bluuebunny/crossref_metadata_2025_split huggingface dataset:
Challenges and innovations in Primary Health Care in the Amazon: A Scoping Review
Authors: Sousa A , Wallace C , Farmer J , Herkrath F J , Bousquat A 
Published: October 2020

Abstract

Background
The Amazon region crosses the territorial borders of nine countries with a vast complexity of ecological and social relations. Outside of large and medium cities, this region comprises a mosaic of ranches, villages, farms, isolated houses and small towns scattered over a vast territory, in large part accessed only by waterway. Working with health in this region requires specific strategies that respect the dynamics of this place. This research aimed to reveal the challenges and innovations of Primary Health Care (PHC) in places outside the largest cities in the Amazon.

Methods
The scoping review methodology was applied to peer-reviewed articles. Six databases were searched to identify scientific papers published in English, Spanish and Portuguese between January 2000 and November 2019. The analytical strategy was to combine descriptive statistics and qualitative content analysis to extract from each article all the content related to the research questions.

Results
This review included 26 papers. The most frequent challenges reported in the studies were related to the way of working (8), specific training for professionals (5), leadership and governance (4) and infrastructure improvement (2). A smaller number of studies were dedicated to innovative experiences, which approached training and methodologies for health agents recruited in the communities (4), technologies to the services (2) and a river unit as a model to work in Amazon(1).

Conclusions
The challenges presented in this review indicate the need to build services that are more sensitive to Amazonian locations and the need to train professionals for this region. Also, it revealed innovations with positive impacts which can be taken as key lessons regarding the functioning of PHC in the Amazon.

Key messages
This research fills a knowledge gap about PHC in the Amazon. The challenges and innovations presented in the review provide insights to assist PHC policy makers and managers with the design and delivery of health services in the Amazon.
External causes in women assisted by the Mobile Emergency Service - SAMU, in Espírito Santo, Brazil
Authors: Machado E , Almeida F , Neto C , Barbosa R , Sogame L , Oliveira J , Pinto H , Duarte S , Vieira L 
Published: October 2020

Abstract

Background
External causes are events that lead to traumas, injuries and any health problems, whether deliberate or not, with sudden onset and with immediate consequence, which may or may not lead to death or incapacitating injuries. Studies show that the main causes of death of women in fertile period are external causes, and they associate this fact with the change in habits and lifestyle adopted by this group in modern times that make them more vulnerable to the risks of becoming ill or dying from such causes. The objective of this study is precisely to analyze the prevalence of the main external causes in women assisted by SAMU 192 in Espírito Santo, Brazil, and in this way, assist in the development of accident and violence prevention strategies and also contribute to the scientific society through the description of the profile epidemiological profile of these events.

Methods
This is a cross-sectional study of primary care provided by SAMU 192, in the state of Espírito Santo, in 2015, in which only women victims of traffic accidents, aggression or falls were selected.

Results
Among the women assisted by SAMU 192, 23.5% were victims of accidents and violence. Of this total, 48.6% received assistance for falls, 46.6% for traffic accidents and 4.9% for aggression. Adulthood was the most frequent, with an average age of 44.9 ± 22.7 years.

Conclusions
External causes involving women represent a major problem in Brazil and worldwide. In Espírito Santo, falling was the most common type of external cause and mainly affected the elderly woman, while the traffic accident mainly affected the adult woman. As for the aggressions, these occurred mainly at night with association with the use of alcoholic beverages. Thus, it is immensely necessary to develop actions to promote and prevent external causes of harm to women's health in the state of Espírito Santo.

Key messages
Knowing what affects the most women's health in an emerging country like Brazil, is essential for public policy actions aimed at reducing the femininity, sexism and the death of women in general. Violence against women is an underreported event because of several factors, leading to the concealment of violence, emphasizing once again the importance of public policies for this purpose.
Experiences of using Cochrane systematic reviews by local HTA units
Authors: Poder T G , Rhainds M , Bellemare C , Deblois S , Hammana I , Safianyk C , St-Jacques S , Dagenais P 
Published: October 2020

Abstract
The aim of this study is to evaluate the utilisation of CSRs by Quebec's local health technology assessment (HTA) units to promote efficiency in hospital decision-making. A survey was conducted using a structured online questionnaire to examine: Characteristics of the HTA units; Knowledge about works and services from the Cochrane Collaboration; Level of satisfaction about the use of CSRs; Facilitating factors and barriers to the implementation of CSRs evidence in a local context; Suggestions to improve the use of CSRs. Data accuracy was checked by two independent evaluators (TGP and CAB). Ten HTA units participated. Mean number of staff was 6.3 [2-18], producing about 4.7 reports per year [2-7.3]. From their implementation a total of 321 HTA reports were published (49.8% included a SR). Works and services provided by the Cochrane collaboration were very well known and HTA units were highly satisfied with CSRs (80-100%). However, only 24.7% (21/85) of topics were searched with success. As regards to applicability in HTA and use of CSRs, major strengths were as follow: Useful as resource for search terms and background material; May reduce the workload (e.g. brief review instead of full SR); Use to update a current review. Major weaknesses were: Limited use since no CSRs were available for many HTA projects; Difficulty to apply findings to local context (lack of contextualisation); Focused only on efficacy and innocuity; Cannot be used as a substitute to a full HTA report. This study provided a unique context of assessment with a familiar group of producers, users and disseminators of CSRs in hospital setting. HTA units generally use other articles from the literature or produce an original systematic review in complement with CSRs. These results led to some suggestions to improve the use of CSRs by HTA units. However, the main limit for the use of CRS in local HTA will remain its lack of contextualisation.

Key messages
The main limit for the use of CRS in local HTA will remain its lack of contextualization. Context and scientific data are complementary.
Anti-meningococcal B vaccination in Italian adolescents: a cost-effective health opportunity
Authors: Panatto D , Landa P , Amicizia D , Lai P L , Lecini E , Bechini A , Bonanni P , Boccalini S 
Published: October 2020

Abstract

Background
Invasive disease due to Neisseria meningitidis (Nm) is a serious public health problem even in developed countries, owing to its high lethality rate (8-15%) and the invalidating sequelae suffered by many (up to 60%) survivors. As the microorganism is transmitted via the airborne route, the only available weapon in the fight against Nm invasive disease is vaccination. Our aim was to carry out an HTA to evaluate the costs and benefits of anti-meningococcal B (MenB) vaccination with Trumenba® in adolescents in Italy, while also considering the impact of this new vaccination strategy on organizational and ethics aspects.

Methods
A lifetime Markov model was developed. MenB vaccination with the two-dose schedule of Trumenba® in adolescents was compared with 'non-vaccination'. Two perspectives were considered: the National Health Service (NHS) and society. Three disease phases were defined: acute, post-acute and long-term. Epidemiological, economic and health utilities data were taken from Italian and international literature. The analysis was conducted by means of Microsoft Excel 2010®.

Results
Our study indicated that vaccinating adolescents (11th year of life) with Trumenba® was cost-effective with an ICER = € 7,912/QALY from the NHS perspective and € 7,758/QALY from the perspective of society. Vaccinating adolescents reduces the number of cases of disease due to meningococcus B in one of the periods of highest incidence of the disease, resulting in significant economic and health savings.

Conclusions
This is the first study to evaluate the overall impact of free MenB vaccination in adolescents both in Italy and in the international setting. Although cases of invasive disease due to meningococcus B are few, if the overall impact of the disease is adequately considered, it becomes clear that including anti-meningococcal B vaccination into the immunization program for adolescents is strongly recommended from the health and economic standpoints.

Key messages
Free, large-scale MenB vaccination is key to strengthening the global fight against invasive meningococcal disease. Anti-meningococcal B vaccination in adolescents is a cost-effective health opportunity.
Azathioprine in the maintainance remission in inflammatory bowel disease patients: 7-year follow up
Authors: Cassieri C , Mastromatteo A M , Pica R , Zippi M , Corazziari E S , Paoluzi P , Lecca G P , Vernia P , Brandimarte G , Nasi G 
Published: October 2020

Abstract

Background
Azathioprine (AZA) and thiopurine are widely used for induction and maintenance of remission in steroid dependent patients with inflammatory bowel disease (IBD).

Methods
Aim of this study has been to investigate its efficacy and safety in maintaining steroid-free remission in steroid dependent IBD patients seven year after the institution of treatment. Data from consecutive IBD outpatients referred in our Institution, between 1985-2016, were reviewed and all patients treated with AZA were included in this retrospective study. AZA was administered at the recommended dose of 2-2.5 mg/kg.

Results
Out of 2802 consecutive IBD outpatients visited in the index period, AZA was prescribed to 433 patients, 236 (54.5%) were affected by Crohn's disease (CD) and 197 (45.5%) by ulcerative colitis (UC). One hundred and seventy-nine patients with a follow-up &lt; 84 months were excluded from the study. Two hundred and fifty-four patients were evaluated, 141 (55.5%) with CD and 113 (44.5%) with UC. One hundred and thirty-nine (54.7%) were male and 115 (45.3%) female (average age of 35.62 ± 14.20 SD years, range 14-74 y.). Seven year after the institution of treatment, 127 (50%) patients still were in steroid-free remission (83 CD vs 44 UC, 58.8% and 38.9%, respectively, p = 0.0024), 71 (27.9%) had a relapse requiring retreatment with steroids (29 CD vs 42 UC, 20.6% and 37.2%, respectively, p = 0.0047), 56 (22.1%) discontinued the treatment due to side effects (29 CD vs 27 UC, 20.6% and 23.9%, respectively). Loss of response from 1st to 7th year of follow-up was low, about 20%.

Conclusions
Seven year after the onset of treatment 50% of patients did not require further steroid courses. After the first year loss of response was low in six subsequent years. In the present series the maintenance of steroid-free remission was significantly higher in CD than in UC patients. The occurrence of side effects leading to the withdrawal of AZA treatment has been low.

Key messages
An important therapeutic moment of IBD is mantaining remission in steroid dipendent patients. AZA can be a viable and inexpensive alternative to treath these patients.
Hospital resilience after the 2015 earthquake in Nepal: a qualitative study with hospital staff
Authors: Moitinho de Almeida M , van Loenhout J , Singh R , Mahara D P , Guha-Sapir D , Aujoulat I 
Published: October 2020

Abstract

Background
Research on hospital resilience is scarce and favours top-down approaches, and evidence from the field and operational levels is lacking. The aim of our study was to understand the mechanisms of hospital and individual resilience experienced by staff from a tertiary hospital in Kathmandu, Nepal, after the 2015 Earthquake.

Methods
We conducted semi-structured interviews with different professionals in May 2018; undertook a deductive thematic analysis of hospital resilience using the framework proposed by Bruneau et al; and used an inductive thematic analysis for individual resilience.

Results
The earthquake caused different types of burden to the hospital and individuals. Redundancy was mostly influenced by linkages with lower levels of care. Resourcefulness consisted mostly of spontaneous adaptations, with task shifting the most important for human resources. External provision of resources enabled the transfer of part of the burden but precipitated accountability-related challenges. The hospital's robustness depended not only on its physical resistance, but also on the functional capacity to provide life saving care, although routine services were interrupted and quality decreased. The hospital ensured rapidity in providing life saving care to the victims and re-start of routine activities, but recovery to a sense of normality was more conflicting and dependent on the individual. Individual resilience was dictated by safety, a sense of meaningfulness, self and external appreciation, and community support.

Conclusions
Our study shows the importance of staff experiences to improve hospital resilience. Disaster plans should acknowledge the role of task shifting, and basic care should be taught to all, not just those with clinical functions. Health workers are extremely overwhelmed during disaster response, and disaster plans should engage staff at an early stage to ensure they feel safe and sufficiently supported.

Key messages
Our work is one of the first to study hospital resilience with field data from qualitative interviews with hospital staff. Hospital resilience strategies should also address individual resilience of hospital staff.
Early scientific response to COVID-19 epidemic: a scientometric perspective
Authors: Golinelli D , Nuzzolese A G , Boetto E , Rallo F , Greco M , Degli Esposti M , Fantini M P 
Published: October 2020

Abstract

Background
The recent COVID-19 epidemic is showing how the response of the scientific literature is fundamental in the first days following the onset of a new epidemic. Quantifying which studies have a greatest impact can help researchers and policymakers in controlling the epidemic. The aim of this study is to describe the early scientific production in response to the COVID-19 epidemic through a scientometric analysis.

Methods
The study consisted of: 1) review of the scientific literature produced in the 30 days since the first paper related to COVID-19 has been published on Pubmed; 2) Identification of papers' Digital Object Identifiers (DOI) and analysis of related metrics with the construction of a 'Computed Impact Score' (CIS) that represents a unifying score over heterogeneous bibliometric indicators. The CIS takes into account all the bibliometric indicators both traditional (i.e. counting of citations) and alternative (i.e. altmetrics). In this study we use the altmetrics provided by Plum Analytics (PlumX). All bibliometric indicators for the selected papers have been collected by using their corresponding DOIs as the key for querying Scopus API, which integrates PlumX. On top of those indicators we compute the CIS. The papers with higher CIS are discussed and presented.

Results
239 papers have been included in the study. A threshold for CIS of t = 1.04 (i.e.95% quantile) allowed us to record 8 papers as potentially impactful. The 8 papers are: 6 case reports, 1 methodological study, 1 editorial. First authors come from China (n = 6), USA (n = 1) and Germany (n = 1). The main topics are: case/s description (n = 5), outbreak investigation (n = 2) and 1 genomic study.

Conclusions
The early response of the scientific literature during an epidemic does not follow a pre-established pattern. Tracing the traditional and non-traditional metrics measures of papers can help to understand and evaluate the impact of literature on the scientific community and general population.

Key messages
The dynamic of the scientific community represents an important aspect of the early response to the onset of a new epidemic, which must be studied also to increase systems’ preparedness. In a connected digital world, tracing metrics measures of scientific papers can identify those with the greatest impact and help professionals to correctly inform the population.
Individual preparedness for natural disasters: a cross-sectional study from Portugal
Authors: Ferreira R , Rodrigues C , Correia-Santos P , Moreira M , Silva S 
Published: October 2020

Abstract

Background
Individual preparedness is critical in mitigating the adverse effect of natural disasters (ND). Factors influencing preparedness are complex and multifaceted, with certain groups having different needs and vulnerabilities. We aimed to explore the factors associated with individual ND preparedness in residents from Vila Nova Gaia (VNG), Portugal.

Methods
A cross-sectional study was conducted in VNG, Portugal, in January 2020 (N = 192; ≥18 years). Data on sociodemographic characteristics, risk perception, and preparedness were collected using a structured questionnaire, in parishes randomly selected. Crude and adjusted odds ratio (OR) and respective 95% confidence intervals (CI) were estimated using logistic regression models.

Results
About 33% of participants aged ≥65 years and 66% had low education. Results show that 20% had a survival kit. In univariate comparisons, older (11% vs. 24%, p=.029) and lower educated participants (≤12th grade: 13% vs. &gt;12th grade: 32%, p=.002) were less likely to have a survival kit; only education remained associated after adjustment for age (OR = 2.61, 95%CI:1.22-5.58). About 21% had a family plan for disaster and only education level is associated (≤12th grade: 17% vs. &gt;12th grade: 29%, p=.040). Almost 35% had a family member with basic life support training; older age, lower education and higher risk perception were negatively associated and these remained after adjustment (≥65 vs. &lt;65 years OR = 0.36, 95%CI:0.16-0.77; ≤12th vs. &gt;12th grade OR = 0.40, 95%CI:0.21-0.78; risk perception OR = 0.66, 95%CI:0.45-0.95). Only 22% participated in community drills; older people (6% vs. 31%, p&lt;.001) and less educated (14% vs. 39%, p&lt;.001) were less likely to have ever participated, which persisted in multivariate model.

Conclusions
Our findings revealed a low-level of ND preparedness, and older and less educated people seem to present worse preparedness. This highlights the need to design specific public health interventions among these groups.

Key messages
We found a low-level of individual preparedness for natural disasters in VNG, Portugal. Community-based public health interventions are needed to improve individual preparedness for natural disasters. Specific interventions targeting older and less educated people should be designed to decrease their vulnerability facing a natural disaster.
Knowledge and attitudes of medical students about SARS-CoV-2
Authors: Taneri P E 
Published: October 2020

Abstract

Background
Since the declaration of the new coronavirus outbreak, there is a growing concern and panic among people worldwide. The aim of the study is to evaluate the knowledge and attitudes of medical students towards current outbreak.

Methods
This cross-sectional study was conducted between 20 February - 4 March 2020 via an online survey with 285 students from one faculty of medicine in Turkey. Ethical approval was obtained from Bahcesehir University Clinical Research Ethics Committee.

Results
Among participants, 59% were female and 70% were Turkish citizen. Mostly, students were getting updates from media (70%) and the following source was WHO (18%). Of all participants, 60% correctly stated that SARS-CoV-2 has lower mortality rate than SARS and MERS. The most used protections were hand-sanitizers, avoiding close contacts with Asians and using masks in crowded areas (respectively 67%, 30%, 29%). On the scale 1 to 10 (1: strongly trust, 10: strongly do not trust); median for WHO's information process was 7, WHO's outbreak management was 6, Turkish Ministry of Health's (TMH) information process was 5 and TMH's outbreak management was 5. Turkish students significantly had lower trust for all of the matters (Mann-Whitney U = 7157.0, p = 0.040; Mann-Whitney U = 6405.5, p = 0.001; Mann-Whitney U = 5313.0, p &lt; 0.001; Mann-Whitney U = 4679.5, p= p &lt; 0.001). Of the participants, 19% said they would not get vaccinated if there was a vaccine. Most common reasons were not feeling at risk and not trusting new vaccines.

Conclusions
There is a lack of the knowledge of SARS-CoV-2 among students, and for that reason a scientific conference about SARS-CoV-2 took place at the faculty in 6th March as an intervention. Especially Turkish students had lower trust for information process and outbreak management of WHO and TMH. One out of five students was not considering to get vaccinated if there was a vaccine for COVID-19.

Key messages
Turkish students had lower trust for information process and outbreak management of WHO and Turkish Ministry of Health. One out of five students was not willing to get vaccinated if there was any.
A silent “shipyard eye”: lessons from an epidemic keratoconjunctivitis outbreak in Portugal
Authors: Moreira A , Abreu Gomes F , Mouro M , Lopes D , Bragança Pereira M , Duarte S , Cunha I , Machado Gil M , Calado J 
Published: October 2020

Abstract

Issue
Adenoviral conjunctivitis is the most common cause of conjunctivitis. Its most severe form is epidemic keratoconjunctivitis (EKC). This highly contagious disease is the only form to significantly involve the cornea and may cause visual impairing sequelae that persist for years.

Description
On January 2020, staff members at a childcare facility (CCF) alerted the Public Health Unit of Loures-Odivelas to a suspected conjunctivitis outbreak. The CCF was responsible for 57 children, separated in different rooms: a nursery (4-12 months), a pre-school (1-3 years) and a kindergarten (4-5 years). At the initial assessment, 4 cases of active disease were identified, all of which were at home and under treatment. CCF staff had previously identified 33 cases. Symptom onset of the index case had occurred more than 5 weeks before the alert. Infection control and epidemiological investigation were initiated. CCF staff was instructed to implement preventive measures, including careful disinfection of surfaces and toys, as well as frequent handwashing. Information about the disease and recommendations were sent to the children's caretakers.

Results
A total of 87 cases distributed in 8 weeks were identified: 28 at the CCF (25 children and 3 workers) and 59 close contacts (50 adults and 9 children). Average duration of disease was 14.1 days. In total, 43.9% of the children attending the CFF were affected. The highest attack rate was observed at the pre-school (69.2%, against 38.9% and 17.6% at the nursery and the kindergarten, respectively). 88.0% of the CCF children's households were affected. The average number of affected close contacts per affected child attending the CCF was 2.63. Corneal involvement was observed in 17,4% of cases.

Lessons
EKC outbreaks may go unnoticed by public health services, despite its high contagiousness and impact. Improvement of communication with organizations in the community is essential to secure future early detection and intervention.

Key messages
Epidemic keratoconjunctivitis is a highly contagious disease with potential long-term consequences. Early detection and intervention by public health services are essential to mitigate the impact of outbreaks and depend on well-established communication lines with institutions in the community.