Exploring the Policies Applied to Pharmaceutical Care Practice for Type 2 Diabetes over the Last Decade in European Community Pharmacies

In the last decade (2010–2020), more than half of European countries have improved their health policies within the primary care for type 2 <i>diabetes mellitus</i>. Community pharmacies have been and could continue to be essential actors in this evolution of fighting the disease by providing a set of pharmacotherapeutic follow-up services for the person with diabetes. These services, designated by the Pharmaceutical Group of the European Union as “<i>diabetes management</i>” and “<i>glucose measurement</i>”, have aimed to optimize adherence to therapy and improve health outcomes. However, to follow the European guidelines of Good Pharmacy Practice, providing these services implies having a normative framework or a legal basis. Thus, this study sought to analyze the normative and regulatory framework on which community pharmacies in 28 European countries were based on providing this health care over the last decade.

COVID-19 among Nursing Staff: Settings and Regional Differences

<b><i>Background/Aims:</i></b> So far detailed insights into the nursing staff’s COVID-19 symptoms, testing, and results are missing. Therefore, this study aimed to describe the setting and regional differences in the occurrence of COVID-19 among nursing staff, analysing symptoms, testing, and their respective results. <b><i>Methods:</i></b> We used an online survey to conduct this cross-sectional study among Austrian nursing staff in different settings between May 12 and July 13, 2020. This article follows the STROBE statement. The survey includes demographic data, including age, professional qualification, e.g., nurse, nurse aid, and in which federal state and setting the participants work. In addition, we asked for COVID-19 symptoms and (result of the) testing. We used descriptive statistics as well as bivariate analysis to calculate the differences. <b><i>Results:</i></b> Nearly every sixth nurse reported experiencing COVID-19 symptoms. We found statistically significant differences between the settings and the federal provinces for the reported COVID-19 symptoms, but not the test results. In total, 1.6% of the participating nurses were tested for COVID-19, of which all were positive for COVID-19. <b><i>Conclusions:</i></b> In the future during a pandemic, health care staff should be comprehensively tested in all settings. Our results showed that shifting the perspectives from critical/acute settings to other settings, such as nursing homes, is needed.

Geographical Distribution of Emergency Services Times in Traffic Accidents in Extremadura

<b><i>Objective:</i></b> To analyze the response time and transport time taken by the emergency medical services (EMS), considering their urban or rural location, to attend traffic accident casualties that occurred in the different geographical areas of Extremadura (Spain) from 2012 to 2015. <b><i>Methods:</i></b> This was a cross-sectional study of the data recorded by the Emergency Response Coordination Center 112 (ERCC-112) from traffic accidents attended by EMS. Response time was defined as the time elapsed from the request-for-care receipt until arrival of the EMS at the accident scene, and transport time as that from leaving the scene until arrival to the referral hospital. Rural EMS were those based in locations where there is no hospital, and urban EMS those located in towns or cities with a hospital. <b><i>Results:</i></b> During the 4-year period studied, 5,572 traffic accidents requested assistance through the ERCC-112. From the 2,875 accidents (51.9%) in which EMS were mobilized, 55.4% occurred in urban roads and the remaining in interurban ones. A total of 113 people (mean age 48.4 ± 19.0 years, range 15–84 years) died at the accident scene or before arrival to the hospital, 88.5% of them in interurban accidents. The average response time of urban and rural EMS was 10.7 ± 7.3 and 18.0 ± 12.6 min (<i>p</i> &#x3c; 0.001), respectively, and the average transport time was 13.2 ± 11.7 and 45.2 ± 25.0 min (<i>p</i> = 0.009). Response time was longer than the 30-min optimum only in the most peripheral areas of Extremadura, while transport time exceeded the optimum of 90 min in the eastern regions of two health areas (Cáceres and Don Benito-Villanueva). 19.1% of the victims attended by rural EMS were classified as having a serious prognosis or as having died, as compared with 11.2% (<i>p</i> = 0.048) of those attended by urban EMS. <b><i>Conclusions:</i></b> The geographical location of EMS in Extremadura (Spain) guarantees adequate response times in traffic accidents, both in rural and urban areas. However, recommended transport times were occasionally exceeded in the most peripheral areas, due to hospital location.

Urban Noise Exposure and Cardiometabolic Diseases: An Exploratory Cross-Sectional Study in Lisbon

<b><i>Introduction:</i></b> Urban noise pollution has been associated with an increased risk of developing metabolic syndrome. Nevertheless, existing observational studies relating to noise exposure and metabolic syndrome are based on non-generalizable cohorts. Lisbon remains a noisy city where this association has not been evaluated, and for this reason, we studied the relationship between exposure to urban noise and the prevalence of type 2 diabetes mellitus, obesity, and hypertension. <b><i>Methods:</i></b> Diurnal, evening and nocturnal noise emission levels were obtained for each street in the city from the Lisbon noise map. After allocation of all roads to the respective parish of Lisbon, the noise emission for each parish was averaged for each day period. The number of adult patients with type 2 diabetes mellitus, obesity and hypertension in 2014, 2015 and 2016 in each parish of Lisbon was obtained from the Regional Health Administration of Lisbon and Tagus Valley. Prevalence as a percentage of the population was determined using the number of residents in each parish determined in the 2011 population census. Spearman’s non-parametric correlation coefficient was used due to the non-normal distribution of the variables, at the 5% significance level (α = 0.05). <b><i>Results:</i></b> No correlations were found between daytime, afternoon or night-time noise exposure and the prevalence of type 2 diabetes mellitus, obesity or hypertension, although correlations were found between the cardiometabolic variables. Nevertheless, noise levels in Lisbon were above the legally established limit and the World Health Organization guidelines for environmental noise exposure in the European region. <b><i>Conclusion:</i></b> Our results do not agree with previous studies and should be faced as preliminary due to a strong biological plausibility for an association between noise exposure and cardiometabolic diseases and to encourage further studies, with longitudinal cohorts.

Risk Factors Associated with Falls among Nursing Home Residents: A Case-Control Study

<b><i>Introduction:</i></b> To identify factors predictive of falls and enable appropriate management of fall risk it is necessary to understand the behaviour and health conditions of older adults living in nursing homes. <b><i>Objective:</i></b> This study had two main objectives. The first was to find significant predictors for falls in older adults living in nursing homes. The second main goal was to build a predictive model to find the best predictors for falls. <b><i>Methods:</i></b> Out of 56 nursing homes with the same legal statute, 25 agreed to participate. The sample was randomly selected and only the independent or slight/moderately dependent participants were included in the study (<i>n</i> = 325). <b><i>Results:</i></b> There was a mean of 1.47 ± 0.99 falls (range from 1 to 7) per resident in nursing homes. By using the <i>t</i> test and odds ratio analysis, ten factors related to falls were identified. Through the binary logistic regression, a model was tested identifying four robust predictors: static balance, resorting to emergency services, polypharmacy, and an independent self-care profile. <b><i>Conclusions:</i></b> The present study replicated the main results of contemporary research on the risk factors of falls. More importantly, it suggests that the self-care profile model should be taken into account in future studies and early interventions. It is crucial to implement preventive measures consistent with safer environments and to establish an individual plan for integrated activities according to older adults’ health needs.

Departments of Pediatrics Approach at the Beginning of the COVID-19 Pandemic

<b><i>Introduction:</i></b> The novel coronavirus pandemic poses a challenge to healthcare systems’ balance. Since children apparently have milder disease courses, COVID-19 guidelines were not easily adapted to pediatrics. We intend to characterize how the national departments of pediatrics adapted to the pandemic at the beginning and describe the measures that were taken to protect healthcare workers. <b><i>Methods:</i></b> An unvalidated online questionnaire was sent to all departments of pediatrics directors of Portuguese public health system hospitals regarding course of actions taken between April and May 2020 to face the new coronavirus pandemic. Neonatology units were excluded. <b><i>Results:</i></b> Thirty-eight questionnaires were included (93% of public health system departments). All departments divided the pediatric emergency unit into non-COVID-19 and COVID-19 areas: 68% in different areas, 47% divided the same space with a physical barrier and 16% with a line on the floor. Healthcare workers were divided into non-COVID-19 and COVID-19 teams in 71% of the departments. Personal protective equipment mostly used in COVID-19 areas consisted of face shield/goggles (97%) and respirators (95%). Others wore surgical masks (8%). The main clinical criteria for testing were Direção-Geral da Saúde criteria (84%). Presential appointments were maintained in 68% of departments with selected follow-up (81%) and priority-first appointments (73%). <b><i>Discussion:</i></b> National departments of pediatrics faced the pandemic differently and measures taken in the emergency department were more similar. Personal protective equipment was adequate in all wards with occasional overuse, considering national and international guidelines.

Mandatory Vaccination in Child Daycare and Its Relevance to COVID-19

Last month, the European Human Rights Court in Strasbourg made a landmark ruling on mandatory vaccination of children. After a long legal battle that lasted 16 years, the Grand Chamber decided, in the Vavricka case, that a Czech national law imposing a statutory duty of a set of standard vaccinations for children under the age of 15 does not violate the right to private life as protected under the European Convention on Human Rights (ECHR). Although the outcome of this ruling is not surprising, it may also have consequences relating to the controversy of mandatory COVID-19 vaccination which has been raised in other European countries.

How Many People Live with Dementia in Portugal? A Discussion Paper of National Estimates

Dementia poses major public health challenges, and high-quality epidemiological data are needed for service planning. Published estimates of numbers of people with dementia in Portugal have been based, in most cases, on prevalence rates derived from international studies or expert consensus. As in many other countries, Portuguese community prevalence studies’ results are nongeneralizable to a country level. Moreover, their prevalence estimates differ (not surprisingly, owing to different methodologies, e.g., design, sampling, and diagnostic criteria). Regardless, the Portuguese 10/66 Dementia Research Group (10/66 DRG) population-based survey fulfilled 10 out of 11 Alzheimer’s Disease International quality criteria for prevalence studies. It relied on cross-culturally validated methods, fostering a wide comparability of results. Therefore, we can provide rough estimates of 217,549 community dwellers with dementia in Portugal according to the 10/66 DRG criteria (that would be only 85,162 according to DSM-IV criteria). This refers to people aged 65 years or older who are not institutionalized. Although broadly consistent with international projections, these estimates must be cautiously interpreted. Particularly in the context of scarce funding, which will probably last for years, we need more efficient, evidence-based dementia policies. Concerning further epidemiological studies, high-quality methods are needed but also their comparability potential should be improved at national and international levels. Most of all, fund allocation in Portugal should now privilege routine dementia information systems in both health and social services.

HTA Reshaping: Rethinking the Health Technology Assessment Framework in Portugal

<b><i>Introduction:</i></b> Health technology assessment (HTA) aims to provide decision makers with relevant data to make informed choices. Recent changes in the Portuguese HTA framework have altered substantially the assessment methodology with regard to economic evaluation, with potential impacts on access and process efficiency. The HTA Reshaping Project had as its main objective informing the debate on HTA in Portugal, thereby identifying improvement opportunities and solutions to the HTA framework that address future challenges. <b><i>Methods:</i></b> The project comprised several phases, i.e., (1) mapping and evaluation of different HTA frameworks across Europe, identifying best practices and key variables to consider in future frameworks; (2) conduction of in-depth interviews with relevant stakeholders (<i>n</i> = 11); and (3) development of 2 workshops – one with young professionals (<i>n</i> = 12) and another with relevant HTA stakeholders (<i>n</i> = 19) – to consolidate and further explore vital elements of HTA, aimed at brainstorming ideas and developing solutions to improve some of the most critical points, with a view to addressing future challenges. <b><i>Results:</i></b> The comparison of HTA frameworks showed that their purpose and sophistication vary across European countries. For example, the need for economic evidence is not unanimous, and reimbursement agreements vary considerably. Among the stakeholders interviewed there was a high level of agreement on priorities that should be addressed, e.g., expanding and creating national level registries and assuring patient participation throughout the HTA process. The possibility of using managed entry agreements to enhance patients’ access, applying multi-indication pricing for medicines with different therapeutic values per indication, and improvement of registry/system interoperability gathered a moderate level of agreement. <b><i>Conclusions:</i></b> The Portuguese HTA framework might be further adapted to upcoming challenges and should evolve to improve access to innovative therapies. There is still a long path towards the convergence of HTA frameworks in EU member states.