bluuebunny/crossref_metadata_2025 huggingface dataset:
Children with weakness in grammar understanding have weakness in visuospatial abilities
Authors: Kiselev S
Published: October 2020

Objectives

Weakness in grammar understanding is key feature of children with specific language impairments (SLI). The goal of this research was to check out the hypothesis that children with weakness in grammar understanding have also weakness in visuospatial abilities.

Methods

The children were assessed with the task 'Comprehension of grammatical structures' from Luria's neuropsychological assessment for children. Experimental group included 27 children with weakness in grammar understanding. The control group included 27 children with typical grammar understanding. The children from experimental and control group were matched for IQ, gender and age. To assess the visuospatial abilities in children we used two tasks from Luria's neuropsychological assessment battery (Constructional Praxis and Head Test) as well as the Rey-Osterrieth Complex Figure test.

Results

One-way ANOVAs by group revealed significant differences (p ≤ 0,05) between the groups for scores in all visuospatial tasks. It can be assumed that children with weakness in grammar understanding have also weakness in visuospatial functions. We also revealed significant differences (p ≤ 0,05) between the groups for number of spatial errors in the Rey-Osterieth Complex Figure test.

Conclusions

This study suggests that children with weakness in grammar understanding have also weakness in visuospatial abilities. Received results provided insight into cognitive and language mechanisms in typically developing children and the underlying nature of SLI, helping to elucidate the nature of impaired mechanism in children with weakness in grammar understanding.

Key messages

Children with weakness in grammar understanding have weakness in visuospatial abilities. It is possible that children with specific language impairments have deficit in nonverbal abilities.
The EVITA evidence action tool to improve evidence-based policymaking for public mental health
Authors: Votruba N , Grant J , Thornicroft G
Published: October 2020

The estimated global disease burden of mental illness is 32.4% of years lived with disability. Mental health is a critical determinant for public health, and government-level action is needed for integration of mental health into public health. But in many low/middle-income countries (LMICs) mental health is absent on the policy agenda, despite up to 90% of people with mental illness lacking treatment. Evidence on cost-effective treatments is available, but translation of research into policy is a 'wicked' problem and often fails. We investigate the inter-relationships of research evidence and mental health policymaking in LMICs and present a framework/advocacy tool to guide and support evidence-based public mental health policymaking.

Using a mixed-methods approach, we conducted a systematic review, based on which we developed a provisional framework (EVITA), revised and validated it through expert in-depth interviews. We then empirically tested the EVITA framework against three case studies (provincial, national, global level, South Africa). We collected qualitative data through expert interviews/documentary analysis, coded and analysed the data in NVivo, and finalised the framework and action tool.

We identified agenda-setting as a research theory gap in the context of mental health knowledge translation in LMICs. Thus we developed the EVITA framework for evidence-based mental health policy agenda-setting, and validated it against empirical case studies. Our findings suggest that behavioural methods can support interventions to improve research uptake.

The EVITA action tool has been theoretically and empirically validated, and includes policy agenda-setting and behavioural methods as a novel, effective mechanisms for improving evidence-based policymaking in public mental health. EVITA has the potential to improve the challenging process of research evidence translation into policy/practice in LMICs, and may be applicable to other neglected health areas/countries.

Key messages

The new validated EVITA framework uses agenda-setting and behavioural methods to improve knowledge exchange for better evidence-informed, potentially more effective, public mental health policymaking. The EVITA action tool helps researchers, policymakers & others to strategically take action for public mental health agenda-setting and advocacy interventions for evidence-based policymaking in LMICs.
Autism spectrum disorders – challenges and perspectives
Authors: Tzvetkova S , Tsvetanova K , Karcheva M
Published: October 2020

Background

According the latest data of ADDM in USA one from 59 children is identified with autism spectrum disorder (ASD). ADDM assessments of ASD frequency among children aged 8 years show that this disorder cases increased more than twice in 2012 (1:150) compared with 2002 (1:68). The survey in compliance with ASDEU program comprising 14 European countries shows ratio 1:89 among children aged 7-9 years.

Methods

The following methods were applied: documental (national and regional reports); C.L.A.S.S. -instrument assessing the social communication; IDC and DSM; descriptive and qualitative analysis; anamnestic data and observations. Results of a total 20 cases ranging from 2 yrs. 3 months to 4 yrs. 6 months are commented. The principles of confidentiality, correctness and professionalism were observed.

Results

Common features like disorders in social relations, communication, stereotype behavioral models were found among the surveyed children, as well as some specific features - adoring water 15 (75%), hyperactive 11 (55%), auto-aggressive 5 (25%), fearless in 17 (85%), lack of mutual game in 20 (100%), appearance of “synthetic language” in 6 (30%), cognitive disorders in 20 (100%). Challenges: No academic specialists for ASD therapy are trained in Bulgaria. Frequently the parents look for assistance late. Healthcare handbook - from diagnosis to the complex care, is not created yet. Perspectives: ASD items are already discussed in the sphere of human and medical education. In the sphere not reimbursed by the state function more and more NGO which offer paid social and special services and CSRI provide these services for free.

Conclusions

There is a change from a medical to a social model. In Bulgaria the early diagnostics, early intervention and provision of well-trained professionals are not developed sufficiently well. The increased number of disorders requires fast and adequate reaction.

Key messages

Autism Spectrum Disorders, Bulgaria. Challenges, perspectives.
Positioning work-related stress – General practitioners’ reasoning about a brief intervention
Authors: Hultén A-M , Dahlin-Ivanoff S , Holmgren K
Published: October 2020

Background

General practitioners (GP) can find it difficult to early detect and treat ill health due to work-related stress. In a randomized controlled trial, a brief early intervention using the work stress questionnaire (WSQ) combined with feedback at consultation was tested to reduce sick leave. This study explored GPs' reasoning about using the intervention.

Methods

A focus group study was performed with 23 GPs at six primary health care centers, each constituting one focus group. The discussions, lasting between 30-45 minutes, were analyses based on a method by Krueger.

Results

The GPs positioned work-related stress by making fundamental standpoints on stress and how it should be handled, in order to make sense of their work concerning work-related stress. In addition, they acted to the best of their ability with assigned resources to treat patients with ill health due to stress. Further, the GPs set their regular and preferred way of practicing daily work against the intervention's degree of intrusion and benefits. When the resources and daily work changed, the GPs formed a revised understanding of stress and how it should be handled.

Conclusions

The GPs found their ordinary way of working to be sufficient for early identification and treatment of patients with ill health due to work-related stress. However, when resources were scarce, the responsibility to handle these patients was questioned. Competence and interprofessional collaboration are therefore needed to early identify and treat ill health due to work-related stress. In addition, the GPs' responsibility in relation to other actors must be clarified.

Key messages

The primary health care’s role for patients perceiving work-related stress was not given. The GPs’ confidence in addressing ill health due to work-related stress depended on assigned resources.
Reliability and validity of ecological literacy scale for primary school students
Authors: Öcal E E , Önsüz M F
Published: October 2020

Background

Ecological literacy aims to build up a framework of view that identifies the association with nature and enhances the improvement of new areas to produce sustainable lifestyles. Today, this concept has become one of the important requirements for a sustainable community. The aim of the study was to develop the Ecological Literacy Scale (ELS) to determine the ecological literacy of primary school students.

Methods

This methodological study carried out in 233 primary school 4th grade students in an eco-school in the 2019-2020 academic year. By using literature 91 questions was collected including water, energy, transport and air, biodiversity, purchasing and waste topics which were main issues of ecological footprint. After taking expert opinions, a scale that consists of 32 questions and scored as I agree:3, undecided:2, I disagree:1 and was created named ELS. In order to evaluate the reliability of the scale, item total score correlation and internal consistency (Cronbach's alpha) analyzes and exploratory factor analysis was used for construct validity.

Results

Of the 52.8% students were male and their age ranges from 8-11, the mean was 9.5±0.6. After the scale development study, the scale consisted of 19 items and unidimension. Scale items explain 27.37% of total variance and factor loadings ranged from 0.42-0.64. The Cronbach's alpha coefficient was 0.846 for the scale. In the last form of the scale, the score that can be taken from scale range 19-57. It was accepted that by increasing of the score, ecological literacy level was increased. The mean score of the students was 51.73 ± 5.39 and the median was 53.0.

Conclusions

Ecological literacy could be considered as high level for primary school students in eco-school. ELS was found to be a valid-reliable tool for assesing ecological literacy in primary school students.

Key messages

Ecological literacy is an issue that students should be informed from the primary school period. In the literature, ELS seems the first scale about ecological literacy for primary school students and needs to be tested in large groups of students.
Sleep difficulties and alcohol use behaviors in adolescents and young adults: a systematic review
Authors: Hussain J , Ling L , Stranges S , Anderson K K
Published: October 2020

Background

Sleep disturbances and substance abuse are prevalent in adolescents, often associated with adverse behavioral outcomes and daytime dysfunction. While sleep problems are often seen as consequences to alcohol use, they are risk factors for alcohol misuse and related consequences. However, current evidence in adolescents and young adults (AYA) is mostly observational and is not well-documented in recent years. This systematic review aims to assess the literature surrounding sleep difficulties and their effects on subsequent alcohol misuse in AYA.

Methods

Medline, PsycINFO, and EMBASE were searched for observational studies assessing alcohol consumption, alcohol-related consequences, and self-reported sleep difficulties in AYA aged 16-25. Studies with clinical samples and randomized trials were excluded. Data on measurement tools, measures of association, and sample characteristics were recorded using a standardized form. Associations between sleep difficulties and alcohol misuse were qualitatively summarized by study type (cross-sectional and longitudinal studies). Risk of bias was assessed using CLARITY tools.

Results

Of 7706 records retrieved from databases, 24 studies met the inclusion criteria. Cross-sectional studies (n = 17) found insomnia-like symptoms (difficulties falling/staying asleep, frequent night-time awakenings) were significantly associated with alcohol use frequency and intensity (n = 16) and subsequent intoxication (n = 6). Among longitudinal studies (n = 7), persistent erratic sleep behaviors at baseline were associated with frequent binge-drinking (n = 2) and increased odds of interpersonal problems (n = 2) and risky behaviors at follow-up (n = 1).

Conclusions

The present review assesses the role of sleep difficulties in alcohol use behaviors and related consequences in AYA. Sleep inadequacies are involved in alcohol misuse, prompting investigations to clarify sleep's etiological role in alcohol use behaviors to prevent negative consequences in AYA.

Key messages

Sleep disturbances need to be investigated further as possible risk factors for incident alcohol misuse in young adults. Addressing sleep hygiene and promoting healthy sleep behaviors are important in evaluating the overarching public health issue of alcohol addiction and misuse in adolescents.
Life-style and occupational risk factors for early onset dementia in an Italian community
Authors: Adani G , Filippini T , Garuti C , Malavolti M , Vinceti G , Zamboni G , Tondelli M , Vinceti M , Chiari A
Published: October 2020

Background

Early onset dementia (EOD) is defined as dementia with symptoms onset before 65 years, deeply impacting on patients' employment and income, as well as on their families. Little is known about role of occupational and life-style risk factors, we aimed at assessing their role in disease etiology.

Methods

Using a case-control study design, we recruited all EOD cases resident in Modena province from October, 2016 to October, 2019, and a referent population drawn from patients' care-givers. We investigated residential, life-style history, and occupational and environmental exposures to toxics through a self-administered questionnaire. We used a multivariate unconditional logistic regression model adjusted for sex, age, and education to calculate odds ratios (ORs) and 95% confidence intervals (CIs) of EOD risk for exposed vs. non-exposed subjects.

Results

Overall, fifty-eight EOD cases and fifty-four controls agreed to participate. Possible life-style risk factors are to be widowed (10.3% of cases vs. 2% of controls), and to have a lower educational attainment. Also smoking (OR 1.3, 95% CI 0.6-2.9), playing football (OR 2.2, 95% CI 0.5-9.3) or cycling (OR 2.3, 95% CI 0.4-13.4) were associated with higher EOD risk, although overall sport practice appeared to be a powerful protective factor (OR 0.4, 95% CI 0.2-0.9), particularly swimming (OR 0.2, 95% CI 0.0-0.8). Among occupational factors, disease risk was associated with exposure to aluminum (OR 2.6, 95% CI 0.4-15.7), pesticides (OR 2.3, 95% CI 0.7-7.8), and dyes, paints or thinners (OR 1.7, 95% CI 0.6-5.0). Finally, disease risk was not associate to overall history of any trauma, while head trauma and especially upper arm trauma showed positive association.

Conclusions

Despite the study limitations, our results appear to support a role of modifiable risk factors in EOD etiology, particularly of some chemical exposures and professional sports, while overall sports practice may have a beneficial effect.

Key messages

Some modifiable environmental, occupational and life-style risk factors seem associated with EOD onset. Awareness of EOD environmental and occupational risk factors, as well as life-style ones, is advisable on a public health perspective.
Burnout among preschool teachers in Serbia
Authors: Terzic-Supic Z , Piperac P , Maksimovic A , Karic S , Hacko B , Todorovic J
Published: October 2020

Background

Pedagogical work has been one of the most stressful professions, especially work with pre-school children. Working with each age group has particular challenges, in which educators participate in the development of healthy lifestyles in children, their physical activity habits and their identity as social beings. The incidence of stress-related illnesses is more common among teachers than in the general population. The aim of this study was to examine the prevalence of burnout syndrome among preschool teachers in Serbia and factors associated with it.

Methods

The cross-sectional study was conducted between October 2018 and April 2019 and included National representative sample of 482 pre-school teachers in Serbia. The study instrument consisted of four sections: the socio-demographic, lifestyle and workplace characteristics; Copenhagen Burnout inventory; Beck Depression Inventory, and Zung Anxiety Scale.

Results

The average score on total burnout was 39.1±17.0, while the average score per scales on Copenhagen burnout inventory were: 41.3±18.7 for personal burnout, 41.2±15.9 for work-related burnout and 34.7±22.0 for client related burnout. The frequency of total burnout was 27.1%. Multivariate logistic regression analysis with total burnout as an outcome variable showed that being singe (OR: 0.18, 95% CI: 0.05-0.58), having poor (OR: 6.05, 95% CI: 1.05-34.91), or average (OR: 3.60, 95% CI: 1.57-8.25) self-rated health, not having didactic tools (OR: 2.71, 95% CI: 1.21-6.04), having higher score on Beck depression inventory (OR: 1.19, 95% CI: 1.09-1.29) or Zung anxiety scale (OR: 1.10, 95% CI: 1.03-1.18) was significantly associated with total burnout among our participants.

Conclusions

Our study showed the worryingly high prevalence of burnout among preschool teachers in Serbia. The results indicate its association with mental health problems, depression and anxiety, and yield for preventive action.

Key messages

There is a worryingly high prevalence of burnout among preschool teachers in Serbia. Total burnout was associated with mental health problems.
Anxiety among the Medical students at five Universities in Serbia
Authors: Terzic-Supic Z , Todorovic J , Divjak J , Kocic S , Radovic S , Ukropina S , Mijatovic-Jovanovic V , Mirkovic M
Published: October 2020

Background

Medical education is both academically and emotionally demanding. The demands of medical school can influence the development of anxiety among medical students. The aim of this study was to assess the prevalence of anxiety and factors associated with it among the fifth year medical students at the five universities in Serbia.

Methods

The cross-sectional study was conducted during December of 2019 and included a total of 493 students at the five Universities in Serbia (Belgrade, Novi Sad, Kragujevac, Nis, and Kosovska Mitrovica). The questionnaire used was developed based on the questionnaires from similar research and included the sections on social characteristics, lifestyle characteristics, study engagement, Beck depression inventory, Copenhagen burnout inventory, and Zung anxiety scale. Based on the score on Zung anxiety scale students were classified in two groups: with anxiety (scores ≥45) and without anxiety (scores 20-44).

Results

The mean Zung anxiety scale score was 35.39±8.31 (minimum=20, maximum=69). A total of 64/493 students (13%) was in the group with anxiety. The multivariate logistic regression analysis with the anxiety as an outcome variable showed that anxiety was associated with female sex (OR: 4.20, 95% CI: 1.41-12.50), higher scores on Beck depression inventory (OR: 1.18, 95% CI: 1.12-1.26), and total burnout (OR: 3.98, 95% CI: 1.66-9.54).

Conclusions

This study shows that students with anxiety have a higher likelihood of higher scores on Beck depression inventory and a higher likelihood of having burnout syndrome. The clustering of mental health problems, along with the high prevalence of anxiety among medical students is alarming.

Key messages

One in eight medical students in Serbia has scores on Zung anxiety scale indicative of at least mild anxiety. The anxiety was associated with female gender, higher score on Beck depression inventory and total burnout.
Evidence of content validity on the mental health care needs scale
Authors: Mendonca J M T , Freire A A , Rewa T , Zorzi D , Monteiro C N , Teles A , Paresque M A C , Oliveira I E , Bonfim D , Rebustini F
Published: October 2020

Background

The gap in care for psychological distress has been one of the greatest challenges for health systems. Stepped care models represent attempts to maximize the effectiveness and efficiency of decisions about resource allocation in therapy. In Brazil, there are no tools that support this process. The Hospital Israelita Albert Einstein executes the project entitled PlanificaSUS to organize the health care network and strengthen PHC. We aimed to develop and search for evidence of Content validity on the Mental Health Care Needs Stratification Scale.

Methods

The latent variable is the need for mental health care. The 130 items considered the literature and 73 experts' opinion. The items were categorized into six dimensions referred by users (social, autonomy, functionality, interpersonal relationship, spirituality, and clinical history) and a dimension evaluated by the professional (clinic). The invitation was made by the snowball method. Content validity was based on clarity, relevance, and semantics, and calculated by Content Validity Ratio (CVR), considering a critical CVR value> 0.11. This study was approved by the research ethics committee.

Results

A total of 73 professionals including health service professionals, teachers, and psychometrists, from all regions of Brazil participated, most of them female (73%), the average age was 40 years old, most with specialization (47%). Most were nurses (36.8%), psychologists (15.8%), PHC doctors (10.5%), social workers (9.2%), with more than 10 years of experience in the service (28.9%). At the end of the content validation, the scale presented 43 items with CVR between 0.11 and 0.25.

Conclusions

There is evidence of content validity of the scale, and it will supports professionals in making decisions about which is the right therapy, at the right time, for the right patient.

Key messages

The scale will be a powerful tool for the coordination of care between Primary Health Care and Mental Health specialized services. For practice use, it still is necessary to validate the internal structure.
Addictions and mental health disorders among adolescents: a cross-sectional study; Tunisia 2020
Authors: Amara A , Ghammem R , Sahli J , Alouani D , Dziri F , Maatoug J , Ajmi T
Published: October 2020

Introduction

Adolescence is a period of significant and rapid development, marked by the growing influence of peers, individual behavioral choices and increased risk taking, including addictive behaviors. Furthermore, association between these behaviors and mental health disorders such as anxiety, depression and low self-esteem, has been demonstrated in literature. In accordance with this need, we conducted this study to determine the prevalence of addictive behaviors and screen for mental disorders among adolescents.

Methods

We conducted a cross sectional study in Enfidha (a town in the Sousse governorate; Tunisia). The setting of the study was in high and middle schools. Data collection was done during January and February 2020. A structured self-administered questionnaire was used in this aim. It included socio-demographic characteristics, screening for mental health problems and addictive behaviors (self-esteem, depression, anxiety, facebook addiction and video game addiction). The scales are self-report validated instruments.

Results

We included 1195 participants with a median age of 14 years (IQR 13-16). Females represented 54.2 % of the sample. Concerning depression and anxiety, it was reported among 71.3%, 62.4% of participants, respectively. We noted that self-esteem was low among 49.5% of respondents. The pooled prevalence of internet gaming disorder and Facebook addiction was 37.4% and 32.3%, respectively. Our finding yield that girls were more prone to be Facebook addict. Meanwhile, internet gaming disorder was more common among boys. Regarding tobacco and alcohol use, it was reported among 16.7% and 3.2% of students, respectively. Our results pointed out that illicit substances' experimentation was disclosed among 2.1% of our sample.

Conclusions

Our study is one of rare and recent research in our country interesting the striking issue of addiction and mental health disorders among adolescents.

Key messages

Tobacco and alcohol use was reported among 16.7% and 3.2% of students. Illicit substances’ experimentation was disclosed among 2.1% of our sample.
Violence committed and victimization in courtship in adolescents: Does gender matter?
Authors: Villegas Vázquez E A , Leyva Chipol J C , Cervantes Gómez K C , Valencia Almeida S I , Márquez Celedonio F G , Villegas Domínguez J E
Published: October 2020

Introduction

Within the current context in our Mexico, major states of violence for women have been manifested on a daily basis without having any more reason than being female. Veracruz is the first place in feminicides in Mexico with a rate of 3.44 per 100 thousand women. Research question: What is the intensity of the violence committed and victimization in the courtship of young students of the Upper Middle level in the Veracruz - Boca del Río area, according to their gender?

Material and Methods

A cross-sectional, prospective, observational and analytical study was carried out from December to February 2020. Middle-high school students from the Veracruz-Boca del Río region were included, who had a dating relationship and were excluded those who did not accept to participate. The variable “violence committed and victimization in courtship” was quantified with the CADRI instrument. The spss v22 software was used, Sudent's T was calculated for independent samples, with statistical significance p < 0.05.

Results

741 students were included. There was a prevalence of violence committed of 86.2% and victimization of 89.2%. Of the total number of students who suffered and committed violence, women occupy 66.3% and 66.7% respectively. There is a difference in the intensity of violence between women and men in verbal-emotional violence (4.5 ± 4.2 vs. 3.4 ± 3.4), physical violence (0.6 ± 1.3 vs. 0.36 ± 3.6) and violence in general (5.7 ± 5.7 vs 4.3 ± 4.8) (p < 0.05), while victimization scores do not make a difference between both genders (p > 0.05). The history of psychological and sexual violence in previous relationships, as well as sexual violence in daily life are more frequent in the female sex (p < 0.05)

Conclusions

The violence generated is more intense in women, however, they also have a history of having suffered violence more frequently in previous relationships and in their daily lives.

Key messages

Women suffer more aggressions at different stages of their lives, which may increase the risk to tolerate aggressions or be more aggressive or suffer mental health problems. We must study if the violence generated by women is a response to a previous aggression from their boyfriend.
Association between accessibility to elementary school and depression in older Adults: JAGES Study
Authors: Nishida M , Hanazato M , Kondo K
Published: October 2020

Background

The connection in a local community has diluted in an aging society, and the importance of intergenerational exchange has increased for older adults' health. Some positive effects of intergenerational exchange have reported. For example, a reciprocal intergenerational exchange contributes to better mental health in later life. However, there is little evidence of the relationship between neighborhood environments causing intergenerational exchange and the health status of older adults. This study investigated the association between geographical accessibility to elementary school, enhancing intergenerational exchange, and depression in older adults.

Methods

The data were retrieved from the Japan Gerontological Evaluation Study (JAGES) 2016, a population-based study of independently living people ≥65 years old. The dependent variable is depression evaluated by the Geriatric Depression Scale (GDS≥5). The geographical accessibility to elementary School is the distance between the representative points of their residences and the nearest elementary school. Logistic regression analysis calculates the odds ratio to determine the association between depression and accessibility to elementary school and compare models to examine the effect of intermediate factors.

Results

Overall, 20.4% of the participants had depression. Compared with the longest distance from elementary school (≥950m), the odds ratio was 0.91 (95% CI = 0.86, 0.96) for the nearest category (<330m), 0.91 (95% CI = 0.87, 0.96) for the second-nearest (330-490m) and 0.94 (95% CI = 0.89, 0.99) for the third (490-670m) in model 1. After adjusting for intermediate factors, the odds ratio was 0.94 for the first and second-nearest groups.

Conclusions

Geographical accessibility to elementary school was associated with decreased depression for older adults. The result indicates that older adults' daily meetings with children around elementary schools can result in a positive effect on their mental health.

Key messages

Geographical accessibility to elementary school was associated with decreased depression for older adults. The neighborhood design enhancing intergenerational exchange might be useful for age-friendly cities.
Detection of cognitive decline in metabolic syndrome
Authors: Kostadinova P S , Atanasova G N , Kostadinov S D , Kostadinov S S
Published: October 2020

Background

Metabolic syndrome (MetS), a risk factor for many vascular conditions, may be a prodromal manifestation of vascular cognitive impairment. Diagnosing early stages of cerebrovascular pathology can lead to prevention and delay of the progression of pathological conditions such as vascular cognitive impairment.

Methods

The objective of the study was to investigate new biomarkers for early diagnosis of MetS and cognitive decline as a follow-up. A cardiological, neuropsychological and neurological study was conducted among 75 Bulgarian participants. Beta amyloid in the blood, procalcitonin (PCT), NT-proBNP as predictors of cognitive impairment in patients with metabolic syndrome were identified. Clinical, anthropometric, biochemical, neuropsychological, cognitive and statistical data processing. Plasma amyloid beta (Aβ) levels, procalcitonin, NT-proBNP in MetS were investigated in participants with MetS and in group of healthy people.

Results

In the present study, plasma levels of Aβ42 and Aβ40 were found to be reduced in MetS participants. Procalcitonin concentration was significantly higher in males than in females. NT-proBNP was significantly higher in females than in males (p < 0.001). Regression analysis showed a positive relationship between NT-proBNP and systolic blood pressure (p < 0.001) and fasting blood glucose (p < 0.05). An inverse relation between NT-proBNP and diastolic blood pressure, waist circumference, triglycerides, HDL- and LDL cholesterol was found.

Conclusions

There was a positive association between PCT levels, decreased levels of Aβ42 and Aβ40, as well as elevated NT-proBNP and cognitive impairment in people with MetC. A concentration of NT-proBNP of 60 pg / ml or greater could be an indicator of metabolic abnormalities and early cognitive decline.

Key messages

Metabolic syndrome may be a prodromal manifestation of vascular cognitive impairment. The use of new biomarkers for diagnosis can lead to preventing and slowing the progression of complications associated with MetS.
Primary care professional validation of visual model of prescription – Illustrated prescription
Authors: Cubas-Rolim E , Yung F R , Marques L A , Souza B V , Gripp M R , Ribeiro L , Oliveira C L A , Gasperi C , Fagundes M C , Mendonça D L
Published: October 2020

Issue

Chronic diseases such as hypertension and diabetes have great global impact on morbidity, mortality and costs. Incorrect use of medicines is especially worrisome for vulnerable populations with low health literacy, and visual models of prescription can bring benefit. The objective of this study was to validate the visual model of prescription Illustrated Prescription to obtain an adapted prescription with greater clarity, correction and cost-efficiency especially for risk users in a vulnerable peripheral region of the capital of Brazil served free of charge by the Unified Health System.

Description of the Problem

We conducted a content validation by primary health care nurses, pharmacists and physicians (PHC) by Delphi technique, applied in two phases from November to December 2018, through a questionnaire that evaluated clarity, relevance and feasibility of performing Illustrated Prescription, with field for comments. We used a 4-point Likert scale, Cronbach Alpha for reliability and Content Validation Index (CVI) with agreement above 0.8 indicating validation. Project approved by the Ethics Committee - FEPECS.

Results

Round-1: 29 out of 32 items were validated, with Cronbach's alpha .9812. Round-2: Included 4 new items, guidelines for indicating whole tablet, adjustment of the font size and color column size of elastic alloys, all items being validated and Cronbach's alpha of 0.9876.

Lessons

Validation ensures clarity and correction of the Illustrated Prescription, being extremely important for dissemination of the visual model for prescribing. It allows future evaluation of increased drug adherence and risk reduction related to incorrect use of medications especially for illiterate or visually impaired users.

Key messages

Illustrated Prescription is a validated tool that opens up the possibility of greater safety and efficient use of chronic medications, especially for vulnerable users with chronic diseases. Validation ensures clarity and correction of the Illustrated Prescription, being extremely important for dissemination of the visual model for prescribing.
Association between Oral Contraceptives and cutaneous melanoma: a systematic review and metanalysis
Authors: Giacchetta I , Chiavarini M , Naldini G , Fabiani R
Published: October 2020

Background

The probability of developing invasive cutaneous malignant melanoma (CMM) is higher in women than in men up until the age of 49. Several studies investigated the association between hormonal factors and CMM. The aim of this systematic review and meta-analysis is to summarize the evidence on the association between Oral Contraceptives (OC) and the risk of CMM.

Methods

This review and meta-analysis follow the PRISMA guidelines. A systematic literature search was conducted on Medline and Web of Science until December 2019. Studies were eligible if reported a risk estimate for the association between OC and CMM. Heterogeneity testing was performed using Cochran's Q and I2 statistics. Publication bias was assessed by Egger's test and Begg's test. Meta-analysis was performed using random effect model.

Results

The results of the pooled analysis of all 32 studies showed no significant association between OC and the risk of CMM (OR 1.02; 95% CI 0.94-1.11; I2=39.32%, p = 0.013). The stratified analyses by study design found no significant association between OC and the risk of CMM neither in the 18 case-control studies (OR 1.02; 95% CI 0.87-1.21; I2=56.91%, p = 0.002) nor in the 14 cohort studies (OR 1.04; 95% CI 0.98-1.11; I2=0.00%, p = 0.557). No significant publication bias could be detected by Egger's test or Begg's test.

Conclusions

This meta-analysis of available literature suggests no significant association between OC and the risk of developing CMM. Further investigations are needed to evaluate the possible relationship of OC use and other hormonal factors potentially contributing to the increased risk of CMM in women during their reproductive years.

Key messages

Oral contraceptives (OC) do not significantly contribute to the risk of Cutaneous Malignant Melanoma (CMM). Further studies are needed to investigate the potential role of other hormonal factors in the increased probability of developing CMM in women during their reproductive years.
Body mass index at diagnosis and prognostic significance on head and neck carcinoma survival
Authors: Pastorino R , Grossi A , Luca G , Boccia S
Published: October 2020

Background

Previous findings suggest there might be an inverse association between body mass index (BMI) and overall (OS) and Head and Neck-specific survival. The aim of this study was to investigate the prognostic role of BMI in the largest available cohort of HNC patients.

Methods

We performed a pooled analysis of studies participating at the INHANCE consortium. Cases were adults with HNCs of the oral cavity, oropharynx, hypopharynx and larynx. We used cox's proportional hazards models to estimate the relationship between BMI and overall and HNC-specific mortality. Sensitivity analysis were performed according to tumour location, smoking status and length of follow-up.

Results

The study included 9484 patients from 10 centres worldwide for a median follow-up of 48 months (IQR: 18-69). Overall 3623 patients (38.2%) died from all-causes and 1493 (15.7%) from HNC. Compared to patients with a normal weight, overweight or obese was associated with a longer HNC-specific survival (HR = 0.58, 95% CI: 0.35-0.95, HR = 0.37, 95% CI: 0.17-0.78, respectively), while underweight was associated to a shorter survival (HR = 1.73, 95% CI: 1.36-2.21). Results were heterogeneous according to tumour site, with the strongest effect among oropharynx and oral cavity cancer sites. When we restricted the analysis among patients with a follow-up longer than 5 years, underweight (HR = 5.17, 95% CI: 3.02-8.86) was associated with shorter HNC-specific survival.

Conclusions

Our findings suggest low BMI values are at diagnosis increase mortality in HNC patients. The protective effect of high BMI might be partially explained by residual confounding and reverse causality, so that further research is needed to clarify the potential role in tertiary prevention of BMI.

Key messages

BMI at diagnosis is a prognostic factor of HNC. Low BMI values predict unfavourable outcomes.
Understanding the needs of carers in Vietnam and the development of online supportive resources
Authors: Jenkins C , Ho H t , Santin O
Published: October 2020

Issue

Informal carers provide an important and often overlooked role in the care of people with a cancer diagnosis. Our study sought to better understand carers needs and develop an online resource to help address the needs identified. There are not currently any widespread or embedded support services for cancer carers in Vietnam.

Description of the Problem

We conducted in-depth interviews and focus groups with both carers (n = 20) and healthcare providers (n = 22) to understand the needs and challenges of caring for someone with a cancer diagnosis. We discussed what resources would alleviate challenges and used these discussions to inform a process of co-designing an online resource. This process was modelled off a peer-led online resource intervention developed in the United Kingdom. This process of co-design is transferable to other contexts, and when adapted could help meet the needs of cancer carers in other lower and middle income countries.

Results

Carers in Vietnam reported (i) economic challenges of care; (ii) not being able to access facilities and secure accommodation when caring for inpatients; (iii) lack of information about cancer and nutrition; (iv) lacking emotional support; and (v) requiring training to support both the treatment and recovery of people under their care. Suggestions for content of an online resource included the need for contextually appropriate Vietnamese content, specific information on diet and nutrition, support in making decisions around treatment, and signposting for other services.

Lessons

Successful co-design of resources requires input from multiple key stakeholders. This is necessary to successful adapt and modify interventions for new contexts. Our process revealed new information about the roles and needs of carers, and enabled us to incorporate solutions to these needs within our online resource. Given the lack of other supportive services for carers, the development of such resources should be considered a priority.

Key messages

Cancer carers in Vietnam experience specific challenges including provision of nutrition, supporting navigation of hospital administration, and taking a central role in treatment decision-making. Co-designed online resources have the potential to support carers in providing relevant and appropriate information and signposting to other important services.
Estimated direct costs of non-small-cell lung cancer by stage and care phase: a whole disease model
Authors: De Luca G , Buja A , Rivera M , De Polo A , Marchetti M , Scioni M , Pasello G , Bortolami A , Schiavon M , Conte P F
Published: October 2020

Background

Non-small-cell lung cancer (NSCLC) is the first cause of cancer-related death among men and the second among women worldwide. It also poses an economic threat to the sustainability of healthcare services. This study estimates the direct costs of care for patients with NSCLC by stage at diagnosis and management phase of pathway recommended in local and international guidelines.

Methods

Based on the most up-to-date guidelines we developed a detailed “whole-disease” model that lists the probabilities of all potentially necessary diagnostic and therapeutic actions involved in the management of each stage of NSCLC. Then we assigned the cost sustained by the public authorities to each procedure, obtaining an estimate of the total and average per-patient costs of each stage of the disease and management phase in Veneto Region, Italy.

Results

The mean expected cost of a patient with NSCLC is 22,968 € in the first year: 20,222 € in stage I, 23,935 € in stage II, 23,027 € in stage III, 22,915 € in stage IV and 31,749 € for Pancoast's tumors. In the second year the mean per patient-costs patient ranged from 2,722 €, for a patient with stage I disease, to 13,396 € for a patient with stage IV, with an overall average cost of 8,307 €. In the early stages, the main cost was due to surgery, whereas in the more advanced stages radiotherapy, medical therapy, treatment for progressions and supportive care become variously more important.

Conclusions

Our study enabled a prediction of the direct costs and outcomes for patients diagnosed with NSCLC on a two-year timeline after the diagnosis. An estimation of the direct costs of NSCLC, and in general for cancer, appears fundamental to predict the burden of new oncological therapies and treatments on healthcare services, and, in our opinion, our model could represent a useful tool for policy-makers in the optimization of resources allocation.

Key messages

Whole disease model allows an economic evaluation of a clinical pathway. The model is able to estimate direct costs of NSCLC by disease stage and management phase within a time horizon of two years. High cost-surgery makes the early stages no less expensive than advanced stages during the first year. In the second year, an advanced stage case costs almost five times more than an early stage case.
Intersecting gender inequalities in non-communicable disease risk factors in Kerala: A primary study
Authors: Negi J , Sankar H , Nair A B , Nambiar D
Published: October 2020

Evidence globally and in India indicates intersecting gender inequalities in Non-Communicable Diseases (NCDs) risk factors. These are understudied in Kerala, which is at an advanced stage of an epidemiological transition. We estimated sex differences in self-reported prevalence and screening coverage of blood pressure (BP) and blood glucose (BG) grouped by the socio-economic status. A multistage cluster random sampling survey of 3398 women and 2982 men was conducted in 4 districts of Kerala from July to October 2019. Descriptive, Relative Concentration Index (RCI) for age, wealth and education and Population Attributed Fraction (PAF) for caste/tribal groups and religion were computed using Stata 12 and WHO's Health Equity Assessment Toolkit (HEAT) Plus. More women reported BP and BG screening than men (BP - W: 90.3%; 95%CI: (89.1, 91.4) vs M: 80.8%; 95%CI: (78.5, 82.9); BG- W: 86.2%; 95%CI: 84.9, 87.4 vs M: 78.3%; (95%CI: 75.9, 80.6)).BP prevalence was significantly higher among women than men (BP - W: 11.2%; 95%CI: (9.0, 13.9) vs M: 7.9%; 95%CI: (6.6, 9.6). BP screening was concentrated among less educated women (WRCI: -0.2: 95%CI: -0.2, -0.1), older (WRCI: 0.3: 95%CI: 0.2, 0.4; MRCI: 0.5: 95%CI: 0.4,0.7) and wealthier populations (WRCI: 0.1: 95%CI: 0.03, 0.2; MRCI: 0.3: 95%CI: 0.1, 0.4).High BP was concentrated among more educated women (WRCI: 0.9: 95%CI: 0.1, 1.6) and less educated men (MRCI: -1.6: 95%CI: -2.6, -0.6). High BG was concentrated among less educated women (WRCI: -1.6: 95%CI: -2.4, -0.8) and more educated men (MRCI: 0.9: 95%CI: -0.1, -1.6). Religion inequality in high BG among women was -19.1(95%CI:-28.0, -10.2).We found distinct patterns of sex related inequalities in NCD risk factors in Kerala. There is a need for greater screening among men but also sub populations of women who may be under-served by screening services. These patterns require further exploration to understand contexts and pathways to ensure program design leaves no one behind.

Key messages

Intersecting gender inequalities in prevalence and screening coverage of NCD risk factors in Kerala, India. NCD screening should reach all gender equitably despite of their social economic status.
Is providing informal care risky? A mental health perspective in a Belgian population-based sample
Authors: Gérain P , Zech E
Published: October 2020

Background

Informal caregiving refers to providing unpaid assistance to a relative or friend who has a disease or a disability. The assumption that providing informal care leads to deleterious health outcomes is widespread and commonly accepted. However, several comments have been made about the need to question this belief.

Methods

To put this assumption to test, the Belgian National Health Survey from 2013 was used. In this nationwide sample, the association between informal care and mental health was investigated through the GHQ-12 and the SCL (depression, anxiety, and sleep subscales). Three complementary comparison were performed: (1) between informal caregivers and non-caregivers; (2) between informal caregivers at home, outside of home, and non-caregivers; (3) between informal caregivers providing care for more than 20 hours a week, those providing between 1 and 20 hours a week, and non-caregivers. Statistically significant differences were controlled afterwards for gender, age, and perceived quality of social support.

Results

Overall, the results show that, with a population-based point of view, informal caregivers are not particularly at risk. Few comparisons were statically different, and when they were, the effect sizes remained low.

Conclusions

Far from settling this debate, these results rather suggest that the key point might lie elsewhere, as informal caregivers represents a diverse population in itself. Therefore, the focus should probably not be on the sole investigation of the differences between informal caregivers and the general population, but rather on how and why some caregivers differ from other caregivers and how such difference can represent a risk for them.

Key messages

Informal caregiving is often seen as a risk factor for mental health, but our results point to non-significant and little differences. By questioning this assumption, we call for a better understanding of what could be at risk in informal care.