bluuebunny/crossref_metadata_2025_split huggingface dataset:
Preparing health professionals to practice environmentally sustainable healthcare
Authors: Madden D L , McLean M , Horton G L , Canny B , Haq B , Roiko A , Capon A , Alsop-ten Hove B , McKay I , Hankinson A 
Published: October 2020

Abstract

Background
In 2019 the WHO identified climate change and air pollution as the top global threat to health. This was illustrated by the health consequences of the catastrophic 2019-20 Australian bushfire season. Health-care systems also contribute to climate change and environmental degradation. For Australia, health care contributes 7% of total carbon emissions and produces considerable clinical and non-clinical waste which is either incinerated or sent to landfill. Despite these threats to health there is a limited response by health professions education to include climate change and environmentally sustainable healthcare in curricula.

Methods
Medical Deans of Australia and New Zealand (MDANZ) is the peak body for professional medical education in Australasia. MDANZ formed a Climate Change and Health Working Group to develop curriculum and learning resources. The Group comprises representatives of Australasian medical schools and student representative organisations. The scope for curriculum was defined by searching the literature, reviewing teaching experience, and benchmarking against relevant courses developed for medical students by peers.

Results
Five broad areas of learning were identified; graduate outcome statements and learning objectives were developed aligned with these. Once endorsed by MDANZ these were circulated to all medical schools to inform curriculum review. A resource repository is being developed to support curriculum change. Ways to measure and monitor inclusion in medical programs are being researched.

Conclusions
We must prepare future practitioners for their role in transforming health care to become carbon neutral. Using a public health approach, system level change in medical education is being supported in Australasia. All health professions have a role in providing environmentally sustainable health care. The Group provides a model that can be used by other health professions to create change at the necessary pace and scale.

Key messages
The health education sector must prepare graduates for climate change and environmentally sustainable healthcare. By working collaboratively at a systems level, change can occur at pace and scale.
CO levels in waterpipe cafes of Karachi, Pakistan
Authors: Baloch R , Pervez M 
Published: October 2020

Abstract

Background
The dangers of water-pipe smoking have been documented, but data from water-pipe (WP) cafés is lacking. Assessing carbon monoxide (CO) levels in the air inside WP cafés may aid the understanding of the toxins and exposure of the employees. The results can provide novel information regarding WP's effect on air quality which may help generate regulatory efforts to protect the café employees against WP smoke. We wanted determine the air quality through measurement of CO levels in closed room cafés and restaurants of Karachi, Pakistan.

Methods
It was a cross sectional study design. 3 WP cafes in the city of Karachi, Pakistan were surveyed during June 2015. All cafés were indoors and air-conditioned. Carbon Monoxide (CO) air samples were collected from the included cafés using CO USB Data logger. The Sampling device was left with café admin managers and was left for 30 hours at venue #1, for almost 7 hours at venue #2, and for 70 hours at venue #3 to measure the CO levels in cafés. The average sampling duration was around 36 hours. The graphs were automatically generated by the device.

Results
Overall, readings of the CO monitoring samples from all included venues were within / lower than threshold limit value (TLV) of 25 ppm, and MAK maximum workplace value of 30 ppm.

Conclusions
The findings of this study provide evidence that the air quality in water-pipe cafes is potentially hazardous to the health of its employees, which is critical to inform tobacco control policies and regulations for such venues. The study findings indicate a clear need to extend research to not only focus on the indoor air quality of water-pipe cafes, but also the biological monitoring of employees in water-pipe cafes.

Key messages
Employees working in waterpipe cafes are exposed to toxic substances that can potentially manifest adverse health effects. Air quality of indoor waterpipe cafes should be assessed to protect employees.
The three paradigms on urban health
Authors: Kim J , de Leeuw E , Harris-Roxas B , Sainsbury P 
Published: October 2020

Abstract

Background
While public health and urban planning share a historical connection in the mid-19th century, when public health and sanitation became a key guiding principle for urban planning, the two disciplines evolved in separate ways after major technological and social developments such as the development of germ theory and the ascent of biomedicine. Recently, urban planners and public health experts globally are calling for a reconnection between the health and urban planning spheres. However, there are different schools of thought around how to address health in the urban context that originates from different worldviews and epistemological traditions of the disciplines.

Methods
This study is a narrative review that explores the core beliefs and assumptions of the different research traditions that are observed around health in the urban context.

Results
The study identifies three main traditions. The 'urban health science' tradition is characterized by the pathogenic and epidemiological analysis of urban problems, suggesting predominantly technological solutions to these issues. Scholars of this tradition emphasize that urban health requires straight Cartesian causal thinking to inform interventions to promote the health of urban populations. The 'healthy cities movement' tradition is based on the principles of the Ottawa Charter for Health Promotion with strong roots in social movements, and takes a value-based approach to solutions that embraces the principles of solidarity, equity, sustainability and empowerment. While these two traditions originate from the discipline of public health, the third 'healthy urban planning' tradition emerged from the urban planning discipline and proposes to include health as objectives in the spatial development of cities.

Conclusions
This study identifies the core beliefs and assumptions of the paradigms of urban health and highlights areas where beliefs and assumptions epistemologically or practically overlap and interface.

Key messages
Scholars from different epistemological traditions possess different worldview on the problem definition and solution to urban health. The three paradigms on urban health are not mutually exclusive, rather each could learn from each other to promote the health of urban citizens.
Air pollution and rhinitis in the Constances cohort
Authors: Savouré M , Lequy E , Vienneau D , de Hoogh K , Nadif R , Jacquemin B 
Published: October 2020

Abstract
The prevalence of rhinitis has increased in the past decades. We aim to study the effect of air pollution, as one of the environmental factors that may explain the increase of rhinitis prevalence. A total of 21507 (80%); of the 26737 participants included until December 2013 in Constances, a large French population-based cohort, answered standardized questions on rhinitis in 2014. Ever rhinitis was defined by a positive response to “Have you ever had a problem with sneezing or a runny or a blocked nose when you did not have a cold or the flu?”. Current rhinitis was defined among those reporting ever rhinitis and nasal symptoms in the past 12 months. Annual exposure to nitrogen dioxide (NO2), particulate matter ≤2.5 µm (PM2.5) and black carbon (BC) was estimated at the participants' residential address by extrapolating European land-use regression models for 2010 to year 2014. Associations between annual exposure to air pollution and rhinitis were estimated using a logistic model adjusted for age, gender, smoking and education level.
After exclusions, 18506 participants were included (mean age: 52, 45% men, 13% ever asthma). Ever and current prevalence of rhinitis were 58% and 41% respectively. Significant and positive associations were found between each pollutant and current rhinitis. Adjusted ORs were 1.26 [1.16-1.36] per 15 µg.m-3 increase in NO2, 1.28 [1.17-1.41] per 5 µg.m-3 increase in PM2.5, and 1.36 [1.22-1.51] per 10-5.m-1 increase in BC. Results were similar for non-smoking participants and those whose address had not changed since inclusion.
Exposure to air pollution is associated with current rhinitis in adults in the general population. In view of the high prevalence of rhinitis and its costs, these findings have an important public health impact and reinforce the need to reduce the population's exposure to air pollution.

Key messages
Exposure to air pollution is associated with current rhinitis in adults in general population. These results contribute to a better understanding of health effects of air pollution.
The impact of heatwaves on ED visits at Ljubljana University Medical Center, from 2013 to 2017
Authors: Percic S , Hojs A , Cegnar T , Pohar M , Mozina H 
Published: October 2020

Abstract

Background
Morbidity increases during the summer heatwaves globally. Despite increasing heat load, public health efforts probably improve public awareness and behavior. Our study aimed to assess whether ED visits during heatwaves in Slovenia decreased in the last years.

Patients and Methods
We analyzed data from the Ljubljana University Medical Centre database for consecutive patients arriving at ED, covering the Osrednjeslovenska region (around 650.000 people) in the summer period 2013 to 2017. We estimated relative risks for a number of ED visits for the observed diagnoses, sex, and age, as well as 95% confidence intervals and excess ED visits associated with heatwaves occurring in all observed years.

Results
Statistically significant were: in 2013: all, all causes (RT 0.78 (95% IZ, 0,72-0,85)); male, all causes (0.78 (0.70-0.88)); female, all causes(0.77 (0.68-0.87)); 75+ years, all causes (0.79 (0.70-0.91)); all, circulatory system (0.74 (0.63-0.86)); male, circulatory system (0.74 (0.60-0.91)); female, circulatory system (0.74 (0.59-0.93)) and all, digestive system (0.7 (0.35-0.91), in 2014: all, all causes (1.17 (1.07-1.28)); male, all causes (1.14 (1.01-1.29)); female, all causes (1.2 (1.06-1.35)) and all, 75+ years, all causes (1.21 (1.06-1.38)), in 2015: all, all causes (1.08 (1.01-1.16)); female, all causes (1.1 (0.01-1.22)); all, endocrine diseases (1.47 (1.03-2.1)), in 2016: all, all causes (0.92 (0.86-0.98)) and all, 75+ years, all causes (0.9 (0.81-0.99), in 2017: all, 75+ years, all causes (0.89 (0.81-0.97)), all, circulatory system (0.86 (0.77-0.96)), female, circulatory system (0.83 (0.7-0.97)); all, digestive system (0.76 (0.32-0.93)) and all, endocrine diseases (1.38 (1.02-1.85)).

Conclusions
The scientific evidence shows that it is possible to influence heat-related outcomes with proper public health interventions. The results of our research show a decrease in ED visits during heatwaves and support the hypothesis that public behavior is changing.

Key messages
ED visits due to heatwaves can be preventable. In Slovenia we are on good way with public health interventions. Heatwaves will become more frequent, more intense and will last longer, so we must continue with public health efforts.
An evaluation of the global health security agenda steering group governance interventions
Authors: DeShore N E , Johnson J A , Malone P , Greenhill R , Wuenstal W 
Published: October 2020

Abstract

Background
Member States lack of compliance with 2005 IHR implementation led to the launched of the Global Health Security Agenda. This research will provide an understanding of how the Global Health Security Agenda Steering Group (GHSA SG) governance interventions impact health system performance and global health security. This will enhance the understanding of a Steering Group's governance interventions in complex Global Health initiatives. Research questions: To what extent have GHSA SG governance interventions contributed towards enabling health system performance of WHO Member States? To what extent have GHSA SG governance interventions contributed towards the implementation of global health security among WHO Member States?

Methods
Correlational analysis using Spearman's rho examined the relationship between governance, health system performance and global health security variables at one point in time. A convenience non-probability sample consisting of eight WHO Member States was used. SPSS Statistics generated the bivariate correlation analyzes.

Results
Governance and health system performance analysis indicated a statistically significant strong positive effect size in 11 out of 18 and moderate positive effect size in the remaining seven out of 18 health system performance indicators. Governance and global health security analysis concluded three of the governance indicators had strong and moderate positive coefficients. Global health security variables demonstrated weak effects in the remaining three governance indicators.

Conclusions
This study presents a case for health systems embedding in global health security. Health system performance is only as effective at protecting populations when countries achieve core capacities of preparedness and response to global health threats. The associations provide stakeholders information about key characteristics of governance that influence health system performance and global health security implementation.

Key messages
This study provides an argument for the continued support of the GHSA 2024 Framework with implementation of global health security capabilities and meeting 2005 IHR requirements. The GHSA SG governance role remains profoundly important in establishing sustainable efforts internationally towards achieving the objectives of the GHSA in support of the 2005 IHR standards.
Gender-specific violence and/or abuse: strategy for dealing with a hidden phenomenon
Authors: Dei S , Marchetti C , Monti G , Pifferi A , Moscatelli C , Pagliara C , Erba F , Michelangeli L , Lelli S , Doretti V 
Published: October 2020

Abstract

Background
Exposing episodes of violence against women or hate crimes was extremely difficult in the past, due to a lack of awareness in emergency departments, the absence of a social, institutional and health network, and poor communication by Anti-Violence Centers. Until about 10 years ago, professional skills employed to address this kind of episodes were strictly related to the specificity of the trauma reported (gynecological, orthopedic, surgical and psychiatric).

Purpose
introduce a necessary holistic approach, that takes into account all aspects of the issue that normally are completely overlooked.

Methods
The “Codice Rosa” project began in the Grosseto Health Department (Tuscany) on 2009. It ensured reserved access to the emergency room for victims of violence, in particular women, children and discriminated persons. Later, it evolved into a regional network for women who have suffered from gender-based violence and for victims of hate crime violence. The project currently includes all victims, no matter whether they access the sanitary service through the emergency room, ambulatory or ordinary hospitalization. It follows a precise alert procedure triggering subsequent steps over the territory, with the goal to ensure ongoing support and a global care scheme.

Results
from 2010 up to July 2019 in the Grosseto Health Department 3483 “Codice Rosa” (mistreatment, abuse, stalking) have been admitted, 3088 adults and 395 minors respectively. In Tuscany from 2012 up to July 2019, the Codice Rosa patients were 20162, 17305 adults and 2857 minors respectively.

Conclusions
The program operates synergistically with other entities, institutions and overall with the local network of Anti-Violence Centers and Social Services, in line with national and international directives. It has provided a strong contribution to the development of current national guidelines in Italy.

Key messages
Gender specific violence and hate crimes phenomenon have to be specifically addressed. Improving the regional/national networks among the various actors involved in the fight against gender violence and hate crimes.
Differences obesity at subnational levels in Chile and the potential for targeted interventions
Authors: Urquidi C , Cumsille F , Sepulveda A , Garrido M 
Published: October 2020

Abstract

Background
Chile has a high prevalence of obesity (PO), and this has increased even more in recent years. Public health interventions have not impacted, probably because a geographic distribution of the cases at a lower level is unknown. We described the geographic distribution and change of obesity at a sub-regional level in Chile, and to identify targets areas/groups for interventions.

Methods
We did a secondary analysis of the latest two National Health Surveys (2009, 2016), using Regions and Health Service (HS) levels, which are the second and third administrative division of Chile, respectively. HSs were the smallest geographical unit possible to analyze with this data. Logistic regression models were fit to test differences between sex, age, number of children, family income, educational level, regions, and HS, using the lowest value of each variable as the reference group, adjusting by sex and age.

Results
At the national level, PO increased from 25% to 34% from 2009 to 2016. The southern regions have the highest PO in 2016 (Los Rios: 45%, Aysen:44%, Araucania:42%), and the lowest PO is even more than 30%. Although, the highest relative increase was in the north and central regions (Tarapacá:94%, Valparaíso:89%, Coquimbo:62%), as well as their HS. At HS level, in the Metropolitan Region, the PO varies from 21% to 46% in 2016 (OR = 3.3 IC95%1.4-7.9). Likewise, in the Valparaiso Region, it goes from 24% to 44% (OR = 2.9 IC95% 1.2-7). These differences in PO among HS levels in those regions were lower in 2009. Lower family income, educational level, and females with two or more children were associated with obesity in both surveys.

Conclusions
There is a high prevalence and increases in obesity in Chile at national and sub-national levels. The large variability in obesity observed among regions and Health Services suggests that lower geographical areas would be a potential target for effective interventions, complementarity to those at national levels.

Key messages
Analysis and intervention at a subnational level are required for preventing obesity in Chile. The high prevalence of obesity in Chile has a large variability among the subnational levels.
Cuina sense pares / Cooking without parents
Authors: Bertran M , Diaz C , Garcia T , Iglesias M , Martinez F , Polo C , Puigdemont I 
Published: October 2020

Abstract

Issue
Health promotion in Catalunya isn't a mandatory competency for councils; hence fomenting healthy eating habits isn't a priority for many municipalities because they have to destiny the resources in required issues. To revert this situation, Barcelona Provincial Council, a second level local administration, gives both technical and economic support for health promotion which is specially needed for municipalities with fewer inhabitants.

Description of the Problem
Adolescence implies autonomy to eat and often it turns in unhealthy eating habits. For this reason, Barcelona Provincial Council, in 2010 creates the project “Cuina sense pares” to promote a healthy eating and an optimum nutritional state from 14 to 18 teenagers in the province of Barcelona. The project counts on cooking workshops throughout territory and on a website www.cuinasensepares.cat that facilitates resources and cooking proposals adapted to the collective.

Questions
What was the response of the municipalities in the project? How municipalities value the project? Has it been echoed in the media?

Results
In 10 years, 673 workshops have been realised in 154 municipalities from the 311 in the province of Barcelona with a participation of 9.069 teenagers. Additionally, a 60% of the applicant municipalities have less than 10.000 inhabitants. The municipal technicians have rated the cooking workshops with an average of 9.11 among all. It has appeared 126 times in news media. In addition, the website has had more than 94.000 views and the Youtube channel has had 33.400.

Lessons
Involve the young in their eating by the elaboration of easy and healthy recipes. As an innovation, healthy cooking workshops are offered to municipalities complemented by a website.

Key messages
Facilitate tools to municipalities to boost healthy promotion eating programmes between the young. Foment a healthy eating between the young by attractive cooking proposals.
Can animal welfare have an impact on food safety? A study in the poultry production chain
Authors: Iannetti L , Neri D , Torresi M , Acciari V A , Di Marzio V , Centorotola G , Scattolini S , Pomilio F , Di Giannatale E , Vulpiani M Podaliri 
Published: October 2020

Abstract

Background
Animal welfare is a major issue in the production of food of animal origin. A project funded by the Italian Ministry of Health was carried out in order to collect scientific evidence that animal welfare is not only an ethical issue, but should also be related to food safety.

Methods
The project was carried out along an Italian integrated poultry production chain. Animal welfare was measured at farm in 13 broiler chicken batches, including 2 organic, using Welfare Quality®, an animal- and resource-based internationally recognised protocol. Samples for the detection and enumeration of Campylobacter, Salmonella and Listeria monocytogenes were taken at different levels, from the live animal (faeces at farm and after transport) to the end product (caecal content and carcass skin at slaughterhouse), with a total of 2,080 samples. Strains were deeply characterised (serotyping, PFGE).

Results
Higher welfare scores were reported in organic batches. Transports to the slaughterhouse longer than 1 hour were associated to increased Campylobacter prevalence. Significantly lower Campylobacter concentrations both in faeces and carcass (P &lt; 0.05) were reported in organic batches. Low-welfare batches showed higher prevalence of Salmonella, with statistically significant difference compared to high-welfare batches (43.6% versus 2.9% in carcass; 19.3% versus 0% in caecal content; P &lt; 0.00001). L. monocytogenes was never found in faeces, in contrast with high prevalence in carcases (up to 72.5%) with undistinguishable genetic profiles recurrent in different batches after long time (up to 18 months).

Conclusions
Our results support the hypothesis that poultry meat contamination is influenced by the welfare or stress which broilers experience during their life. Longer transports enhance Campylobacter prevalence. L. monocytogenes in poultry meat should not be linked to increased stress but rather to persistent contamination in the slaughterhouse processing environment.

Key messages
“High-welfare” broiler chicken batches show lower Campylobacter and Salmonella contamination compared to “Low-welfare” batches. Microbiological safety of poultry meat can be improved by the application of high animal welfare standards at farm and during transport.