bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluating the effectiveness of pneumococcal conjugate vaccine in Taoyuan city on adult population
Authors: Yen A , Chen L , Jeng Y
Published: October 2021

Pneumococcus is one of the major threat for senior citizens health worldwide. Pneumococcal Conjugate Vaccines (PCV7, PCV10, and PCV13) were gradually commenced in the national pediatric immunization programme in Taiwan since 2005 and polysaccharide pneumococcal vaccine (PPV23) was granted adult indication since 2015. However, in a most-recent nationwide long-term surveillance, the PCV13 serotypes have shifted to being dominated types in that of > = 65 years-old seniors. This study aims to evaluate the PCV13-introduction effectiveness based on a selected test city. Data of the national health insurance research database (NHIRD) between 2013 and 2018 were retrieved to collect data on yearly medical use of citizen aged 65-66 years and were linked to the death registry database for death-ascertainment. Compared to females, males had more hospitalization due to IPD (RR = 1.37, 95% CI: 1.04-1.79) and due to pneumonia (1.69, 1.34-2.14). The introduction of PCV13 free-vaccination was associated with significant reductions of hospitalization by 40% for IPD (0.6, 0.51-0.71) and 36% for pneumonia (0.64, 0.58-0.7) in females. However, the effects were not significant in both sex combined and in males. As far as mortality is concerned, the introduction of the PCV13 free-vaccination had 33% lower risk of all cause death with IPD claimed within one month of death (0.67, 0.49-0.91) and for pneumonia (0.77, 0.60-0.99). This was also observed in both sex combined (0.82, 0.68-0.98) for IPD, but not for pneumonia, or for both events in males. In conclusion, the policy of PCV13 vaccination for seniors aged 65 years was associated with all-cause mortality with IPD or pneumonia claims one month before death. The evidence was stronger in females than in males. The effectiveness for the associated reduced hospitalization has been demonstrated in females. Further analysis with individual vaccination history and extended years is needed. Funding: The current study was funded by Pfizer Limited (Taiwan).

Key messages

The pneumococcal serotype shift has been found in elderly from PPV-23 vaccine-type to PCV vaccine-type and hence the preparedness of PCV13-introduction for elderly immunization programme is necessary. The findings of this pilot study included the effectiveness of PCV13-introduction in seniors aged 65 years and some implications to subgroup analyses needed for preparing a nationwide implementation.
Parents’ perception of overweight-obese children Quality of Life in different settings
Authors: Esposito F , Sanmarchi F , Marini S , Masini A , Gori D , Scrimaglia S , Reno C , Serra L , Vandini S , Dallolio L
Published: October 2021

Background

Children's Health-Related Quality of Life (HRQoL) has been frequently investigated, in particular among individuals affected by chronic diseases. It is reported that agreement between child and parent ratings regarding the child's HRQoL is strongly influenced by the latter's health status. To our knowledge, there is no evidence of how this agreement is related to different healthcare settings. Thus, our study aims to examine the relationship between child's and parent-proxy reported HRQoL of similar overweight/obese children according to the recruitment setting.

Methods

A cross-sectional study was conducted among 68 overweight/obese children, aged 6-10, recruited in a primary school (Group1, G1) and in a hospital outpatient clinic (Group2, G2) of Imola (Italy) in 2019. HRQoL was assessed using Italian version 4.0 of the Pediatric Quality of Life (PedsQL) questionnaire. For each child, we obtained self-reported children's and parents' perceived children's HRQoL total score (5 questions investigating Physical Health domain and 10 questions investigating Psychosocial Health domain divided in Emotional, Social and School Functioning).

Results

In G1 there were n = 42 overweight/obese children and in G2 n = 26. The correlation between children's reported and parents' perceived HRQoL scores is lower in G1 (Physical Health: r=-0,17; Psychosocial Health: r = 0.38) compared to G2 (Physical Health: r = 0.80; Psychosocial Health: r = 0.66). Notably, in G1, parents tend to overestimate their children's HRQoL, specifically in the Physical Health domain.

Conclusions

Correlation between children's and parents' HRQoL scores is higher in the clinical setting compared to the school setting. Implementing this questionnaire on a large scale would allow us to identify settings which need awareness-raising initiatives to improve parents' knowledge about their children's health.

Key messages

Parents’ overestimate children’s HRQoL in the school setting, particularly in the Physical Health domain. Children’s HRQoL misinterpretation might determine less targeted actions to improve their wellbeing and highlights the need for raising parents’ awareness about obesity and its effects on children.
Do families have moderating or mediating effects on early health inequalities? A scoping review
Authors: Hoffmann S , Sander L , Blume M , Schneider S , Herke M , Fialho PM , Pischke CR , Schüttig W , Lampert T , Spallek J
Published: October 2021

Background

During early childhood, families have a crucial impact on children's health behaviour, health, and development (bhd). However, a family's socioeconomic position (SEP) determines both the parental behaviour, living conditions, and child health. To understand how family characteristics may influence the development of health inequalities, this scoping review synthesised research on their mediating and moderating effects.

Methods

The review followed the guidelines of the PRISMA Extension for Scoping Reviews. The search included German and English peer-reviewed articles published between January 1st, 2000 and December 19th, 2019. The search in PubMed, PsycINFO, and Scopus used both free text terms in the title/abstract and index terms within linked keyword blocks: (1) family characteristics, (2) inequalities, (3) income, education, occupation, (4) bhd, (5) newborn, infant, toddler, preschooler. Two researchers independently examined eligibility for inclusion in two rounds (title/abstract; full-text).

Results

Of 7,089 articles identified, ten sources were included that studied family characteristics and health inequalities among 0-6 years olds. Parental rules, stress, and screentime, and TV in bedroom showed mediating effects on inequalities in behaviour problems or children's screentime. Families' negativity, single parenthood, and the number of children in the household moderated differences in impairment, health, behaviour problems, development or breastfeeding initiation.

Conclusions

The effect of family characteristics on early health inequalities has been sparsely investigated. The evidence supported models of family stress and investment. Further research is needed to comprehensively understand this association.

Key messages

Family characteristics contribute to health inequalities. Taking families’ stress and investment into account could improve targeted prevention efforts aimed at reducing health inequalities.
Community Readiness – are municipalities prepared to prevent obesity in childhood and youth?
Authors: Schröder M , Babitsch B , Hassel H
Published: October 2021

Background

Essential for the success of prevention efforts is the readiness to address a health problem (community readiness). Aim of this study is to analyze the stage of community readiness for the prevention of childhood obesity in municipalities using the Community Readiness Model (CRM). Based on this, strategies will be developed to improve community readiness for the prevention of obesity in childhood and youth.

Methods

A systematic literature review (SLR) was conducted in the databases PubMed, LIVIVO, Cochrane and Google Scholar to identify studies that used the CRM for the prevention of childhood obesity. In order to assess community readiness, the CRM, a structured interview guide and scoring system, was used. Following the CRM protocol, guided interviews were conducted with key informants that were identified in a modified stakeholder analysis. The transcribed interviews were analyzed by two scientists following the CRM scoring system.

Results

The SLR revealed 270 hits. In 28 international studies the CRM has been applied to childhood obesity prevention, predominantly in the Anglo-American language area. In Germany, no studies could be identified using the CRM for the prevention of childhood obesity. Key informant interviews (n = 28) were conducted in five Bavarian municipalities from January to April 2021. The key informant sample comprised administration departments, health and educational facilities.

Conclusions

The CRM enables a multidimensional analysis of a municipality's material and immaterial infrastructure. In workshops with the participating municipalities the results of the community readiness assessment will be reflected. The aim is to develop an action plan with strategies to increase the stage of readiness and support prevention efforts in order to address childhood obesity.

Key messages

The CRM provides a theoretical basis to understand and improve community readiness. It enables the analysis of assets and weaknesses that can influence obesity prevention in municipalities.
Pregnant women and midwives’ perception regarding physical activity recommendation during pregnancy
Authors: Scognamiglio F , Soldà G , Marini S , Masini A , Messina R , Caravita I , Leccese V , Bertini V , Parma D , Dallolio L
Published: October 2021

Introduction

Physical activity (PA) is a modifiable lifestyle factor which contributes to improve pregnancy and perinatal outcomes. Therefore, pregnant women (PW) without contraindications should practice 150 minutes of moderate PA per week, according to the World Health Organization (WHO) guidelines. Nevertheless, a reduction of PA throughout the gestational period appears to be worryingly common. The aim of this survey was to analyse the feasibility of the WHO recommendations, investigating PW and midwives' perceptions towards PA during pregnancy, in a view to enhance future PA interventions.

Methods

A total number of 4 focus groups, involving 10 midwives (aged 43-61) and 10 PW (aged 30-46), recruited at the University Hospital of Bologna, were carried out between July 2020 and April 2021. Due to SARS-CoV-2 restrictions, all meetings were held online, recorded, transcribed and then analysed using the COM-B model.

Results

WHO recommendations were deemed feasible by both midwives and PW when time management skills and capabilities to adapt PA to individual needs were present. Clearly, women with a background in PA practice tend to be highly motivated thereby maintaining the PA routine also during pregnancy. Both groups reported that PA represents a positive element for the mother's and baby's well-being, triggering a virtuous circle and increasing motivation. Being able to access and perform simple, structured, evidence-based activities, family support, and using every opportunity to be less sedentary were reported as key aspects amongst opportunities to improve PA levels.

Conclusions

Positive perception regarding feasibility of the recommendations was similar between groups; nevertheless, midwives perceived pregnancy as an opportunity to change PA routines, while PW considered pregnancy a less dynamic period. Therefore, implementing PA promotion involving midwives might represent a good strategy given their central role during this woman' unique period.

Key messages

WHO physical activity recommendations are overall deemed feasible, but tailored opportunities and strategies tackling everyday obstacles and lack of information need to be provided. Enhancing PA is a key challenge for pregnant women in a view of their own and baby's health. The COM-B model can be used to implement new strategies involving midwives to reach the goal.
Opinion of health professionals about legal issues of surrogacy
Authors: Zubko AV , Borovkova VV , Krasnov GS , Khomanov KE , Shatalina SI , Sabgayda TP
Published: October 2021

The study summarizes opinions of 7504 representatives of the medical community on organizational issues of surrogacy programs, rights, and responsibilities of their participants. Although Russian lawyers are yet to consolidate in developing the surrogacy legal framework, health professionals think that legal aspects are crucial. Almost all health professionals believe that surrogate mothers and contracting parents should be offered a lawyer before making a decision on surrogacy to explain the rights, obligations and responsibilities (92.6%). The majority consider that surrogacy can be used by couples in which a woman cannot give birth for medical reasons (81.0%) and that the surrogate mother should have the right to psychological support after the childbirth and weaning (87.8%). One-fifth of the respondents have no definite opinion on the remaining issues. The majority of the respondents believe that surrogacy should not be funded by the state and genetic parents have to pay for surrogacy; Russia should allow altruistic surrogacy (assistance to friends or relatives); and priority rights for a newborn are held by contracting parents-customers: the contracting parents have the right to request prenatal diagnostics during pregnancy and abortion in case of the detected pathology. Health professionals are hesitant to determine whether the surrogate mother can renegotiate the contract and choose an abortion. Unlike lawyers, health professionals consider it possible for single men to use surrogacy. According to the respondents, during pregnancy and childhood, decisions regarding lifestyle, hospitalization and methods of delivery should be made only in conjunction with specialists from the medical organization that signed the contract. Significant variations by region in the response structure suggest that socio-economic differences, diversities in culture and traditions in these issues have a greater impact on the opinion about surrogacy rather than professional experience.

Key messages

Unlike lawyers, health professionals consider it possible for single men to use surrogacy technology. The majority of the respondents consider that surrogacy can be used by couples in which a woman cannot give birth to a child for medical reasons.
Catering situation at Austrian schools
Authors: Schätzer M , Bhardwaj J , Sommer J , Miskovic R , König J , Hoppichler F
Published: October 2021

Background

Due to the increase in all-day compulsory schools in Austria, it is important that students receive health-promoting meals throughout the day. The aim of the analysis was a nationwide evaluation of the current situation concerning catering at schools.

Methods

Using a nationwide representative sample of schools from the 5th grade upwards, a questionnaire was conducted as a telephone interview with 331 randomly chosen schools. In addition, 56 schools in Vienna from the 5th grade onwards were randomly selected in order to analyze the current offer at school cafeterias in detail.

Results

Lunch was offered at 72% of all schools, a school cafeteria was available at 81%, a cold drink vending machine at 66%, a hot drink vending machine at 41% and a snack vending machine at 23%. With regard to the health promoting composition of the catering offer, 18% of all schools already had a certified lunch menu, 22% a certified school cafeteria, 14% a certified cold drink vending machine and 5% a certified snack vending machine. In 79% of schools there is direct competition for school catering (93% supermarkets, 45% bakeries, 33% snack stands, 8% fast food restaurants). The results of the detailed analysis in Vienna showed that only 35% of all school cafeterias are certified. All of these locations are advised externally.

Conclusions

The majority of the schools offer catering during breaks and at lunchtime. Without external advice, the majority of the offers must be classified as not health promoting.

Key messages

The food offered at schools is an important component in the nutrition of students in Austria. Cafeteria operators in schools often need external advice in order to be able to offer a healthy selection of food and beverages.
Neonatal malformations: organization of information flows in the S. Anna Hospital of Torino
Authors: Bordino V , Musso A , Bert F , Siliquini R
Published: October 2021

Background

Congenital malformations (CMs) represent a serious public health problem, both in terms of size (3% newborns/year) and severity of outcomes. The surveillance activity carried out by the Registers is an important tool for monitoring the frequency of events, to evaluate etiology, support research and public health actions. The aim is to evaluate the organization and the information network related to the diagnosis of malformation in the S. Anna presidium.

Methods

the retrospective study analyzed all newborns with one or more CM and all cases of TOPFA (Termination of Pregnancy for Fetal Anomaly) for CMs in the period 01/2020 - 01/2021. A forward-looking pilot study was then set up to assess the impact on the quality of data collection through the introduction of a MC sheet.

Results

510 cases of CMs were found in live births, 180 in TOPFA for CMs and 4 in stillbirths. The duration of hospitalizations averaged 14.5 days (σ 36.56), with a median of 4 days. In the CMs group, an average maternal age of 33.40 years (σ 9.32), a median of 33 years and a mode of 33 years were calculated, in the TOPFA group an average maternal age of 34 years (σ 6.34), a median of 34 years and a mode of 32 years. In the live births group, 701 maternal diagnoses were detected, categorized and compared with the various national reports. The MC Sheet was compiled for 60 patients, 16 (4.30%) patients before the introduction of the sheet (01/2020 - 09/2020) and 44 (30.43%) after its introduction (10/2020 - 01/2021). Regarding the assessment of the proper use of ICD9CM an adequacy of 78% was observed in the first group vs one of 100% in the second.

Conclusions

Our preliminary data assess the need for a Regional registry, for a comparison with the main national and regional sources available (also with a view to possible participation in the EUROCAT and ICBDSR registers) and for regional health planning.

Key messages

The study underlines the need for a Regional Registry of congenital malformations. The clinical file is not always a complete source for analysing data on congenital malformations.
The impact of obesity on maternal-fetal prognosis through a comparative study
Authors: Bannour I , Frigui R , Bannour R , Khairi H
Published: October 2021

Objectives

To clarify the impact of obesity on the course of pregnancy and childbirth by specifying maternal and fetal complications.

Materials and Methods

This is a comparative case-control study, conducted over a period of two months from February 1 to March 31, 2019, which included patients who gave birth in the Farhat Hached Sousse University Hospital and the Maternity and Neonatology Hospital of Monastir. Patients meeting the inclusion criteria were divided into two groups according to body mass index (BMI) at the end of pregnancy: group I: normal weight 18,5≤ BMI <25 and group II BMI greater than or equal to 30.

Results

Pregnancies of women in Group II were more frequently complicated by gravidic hypertension 8% against 1%, 3% pre-eclampsia against 0% and gestational diabetes 14% against 3%, as well as infections. In obese patients, there were more labor abnormalities with a 17% vs. 3% cesarean section rate and higher instrumental delivery rate 15% vs. 7%. Post-partum follow-up was marked by the occurrence of infectious maternal complications, anemia with breastfeeding difficulties. The newborns of group II women were born with a lower Apgar score and had more neonatal complications such as trauma 6% versus 0% meconium inhalation 6% versus 2% and hypoglycemia 4% versus 0%.

Conclusions

Obesity is a serious problem in obstetrics, with adverse effects on the health of the mother and her baby throughout pregnancy, childbirth and post-partum. The management of obese or overweight pregnant women must be early and adapted to each case with close obstetrical surveillance.

Key messages

Obesity is a serious problem in obstetrics, with adverse effects on the health of the mother and baby. The management of obese or overweight pregnant women must be early.
Evaluation of eating habits and unhealthy eating patterns in high-school girls from Varna, Bulgaria
Authors: Marinov D , Naydenova D
Published: October 2021

Background

Eating habits in children and adolescents are fundamental for their optimal physical and mental health and development. In adolescent girls, adequate nutritional status is paramount for the reproductive system function and reaching peak bone mass. Epidemiological studies have found an increased incidence of unhealthy eating patterns that pose a risk of nutritional deficiencies in adolescents from different European countries. More data is needed on the prevalence of the problem among Bulgarian adolescents, and especially school-aged girls, who are a specific risk group.

Methods

The study included 226 adolescent girls aged 17-19 from Varna, Bulgaria. Data was collected after receiving informed consent. The methods used include:

Anthropometric measurements, including height and weight; Bioelectric impedance analysis using calibrated Tanita BC-420MA (ISSO 9001) and following ESPEN guidelines; Food frequency questionnaire (FFQ).

Results

10% of girls were underweight, 78.5% had normal BMI (18.7-25kg/m2) and 11.5% were overweight/obese. Underweight girls had an average BF%=13.78±4.28, with the lowest BF%=3. Underweight girls had significantly lower consumption of vegetables, whole grains, and dairy products. More than half of the underweight group didn't consume vegetables daily (54.5%). 27.7% of the underweight participants consumed whole grain foods every day compared to 42.9% overweight/obese group. 27,2% of underweight girls met the recommendations for consuming daily dairy consumption, compared to 58.1% in the normal BMI and 65.4% in the overweight/obese group. Fish consumption was low in all groups - 13.6% of underweight girls, 17.7% of the participants with normal BMI, and 3.8% in the overweight/obese group consume fish at least twice per week or more.

Conclusions

Underweight teenage girls have inadequate intake of vegetables, whole grains, and dairy products. The majority of adolescent females do not meet the minimum requirement for fish consumption.

Key messages

The combination of low body weight and inadequate intake of foods rich in bioavailable calcium are risk factors for not achieving peak bone mass in adolescence. Underweight teenage girls are at an increased risk of vitamin and mineral deficiencies due to inadequate intake of vegetables, whole grains, fish, and dairy products.
Mental health during pregnancy and early childhood: recommendations from evidence-based guidelines
Authors: Reinsperger I
Published: October 2021

Background

Mental health problems are common during pregnancy and after birth and are therefore often addressed in the context of antenatal and postnatal care. The project is an update of previous work and aimed at identifying and summarising screening and counselling recommendations from evidence-based guidelines. Mental health was defined broadly and included topics such as substance use and domestic violence.

Methods

Relevant guidelines were identified by searching 2 databases (G-I-N, TRIP Database) and websites of relevant institutions and professional societies. Guidelines, that were published or updated within the last 5 years and fulfilled methodological quality criteria, were included.

Results

A total of 52 guidelines from 16 different institutions fulfilled the inclusion criteria. The guidelines (predominantly) advocate the following mental health screenings: Interviewing about psychosocial stress factors and support needs during pregnancy and after birth; screening for postpartum depression and anxiety disorders; interviewing pregnant women about substance use (smoking, alcohol, drugs) and appropriate counselling. With regard to domestic violence and child welfare risks, some guidelines recommend routine screening and some recommend increased awareness of signs and symptoms by health workers. Routine screening for specific mental and behavioural disorders in children is not recommended by included guidelines; however, if there are indications and symptoms, clarification should take place and attention should be paid to signs and symptoms during preventive examinations.

Conclusions

The included guidelines recommend screening and/or counselling for the majority of the topics addressed. The results of the report can be used as a basis for decision-making for updating national antenatal care and screening programmes.

Key messages

The majority of the included evidence-based guidelines strongly recommend addressing mental health issues during pregnancy and after birth by offering screening and/or counselling. The recommendations from evidence-based guidelines can serve as a decision support for developing national antenatal and postnatal care programmes.
Tobacco use among middle school pupils in Sousse, Tunisia across three years of monitoring
Authors: Zammit N , Ghammem R , Ben Fredj S , Bennasrallah C , Maatoug J , Ghannem H
Published: October 2021

Background

Tobacco use represents a major risk factor for incident disability-adjusted life years among adolescents especially in developing countries. In Tunisia, a national strategy to reduce tobacco use was set up since 2008. However, no surveillance system was implemented to evaluate it.

Objective

To examine trends in tobacco use among middle school children in Sousse, Tunisia between 2014 and 2016 and to determine predictors of its experimentation.

Methods and findings

Three cross-sectional studies were conducted in 2013/2014, 2014/2015 and 2015/2016 school years among middle school-children randomly selected from the governorate of Sousse-Tunisia. The required sample size for each study was 760 participants. Each year, the same procedure was used to recruit pupils from the same middle schools. The same pre-tested questionnaire was self-administered anonymously to participants in their classrooms.

Results

Lifetime tobacco use rose from 11% in 2013/2014 to 17.3% in 2015/2016 (p = 0.001). Across the three years of survey, predictors of lifetime tobacco use were: The male gender (OR, 95% CI: 4.4 [3.2-6.1]), age above 13 (OR, 95% CI:2.3 [1.7-3.1]), lifetime illicit substances use (OR, 95% CI: 3.9 [1.1- 13.8), lifetime inhalant products use (OR, 95% CI:2.2 [1.2-4.3]), tobacco use among the father (OR, 95% CI:2.2 [1.2-4.3]), tobacco use among siblings (OR, 95% CI:1.7 [1.2-2.4]) and current anxiety problem (OR, 95% CI: 1.8 [1.4-2.4]).

Conclusions

Tobacco experimentation is in expansion among the young adolescents of Sousse. Its prevention should integrate a comprehensive substances use prevention program with emphasis on second hand smoking and the associated mental health problems.

Key messages

More attention should be paid to young adolescents in order to prevent tobacco and other substances use among them. Second hand smoking and mental health problems should be considered when planning for prevention programs of tobacco use.
Sexual behavior of Roma women in Romania
Authors: Nanu M , Stativa E , Nanu I , Kozma A , Otelea M , Nanu A , Scantee S , Ciutan M , Popovici G
Published: October 2021

Background

Roma women are considered a vulnerable population with regard to reproductive health. Early pregnancy and childbirth is common among Roma women. Roma women use less preventive services prenatal care, cancer screening and family planning.

Methods

The present study aims to analyze the sexual behavior of Roma women based on the secondary analysis of a subsample of 343 Roma women aged 15-44, as a part of the Romanian Reproductive Health Survey 2016.

Results

The main sexual events of the Roma women start in adolescence: 63.9% of Roma women had their first sexual intercourse at age of 15-19and 26.7% at age of 15 and 9.4% between 20-24 years. Roma with a low educational level start earlier sexual life, 28,8% of Roma women with no education had their sexual intercourse before age 15 and 64.8% between 15-19 years. Roma women are living in couples as adolescents with a higher prevalence of teenager couples in rural area 19.4% of Roma women in rural areas and 13.4% in urban areas are in a couple before the age of 15, (p < o,o5) and 60.5% in rural areas and 58.9% in urban areas between 15-19 years. 2/3 of Roma women had their first pregnancy in adolescence, 66.9% between 15-19 and 8.4% under 15 years of age. Concerning the first delivery 65.4% Roma adolescent girls had their first child at 15-19 years, and 2.8% at ages under 15 years.

Conclusions

The Roma female minorities had in adolescence their main sexual events, the first sexual intercourse, the start of a life in couple, the first pregnancy and the first delivery; Roma women from rural areas and women with a low level of education had all these experiences earlier; In order to prevent unwanted pregnancies, public reproductive health policies in Romania should include measures addressed to the need and specific educational and cultural characteristic of Roma women and their partners.

Key messages

Main sexual events of Roma women begin in adolescence. The reproductive health policies should be adressed with special emphasis to Roma adolescent women.
An evaluation of spatial accessibility to mental health services in Porto, Portugal
Authors: Aluh DOS
Published: October 2021

Background

Access to mental health service is an important problem globally. The probability of using a particular health service is affected by increased distances to the location of care and reducing this distance can reduce travel time and cost of accessing these services. This study aimed to assess spatial distribution and accessibility to mental health care services in Porto, the second largest city in Portugal.

Methods

Data regarding the population statistics in Porto was obtained from the Population and Housing census in 2011 while datasets related to all the mental health facilities in Porto were obtained from ACES Porto Oriental and Carta social. Standard distance, Nearest neighbor index, average distance to a mental health service were all computed. All spatial analysis techniques were employed in ARC/GIS environment.

Results

The study findings indicated that the mental health services were clustered around three municipalities in Porto; Campanhã, Bonfim and Paranhos. The mean time to access a mental health service was 6.47±3.726 minutes and the maximum time to reach a service center among the residents was 19.44 minutes. Pearson correlation showed a significant negative moderate association between the population density and the average near distance to a mental health service (r = -0.617, p = 0.002). 77.7% of the population lived within 1 km of a mental health service.

Conclusions

Mental health services were clustered in some parishes in Porto. A significant proportion of the residents were living near a mental health service. However, certain areas did not have adequate numbers of mental healthservices. It is important to determine areas of mental health service shortage to help in planning the location of mental health services.

Key messages

Mental health services are clustered around areas of high population density in Porto. There is need for more mental health services to serve the needs of people living in sparsely populated areas.
Self-esteem and university students: Findings from a multi-center study
Authors: Ketata N , Ben Ayed H , Baklouti M , Trigui M , Yaich S , Abdelmoula M , Feki H , Damak J
Published: October 2021

Introduction

Self-esteem refers to the degree to which a person esteem himself or herself. Accordingly, low self-esteem has a remarkable impact on mental health that may influence successful development and life outcomes, especially for young people. The purpose of this study was to determine the prevalence and factors predisposing to low self-esteem among university students (US) in Southern Tunisia.

Methods

A cross-sectional study performing a stratified randomized sample of 8 universities was conducted in Sfax, Southern Tunisia, on April 2021. A structured an anonymous self-administered questionnaire including the 10-item Rosenberg Self-esteem Scale was applied for a total of 1071 US.

Results

Among 1071 US, 759 cases (71%) were females, giving a male to female ratio of 0.4. Their mean age was 22.2 ±2.5 years. There were 1035 single US (96.5%), 246 smokers (23%) and 140 alcohol consumers (13.1%). Students with low self-esteem were identified at a prevalence of 29.5%. Living in a urban region (OR = 1.7; p = 0.004), studying in a private university (OR = 2.5; p = 0.013), having a low monthly income (<2 minimum wage) (OR = 1.6; p = 0.014) and a chronic disease (OR = 2.1; p < 0.001) were major risk factors of low self-esteem. Moreover, daily TV time >4 hours (OR = 5.9; p = 0.009) and absence of leisure activities (OR = 1.8; p = 0.006) were significantly associated with higher prevalence of low self-esteem. Otherwise, practicing physical activity 3 times/week (OR = 0.6; p = 0.04) and high academic performance (OR = 0.8; p = 0.004) were identified as protective factors of low self-esteem.

Conclusions

The findings from the current study highlighted that low self-esteem was ranking at an alarming rate among US. These results therefore suggested the need for a school-based or web-based provision aiming at proactively increasing students' self-esteem and skills for dealing with their academic career and self-confidence.

Key messages

Low self-esteem and its associated factors. University students.
Presence of resistance in building resilience of Health workforce in the COVID-19 crisis
Authors: Jevtic M , Tobi Strizovic M , Despotovic T , Jovicic V
Published: October 2021

In the extraordinary circumstances of the Covid pandemic, Group Analytic Society Belgrade (DGAB) devised and organized online support groups for health workers, health associates and student volunteers. Participation is devised to be voluntary, while respecting confidentiality and non-disclosure of content outside the group. Support groups for health workers aim to share experiences, feelings and mutual support that they invest in daily work. We assume that the groups as a space of integration understanding and common thinking, could impact the building of resilience of health workers in the given conditions of a pandemic crisis. Groups are organized two times a week - 1 h and 15' each. One may apply by filling out an online form, and choosing one of the offered dates, that provides access to the group once a week. Group leaders are experienced analysts, DGAB members and analysts in their final years of education. In the initial phase, they are open - it is enough to choose a day that suits the participant when filling out the application, and in the selected term to join via the link for the zoom meeting (the link is sent to the e-mail given in the application). The aim is to present challenges we encountered in forming the groups, from strong resistance in accepting the help offered, negating the need for support to the helplessness and hopelessness that any help is possible. Exploring ways to overcome noticed resistance and presenting experience in providing support to health professionals is vital to strengthen the capacity of human resources and health systems in general. The pandemic crisis has not only affected the conditions and needs of patients, but has created a need for complex approach and care for health workers (human resources), so health systems could achieve sustainability and overcome the crisis that has befallen them.

Key messages

The pandemic crisis has not only affected the conditions and needs of patients, but has created a need for complex approach and care for health professionals. Management of healthcare organizations should ensure to all health professionals support to overcome the crisis that has befallen them.
Validation of the Distress Thermometer Questionnaire for Parents of Children with Down syndrome
Authors: Ben Cheikh A , Bannour R , Dardour L , Tahri O , Mhamed A , Trabelsi M , Zemni R
Published: October 2021

Background

Down syndrome is the most common neuro-genetic disorder in the world. In Tunisia, the number of births of children with Down's syndrome is estimated at 200 each year. However, few studies have assessed the quality of life of these families and their specific needs. The most used tool to assess the distress of parents of a chronically ill child is the DT-P.

Aim

The aim of this study was to validate the DT-P in Arabic language and evaluate the degree of distress of parents having a child with a Down syndrome in Arabic-speaking members of the Tunisian union for assistance to intellectual disability in the city of Sousse and those consulting in the department of hereditary and congenital disorders at the University Hospital Charles Nicolle of Tunis during the period between June, 1st 2020 and July, 31st 2020.

Results

The translation was process according to the translation -back translation method. Two aspects of validity were tested: Content validity via pretest and judgment experts. The construct validity was tested in its external component via the convergent validity, by determining the correlations of the DT-P results with the results of the Hospital Anxiety and Depression Scale (HADS). Overall, the correlations were moderate to strong. Precision was tested using the Cronbach index and was globally satisfactory with indices greater than 0.8. The distress thermometer average was 5.19 ± 2.9. The majority of parents reported distress (75.3%). The emotional problems were the most reported and 67.7% of parents asked to be referred to a professional for psychological support.

Conclusions

The DT-P appeared to be a valid and reliable short screening-tool for identifying parental distress. Therefore, it would be easier to provide them with professional support.

Key messages

The quality of life of families with child with Down Syndrom is usually neglected. The DT-P can be used as a reliable short screening-tool for identifying parental distress and providing them with professional support.
Dterminants of medication adherence in Moroccan schzophrenic patients
Authors: Tsoumbou-Bakana G , Salihi I , Raoui S , Traore B , Mchichi Alami K , Nani S
Published: October 2021

Introduction

Schizophrenia is a psychiatric condition in which patient adherence is a key issue in its management.

Objectives

To estimate the prevalence and determine the factors associated with medication adherence in patients with schizophrenia.

Methods

This was a cross-sectional study conducted at the psychiatry department of the CHU IBN Rochd of Casablanca among schizophrenic patients followed from May 2019 to January 2020. The sample size was calculated apriori and the measurement of therapeutic compliance and Insight (patients' perception of the disorders related to their pathology) was made thanks to the Medication Adherence Rating Scale (MARS) and the Birchwood insight scale (BIS) respectively. Socio-demographic data and data on the management of schizophrenia were also collected. Statistical analyses were performed with RStudio software and the multivariate analysis method of logistic regression was used. The threshold of significance was set at 5%.

Results

A total of 370 were collected, the median age was 31 years and the most represented class was the over 28 years (26.25%). The female gender represented 28% and the majority was single (72%). Substance abuse was 68.8%, 46% were on dual therapy and 43.2% of patients were on regular follow-up. The prevalence of therapeutic compliance was 25.6% and 30.3% were aware of their pathology. The determinants of medication adherence in the schizophrenic patients included in the final model were: regularity of follow-up (p < 0.001), insight (p < 0.001), number of medications (p = 0.011), history of substance use (p = 0.008), place of residence (p = 0.082).

Conclusions

Therapeutic compliance was low, the knowledge of the factors associated with therapeutic compliance in schizophrenia allows us to put forward hypotheses in order to improve the management of patients.

Key messages

Patient adherence to treatment is important in the management of Schizophrenia. Therapeutic compliance is poor.
Epidemiological profile of women victims of domestic violence in Casablanca
Authors: Tsoumbou-Bakana G , Naitrobah A , Mchichi Alami K , Nani S
Published: October 2021

Introduction

Violence against women is a major public health problem because, whatever its form, it has an impact on the physical and psychological health of victims.

Objectives

To describe the socio-demographic characteristics of the victims and their partners as well as the different forms of violence observed and their impact on the victims.

Participants and Methods

This was a descriptive cross-sectional study conducted from January to March 2019 in two associations providing assistance to women victims of domestic violence.

Results

Our study collected 102 women whose average age was 33 +/- 10.8 years (18-67 years), 77% resided in urban areas, 54% had left the marital home. Regarding marriage, 86% were married and 37% had been married for more than 10 years. The average number of dependent children was 1.75 +/-1.3. Regarding employment status, 65% were housewives and 61% had no income; a quarter of the victims had a history of domestic violence. Regarding their spouses, the average age was 40 years old, 9% were unemployed; 41% had consumed alcohol at the time of the violence and one third of them had taken drugs. Physical and psychological violence were present in almost all cases, respectively 99% and 97%, economic violence in 73% of cases and sexual violence in 69% of cases. These incidents occurred mainly in the context of conflict with in-laws (66.7%).

Conclusions

Despite the measures undertaken by the authorities, domestic violence is a scourge that is not limited to any particular profile and has complex triggering mechanisms.

Key messages

Domestic violence is still a scourge today. The identification of strategic axes of prevention is essential.
Educational differences in alcohol-related mortality in Spain using multiple causes of death
Authors: Trias-Llimós S , Spijker J
Published: October 2021

Background

Socioeconomic inequalities in alcohol-attributable mortality are commonly studied using only underlying causes of death (UCOD). We aim to assess absolute and relative educational inequalities in alcohol-related mortality, and to estimate the role of alcohol in educational inequalities in both life expectancy and lifespan variation in Spain.

Methods

We used multiple cause-of-death (MCOD) mortality data for individuals aged 30 and over for Spain (2016-18) by educational attainment. We estimated by sex and educational attainment age-standardized alcohol-attributable mortality rates, relative and absolute indices of educational inequalities; and total life expectancy and lifespan inequality at age 30 for all-cause mortality and after eliminating alcohol-attributable mortality.

Results

The use of MCOD resulted in an additional 2,543 annual alcohol-related deaths (+75% among men, and +50% among women) compared to estimates derived from UCOD. In absolute terms, the most unequal age groups were those aged 45-84 among men and 45-65 among women. In relative terms, higher inequalities exist in working ages, whereas at older ages inequalities tended to be lower, although still important among men. Alcohol contributed to educational inequalities in life expectancy (men: 0.13 years (3.2%); women 0.02 years (0.7%)) and lifespan inequalities (2.1% and 1.4% for men and women, respectively).

Conclusions

Alcohol-related estimates derived from MCOD are more accurate compared to estimates derived from UCOD approaches, although these estimates are still underestimating the impact of alcohol on mortality in Spain. Alcohol remains an important lifestyle to be tackled in order to reduce mortality inequalities.

Key messages

Alcohol-related mortality estimates using multiple causes of death (MCOD) increased the death counts related to alcohol by 75% among men and 50% among women compared to underlying causes of death. This study confirms the role of alcohol on mortality in both mean indicators (life expectancy) and indicators of age-at-death dispersion (lifespan inequality).
Building sustainable research and data tools and partnerships for a healthy city for all
Authors: Marriott P , Hart M
Published: October 2021

Vancouver is located in a temperate rain forest surrounded by mountains and water. Indigenous communities, including the Nations whose homelands the city occupies, have recognized that the abundance of this place can build healthy communities for many generations. But contemporary Vancouver is not a healthy city for all. Since 2014, Vancouver has adopted a Healthy City Strategy, a master social sustainability plan to address inequities in the social determinants of health at a population scale. This includes a number of population health targets and indicators. However, implementation has been slow, with substantive integration of health into policy not yet achieved. With support from the Partnership for Healthy Cities, we have translated the Healthy City Strategy's indicators into an online dashboard, including disaggregated local data. In addition to public accountability, this tool enables data to be a platform for aligning city policy, action and investment toward common health outcomes. In parallel, we are also piloting more community-generated approaches to health data and indicators, with a focus on co-creating health indicators with Indigenous communities. Preliminary results have shown improvement in collaboration across city departments, leading to increased focus on upstream, preventive work. The dashboard is enabling frameworks for funding and working with the social service sector toward common health goals. Engagement efforts have shown the continued importance of a holistic strategy for health that is co-created with community knowledge and priorities. These interventions must be sustained and integrated into ongoing work. The technical work of developing the dashboard contributes to city-wide efforts toward data monitoring and reporting. Data has shown to be an important tool for beginning conversations, but sharing data about health inequities experienced by communities must be matched with an ongoing commitment to engagement and co-creation.

Key messages

Population health data can be leveraged through interactive tools to better integrate and align city policies, plans and investments to address the social determinants of health. Engaging and co-creating policy with communities supports upstream, preventive action on health inequities.