (mean: 2.08±11.39 µg/kg BW/day) and MiNP (mean: 0.20±0.33 µg/kg BW/day) appeared below the TDI values set up by EFSA.

Conclusions
Although the widespread diffusion of phthalate monoesters in breast milk, their levels resulted lower than those reported in other studies and the EFSA recommended values. Thus, the use of breast milk, a unique nourishment for infants, should not be discouraged.

Key messages
Monitoring phthalates’ levels in breast milk is crucial to check breastfed infants’ exposure and to prevent potential health risks associated with this exposure. It’s essential to adopt effective public health interventions to reduce phthalates dissemination in environment and food and consequently the maternal and infant exposure to these contaminants.