bluuebunny/crossref_metadata_2025 huggingface dataset:
Survival of people living with AIDS with or without tuberculosis in Sao Paulo, Brazil
Authors: Tancredi M V , Sakabe S , Domingues C S B , Pereira² G F M , Waldman E A
Published: October 2020

Background

To estimate median survival time of AIDS patients, with and without tuberculosis (TB), in a cohort in Sao Paulo, Brazil, and to investigate survival predictors.

Methods

Retrospective cohort study of AIDS patients above 12 years old, registered at the Ministry of Health AIDS surveillance system between 2003-2007, and followed until 2014. Survival analysis used the Kaplan-Meier method and Cox proportional hazards model to estimate hazard ratios (HR), with respective 95% confidence intervals (CI = 95%).

Results

35,515 patients were included, being 4,581 (12.9%) co-infected with TB. Among the latter, probability of survival 12 years after AIDS diagnosis was 95.2%, 82.9%, and 21.9%, respectively for patients receiving at least one third line ARV (HAART2), receiving triple therapy (HAART1) and the last one not on ARV. In the same period, the probability of survival for patients without TB, in the same order as for the therapeutic regimens, was 95.2%, 90.5%, and 40.9%, respectively. The main factors associated with survival, adjusted for the year of diagnosis, were: Living in the city of Sao Paulo (HR = 1,16;IC95% 1,01-1,32), living away from the capital city (HR = 1.43; 95%CI 1.25-1.62); or on the coast (HR = 1.49; 95%CI 1.21-1.82); having TB (HR = 1.70; 95%CI 1.49-1.87); above 49 years old (HR = 1.35; 95%CI 1.18-1.54); black (HR = 1.27; 95%CI 1.12-1.45); IV drug use (HR = 1.73; 95%CI 1.49-2.02); CD4+ below 200 cell/mm³ at AIDS diagnosis (HR = 2.31; 95%CI 1.97-2.72); viral load above 500 copies at AIDS diagnosis (HR = 1.99; 95%CI 1.72-2.30); HAART1 scheme (HR = 1.94; 95%CI 1.47-2.55); no ARV (HR = 8.22; 95%CI 2.95-22.87).

Conclusions

A large proportion of patients did not receive ARVs or were late diagnosed with AIDS, especially those with TB, whose survival was shorter. Survival is heterogeneous in the state, being lower in regions with higher TB rates. The results point to the need for specific strategies for patients with TB-HIV co-infection.

Key messages

Tuberculosis is the main cause of death among HIV-infected people, being responsible for one third of deaths in this group and causing a great impact on the survival of this population. The Brazilian policy of universal access to ARV and treatment for TB has increased the survival of AIDS-TB from 22% to 95% and in patients without TB from 50% to 95% up to 12 years after diagnosis.
Machine Learning to predict tuberculosis in cattle from the state of Sao Paulo, Brazil
Authors: Pereira L E C , Ferraudo A S , Panosso A R , Carvalho A A B , Mathias L A , Saches A C , Hellwig K S , Ancêncio R A
Published: October 2020

Tuberculosis is a well-known and worldwide spread zoonosis. In Brazil 1.594.787 cases were confirmed cases since 2001, where, in Sao Paulo state, 8.226 deaths were reported. This study aims to present steps related to the use of machine learning algorithms for predictive analysis for bovine tuberculosis. For this, an application was made based on data from farms in state of São Paulo, Brazil, of an epidemiological survey, using a specific questionnaire, carried out on farms (n = 1,743). Response variable was presented by apparent prevalence of positive properties for disease, and predictors by (k = 77) predictors related to type of farm, type of lactation, number of animals on property. Application was organized according to following steps: division of data in training (75%) and testing (25%), pre-processing of predictors, learning and model evaluation. In the learning step, algorithm for adjusting gradient boosted trees models was used. The hyperparameters of algorithms were optimized by 10-fold cross-validation, to select those corresponding to best models. Models showed an accuracy of 88.07%, with an error in learning process equal to 3%. In the test / model validation procedure (n = 436), an error in 12% estimate was observed. Five important predictors were daily milk production, number of cows, type of farm, bovine breed and slaughter of adult animals. Proportion of false positives among all individuals whose response of interest was observed was 2.06%, and proportion of false negatives among those with a response of absent interest was 9.86%. It is hoped that, with increase in trained surveillance to detect the disease and availability of data, it will be possible to develop predictive models of machine learning with potential to efficiently assist professionals in disease control and assist in education program in animal health

Key messages

Predictive analyzes in health: application for tuberculosis in cattle from the state of Sao Paulo, Brazil. An infectious disease and zoonosis important to the world that needs support to develop means to control and consequently eradicate it.
Notification of sexually transmitted infections: the tip of the iceberg?
Authors: Duarte S , Abreu Gomes F , Lopes D , Bragança Pereira M , Moreira A , Cunha I , Machado Gil M , Sousa Pinto C
Published: October 2020

Background

Sexually transmitted infections (STIs) are a major public health problem in Europe and in Portugal, their incidence has been increasing since the 90s. Although STIs are among the most frequently reported infections globally, they still go often underdiagnosed. Their under notification is also a problem in Portugal. The aim of this study is to describe STIs' notifications in the area of the groups of primary healthcare centers of Loures-Odivelas (ACES LO), between 2015-2019.

Methods

An observational, descriptive, quantitative study was performed. Data was collected in January 2020, from the National System of Epidemiological Surveillance Database. Variables included for each STIs notification were age and sex. Univariate descriptive analysis and evolution trends were performed for each variable.

Results

A total of 638 cases of STIs were reported from 2015 to 2019. The number of reported cases increased from 87 to 197 cases (126.4%). The annual mean incidence of HBV and HCV notifications were 8 and 4, respectively. There was an increase in reported cases of syphilis (33 to 57), HIV (13 to 29), chlamydia (13 to 46) and gonorrhea (18 to 51). In 2019, 30.9% of the notified cases were syphilis infections, 23.5% gonorrhea infections, 22.1% chlamydia infections and 13.2% HIV infections.Males comprised 460 cases (72.1%), and, in patients aged between 15 and 44 years old, 484 cases (75.9%) were reported. From 2015 to 2019, the co-infections of gonorrhea and chlamydia increased from 2 to 10 cases (25.0%). In 2019, 17.5% of the notified cases of gonorrhea were co-infections.

Conclusions

The modification of risk behaviors and the appropriate treatment of infected people, including infected partners, are determinant to prevent recurrent infections and to interrupt the transmission cycle. Increasing notification should facilitate the monitoring of STIs' trends, contributing to the implementation of appropriate interventions and for better decision-making in public health.

Key messages

Campaigns about sexual health promotion are important to increase safer sexual health practices. More notifications contribute to better data quality and more robust decision-making.
Determinants in the intention to use PrEP and PEP in University students
Authors: Jiménez Triana A , Hernández Blanco K , Caporal Taffoya C , Romero Montero C , Márquez Celedonio F G , Villegas Dominguez J E
Published: October 2020

Background

Veracruz, Mexico, was ranked as the second national place on HIV/AIDS incidence during 2019, with 28.5% corresponding to people between 15 and 24 years old. Post-Exposure Prohylaxis (PEP) is currently available in Mexico, whereas Pre-Exposure Prophylaxis (PrEP) hasn't been introduced as an actual alternative for mexican population. Research question: What are the determining factors in the intent to use PrEP and PEP in university students in a city with high risk of infection for HIV/AIDS?

Methods

An observational, prospective, cross-sectional and analytical study was conducted in Veracruz, Mexico between June and December 2019. University students in the cities of Veracruz and Boca del Río were included, selecting participants through non-probabilistic sampling. HIV/AIDS-65 test was applied to assess attitudes, self-efficacy and susceptibility. Awareness of the existence of PrEP and PEP, along with the willingness to use them, were assessed by a questionnaire formulated by the authors. The surveys were conducted through Google Forms®. The results were collected and analyzed with the SPSS Statistic® program.

Results

565 students were included, of which 19.8% were aware of the existence of PrEP and 13.4% were aware of the existence of PEP. 20.3% would be willing to take the PrEP and 22.3% were willing to take the PEP in case of having risky sexual encounters. Willingness to use the PrEP if required, showed different susceptibility (47.7 ± 1.8 vs. 44.4 ± 20) among those who responded positively. Levels of knowledge, attitude, susceptibility and self-efficacy had no differences among those who accepted to use PEP and those who didn't (p > 0.05). The accordance between those who were aware of the existence of PrEP and their intention to use it had a Kappa of 0.17, while the one for using PEP was 0.13.

Conclusions

Better interventions are needed to improve awareness among university students to use PrEP and PEP since the high risk of HIV-transmission in Veracruz.

Key messages

We consider convenient to propose a reproductive health module to promote HIV-focused health in university students. We must carry out a program to promote the use of PrEP and PEP if required.
Case management of preterm deliveries: Birth-registry based study
Authors: Baghaturia D , Kereselidze M , Skhvitaridze N , Lobjanidze T
Published: October 2020

Modern studies are possible to determine the degree of newborn's prematurity. Evidence based data from 65 countries show the increasing trend of preterm births over the past 20 years. Numbers from the National Center for Disease Control and Public Health of Georgia indicate that of 51 183 infants born in 2018, 7 071 (14%) were delivered between 34 to 37 gestational weeks. The aim of this study was to determine the similarities and differences between preterm newborns delivered at 34-37 gestational weeks according the selected variables.

This is the quantitative, retrospective study. Data source was the Georgian birth registry for the year 2018. Variables, as gestational age, mode of delivery, newborn weight, Apgar score, newborn diagnoses according the ICD-10, length of stay in maternity home, and others were used for descriptive statistics.

In 2018, for preterm deliveries at 34-37 gestational weeks, 53.7% of newborns were delivered by cesarean section and 46.3% physiologically. Despite the similar characteristics, majority of cases had different length of stay at maternity homes, with variation from four to 66 days. The big concern was the quality of target variables - in 30% of cases occurred missing information. Inconsistent occurred in cross-checking of variables - newborns stay at hospital over the recommended data was not justified by provided diagnosis.

The results show the big variance between the preterm newborns with the similar characteristics, delivered at 34-37 gestational weeks in Georgia, mainly for the length of stay. Study reveal necessity to provide awareness rising activities among medical personnel to provide reliable, timely and validated data. The major recommendation is to advice Georgian health sector representatives to develop a mechanism for monitoring and ensuring the measures to evaluate the quality of data, uploaded in the birth registry.

Key messages

Reliable, consistent and validated data are contributing to the rationalization of the healthcare associated resources and controlling costs. Ongoing monitoring of quality in Georgian birth registry should be top priority of responsible authorities.
Characteristics of smoking behavior in adolescents, Sousse, Tunisia
Authors: Ghali H , Khefacha S , Ben Cheikh A , Bhiri S , Tourki Dhidah M , Dhidah L , Ben Rejeb M , Said Latiri H
Published: October 2020

Background and aims

Adolescence is a period of physical, psychological and socio-cultural transformation, but also of curiosity, experimentation and acquisition. It is mainly during adolescence that people are introduced to the use of legitimate psychoactive substances, such as alcohol and tobacco, as well as illicit substances such as cannabis. We aimed to determine the prevalence of smoking among high school students in the region of Sousse and to specify its characteristics.

Methods

We conducted a cross-sectional study in two public schools in the governorate of Sousse during the 2017/2018 school year. The data were collected by anonymous self-administered questionnaire, then processed and analyzed using the SPSS software version 20.

Results

A total of 294 students were included. The sex ratio was 0.78 with mean age of 17.03 years (standard deviation = 1.51). Results showed that 27.6% of students reported having already tasted tobacco. Among them, 61.8% of their parents did not know they were smoking. 17.28% started before the age of 14. Only 26% of them tried to stop but failed. Boys smoked twice as much as girls (p = 0.001). In addition, 63% of young smokers used chicha, 48.1% drank alcohol, and 35.8% used cannabis at least once.

Conclusions

The prevalence of smoking among these adolescents is worrying. Knowledge of related factors is important for program planning to prevent the tobacco epidemic in schools.

Key messages

Adolescence is the age of initiation for addictive substance use specially, Tobacco use. Knowledge of related factors is important for prevention program planning.
A study on the educational significance of special needs education in basis PHN education - 1st report
Authors: Hirokane K , Inamoto M , Takata E , Okamoto R
Published: October 2020

Background

For public health nurses to support school-aged children with disabilities who live in the community, it is necessary to understand the mechanism of special needs education and learn the inter-professional collaboration that takes place in it. A survey was conducted on school teachers supporting school-aged children with special needs, and the perception of educational significance in basic PHN education and its related factors were examined.

Methods

In December 2019, a survey questionnaire was sent to all 1,052 special needs schools in Japan. Of the 350 respondents, 330 valid replies were analyzed. Regarding the significance of providing special needs education in basic PHN education, we asked for answers on a four-point scale from “strongly agree” to “strongly disagree” and scored 4 to 1 points. Then, unpaired t-tests were performed between every two groups of “school-targeted type of disabilities,” “respondent's position,” and “respondent's perception/experience.” In addition, Pearson's correlation coefficient test was performed on the relationship with the years of teacher experience in special needs schools.

Results

Perception of the significance of providing education was as follows: “school-targeted type of disabilities” refers to school groups with hearing impairments (p < 0.05), “respondent's position” groups are special needs education coordinators (p < 0.05), “respondent's perception/experience” was significantly higher in the group with a high cognition of PHN work (p < 0.05) and in the group with experience of cooperating with PHN (p < 0.001). However, there was no significant correlation with the years of teacher experience in special needs schools.

Conclusions

There was a high perception of the significance of providing education in school groups with hearing impairment and groups with actual coordination experience, especially where early detection and care were particularly required, regardless of years of teacher experience.

Key messages

Special needs education should be included in basic PHN education to promote inter-professional collaboration for improving QOL of school-age children with disabilities living in communities. To foster the foundation for promoting special needs education in basic PHN education, in-service PHNs need to work closely with schools to meet their expectations for PHNs.
Healthy babies healthy futures - a collaborative approach
Authors: Rishi V
Published: October 2020

Maternal and child obesity is a complex issue as it is influenced by a range of health, as well as non-health determinants, and requires a holistic, multifaceted approach if we are to make a significant difference.

A culturally appropriate health promotion intervention named Healthy Babies Healthy Futures (HBHF) was developed in 2014 to serve multi-ethnic communities focusing on Maternal Infant Nutrition & Physical Activity. Today HBHF has entered its 6th year delivering its services to the Maori, Pasifika, South-Asian and East-Asian communities. Cultural appropriateness and collaboration are the two pillars of HBHF; Culturally appropriate Community Learning Programme (CLP) - Six healthy lifestyle modules.Collaboration between The Ministry of Health, Two District Health Boards, the Roopu Kaitiaki (governance group), The Technical Advisory Group (TAG) and NGOs.

This presentation will focus on these two pillars and share the; highlights we experiencedchallenges we encounteredopportunities we gained

We cannot overrule the importance of inter and intra-sectoral partnerships that has made this initiative a great success. Of course, designing culturally appropriate intervention & activities for four ethnic groups was a big challenge. This presentation will talk through some of these challenges and learning from the same, including its unique funding model.

Collaboration is when we are all working towards progress. This is made easier when we share the same vision, agree to the same values and strive for the same outcomes. This is demonstrated by how we share the limited resources, how we treat each other and how we serve four multi-ethnic communities.

Key messages

Cultural appropriateness and collaboration are the two pillars of health promotion. Inter and intra-sectoral collaborations is the key to success.
Congenital Anomalies and assisted conception in the Population-based registry from a Spanish Region
Authors: Cavero Carbonell C , Barrachina-Bonet L , García-Villodre L , Moreno-Marro S , Páramo-Rodríguez L , Guardiola-Vilarroig S , Zurriaga O
Published: October 2020

Background

The Congenital Anomalies (CA) population-based Registry of Valencian Region (RPAC-CV) has identified 12917 cases during 2007-2017, confirmed by clinical documentation. The Spanish Fertility Society (SEF) has identified a CA's prevalence per 10000 live births (LB) from assisted conception of 305.2 with a 95% confidence interval (CI) of 296.1-314.2 from 2013 to 2017.

Objective

to identify differences in sociodemographic and clinical characteristics between cases with CA according to the type of conception: natural (N) or assisted (A). To determine the CA's prevalence of LB in the RPAC-CV.

Methods

RPAC-CV cases since 2007 until 2017 were classified in N or A conception, and their sociodemographic and clinical characteristics were compared. Cases with no information about type of conception were excluded. The prevalence per 10000 LB with CI 95% in the RPAC-CV between 2013-2017 was calculated.

Results

Conception's information was available in 58.3% of the cases (90.4% N, 9.6% A). Differences were found in the following variables (values are shown by %N/%A) multiple pregnancy (6.5%/47.9%); birth before the 37th gestational week (24.5%/56.8%); weight at birth less than 2500 grams (24.6%/55.2%); dead before one week of age (4.4%/7.9%); mother older than 35 years (31.3%/64.2%). Statistically significant differences were found in the Nervous System CA group, being a higher proportion in A conception cases (12.5% (CI95%:9.8-15.2)) than in N (7.6% (CI95%:6.9-8.3)). The CA prevalence per 10000 LB in RPAC-CV was 194.1 (CI95%:188.3-199.9).

Conclusions

The CA's prevalence in the RPAC-CV was significantly lower compared to SEF's. Partially could be due to SEF includes minor CA and RPAC-CV not, although differences are overly high. Encourage the collection of the conception information in the clinical documentation will increase data quality in cases from assisted conception and allow having interesting information available for the development of health policies and research.

Key messages

CA’s prevalence, identified in a population-based registry from a Spanish region, was significantly lower than the one identified in assisted conception cases at national level for the same period. Analysing natural versus assisted conception, significant differences in cases’ characteristics have been identified in a CA’s population-based registry in Spain.
Evaluation of risk for pregnancy adverse outcomes in Baixada Santista – São Paulo State, Brazil
Authors: Braga A L F , Baldini C E S
Published: October 2020

Background

Brazil has the fifth biggest territory in the world, and the eighth economy. In the Brazilian Health System, universal health coverage has been the target to be pursuit. However, there are many obstacles to assured this right to the entire population. Even in São Paulo, the state with the biggest part of Brazilian GDP, there are regions with serious economic problems impacting negatively health coverage, education programs and urban infrastructure. The metropolitan region of Baixada Santista includes nine cities with different socioeconomic status and a well-known history of environmental contamination. These environmental and economic stressors are risk factors that can impact pregnants and their offspring. In 2018 the infant mortality in the region was 14.02 for each one thousand newborns while in the São Paulo State it was 10.7 and in Brazil 12.4. The aim of this study was to investigate risk factors associated to adverse pregnancy outcomes in the Metropolitan Region of Baixada Santista.

Methods

We adopted a crossectional design using data from the Born Alive Information System (Brazilian Health Ministry) from 2006 to 2016. Low birth weight, malformation, low Apgar score and prematurity were assumed as dependent variables in specific single e multiple logistic regression models.

Results

Besides the effects of risk factors already seeing in other investigations on adverse pregnancy outcomes, as maternal age and years of study, we found prematurity associated with living in Guarujá (OR = 1,37; 95% CI 1,25 - 1,51) and inadequacy of pre-natal (OR 2,9; 95% CI 2,74 - 3,11). Also, low birth weight was associated with living in Cubatão (OR 1,88; 95% CI1,67 - 2,12) or São Vicente (OR 1,80; 95% CI 1,62 - 2,01), and inadequacy of pre-natal (OR 2,96; 95% CI 2,62 - 3,24).

Conclusions

Differences on primary health care structure and medical coverage, by city, may contribute to increase the risk of pregnancy adverse outcomes.

Key messages

Improvements have to be implemented in municipal health structure to minimize the risk of pregnancy adverse outcomes. Preventing evitable factors for adverse birth outcomes costs less than treating the consequences of a them.
Children-menus in restaurants of Portuguese, Hungarian and Croatian shopping centres: A qualitative study
Authors: Lima J P M , Viegas C , Afonso C , Tóth A , Illés C B , Bittsánszky A , Šatalić Z , Filipec S V , Fabijanić V , Rocha A
Published: October 2020

Background

Families to eat out frequently use shopping centres and, there is evidence that children's menus are poor nutritional quality. Obesity rates have increased all over the world, and it has been associated to the observed out of home food consumption. This study aimed to characterise children's menus in shopping center restaurants in Portugal, Hungary and Croatia, as a preliminary study to further develop strategies to intervene.

Methods

An observational cross-sectional study was carried out in shopping centres in Portugal, Hungary and Croatia. Only the ones providing a children's menu were selected. Data collection tool was developed by the research team, consisting of a three-section form to identify and characterise the restaurant and analyses the quality of children's menu.

Results

Researcher visited 295 restaurants, from which only 69 provided a children's menu. From these 12 restaurants offered gifts associated with it. The most frequently featured items on the menu were hamburgers (22%), grilled or fried chicken (19%), nuggets (17%) and pizza (12%). Potato chips were the most frequent side dish option (33%). Only 11 restaurants offered vegetable soup or vegetables. Although water was available, a variety of soft drinks and sugary fruit juices were also options. Sweet dessert is a common part of the menu. Nutritional information is present in only 13% of the menus. Menu prices do not differ much, Portugal having the higher average (x ̅ = €5.35±1.45). Hungary had the lower average (x ̅ = €4.30±1.50) and Croatia the lowest range (min=€3.00, max=€7.40).

Conclusions

Children's menu options have poor quality. Shifting foods offered to children in restaurants has the potential to improve diet quality, reduce excess energy intake and promote healthy eating habits.

Key messages

European strategies are needed to promote children healthy food environment. Following aim is to develop and test balanced menus for children among food chains.
QUIGK-K: An instrument for measurinng health literacy in children
Authors: Teufl L
Published: October 2020

Background

Childhood is characterized by a wide array of cognitive and social-emotional developments, which facilitate the overall learning capacities. Therefore, children should be seen as a target group for programs and interventions concerning health literacy. An appropriate measurement tool for taping children's health literacy is still needed since the quality of the current tools does not reach satisfying levels and/or these tools can only be applied in clinical settings. This study aimed to develop an age-appropriate measurement tool to fill this gap.

Methods

The authors used four cognitive processes (access, understand, appraise and apply) and five topics (physical activity, nutrition, media, psycho-social health, and health care) to develop the items. These items were then discussed with primary school teachers and health intervention experts. Developmental characteristics of the middle childhood guided and shaped the decisions on the test and item formats. During the pilot testing, 155 pupils aged 8 to 10 years fillet out the 60 items of the piloting-version of the QUIGK-K.

Results

After the pilot testing, a reduction to 40 items based on the data was made. The final QUIGK-K shows (very) good quality with regards to reliability and validity.

Conclusions

The application of the QUIGK-K takes 40 minutes and can be conducted in a group context. The test yields five scores representing the overall level of health literacy and detailed information on the four cognitive processes involved. Therefore, the QUIGK-K fills in the gap of the missing age-appropriate measurement tool for health literacy.

Key messages

An age-appropriate measurement tool for health literacy is now available for children aged 8-10 years which allows profile analyses via five test scores. The (very) satisfying test quality may be attributed to the design as a performance test and the active integration of the developmental characteristics of the target group.
Protocol of a study to evaluate a lifestyle intervention during pregnancy
Authors: Nawabi F , Lorenz L , Krebs F , Alayli A , Lück I , Bau A M , Stock S
Published: October 2020

Background

The risk of developing obesity and chronic diseases (e.g. diabetes mellitus) in children is influenced by the mother's lifestyle during pregnancy (prenatal programming). This study evaluates a computer-assisted preventive lifestyle counseling carried out during prenatal visits and infant check-ups. GeMuKi (acronym for 'strengthening health promotion: enhanced check-up visits for mother and child') is a complex intervention consisting of multiple components implemented by different cooperating healthcare providers.

Methods

GeMuKi supplements regular prenatal visits and infant check-ups with an additional counseling regarding physical activity, nutrition and alcohol and tobacco use. Providers, who carry out the counseling, receive communication training using motivational interviewing techniques. Pregnant women in 4 intervention regions in Germany receive GeMuKi from gynecologists, midwives and pediatricians, while participants in the 4 control regions receive standard care. As part of a hybrid effectiveness-implementation trial with 1860 participants, questionnaires are filled in at 4 time points. Weight development and health data of the mother and child are recorded. Health services use will be analyzed using statutory health insurance claims data. Interviews will be conducted to evaluate the implementation process.

Results

Targeted preventive measures at the beginning of pregnancy intend to reduce the risk of inadequate gestational weight gain (primary outcome). Secondary endpoints are amongst others maternal lifestyle, infant weight development and body composition.

Conclusions

GeMuKi is set up as a long-term, low-threshold, multimodal intervention in living environments and existing structures. Findings will add to the evidence on lifestyle interventions during pregnancy to reduce the risk for overweight and obesity. Results will contribute to the prevention of early programming of chronic disease and will inform decisions about scale up and public funding.

Key messages

Lifestyle interventions provided from the beginning of pregnancy intent to be beneficial for the health of both mother and child to prevent obesity and chronic diseases. Low-threshold interventions embedded in regular prenatal visits are accessible for the complete pregnant population, including vulnerable groups.
Cardiotocography monitoration in antepartum care: analysis of controls
Authors: Napolitani M , Kundisova L , Giannini B , Moirano F , Alaimo L , Nante N
Published: October 2020

Introduction

WHO does not recommend the routine prenatal cardiotocography (CTG) during pregnancy to improve maternal and perinatal outcomes. Instead, Italian guidelines consider CTG after the 41st week of pregnancy to be useful. The aim of this work was to identify the variables associated with CTG performed before the 40th week.

Materials and Methods

A retrospective study was conducted at the Hospital of Siena (Italy), all females that accessed to CTG from 2016 to 2018 was included. The variables were: nationality, pregnancy associated pathology(PAP), gestational age(GA), parity, type of access (urgent/programmed), n° of accesses, active fetal movements (AFM), amniotic fluid index (AFI) and necessity of recovery. The statistical analysis was carried out using Stata 12.

Results

The women included were 4010, mean age was 32.8±5.6 years (75% Italian; 62.4% primiparous). A mean GA was 38 ± 3 weeks; 47.5% had one access, 27% two accesses, 14% three accesses. The 22% were urgent accesses, 11.5% had PAP (70% diabetes mellitus). The 58% showed up before the 40th week, the probability was higher for non-Italian women (OR 1.3), multiparous (OR 1.32), women with urgent access (OR 7.9) and women with PAP (OR 3.4). In 5.4% the CTG was altered, 23% had absent AFM and 2% had alterated AFI. Females that came before 40th week were more likely to have absent AFM (OR 4.5) and AFI (OR 2). The 3% needed an immediate hospitalization, mainly in non-Italian (OR 1.7), urgent accesses (OR 4.4), those that came before 40th week (OR 2.44), absent AFM (OR 21.8), and altered AFI (OR 15.8),

Conclusions

Our analysis shows the association between precocious access to CTG and urgent medical condition and PAP as expected, but also with other variable as parity and nationality. The low GA without an indication of high risk at the moment of the access suggests the possible overmedicalization of pregnancy. It seems useful to review clinical practices to ensure obstetric care close to best practice.

Key messages

As literature reports, to avoid overmedication of pregnancy cardiotocography should not be performed before the 41st week of pregnancy. In some situations the CTG is anticipated and for this reason it seems useful to review the clinical practices implemented in order to ensure obstetric care close to best practice.
In utero opioid exposure and birth outcomes: a systematic review and meta-analysis
Authors: Graeve R I , Balalian A A , Richter M , Kielstein H , Martins S , Philbin M M , Factor-Litvak P
Published: October 2020

Background

The nonmedical use of opioids during pregnancy, either those prescribed or obtained illegally, is a worldwide public health issue. Opioids pass through the placental barrier, which can expose the fetus to maternal opioid use; opioid-exposed babies may experience Neonatal Abstinence Syndrome (or Neonatal Opioid Withdrawal). We conducted a systematic review and meta-analysis to investigate how maternal opioid use during pregnancy may impact infants' birth outcomes.

Methods

We searched PubMed, Embase, PsycInfo, and the Web of Science, and identified 90 articles that met our inclusion criteria. Cohort, case-control and cross-sectional studies comparing birth outcomes of any opioid-exposed group (prescribed or obtained illegally) and a non-exposed comparison group were eligible for our systematic review. An adapted version of the Newcastle-Ottawa-Scale was used for quality assessment of the studies. Due to high heterogeneity between studies, we used random effects models to estimate pooled effects.

Results

In meta-analyses, opioid-exposed infants had lower birthweight (mean difference (MD):-405.9 grams, 95%CI: -472.26,-339.54, N = 37 studies), smaller head circumference (MD:-1.19 cm, 95%CI:-1.41, -0.96,N=22 studies), shorter gestational age (MD:-0.93 weeks, 95%CI: -1.20, -0.66,N= 34 studies), and shorter birth length (MD:-0.97 cm, 95%CI: -1.20, -0.74, N = 15 studies). The pooled relative risk of fatal outcomes was higher among the exposed infants: (RR:2.64, 95%CI: 1.06,6.59). Almost half of the studies were rated as poor, based on the Newcastle Ottawa Scale.

Conclusions

Our meta-analysis provides evidence of a link between opioid use during pregnancy and multiple adverse infant birth outcomes. Efforts should focus on increasing awareness about risks associated with opioid use and provide access to harm reduction measures for people who use opioids preconceptionally and in pregnancy.

Key messages

This meta-analysis provides insight into the magnitude of effects of in-utero opioid exposure on birth outcomes among the included studies. The findings highlight the importance of access to harm reduction measures in the periconceptional period and during pregnancy for people who use opioids.
Environmental factors and physical activity among youth in rural Japan: a 1-year prospective study
Authors: Abe T , Kitayuguchi J , Okuyama K , Okada S , Nabika T , Tanaka C
Published: October 2020

Background

Although moderate-to-vigorous physical activity (MVPA) has multiple health benefits, current global activity levels among children are quite low. Environmental influences on MVPA levels among children and adolescents in rural areas are unclear. The present study examined if environmental factors were associated with MVPA in children and adolescents in rural Japan.

Methods

Two school-based serial surveys were conducted in 2017 and 2018 for 1,461 children and adolescents (10-14 years old) in Unnan City, Japan. If meeting the WHO recommended MVPA levels: at least 60 minutes/day was assessed via the Japanese translation of the WHO Health Behaviour in School-aged Children survey questionnaire. Environmental factors, namely habitable land area, population size, and population density were calculated for each individuals' residential town, and categorized into three levels (small, medium, and large). Logistic regression was used to determine odds ratios (OR) and 95% confidence intervals (CI) of engaging in the recommended level of MVPA after 1 year by each environmental factor, adjusting for sex, school grades, body mass index, screen time, preference for PA, and MVPA level at baseline.

Results

Only 22.4% of children and adolescents were engaging in the recommended MVPA levels in 2018. Engaging in the recommended level of MVPA after 1 year was significantly associated with medium (OR = 1.63; 95%CI, 1.08-2.46) and large (OR = 1.69; 95%CI, 1.15-2.47) compared to small habitable areas, and with medium (OR = 1.01; 95%CI, 0.61-1.67) and large (OR = 1.75; 95%CI, 1.09-2.81) compared to small population size. Population density was not associated with MVPA.

Conclusions

This prospective study found that habitable area and population size were positively associated with MVPA at 1-year follow-up in rural Japan. In rural areas, habitable land areas and population size itself may be a better predictor for MVPA among children than population density.

Key messages

Habitable area and population size was positively associated with physical activity among children and adolescents in rural Japan. Population density as an environmental factor was not associated with physical activity.
Systems approach for assessment of maternal deaths in Rajasthan: A feasibility study
Authors: Raghav P , Gupta M K , Rustagi N , Mishra N , Garg S
Published: October 2020

Background

High maternal mortality in the state like Rajasthan, which is at second rank in terms of high Maternal Mortality Ratio (MMR) in India, require concentrated efforts in this direction The objectives of this study were to assess the magnitude and trend of maternal death and underlying factors contributing to maternal deaths in Rajasthan and to identify barriers and challenges in reporting maternal deaths in Rajasthan.

Methods

Data related to maternal deaths, cause of deaths and live births were retrieved from official Government sources and MMR was calculated. To find out the underlying factors contributing to maternal deaths, Verbal Autopsies were conducted through household surveys. In-depth interviews of health care staff were conducted to carry out the 'SWOT' analysis in order to identify the barriers in reporting maternal deaths. Data was analysed using SPSS version 23.

Results

A total of 7185 maternal deaths were reported from Rajasthan in last five years. The mean age of mothers was 25.18±4.98 years. Haemorrhage were reported as most common cause of maternal death (17%) followed by Severe hypertension or fits (8%) and obstructed labour (2%). The median duration of hospital stay was 23 hours (IQR=7.5-70). Maximum deaths were reported during post-partum period (61%), while around one fourth of the deaths happened during delivery.

Conclusions

The discrepancies were observed in the reporting of number and causes of maternal deaths. The trend and forecasted figures were quite different from the published National and State level reports in this regard.

Key messages

need to streamline and strengthen the Maternal Deaths Surveillance and Response to track the number of deaths and get the exact information about the underlying factors contributing to them. Effective strategies can be developed to reduce the Maternal Deaths in the State.
Empowering adolescent girls and creating lifelong champions to improve immunization coverage
Authors: Mehmood M , Siddiqi D A , Abdullah S , Baig Q , Khan A J , Chandir S
Published: October 2020

Background

Despite the global imperative to 'leave no child behind', one in every 5 children remain deprived of life-saving vaccines. Low immunization coverage is in part due to the weak linkages between community and health system, inaccessibility of outsiders to closely-knit societies and low parental awareness regarding immunizations. The Kiran Sitara (Shining Stars; KS) Adolescent Health and Leadership Program (AHLP), was implemented using adolescent girls (Kiran Sitaras-KSs) as the agents of change, who by virtue of belonging to the community were able to cause a ripple effect in boosting uptake for WHO-recommended immunizations for children under 2 years of age. Our research evaluated the feasibility of the KS community mobilization and validated KS's ability to accurately identify under-immunized and zero-dose (never-vaccinated) children.

Methods

AHLP was implemented in grades 8-10 of two public secondary schools in Shikarpur and Lakhi Town, Pakistan. From April-May, 2017, a door-to-door survey was conducted by KSs followed by visits of trained staff to verify the immunization statuses identified by KSs.

Results

KSs (N = 45) screened 207 children and identified under-immunized and zero-dose children with an accuracy of 74% and 94% respectively.

Conclusions

Our strategy of mobilizing girls from within the communities provides a promising avenue to provide immunization services in high-risk areas that cannot be penetrated through conventional mechanisms. We are actively scaling-up our sustainable solution by implementing AHLP in 250+ schools and creating a force of 100,000+ KSs who can promote health equity today and champion the cause in their capacity as tomorrow's mothers.

Key messages

The Kiran Sitara initiative via its community-centered approach leverages the force of adolescent school girls to boost demand and provide referrals for immunization in unreached geographical pockets. The Kiran Sitara initiative utilizes the power of youth engagement to identify zero-dose and under-immunized children, link them to immunization services and improve knowledge among caregivers.
Maternal diabetes during pregnancy and carotid intima-media thickness in children
Authors: Chiolero A , Epure A , Rios-Leyvraz M , Anker D , Mivelaz Y , Di Bernardo S , Da Costa B R , Sekarski N
Published: October 2020

Background

Cardiovascular risk over the life course may be related to intrauterine risk factors, for instance, the exposure to maternal diabetes. Our objective was to systematically review studies that assessed the association of maternal diabetes during pregnancy and carotid-intima media thickness (CIMT), a marker of cardiovascular risk, in children.

Methods

We followed methods outlined in a published protocol for a systematic review on risk factors and determinants of CIMT in children (PROSPERO registration: CRD42017075169). Standardized mean differences in CIMT between offspring of women with and without diabetes during pregnancy were computed. Random effects meta-analyses were performed. The reliability of CIMT measurements was assessed.

Funding

SNSF 32003B-163240.

Results

Three observational studies involving 658 children were retained. Two studies were conducted in Europe and one in Australia. Age at CIMT assessment ranged from 2 days to 8 years. Two studies evaluated gestational diabetes during pregnancy and found no difference in CIMT among exposed children compared to controls (0.00 (95% CI: -0.41 to 0.41); 0.00 (95% CI; -0.28 to 0.28)). One study, that did not specify the type of diabetes evaluated, identified a higher CIMT (0.46 (95% CI; -0.07 to 1.00)). The pooled standardized mean difference in CIMT between offspring of women with and without diabetes during pregnancy was 0.08 (95% CI: -0.16 to 0.33; I2: 17.1%).

Conclusions

Overall, there is no clear association between maternal diabetes during pregnancy and offspring's CIMT. The degree of confidence in results is limited by the low number of studies, with relatively small sample sizes and a low number of participants exposed to maternal diabetes.

Key messages

Children exposed to maternal diabetes have no substantial alterations in vascular structure. More research is needed to inform primordial prevention of cardiovascular disease among these children.
Primary school children’s diet assessment with a 7-day diary – comparison between Italy and Poland
Authors: Kawalec A , Piscitelli G , Pawlas K , Dallolio L
Published: October 2020

Background

Dietary habits acquired in childhood are often followed in later life, and if unfavourable may result in negative long-term health consequences. The study aimed to assess diet of primary school children with an interactive 7-day food diary in the form of a colouring book.

Methods

At first the study was conducted among 428 primary school children from Calderara di Reno (Italy). After questionnaire's translation and adjustment, the study continued as a pilot-study among 83 children from Wałbrzych (Poland). Under supervision of parents and teachers children completed a 7-day food diary. The quality of diet was evaluated with KIDMED test. Composition of breakfast was rated due to content of water (+1), carbohydrates (+1), proteins (+1), fibre (+1), vitamins/minerals (+1), free sugars (-1), assuming adequate breakfast if scored > =3 points and contained source of protein or carbohydrates. Statistical analysis with chi-square test was performed.

Results

Adherence to the model diet was medium or high among 64.49% of Italian and 40% of Polish children (p < 0.001). Significantly more Italian children had adequate breakfast each day during a week (51.17% vs 27.71%, p < 0.001) and each school day (51.40% vs 34.94%, p = 0.006). There was no difference in number of children consuming well-balanced breakfast during a weekend (p = 0.749). Consumption of fruits and vegetables in both groups was far below recommended level- 75.9% of Italian and 81.9% of Polish children ate less than 3 portions of fruits and vegetables per day.

Conclusions

The study underlines the need for improvement of children's diet and increase in parent's awareness of family eating habits. This 7-day diary is a innovative tool, which allows identification of incorrect dietary behaviours among children and enables school professionals to design adapted health promotion activities and educational programmes for pupils and parents, aiming to increase knowledge about the role of diet and nutrition in health.

Key messages

There is a constant need for nutritional education and healthy lifestyle promotion among children, parents and teachers. Assessment of children’s diet and screening for unfavourable dietary habits may be helpful in planning health promotion and preventive activities at schools.