Teaching young consumers in Europe: a multicentre qualitative needs assessment with educators on food hygiene and food safety

AIM

Foodborne illnesses have a significant global burden and can be life-threatening, with higher risk in vulnerable groups such as children. SafeConsume is an EU-funded, transdisciplinary project aiming to improve consumers' food safety behaviour. Developing educational resources on food safety for use in schools has potential to improve teaching of our young consumers. The aim of this study was to explore school educators' attitudes, behaviours and knowledge towards food hygiene, safety and education.

METHODS

Focus groups and interviews in England, France, Portugal and Hungary explored educator knowledge, skills, intentions and beliefs around educating young people (11-18 years) about food safety. Data were analysed using NVivo and emerging themes were applied to the Theoretical Domains Framework.

RESULTS

A total of 48 educators participated. Knowledge, confidence and skills to teach food safety to young people varied depending on background and training. Educators reported they had a role to teach food safety to young people, were positive about delivering education and optimistic they could improve students' food safety behaviour. Barriers to teaching included lack of national curriculum coverage, limited time and money, and lack of facilities. Educators reported that social influences (family, celebrity chefs, public health campaigns and social media) were important opportunities to improve young peoples' awareness of food safety and consequences of foodborne illness.

CONCLUSION

Educator food safety expertise varied; training could help to optimise educator knowledge, confidence and skills. Ministries of Health and Education need encouragement to get food safety incorporated further into school curricula across Europe, so schools will be motivated to prioritise these topics.

The impact of COVID-19 on rare metabolic patients and healthcare providers: results from two MetabERN surveys

The ongoing coronavirus disease 2019 (COVID-19) pandemic has caused disruption in all aspects of daily life, including the management and treatment of rare inherited metabolic disorders (IMDs). To perform a preliminary assessment of the incidence of COVID-19 in IMD patients and the impact of the coronavirus emergency on the rare metabolic community between March and April 2020, the European Reference Network for Hereditary Metabolic Diseases (MetabERN) has performed two surveys: one directed to patients’ organizations (PO) and one directed to healthcare providers (HCPs). The COVID-19 incidence in the population of rare metabolic patients was lower than that of the general European population (72.9 × 100,000 vs. 117 × 100,000). However, patients experienced extensive disruption of care, with the majority of appointments and treatments cancelled, reduced, or postponed. Almost all HCPs (90%) were able to substitute face-to-face visits with telemedicine, about half of patients facing treatment changes switched from hospital to home therapy, and a quarter reported difficulties in getting their medicines. During the first weeks of emergency, when patients and families lacked relevant information, most HCPs contacted their patients to provide them with support and information. Since IMD patients require constant follow-up and treatment adjustments to control their disease and avoid degradation of their condition, the results of our surveys are relevant for national health systems in order to ensure appropriate care for IMD patients. They highlight strong links in an interconnected community of HCPs and PO, who are able to work quickly and effectively together to support and protect fragile persons during crisis. However, additional studies are needed to better appreciate the actual impact of COVID-19 on IMD patients’ health and the mid- and long-term effects of the pandemic on their wellbeing.

Hypofractionated adjuvant surgical cavity radiotherapy following resection of limited brain metastasis

BACKGROUND

Following surgical resection of oligometastatic disease to the brain there is a high rate of local relapse which is reduced by the addition of focal radiation therapy, often delivered as single fraction stereotactic radiosurgery (SRS) to the surgical cavity. This study audited the outcomes of an alternative approach using hypofractionated radiation therapy (HFRT) to the surgical resection cavity.

METHODS AND MATERIALS

Seventy-nine patients who received surgical resection and focal radiation therapy to the surgical cavity using HFRT with intensity modulated radiation therapy with or without stereotactic radiotherapy were identified. Doses were delivered in five fractions every second day for 10 days. Follow-up involved MRI surveillance with three-monthly MRI scans post resection. The major endpoints were local control at the surgical cavity site, and presence of radiation necrosis at the treated site.

RESULTS

Seventy-nine patients were included for the analysis with a median follow-up of 10.8 months. Of the cohort, 56% experienced intracranial progression, with all patients progressing distant to the resection cavity, and 7% progressing locally in addition. The one-year local control rate was 89.8%. The median progression-free survival was 10.0 months and median overall survival was 14.3 months. There was one CTCAE grade 3 toxicity of symptomatic radiation necrosis with no grade 4-5 toxicities seen.

CONCLUSIONS

The rate of local relapse following HFRT to the surgical cavity is low with minimal risk of radiation necrosis. HFRT can be considered as an alternative to SRS for focal radiotherapy after brain metastasis resection.

Cardiovascular risk and missed opportunities for treatment in patients with type 2 diabetes presenting with very premature coronary artery disease

Background

Type 2 diabetes mellitus (T2D) is a major cardiovascular risk factor (CVRF), and comprehensive risk factor management reduces the incidence of cardiovascular events.

Purpose

To assess 1) prevalence of T2D among patients presenting with newly diagnosed very premature coronary artery disease (CAD) and its impact on CVRFs and extent of atherosclerosis; 2) effectiveness of glucose and lipid control in T2D patients before presentation with CAD.

Methods

We studied patients with angiographically proven CAD with stenosis of ≥50% who presented at the age of ≤50 years for males and ≤55 years for females. Diabetes was defined as fasting plasma glucose ≥7 mmol/L, haemoglobin (Hb)A1C ≥6.5% or diagnosis or treatment of T2D before or at presentation with CAD. CVRFs were defined as dyslipidemia, hypertension, obesity, current smoking, and family history of premature cardiovascular disease (CVD). Values are reported as mean (±SD), median (interquartile range) or percentages.

Results

From 417 premature CAD patients, 112 (26.9%) had T2D at the time of presentation with CAD. In 27 (24.1%) patients, T2D was newly diagnosed at presentation with CAD. Age of diagnosis of T2D was 41.3 (±6.9) years old. Patients with T2D had higher prevalence of dyslipidemia (83.0% vs 63.3%, p<0.001), hypertension (65.2% vs 40.3%, p<0.001), and obesity (56.3% vs 34.8%, p<0.001), higher cumulative number of CVRFs per person (2.8 (±1.2) vs 2.0 (±1.2), p<0.001) and less favourable lipid profiles, with higher levels of triglycerides (3.3 (2.1–4.7) vs 2.3 (1.5–3.4) mmol/L, p=0.001) and lower HDL-cholesterol (0.9 (±0.3) vs 1.1 (±0.3) mmol/L). Prevalence of smoking (32.1% vs 24.9%, p=0.14) and family history of premature CVD (43.8% vs 39.7%, p=0.45), levels of LDL-cholesterol (3.7 (±1.4) vs 3.8 (±1.2) mmol/L, p=0.23) and lipoprotein(a) (206 (99–819) vs 200 (99–700) mg/L, p=0.57) were not significantly different between groups. T2D patients had a greater prevalence of 3-vessel disease (35.7% vs. 22.2%, p=0.006) and were less likely to receive revascularization (70.5% vs 83.9%, p=0.002).

Prior to presentation with CAD, 31 (27.7%) of T2D patients received insulin, 42 (37.5%) received oral hypoglycemic drugs, and 12 (10.7%) received no pharmacological treatment for diabetes. Only 23 (27.1%) of them achieved HbA1C ≤7% at the time of presentation with CAD (Figure 1). Among all T2D patients, 35 (31.3%) received treatment with statins and 16 (14.3%) reached guideline-recommended lipid targets of LDL cholesterol ≤2 mmol/L and/or non-HDL cholesterol ≤2.6 mmol/L.

Conclusion

Among patients with very premature CAD, T2D was common, was previously unrecognized in up to one quarter, and was associated with a greater burden of CVRFs and more extensive CAD at presentation. Few patients with T2D achieved guideline-recommended lipid or glucose targets. These data point to the need for improvements in screening and comprehensive CVRF treatment of T2D in order to reduce the burden of premature CAD.

Figure 1

Funding Acknowledgement

Type of funding source: Public grant(s) – National budget only. Main funding source(s): Canadian Institutes of Health Research. St. Paul's Hospital Foundation and the Vancouver General Hospital Foundation

HESRi potential for action

Resolution on Health Equity (EUR/RC69/R5) puts equity, gender equality, human rights and social determinants as high priority for action of all 53 WHO EURO Member States (MS) and partners. The resolution was unanimously adopted following a year of extensive consultation and dialogue with MS and partners: NGOs, scientific community, professional associations and UN and bilateral agencies. WHO scientific leadership role in health equity in EURO was key to success as it brought forward innovations in health equity analysis and solutions which were also presented and debated at the high-level regional conference. Together with member states WHO is now developing Health Equity Solutions Platform to connect innovative life policy sites with the latest available evidence and practical tools to accelerate development of solutions. New narrative, set of tools and innovative methodology in data analysis were taken up globally, represent a model for the global report on health inequities and feed into global strategy on social determinants of health.

Surgical training rotation design: effects of hospital type, rotation theme and duration

BACKGROUND

Entrants into UK surgical specialty training undertake a 2-year programme of core surgical training, rotating through specialties for varying lengths of time, at different hospitals, to gain breadth of experience. This study aimed to assess whether these variables influenced core surgical trainee (CST) work productivity.

METHODS

Intercollegiate Surgical Curriculum Programme portfolios of consecutive CSTs between 2016 and 2019 were examined. Primary outcome measures were workplace-based assessment (WBA) completion, operative experience and academic outputs (presentations to learned societies, publications and audits).

RESULTS

A total of 344 rotations by 111 CSTs were included. Incremental increases in attainment were observed related to the duration of core surgical training rotation. The median number of consultant-validated WBAs completed during core surgical training were 48 (range 0-189), 54 (10-120) and 75 (6-94) during rotations consisting of 4-, 6- and 12-month posts respectively (P < 0·001). Corresponding median operative caseloads (as primary surgeon) were 84 (range 3-357), 110 (44-394) and 134 (56-366) (P < 0·001) and presentations to learned societies 0 (0-12), 0 (0-14) and 1 (0-5) (P = 0·012) respectively. Hospital type and specialty training theme were unrelated to workplace productivity. Multivariable analysis identified length of hospital rotation as the only factor independently associated with total WBA count (P = 0·001), completion of audit (P = 0·015) and delivery of presentation (P = 0·001) targets.

CONCLUSION

Longer rotations with a single educational supervisor, in one training centre, are associated with better workplace productivity. Consideration should be given to this when reconfiguring training programmes within the arena of workforce planning.

Sarcopenia and myosteatosis in patients undergoing curative radiotherapy for head and neck cancer: Impact on survival, treatment completion, hospital admission and cost

BACKGROUND

Computed tomography (CT) is the gold standard of body composition analysis at the tissue-organ level. The present study aimed to determine the impact of CT-defined sarcopenia and myosteatosis on outcomes, including overall survival, unplanned hospital admissions and related costs, in patients who had completed treatment of curative intent for head and neck cancer (HNC).

METHODS

Retrospective observational study of patients undergoing radiotherapy of curative intent ± other treatment modalities for HNC. Tissue density data derived at the third lumbar vertebra (L3) were evaluated with sarcopenia defined per sex-specific published threshold values for skeletal muscle index, stratified by body mass index and mean skeletal muscle attenuation in HU (Hounsfield units).

RESULTS

Pre- or post-treatment images were available for 79/98 patients (80.6%) and 61/98 patients (62.2%), respectively. Sarcopenia was present in 42/79 patients pre-treatment and 36/61 patients post-treatment, whereas myosteatosis was present in 63/79 patients pre-treatment and 48/61 patients post-treatment. In patients with pre- and post-treatment images (n = 60), the median (range) percentage weight change was -8.5% (-29.9 to +11.7). On multivariable analysis, a post-treatment sarcopenia hazard ratio of 3.87 (95% confidence interval = 1.22-12.24, P = 0.021) and a pre-treatment myosteatosis hazard ratio of 8.86 (95% confidence interval = 1.12-69.88, P = 0.038) were independent predictors of reduced overall survival. There was no difference in radiotherapy or chemotherapy treatment completion based on pre-treatment sarcopenia status. The mean (SD) difference unplanned hospital admission cost was $15 846 ($17 707) for patients without sarcopenia versus $47 945 ($82 688) for patients with sarcopenia at any time point (P = 0.077).

CONCLUSIONS

As CT-defined sarcopenia and myosteatosis hold clinically meaningful prognostic value, muscle status evaluation is recommended in routine clinical practice.

Variation in training requirements within general surgery: comparison of 23 countries

Background

Many differences exist in postgraduate surgical training programmes worldwide. The aim of this study was to provide an overview of the training requirements in general surgery across 23 different countries.

Methods

A collaborator affiliated with each country collected data from the country's official training body website, where possible. The information collected included: management, teaching, academic and operative competencies, mandatory courses, years of postgraduate training (inclusive of intern years), working‐hours regulations, selection process into training and formal examination.

Results

Countries included were Australia, Belgium, Canada, Colombia, Denmark, Germany, Greece, Guatemala, India, Ireland, Italy, Kuwait, the Netherlands, New Zealand, Russia, Saudi Arabia, South Africa, South Korea, Sweden, Switzerland, UK, USA and Zambia. Frameworks for defining the outcomes of surgical training have been defined nationally in some countries, with some similarities to those in the UK and Ireland. However, some training programmes remain heterogeneous with regional variation, including those in many European countries. Some countries outline minimum operative case requirement (range 60–1600), mandatory courses, or operative, academic or management competencies. The length of postgraduate training ranges from 4 to 10 years. The maximum hours worked per week ranges from 38 to 88 h, but with no limit in some countries.

Conclusion

Countries have specific and often differing requirements of their medical profession. Equivalence in training is granted on political agreements, not healthcare need or competencies acquired during training.

The value of peer support for self-management of diabetes among veterans in the Empowering Patients In Chronic care intervention

AIM

To examine the value of peer support in the self-management of diabetes among veterans in an integrated health care system.

METHODS

We conducted semi-structured in-depth interviews with veterans and clinicians 6 months after their participation in Empowering Patients in Chronic Care (EPIC), a group-based diabetes intervention with a peer-support component. Interviews elicited clinicians' narratives of how peer support unfolded in the groups and veterans' experiences of giving and receiving support from their peers. Data analysis was guided by principles of framework analysis using Heisler's peer-support model.

RESULTS

Findings support Heisler's peer-support model and provide evidence supporting professional-led group visits with peer exchange. Clinicians and veterans endorsed informational and emotional support received in EPIC groups. Clinicians often referred to EPIC as an open forum or a support group where veterans could both give and receive help. Veterans noted the benefits of shared problem-solving and the support they received. Clinicians and veterans perceived the peer-support component of EPIC as facilitating increased empowerment in terms of self-efficacy, increased perceived social support and increased understanding of self-care. Ultimately, many veterans acknowledged that their participation in EPIC facilitated improved health-related quality of life, improved health behaviours and improved chronic disease control.

CONCLUSIONS

Findings emphasize the value of peer support in managing chronic illness. Peer-support programmes may address veterans' unique challenges and have the potential to improve physical and mental health.

Tools and approaches towards sustainable investment for health equity

Issue

The drive to deliver better results for the economy and for society is challenged by the daily pressures faced by policy makers to contain the public expenditure while delivering improved outcomes. This is evident also in the health sector where costs are perceived to be spiralling. As a result, the sector faces huge pressure to cut budget and services. On the other hand, the health sector is a minor contributor towards health equity, as social, economic and environmental determinants of health are mostly responsibility of other sectors. Health equity and well-being are outcomes of societal values, culture and policy choices, that create the conditions for prosperous lives for all, leaving no one behind.

Description

There are different approaches and tools that can be used for advocating, planning and monitoring investments for health equity. To name a few that the health system can introduce: mainstreaming equity into health services, employment, procurement and purchasing practices for better social and economic benefits; Health Equity Impact Assessment that supports implementation of Health Equity in All Policies and Agenda 2030; voluntary national review reporting on SDGs - all stressing the need for disaggregation of data, new evidence and methods, and monitoring.

Results/Lessons

Health equity is a complex issue that needs comprehensive response combining various approaches and tools in advocating, planning, implementing and monitoring. Besides situation analysis, more and more WHO Member States are requesting evidence about what works and how to do it. Therefore, tailor made assessment, solution development and monitoring is becoming a standard. This needs to be supported with continuous training and capacity building. WHO European Office for Investment for Health and Development developed a Health Equity Status Report and a flagship course on Equity in Health in All Policies, built on the latest evidence and tailored to country / community needs.

Panelists: Marleen Bekker

EUPHA (PHPP)

Wageningen University & Research, Netherlands

Contact: marleen.bekker@wur.nl

Diana Sonntag

EUPHA (ECO)

University of Heidelberg, Germany

Contact: diana.sonntag@medma.uni-heidelberg.de

Aileen Clarke

Warwick Evidence, The University of Warwick, Coventry, UK

Contact: aileen.clarke@warwick.ac.uk

Ana M Carriazo

Regional Ministry of Health and Families, Andalusia, Seville, Spain

Contact: anam.carriazo@juntadeandalucia.es

Cross-sectional study of the prevalence, causes and management of hospital-onset diarrhoea

BACKGROUND

The National Health Service in England advises hospitals collect data on hospital-onset diarrhoea (HOD). Contemporaneous data on HOD are lacking.

AIM

To investigate prevalence, aetiology and management of HOD on medical, surgical and elderly-care wards.

METHODS

A cross-sectional study in a volunteer sample of UK hospitals, which collected data on one winter and one summer day in 2016. Patients admitted ≥72 h were screened for HOD (definition: ≥2 episodes of Bristol Stool Type 5-7 the day before the study, with diarrhoea onset >48 h after admission). Data on HOD aetiology and management were collected prospectively.

FINDINGS

Data were collected on 141 wards in 32 hospitals (16 acute, 16 teaching). Point-prevalence of HOD was 4.5% (230/5142 patients; 95% confidence interval (CI) 3.9-5.0%). Teaching hospital HOD prevalence (5.9%, 95% CI 5.1-6.9%) was twice that of acute hospitals (2.8%, 95% CI 2.1-3.5%; odds ratio 2.2, 95% CI 1.7-3.0). At least one potential cause was identified in 222/230 patients (97%): 107 (47%) had a relevant underlying condition, 125 (54%) were taking antimicrobials, and 195 (85%) other medication known to cause diarrhoea. Nine of 75 tested patients were Clostridium difficile toxin positive (4%). Eighty (35%) patients had a documented medical assessment of diarrhoea. Documentation of HOD in medical notes correlated with testing for C. difficile (78% of those tested vs 38% not tested, P<0.001). One-hundred and forty-four (63%) patients were not isolated following diarrhoea onset.

CONCLUSION

HOD is a prevalent symptom affecting thousands of patients across the UK health system each day. Most patients had multiple potential causes of HOD, mainly iatrogenic, but only a third had medical assessment. Most were not tested for C. difficile and were not isolated.