EuroNews #18 – Survey of the current state of public health emergency management teaching in italian schools of specialization in hygiene and preventive medicine among medical residents

by: Dott. Stefano Greco, MD. Resident in Hygiene and Preventive Medicine at the University of L’Aquila, Co-ordinator of the Consulta SItI’s working group of Emergency Management and Disaster medicine; Dott. Francesco Rosiello, MD; Dott. Antonio Vinci, MD. Resident in Hygiene and Preventive Medicine at Università di Tor Vergata; Dott. Mario Muselli, MD. Resident in Hygiene and Preventive Medicine at University of L’Aquila

 

Abstract

Following the institution of the working group on Emergency Management and Disasters Medicine within the Italian Advisory Body of Medical Residents in Hygiene, Preventive Medicine and Public Health ( Consulta SItI), an official body of the Italian Society of Hygiene, Preventive Medicine and Public Health (Società Italiana di Igiene, Medicina Preventiva e Sanità Pubblica, SItI), a survey on preparedness, knowledge demand and professional interest on disaster medicine among residents in public health has been conducted. 96 out of about 500 interns answered the survey.

From the answers it can be affirmed that, despite growing attention on the matter (especially due to the numerous nefarious events that afflicted Italy in the last 10 years), a very small number of Schools of Specialization dedicate time of resources on the thematic.

Introduction

Italy, during the last 10 years, was afflicted by 5 earthquakes of medium-high intensity (Richter >3) and several floods and\or unseasonal meteorological hazards. These events sum up to anthropic disasters of national relevance, such as the collapse of Morandi Bridge in Genua, interrupting a fundamental traffic road not only for the city and the hinterland, but for the entire national road movements of people and goods.

Materials and Methods

After a first meeting (in person) on the creation of the working group, several online meetings were indicted via skype in order to design a questionnaire to be delivered on all Italian’s Public Health (Hygiene) residents.

The final questionnaire consisted of 12 Items, based on a 6-steps increasing scale (0-5), yes/no answers and open ones. It was host on Google module and diffused to all Schools, whose interns had ample time to answer to (one month).

Results

96 out of 500 interns answered the questionnaire, from 26 out of 35 schools. Overall compliance was of 19,2% for interns and 74,2 for schools.

The answers, shown in figure 2, were as follow: 79% declared they never attended any activity on emergency management in public health; 93.8% is not satisfied by the space reserved to the thematic in their School; 75% declared to be interested in the thematic (scale score >= 4); 80% declared they never attend to any course on the matter and 86% that their university did not have any Master active on the thematic.

As per sources of information, 58,9% declared they look for information on courses and congresses, with a strong interest on workshops, simulations, and formative events.

Last but not the least, 81,3% declared absence of a sharing policy for confrontation and experiences exchange among Schools from clinical areas.

Strengths and Limitations

Unfortunately, number of respondent residents was only a fraction of the total resident number, most likely those who already had a keen interest in the matter. This could have lead to a selection bias, at least on the interns’ interest section; it must be noted, however, that this has no repercussions on the study section regarding presence of specific courses or masters, since this does not depend from the number of participants.

Also this did not influence the statistics covering information sources either, since those who have no interest are not expected to have a source of information at all.

Discussion

An analysis of answers shows that there is high interest on the matter by Italian residents, but unfortunately such interest is not always met by the courses held in the respective  Specialization Schools. Henceforth, the authors believe it is opportune to allow an enrichment of the formative portfolio of Italian interns, and that this should be reported in all opportune environments, in order to answer to the formative demand hereby emerged.

Acknowledgements

The survey was conducted by Dr. Stefano Greco, MD, resident from L’Aquila University and co-ordinator of the Consulta SItI’s Emergency Management and Disaster medicine working group. All the members of the Working Group actively helped Stefano to realize this project.

EuroNews #18 – Migrants’ Health: new perspectives from a Symposium in Amsterdam

by Giulia Gherardi, MD
PH resident University of Bologna, Italy

“Challenges and realistic Solutions to Migrant Health Burden in Europe” has taken place in Amsterdam 12 July 2019. Amsterdam Public Health-Global Health Section within the Amsterdam UMC (University Medical Centers)
has organized this symposium. The seminary started at 9:30 AM in a stunning Mennonite Church in Singel Street and ended at 6:00 PM with a celebration for the recent “full Professor title” of Professor Charles Agyemang.

In the morning three keynote lectures has been presented by leading scholars in the field of ethnicity, health and migration, including Prof. Raj Bhopal (University of Edinburgh), Prof. Allan Krasnik (university of Copenhagen) and Prof. Karien Stronks (Amsterdam UMC, University of Amsterdam).

The first presentation has dealt with risk factors, both genetic and environmental, for diabetes type 2 among South Asian population living in Amsterdam. The result imputed, as a major risk factor, the lifestyle and the particular way of cooking at very high temperature that concentrate trans-fat acids. On the other hand, the second and the third
lectures have been broader, addressing the important role of inequalities and social determinants on migrants’ health.

They strengthened the need of improvement cultural competence of health services as well as the creation of target programs for selected population.

After the lunch, PhD students of UMC presented some thriving researches about the burden of chronic non-communicable diseases among migrant population. Some of them has been extremely specific (metabolism and molecular pattern) and mostly based on the South Asian community, which is the more representative in the city of Amsterdam.

In the end, a Round Table Discussion has been carried out with the keynote speakers. This dynamic interaction pointed out that we need a system thinking with inclusive intervention designs with community engagement and stakeholder participation in order to develop achievable and realistic solution to this issue. Professor Agyemang’ celebration has probably been the best part. To honor also is Ghanaian origin he presented a wide interesting lecture “Healthy Migrants, Healthy Society” about migration and all its aspects.

Personally, this attendance has been a pleasure. Especially noticing that UMC really cares, allocates resources and promotes research in migrants’ health, as it is seriously considered an important public health issue.

EuroNews #18 – “Patient Planet”

by Rachael Marsh
Public Health resident, Bristol, UK

“We can only pray that our sick planetary patient might be placed on a road to recovery – failure to write the prescription, however, might leave us contemplating the death certificate instead”. Prince of Wales 2015, Royal Society in London.

Our Planet is Critically Sick

If we were to consider our Planet as a patient, as health professionals, we would be seriously concerned about their health and would quickly diagnose that ‘Patient Planet’ was critically sick. A rapid assessment of the Planet’s health
would find an escalating fever, with difficulties breathing, a faltering circulation, with metabolic acidosis and a toxic status, failing liver and kidney functions, a pale, blotchy skin indicating signs of shock, with a rapidly declining mental state.
Human systems can be seen as a microcosm of the Earth’s living biosphere, although there are significant differences in scale and functioning of some of these systems, in terms of appreciating the seriousness of the Earth’s failing eco-systems, it is helpful to consider the analogies of the Planet’s health with that of a human, as below:

“Fever – escalating temperature – 1°C now, rapidly rising to 3-4°C by 2100 and 3-10°C by 2200 (a temperature rise of 3-4°C is considered a medical emergency and risks fatally in humans).
Respiratory System – escalating carbon emissions with CO2 at 411ppm; air pollution dangerously high with 91% of places exceeding WHO guidelines; wildfires and continued loss of global forests.
Circulatory system – oceans 30% increased acidity having absorbed 50% of postindustrial carbon emissions and 90% of the excess heat (equivalent to 36°C when released back to the atmosphere); pollution with toxins and plastics; freshwater scarcity.
Organs (liver and kidneys) – an annual 3% loss of swamp and marsh lands that protect coasts, detoxify and regenerate.
Skin – increasing desertification, mudslides, and depleted agricultural land.
Mental Health – biodiversity loss at 60% for mammals, birds, fish and reptiles since 1970, nearing the threshold for a sixth mass extinction at 75% loss.”

Source. IPCC (2018); WHO (2016); NASA (2019); FAO (2019); WMO (2019); Living Planet Report (2018); IUCN (2016); Drawdown (2017); Lewis and Maslin (2018); Kumar and Clark (2016).

Diagnosis and prognosis – will ‘Patient Planet’ die?

As physicians, we would diagnose an escalating fever with a critical risk of multiple organ failure and send ‘Patient Planet’ straight to Critical Care. Not knowing what else to do, we could declare the situation as chronic, terminal, and just take steps to make the patient as comfortable as possible until the end came. However, we stand at a critical moment in the history of our Planet. Over the next decade, we are the generation that holds the responsibility to reverse the epidemic explosion of carbon emissions and urgently stabilise the risks from runaway climate change.

Management – how can we save ‘Patient Planet’?

Just like for a sick patient, by taking a Critical Care Response approach as below, we can halt and potentially reverse the harm done so far.

Resuscitation: declare a Climate Emergency.
We already have mechanisms like the WHO Emergency Response Framework in place, and given the critical state of the Planet’s Health, this should warrant an urgent assessment, which based upon risks and severity of global impacts, should be placed at Grade 3, triggering a multi-sector, global emergency response (WHO, 2017). We can draw lessons from handling other emergencies like Ebola, which led to rapid mobilisation of resources, strategic co-ordination and action at speed and scale.
Stabilization: homeostasis/ re-stabilization of systems requires a rapid reduction of carbon emissions over the next decade, including actively sequestering carbon to lower the driver of increasing temperatures. Stabilisation
of ocean temperatures and acidity may also be required.
Treatment: depending upon the successful resuscitation and stabilisation, ‘Patient Planet’ would be able to leave the critical care unit, with a longer-term treatment plan, including an initial recovery period, during which time
toxins and plastics would be removed to allow healing.

Recovery: to enhance the recovery of ecosystems
Air – rapid investment in clean energy and transport systems
Water – restore healthy ocean and coastal environments, enhance naturebased solutions for clean water and
sanitation systems
Food – reduce food waste and excess consumption, enhance plant based healthy foods and clean cooking
Rehabilitation: additionally, a preventive approach would be taken, including building climate resilience/ emergency preparedness (flood management, drought response, etc). Development of planetary health indicators to
act as an Early Warning Score enabling detection of high-risk symptoms, and corresponding early intervention.
Promotion: promote sustainable development with a focus on actions that primarily benefit the health of the Planet, whilst maximising cobenefits for humans, including: continuing work towards the Sustainable Development Goals (SDGs, 2015) and actions such as; reduced food waste, plant rich diets, family planning, educating girls, clean cookstoves, renewable energy, housing insulation, recycling, forest protection, water saving, walkable cities, and
cycling infrastructure (Drawdown, 2017).
The UN recently declared that we have to reduce global carbon emissions by 45% by 2030, in order to keep to within safe limits (1.5°C), with a target of zero emissions by 2050. This requires urgent, large-scale action with an estimated annual investment of 2.5% of global GDP (IPCC 2018).

Please share this analogy widely to help save ‘Patient Planet’. Concept adapted from work by Dr Joanna Nurse
(Strategic Advisor to InterAction Council).

References

Drawdown, (2017) ‘The most comprehensive plan ever proposed to reverse global warming’ edited by Paul Hawken, Penguin.
FAO (2019) ‘The State of the World’s Biodiversity – for Food and Agriculture’ http://www.fao.org/3/CA3129EN/CA3129EN.pdf
IPCC (2018) ‘Global Warming of I.5C’ Intergovernmental Panel on Climate Change; https://www.ipcc.ch/site/assets/uploads/sites/2/2018/07/SR15_SPM_High_Res.pdf
IUCN (2016) ‘Explaining Ocean Warming – causes, scale, effects and consequences’ https://portals.iucn.org/library/sites/library/files/documents/2016-046_0.pdf
Kumar and Clark (2016) ‘Clinical Medicine’ 9th Edition, Elsevier.
Lewis SL and Maslin MA (2018) ‘The Human Planet – How We Created the Anthropocene’ Pelican, Penguin Random House UK; www.greenpenguin.co.uk
Living Planet Report, (2018) “Aiming Higher” World Wildlife Fund:https://www.wwf.org.uk/sites/default/ files/2018-10/wwfintl_livingplanet_full.pdf
NASA (2019) Carbon Dioxide Vital Signs: https://climate.nasa.gov/vital-signs/carbon-dioxide/
Stockholm Resilience Centre, (2018) Hothouse Earth Scenario: http://www.stockholmresilience.org/research/research-news/2018-08-06-planet-at-risk-of-headingowards-hothouse-earth-state.html
SDGs (2015) ‘Sustainable Development Goals’ United Nations https://sustainabledevelopment.un.org/sdgs
WHO (2016) ‘Ambient Air Pollution – a Global Assessment of Exposure and Burden of Disease’ https://apps.who.int/iris/bitstream/handle/10665/250141/9789241511353-eng.pdf?sequence=1
WHO (2017) ‘Emergency Response Framework’ https://apps.who.int/iris/bitstream/handle/10665/258604/9789241512299-eng.pdf;jsessionid=3B3D33D3A90B88252DBB9FBF840F0705?sequence=1
WMO (2019) ‘Statement on the State of the Global Climate in 2018: https://gallery.mailchimp.com/daf3c1527c528609c379f3c08/files/82234023-0318-408a-9905-5f84bbb04eee/Climate_Statement_2018.pdf

Vienna Summer Meeting 2019

For the first time in EuroNet history a meeting will be organized in the Austrian Capitol of Vienna. The Vienna Organizing Committee would like to invite you to join us at the EuroNet Summer Meeting where we will focus on vulnerable communities.

Next to new things you will learn, the meeting is a great opportunity to meet and network with fellow residents from around Europe. The meeting and participation will help in strengthening the position of the public health residency program in Austria and increasing the visibility of the program and public health work in Austria.

And if that isn’t enough, join us and enjoy the great culture, music and cool urban vibes of one of the most hospitable cities on the planet!

Location / Venue

The meeting will be held at the Center for Public Health, Kinderspitalgasse 15, 1090 Vienna, location on the U6 line (underground, brown line) by the doorstep of U6 ALSER STRASSE station.

Schedule

There’s a draft available here.

Casa EuroNet / Where to stay

Hostel bookings are welcome at 1070 Vienna Hostel. With the code “Symposium 2019”, when booking through their website, they can make sure EuroNet participants will be staying in the same dormitories (Casa EuroNet style!). Price for a night, including sheets and breakfast buffet, is 20eur/person in a dormitory (or 23.50eur for a bunk bedroom for 2 people).

Transportation

Vienna boasts one of the best public transportation systems in the world (bus, tram, underground and in-city-train) and that basically you are 30-40 min away from any point in this city from wherever you are. The hostel is within walking distance from the venue (15 minutes), however if you want to take public transportation the single tickets price is 2,40€. Taking the train between the Vienna airport and the city centre costs around 4,80€.

Social Programme

A social programme is being organized, and you’ll have to wait a bit longer to get insight on it… but, for a taste of it: there will be a three course dinner (costing 23,50€, drinks not included).

 

[Registration is closed!]

Looking forward to see you in Vienna,
The Vienna Organizing Committee

 

Torino Spring Meeting 2019

Between the 11th and 13th of April we had our Spring Meeting in the lovely city of Turin, Italy.

There were interactive workshops, plenary sessions, working group meetings and a rich social programme! All that can be expected from a EuroNet meeting 🙂 It was a wonderful event, and we're so grateful to have shared these moments with all the attendees. See you soon for the Summer Meeting! Stay tuned for dates and location... soon...

Meanwhile, below you may see some of the pictures taken during the meeting. A big thank you to Jona Blatnik, a Slovenian resident, for her pictures.