bluuebunny/crossref_metadata_2025_split huggingface dataset:
Public health services at community pharmacies and strategies for expanding the role of pharmacists
Authors: Kazaryan I , Sevikyan A , Amirkhanyan A , Vardanyan L 
Published: October 2020

Abstract
Pharmacy practice is evolving and the role of pharmacists in public health is expanding in many countries. The objective of this work was to analyse involvement of community pharmacy staff in public health activities, as well as to identify opinion of pharmacy professionals about strategies for expanding their public health role in Armenia.
Survey was conducted in different regions of Armenia. Pharmacists and technicians working in community pharmacies were asked to complete pre-tested questionnaire that includes questions about their involvement in public health activity, motivation and opinion on strategies for improvement of the situation. 162 pharmacy professionals completed the questionnaire. Data were analysed with SPSS statistical software, version 22.0.
76.5% of responders indicated that they agree that community pharmacy practice should involve provision of public health services. Only 22.2% of community pharmacists and technicians reported that they are currently engaged in any public health activity. The main reasons for providing public health services indicated by responders are professional responsibility (84.6%), patients' satisfaction (66.0%) and personal satisfaction (63.6%). 80.2% of responders suppose that providing public health services in community pharmacies can have an impact on improving population health. Respondents indicated strategies which could be effective for expanding pharmacists' role in public health: increasing public awareness (82.7%), expanding pharmacists' knowledge (82.1%) and guidelines (71.6%).
Only part of pharmacy professionals is engaged in public health activity. Many of them believe that certain strategies are able to improve the situation with involvement of community pharmacy staff in providing public health services in Armenia.

Key messages
Pharmacists are motivated to implement public health services. Special strategies should be introduced to increase engagement of pharmacists in public health.
Are large scale, urban, comprehensive CHW programs effective? The South African experience
Authors: Thomas L S , Buch E , Pillay Y , Jordaan J 
Published: October 2020

Abstract

Background
South Africa is an upper middle-income country, but has one of the widest GINI co-efficients in the world. It faces a heavy burden of disease and poor health outcomes remain a challenge for millions of South Africans. Slow economic growth, rapid urbanization and high unemployment could de-rail the efforts to improve access to health care and health outcomes amongst the most vulnerable in the country. Within this context, the introduction of large scale, comprehensive community health worker (CHW) programs, in urban areas are seen to be game changers. However, there is inadequate global evidence on whether such programs work.

Methods
This is a multi-method, quasi-experimental intervention study measuring the effectiveness of a CHW program in the Ekurhuleni health district; set in an urban province of South Africa, where CHWs support approximately one million people. Health indicator performance was compared in clinics with good coverage of CHWs and those with low or no CHW support. Poor and vulnerable households with CHW support were compared to those with no CHW support.

Results
Over a nine-year period since implementation, clinics with CHW programs improved better than clinics without; on identified pregnancy, child health, infectious disease and non-communicable disease indicators. Odds ratios showed that households with good CHW coverage had better social support, health-seeking behavior, morbidity and mortality than households without. p-values were statistically significant (&lt;0.05) for social support, chronic disease diagnosis and chronic disease control outputs.

Conclusions
This CHW program has shown its worth as it has been effective in improving early screening, referrals, diagnosis and disease control across a number of health conditions in an urban setting.

Key messages
Large-scale comprehensive CHW programs are a good investment towards achieving universal health coverage for all by improving access and care to the poor and vulnerable. Community Health Worker services in households are effective and should be a legitimate level of health care delivery in developing countries.
“Transfer, Contestation and Conflict”: How Italian regional and national governments claim and challenge authority in mandatory vaccination policies
Authors: Rizzi M , Attwell K , Casigliani V 
Published: October 2020

Abstract

Background
This paper explores conflictual policy transfer in Italian vaccination policy 2007-2018. The region of Veneto formally suspended mandatory vaccination in 2007. Soon after, declining vaccination rates across the country sparked a public health crisis. Emilia Romagna adopted a new vaccine mandate for early education, which the national government adopted in 2017. Each policy decision invoked collaboration and contestation between governments. In showing the conflictual aspects of intra-state policy transfer, we offer lessons for multi-level health governance of contested issues.

Methods
We used qualitative documentary analysis of parliamentary transcripts, legislation and government reports, supplemented with semi-structured key informant interviews, using the coding software NVivo 12. We applied theoretical and conceptual scholarship to develop an analytical framework drawing out the key mechanisms through which contestation and conflict take place.

Results
Italian regional and national governments employed three key mechanisms to forcibly transfer or resist vaccination policy: ideas, evidence, and law. Ideas included “the nation”, “herd immunity” and “science.” Evidence included coverage rates and explanations of changes over time. Protagonists of Italy's coercive policy transfers used the law to claim and challenge authority. Contestations occurred in political and bureaucratic spheres. Discrepant historical and evidentiary narratives emerged between levels of government that had injected significant resources into acquiring or defending governance of vaccination policy.

Conclusions
Scholarship has predominantly considered coercive policy transfer at a supra-national or inter-state level. We demonstrate the political blood-spilling within a country when divergent regional policies become contested in a situation of national crisis. 'Evidence' and 'law' can be open to differing interpretations, with 'ideas' shaping the context in which policies prevail.
Impact of Australian mandatory policies on immunisation services, parental attitudes to vaccination and vaccine uptake in a tertiary paediatric hospital
Authors: Armiento R , Hoq M , Kua E , Crawford N , Perrett K , Elia S , Danchin M 
Published: October 2020

Abstract

Introduction
'No Jab, No Play' and 'No Jab, No Pay' mandatory immunisation policies were introduced in the state of Victoria and Australia nationally in January 2016. They restrict access to childcare/kindergarten and family assistance payments respectively, for under-vaccinated children. We aimed to describe the proportion of attendees to immunisation services of a tertiary hospital, the Royal Children's Hospital Melbourne (RCH), who were motivated by the policies to discuss or catch up vaccination. We also explored the association between policy motivation, vaccine hesitancy (VH) and intent to seek medical exemption, with vaccine-uptake. Referrals to the Specialist Immunisation Clinic (SIC) were also reviewed.

Methods
Parents/Guardians and clinicians completed surveys October 2016-May 2017 from the nurse-led immunisation Drop in Centre (DIC) or physician-led SIC. Vaccine-uptake was measured using the Australian Immunisation Register at baseline, 1 and 7 months post-attendance. The association between vaccine-uptake, policy motivation and VH was explored by logistic regression.

Results
Of 607 children included, 393 (65%) were from the DIC and 214 (35%) SIC. 74 (12%) of parents were motivated by the policies to attend immunisation services and 19% were VH. Only 50% of VH parents planned to catch-up vaccination for enrolment to childcare/kindergarten. Fewer children were fully immunised at 7 months if their parents were VH (difference 18%; OR 0.24, CI 0.1-0.54,p&lt;0.001) or seeking medical exemption (difference 33%, OR 0.08, CI 0.01-0.6, p 0.015).

Conclusions
The 'No Jab' policies motivated attendance to a tertiary immunisation service but children of vaccine hesitant parents and those seeking medical exemption to immunisation were less likely to be fully immunised post attendance, compared to baseline. These data will be used to inform a comprehensive evaluation of the impact of the policies, particularly the educational impact from loss of early childhood education.
Frailty and social support: the care services response to aging in Russia
Authors: Kholostov E 
Published: October 2020

Abstract
In the twenty-first century, ageing of population, having become a global phenomenon, raised questions about the need to consider the social services of the elderly from an institutional perspective. Thus, the number of Russians over the age of 100 in 2018 exceeded 15.7 thousand people. In Moscow, as in the mega polis, in 2018 more than 3.4031 million people (27.2%) are older than working age.
Different countries have their own characteristics of social service systems, models and policies, it depends to a large extent on the traditions of assistance, sources of financing, the space of responsibility assumed by the State, society, the family and the individual himself.
New technologies to be applied for working with the elderly in Russia. Transition to the establishment of a system of long-term care at the level of multidisciplinary cooperation (reform of the residential care system; development of community based services, formation of Social Support Services for 75+, foster family for the elderly).Development of active longevityChanging the role repertoire of an older person (formation of new types of social roles previously characteristic of younger ages; changing of intergenerational link formats, etc.).The growing social responsibility of the State contributes to a more effective interaction between health and social care authorities, as well as a more active involvement of the NGO sector in addressing the problems of older persons.The increase in the number of older persons leads to the creation and active development of a silver economy that contributes to improving the well-being of people.Transfer of retraining and advanced training systems to the competent level according to professional standards (independent assessment of qualifications, personnel diagnostics, formation of individual trajectory of education, training of multiple disciplinary teams).
Prevalence of mild cognitive problems in Flemish Nursing homes
Authors: De Vriendt P , Gorus E , Bilsen J 
Published: October 2020

Abstract

Background
Mild cognitive decline in Nursing Home (NH) residents without dementia is often noted very late since cognitive demands are relatively low in this setting. Therefore, subtle cognitive changes could remain undetected. This study aimed to evaluate the prevalence of mild cognitive problems in NHs.

Methods
First, a file study was performed to exclude residents with a diagnosis of dementia or known cognitive problems (Mini Mental State Examination-MMSE &lt; 24) in 16 NHs. Second, remaining residents were screened for cognition with the Montreal Cognitive Assessment (MoCA). Also, an evaluation of functionality (ADL-Questionnaire), mood (Geriatric Depression Scale), neuropsychiatric symptoms (Neuropsychiatric Inventory Questionnaire) and subjective memory complaints (Informant Questionnaire on Cognitive Decline) was performed.

Results
On a total of 1339 residents, 229 persons (17.1%) had no diagnosis of dementia and an MMSE &gt;23. Based on MoCA-cut-offs 2.7% (n = 36), 11.4% (n = 152) and 3.1% (n = 41) could be labelled as cognitively normal (&gt;25), mild cognitive impairment (&gt;16 and &lt;26) and mild dementia (&lt;17) respectively. This resulted in a prevalence of undetected mild cognitive problems of 14.5% (n = 193) in the total NH population. Significant differences between the 3 groups were found for functionality, mood, neuropsychiatric symptoms and subjective memory complaints (all p &lt; 0.05).

Conclusions
Considering their advanced age NH residents are vulnerable to develop dementia. This study showed that an important part of them has unnoticed mild cognitive problems. NHs should be aware of this risk group in order to provide adequate prevention and support.
Examining ‘immunity passports’ from an ethics perspective – ten reasons why they are bad idea
Authors: Kofler N , Baylis F 
Published: October 2020

Abstract
The two panelists will elaborate on 'four practical problems and six ethical objections', which add up to one very bad idea, i.e., the 'immunity passport'. Such an idea is equal to restricting movement on the basis of biology threatens freedom, fairness and public health. Lessons from previous pandemics will be examined in the context of current measures being deployed, assessing practical and ethical aspects. For example, false negatives in people with few antibodies leading to immune individuals being incorrectly labelled as not immune or not having access to testing to demonstrate immunity. Additionally, the case of healthcare workers will be examined considering feasibility of testing, but also in terms of discrimination and stigma. Another aspect to be explored in detail is monitoring and how it erodes privacy, with the main aim of immunity passport controlling movement. Documentation systems are already presenting a serious risk to privacy, with China announcing the QR-code tracking systems is likely to stay in place after the pandemic ends.
Access issues to testing can contribute to further discrimination, whereas labelling people on their basis of their COVID19 status would create a new measure of dividing the society to 'immunoprivileged and immonodeprived' people. A labelling particularly disconcerting in the absence of a free, universally available vaccine. Furthermore, Social and financial inequities would be amplified, whereas divisions between nations could be fueled. Already people with HIV are subjected to restrictions on entering, living and working in certain countries with laws that impinge on the rights of those from sexual and gender minorities. Governments should instead invest on pandemic damage limitation - test, trace and isolate, and apps that empower individuals to make safe choices about their own movements should be prioritized. Also, the development, production and global distribution of a vaccine for SARS-CoV-is key. Universal, timely, free access to a vaccination becomes possible could allow for ethical recording of vaccination status in the context of certain activities. Threats to freedom, fairness and public health are inherent to any platform that is designed to segregate society on the basis of biological data. All policies and practices must be guided by a commitment to social justice.
Public health law and COVID-19: Human rights and global health security
Authors: Petelos E 
Published: October 2020

Abstract
The WHO has highlighted the technical challenges of assessing immunity status, cautioning against immunity passports. Similarly, the ECDC indicated that “current scientific knowledge that exists on the immunological response to SARS-CoV-2 (quality, quantity and duration of human antibodies) or the available testing methods (laboratory based and point-of-care)” does not support their use. Accordingly, the European Commission has emphasised the risks compulsory testing, noting that “border control [is not] an effective measure to limit the transmission of the virus, while the Council of Europe raises awareness of the interference of SARS-CoV-2 measures on human rights, underlining that “the major social, political and legal challenge facing our Member States will be their ability to respond to this crisis effectively, whilst ensuring that the measures they take do not undermine our genuine long-term interest in safeguarding Europe's founding values of human rights, democracy and the rule of law”.
Nevertheless, immunity passports and immunity registries are being discussed more than ever before, with governments under pressure to find a viable solution. This presentation will examine the GDPR, and current legislation protecting rights vs. legislation allowing testing, quarantine, administration of medicines, recording of immunity vs. vaccination. It will debate the legal nature of immunity passports and the relevance to fundamental European freedoms, linking key concepts to global public health law. Implications regarding the personal right in Health/right of Public Health and legal substance and human rights limitations will also be examined. Criteria and the use of immunity passports as limitations of human rights -prescribed by law, legitimate aim and necessary in a democratic society- with extrapolation in terms of discrimination will be discussed. Finally, the jurisprudential approach and control (national, European, ECHR, global) will be mentioned, along with a brief highlight to the implications for migrant populations and cross-border care.
Governance of conflicts of interest in the publication of health research – perspectives on ways forward from a journal
Authors: Chatfield C 
Published: October 2020

Abstract
Identifying corporate influence and biases in the publication of academic research is fraught with difficulty, as this presentation explores. Journals often rely on authors' own disclosures of interests, which may intentionally or unintentionally omit relevant conflicts. Financial conflicts of interests may be easier for authors and editors to identify, allowing some mitigation, but non-financial conflicts of interest and corporate influence can be harder to tease out. Both authors and journals make multiple judgements on which interests are relevant and it is easy for opaque conflicts to slip through the cracks.
Even if these conflicts of interests are declared, moreover, many journals rely on transparency to inform their policy on publishing research by authors with links to industry; this transparency assumes that readers are able to discern the potential bias arising from these relationships. However - while we know that readers consider research papers written by authors with declared financial links to industry to be less important, relevant, rigorous, and believable - this may lead readers to place unwarranted trust in research from authors whose conflicts are less clearly visible. For example, from authors aligned with academic institutions whose departments may experience corporate influence, but in a manner too indirect to be declared.
In order to consider these issues in context, delegates will be asked to make judgements on whether particular conflicts of interest statements would exclude authors from publishing with one leading journal, the British Medical Journal. They will hear how journals are now moving beyond transparency in order to better engage with these themes: via such initiatives as, for example, registries of interests; the re-definition of competing interests as relationships; and increasingly widespread policies that entirely exclude authors with financial ties to industry from publishing.
Impacts of climate change on Public Health of the Mediterranean population
Authors: Paz S 
Published: October 2020

Abstract
The Mediterranean Basin is undergoing a warming trend with longer and warmer summers, an increase in the frequency and the severity of heat waves, changes in precipitation patterns and a reduction in rainfall amounts. This populated region is characterized by significant gaps in the socio-economic levels, parallel with population growth and migration, increased water demand and forest fires risk. Consequently, the vulnerability of the Mediterranean population to human health risks as result of climate change increases significantly.
Climatic changes impact the health of the Mediterranean population directly through extreme heat, drought or storms, or indirectly by changes in water availability, food provision and quality, air pollution and other stressors. The main health effects are related to extreme weather events, changes in the distribution of climate-sensitive diseases and changes in environmental and social conditions. The poorer countries, particularly in North Africa and the Levant, are at highest risk. Climate change affects the vulnerable sectors of the region, including an increasingly older population, with a larger percentage of those with chronic diseases, as well as poor people, which are therefore more susceptible to the effects of extreme temperatures. For those populations, a better surveillance and control systems are especially needed parallel with adaptation planning that become ever more imperative. In order to achieve these goals, it is essential to define indicators of vulnerability and exposure based on health impact assessment, as well as indicators that will promote adaptation planning and resilience for health risk management. In view of the climatic projections and the vulnerability of Mediterranean countries, such indicators will contribute to correct preparedness at the regional and national levels.
10.E. Workshop: Childhood obesity: how to tackle this wicked problem?
Authors:   Organised by: GGD Amsterdam (Netherlands),   Chair persons: Arnoud Verhoeff - Netherlands
Published: October 2020

Abstract
The City of Amsterdam was awarded the City European Health Award 2019 with its Amsterdam Healthy Weight Approach (AHWA). The European Union stated that the AHWA contributes to a healthier environment for children in Amsterdam to grow up in. In this workshop we will share our insights and experiences with the AHWA as a Whole Systems Approach (WSA), supported by a multidisciplinary, innovative and dynamic research infrastructure.
More and more scientific knowledge indicates that key modifiable influences on overweight and obesity lie in our local environments. The FORESIGHT report (2007) illustrated the complex web of influences which are widely considered to foster overweight and obesity through the fundamental features of a complex adaptive system. These include long, non-linear causal chains which over time produce emergent properties and unintended effects in a dynamic system.
WSAs seem to be appropriate to contribute to the reduction of overweight and obesity which are embedded in a complex adaptive system.
The AHWA constitutes a WSA since it adopts the following working principles: actions aiming to modify the local political, physical, social, health education and careenvironment in multiple settings (the home, neighborhood, school and city);cross-sectoral working across municipal sectors and public, private, community and academicpartners to develop and implement actions;a learning approach to enable program adaptation in response to change in the complexadaptive system comprising the local environment (i.e. the Amsterdam context).
The objectives of the workshop are fourfold: Present the WSA of the Amsterdam Healthy Weight Approach.Present the learning cycle, with a key role for Sarphati Amsterdam as multidisciplinary research institute in which the City and the Amsterdam knowledge institutions (University of Amsterdam, VU University, Amsterdam Academic Medical Centre, Amsterdam University of Applied Sciences) cooperate.Share examples of participative research projects within the context of AHWA and Sarphati Amsterdam, through lived experiences.Invite participants of other cities for collaboration (City2City): shared learning to tackle this wicked problem is essential.

Key messages
Whole Systems Approaches are appropriate when tackling wicked public health problems. Whole Systems Approaches should be supported by innovative, adaptive, multidisciplinary research every step of the way.