bluuebunny/crossref_metadata_2025 huggingface dataset:
Prevention of metabolic diseases through measures at the workplace
Authors: Schätzer J , Schätzer M , Putzhammer C , Moser N , Bhardwaj J , Hoppichler F
Published: October 2021

Background

Metabolic diseases such as type 2 diabetes pose a risk for both individuals and companies. According to the current Austrian health report, only 13.5% of adults participate in preventive medical examinations. As a result, there is a lack of information on important health parameters. To counteract this, a modular system with health checks that take place directly at the workplace was developed.

Methods

In 2018 and 2019, a health check was carried out on 877 people (male: 70.7%; female: 29.3%) at their workplace. In addition to checking the abdominal girth and calculating the BMI, parameters such as blood pressure, blood sugar, LDL, and total cholesterol levels were measured.

Results

62.5% of all participants were overweight or obese (male: 66.3%; female: 53.5%). The proportion of people with obesity was 11.5% (male: 11.4%; female: 11.7%). The abdominal girth was too high in 50.2% of the participants (male: 47.6%; female: 56.5%). 36.5% of the examined persons had elevated blood pressure readings (male: 42.3%; female: 22.5%). Total cholesterol was too high in 37.6% of the persons (m: 38.8%; w: 34.9%), LDL cholesterol was too high in 22.5% (m: 24.2%; 20.4%). The blood sugar levels were too high in 9.9% of the participants (male: 9.4%; female: 12.6%), regardless of whether they fasted or not. 81% of the participants stated that they had received new information about their state of health in the course of the examinations.

Conclusions

Measures to monitor the central metabolic parameters directly at the workplace represent an important component in prevention, which is essential for both the individual and the company.

Key messages

Metabolic diseases and obesity, as well as their consequences, pose a risk for both individuals and the companies they work for. Health checks directly at the workplace represent an important component in prevention and support companies in keeping their employees healthy.
What is important to you? Socioeconomic inequalities in the relative importance of health
Authors: Verra SE , Poelman MP , Mudd ALM , de Vet E , van Rongen S , de Wit J , Kamphuis CBM
Published: October 2021

Pressing issues, like financial concerns, may outweigh the importance people attach to health. This study tested the hypothesis that health is considered more important by people in high than low socioeconomic positions, with future focus and financial strain as potential explanatory factors. A cross-sectional survey was conducted in 2019 among N = 1,334 Dutch adults aged 25-60. Participants rated the importance of two health-related domains (not being ill, living a long life) and six other life domains (e.g. work, family) on a five-point Likert scale. A latent class analysis grouped participants in classes with similar patterns of importance ratings. Differences in class membership according to socioeconomic position (indicated by income and education) were examined using structural equation modelling, with future focus and financial strain as mediators. Three classes were identified: neutralists found all domains neutral or unimportant (3.5% of the sample); hedonists found most domains important except living a long life, work, and religion (36.2%); and maximalists found nearly all domains important, including both health domains (60.3%). Low income predicted belonging to the neutralists, and high education and unemployment predicted belonging to the hedonists (both compared to belonging to maximalists). No mediation pathways via future focus nor financial strain were found. People with lower incomes were less likely to consider health important. Neither future focus nor financial strain explained these inequalities. Future research should further investigate socioeconomic differences in conceptualisations of health, and if and how inequalities in the importance of health are associated with inequalities in health.

Key messages

This study identified small socioeconomic inequalities in the perceived importance of health. Neither future focus nor financial strain contributed to these inequalities.
An Intervention Study to Increase the Medication Compliance of 60 Years and Older Individuals
Authors: Yüksel Güner M , Kara M , Kavukcu N , Çevik M , Gören Y , Kocaarslan D , Şengezer T , Aslan D
Published: October 2021

Background

In older age, taking medication at the desired level contributes to the health and well-being, and therefore, constitutes an essential part of the effectiveness of treatment and ultimately desired public health impact and reduced healthcare budgets. However, it is known that medication compliance among older persons is frequently not at a desired level. Therefore, in this study, it was aimed to increase medication compliance through an educational intervention for patients aged 60 and over, who applied to two healthcare facilities in Ankara, Turkey.

Methods

This intervention study was implemented in two public health hospitals between March and June 2019. 315 people aged 60 and over participated in the study. The intervention tool was the “teach-back” method. SPSS program was used for data entry and analysis. P value less than 0.05 was indicated for statistical significance.

Results

Mean age of the participants was found to be 70.16±7.9 for the control group and 70.27±7.4 for the intervention group. In the intervention group, a statistically significant increase was found in the capacity of learning the long-term benefits of drugs, their side effects and storage conditions, and knowing when the drugs shouldn't be taken, and repeating information about the drugs used (p = 0.000).

Conclusions

This study has revealed that medication compliance among older individuals can be increased with an appropriate communication and training method in healthcare settings. Time allocated by health workers in this regard has a potential to respond to the compliance-related needs. With the “Teach-back” method utilized in the interactions between older patients and health workers, it is possible to attain meaningful, large-scale and cost-effective public health outcomes that contribute to the clinical benefits of treatments and the effectiveness of health systems.

Key messages

Older people are open to receive information on the actual health needs. A well-structured interaction between healthcare workers and patients involving “teach-back” method contributes to medication compliance among the elderly.
Online-Training to strengthen Health Literacy in Austrian Companies
Authors: Movia M , Tuttner S , Hofer-Fischanger K
Published: October 2021

Background

The HL-Survey-EU-2011 showed limited health literacy [HL] among the European population especially within Austria. In fact, every second Austrian is affected by limited health literacy [51,6%]. Approaches to strengthen HL in organisations are lacking in Austria.

Objectives

A Massive-Open-Online-Coors (MOOC) was developed in a four-step-approach to strengthen HL in Austrian companies: step 1) Literature review; step 2) Development workshops [n = 3]; step 3) National and international expert feedbacks [n = 8]; step 4) In-person pilot testing [n = 10 companies]. The MOOC took place in autumn 2020.

Results

In total, n = 81 people within service and production sectors were registered for the training. The final training concept covered six modules and was carried out in a four-week online training. Modules were: M1) Concepts of health; M2) Individual HL and HL in organisations M3) Health information search and critical assessment; M4) HL Communication [and how to make information available for workforce & costumers]; M5) Project management for practical implementation; M6) Development of HL initiatives for each company (mutual exchange of ideas). The four-week MOOC was free of charge. Participants spent 3-4 hours per week. Each week had a focus and was led by an expert. Contents were provided through learning videos, literature and exercise materials. Participants were encouraged to discuss the given forum and upload completed tasks based on provided templates. Participants graduated with a certificate.

Conclusions

This is the first virtual HL training programme for companies in Austria. HL is a new and complex topic for service and production sectors. Trainers need comprehensive competences in order to transform the topic into operational practice. Mutual exchange among participants and course instructors seem crucial for HL online trainings. It is important to advertise HL-MOOCs intensively right before the start. The online course provides reusable content.

Key messages

Mutual exchange and interactive discussions between participants and course instructors (e.g. in discussion forums) strengthen the online learning success. Trainers and course instructors need comprehensive competences in order to transform the topic into operational practice.
Study of the quality of educational, scientific, clinical processes in medical colleges of Kazakhstan
Authors: Koikov VV , Derbissalina GA , Akanov AB , Baigozhina ZA , Kabdullina GB , Mergentai A
Published: October 2021

Background

One of the key challenges facing the healthcare system of Kazakhstan is the need to take measures to improve the quality of practical training of nurses at the level of medical colleges (MC). To develop further steps to improve the training of nurses at the level of MCs, it is required an assessment of the key components of their activities for the organization and quality assurance of educational processes (EP), clinical processes (CP) and scientific processes (SP).

Methods

The study of the quality of EP, CP, SP was carried out on the basis of a survey of 13110 students, 825 teachers and 199 administrators of 78 MCs. We have developed 3 types of questionnaires for each category of respondents. The survey was conducted on the SurveyMonkey platform in May-June 2020.

Results

Teachers with little pedagogical experience and administrators with no/short duration of pedagogical experience tend to overestimate EP, CP, SP. Teachers and administrators give a much higher assessment of the effectiveness of teaching methods, the objectivity of assessment methods, ensuring the rights of students, key components of SP and CP than the students themselves, which, in fact, indicates insufficient contact between teachers and administrators with students in terms of assessing their needs. Administrators tends to give a higher assessment of the quality of the SP and CP than teachers and students.

Conclusions

The discrepancy in the assessments of certain categories of respondents indicates the need for regular feedback from students, conducting a survey of teachers and administrators. It is necessary: to strengthen the selection of personnel for administrators' positions in MCs with the introduction of a mandatory requirement for the presence of teaching experience and academic degree; to encourage the practice of combining positions of teacher and administrator; to introduce mandatory attestation of MCs' teachers and administrators every 3-5 years according to clear KPI criteria.

Key messages

The discrepancy in the assessments of certain categories of respondents indicates the need for regular feedback from students, conducting a questionnaire survey of teachers. It is necessary to require the presence of pedagogical experience and academic degrees in the selection of personnel for the positions of administrators in medical colleges.
EuroNet MRPH: Networking Opportunities for Public Health Medical Residents
Authors: Monteagudo JF , Peyre-Costa D , De Souza S , Alonso-Jaquete A , Failla G , Grosso FM , Chen-Xu J , Miranda JO , Borghi G
Published: October 2021

Background

The European Network of Medical Residents in Public Health (EuroNet MRPH) is a non-profit, international, independent and non-governmental network of national associations of public health residents around Europe.

Objectives

To describe the results accomplished by EuroNet MRPH and to show networking opportunities provided to medical residents in public health (MRPH) from 2011 to 2021.

Results

EuroNet's mission is to improve and facilitate connection between MRPH, to promote pan-European Research, and to facilitate international mobility. Digital and quarterly face-to-face meetings are used as a way of communication. Since 2011, 10 European MRPH associations and 4 individual members have joined the network, representing the UK, France, Spain, Italy, Portugal, Ireland, the Netherlands, Croatia, Slovenia, Turkey, Malta, Poland, Bosnia and Herzegovina, and Austria. In this period, 27 face-to-face meetings have been organised, promoting cooperation and exchanging of ideas between MRPH. Moreover, three working groups (WG) have been established, focusing on research, internships, and communication. Regarding research, studies about e-cigarettes, conflicts of interest, and the impact of COVID-19 on mental health of MRPH have been conducted. When it comes to internships, more than 20 possible destinations and an online form are available on our website, providing MRPH information and support. Finally, thanks to the communication WG, 20 newsletters have been published, sharing experiences and thoughts from members of the network. Moreover, EuroNet has an established presence in social media, with active accounts in Twitter, Instagram and Facebook, where public health information and opportunities for young professionals are promoted.

Conclusions

In the last ten years, EuroNet MRPH has actively promoted networking opportunities among European Medical Residents in Public Health.

Key messages

Enhancing international cooperation among young public health professionals is fundamental in order to face current and future public health challenges. EuroNet MRPH represents a useful tool to promote collaboration among young public health professionals.
Determinants of drug prescription in general practice in Casablanca: Cross-sectional study
Authors: Traore B , Zoukal S , Tsoumbou-Bakana G , Nani S , Hassoune S
Published: October 2021

Background

Rational drug prescribing is essential to ensure good disease management and avoid the emergence of drug resistance. However, the decision to prescribe a drug is not only based on the medical knowledge of physicians, but other factors may also influence this decision. We conducted this study to determine the factors that may influence drug prescribing in general practice in Casablanca.

Methods

A cross-sectional study was conducted in Casablanca (Moulay Rachid and Sidi Bernoussi prefectures) from January to April 2019 among general practitioners in the public and private sectors. The survey was based on the response to a self-administered questionnaire designed and pre-tested by epidemiology laboratory of the Faculty of Medicine and Pharmacy of Casablanca. In addition to a descriptive analysis of the results, a logistic regression analysis was performed to evaluate the factors that could be associated with drug prescription.

Results

Among 191 general practitioners practicing in the prefectures of Moulay Rachid and Sidi Bernoussi 140 agreed to participate in our study, among which 101 (72.1%) prescribed on average more than two drugs per consultation. In addition to patient-related characteristic: enrolment in medical coverage (OR = 0.1 [0.1; 0.9] if 25-50% of patients had medical coverage), long-term illnesses (OR = 1.73 [1.57; 1.90]); the independent factors associated with this doctor-related prescription were age (OR = 0.23 [0.1; 0.7] over 55 vs. under 40 years), sector of activity (OR = 22.8 [7.4; 70.0] private sector vs public sector), professional seniority (OR = 0.1 [0.01; 0.8] if seniority more than 5 years), and consultation duration (OR = 1.1 [1.09; 1.2]).

Conclusions

In addition to seniority, duration of consultations, and sector of activity, patient characteristics influence GPs' drug prescription.

Key messages

The decision to prescribe a drug is influenced by the length of time the GP has been in practice, the duration of consultations and the sector in which he/she works. Patient characteristics influence GPs' drug prescribing.
Knowledge, attitude and practice towards antibiotic resistance among general practitioners in Armenia
Authors: Muradyan D , Demirchyan A , Petrosyan V
Published: October 2021

Background

Antibiotic resistance is an important public health issue. This study sought to measure general practitioners' (GPs) knowledge, attitude, and practice on antibiotic resistance; explore the adjusted associations between their antibiotics prescribing practice score and knowledge and attitude scores, and identify barriers for rational prescription of antibiotics by GPs.

Methods

A cross-sectional self-administered survey was conducted among GPs. Multivariable linear regression was applied to analyze the data.

Results

Overall, 291 GPs participated in the study. Knowledge, attitude, and practice mean percent scores were 58.3%, 67.5%, and 63.0%, respectively. In the adjusted analysis, the practice percent score was significantly associated with the attitude percent score (β = 0.58; 95% CI: 0.41, 0.75; p < 0.001), though the relation between the practice and knowledge scores was insignificant. The main barriers reported by GPs: lack of rapid diagnostic tests, high costs of laboratory tests, high costs of some antibiotics, and lack of guidelines.

Conclusions

Identified low knowledge, attitude, and practice mean percent scores suggest a need for improvements in these areas. Availability of rapid and inexpensive diagnostic tests, enforcement of prescriptions could potentially prevent the development of antibiotic resistance.

Key messages

Availability of rapid and inexpensive diagnostic tests, enforcement of prescriptions, and regulation of antibiotics’ prices could help to improve antibiotics prescribing practices of GPs. Low knowledge, attitude and practice levels regarding antibiotic resistance among GPs in polyclinics suggests a need for improvement in these areas.
A case-control study on body composition of teenagers with adolescent idiopathic scoliosis
Authors: Marinov D , Dimitrova T
Published: October 2021

Background

Adolescent idiopathic scoliosis (AIS) is the most common form of spinal abnormality. It affects about 2-3% of all teenagers. Its etiology remains unknown but studies suggest that multiple factors may play a role. A growing body of evidence supports the role of body composition abnormalities including low body mass index (BMI) and low body fat percentage (BF%) as risk factors for AIS development. This study aimed to evaluate these indicators in a group of teenagers with AIS and compare them to age and gender-matched controls.

Methods

The study included 98 adolescents with AIS and 73 controls aged 11-18 years from Varna, Bulgaria. Data was collected after receiving informed consent from the parents. Data on AIS diagnosis and severity was collected from the available medical documentation. Anthropometrics were measured using calibrated Tanita BC-420MA (ISSO 9001) and following ESPEN guidelines. BMI for age and BF% for age were estimated using WHO Child Growth Standards and BF% reference curves for children.

Results

In the AIS group, 15% were underweight with BMI for age under -2SD. 11% were above +1SD indicating a risk of overweight or obesity. In comparison, 7% of the control group were underweight while 32% were at risk of being overweight or obese. There is a statistically significant difference between the BMI for age in the two groups (χ2=19.564 Đ¿рĐ, p < 0.005). In the AIS group, 47% had BF% for age under the 2nd percentile indicating underfat, while 7% of AIS cases had BF% for age above the 85th percentile indicating they are overfat or obese. In comparison, 15% of the control group were underfat while 19% were overfat or obese. There is a statistically significant difference between the BF% for age in the two groups (χ2=21,504 Đ¿рĐ, p < 0.001).

Conclusions

Children with AIS are more likely to be underweight and underfat compared to their healthy peers. Cases of having a high BF% and being overweight or obese are scarce amongst AIS patients.

Key messages

The majority of children with AIS have abnormal body composition compared to healthy age and gender-matched controls. Aspects of the nutritional status may play a role in the etiology of AIS. Children with low body fat might be at a higher risk of developing AIS. AIS screening programs should be directed towards underweight children.
Factors associated with liking of milk among preschool children
Authors: Greene E , Murrin C
Published: October 2021

Background

Adequate calcium intake in childhood is essential for bone health, and dairy products are an important dietary source. However, children's milk consumption has reduced over the past decade in developing countries. Food preferences are a key determinant of consumption, and those developed in early life can persist into adulthood. Therefore, promoting a liking for milk before school age may be effective in improving milk consumption further into childhood. The aim of this analysis is to explore the factors associated with liking of milk among preschool children.

Methods

Questionnaires were completed by parents of 2-5 year-old children as part of a pilot intervention aiming to increase milk consumption in 12 preschools. Chi-squares and hierarchial logistic regression were used to examine the association between children's liking of milk, as reported by parents, and child-related factors (infant feeding; demographics; diet) and parent-related factors (attitudes; milk consumption and liking; education).

Results

Responses from 319 parents of 2-5 year-old children (50.5% male, 49.5% female) were analysed. Ninety-two percent of respondents were mothers and 85% of parents reported that their children liked the taste of milk. In a logistic regression model (N = 281) parents' belief that it is difficult to encourage their child to drink milk was associated with a lower likelihood of children liking the taste of milk (OR = 0.028; CI = 0.011, 0.075; P < 0.001). Liking of milk was not significantly associated with other factors examined (P < 0.05).

Conclusions

The present analysis suggests that parents' self-efficacy in encouraging their child to drink milk may be important in influencing their child's liking of its taste, and should be considered in interventions aiming to improve milk consumption. The taste of milk was well-liked in this cohort of preschool children and therefore, further research is necessary in a cohort with varying levels of milk consumption and liking of milk.

Key messages

Parental beliefs should be included as intervention targets when aiming to improve a liking for milk among preschool children. Further research on the determinants of milk consumption and liking of milk is necessary in diverse cohorts of preschool children.
Adverse childhood experiences and health risk behaviours by gender among Tunisian adolescents
Authors: Mlouki I , Elomma Mrabet H , Rezg N , Chebbi F , Omri N , Ben Youssef F , Sfar H , El Mhamdi S
Published: October 2021

Background

Adverse Childhood Experiences (ACEs) have become an alarming phenomenon exposing individuals at a great risk of developing mental health issues. To date, there remains a lack of adequate researches on ACEs especially among adolescents. This survey aimed to describe the prevalence of childhood adversities and to determine their role in developing risky behaviours amongst Tunisian youth.

Methods

We conducted a cross sectional study among schooled adolescents in the governorate of Mahdia (Tunisia) from January to February 2020. Exposure to violence was assessed using the validated Arabic version of the WHO ACE questionnaire. The Internet Addiction Test (IAT) and the Hospital Anxiety and Depression scale (HAD) were used as a screening tool for internet addiction, anxiety and depression.

Results

A total of 1940 adolescents were recruited. The majority of them (97.5%) reported experiencing at least one ACE. Emotional neglect (83.2%) and witnessing community violence (73.5%) were the most reported ACE categories. According to gender, males had higher rates of exposure to physical abuse and social violence than females. The most common risky behaviour was internet addiction (50%) followed by substance use (16.6%). After adjustment for anxiety and depression, the dose-response association between ACE and risky behaviours was well established.

Conclusions

These results among youth have both public health and societal implications.

Key messages

The prevalence of exposure to adverse childhood experiences as well as risky behaviors are alarming among Tunisian adolescents. Screening addictive behaviors among youth with a history of childhood adversities is needed.
Factors associated with the level of knowledge about breastfeeding
Authors: Perez Juarez M , Villegas Dominguez JE , López Santiago N , Martínez Solorzano J , Márquez Celedonio FG
Published: October 2021

Background

In Mexico, 95.6% of children under 2 years of age are breastfed at least once in their lifetime; however, only 28.6% are exclusively breastfed and 40.2% are predominantly breastfed up to 6 months of age. Mothers who do not breastfeed their children or abandon breastfeeding before 6 months of age give reasons that suggest lack of knowledge or lack of support.

Aim

to determine the factors associated with a high or higher level of knowledge about breastfeeding in women in Veracruz, Mexico.

Methods

A cross-sectional, prospective, observational and comparative study was carried out. Women between 18 and 35 years old, from Veracruz, Mexico were included, between July to December 2020. Virtual surveys were applied through social networks, using a non-probabilistic sampling, evaluating knowledge about breastfeeding through the application of the ‘Breastfeeding knowledge questionnaire', and its interpretation is carried out at four levels of knowledge: poor, regular, high and very high (Cronbach's alpha of 0.722).

Results

1241 participants were included. The patients showed high or greater knowledge in 1057 (85.1%) cases. Having school as the main source of information for breastfeeding, reported an Odds Ratio (OR) of 1.5 (95%CI 1.05-2.2) and having intentions to exclusively breastfeed in the next pregnancy had an OR of 1.7 (95% CI 12 .-2.4), while obtaining the information through friends, family or acquaintances had an OR of 0.6 (95% CI 0.4-0.8), both with p values <0.05. Marital status, educational level, age, occupation, religion, having medical attention through social security, the number of children, receiving information about breastfeeding from a health institution, from social networks or looking independently had p values > 0.05;

Conclusions

The high level of knowledge is positively associated with the information received at school from while it is negatively associated with having family or friends as the main sources of information.

Key messages

The high level of knowledge is positively associated with the information received at school. The high level of knowledge is negatively associated with having family or friends as the main sources of information.
Prevalence, time of diagnosis and mortality of newborns with congenital digestive malformation
Authors: Traore B , Chraa FZ , Tsoumbou-Bakana G , Hassoune S , Nani S , Yaqini R
Published: October 2021

Background

Congenital digestive malformations are a leading cause of infant mortality and morbidity. There are currently no reliable estimates of the number of children born with these malformations and the diversity of the underlying causes requires a range of preventive approaches. Thus, to estimate the prevalence and mortality of these pathologies and to determine the interest of prenatal diagnosis in Casablanca, we initiated this study.

Methods

This was a cross-sectional study conducted at the Ibn Rochd University Hospital in Casablanca from January 1, 2016, to December 31, 2019, among newborns with congenital digestive malformations diagnosed by a specialist in visceral and digestive surgery. Data related to pregnancy, delivery, and time of diagnosis were collected through the medical record and complemented by clinical and surgical data from the hospitalization registry. In addition to the descriptive analysis of the results, the statistical analysis included Log Rank tests and the Cox method.

Results

Among 33853 live births 140 cases (56 Esophageal Atresia, 12 Diaphragmatic Hernia, 29 Laporoschisis, 20 Neonatal Occlusion, and 23 Omphalocele) of neonatal digestive malformation (4,13/1000 live births) had been diagnosed, 19.3% (27/140) of which were diagnosed during the antenatal period with an estimated mortality of 2.86/1000 (96/33853) live births and a mean survival time of 9.14±0.92 days. There was no statistically significant association between the time of diagnosis (prenatal vs postnatal) of the disease and the risk of mortality (Log Rank test p = 0.781), and the differences in the association between prenatal diagnosis and infant mortality in the five neonatal digestive malformations were not statistically significant.

Conclusions

These results imply that survival may no longer be the most relevant outcome, or the best criterion, for assessing the impact of prenatal diagnosis on the outcome of neonatal digestive malformations.

Key messages

The prevalence and mortality of children with neonatal GI defects is high. Survival may be the most relevant outcome to assess the impact of prenatal diagnosis on the outcome of neonatal GI defects.
The burden of Alzheimer’s caregivers and social support in the Tunisian family
Authors: Dhouib W , Ibrahim B , Bannour R , ben Cheikh A , Bhiri S , Ghali H , Khefacha S , Said Latiri H , Ben Rejeb M
Published: October 2021

Background

Alzheimer is a pathology that concers the patient and his family having a physical, social, economic and psychological impact. Research on family caregivers is still lacking and little is known about caregivers burden and ist associated factors in Tunisia. The aim of this study were to describe caregiver burden among Tunisian family caregivers of patients with alzheimeŕs disease, its associated factors and ist relationship to social support.

Methods

We conducted a cross-sectional study among 118 family caregivers during three months at the neurology outpatient departments of two university hospitals. Sahloul, Sousse and Taher Sfar, Mahdia. Using the Zarit Burden Interview-22 (ZBI)items and the Medical Outcome Study-Social Support Survey to assess burden and social support among the caregivers.

Results

We included 118 caregivers of patients with Alzheimeŕs disease,with an average age of 45±15 years. Women were more predominant with a sex ratio of 0.57.Half of caregivers were the descent of patients. The Mean years of caregiving was 5±3 years with an average of 13 hours ±3 of care assistance per day. The mean ZBI Score was 38.4±18.5 and 16.1% of caregivers percived a severe burden. The mean ZBI Score was higher in female, retired, lowmsocio economic status and in rural area with a statistically significance difference. We found that caregiver burden and social support were highly correlated (p < 0.001,r=-0.41)indicating that a high level of caregiver burden was asoociated with a less level of social support.

Conclusions

The level of burden in family caregivers who are caring for a patient with alzheimeŕs disease is high. A considerate help and support from helth care and social institutions is required by taking into account the factors that contribute to caregivers burden and considering the importance of social support in alleviating caregiver burden.

Key messages

The level of burden in family caregivers who are caring for a patient with alzheimeŕs disease is high. High level of caregiver burden was asoociated with a less level of social support.
Impairment of visual working memory as endo-phenotypic marker for paranoid schizophrenia
Authors: Veleva I , Stoimenova M , Valkova M
Published: October 2021

Background

Examination of cognitive endo-phenotypes is a modern approach for establishing genetic risk for schizophrenia. Visual working memory (VWM) is significantly impaired in cases with paranoid schizophrenia (PSch). Benton Visual Retention Test (BVRT) is a standardized neurocognitive instrument for accessing VWM. The aim of the study was to access VWM in patients with PSch and their first-grade relatives (FGR) and to compare the results with healthy controls.

Methods

We examined VWM in 108 patients with PSch - 66 males and 42 females; their mean age was 38.86±10.02 years and average disease severity 71,8±5,1 points measured on Positive and Negative Syndrome Scale. The FGR group included 30 males and 28 females with a mean age 36.71±11.74 years. The control group consisted of 37 males and 23 females aged 35.68±11.36 years. The VWM in all cases was measured by BVRT. The study was approved by the University of Pleven Ethical Committee. Mann-Whitney U and z-tests were used for between-group comparisons. All correlations were interpreted as significant at 95% confidence level. Data processing was performed by IBM SPSS Statistics v.24.

Results

Patients with PSch showed lower correct answers and more total errors on BVRT as compared to their first-grade relatives (z= -6.482; p = 0.0001). They also made more omissions, distortions, perseverations, misplacement errors and had specific tendencies for changing angular figures with circles. First-grade relatives had greater total number of errors and more distortions, perseverations, misplacement errors and horizontal shifts compared to healthy controls. All differences were significant at p = 0.01 or even p = 0.001.

Conclusions

Both PSch and FGR show difficulties in space organization and/or have restricted analysis of perception and poor scheme of getting information. This illustrates a deficit in the hierarchical organization, planning and strategy development for visual perception resulted from the frontal disfunction.

Key messages

First-grade relatives of patients with paranoid schizophrenia show specific impairments of visual working memory which makes it suitable endo-phenotypic marker for paranoid schizophrenia. Visual working memory could be used in clinical scientific research for the purpose of differentiation of high-risk groups for schizophrenia.
Consequences of cyberaggression on Social Network on mental health of Italian adults
Authors: Martella M , Bert F , Colli G , Lo Moro G , Pagani A , Tatti R , Scaioli G , Siliquini R
Published: October 2021

Background

Cyberaggression (CyA) comprehends a broad spectrum of hostile behaviours carried out through electronic means. Acts of CyA were studied mostly among adolescents. This cross-sectional study aims to evaluate the nature, extent and outcomes in terms of depressive and anxiety symptoms as well psychosomatic disorders in adults in Italy.

Methods

An internet-based survey comprehensive of 34 items was distributed through Social Media and targeted only adults. Descriptive analysis and correlation tests were performed in order to identify the extent of the CyA phenomenon.

Results

The survey received a response from 341 Participants (60% women), 43% of them declared to have been victim of CyA almost 1 time in their life and the most representative forms were insults (24.7%) and harassment (19.9%). Only 13% of participants were author of acts of CyA almost 1 time in their life, and 11% of them insulted someone else online. The 74.1% was bystander of CyA episodes as insults (62.7%), discrimination (62%) and defamation (47.8%). According to 95.1% of participants, these episodes were seen on Social Network, 17% on Facebook. The 39.5% of participants asserted an increased frequency of the events during the pandemic restriction. The main reasons of CyA declared were politics (70%), racism (65.8%), sexual orientation (65%) and female gender (53.1%). Chi square Test showed a significant correlation only between sexual orientation and victimization (69.4% of non-heterosexual asserted to be victim). The 33.6% of victims of CyA asserted anxiety and sadness after episodes, while the 39.8% stated to be angry.

Conclusions

CyA episodes are widespread in the European context and potentially harmful for mental health of victims. Sexual and ethnic minorities and females are more frequently the target. Pandemics enhanced this phenomenon. European public health professionals should take into careful consideration this issue for its potential negative consequences.

Key messages

Cyberaggression is a widespread phenomenon in Europe with potential negative consequences on mental health of victims, especially during the current pandemic. Sexual and ethnic minorities and females are more frequently the target of cyberbullying and European public health professionals and policy-makers should implement strategies to prevent this issue.
What are the predisposing factors of depressive disorders among school teachers?
Authors: Ketata N , Ben Ayed H , Maamri H , Baklouti M , Yaich S , Jdidi J , Kassis M , Feki H , Damak J
Published: October 2021

Introduction

Teachers' psychological wellbeing is important for both teachers and student's development, but is highly stressful, particularly in special education. Chronic stress is associated with a range of mental health problems including risk of depression, which could lead to low quality of life and dropout. This research aimed to determine the prevalence of depression and their predisposing factors among school teachers.

Methods

A cross-sectional study was conducted on a randomized sample of 258 secondary school teachers in Sfax, Southern Tunisia on march 2021. The instrument used for depression measurement was adopted from the generalized anxiety disorder assessment (GAD-7).

Results

Among 258 school teachers, 136 were females (52.7%). The mean age was 47.5±8.1. Overall, 47 teachers (18.2%) had a work seniority above 30 years. According to the work conditions, 118 cases (45.7%) had problems with their students, 30 cases (11.6%) had problems with parents and 10 subjects (4%) had conflicts with their colleagues. The prevalence of depression was 44.6%. Moderate and severe depression were respectively noted in 72 (27.9%) and 43 (16.7%) teachers. In multivariate logistic regression, female gender (Adjusted odds ratio (AOR)=2.1; p = 0.004), history of chronic disease (AOR= 2.6; p = 0.001), working outside the family's region of residence (AOR= 1.8; p = 0.048), active smoking (AOR= 1.9; p = 0.042) and having problems with students at school (AOR=2.2; p = 0.039) were independently associated with higher prevalence of depression.

Conclusions

The prevalence of self-reported depression among school teachers was notably high, which may hamper their relationships and effectiveness with students. The most prominent risk factors were related to unhealthy lifestyle and lack of social support with students. Therefore, managing work conditions and establishing appropriate consulting and supporting programs are urgently required.

Key messages

Depression disorders. School teachers.
Migrants’ health and Bulgarian health care system performance: experts’ and society point of view
Authors: Kamburova M
Published: October 2021

Introduction

Migrants often face serious inequities concerning their state of health and access to good quality health services. The aim of the study is to compare the experts' and society point of view on migrants' health and Bulgarian health care system performance in this field.

Methods

Within the TRAIN4M&H project, founded by EC, in March 2019th a work seminar was organized in Bulgaria. Data were collected through an unstructured interview. The focus group and facilitated discussion with 22 experts intended was performed. To elicit information about significant migrants' health problems the questionnaire among 388 people was applied. Data processing was performed by SPSS v.24.

Results

22 frontline professionals and 388 people of the society were covered. 20% of the surveyed experts completely disagrees with the opinion that migrants are a threat to public health while nearly nine out of ten surveyed members of the public fully (38.0%) or partially agree (51%) with that statement (χ2=37,84;df=3;p<0,001). The majority (47.8%) of the respondents from the public express an opinion for greater needs for health care of migrants compared to the Bulgarian population while according to three quarters of the specialists there is no difference (χ2=24,07;df=2;р<0,001). About 40% of the representatives of the society claim that the health care system in Bulgaria is not prepared to provide adequate health care to migrants. Almost two thirds of the experts share the opinion that health care in the country can provide only some specific health care to migrants (χ2 = 15.11; df = 2; p < 0.001). The point of view of the groups compared coincided on the issues of restricting the access of migrants in the country and provision of health care, regardless of the legal status of migrants.

Conclusions

The society is not familiar with the health problems of the migrants, but accepts their health as worse than that of the Bulgarian population and threatening the public health in the country.

Key messages

The society is not familiar with the health problems of the migrants, but accepts their health as worse than that of the Bulgarian population and threatening the public health in the country. According to the experts working at local level with migrants Bulgarian health system is not well prepared and provides adequate health care for migrants only in some specific cases.
Sex Differences in the Relation Between Frailty and Endothelial Dysfunction in Old Mice
Authors: Cole Jazmin A , Kehmeier Mackenzie N , Bedell Bradley R , Krishna Kumaran Sahana , Henson Grant D , Walker Ashley E
Published: October 2021

Vascular endothelial function declines with age on average, but there is high variability in the magnitude of this decline within populations. Measurements of frailty, known as frailty index (FI), can be used as surrogates for biological age, but it is unknown if frailty relates to the age-related decline in vascular function. To examine this relation, we studied young (4–9 months) and old (23–32 months) C57BL6 mice of both sexes. We found that FI was greater in old compared with young mice, but did not differ between old male and female mice. Middle cerebral artery (MCA) and mesenteric artery endothelium-dependent dilation (EDD) also did not differ between old male and female mice; however, there were sex differences in the relations between FI and EDD. For the MCA, FI was inversely related to EDD among old female mice, but not old male mice. In contrast, for the mesenteric artery, FI was inversely related to EDD among old male mice, but not old female mice. A higher FI was related to a greater improvement in EDD with the superoxide scavenger 4-hydroxy-2,2,6,6-tetramethylpiperidin-1-oxyl in the MCAs for old female mice and in the mesenteric arteries for old male mice. FI related to mesenteric artery gene expression negatively for extracellular superoxide dismutase (Sod3) and positively for interleukin-1β (Il1b). In summary, we found that the relation between frailty and endothelial function is dependent on sex and the artery examined. Arterial oxidative stress and proinflammatory signaling are potential mediators of the relations of frailty and endothelial function.
2. Copyright I: History, Justifications, Sources of Law, and Subsistence
Authors: Aplin Tanya , Davis Jennifer
Published: October 2021

All books in this flagship series contain carefully selected substantial extracts from key cases, legislation, and academic debate, providing able students with a stand-alone resource. Copyright refers to a set of exclusive rights in relation to cultural works such as literature, newspapers, photographs, drawings, artworks, films, music, and plays, and also extends to less obviously aesthetic creations, such as computer programs and databases. This chapter discusses the history, justifications, and sources of UK copyright law as well as the requirements for copyright protection. The requirements for protection that are explored are subject matter, originality,and fixation. The impact of EU copyright law on these UK requirements is examined.
6. Trade Marks I: Justifications, Registration, and Absolute Grounds for Refusal of Registration
Authors: Aplin Tanya , Davis Jennifer
Published: October 2021

All books in this flagship series contain carefully selected substantial extracts from key cases, legislation, and academic debate, providing able students with a stand-alone resource. This chapter examines the main justifications for the protection of registered trade marks. It considers the substantive law relating to the subject matter of registration as set out in the Trade Marks Directive (2016), its predecessor and domestic law. It looks at which signs will be registered as well as the absolute grounds for refusal of registration and at the Court of Justice of the European Union and domestic case law interpreting these grounds. The practicalities of the trade mark registration process both domestically and internationally are also considered. The chapter then looks at the relationship between registered marks and the public domain.
7. Trade Marks II: The Relative Grounds for Refusal of Registration, Infringement, and Remedies
Authors: Aplin Tanya , Davis Jennifer
Published: October 2021

All books in this flagship series contain carefully selected substantial extracts from key cases, legislation, and academic debate, providing able students with a stand-alone resource. This chapter discusses the relative grounds for refusal to register a trade mark; acts that constitute infringement; and remedies for infringement. It considers the finding of the Court of Justice of the EU that the investment, advertising, and commercial functions of a trade mark will be protected as well as its role as a badge of origin in cases of ‘double identity’ under the Trade Marks Directive and domestic law. The chapter considers possible changes to the position under the new Trade Marks Directive and following the UK’s departure from the EU. It looks at cases in which a third party is deemed to have taken unfair advantage of a trade mark with a reputation. It also discusses the use of trade marks on the internet and the implications for findings of infringement.
9. Breach of Confidence
Authors: Aplin Tanya , Davis Jennifer
Published: October 2021

All books in this flagship series contain carefully selected substantial extracts from key cases, legislation, and academic debate, providing able students with a stand-alone resource. This chapter focuses on the action for breach of confidence as it relates to commercial secrets. It first considers the jurisdictional basis of the action for breach of confidence and then discusses the elements for establishing a breach of confidence. The first element is that there must be confidential information; the second element is that the defendant comes under an obligation of confidence; the third element of a breach of confidence requires an unauthorized use of the information to the detriment of the person communicating it. The chapter also reviews the main confidentiality obligations that apply to employees and ex-employees with regards to commercial secrets. Finally, the chapter considers UK implementation of the Trade Secrets Directive and its relationship to breach of confidence.
4. Judicial Independence
Authors: Thompson Brian , Gordon Michael , Tucker Adam
Published: October 2021

This chapter examines the notion of judicial independence. It discusses the Constitutional Reform Act 2005 and its provisions reforming the office of the Lord Chancellor, establishing a new Supreme Court, and restructuring judicial appointments. Judicial diversity and discipline, along with further change to the judicial appointments process, are also considered. The chapter also considers the accountability of the judiciary to Parliament and the public, and the relationship between judicial independence and parliamentary privilege.