bluuebunny/crossref_metadata_2025_split huggingface dataset:
eHealth for chronic diseases management: challenges and opportunities
Authors: Chiolero A 
Published: October 2023

Abstract
Digital health technology, also known as eHealth, could help improve the management of chronic diseases such as diabetes by facilitating data exchange between patients and health professionals. Further, the use of digital health technology and mobile devices could improve disease monitoring and strengthen patient empowerment. However, not all healthcare professionals are comfortable with digital health technology, and several barriers limit their use, including patients’ socio-demographic factors. Based on the results of a study assessing the eHealth profile of patients with diabetes, we will discuss challenges and opportunities in the use of digital health technology for chronic disease management.
Barriers and levers to vaccination of the elderly: results of a qualitative study
Authors: Addario A , Pardo M , Dorier S , Barth N , Gavazzi G , Botelho-Nevers E 
Published: October 2023

Abstract

Although vaccination is an essential element in the prevention of infections in the elderly, vaccination coverage in this population is low. In this population, there is less data concerning the levers and obstacles to vaccination than in the general population. The aim here is to identify the levers and obstacles to recommended vaccinations in the 65 years and over group, but also to shed light on the possible arguments that could play a role in the commitment to new vaccination behaviour. A qualitative survey based on 14 semi-structured interviews was conducted with people aged 65 and over, living at home in the Auvergne Rhône-Alpes region (France) from March to May 2022. The interviews were recorded, transcribed in their entirety and then subjected to a thematic content analysis by two independent persons. The participants interviewed were generally in favour of vaccination. The fears and motivations for vaccination reported by the participants are similar to those of the general population. We find the following obstacles: the low effectiveness of certain vaccines, potential side effects, lack of confidence in the government and health authorities and in pharmaceutical laboratories. As far as levers are concerned, free health care, limits on health expenditure, prevention of infections or even their eradication, and collective action are elements that are found in the discourse of the seniors. The general practitioner is at the centre of their vaccination decision, he is a person of trust and knowledge with a paternalistic vision and yet sometimes he is the one who does not recommend a vaccine. Moreover, the past experience of polio epidemics has left its mark on the seniors because of its impact on their autonomy and their bodies. The analysis of a common experience of the patient-doctor relationship and of poliomyelitis made it possible to support the hypothesis of a ‘generation effect’ in the relationship to vaccination among seniors.

Key messages
• The general practitioner has a central role in the vaccination of the elderly.
• the past experience of polio epidemics has left its mark on the seniors because of its impact on their autonomy and their bodies.
The COVID-19 pandemic and the regional orthopedic anesthesia guidelines
Authors: Macarico A , Bacelar-Nicolau L 
Published: October 2023

Abstract

Background
The infection of humans with virus SARS-Cov-2 was first reported in December 2019, in Wuhan, China and in 11th March 2020, COVID-19 was declared a pandemic by the World Health Organization. Since transmission was mainly through inhalation of droplets, general anesthesia was considered a high-risk transmission procedure. In this context, to choose regional anesthesia whenever possible, was recommended. Our main aim was to analyze if COVID-19 lead to an increased use of regional anesthesia in orthopedic surgeries.

Methods
Based on the orthopedic anesthetic activity of Hospital de Cascais (Portugal), two six months periods were compared: one following the resume of surgical activity after the first pandemic wave (“after COVID period”) and the homologous period of the previous year (“before COVID period”). Both periods were assessed for homogeneity for: age, sex, ASA status, contraindications for regional anesthesia, type of surgery, duration, priority and outpatient/inpatient care. Chi-square or Fisher tests were applied, as well as a binary logistic regression.

Results
Periods were significantly different for care (p = 0,0028), with more outpatient surgery in the after COVID period (43% versus 37,2%). No bivariate association was identified between periods and anesthesia. However, the binary logistic regression showed higher odds of being submitted to regional anesthesia in the after COVID period (p = 0,002 OR = 1,507 CI95%[1,156-1,964]).

Conclusions
Possible explanations for absent bivariate association between period and anesthesia, are that all patients were tested for COVID-19, and the higher number of outpatient surgery (for which general anesthesia is preferred) in the after COVID period. When all predictors were controlled with the binary logistic regression, the guidelines seemed to have been followed. However, the lower limit of CI95% is near 1. This may indicate that in the future, further efforts to implement regional anesthesia guidelines, may be needed.

Key messages
• COVID-19 Guidelines for regional anesthesia were followed but additional efforts are needed, as new pandemics are expected.
• As a preventive measure for future pandemics, training programs of regional anesthesia should be mandatory.
Post-Covid syndrome in the workplace
Authors: Magnavita N , Arnesano G , Di Prinzio R R , Meraglia I , Merella M , Vacca M E 
Published: October 2023

Abstract

A high percentage of those who develop SARS-CoV-2 infection have post-Covid syndrome. Health surveillance in the workplace must identify workers who develop this syndrome to prepare the appropriate support measures. All workers who developed Covid in a sample of 1378 workers exposed to biohazards were asked to report post-Covid symptoms and to complete questionnaires to measure occupational stress, sleep quality, fatigue, work ability, and mental health. 164 workers had Covid and 115 of these (70%) had symptoms one month after the acute phase. The frequency of the post-Covid syndrome was higher in workers with more severe or longer-lasting acute forms and in females than in males. In 80% of cases, the pattern of symptoms included the association of anosmia and dysgeusia or of weakness, fatigability, and tiredness. In 20% of cases these symptoms were associated with dyspnea, tachycardia, headache, sleep disturbances, anxiety, and muscle aches. In 80% of cases, the pattern of symptoms included the association of anosmia and dysgeusia or of weakness, fatigability, and tiredness. In 20% of cases these symptoms were associated with dyspnea, tachycardia, headache, sleep disturbances, anxiety, and muscle aches. 11% of those who contracted the infection reported worsening of the morbid conditions from which they had previously suffered; these symptoms were still present six months after the acute phase. Workers with post-Covid were found to have poorer quality sleep, increased fatigue, anxiety, depression, and decreased work ability compared with workers whose symptoms had rapidly disappeared. A large percentage of workers, after an infection that might also be mild or modest, developed persistent symptoms that compromise their working capacity and quality of life. Considering the number of Covid cases in the world, it can be estimated that between 42 and 69 million people suffer from post-Covid syndrome.

Key messages
• A large percentage of workers suffer from post-Covid syndrome and require support in the workplace.
• We can estimate that 42-69 million people worldwide suffer from post-Covid syndrome.
A systematic review of real-world contact tracing strategies at the onset of the COVID-19 pandemic
Authors: Rosso A , Amicosante AMV , Mattioli I , Bernardini F , Guglielmi E , Eugeni E , Baglio G 
Published: October 2023

Abstract

Background
Contact tracing (CT) represented one of the core activities for the prevention and control of COVID-19 in the early phase of the pandemic, before the availability of effective vaccines. Poor evidence is available on the real-world implementation of CT strategies and adoption of CT digital tools during the initial phase of the emergency.

Methods
We aimed to provide a comprehensive picture of the organizational aspects of CT activities during the first wave of the pandemic, through the identification and description of CT strategies used in different settings during the period March-June 2020 and of digital tools adopted in the early phase. A systematic review of published studies describing organizational models of COVID-19 CT strategies and digital tools used in real-world settings was conducted. PubMed, Embase and Cochrane Library were searched.

Results
We retrieved a total of 1,637 studies, 30 of which met all our inclusion criteria. Seven studies target the general population, 10 studies described CT activities carried out in specific population subgroups, 13 described the use of CT apps in real world settings. Main activities implemented to rapidly scale-up CT activities included decentralization of CT, involvement of trained non-public health resources (e.g. University students, civil servants), use of digital tools for CT management, inter-agency collaboration, community engagement. Digital apps proved to be a useful supplementary component in CT strategies, however their acceptability was hampered by privacy, equity and effectiveness's concerns.

Conclusions
Despite the lack of data on CT effectiveness, available evidence provides indication on coordination mechanisms and use of human and technical resources needed for the rapid scale up of CT activities. Further research on real world implementation of CT strategies during the COVID-19 pandemic would be needed to contribute to a more robust evidence-making process.

Key messages
• Decentralization of CT activities, involvement of trained non public health professionals, intersectoral collaboration were the key components of early COVID-19 CT strategies.
• The use of smartphone apps and other digital tools proved to be a substantial support for CT activities. However, privacy, ethics and equity issues must be clearly addressed.
COVID-19 vaccine booster dose effectiveness among health workers: systematic review & meta-analysis
Authors: Bartolucci L , Damiani G , Pascucci D , Pires Marafon D , Laurenti P 
Published: October 2023

Abstract

Background
The COVID-19 pandemic still being a major public health issue. New vaccine products have been developed, approved, distributed and given primarily to Healthcare Workers (HCWs). The aim of this systematic review is to define the term of protection offered by the administration of EMA (European Medicines Agency)-approved COVID-19 vaccine booster dose for healthcare professionals, considering the Vaccine Effectiveness (VE) against SARS-CoV-2 infections.

Methods
A systematic research of the literature was carried out using PICO (Population, Intervention, Comparison, Outcomes) model and following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Then, a meta-analysis was carried out.

Results
Starting from 1241 obtained, 5 studies met the inclusion criteria. All studies dealt with only first booster dose. VE against infection was estimated, with Comirnaty booster dose, between 50% (95% C.I. 42-56%) and 86% (95% C.I. 79-90%) and, with Spikevax booster dose, between 56% (95% C.I. 45-65%) and 96% (95% C.I. 82-99%). The meta-analysis showed an overall VE of 73% (95% C.I. 70-76%).

Conclusions
High VE levels among HCWs in the prevention of SARS-CoV-2 infections, which rapidly decline, were reported. Hence, the periodic administration of additional booster vaccine doses would be indicated.

Key messages
• EMA-approved COVID-19 vaccine booster doses are effective among healthcare workers, one of the categories most at risk: they can protect them from infections, keeping them able to work.
• Due to the effectiveness short duration, periodic administration of additional booster doses would be indicated among healthcare workers.
Actions for the protection and prevention of sustainable healthy complementary feeding in nurseries
Authors: Barocco G , Croci E , Bucci F G , Longo T , Marsi A , Guzzo G , Calabretti A , Bogoni P 
Published: October 2023

Abstract

Background
The WHO and UNICEF in the Global Strategy for infant and young children feeding (GS), indicate that the principle actors of society play significant roles in protecting, promoting and supporting safe and adequate complementary feeding for infants and young children. The WHO and FAO in The Sustainable Healthy Diet, guiding principles (SHD) moreover underline synergies among foods, nutrients present in dietary patterns and their bioavailability, degree of food processing, and subsequent health impact. COVID-19's (C) social economic impact has changed food supply costs. The UNICEF Baby-Friendly Community Initiative, involving 41 nurseries with 1600 enrolled children and a coverage rate of 38% (EU objective 35%) has operated in the municipality of Trieste, since 2015. Beginning August 2022 the project aims were to verify the application of food safety regulations (FSR), recommendation of the GS, SHD and regional nutritional guidelines (RNG) in nursery catering services.

Methods
13 nurseries have been verified. 78 food samples (FS) of oven-cooked vegetables (V), meat and fish (MF) were taken from 10 nursery kitchens, with a total production of 1150 meals per day. The University of Trieste has performed over 400 analyses. The outcomes were compared with FSR, literature references and pre C research results carried out in 2015.

Results
Relevant and systemic corrective actions indicated by FSR, GS and RNG have been implemented to overcome non-compliance. The analyses performed on FS have shown that the protective compounds have remained similar, and in some cases improved, in V foods. However, in the MF-based oven-cooked preparations, a significant content of Maillard products was highlighted and only some of them showed values above the acceptable limit.

Conclusions
The evidence of the project will be able to orient public actors for future integrated actions of protection, promotion and support of a healthy and sustainable complementary diet after C.

Key messages
• After the social economic impact of the Covid-19 pandemic it is determinant to support public actors in continuing to protect, promote and support safe and adequate complementary feeding in nurseries.
• It is crucial to program systemic and coordinated actions to ensure adequate resilient food systems in nursery catering services in adherence with the WHO, FAO and UNICEF recommendations.
WHO Support tool to strengthen health information systems
Authors: Novillo-Ortiz D 
Published: October 2023

Abstract
In the first presentation, a representative of the WHO Europe team who took part to the development of the “Support tool to strengthen health information systems: guidance for health information system assessment and strategy development” as part of the European Health Information Initiative (EHII), will introduce the tool and the relevance of performing health information system assessments to support Member States in strengthening their HIS. The 4 main guiding steps of the HIS tool (1. Perform an HIS assessment; 2. Develop an HIS vision; 3. Develop an HIS improvement plan; 4. Monitor progress and perform regular evaluations) will be outlined as well as the HIS assessment item sheet that guides the performing of an assessment, which consists of a core module and several add-on modules. The aim of the core module is to provide an overview of the functioning of the entire national HIS. The aim of the add-on modules is to shed more light on specific parts or functions of the national HIS. As the tool is in continuous development, the plans for the future will be outlined, including a short introduction to the new add-on modules that will be included in the tool.
A cost-consequence analysis of a menu intervention in early childhood education and care
Authors: Kurkela O , Virtanen S M , Erkkola M , Saarinen M , Niinistö S , Raulio S , Ahokas I , Meinilä J , Forma L ,   The FoodStep study group
Published: October 2023

Abstract

Achieving a more climate-friendly, healthy, and sustainable food system that follows the principles of the green economy requires a revision of the current practices in Finland. The early childhood education and care (ECEC) provides a potentially fruitful platform for a systemic change. This study assessed the costs and consequences of a menu intervention as part of the FoodStep-project that aims to develop a novel food system model in ECEC. A randomized controlled study was carried out in 23 ECEC centers to investigate the health, climate, and economic impacts of a novel food system model that was co-created together with the municipality decision makers and professionals in food catering and ECEC. A menu-level cost-consequence analysis was performed to summarize information on the costs and the several essential consequences. Bottom-up micro-costing using data from municipal food services was applied to assess the costs. Differences in nutritional supply in relation to national ECEC meal recommendations and climate impact between existing and new diets were assessed. According to preliminary results, the moderate menu modifications resulted in a slight decrease in mean daily meal costs (breakfast, lunch, snack). A substantial increase in the supply of vegetables, legumes, and poultry was observed, while the servings of red meat decreased notably. New diets did not remove the observed imbalances in energy supply from different sources at the baseline nor the excess supply of salt, however, the overall energy supply was found to be sufficient within both menus. Menu changes resulted in a notable decrease in the unfavorable climate impacts compared with the baseline menus. The implemented changes improved the dietary quality of the menus and decreased the negative climate impact with a modest decrease in costs. Despite the promising results, further analysis of the intervention's cost-effectiveness is required to assess the potential of the novel food system model.

Key messages
• The implemented changes improved the dietary quality of the menus and decreased the negative climate impact with a modest decrease in costs.
• The intervention shows potential for a wider application with the aim of achieving a more climate-friendly, healthy, and sustainable food system.
Food system definitions and narratives in Irish agri-food strategies
Authors: Stanley I , Murrin C 
Published: October 2023

Abstract

Public health challenges, including malnutrition, chronic diseases and climate change, are interrelated and encompass several policy areas. Food policymaking that recognises interlinkages between agriculture, health, trade and the environment can create public policies that create for better livelihoods and planetary health. To date there has been limited research undertaken to document the food policymaking process in Ireland and to assess policy coherence. Though there has been increased emphasis on sustainability in agri-food policymaking, national level strategies have so far neglected to fully consider public health and environmental impacts, creating a barrier to more sustainable and resilient systems. This could be due to differing definitions of ‘sustainable food systems’ between sectors, creating incoherence in policy aims and goals. The aim of this study is to examine food system definitions in Irish agri-food strategies and to compare them to narratives and approaches set out in academic literature and international reports. Food Vision 2030 is the latest Irish Agri-food strategy and the first to propose a food systems approach to transform the agri-food sector. A content analysis of the strategy report was conducted and strategy missions and actions were compared to food system definitions and strategies employed at the United Nations Food System Summit 2021 (UNFS). The definition of food systems used in the strategy matched the UN definition and two of five Food Vision Missions were considered ‘well aligned’ with the UNFS Action Tracks. These related to ‘nature-positive’ food production and equitable livelihoods. Overarching missions relating to food supply and consumption were less aligned. Actions were targeted at production (29%). 12.4% of actions related to natural resources and 3.5% to consumption. While the overarching message in agri-food strategies aligns with UN definitions a disconnect in the the development of policy actions remains.

Key messages
• Understanding definitions of ‘sustainable food systems’ across sectors is important for aligning policy goals and objectives.
• Food Vision 203 is a step in the right direction for Irish agri-food strategies. However, it is evident at ‘action level’ that the primary focus remains in the productivism approach to agriculture.
Health equity implementation expectations and challenges in a multi-level system reform initiative
Authors: Bouckley T , Peiris D , Nambiar D , Schierhout G 
Published: October 2023

Abstract

Background
Within Australia, a system reforming place-based initiative across an area the size of Spain is being implemented. The aim is to expand community-based care models and reduce hospital demand. As COVID-19 demonstrated, sustainability of healthy societies requires a health equity focus across all stages of health reform. Despite central equity principles, pressures risk diminishing this goal as policy is translated into practice across system levels. This initiative is a perfect case study opportunity to inform policy implementation through understanding operationalisation challenges and protections across a multi-level system.

Methods
18 semi-structured interviews were conducted in 2022 and 2023 with a purposive sample of senior policy executives, program managers and clinicians across partner organisations and the NSW Ministry of Health. An iterative interview process captured perspectives across system levels as the program was progressively implemented. Interviews were analysed using an inductive constant comparative approach.

Results
Preliminary findings indicate tensions that impact on realising equity goals. Key tension points exist between levels of operationalisation. These can manifest as perceived trade-offs between health equity and efficiency; place-based reforms that put downward pressure on resource challenged local services to manage equity; and funding models that discourage access. Tension mitigation is partially achieved through leadership commitment, community building, and ring-fenced equity funds. The shared equity understanding in rural areas is also a protective factor.

Conclusions
While local mitigation factors can protect equity goal preservation, we recommend consideration towards building alignments across system levels. This can include aligning leadership goals and designated funding streams across levels. Further opportunities not often captured in the interviews exist, including aligning accountability and monitoring processes.

Key messages
• Mitigation strategies exist to overcome inherent system tensions that impact on reforms achieving equity goals. While these can be partially achieved at one level, multi-level alignment is critical.
• Shared leadership goals and designated funding streams can support overcome health equity tensions during implementation of reform initiatives, and would be supported by multi-level system alignment.