bluuebunny/crossref_metadata_2025_split huggingface dataset:
Perception of health risk linked to environmental factors by pregnant women
Authors: Sauvant-Rochat M , Kouamé N G L , Bernard L , Marie C , Lémery D , Vendittelli F 
Published: November 2019

Abstract

Bacground
Recently, the International Federation of Gyneco-Obstetrics (FIGO) advocates limiting exposure to chemicals present in everyday products during pregnancy. To date, the chemicals, and the risks related, are not well-known, as well by perinatal health professionals (PHP) as by pregnant women (PW). AIMS: to estimate the sensitivity to the environment and the perception of risks related to chemical substances by pregnant women.

Methodology
A descriptive cross-over study was carried out among pregnant women ((followed or hospitalized in different health establishments in Auvergne). The collection of data (socio-demographic characteristics, sensitivity to the environment, use of cosmetics, perception of environmental risks) was carried out by interviewers, using a standardized questionnaire. The statistical analysis (logistic regression) was performed with Modalisa® 8.0 (Kynos, Paris).

Results
Three hundred questionnaires were analyzed. The sensitivity to the environment is estimated at 6.3 ± 1.7 (scale 0 to 10). For the majority of women, exposure to chemicals is primarily related to the use of cleaning products, DIY products, and gardening products. Food can also be a source of exposure (especially for pesticides). On the other hand, cosmetics are not perceived as products containing chemical substances, with potential risk to health. This vision of chemical substances is related to age, educational level, socio-professional category and sensitivity to the environment. Only 5% (19/300) of PW considered health professionals as referents on chemical substances and environmental problems.

Conclusions
This study highlighted the sensitivity of pregnant women to environmental issues, but a lack of knowledge of chemicals and the risks which they represent for health. It is important to reinforce the information given to pregnant women by perinatal health professionals about healthy behaviors.

Key messages
Pregnant women don’t know all sources of exposure to chemical substances. Training in environmental health must be increased for perinatal health professionals.
Capacity Building in Nurturing Care in Serbia
Authors: Jankovic S Mladenovic , Matijevic D , Tamburkovski G , Grujicic A , Markovic M 
Published: November 2019

Abstract

Background
Training program for home visitors on early child development was developed and implemented within UNICEF supported projects involving 25 primary health centers. Training content was notably based on resource modules “Supporting Families for Nurturing Care”, adapted according to the local context. Health professionals are seen as the critical actors to support development of young children and their families. Family-centered approach that addresses social as well as medical dimensions of problems became priority in their practice with a special focus on working with children from socially deprived settings and children with disabilities.

Objectives
The main objective was to improve knowledge and practice of home visitors on early child development based on most recent scientific evidence. Broad spectrum of topics was covered including engaging fathers, early detection of postpartum depression, attachment, developmental monitoring, age-appropriate play, home safety, stigma and discrimination. Training were organized as interactive face to face sessions and online courses and attendees were actively engaged in reflection. Comprehensive check list with various assessment instruments was developed to provide guidance to home visitors in implementation of gained skills.

Results
Increase in knowledge of 150 home visitors was between 57.6% and 82.9%. Enhanced knowledge and skills have been applied in 14912 families of which socially deprived was 34.5% during 2-year period of implementation. Parent-child interactions, assessed by visiting nurses, were improved by 32.6%, responsive feeding practices by 27.4%, while age-appropriate play by 34.4% after interventions during home visits.

Conclusions
Well-developed monitoring system was crucial for implementation of gained knowledge and skills in practice of home visitors.

Key messages
Home visitors were empowered to take a strengths-based approach in their work with families. Developed tools facilitated prioritization of most vulnerable families and tailoring support according to needs.
Prenatal exposure of extra vitamin D from fortification and later risk of inflammatory bowel disease
Authors: Duus K S , Moos C M , Frederiksen P , Andersen V , Heitmann B L 
Published: November 2019

Abstract

Introduction
Inflammatory bowel disease (IBD) is a chronic immune-mediated inflammatory disease that can affect the entire digestive tract. Approximately 1% of the Danish population has IBD today. Both the incidence and prevalence of IBD are increasing globally, but the etiology of IBD is still not fully understood. Some, but not all studies find that vitamin D has both protective and therapeutic effects on IBD. To our knowledge, no other study has investigated prenatal exposure to extra vitamin D from either fortified food, diet or supplements in relation to IBD. The aim of this study was to investigate whether a small extra dose of vitamin D from fortification during gestation, was associated with a lower risk of developing IBD in the offspring.

Methods
In 1985 mandatory fortification of margarine with vitamin D in Denmark was canceled. To investigate the effect of this policy change we selected all individuals from 2 full year birth cohorts before and after the termination of the mandatory fortification. All individuals were followed for 30 years. By merging data from the Medical Birth Registry with the Danish National Patient Registry, we identified individuals with IBD.

Results
217,249 individuals were included in the analysis. 875 among the exposed and 1102 among the unexposed fulfilled the criteria for being diagnosed with IBD. A lower odds ratio OR = 0.867 (95% CI: 0.792;0.947) for IBD was observed among those who had been exposed to extra vitamin D from fortified margarine during gestation, compared to those who had not been exposed. The analysis was adjusted for sex and season of birth, but results were essentially similar before and after this adjustment.

Conclusions
This study shows, that a small extra dose of vitamin D from fortified margarine during gestation may lower the risk of developing IBD in the offspring, until the age of 30. If these results can be replicated, fortification with vitamin D could be recommended to prevent IBD on a public level.

Key messages
Prenatal exposure of vitamin D from fortified food could lower the risk of IBD later in life. Fortification with vitamin D even at a relatively low level could have public health benefits.
Individual-level high definition spatial distribution of mammography uptake in Geneva (Switzerland)
Authors: Sandoval J L , Himsl R , Joost S , Guessous I 
Published: November 2019

Abstract

Background
The local social and physical environment influences health outcomes and individual behaviour. It remains unknown if the environmental influence is independent of individual socioeconomic status (SES). We studied the spatial distribution of mammography screening uptake in the Swiss urban population of Geneva and determined its independence from SES.

Methods
We used individual-level geo-referenced data (n = 5 002) from the participants in the Bus Santé study, a population-based cross-sectional study ongoing in Geneva since 1992. Data from 1992 to 2014 have been included in this study. Local indicators of spatial association (LISA) were calculated and used to assess the spatial dependence of mammography uptake (defined as having had a mammography in the past). We report unadjusted spatial clusters; adjusted for neighbourhood income and individual educational attainment; and for demographic variables (age and Swiss nationality). Furthermore, we evaluated the association between the distance to the nearest screening centre and the identified spatial clusters.

Results
Mammography uptake was not randomly distributed, with spatial clusters overlapping with those of SES. Spatial clusters were reduced to 56.2% of their initial size (n = 1,033) after adjustment for SES variables. Adjustment for age and nationality further reduced the proportion of individuals exhibiting spatially-dependent behaviour (to 36.5% of the initial size). Distance to the nearest screening centre was not associated with the spatial distribution of mammography uptake.

Conclusions
High definition spatial distribution studies using analysis of individual data allow identifying spatial clusters which are not based on pre-determined administrative units (e.g. postal code) but rather on individual behaviour. Persistent spatial clusters after adjustment for SES and demographic confounders suggest additional area-level determinants influencing the spatial distribution of mammography uptake.

Key messages
High definition spatial studies can help uncover new patterns of health outcomes distribution independent of SES and based on individual behaviour, rather than administrative units. While SES explains a great proportion of the spatial distribution of mammography uptake, other still elusive factors may be contributing to the observed spatial inequalities in mammography uptake.
Mathematical modeling of medical equipment needs for public health purposes
Authors: Gajic J , Gengeljacki I , Tesic N , Misanovic N , Zunji M , Bjelica N , Cocic S , Jevtic M , Luzanin Z , Jakovetic D 
Published: November 2019

Abstract

Issue
A public health challenge facing many developing countries is the lack of medical equipment, such as mammograms and CT scanners, as well as the unequal access to available equipment. In order to rationalize costs and provide patients with more equal access to preventive and diagnostic services, optimized distribution based on actual needs, considering factors such as population structure and private sector capacities is necessary. The suggested optimization was made in cooperation between students of public health, applied mathematics, and information technology.

Description of the problem
Based on Open data released by the institutions of Republic of Serbia, pertaining to radiological equipment operated by state healthcare facilities over a period of three years (2015, 2016 and 2017) and projected population, by sex, age, and region, a mathematical model has been made, aimed at optimizing equipment distribution across the 4 regions. With the goal of finding an adequate model, region and year specific data were used for calculating the Gini coefficient. Multiple alternatives were tested over a period of a few months, with the results displayed graphically, using a web application presenting the equipment distribution.

Results
In maximizing the territory covered, the availability of the equipment to the patients was increased, and with it, the equipment’s utility. The results indicate savings can be achieved, taking into consideration the capacities of the private sector.

Lessons
An adequate mathematical model can contribute to a better distribution of equipment, as well as cost saving. Taking into consideration that inadequate funding is one of the major challenges faced by state healthcare services worldwide, with appropriate data, the model would find use in other countries as well.

Key messages
Open medical data opens up new space for action by the interested parties. Inter-professional cooperation holds great potential in solving public health problems.
Azienda Sanitaria Locale Roma 4: the external evaluation as strategy to improve vaccination services
Authors: Fusillo C , Sinopoli M T , Morucci L , Marchetti C , Quintavalle G 
Published: November 2019

Abstract

Issue
Azienda Sanitaria Locale (ASL) Roma 4 is one of the ten local healthcare companies of Lazio Region. Vaccination Service (VS), organized in 15 ambulatories, is managed by dedicated and trained staff and this organization has led to high vaccination coverage over the years. In 2017, the National Immunization Plan and the new law on mandatory vaccination required a reshaping of VS. The Health Management of ASL Roma 4 has requested an external evaluation of the VS to a private company (PC) with the aim to highlight weaknesses and strengths.

Description of the problem
The PC, through inspections and questionnaires addressed to personnel, analysed four features: amplitude of the access to the ambulatory; management of the access; communication; tools. The analysis focused specifically on vaccination for people under 18 years old.

Results
The PC underlined these weaknesses: massive free access; strong influx of users from other adjacent ASL; computerized vaccination registry not available online; absence of a centralized booking and information request system; lack of targeted use of social networks. Best practices of the VS are: vaccination stocks centrally managed; preventive interview for travellers; structured procedures shared throughout the territory; focused vaccination campaigns; information material sent to the families of the new born; online portal available to users to view their personal data and download vaccination certificates; vaccination counselling; openings dedicated to specific user categories.

Lessons
The PC suggested these solutions: division of ambulatory opening into free access and booking/active call; online computerized registry; unique call center constitution; creation of official social network pages. ASL Roma 4 activated the unique call center and taken corrective actions for the other weaknesses.

Key messages
Best practices can be used in other healthcare setting and the periodically external evaluations can improve the vaccination service. Continuously monitoring the activities improves the quality of the vaccination service.
Vaccine Prevention of Paediatric Chronic Lung Disease: Targeting Haemophilus
Authors: Parkes M , Grady KA O 
Published: November 2019

Abstract

Background
Chronic Suppurative Lung Disease (CSLD) is an emerging term encompassing a spectrum of chronic childhood respiratory disease. Characterised by early and severe infections and recurrent exacerbations, it is associated with progressive deterioration in lung function and quality of life. CSLD is highly unequally distributed and largely preventable, and is a major contributor to the global burden of chronic paediatric respiratory disease. Relatively few pathogens comprise the main culprit organisms identified in the aetiology of CSLD, over which Non-Typeable Haemophilus influenzae (NTHi) predominates.

Methods
We review developments that establish the role of NTHi in disease progression, focusing on high-risk population subgroups with an established CSLD burden. We consider current studies examining the role of prenatal NTHi and pneumococcal vaccination in preventing CSLD through reducing infections in high-risk populations, and discuss current directions in future research, including the need for precise identification of the pulmonary microbiome in CSLD.

Results
Early, repeated NTHi infections are clearly implicated in the aetiology of CLSD. Early results of current studies indicate NTHi vaccination may reduce the frequency of causal infections in high-risk groups. Clinical and immunological data show vaccination also reduces frequency of exacerbations and antibiotic usage in CSLD.

Conclusions
We provide the first clinical and immunological data for H. influenzae vaccination in children with CSLD. Targeted vaccination strategies may prevent CSLD establishment, slow progression, and potentially reduce morbidity, healthcare presentations and antibiotic consumption. This implicates vaccination as a potential aid in both antimicrobial stewardship and prevention of chronic disease. In the face of threats posed to health systems by antimicrobial resistance and the growing burden of chronic disease, vaccination is again emerging as a uniquely powerful public health tool.

Key messages
Hi vaccination can reduce infective exacerbations and antibiotic use in children with CSL. Vaccines may have a role in preventing chronic disease progression and reducing antibiotic reliance.
Severe outcomes following invasive pneumococcal disease in adults in France
Authors: Danis K , Ploy M C , Varon E , Levy-Bruhl D ,   SIIPA group, Gaillat J 
Published: November 2019

Abstract

Pneumococcal vaccine serotypes and host factors may increase the risk of severe invasive pneumococcal disease (IPD). In France, pneumococcal vaccination in adults is recommended for at-risk groups (immunosuppression or at-risk conditions/diseases). In 2014-2017, we conducted a study of IPD in adults to identify factors/serotypes associated with disease severity.
We included IPD cases, excluding meningitis, in adults from 25 acute-care sentinel hospitals in six regions. Severe cases were IPD patients either admitted to an ICU or under mechanical ventilation or with severe sepsis or shock. Infectious disease specialists collected clinical/microbiological data on all cases. We calculated adjusted risk ratios (aRR) using binomial regression.
In 2014-2017, 908 cases (median age 71 (range 18-101) years) were diagnosed; 48%(431/908) were severe and 84%(764/908) were at-risk. Compared with non-risk individuals, the risk of severe disease increased from 20% (aRR 1.2; 95%CI 1.0-1.4) in cases with 1-2 chronic diseases to 30% (aHR 1.3; 95%CI 1.0-7.0) in those with &gt;2 chronic diseases. The risk of severe disease was 42% (aRR 1.4; 95%CI 1.2-1.6) higher for PCV13 serotypes compared with non-vaccine serotypes. Among cases infected with PCV13 serotypes, the risk of severe disease did not differ (aRR 0.96; 95%CI 1.2-23) between no-risk or at-risk cases. However, among cases infected with non-vaccine serotypes, the risk increased 49% (aRR 1.5; 95%CI 2.1-22) in at-risk compared with no-risk cases (homogeneity test p = 0.03).
We observed a cumulative effect of concurrent comorbidities on severe IPD outcomes. The risk of severe IPD increased for vaccine serotypes regardless of risk status. However, non-vaccine serotypes increased the risk of severe outcomes only in risk groups, suggesting a different interplay between host factors and the pathogen in vulnerable groups. We recommend enhancing vaccination among risk groups and especially in those most at risk for poor IPD-related outcomes.

Key messages
Cumulative effect of concurrent comorbidities on severe invasive pneumococcal disease outcomes. Non-vaccine serotypes increase the risk of severe invasive pneumococcal disease outcomes only in vulnerable groups.
Potential predictors of unmet health needs among the elderly: a population-based study in Serbia
Authors: Milićević M Šantrić , Kostadinović M , Nikolić D , Todorovic J , Terzic-Supic Z 
Published: November 2019

Abstract

Background
This study assessed the prevalence of unmet health needs of the elderly and the associated factors regarding socioeconomic, health and functional status.

Methods
A secondary analysis of the 2013 National Health Survey data was conducted on a representative sample of 3540 persons aged sixty-five and older (the lowest response rate was 99.7%). Participants characteristics such as socioeconomic status, health self-perception, diagnosed chronic disease, physical functional limitations, performing essential daily activities in the home and daily personal care were explored with logistic regression analysis (Odds Ratio - OR and 95% Confidence Interval) in relation to five aspects of unmet health needs.

Results
15.8% participants had unmet health needs due to the long waiting times, 16.1%, had unmet needs for medical care, 17.7% for dental care, 15.2% for drugs prescription and 96.9% participants for mental health care. Common predictors exist for medical, dental drug prescription and due to long waiting times unmet needs including older age years, middle education, rural residence, lower wealth index, single persons, with average or bad self-perceived health, chronic disease and difficult daily performance of personal care and of home activities. Unmet mental health needs by 61% less likely had participants with average wealth index, while a greater likelihood had participants with average and bad self-perceived health by 3.7 times and 8.4 times (p = 0.035, p = 0.001) respectively, by 6.2 times those with difficulties (p &lt; 0.001) and by 5.9 times unable (p = 0.045) to perform daily activities of personal care and by 1.7 times those with difficulties (p = 0.037) to perform home activities.

Conclusions
Unmet health needs reported less than 20% of the elderly but almost all have unmet mental health needs. Unmet health needs are associated with negative health outcomes, age, low education level, single persons, rural settings, poorer households, and limited daily activities.

Key messages
Unmet mental health needs of the elderly are an extremely important problem for the health system and healthy ageing in Serbia. A strong association of unmet health needs of old, low educated elderly without partners, from rural settings and poor households with health and functional outcomes, requires responsive policies.
Midwifery matters: resilience and subjective wellbeing of midwives
Authors: Caiazzo D , Kundisowa L , Bocci G , Vonci N , Alaimo L , Ardis S , Nante N 
Published: November 2019

Abstract

Introduction
Resilience is the ability to resist, cope with life positively after suffering a negative event. Midwifery has been defined as ’emotionally demanding’; midwives with an higher levels of resilience experience higher levels of subjective well-being (SWB). The aim of this study was to evaluate the relationship between resilience and SWB amongst midwives.

Materials and methods
Data were collected using a questionnaire, distributed between September 2018-January 2019 in hospitals in the Tuscany region (Italy). For evaluation of SWB, we used OECD scale (2013) evaluating three items: actual happiness (AH); emotive wellbeing (BE) composed of positive (PA) and negative affect (NA) and life satisfaction (LS). Also, job satisfaction (JS) was evaluated. Resilience (RS) was evaluated using the Italian version of the Resilience Scale by Wagnild and Young. All items were expressed on the Likert scale, statistical analysis was performed with Minitab 18.

Results
In total 123 questionnaires were analyzed. The average scores were: AH: 6.9±1.8; BE: 5.9±1.6; PA: 6.0±1.8; NA: 4.2±2.1; LS: 7.1±1.6; JS: 6.5 ± 2.4. Average R was 130.3±18.1. RS was correlated (p &lt; 0.001) to AH (Coef=0.4), PA (Coef=0.4), BE (Coef=0.3) e LS (Coef=0.4). The sample was divided into three groups according to RS: low (LR)&lt;116, medium (MR):116-139 and high (HR) ≥140. MR represented 44%, followed by HR (35%). AH, PA, BE values were significantly higher in the HR group (ANOVA; Tukey; p &lt; 0.001). For NA the highest values were observed in the LR group, but the difference was not significant. LS resulted significantly lower in LR group (ANOVA; Tukey; p &lt; 0.001) and JS was significantly higher in medium resilience group in confrontation to other two groups (ANOVA; Tukey; p &lt; 0.001).

Conclusions
Our results confirmed, that the higher levels of RS influenced positively almost all components of SWB (AH, PA, BE, LS). On the other hand to achieve a higher level of JS the level of RS should not be nor too high, nor too low.

Key messages
Midwifery has been defined as ’emotionally demanding’, higher levels of resilience influenced positively almost all components of subjective wellbeing. The medium resilience was correlated to higher level of job satisfaction.