bluuebunny/crossref_metadata_2025 huggingface dataset:
Utility of data-driven clusters for the prevention of type 2 diabetes
Authors: Yacaman-Mendez D , Zhou M , Ponce de leon A , Ebbevi D , Lager A
Published: October 2020

Background

Type 2 diabetes (T2D) is an important cause of mortality, disability and health care expenditures. Prevention is crucial to counter global trends, but individual variability of different risk factors leading to T2D has made prevention difficult to achieve. We aimed to identify clusters of individuals based on individual level characteristics of different risk factors using a data driven approach.

Methods

We used data from the Stockholm Diabetes Prevention Program. A population-based, prospective study. Healthy participants who were born in Sweden and aged 35 to 55 years old were recruited between 1992 and 1998 and followed up after 10 and 20 years. At each visit, participants answered extensive questionnaires, anthropometric measures, laboratory examinations and an oral glucose tolerance test. We used age, sex, family history of diabetes, fasting and two hours glucose and insulin, body mass index (BMI), systolic and diastolic blood pressure, and level of education were at baseline to group participants using the k-prototype algorithm. We then examined the risk of diabetes between clusters using survival analysis.

Results

A total of 7,173 participants representing 138,942 person years of follow-up were included in this study. Among them, 998 (14%) developed T2D. We identified six stable clusters: the group with the lowest cumulative incidence of T2D (2.3%) was used as reference (n = 1,265). In the group with the highest risk, 47% developed T2D (n = 772, HR 26.3, 95%CI 17.9-38.5) followed by 17.1% (n = 1,146, HR 7.6, 95%CI 5.1-11.22), 15.2% (n = 1,453, HR 6.7, 95%CI 4.5-9.8), 9.5% (n = 1,384, HR 4.1, 95%CI 2.8-6.2) and 5.2% (n = 1,157, HR 2.0, 95%CI 1.3-3.1) in the remaining groups.

Conclusions

There is important variability between individuals regarding the effect of different risk factors on the incidence of T2D. Data driven categorization strategies can be useful epidemiological tools to pave the way for more precise T2D intervention programs.

Key messages

Prevention strategies for T2D usually follow a one-size fits all approach, ignoring the important variability of risk factors and their consequences among individuals. It is possible to identify subgroups of people with different risk of T2D based on simple clinical and phenotypical characteristics, and could help to improve prevention and treatment of T2D.
Prevalence of antenatal depression in South Asia: a systematic review and meta-analysis
Authors: Mahendran R , Puthussery S , Amalan M
Published: October 2020

Background

Antenatal depression carries significant adverse implications for the health and well-being of women, babies and their families. While prevalence of perinatal mental disorders in low-and lower-middle-income countries tends to be higher compared to high-income countries, rates tend to vary widely among countries in certain regions such as South Asia. This study estimated the pooled prevalence of antenatal depression in South Asia and examined variations in individual countries.

Methods

We conducted a systematic review and meta-analysis. A comprehensive search was conducted on thirteen electronic databases and grey sources for articles published between 1·1·2007 and 31·5·2018 from South Asian countries including Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan, and Sri Lanka. Studies reporting quantitative prevalence estimates of antenatal depression using a validated diagnostic/ screening tool identified, screened and appraised using a two-stage process. A meta-analysis was conducted using the proportion (%) of pregnant women identified as having antenatal depression as the primary outcome.

Results

Thirty-three studies involving 13,087 pregnant women were included in the meta-analysis. Overall pooled prevalence was 24·57% (95% CI: 19·34, 30·69). Prevalence rates for India (17·74%, 95% CI: 11·19, 26·96) and Sri Lanka (15·87%, 95% CI: 14·04, 17·88) were lower compared to the overall prevalence whereas the rates for Pakistan (32·2%, 95% CI: 23·11, 42·87) and Nepal (50%, 95% CI: 35·64,64·36) were higher.

Conclusions

While robust prevalence studies are sparse in most South Asian countries, one in four pregnant women is likely to experience antenatal depression in the region. The issue needs to be recognised in health policy and practice for resource allocation and capacity building at regional and national levels for prevention, diagnosis and treatment.

Key messages

One in four pregnant women is likely to experience antenatal depression in South Asia region. Targeted efforts are needed at national and regional levels for prevention, diagnosis and treatment.
Sexual and gender minorities among students in Italy: population estimate and risk behaviours
Authors: Fonzo M , Baldovin T , Bertoncello C , Cappella G , Baldo V , Cocchio S
Published: October 2020

Background

Sexual and gender minorities (SGM) are at higher risk for stigma, discrimination and, ultimately, development of risky health behaviours than heterosexual counterparts. Latest demographic data on SGM population in Italy date back to 2011 census. The prevalence of risk behaviours among SGM university students has not been previously estimated in Italy. We aimed at estimating the population of SGM university students and assessing the prevalence of risk behaviours.

Methods

We conducted a cross-sectional survey involving a sample of 18-25 years old students. Participants were asked to complete an anonymous, self-administrated questionnaire on sexual identity/orientation, smoking, use of condom and sexual partners in the last 24 months. χ2 tests were performed.

Results

We collected 9,988 questionnaires (response rate 91.3%); 1.41% did not disclose sexual orientation. Transgender individuals were 0.12%. Among cisgenders males, 95.39% identified as hetero-, 2.52% as homo- and 2.02% as bisexual; 94.50% of females as hetero-, 1.28% as homo- and 4.21% as bisexual. While among men the proportion of smokers was 30.7% without significant differences among subgroups (p=.219), this proportion was 26.1%, 40,5% and 51.6% among hetero-, homo- and bisexual women (p<.001); 62.4% of all males declared to use the condom without significant differences (p=.089), but 19.0% of homo- and 43.4% of bi- females did compared with 55.5% of heterosexual (p<.001); 18,7% of hetero-, 49.4% of homo- and 32.4% of bisexual men declared to have had three or more partners (p<.001); among hetero- women the proportion was 11.1%, while 12.5% and 26.3% among homo- and bisexuals.

Conclusions

SGMs were 5.26% of university students. Compared with hetero- counterparts, homo- and bisexual women showed a higher prevalence of all risk behaviours investigated. In contrast, homo- and bisexual men showed a similar behaviours compared with heterosexual men, except for a significantly higher number of partners.

Key messages

Sexual and gender minorities (SGMs) account for 5.26% of the investigated university student population; 4.54% of cisgender men and 5.49% of cisgender women are homo- or bisexual; trans are 0.12%. SGMs show unhealthier behaviours compared with heterosexual counterparts; in particular, bisexual women show higher prevalence of smoking and non-use of the condom.
Southwest US Latinas’ Weight Health: A Randomized Controlled Trial to Evaluate the De Las Mías App
Authors: Macario E , Consuelo A
Published: October 2020

Background

Three-quarters of Mexican American women are overweight vs. 64% of white women. Our preliminary 3-year study tested a culturally tailored app to improve weight health among Latinas in Southwest U.S. Phase II randomized controlled trial (RCT) compared experimental group and control group changes in weight health, attitudes, and behaviors at 6 months. The primary outcome was weight loss of > =5% of a participant's body weight at 6 months (weight loss of this amount has shown significant health benefits).

Methods

Phase I evaluated a prototype (n = 54). Phase II RCT tested the app (n = 195). Both included adult Latinas with BMI 25-39 in New Mexico who reported wishing to lose weight. Weight was measured at 0-, 3-, and 6-months; an interview was conducted at 9-months. The experimental group was exposed to the app and the control group was exposed to non-culturally specific government education print materials.

Results

For Phase II participants 35-50 years, 29.4% of those in the experimental group, compared with 12.1% in the control group, had a weight loss of 5% at 6 months (p-value=0.04). Phase II participants <35 years were 3.9X more likely to experience a weight loss of > =5% at 6 months relative to those 50+ years; 9 of 10 participants overall maintained some healthy lifestyle changes at 9 months, with a slightly higher percentage of the experimental than the control group reporting positive changes.

Conclusions

De Las Mías (bilingual healthy lifestyles platform for Latinas) achieved the most impact among women 35-50 years. The primary weight loss drivers were increased efficacy in making changes in healthy eating/physical activity. The food log was difficult to use; thus, new offerings (in-app communications/videos/interactivity) consider literacy. A Healthy Lifestyle Checklist was added to improve usability. New content targets women <35 and 50+ years; builds efficacy to structure habits; and explores in-app peer support and more rewards on weight management.

Key messages

Our preliminary study validates and supports culturally tailored innovation for population health. Valuable lessons learned continue to inform ongoing iterations for an effective De Las Mías platform.
COVID-19 and staff mental health: is there an evidence? An Italian field study
Authors: Magnavita N , Di Prinzio R R , Chirico F , Sacco A , Quintavalle G
Published: October 2020

Since the early months of the COVID-19 epidemic, a large number of scientific papers have considered the possibility that healthcare professionals (HCWs) were affected by depression, anxiety, post-traumatic stress, and psychological distress. The abundance of research has also made it possible to produce several systematic reviews and meta-analyzes. All the studies retrieved in these reviews, however, were cross-sectional. Depressive symptoms and anxiety in HCWs were compared to “normal values”, administrative staff, or external sample; moreover, some studies had no control group. No longitudinal study has been produced so far. Some studies had negative results. Overall, there is still little evidence of an increase in mental health problems and sleep disturbances in HCWs during the outbreak.

To fill this gap, we investigated the mental health of workers who have been monitored for many years in an Italian local health unit. Mental health was investigated with standardized questionnaires. 82 HCWs who tested positive at the COVID-19 nasopharyngeal swab, 152 exposed workers who tested negative and 361 unexposed controls participated in the survey. Anxiety was reported by 16.6% of COVID-19 cases and depression by 20.3%, with a significant increase in the estimated risk (OR = 4.3; CI95%=2.4-7.4 for anxiety, OR = 3.5; CI95% =2.0-6.0 for depression). In test-positive cases, sleep was a significant moderating factor in the relationship between occupational stress or PJ and anxiety. Exposed, negative HCWS also had an increased OR for anxiety (1.84, CI95% 1.1-3.1) and depression (2.2 CI95% 1.4-3.5).

The frequency of anxiety and depression disorders in the population examined was not higher than that recorded in the years preceding the epidemic during periodic occupational health checks in the workplace. Mental health support and organizational interventions must mainly concern workers with positive tests and should also tend to improve sleep quality.

Key messages

Health care workers who have had unprotected exposure to COVID-19 patients, and even more those who have contracted the infection, have sleep problems, anxiety and depression. The psychological support intervention for health care workers should include the promotion of sleep hygiene.
Effects of Covid-19 lockdown on mental health and sleep disturbances, results from an Italian survey
Authors: Voglino G , Gualano M R , Lo Moro G , Bert F , Siliquini R
Published: October 2020

Background

The Covid-19 pandemic is affecting different aspects of our society and brand-new conditions are expected after the lockdown. Italy was the first European country that entered a nationwide lockdown during the COVID-19 pandemic. Since quarantine can impact on mental health, this study aimed to estimate the prevalence of depressive symptoms, anxiety symptoms and sleeping disturbances in the Italian population during lockdown. The factors that might influence such outcomes were explored.

Methods

The COvid COllateral ImpactS (COCOS) project was a national cross-sectional survey performed during the last 14 days of the Italian lockdown. Questionnaires were online and included items on socio-demographics, behaviours, and healthcare access. Depression was assessed through the Patient Health Questionnaire-2, anxiety through the Generalized Anxiety Disorder-2. Participants referring sleep disturbances completed the Insomnia Severity Index. Descriptive analyses, univariable and multivariable logistic regressions were performed (p-value<0.05 significant).

Results

The sample size was 1515. Females were 65.6%, and the median age was 42 years (IQR=23). Depression and anxiety symptoms prevalence were 24.7% and 23.2%. The 42.2% had sleep disturbances and, among them, 17.4% reported moderate/severe insomnia. Being female, increased time spent on internet, and avoidance of activities for peer pressure increased the likelihood of at least one of mental health outcomes. Increasing age, not experiencing work-related troubles, being married/cohabitant reduced such probability. Females and participants with chronic conditions resulted positively associated with sleep disturbances.

Conclusions

The results showed a high prevalence of mental health issues. Since the impact might be long-lasting, it is crucial to study effective interventions, specifically planning strategies for more vulnerable groups, e.g. youths, and considering the role of internet.

Key messages

A high prevalence of mental issues and sleep disturbances was recorded during the last week of the lockdown. Age, gender, marital status and the time spent on internet affected mental health while gender and presence of chronic conditions were predictors of sleep disturbances.
Non-nutritive sweeteners in the food supply: changes after the first phase of the Chilean Food Law
Authors: Zancheta Ricardo C , Corvalan C , Tallie L , Quitral V , Reyes M
Published: October 2020

Background

In June 2016, Chile implemented the Food Labeling and Advertising Law, which includes mandatory front-of-package warning labels in products with high content of sugars and other key nutrients. We evaluated whether the non-nutritive sweeteners (NNS) use increased among foods/beverages 7-8 months after implementation of the law.

Methods

We obtained data from packaged foods/beverages available in 6 major supermarkets and 3 candy distributions in Santiago, Chile, in January 2015/16 (T0) and January 2017 (T1). We included products with market share ≥1% of their food groups, with added sugar, salt or fat (i.e. products subject to regulation) and/or with NNS from 7 food groups: beverages, breakfast cereals, candies, sweet spreads, desserts, yogurts, and milk-based drinks, in cross-sectional (T0: N = 1,809; T1: N = 1,478) and longitudinal (i.e. same product collected in both periods; N = 999) samples. We compared the frequencies applying Chi-square and McNemar tests.

Results

In the cross-sectional analysis, there was no significant change in the frequency of NNS use neither considering the overall sample or each food group. Across all groups, about 40% of products presented at least one NNS in both periods, with the highest prevalence among beverages (T0:77%; T1:80%, p = 0.314) and yogurts (T0:63%; T1:68%, p = 0.312). In the longitudinal sample, the frequency of NNS use increased from 38% in T0 to 44% in T1 (p < 0.001). Changes were observed in milk-based drinks (T0:50%; T1:67%, p = 0.008); beverages (T0:72%; T1:83%, p < 0.001); desserts (T0:14%; T1:23%, p < 0.001); and yogurts (T0:60%; T1:63%, p = 0.046).

Conclusions

Our results suggest increased NNS use in the longitudinal subsample after the implementation of the law; however, the overall frequency in the food supply remained the same, which could be explained either by changes in the food supply or sampling differences between the periods. Further analyses must explore the impact of these changes in NNS consumption.

Key messages

Regulations aimed to reduce food sugar content could impact the food NNS content. Monitoring the use of NNS in the food supply and its impact on NNS consumption is important in the current policy scenario.
Prevalence and correlates of elevated HbA1c in rural Zambia: A population-based cross-sectional study
Authors: Tateyama Y , Techasrivichien T , Musumari P M , Macwan’gi M , Zulu R , Dube C , Suguimoto S P , Ono-Kihara M , Kihara M
Published: October 2020

Background

Diabetes mellitus (DM) poses a serious challenge to the health systems in sub-Saharan Africa. In Zambia, the estimated prevalence of DM among adults was 4.2% in 2016. However, little is known about its magnitude among the rural population. To address this gap, we investigated the prevalence of DM and its correlates among rural residents in Zambia.

Methods

In 2016, we recruited 690 rural residents aged 25-64 of Mumbwa district by multistage, clustered, household sampling. Questionnaire survey was conducted along with anthropometric and biological measurements including HbA1c. Data analysis was adjusted for complex sampling.

Results

The prevalence of elevated HbA1c (≥5.7) was 41% (Men 34%, Women 48%). DM, defined as HbA1c ≥ 6.5%, was present in 2.6% of the participants. Sixteen percent of men and 37% of women were overweight or obese (BMI≥25). In multivariable analysis, high cooking oil intake and obesity (BMI≥30) were associated with higher odds of elevated HbA1c (adjusted odds ratio [AOR]=1.76 and 3.30), but the association was inverse for alcohol intake (AOR≈0.55). By gender, obesity was positively associated with an elevated HbA1c in both genders (AOR= men 6.57, women 2.11). Secondary education was inversely (AOR=0.52), and high sugar intake was positively (AOR=1.66) associated with elevated HbA1c in men. Older age and high cooking oil intake were positively associated (AOR=1.89 and 2.14), and alcohol intake (AOR=0.46) was inversely associated with elevated HbA1c in women.

Conclusions

More than 40% of rural residents in Zambia had elevated HbA1c. The risk factor profile was different between genders. Obesity increased the odds of elevated HbA1c in both genders, but the odds was disproportionately higher in men than in women. The reasons for such gender difference remain unknown, but we speculate that it might be explained by the early onset of obesity in women. Such gender difference should be addressed in health interventions in this population.

Key messages

Over 40% of rural residents in Zambia are at risk of prediabetes or diabetes. Health interventions should address the gender difference in the risk of elevated HbA1c.
Predictors of preventable hospitalizations in an Italian hospital: analysis of administrative data
Authors: Carfagnini F , Cedrone F , Fortunato V , Del Duca L
Published: October 2020

Background

Preventable hospitalizations (PHs) represents less efficiency and low access to outpatient and primary health care. The lengthening of life expectancy and comorbidities that can be treated with primary care are associated with PHs. This study examines the risk of having a PH based on age, gender and comorbidities.

Methods

We designed a retrospective observational study of admission occurred in a great hospital of the southern of Italy from 2014 to 2019. Composite indicator for PHs were selected using the algorithm proposed by the Agency of Health Research Quality. Any composite indicator (PQI90, PQI91, PQI92) were used as dependent variable of a Poisson model to compute RRs. Comorbidities were decoded as proposed by Charlson et al. in secondary diagnosis.

Results

A total of 185264 admissions were included in the study, with 11815 (6,37%) PQI90, 2706 (1,46%) PQI91, 9109 (4,91%) PQI92. Age (1.03; CI95%1.03-1.03), cerebrovascular disease (1.33; CI95%1.22-1.44), Chronic obstructive pulmonary disease (COPD) (1.40; CI95%1.30-1.51), diabetes without (1.70; CI95%1.61-1.80) or with (1.83; CI95%1.53-2.18) complications and a mild liver disease (1.76; CI95%1.54-2.00) were associated with PQI90. Age (1.02; CI95%1.02-1.02), cerebrovascular disease (1.60; CI95%1.35-1.90), COPD (1.49; CI95%1.24-1.78), diabetes without complications (1.52; CI95%1.32-1.74) and a mild liver disease (2.87; CI95%2.33-3.54) were associated with PQI91. Age (1.04; CI95%1.04-1.04), cerebrovascular disease (1.26; CI95%1.15-1.39), COPD (1.38; CI95%1.26-1.50), diabetes without (1.76; CI95%1.65-1.87) or with (2.03; CI95%1.68-2.45) complications and a mild liver disease (1.40; CI95%1.18-1.65) were associated with PQI92.

Conclusions

All indicators of PHs are associated with the increase in age and the presence of common and treatable comorbidities in primary care assets. These indicators are useful for implementing preventive strategies in order to reduce the burden of admission in the hospital setting.

Key messages

Preventable hospitalizations represent an important portion compared to total hospitalizations. Improvement of primary care strategies are needed to reduce the burden of preventable hospitalizations.
12.I. Skills building seminar: Making the elevator pitch more effective: how to convince a policymaker in less than 2 minutes
Authors:   Organised by: EUPHA, EUPHAnxt,   Chair persons: Dineke Zeegers Paget - EUPHA, Maaike Droogers - EUPHA
Published: October 2020

Since a number of years, the European Public Health Association (EUPHA), the European Public Health Conferences and other associations, have been working hard to translate the evidence in a such a format that policymakers take notice. For example, the WHO Regional Office for Europe works on 'telling the public health narrative' and provides factsheets and infographics, in order to effectively communicate public health messages to policymakers. At the European Public Health Conference so-called pitch presentations were introduced (at Glasgow 2014), where researchers are asked to present their work in 5 minutes with maximum 5 slides (no animations), as a way to learn to present key messages from research in just a few minutes. EUPHA has organised several skills building workshops on translation of evidence in the past years, including last year's session 'making the elevator pitch work'. Lessons learned during this workshop in Marseille are: Have a clear ask (keep it simple)Appeal to the policymaker's own interests and prioritiesSpell out how action will be beneficial for the policymakerBe aware of upcoming electionsBuilt a relationship with the assistants of politicians

Following the great interest in last year's workshop, this workshop will complement the outcomes of the 'lessons learned' with additional tips for convincing a policymaker. The list of lessons learned will be expended by reflecting on models of knowledge translation. Models of knowledge translation and evidence informed policymaking are abundant. Some key aspects that can be added to the list are: considering the 'policy window', making the comparison with the policy plans, identifying the relevant stakeholders and groups affected by the problem.

In this skills-building workshop, we will select a number of abstracts that have been accepted by the International Scientific Committee as posters and we will invite the presenting authors to this dare: Present your work and key messages in less than 2 minutes. In order to see whether the policymaker is convinced, we are organising a small panel of policymakers and ask them to give their feedback. Are they interested? Do they remember the key message? And if all goes well, do you get an invitation to come back and present more of your work?

Key messages

Being able to present your key messages anywhere, anytime is needed. Telling the public health narrative and telling a story are important skills for public health professionals to have.
Understanding and comparison of self-reported problems of Syrian refugees in three countries
Authors: Morina N , Drescher A , Akhtar A , Spaaij J , Kiselev N
Published: October 2020

Background

Syrian refugees have high levels of mental disorders. They face multiple stressors before, during and after migration which affect their psychosocial wellbeing. Stressors after flight may vary due to different geographic, economic, cultural, socio-political contexts. Previous studies demonstrate that displacement-related factors are as likely as war exposure to contribute to distress after migration and hence, are pivotal to include in public health policy. Assessments in mental health care are mainly through nomothetic measurements, often developed in western countries. A growing body of literature recognizes the importance of clients' own perspective, especially in cross-cultural settings. The aim of this multi-country study was to describe and compare self-reported problems of Syrian refugees between Jordan, Turkey and Switzerland.

Methods

Using the semi-structured client-generated outcome measurement PSYCHLOPS enabled to identify and compare problems in various study settings: camp-based in Jordan (N = 61), community-based in Turkey (N = 46) and Switzerland (N = 57), respectively. Questionnaires were analyzed following thematic analysis. The developed coding framework allowed to qualitatively illustrate the meaning and quantitatively compare the frequency of codes.

Results

Almost all the emerged themes are related to post-migration stressors. Over half of the participants reported practical problems with an emphasis on financial, employment, government regulations, followed by psychological and physical health problems. For participants in Turkey, finances are of much more concern than in Jordan and Switzerland, whereas in Switzerland, problems with government regulations stand out.

Conclusions

This study underlines the importance of displacement-related factors with special regard to local key factors on psychosocial wellbeing. Consequently, when planning mental health care services and preventive measures such factors must be considered and addressed.
Group problem management plus for decreasing psychological distress in Syrian refugees in Turkey
Authors: Acarturk C , İlkkurşun Z , Yurtbakan T , Troian J , Uygun E
Published: October 2020

Background

The crisis in Syria has caused millions of Syrians to seek refuge in neighboring countries and Europe. Refugees often experience war related traumatic events and other various adversities during war and flight. These traumatic events increase the risk for common mental health disorders such as depression, anxiety, posttraumatic stress disorder and related somatic symptoms compared to that of host populations. However, despite the high prevalence rates of mental health disorders, refugees' access to mental health services are low. As a public health priority, it is essential to address the mental health needs of refugees. The World Health Organization has developed evidence-based short psychosocial interventions to bridge this gap and Problem Management Plus (PM+) is one of them. PM+ is under investigation within the STRENGTHS project and in Turkey, which is a partner country to the project, the group version of the intervention has been implemented with Syrian refugees. This presentation will provide an overview of the pilot study in Turkey.

Methods

A randomized controlled trial with 46 Syrian refugees in a community sample was conducted. Participants with elevated levels of distress measured by Kessler 10 (K10 > 15) and self-reported functional impairment (WHODAS 2.0 > 16) were randomly allocated in a 1:1 ratio either to Group PM + (N= 24) or enhanced care as usual (E-CAU, N = 22).

Results

No adverse events were reported during the trial and assessments. There was no significant difference between control and experiment group with respect to anxiety (d = .14, p=.63), depression (d = .27, p=.36) and symptoms of posttraumatic stress disorder (d = .18, p=.55) at 3 months follow-up. The main trial will be conducted with a larger sample (N = 380) to detect any significant effect and provide more generalizable results.

Conclusions

The challenges of implementation of group PM+ in a community sample of Syrian refugees in Turkey will be discussed.
Potential opportunities for nurse’s participation in cardiovascular disease prevention in Bulgaria
Authors: Todorova M
Published: October 2020

Background

The role of the nurse in the prevention of cardiovascular disease (CVD) is not clearly regulated in Bulgaria. Autonomous nursing interventions related to health education and monitoring of CVD patients are poorly integrated in the nursing profession. The aim of the study was to determine the impact of the disease on social life among CVD patients and the need for preventive nursing care.

Methods

The study included 146 CVD patients and a control group of 146 individuals. The number of men and women in both groups is equal. The mean age of the respondents is 61.15 ± 2.35. The toolkit contains 3 parts: a standardized questionnaire for the study of the quality of life (EQ-5D-3L), an adapted Bulgarian version of the anxiety test (STAI), a panel for social adaptation and health care. Statistical analysis was made using the SPSS software.

Results

Anxiety negatively affects patients' ability to cope with occupational and family involvement (χ2 = 27, p = 0.000); limits leisure activities (χ2 = 22.97, p = 0.000); the frequency of communication with friends and colleagues is decreased (χ2 = 10.58, p = 0.01); the possibilities for organizing daily life according to needs are limited (χ2 = 22.37, p = 0.000). Increasing anxiety levels decreases patients' health scores. The relationship between the variables anxiety and quality of life is inversely moderate (r = -0.492). One-third of patients indicate the need for health information about the disease and training by a nurse to deal with the symptoms of the disease.

Conclusions

The chronic illness complicates the daily life and social life of CVD patients. The outlined psychosocial characteristics of CVD patients are directly related to the assessment of quality of life and health. The nurse can actively participate in the training of patients to control disease manifestations and adapt to daily life.

Acknowledgments

This study was supported by Medical University of Plovdiv, Bulgaria, Postdoctoral Project-08/2019.

Key messages

Nurses have professional competencies for monitoring and training patients to cope with risk factors and their integration in teams with other medical specialists can be beneficial. The active participation of nurses in the prevention of CVD will contribute to improving the quality of patient care.
Nurse students’ willingness and capability for oncology care provision
Authors: Gergova P , Georgieva S
Published: October 2020

Background

Oncology care is a growing and very specific area. Provision of care for oncology patients requires specialized knowledge and skills, and high nurses' motivation. The aim of this study is to examine student nurses' career plans as well as their readiness to provide qualified in-patient and out-patient oncology care.

Methods

The study is a part of a wider project observing nurses' capability to provide high quality care for patients with oncology diseases. Data were collected by direct group self-administered questionnaire amongst 123 fourth year student nurses in Medical University - Pleven, Bulgaria. Questions were directed to students' opinion about the readiness to work, preferences for oncology units, willingness to provide comprehensive care, motivation to improve their qualification etc. Data processing was performed by SPSS v. 24.

Results

Willingness to practice oncology care after graduation report 45.24% of the respondents while 54.76% don't prefer to work at this area. Preferable units for work are Clinic of oncology surgery (73.68%), followed by departments of chemotherapy (18.52%) and radiation treatment. Although students said they must have special competencies for oncology care, no significant part of them appreciated their knowledge as excellent (11.90%) or very good (23.81%). About two thirds of study subjects (64.29%) assess their competences as good or lower. Willingness to practice oncology care is significantly associated with higher self-assessment (p < 0.05). Students assess the necessity of improvement of their competences after graduation through postgraduate courses (19.06%), specialization in oncology care (47.62%) and continuing education in a Master's degree (11.90%).

Conclusions

Implications include providing more intensive faculty mentoring in oncology care to increase the number of nurses seeking this professional area after graduation and help with possibilities for future enhancement of their professional competencies.

Key messages

Most of the new graduated nurses don’t want to provide oncology care. Self-assessment of their specific competences is not high which might decrease their motivation to work in this professional area. Faculty mentoring in oncology care should be more intensive. Moreover, possibilities for improvement of competences by postgraduate courses, specialization and continuing education must be available.
Pneumococcal and meningococcal vaccines - A significant reduction of pediatric admissions and deaths
Authors: Elias A , Nogueira P , Sousa P
Published: October 2020

Background

Mortality rates associated with paediatric inpatient stays in mainland Portuguese Hospitals have decreased approximately 50%, between 2000 and 2016, despite the majority of deaths occurring in hospitals. During this timeframe meningococcal and pneumococcal vaccines were introduced in the National Vaccination Programme (NVP). In this study, the authors analyzed admission and mortality rates associated with vaccine preventable diseases such as pneumococcal and meningococcal disease.

Methods

A sequential cross-sectional retrospective study was performed, from 2000 and 2016, to assess the hospitalizations for meningitis, sepsis and pneumonia of children and adolescents at the SNS (National Health Service) hospitals in mainland Portugal. An administrative Portuguese database that contains all the public hospital admissions to mainland Portugal hospitals was utilized and diagnoses were coded per ICD9. National Institute Of Statistics (INE) data was accessed as reference. All admissions of individuals 17 years old and younger were analysed.

Results

A 10-fold reduction of admissions and deaths for pneumococcal pneumonia and a 3-fold reduction of meningococcal sepsis were observed after the introduction of the antipneumococcal and antimeningococcal vaccine in the NVP, respectively.

Conclusions

These results highlight the importance of vaccination to prevent illness, hospital admissions and deaths in children and can provide evidence to educate the public towards vaccination.

Key messages

The results highlight the importance of vaccination to prevent illness, hospital admissions and deaths in children. The results show a 10x reduction in pneumococcal pneumonia hospital admission and deaths and a 3x in meningococcal meningitis.
Intra-familial communication of hereditary breast and ovarian cancer information in Italian women
Authors: Di Pietro M , Zace D , Orfino A , Di Raimo F R , Poscia A , Lucci Cordisco E , Genuardi M
Published: October 2020

Background

Genomic testing expansion for hereditary breast and ovarian cancer (HBOC) comes with an increased need for genetic counseling and intra-familial communication. Genetic counseling can play an important role in facilitating intra-familial communication and relationships, thus avoiding misunderstandings within the family.

Methods

We conducted a cross-sectional, multicenter study including 252 Italian women, using a questionnaire divided in two sections; the first to be filled after the pre-test counseling and the second after receiving the genetic test results. This aimed at assessing the factors influencing the disclosure of genetic information for HBOC, family members that probands share genetic information with, and the degree of understanding of the information received by the counselees during genetic counseling.

Results

Women were accompanied to the counseling more by their husbands/partners. Among those with a positive test result, 49% shared it with their offspring and 27 % with their husband/partner. Younger women, those living with their husbands/partners and those who described family communication as open/deep had a higher probability of being accompanied at the genetic counseling and discuss about it with relatives. Being alone at the genetic counseling was significantly associated to non-existing familial relationship (p = 0.003) and problematic intra-familial communication (p = 0.005). Sincere or joyful familial relations were associated with the decision to undergo genetic testing as a responsibility towards relatives. Women had a good understanding of the counseling (mean score 9.2 in a scale1-10).

Discussion

Genetic counseling providers should consider that the disclosure of genetic information does not depend only on the clarity of the information provided, but also on pre-existing intra-familial communication and relationship, family structure and marital status, indicating the need of a personalized approach based on these factors.

Key messages

The disclosure of genetic information from women to their relatives in the case of HBOC is a complex relational process, which poses practical and ethical problems for individuals and families. Genetic counseling providers should be able to advice their patients on the importance of genetic information disclosure, considering, also, the pre-existing intra-familial communication dynamics.
Occupational inequality in disability pension among persons with diabetes and comorbidity
Authors: Bender A , Andersen I , Brønnum-Hansen H , Vrangbæk K
Published: October 2020

Background

Persons with type 2 diabetes (DM2) have higher probability of an early exit from the labour market and to receive permanent disability pension compared with persons without DM2.

Objectives

To assess the association between occupational class and disability pension among persons without disease, with DM2 only and DM2 with six comorbid conditions (CVD, musculoskeletal disorders, mental disease, cancer, cerebrovascular disease and ≥2 comorbid diseases).

Methods

All employed persons aged 40-64 living in Denmark in the period 2011-2017(n, year 2011=1,454,649) were stratified according to DM2 and six major concomitant diseases. We estimated the relative risk of disability pension dependent on DM2 comorbidity status and occupational class by means of a log-binomial regression. Reference group was upper non manual employees with no disease.

Results

The highest risks of disability pension were seen for DM2 + mental disease, age 40-59 (RR = 2.45 [2.3-2.5]), DM2 + cerebrovascular disease (RR = 2.45 CI 95% [2.1-2.8]) and DM2 + ≥2 diseases (RR = 2.98 [2.9-3.1]). Unskilled and manual workers were more likely to receive disability pension. The occupational inequality was highest among younger persons and groups of persons with DM2 only and DM2 + CVD and lowest for persons with more than one concomitant disease.

Conclusions

The results suggest that among people with DM2, labour market exit depend on both comorbid conditions and occupational class. Overall, our results show that the relative effects of occupational class on disability pension decrease in cases with severe comorbid conditions. In younger persons the mechanisms may be more nuanced, suggesting that persons with DM2 + comorbid conditions in particular have difficulties fulfilling the working requirements of lower occupational jobs. Practitioners may use the results in targeting prevention interventions to persons in high risk of early labour market exit.

Key messages

Low occupational class and comorbidity increase the risks of disability pension among persons with DM2. Constrained work-flexibility of low occupational jobs may influence diabetes self-care and explain high inequality in disability pension.
#UsapTayo: Utilizing Tweetchat for Mental Health Advocacy in the Philippines
Authors: Zuniga Y , Dahildahil R , Mina J , Libanan A , Mojica R , Laude K , Galindo C , Eloriaga M , Labordo E
Published: October 2020

Mental health remains a public health concern across countries. It is estimated that 1 in 4 people will be affected by mental or neurological disorders at some point in their lives. In the Philippines, about 3 million Filipinos live with depression. Mortality rate for suicide is 3.2 per 100,000 population. Meanwhile, social media use remains high in the country with 76 million users in 2019. It is thus important to explore potential ways in maximizing social media for mental health advocacy.

From January 1 to December 31, 2019, a mental health tweetchat “#UsapTayo” (direct Filipino translation of WHO's #LetsTalk) was observed every 10th, 20th, 30th of the month from 7:00 to 8:00 PM. #UsapTayo aimed to answer how effective social media platforms like Twitter in promoting mental health awareness and education among Filipino Twitter users. Engagements and impressions from users were measured using Symplur, a healthcare hashtag analytics platform.

From January to December 2019, a total of 4,626 users participated in the tweetchat. Impressions for the year reached 52 million with an average of 4.75 million impressions per month. Engagements and impressions were recorded highest in the month of September with 1,169 users and 8.74 million, respectively. Overall, the tweetchat #UsapTayo was able to generate 14,385 tweets for the complete calendar year with suicide prevention identified as the most discussed topic among Filipino Twitter users.

Given the country's high social media penetration rate at 71% with Twitter ranking as the second most frequently used social media, leveraging this platform improves access to information and helps in normalizing conversations on mental health. #UsapTayo then partnered with #ThereIsHelp, a project initiated by Twitter to create safer spaces online through integration of suicide prevention measures. It was also recommended convening a multistakeholder consultation to develop a national mental health promotion and communication plan.

Key messages

Innovative platforms in social media like tweetchat can be leveraged to promote safer digital space for mental health and to strengthen online effort for suicide prevention especially among youth. It is important to maximize the use of social media platforms for mental health advocacy particularly suicide prevention given the Philippines’ high penetration rate and access to social media.
Evaluating the long-term impact of an antenatal healthy lifestyle service: retrospective cohort study
Authors: Fair F , Soltani H
Published: October 2020

Introduction

Maternal obesity is associated with increased odds of obesity in the offspring. The antenatal period is considered a good opportunity to promote lifestyle improvements. The long-term impact of maternal characteristics and attending a maternal healthy lifestyle service (MHLS) on childhood risk of overweight was evaluated.

Methods

Women with a body mass index (BMI) ≥35kg/m² referred to one MHLS in England from 2009 were included in a retrospective cohort study. Pseudo-anonymised data from the National Child Measurement Programme were matched to data from women referred to this service. Children were classified as 'overweight' if their weight centile was ≥95th centile at 6-8 weeks or 9-12 months or their BMI was ≥95th centile at school entry (4-5 years). Univariate logistic regression determined the odds ratios (OR) and 95% confidence intervals (CI) of childhood overweight according to uptake of the MHLS, gestational weight gain (GWG) and other characteristics.

Results

The proportion of infants classified as overweight increased over time [2.8% at 6-8 weeks (20/713), 13.8% at 9-12 months (89/647) and 30.4% at school entry (206/677)]. The odds of overweight increased with each unit increase in birthweight (OR 39.9 95%CI 13.4-119.1 at 6-8 weeks, OR 3.7 95%CI 2.4-5.7 at 9-12 months and OR 1.9 95%CI 1.4-2.5 at school entry). GWG above Institute of Medicine recommendations increased the odds of overweight at 6-8 weeks (OR 2.9 95%CI 1.1-7.4). Women living in the most deprived quartile (OR 1.6 95%CI 1.1-2.2) or who smoked when booking for antenatal care (OR 1.5 95%CI 1.0-2.2) had increased odds of infant with BMI ≥95th centile at school entry. Attendance at a MHLS and maternal BMI did not significantly impact on child overweight at any time; however the sample only included women with a raised BMI.

Conclusions

Lifestyle during pregnancy, GWG and other wider health determinants such as deprivation have long lasting effects on infant health and childhood obesity.

Key messages

Overweight at school entry is high (>30%) for women with a raised BMI when booking for antenatal care. Addressing maternal socioeconomic conditions, gestational weight gain and smoking during pregnancy are key priorities for the long-term health of children.
Promoting Antenatal Care: Identifying Policy Levers in Indian Context
Authors: Singh V
Published: October 2020

Background

The growing body of literature associates Antenatal Care (ANC) with early detection and prevention of maternal complications which in turn reduce the likelihood of maternal and infant death. Studies report that only about 40% of pregnant women in developing countries have attended four ANC visits. This situation mandates identifying policy levers for promoting ANC visits.

Methods

The study uses data from the Demographic and Health Survey (DHS) India (2015-16). We analyze a sample of about 100,000 women in the age group of 15-49 years who gave birth in three years preceding the survey. Using the theory of health seeking behaviour we propose a conceptual model to understand the a) Predisposing factors; b) Enabling factors and c) Need factors affecting the ANC visits in Indian context.

Results

17 % women in our sample never went for ANC. 46 % women in our sample went for at least four ANC visits. SEM analysis suggests that our structural model fits well with the sample data (RMSEA: 0.05; TFI: 0.93; SRMR: 0.038). Higher age, lower parity, higher awareness and higher levels of education significantly predisposes women to go for ANC visits. The significant (95% CI) enablers include higher socio-economic status, meeting with Community Health Worker (CHW) and enrolment in government sponsored nutrition support program. While health system barriers and personal barriers act as disablers. Bad obstetric history and health issues during pregnancy are significant need factors. Our analysis suggests that meeting CHWs increases ANC visits by 1.8 units and enrolment in nutrition support programme increases ANC visits by 1.4 units.

Conclusions

CHW and nutrition support programme are significant policy levers to promote ANC care and reduce maternal and child morbidity and mortality. Antenatal care services must be included under universal health coverage domain to reduce financial barriers for women of low socio-economic strata

Key messages

Involvement of Community Health workers in the promotion of maternal and child health care is a cost-effective strategy. Nutrition support programmes through Anganwadi centres help advance maternal and child health care by promoting ANC care.