bluuebunny/crossref_metadata_2025 huggingface dataset:
Socio-demographic and lifestyle determinants of the micronutrients status during pregnancy
Authors: Polanska K , Trafalska E , Hanke W , Wesolowska E , Jankowska A , Kaluzny P , Janasik B , Gromadzinska J , Wasowicz W , Calamandrei G
Published: November 2019

Micronutrients status during pregnancy is recognized as one of the environmental factors that can have an impact on maternal and children’s health. The study aims at evaluating sociodemographic, lifestyle, environmental, and pregnancy-related determinants of maternal micronutrients status during pregnancy.

The analysis was based on data from the Polish Mother and Child Cohort (REPRO_PL). During the second trimester of pregnancy, 1306 women filled in a modified version of the validated food frequency questionnaire (FFQ) based on which the intake of the following micronutrients was estimated: calcium, magnesium, zinc, copper, selenium, folate, vitamin D, vitamin A and vitamin E. In addition, copper, zinc and selenium levels were measured in the blood collected during the second trimester of pregnancy.

About 95% of the women took dietary supplements during pregnancy. Despite such supplementation in the case of a high proportion of the women the intake of majority of the analyzed micronutrients was below recommendations for the pregnancy period (based on the Estimated Average Requirement). The mean plasma zinc, copper and selenium concentrations were 0.9±0.3 mg/l, 2.0±0.6 mg/l and 48.4±10.5 ug/l, respectively. The chance to reach the recommended intake for vitamin A, vitamin D and selenium was higher among the multiparous women (OR = 1.53 p = 0.007; OR = 1.44 p = 0.02; OR = 1.48 p = 0.009) and for zinc among the women with a higher socio-economic status (SES) (OR = 1.43 p = 0.04). For other variables the results were not statistically significant. A higher selenium level in the plasma was observed among the older women (p = 0.01) and those with a higher SES (p = 0.03).

The current study presents evidence on specific factors influencing the micronutrients intake. They need to be accounted for in educational programs and interventions that focus on healthy diet recommendations during pregnancy.

Key messages

In the case of a high proportion of the women the intake of majority of the analyzed micronutrients was below recommendations for the pregnancy period. More effort should be taken to educational programs and interventions that focus on healthy diet recommendations during pregnancy.
Abriendo Futuros: An empowerment program for indigenous adolescent girls in Yucatán, Mexico
Authors: Romero F , Cicolella L , Larrea S , Domínguez D , Aponte A , Del Valle A , Hallman K , Vieitez I
Published: November 2019

Background

Abriendo Futuros is a a girl-centered empowerment program that engages community leaders and trains older indigenous girls as mentors to run community girls’ clubs, known as safe spaces. Mentors work directly with indigenous girls to deliver program curricula tailored to the girls’ specific and unique needs to builds girls’ assets in areas such as sexual and reproductive education, gender equality, violence prevention, leadership, financial education and healthy lifestyles.

Objectives

The program aims to improve critical health, social, and cognitive skills that help girls have a voice and choice in their lives and allows them to draw the path to a healthy adult life, overcoming the risks present in their context. The program was implemented in 8 rural communities in the south of Yucatan. A total of 657 girls were enrolled over the 18-month-implementation period (2015 - 2017).

Results

A quasi-experimental evaluation was implemented in 11 communities (8 intervention and three control). Preliminary findings, using the Propensity Score Matching technique, suggest significant positive effects on intermediate outcomes such as financial literacy, attitudes towards gender norms, sexual reproductive health knowledge, social capital, and perceived exposure to physical violence. No statistically significant results were achieved in main outcomes (reduce adolescent pregnancy and school dropout). We associate this, mainly to the fact that the intervention was only at an individual level, but also to the limited sample size and the brief observation period (18 months).

Conclusions

Girl-centered programming increases access to spaces where girls meet to expand their knowledge and social networks and build assets that reduce their risks and broadens their opportunities. However, further evidence is needed on multi-level and multisector girl-centered interventions to address teenage pregnancy and other complex issues.

Key messages

The program generates a social safety net among girls and mentors that is key to the well-being of girls. Girl-centered programs have positive effects on girĺs empowerment for girls who live in vulnerable situations and unequal social contexts.
How adolescents use an online question-answer (QA) service to address their mental issues
Authors: Sand K , Tøndel G , Lassemo E
Published: November 2019

Background

Ung.no is Norway’s largest information website directed at adolescents, with more than 800 000 users per month. Ung.no offers an online QA service in which 13-20-year-olds post their questions and get answers from professionals. Anonymous answers are publicly available online. Descriptive analysis of over 125 000 questions written to ung.no from 2016-2018 showed that most adolescents asked questions about body and health. Subsequent qualitative content analyses of the body-and-health-questions showed that mental health is one of the most prominent topics in the adolescents’ questions. The aim of the present study is to investigate how adolescents use the QA service to address mental issues.

Methods

A random selection of 360 questions - stratified by age and gender - concerning body and health were made. The questions were analysed by use of a qualitative thematic analysis with a functional textual approach, i.e. examining the questions’ linguistic functions.

Results

In the sample, 20 % of the questions concerned mental issues, ranging from negative feelings of sadness, fear or anger, to disorders such as psychosis and depression and grave issues such as suicidal thoughts and self-harm. Three main functions of the adolescents’ questions were identified: 1) Telling about their troubles for the first time; some of them did not ask a question in their post, they just described their feelings; 2) Asking what to do when nothing else has been of help and 3) Seeking confirmation of information they have already received from health experts, teachers, parents or friends, or read on the internet.

Conclusions

A low threshold service such as an anonymous QA service seems to be useful for adolescents when they need and want to tell about their mental issues or seek help, often for the first time. The outreach of the ung.no QA service is universal, and hence has great potential public health impact.

Key messages

Adolescents use a low threshold online QA service to address a wide range of mental problems. Adolescents use a low threshold online QA service to tell about their mental issues for the first time.
Employment and health of working parents: a joint effort to uncover hidden treasures in birth cohorts
Authors: Albin M , Bültmann U , Casas M , Lawlor D A , Lendzhova V , Leombruni R , Lissaker C , Lucas R , Maule M , Peters S , Polańska K , Sarac J , Selander J , Skroder H , Mehlum I S , Ubalde-Lopez M
Published: November 2019

Birth and child cohorts include a wealth of valuable and under-utilized data on employment and health of parents during pregnancy, at birth and often at one or more follow-up assessments.

OMEGA-NET is a EU COST Action aimed at creating a network to optimize the use of European occupational, industrial and population cohorts and to promote health research on occupation and employment. Within this network, Task Group 3.3 is exploring the possibility of exploiting birth cohort data to investigate the interplay between health, socio-economic conditions, working life and work participation of parents around and after the birth of their children, identify gaps in knowledge, and devise strategies to fill them.

Using a web-based database, www.birthcohorts.net, we have identified cohorts with occupational and health information in up to 200,000 parents. Out of 47 cohorts with information on mothers, maternal employment status and occupational exposures during pregnancy were recorded in 18 and 35 cohorts, respectively. For paternal exposures, the corresponding numbers were 6 and 15. To exploit these data, many challenges have to be overcome, primarily harmonization of exposures and outcomes. Cohorts cover different time periods and geographical regions, which can be at the same time a challenge and a blessing, providing hints on causal effects and mechanisms. Other strengths of pooling birth cohorts include the life-course nature of data and the possibility to investigate neglected occupationally-related exposures like work-family conflicts and their effects on health.

We argue that parental data collected in birth cohorts are a valuable under-exploited source of information that would allow cross-national comparisons of the relationships between work, career trajectories and health of young parents.

Key messages

Birth cohorts hide a treasure of occupational and health information of young working parents. OMEGA-NET has plans to dig them out to investigate their interplay.
Sickness absence and disability pension in relation to first childbirth: three cohorts in Sweden
Authors: Bjorkenstam C , Orellana C , Laszlo K , Svedberg P , Voss M , Lidwall U , Lindfors P , Alexanderson K
Published: November 2019

Background

Childbirth is suggested to be associated with elevated levels of sickness absence (SA) and disability pension (DP). However, knowledge about patterns of SA/DP before and after childbirth as compared to patterns among women who remain nulliparous is limited. We aimed to compare SA/DP across several periods among women with different childbirth status.

Methods

We analysed three population-based cohorts of all women aged 18-39 years who had not previously given birth and who lived in Sweden on 31 December 1994, 1999, or 2004, respectively. We compared crude and standardized annual mean SA and DP net days during three years preceding to three years after the date of first childbirth, among women having (1) their first and only birth during the subsequent three years, (2) their first birth and at least another delivery, and (3) no childbirths before, nor during the study period.

Results

Despite an increase in SA in the year preceding the first childbirth, women who gave birth, and especially women with multiple births, tended to have lower levels of SA/DP days throughout the years than women without childbirths. SA/DP days varied across age groups; young women (aged 18-24 years) without childbirths had fewer SA days, but more DP days than their same-aged counterparts who gave birth, regardless of year. These results did not differ across the three cohorts, suggesting that the results were not affected by period effects.

Conclusions

Women with more than one childbirth had fewer days of SA and DP, as compared to women with one childbirth and to women having no births. Thus, childbirth does not seem to be associated with higher levels of SA and DP. Some of these results can be due to a health selection into giving birth, especially having more births.

Key messages

Except for the year before delivery, i.e., when pregnant, women giving birth had fewer SA and DP days than women with no births. Thus, childbirth does not seem to be associated with higher SA and DP. Women who had more than one childbirth had less SA/DP days than those with one childbirth.
Factors associated with the use of non-pharmacological analgesia for labor pain management
Authors: Merrer J , Chantry A A , Khoshnood B , Blondel B , Le Ray C , Bonnet M P
Published: November 2019

Background

For a decade, pain labor management has evolved: if neuraxial analgesia remains the gold standard, non-pharmacological methods are developing. We aimed to identify individual and organizational factors associated with the use of non-pharmacological analgesia, combined or not with neuraxial analgesia.

Methods

Women who attempted vaginal delivery with labor analgesia were selected from the 13,147 participants of the 2016 National Perinatal Survey. Labor analgesia was studied as follows: neuraxial analgesia only (NA), non-pharmacological analgesia only (NPA) or neuraxial and non-pharmacological methods combined (NA+NPA). Associations between individual and organizational characteristics were studied using a multilevel multinomial logistic regression.

Results

Among the 9 231 women included, 62.4% had NA only, 6.5% had NPA only and 31.1% had NA+NPA. Both NPA and NA+NPA were associated with multiparity with antenatal classes, educational level ≥ 5 years post graduate, antenatal preference to deliver without NA, and delivery in public maternity units. The use of NPA only was positively associated with non-permanent availability of the anesthesiologist and with a high number of midwives per shift in maternity units. Contrastingly, NPA only was negatively associated with foreign nationality and oxytocin use for induction or augmentation of obstetrical labor. NA+NPA was positively associated with primiparity with antenatal classes, but negatively with inadequate prenatal care.

Conclusions

Less than 40% of parturients used non-pharmacological analgesia during labor and for the most of them as complementary methods to neuraxial analgesia. NPA and NA+NPA were associated with individual characteristics as well as characteristics of management of labor and organization of maternity units. Non-pharmacological analgesia appears to be dedicated to high educated and well-integrated women in perinatal health care system.

Key messages

Less than 40% of parturients used non-pharmacological analgesia during labor and for the most of them as complementary methods to neuraxial analgesia. Non-pharmacological analgesia appears to be dedicated to high educated and well-integrated women in perinatal health care system.
Umbilical cord care through community-based distribution of chlorhexidine in rural Sindh, Pakistan
Authors: Shah M , Jamali Q , Aisha F
Published: November 2019

Background

Unsafe practices such as cutting umbilical cord with unsterilized instruments and application of harmful substances, are in practice in many rural areas of Pakistan, and associated with high risk of neonatal sepsis and mortality.

Methods

We conducted an implementation research in 2015 in Tharparkar district, in Sindh province of Pakistan to understand the feasibility and acceptability of community-based distribution of chlorhexidine (CHX) in rural Pakistan. For this cohort group-only study, 225 lady health workers (LHWs) enrolled 495 pregnant women. Enrolled women received 4% CHX gel and user’s instructions for newborn cord care. The LHWs also counseled women on the benefits and correct use of CHX. Study enumerators collected data from CHX receiving women 3 times: at around 2 weeks before delivery, within 24 hours after delivery, and on the 8th day after delivery. We implemented this study jointly in collaboration with Ministry of Health in Sindh province, Pakistan.

Results

Among enrolled participants, 399 women (81%) received only the first visit, 295 women (60%) received first two visits and 261 women (53%) received all three visits by enumerators. Among 399 women, who received CHX gel, counseling on its use and were respondent to the first round data collection, 78% remembered that the CHX gel to be applied to cord stump and surrounding areas immediately after birth; but less than a third (29%) forgot the need to keep the cord clean and dry. Among 295 respondents in the first two rounds of data collection, who delivered at home, 97% applied CHX to cord stump on the first day.

Conclusions

Community-based CHX distribution by LHWs, along with counseling to recipient women, resulted in a high rate of cord care with CHX among newborn delivered at home. Results from this study may help program implementers to consider expanding this intervention for improving newborn cord care on the first day of life in Pakistan.

Key messages

Community-based distribution of chlorhexidine for newborn cord care appears as highly acceptable and feasible in rural communities in Pakistan. Relevant program policy supporting community-based CHX distribution along with counseling by LHW may help expanding coverage of newborn cord care in rural communities in Pakistan.
A vaccination campaign in a Roma community in Rome: an experience of the Local Health Autority Roma1
Authors: Spadea A , Marino M , Valentini F , Furia G , Frisicale E M , Michelazzo M B , Consoli C , Forte U , Bracci S , Goletti M
Published: November 2019

Issue/problem

About 8,000 Roma and Sinti live in the city of Rome, distributed in 33 settlements. This population is particularly at risk of health problems, due to social marginality and reduced access to health and social services. An important challenge for public health is therefore to guarantee and improve the right to health and the availability of health care. In Italy, a new vaccination law was approved in July 2017 and 10 vaccinations became mandatory for minors attending schools.

Description of the problem

In 2018 the District 14 of the Local Health Authority Rome1 (LHA Rome1) organized a vaccination campaign for the Roma and Sinti community being in its area. The aim of the campaign was to analyse the vaccination status of children under-18 living in the camp, based on the local police census data, crossed with the web based regional vaccination registry, to offer free vaccination for those without a regular status, in order to allow school attendance.

Results

Among 109 children living in the targeted Roma and Sinti camp, only 6 (5.5%) had a regular vaccination status according to the Italian law. Two different vaccination opportunity were offered to the community during 2018: a dedicated vaccination session in the local vaccination center, during which 6 children were vaccinated; four vaccination days offered directly at the Roma camp (a total of 53 children were vaccinated). At the end of 2018, the new Police census identified 114 minors resident in the camp instead of 109; of these, 48 (42.1%) had reached a regular vaccination status.

Lessons

Addressing hard-to-reach communities in order to improve the access to health and social services is one of the LHA objectives. The intervention performed in the Roma camp was also an opportunity to promote the importance of vaccination and to inform the target community about various LHA services, in particular maternal and infant services, including those for Temporarily Present Foreigners.

Key messages

The interventions performed straight into communities living in unfavorable health and social conditions are useful to improve the access to health and social services. Vaccination of people living in a social marginality is an important challenge for public health in order to guarantee specific protection measures and promoting the right to health.
What are the determinants of body image distortion and dissatisfaction among Tunisian teenagers?
Authors: Ben Ayed H , Jedidi J , Cheikhrouhou F , Ayadi A , Yaich S , Damak J
Published: November 2019

Background

Body image (BI) is considered as central to many aspects of human functioning including emotions, thoughts, behaviors and relationships. This study aimed to investigate the prevalence and the main determinants of distortion and dissatisfaction among teenagers.

Methods

This was a cross-sectional school-based study using a self-administered questionnaire, conducted among a randomized sample of 1300 school-adolescents in Southern Tunisia, 2018. BI perception was assessed by the Stunkard Figure Rating Scale.

Results

Among 1210 respondents (93%), BI distortion and dissatisfaction prevalence were 44.8% and 42.4%, respectively. Multivariate analysis showed that 16-18 years age group (Adjusted Odds Ratio (AOR)=1.28; p = 0.046), low family financial situation (AOR=1.88; p = 0.014), as well as high frequency of eating pasta (AOR=1.3;p=0.04) and fast-food consumption (AOR=1.7;p=0.042) were independently associated with under-estimated BI. Skipping breakfast (AOR=1.9; p = 0.017) and having one obese parent (AOR=1.9;p=0.01) were independently associated with higher frequency of over-estimated BI. For BI dissatisfaction, independent factors associated with desire to lose weight were female gender (AOR=1.53; p = 0.007), high family financial situation (AOR= 2.1,p=0.008) and having one parent obese (AOR=2.21,p<0.001). Frequent fast-food consumption (AOR=1.9, p = 0.038) and eating between meals (AOR=1.57,p=0.01) were associated with higher desire to gain weight.

Conclusions

Our study highlighted a substantially high prevalence of BI distortion and dissatisfaction among adolescents. Their determinants included socio-demographic factors and lifestyle behaviors. Increased awareness among parents and public health planners may help adolescents improve accuracy of BI attitudes.

Key messages

BI distortion and dissatisfaction are pervasive problems that increased negative affect in adolescents. Promotion of healthy lifestyle including balanced diet and physical activity is warranted.
Prevalence of Italian children living in food insecure households and their health status
Authors: Zace D , de Waure C , Teleman A , Reali L , Di Pietro M L
Published: November 2019

Background

Food insecurity poses a major threat to population’s health status. Children, if affected, are particularly vulnerable to the possible sequels of food insecurity. Considering that, we aimed to assess the prevalence of children (born in Italy, from Italian parents) living in food insecure households and the association with their health and socio-economic conditions.

Methods

The study was conducted from January 2017 to December 2018 in pediatric offices. Parents answered to the 18-items of the Household Food Security Index, 8 of which specifically concern children. Households were classified in 4 categories: very low, low, marginal and high food security, creating then a dichotomized variable (food secure and insecure). Pediatricians answered a dedicated questionnaire on children’s health status. We used logistic regression to assess the socio-economic variables predicting food insecurity and chi2 test to evaluate the association between food insecurity and children’s health status.

Results

Based on parents’ answers, among 573 households with children, 15.4% were food insecure. Food insecurity was associated to lower parent’s education and employment, worse household’s economic condition, higher number of children within a family and geographic location (living in south Italy rather than north). There was a significant association between food insecurity and the presence of visual, relational, psychomotor, dental and physical impairments in children.

Conclusions

Almost 1 Italian child in 7 lives in food insecure households. Children living in food insecure households have higher probability of having physical, mental and social health problems. Considering the impact on children’s health, food insecurity emerges as a public health issue and should be addressed through the appropriate measures.

Key messages

Food insecurity among children represents a public health issue even in a developed country such as Italy, affecting children’s present and future health. Policy makers should consider screening children for food insecurity and taking appropriate actions, especially for the at-risk population.
Association between maternal factors and appropriate medication for nursery school children in Japan
Authors: Yanagi N , Satoh H , Sawada Y
Published: November 2019

Background

Inappropriate medication use for children by caregivers has been reported in Japan. We focused on the factors which could be associated with health literacy (HL) and knowledge of medication (KM). We aimed to examine the association between appropriate use for nursery school children and maternal socioeconomic status (SES) or behavior related to medication adherence among mothers in Japan.

Methods

The data regarding the conditions of medication for children (aged from six months to six years old) at home and in nursery school by the online survey from April to May 2019 was used. Maternal SES, such as education, occupational status, and economic conditions, were asked via a self-administered questionnaire. Maternal behaviors were measured using a 5-point Likert scale and classified into two groups. HL and KM were scored and divided into two categories. Appropriate medication use was evaluated using a 5-point Likert scale for the statement “I give my child medicine as per instructions,” and the answers were classified into two groups. Poisson regression was employed to investigate the association. Age, maternal SES, chronic disease of children, birth order, HL, and KM were used as covariates.

Results

A total of 233 (38.8%) of 600 mothers aged 24-48 years, reported appropriate medication use for children. None of the maternal SES was statistically significant. After adjustment, the individuals, who consent to prescribed medications for children, were 2.16 times (95% confidence interval [CI]:1.64-2.86) more likely to use medicine appropriately compared with their counterparts. ’To be able to consult with pharmacists’ were also statistically significant (Prevalence Ratio=2.14, 95% CI:1.63-2.81).

Conclusions

The mothers, who consent to prescribed medications for children, who consult with pharmacists were more likely to use medicine appropriately. Community pharmacists could support those to improve their skills.

Key messages

The maternal behaviors related to adherence were associated with appropriate medication for children among Japanese mothers, although none of the maternal SES was statistically significant. Community pharmacists could support mothers and contribute appropriate medical treatment for children.
Environmental Health: Knowledge and Practice of Perinatal Health Professionals in Southern France
Authors: Sunyach C , Antonelli B , Tardieu S , Marcot M , Perrin J , Bretelle F
Published: November 2019

Background

The exposure of adults of reproductive age as well as of pregnant women and children to environmental contaminants is of particular concern, as it can impact fertility, in utero development, pregnancy outcomes and child health. Although worrying, this knowledge provides an opportunity to enforce interventions during these critical reproductive/developmental times, when they may have the greatest effect. Consequently, the World Health Organization (WHO) and international societies advocate including Environmental Health (EH) in perinatal care.

Objectives

Our aim was to paint a picture of the current attitudes, representation, knowledge, and training expectations among Perinatal Health Professionals in south-eastern France.

Results

In 2017, a cross-sectional study was performed in a large panel of perinatal HPs. Quantitative and qualitative information was collected via auto-questionnaire. Questionnaires were completed by 962 participants, mainly midwives (41.1%), physicians (25.6%) and nursery nurses (11%). Indoor/outdoor air quality and endocrine disruptors were the best-mastered topics, whereas electromagnetic fields and diet gave rise to unsure responses. Overall, perinatal HPs were ill-trained and -informed about the reproductive risks linked to daily environmental exposure. HPs reported scarce knowledge, fear of patient reaction and lack of solutions as the main barriers to providing information regarding EH to the public.

Conclusions

In South-eastern France perinatal Health Professionals are eager to incorporate EH in their current practice. Our findings highlight the need to set up EH training programs focused on scientific knowledge and to provide simple messages and tips to help perinatal HPs deliver advice to populations to mitigate exposure to environmental toxicants.

Key messages

In South-eastern France perinatal Health Professionals are eager to incorporate EH in their current practice but ask for training. We are currently providing training programs combining practical sessions as well as basic and advanced scientific training adapted to the demand of medical and non-medical professional groups.
Surveillance of transient congenital hypothyroidism using the French newborn screening programme
Authors: Barry Y , Mandereau-Bruno L , Bonaldi C , Guseva-Canu I , Delmas D , Cheillan D , Roussey M , Coutant R , Léger J , Regnault N
Published: November 2019

Introduction

Congenital hypothyroidism (CH) is a condition of thyroid hormone deficiency present at birth. Untreated CH results in severe mental impairment. An increased incidence of CH has been reported in France and worldwide that could be explained by an increase in transient forms of CH (TCH). We aimed to estimate the proportion of transient eutopic gland based on the characteristics of children at birth.

Methods

A probabilistic matching data from French CH neonatal screening program and French national health data system (SNDS) of children born between 2006 and 2012 (1, 763 with CH) allowed to linking 484 (68.8%) among 703 children with eutopic gland. Infants with six months or greater discontinuation of levothyroxine (LT4) treatment before the 31th December 2017 were classified transient CH. We used the Cox model to examine the predictors of TCH.

Results

Among infants with eutopic gland, 52.9% were female, 14.9% were preterm and 14, 1 % had low birth weight, 11.8 % had a first degree family history of thyroid diseases, 48.1% of mild CH (TSH<50mU/L) at diagnosis and 30,0μg/j median dose of LT4 treatment. The probability of transient CH at five years of follow-up was 25.3% [IC95%:21.6% -29.4%] and 36.7% [31.7% -42.2%] after ten years. In a cox multivariable analysis, neonates with a TSH<50mU/L (adjusted Hazard Ratio=4.1 [2.8-6.2]) and preterm 1.9 [1.1-3.4] had more risk to be transient.

Conclusions

Prematurity and TSH level were predictors of transient CH. Additional analyses are ongoing to determine whether the occurrence of transient forms of TCH is increasing over the study period.

Key messages

Transient congenital hypothyroidism represent a significant part of HC at 10 years of follow-up. This finding has important implication on medical practices and should trigger research on the etiology of these transient forms.
VBAC or not VBAC? Improvement of performance and outcome indexes with the promotion of care safety
Authors: Nasi G , Parrocchia S , Mastromatteo A M , Triggiani A , Miraglia B A , Ferrazzani S , Moscato U , Metastasio P , Piscicelli C , Distefano F A
Published: November 2019

Background

In a multidisciplinary approach to Quality Management System and humanization of care, we aimed at evaluating the characteristics that influence the request of women to carry out Vaginal Birth after Cesarean (VBAC).

Methods

Skills have been improved, with the use of tests on dummies and case by case assessments. For the psychological-motivational study we have adopted: Informed consent, Semi-structured interview and Big Five Questionnaire. The women were recruited by both Gemelli and Cristo Re Hospital: the women following the counseling decided to undergo a second Caesarean Section (CS) (41, control group) and women who decided to complete a VBAC (22, experimental group).

Results

The analysis of the data shows that the women of the VBAC group are in the average between 31-35 years (57%), 80% has an education = or > at the 3rd level and the choice of the VBAC was conditioned by the partner (64%). The women of the control group are in average > 35 years (51%), 60% have a higher average education and the influence on the choice is oriented by the gynecologist/obstetrician (64%). From the personality test a statistically significant difference emerges between the dimensions Energy and Mental Opening. Past experience influences the choice of the next birth: women who are inclined to a second CS considered the previous CS as a positive event (66%) while only 36% in the VBAC group; 64% of this was the recovery of the painful post-surgery and a certain type of difficulty in the care of the child, in breastfeeding, of having suffered from post-partum mood alterations, which is why they chose to undertake a Trial of Labor After Cesarean.

Conclusions

The deeper knowledge of women as well as the preparation and safety of the same operators has shown that it is possible to perform a greater number of VBACs, with the sharing, participation and satisfaction of women and the entire team, leading to an improvement in outcomes and performance indexes.

Key messages

The promotion of care safety also improves the performance indexes through continuous training to the operators and the study of psychological aspects that lead to the choice to carry out a VBAC. Good Clinical Practice shown that it is possible to perform a greater number of VBACs, with the sharing, participation and satisfaction of women and the entire team.
Potential effective elements in combined lifestyle interventions for overweight children
Authors: Saat J J E H , Fransen G A J , Naumann E , van der Velden K , Assendelft W J J
Published: November 2019

Background

Combined Lifestyle Interventions (CLIs), offered in primary care, aim to prevent childhood overweight/obesity. Combined means the intervention focuses on optimalising nutrition behaviour, physical activity and mental health, provided by a multidisciplinary team. Although the effectiveness of CLIs is still not clear, CLIs are already implemented in daily practice in the Netherlands. These CLIs are not uniformly designed and have variations in protocols to suit the needs of their community. Due to the many different CLIs it is difficult to investigate their effectiveness. To be able to investigate effectiveness of GLIs, we first need to unravel the ’black boxes’ of CLIs and identify their (potential) effective elements.

Methods

First, we carried out a literature study on elements that may contribute to the effectiveness of a GLI (the so called potential elements). Next, we organized an online brainstorm session, where experts such as researchers and paramedics could add or specify potential elements. We made all elements measurable, with help of experts. These elements were incorporated into a tool to check presence of potential elements in CLIs. This tool was tested on reliability by comparing the results of four researchers who assessed protocols of six CLIs.

Results

42 experts participated in the brainstorm session. The literature study and brainstorm session together resulted in 54 potential elements for CLIs for overweight/obese children, categorized in four themes: organization, content, role of parents and role of experts. For all six protocols, a minimum of 85% of the potential elements in the tool have been scored the same by the four assessors.

Conclusions

We developed a reliable tool to determine potential effective elements in a CLI. In future studies, this tool can be used to identify specific elements that are effective in CLIs for overweight/obese children by comparing the tool with health effects of CLIs.

Key messages

We were able to develop a reliable instrument to better analyze the factors that contribute to positive health effects of combined lifestyle interventions for children with overweight or obesity. the developed tool with potential effective elements must be filled in for more CLIs, where after we can find corresponding elements in the most effective CLIs.
School bullying among Tunisian adolescents: prevalence and psychosocial outcomes
Authors: Sahli J , Limam M , Mellouli M , El Ghardallou M , Ajmi T , Zedini C , Mtiraoui A
Published: November 2019

Background

Bullying is a serious public health concern affecting the emotional well-being of pupils. We conducted this study to examine the prevalence of bullying, its psychosocial associated factors and the perceived involvement of parents, teachers, and classmates to counteract this behavior.

Methods

This is a cross-sectional study conducted in 2015 among a representative sample of pupils enrolled in 14 colleges in Sousse using the revised Olweus Bully/Victim Questionnaire.

Results

We included 1584 students aged between 11 and 15 years. The prevalence of bullying and victimization was 16.0% [95% CI: 14.2%, 17.8%] and 11.3% [95% CI: 9.7%, 12.9%] respectively. Four groups of students were identified, 11.7% were classified as pure victims, 7.8% as pure bullies, 3.2% as bully-victims and 75.5% as bystanders. Compared to other groups, the bully-victims were less likely to report a feeling of empathy (38.3%, p < 10-3) and liking school (30.0%, p < 10-3). They were more likely to be aggressive (56.2%, p < 10-3) and disintegrated in the class (30.6%, p = 0.002). Among the victims, 11.1% reported that their parents contacted the school several times to stop their victimization. The majority of the middle school students perceived that their classmates (54.1%) and teachers (39.5%) did nothing to counteract the bullying behavior.

Conclusions

The school institution is expected to be for pupils a highly meaningful space for social, emotional and academic development. Parents, teachers and students should learn effective ways to handle the bullying problem since it has been emphasized that the most effective programs are comprehensive targeting students, schools, families, and the community.

Key messages

This is the first study conducted in Tunisia to highlight the extent of school bullying. Our findings can help to raise awareness of parents, school staff and policy makers about bullying.
Analysis of coordinating capacities in schools of grades 10 and 11 in a public school of Bogotá
Authors: Morales Eraso N , Riveros Medina M , Gutiérrez Galvis A , Alvarado Melo J , Rubiano Espinosa O , Acosta Rodríguez E , Melo Moreno C
Published: November 2019

Studies that address the problem of excess weight and inactive behaviors such as television and video games in children and adolescents have focused on chronic noncommunicable diseases, with few studies about the effects of sedentary lifestyle on coordination capacities (balance, precision and movement capacity).

The objective of the study is to analyze the coordinative capacities in school children of grades 10 and 11 in a public school in Bogotá. This analytical cross-sectional study was conducted on 63 schoolchildren (30 men and 33 women) with an average age of 16.24 ± 0.689. The motor quotient was evaluated by means of the KTK test with the authorization of the institutional ethics committee, assent signature and informed consent. Descriptive statistics were obtained (mean SD frequencies, percentages). Data were tested using Kolmogorov-Smirnov test and independent t-test was applied to measure the significant difference among the variables. P-value less than 0.05 was considered a significant difference.

The motor quotient showed the following qualifications: symptomatic 11.1% (n = 7), normal 58.7% (n = 37) and good 30.2% (n = 19). Statistically significant differences (p < 0,05) were found in the motor quotient between boys (37,048) and girls (34,374), with girls being mainly in the symptomatic category. It can be concluded that girls need to increase motor experiences to improve their coordinative abilities. The importance of this study consisted in the possibility of identifying the effects of sedentarism on coordination capacities, as well as the impact produced by the current government by reducing hours of physical education in schools, leading to an increase in sedentarism. For this reason, it is essential to develop research aimed at stimulating coordination capacities in schoolchildren as a strategy to reduce public health problems.

Key messages

For this reason, it is essential to develop research aimed at stimulating coordination capacities in schoolchildren as a strategy to reduce public health problems. Promotion of public policy as a Determining factor in the reduction of sedentarism in children, through Strategies that include assessment of Coordinating Capacities of schoolchildren.
Mortality trends for multiple sclerosis in Italy
Authors: Gori F , Kundisova L , Bezzini D , Martini A , Giovannetti L , Chellini E , Nante N , Messina G , Battaglia M A
Published: November 2019

Background

Multiple sclerosis (MS) is the immune-mediated inflammatory disease affecting myelinated axons of the central nervous system with enormous socio-economic impact. The aim of this study was to analyze mortality trends for MS in Italy.

Methods

The mortality data relative to period 1980-2015 were provided by Italian Institute of Statistics, data were aggregated in 5 intervals (1980-1986; 1987-1993; 1994-2000; 2001-2008; 2008-2015). The Age-Standardized mortality Rates (SR) with respective 95% confidence intervals (95%CI) were calculated (using the European standard 2013) in order to evaluate the mortality trends (in confrontation to the initial period) and Standardized Mortality Ratios (SMR), in order to confront mortality in 5 major geographic areas: North-East (NE), North-West (NW), Central Italy (CI), South Italy (SI) and Islands (I).

Results

During the study period 4959 deaths for males and 7433 for females were observed. The SRs were significantly higher for females (0.71;95%CI:0.70-0.73 vs. 0.56; 95%CI:0.54-0.57).

Significantly higher SMR were observed for both sexes in I (M:123.3 vs F:112.7), for females also in NE (106.5) and NW (115.8). Significantly lower SMR for both sexes were observed in SI (M:88.8; F:71.4) and for males in CI (90.9).

The observed SRs during the five intervals for males were: 0.65(95%CI 0.60-0.69); 0.52 (95%CI 0.49-0.56); 0.46 (95%CI 0.43-0.49); 0.53 (95%CI 0.49-0.56); 0.59 (95%CI 0.56-0.62); and for females: 0.69 (0.65-0.73); 0.69 (0.65-0.73); 0.61 (0.58-0.65); 0.68 (0.65-0.72); 0.81(0.77-0.84); respectively. An initial decrease of SRs was observed for males until 2001-2007 in confrontation to the initial period (p < 0.05). For females significant increase of SRs was observed in 2008-2015 (p < 0.05).

Conclusions

An increase of mortality for MS, observed for females, especially after 2000 may reflect the raising prevalence of MS in Italy. Important geographical differences were observed for five main areas.

Key messages

During the study period an increase of mortality for MS was observed for females. Important differences were observed between five main Italian geographic areas.
Mortality inequalities from major causes of death in Lithuania by education during 2001-2014
Authors: Meščeriakova-Veliulienė O , Kalėdienė R , Sauliūnė S , Kaselienė S
Published: November 2019

Background

The aim of the study was to evaluate mortality inequalities from major causes of death by education in Lithuania during 2001-2014.

Methods

Information on deaths (aged 30+) from cardiovascular diseases (ICD-10 codes I00-I99), cancer (ICD-10 codes C00-C97), external causes (ICD-10 codes V01-Y98), and digestive system diseases (ICD-10 codes K00-K93) was obtained from Statistics Lithuania. Mortality rates from these causes were calculated by the level of education (high (post-secondary non-tertiary, tertiary) and low (unknown, preprimary or no education, primary, lower secondary, upper secondary)) per 100,000 person-years. For the assessment of mortality trends during 2001-2014, the Joinpoint regression analysis was applied.

Results

During the analyzed period, mortality from all major causes was higher in the lower educational group (p < 0.05). The most prominent differences in mortality rates between educational groups were found from external causes and cardiovascular diseases. Mortality from cardiovascular diseases (by 2.22% per year), cancer (by 1.87% per year) and particularly from external causes (by 5.2% per year) declined in higher educational group (p < 0.05). In the lower educational groups mortality declined only from cardiovascular diseases (by 0.73% per year), however mortality increased from cancer (by 0.64% per year) and digestion system diseases (by 5.20% per year) (p < 0.05).

Conclusions

Mortality from major causes of death in both educational groups changed unevenly during 2001-2014. In higher educational group mortality declined from cardiovascular diseases, cancer, and especially from external causes, while in lower educational group - just from cardiovascular diseases.

Key messages

In Lithuania, there are still significant inequalities in mortality from the major causes of death by education. Therefore, more attention should be paid for the improvement of the health of the population with lower education.
Improving participation of detained men in organised screening of colorectal cancer in Toulon
Authors: Porte M , Harmel M D , Pernice L , Misserey M , Adam C , Sondey J , Pallier L
Published: November 2019

In France, organised screening for colorectal cancer was set up in 2008. Participation rate was assessed in March 2014 at the prison of Toulon / La Farlède. On the 100 detained men aged 50-74 years old concerned by screening, only 3.9 % were screened. A project aiming at improving participation in screening while addressing specific difficulties related to prison settings (lack of privacy in cells, low socioeconomic and education status of the population, stronger exposition to risk factors for colorectal cancer) was launched in 2015 and has been yearly conducted since then.

How to improve colorectal cancer screening in a prison setting? How to organise a sustainable screening program? What proximity guidance should be provided to foster participation?

The program that was developed mainly consisted in awareness sessions and proximity guidance to testing. Among the 330 detained men targeted between 2015 and 2018, 165 men performed an immunologic test (57.9%) and 45 were excluded for medical reasons. Colonoscopy was performed for 10 of the 13 men with a positive result and lesions were detected for 9 men. Among them, one cancer, 6 high-risk polyps and 2 low-risk polyps were found. Those findings exceeded expected numbers.

Despite a small population sample, data revealed the benefit of the project in comparison with other participation rates: only 33.5% in France and 29.3% in the Var department (estimates for 2016-17 by Santé Publique France). Furthermore, we achieved a participation rate compliant with European recommendations establishing 45% as a minimum target.

The success of our program relied on the synergy between health prevention professionals screening organisers and prison medical staff. Strong involvement of each team constituted a real leverage for project to ensure effective proximity guidance for detained persons leading them to get screened.

Key messages

Awareness program adapted to prison improved participation in colorectal cancer organised screening. Proximity guidance helped to detect cancer and to improve medical care of detained persons.