bluuebunny/crossref_metadata_2025 huggingface dataset:
Development of HELISC Health Literacy, Information and Social Capital Model
Authors: Corvo E
Published: October 2020

Issues

The literature and the interest of health professional on health information has grown rapidly during the last few years, but theory guiding this growth is lacking. The purpose of this article is to describe a developed model on Health Literacy, Information and Social Capital (HELISC) Model.

Methods

HELISc Model was based on the idea of a world of interrelated connections from virtual and traditional life without separation. Social capital represents the degree of social cohesion that exists in communities, furthermore social capital is recognised as the establishment between people of networks, norms, and social trust, and facilitate co-operation for mutual benefit. In evaluating the level of health-seeking information with social networks, it emerged that individuals, after obtaining the information requested, established ties with other individuals, similar to the development of social capital.

Results

The combination of interrelated connections from virtual and traditional life without separation leads to conscious action. This conscious action of health is given by the sum of antecedents (individual and environmental), by the formulation of the informative needs, by the reference information channels (offline/online), which leads to a conscious action. While the information-seeking activity can be labeled as a conscious action, the cohesion among individuals derived by the information exchange in the form of social support and social capital is unconscious. This model shows that there is not only the individual's interest in obtaining the information sought, but the development of a parallel mutual support leading to the development of social capital.

Conclusions

This model considers how virtual social network could be potentially considered as a new way to develop mutual support despite geographical distance and differences between individuals. More research is needed to support with evidence this model.

Key messages

Social capital and virtual health information, a new discover. Without Helisc model we don't understand influence of health information.
Smartphone addiction and anxiety disorder among medical students in Sofia – a preliminary study
Authors: Pravchanska M , Velkova A , Georgieva L , Georgieva E , Pesheva P , Hristov N
Published: October 2020

Background

Digital addictions and their influence on mental health are being intensively studied nowadays but scientific data about Bulgaria is still scarce. The study is focused on the prevalence of nomophobia among medical students, its relationship with anxiety and motivation for seeking professional help.

Methods

The cross-sectional study included 369 medical students, age 19-34 (mean 23) years. We analyzed the whole group and subgroups of Bulgarian/foreign students and second-/sixth-year students. Data were collected by a self-administered questionnaire including smartphone addiction scale (SAS) with a 4-point Lickert scale, a 7-item generalized anxiety disorder scale and socio-demographic questions.

Results

The prevalence of mild smartphone addiction was 55% and of moderate one 30%. The dependency score was higher in the groups with a moderate and severe level of anxiety (P < 0.001). There was no difference in dependency score by age and gender but it was higher among foreign students compared to Bulgarian students and lower in the sixth-year group compared to the second- year one. The anxiety score was higher in females compared to males and among second-year students compared to the sixth-year (P < 0.001). Only 40% of males and 50% of females reported motivation to look for professional help.

Conclusions

The prevalence of smartphone addiction is high among both Bulgarian and foreign medical students. Our results reveal co-morbidity of smartphone addiction and generalized anxiety disorder. The low motivation to consult a specialist points out underestimation of the problem. Implementation of educational programmes, individual and group therapy can help young people to curb smartphone use.

Key messages

Smartphone addiction is related to increased anxiety level and affects adversely mental health. The establishment of a healthy relationship between young people and technologies has to be considered as part of health promotion.
Screening Echocardiography in a Developing Country
Authors: Pereira de Sousa L A , Carvalho V Tostes , Wagner de Oliveira W , Lins de Barros M V , Guimarães Teixeira T , de Abreu de Rosa L Alcantara , Ribeiro AL Pinho
Published: October 2020

Background

The use of tele-echocardiograms could be useful for improving access of patients to echocardiographic evaluation in places where there is a shortage of trained physicians. It was evaluated the agreement between a physician sonographer and another health professional with basic training to acquire transthoracic images, assessed by a remote echocardiographer.

Methods

174 patients underwent echocardiography by a physician level III training in Echo. A moving image protocol (MPEG format, 3 cycles for each image) was stored: 2D parasternal long axis, apical four chambers with and without color. Soon after, a nurse with 20 hours of training in Echo, unaware of the result of the report, acquired the same protocol. The exams were randomized and sent to a remote observer, another echocardiographer level III, blinded to the sonographer's status, to recognize the presence of the any of the following abnormalities: left ventricular enlargement, hypertrophy and systolic dysfunction; right ventricular enlargement, left atrium enlargement and left sided valvopathy at least moderate. Agreement was evaluated by kappa concordance.

Results

It was analyzed 108 females and 66 males, median age= 61 y [P.25=50-P.75=72]; LV ejection fraction= 64 % [58-69] and body mass index= 27.6 kg/m2 [24.5-32.5]. There was a good concordance between the evaluators. All the indices analyzed showed agreement above 0.55 and statistic significance (left ventricular enlargement - 0.84; left ventricular hypertrophy - 0.84; systolic left ventricular dysfunction - 0.82; right ventricle enlargement - 0.72; left atrial enlargement - 0.80; valvopathy - 0.56).

Conclusions

The image acquisition by a tele-echocardiogram screening may be acquired by non-physician professionals with minimum training.

Key messages

Echocardiography. Remote.
Environmental substances associated with osteoporosis
Authors: Elonheimo H , Lange R , Tolonen H
Published: October 2020

Background

Osteoporosis is a disease adversely affecting the bone health and causing fragility fractures. Osteoporosis is affecting the lives of approximately 200 million people worldwide and causing nearly 9 million fractures annually. In the European Union the economic burden of osteoporosis and prior fragility fractures was estimated at €37 billion in 2010; the costs are predicted to double by the year 2050. The disease takes both personal and economic toll by causing significant disability and increasing health-care costs as the population ages. There is evidence, that certain environmental substances may increase the risk of osteoporosis.

Methods

In the framework of the European Human Biomonitoring Initiative (HBM4EU) a set of 18 priority substances and substance groups were selected to be further studied. Within HBM4EU a scoping document has been prepared for each of the substance groups. Based on a review of the recent literature, a scoping review of substances which might be associated with osteoporosis was prepared.

Results

The literature research revealed that there is a possible link of osteoporosis and heavy metals such as cadmium and lead. Additionally, for phthalates and per- and poly-fluoroalkyl substances (PFASs), a potential association was observed. Especially women in perimenopausal and postmenopausal stage have been identified as being at greater risk of harmful effects. Other substances such as bisphenols, arsenic, mercury and polycyclic aromatic hydrocarbons (PAHs) are suspected to have adverse effects on bone health but the evidence is still incomplete.

Conclusions

Although there is some evidence that these environmental substances have an adverse effect on human health, more research is needed. Some of the evidence is inconsistent, and there is a lack of extensive epidemiological studies. Since people are exposed to many substances simultaneously, there is a need to initiate studies which attempt to clarify the possible combined effects.

Key messages

Exposure to cadmium, lead, phthalates and PFASs may adversely affect bone health and increase a risk of osteoporosis. An inverse association of chemicals and bone mineral density is often detected. The growing concern of chemical exposure requires initiating of epidemiological studies on the subject. Multidisciplinary action for safeguarding citizenś health in Europe and worldwide is needed.
Urban health and Physical Activity: how urban design can improve cycling
Authors: Buffoli M , Capolongo S , Boati L , Rebecchi A
Published: October 2020

Introduction

It is well-known that physical inactivity is among the main risk factors that increases chronic degenerative diseases. The emergency is relevant in urban contexts, where, most transfers have a distance of less than 5 km, easily done by foot or bicycle. They would ensure an adequate daily physical activity. An increase of cycling would also lead to several other positive effects on the urban environment (air quality, less traffic, noise, etc.). Therefore, it is necessary to investigate which characteristics of the cycling and walking infrastructures encourage or not adequate lifestyles.

Methods

Starting from an analysis of the State of the Art related to the correlation among active transport, physical activity and health, a questionnaire was handed out to collect data on the current level of urban cycling and to quantify the expected increase in case of the improvement of the bicycle path network. The questionnaire was circulated through on-line and paper forms (1675 users), for a period of 3 months in the city of Milan. The aim was to quantify the increase in physical activity related to a provisional improvement of the infrastructures.

Results

The data collected subdivided into 9 districts show that the choice to use the bicycle, as an active means of transport, would significantly increase both in frequency and in duration: for example in the expected scenario 76.5% of the sample (over 21% more than the current one) would reach 150 minutes of physical activity per week, as WHO suggests. The main reasons for daily use or non-use of the bicycle were also identified.

Conclusions

The survey conducted highlighted the direct correlation between urban planning and active mobility. Actions related to mobility redesign, especially small-scale ones, could play a key-role in reducing physical inactivity with positive effects on health. The methodology could be replicated in other realities in order to highlight the specific strategies to be adopted.

Key messages

Questionnaires for improving cycling in urban contexts. Data analysis on citizens’ lifestyles for encouraging active mobility.
Evaluation of the performance of the partograph in the Kisanga health zone in Lubumbashi
Authors: Mwembo-Tambwe A , Chenge F , Kaya C , Michaux G , Mpunga D
Published: October 2020

Introduction

The partograph allows adequate fetal-maternal care during childbirth and the immediate postpartum in a maternity hospital. The objective of this study was to determine the proportion of the correct use of the partograph in maternity hospitals in the Kisanga Health Zone in Lubumbashi.

Materials and Methods

It was a cross-sectional study on the holding of the partograph, carried out in the Kisanga health zone in Lubumbashi during the month of November 2018. In total 794 partograms completed during the study period by providers in 89 maternity wards were analyzed. Two indicators have been known for the proper use of the partograph (for the decision price) and compliance with the benchmark. An element was considered correctly applied if its compliance rate was greater than 75%. The data were analyzed using SPSS 20

Results

Of 794 partograms collected, 63.6% were official (MSP or WHO) and 36.4% of wealth. In 32.6% of maternities, filling the partograph was easy. In total, 10.1% of maternities made the decision based on the line of attention of the partograph and 17.2% based on the line of action. The overall compliance rate for filling the partograph was 43.4% [41.1-45.6]; it was 50.0% [47.8-52.5] for maternal parameters, 54% [52.8-56.0] for fetal-adnexal parameters and 48.2% [47.4- 49.0] postpartum. The decision-making was 18.4% [18.2-18.5] and the filling time 33.3% [29.3-37.3]. It was found that 85.1% of partograms were completed during labor and 3.0% postpartum. The first point was correctly placed on the alert line in 19.6%

Conclusions

Partograph coverage, correct use and compliance rate are low in the Kisanga health zone. It turns out to be imperative to reinforce the correct use of the partograph and to rethink, if possible, a more simplified model with very sensitive items.

Key messages

This study has just helped to identify the parts of the partograms which are among the least filled and therefore the least understood by health care providers in health facilities. It has the merit of putting the thorny question of simplifying partograms back on the table for discussion in order to facilitate optimal use.
Exposure to tobacco smoke among pupils from Sopot primary schools. SOPKARD study results
Authors: Balwicki Ł , Tyrańska-Fobke A , Suligowska K L , Zdrojewski T
Published: October 2020

Background

The problem of tobacco use among minors and in their immediate environment remains a significant challenge in Poland. Although Poland has passed smoke free law children are still being exposed to tobacco smoke. The purpose of this study was to analyze the phenomenon of tobacco use by children in City of Sopot and in their surroundings.

Methods

The cross-sectional study was conducted as part of the SOPKARD program for early detection of risk factors for civilization diseases in children and adolescents. A limited GYTS questionnaire was utilized to conduct the study. Data was collected from all the fifth grade students (9-11 yo) attending to Sopot primary schools in 2017 and 2018.

Results

The study involved 385 students (161 in 2017 and 224 in 2018). Only few students tried to smoke traditional cigarettes (3%) or use electronic e-cigarettes (2%). Despite the legal ban, 24% of students saw smokers in the school premises. In addition, 34% of children said that one or both of their parents smokes and that in only slightly more than ¾ of the houses smoking is completely prohibited. As many as 66% of students reported smoking incidents in the cars they travel. There were 16% students who think they could start smoking in the future.

Conclusions

The results suggest that Sopot children are still exposed to tobacco smoke inhalation. It happens in private, non-smoking areas (homes and family cars). It is worth conducting educational activities and considering legislative initiatives such as smoking ban in vehicles carrying children to stimulate parents to take care more of the health of their children.

Key messages

Although tobacco legislation in Poland protects people from passive smoking in public places children are still exposed in private premises. Ban on smoking should be extended to privates cars at minimum.
Which body weight status is associated with depression? Results from a European population study
Authors: Cuschieri S
Published: October 2020

Background

A bidirectional relationship has been reported between depression and obesity. Malta, a European small state, is a highly prevalent country for obesity making this population ideal to study this relationship. The aim of this study was to identify the adiposity characteristics of a population-based depression sub-group and explore for any relationships between depression and an increase in adiposity.

Methods

A nationally representative health examination survey was conducted in Malta. Body mass index was measured while a validated questionnaire was used to establish the presence of depression and the sociodemographic characteristics of the participants. The study population was categorized into different sub-populations according to their adiposity status (normal, overweight, obese) and their self-reported depression. Multivariate logistic regression analyses were performed to identify independent adiposity status and socio-demographic factors associated with depression.

Results

The prevalence of self-reported depression was 10.44% (CI 95%: 9.52 - 11.43) with a female predominance and an overweight-obese profile. Extreme obesity (>50Kg/m2) was only present in individuals without depression. Only the overweight status (OR: 1.35 CI95%: 1.03 - 1.78 p = 0.03) was statistically linked with depression along with being female, having a low education level, being unemployed or retired and being a smoker.

Conclusions

The adiposity driver for the growing depression epidemic appears to be overweight rather than obesity. Stressful social determinants including unemployment, retirement, low education and being female have a role in this growing health concern. This calls for preventive action plans targeting overweight status, depression along with unfavourable sociodemographic characteristics.

Key messages

Overweight status was found to be linked with depression. Targeted action plans to prevent overweight and depression should be implemented with special attention to population with unfavourable sociodemographic characteristics.
A new gaming platform to improve cognitive performance and promote healthy behavior: a pilot study
Authors: Baccolini V , Isonne C , Migliara G , Salerno C , Marzuillo C , De Vito C , Villari P , Romano F
Published: October 2020

Background

Brain training games can sharpen the mind and potentially prevent cognitive diseases, that are particularly relevant to the population ageing. The EU funded project ACDC, Adult Cognitive Decline Conscientiousness, developed an online training tool to train cognitive functions and promote healthy behaviors in the adult population.

Methods

An online platform, consisting of 16 games with different levels, was built. Three main brain domains were targeted: memory, visuospatial and verbal skill. After the completion of each game level, healthy lifestyle tips were presented to the users. Participants were actively recruited from the project partners; inclusion criteria were adult age (40-70 years) without cognitive diseases. An adapted version of the Montreal Cognitive Assessment was used to assess cognitive performance at the start and after two hours of active gaming. The paired t-test was used to compare the scores before and after the training. A satisfaction questionnaire was administered at the end of the training session.

Results

Fifty-six participants from three European countries (Austria, Spain and Italy) took part in the pilot phase (median age: 57, IQR: 47-66). Most of them were university graduates (38%) or had a high school diploma (41%), employed full-time (46%) and females (82%). Significant improvements were registered in the verbal domain, where the mean score increased from 4.18 to 4.83 (p = 0.047), and in the memory area, where the mean score grew from 4.80 to 6.60 (p < 0.001). The visuospatial mean score improved from 4.55 to 5.16 (p = 0.0518). Most users (84%) were greatly satisfied with the platform and reported a high level of appreciation for the interactive gaming approach.

Conclusions

Despite the small sample size, the pilot phase detected some improvements in cognitive performance and a good appreciation of the training tool. Given these encouraging findings, the study will now be extended to more participants.

Key messages

The newly developed platform represented a promising tool to train cognitive functions. The proposed interactive gaming approach was greatly appreciated by the users.
Prevalence of depression among three cohorts of medical students
Authors: Georgieva E , Vatansever M , Velkova A , Hristov N , Pesheva P , Simeonova I , Dimitrova D , Pravchanska M
Published: October 2020

Background

Medical education is often related to serious distress for students, that affects negatively their mental well-being. Depression, poor academic performance, increased alcohol consumption, suicidal thoughts, are some of the detrimental effects of diminished mental health. Studies on depression in medical students reveal a higher prevalence (1.4-73.5%) than in the general population. This study aimed to assess and compare depression prevalence and severity in three cohorts of medical students in Bulgaria and Turkey.

Methods

We conducted a cross-sectional online survey with 257 Bulgarian and 288 foreign medical students from Medical University-Sofia, Bulgaria, and with 270 Turkish medical students from Ankara in the winter semester of 2019-2020 academic year. We used the Beck depression inventory (BDI) as valid and reliable instrument to assess depression. The students were categorised according to BDI scores in three groups: with mild depression (10- 18 points); moderate depression (19-29); severe depression (30- 63). Data were analysed with program product Python 3 (v3.6.9) with Pandas v0.25.3 and Scipy v1.4.1.

Results

Depressive symptoms reported 71.5% of Turkish students, 47.1% of Bulgarian and 48.7% of foreign medical students. The depression frequency among Turkish and Bulgarian medical students was significantly different (chi2 = 35.31; p = 0,001). Mean BDI scores were similar for Bulgarian medical students (11.0) and foreign medical students, studying in Bulgaria (11.6). Turkish medical students scored highest on BDI (15.3). Severe depression was detected in 5.6% of foreign, 4.3% of Bulgarian and 6.3% of Turkish students.

Conclusions

Depression prevalence was high in all studied medical students cohorts, with Turkish cohort affected most, probably because of cultural and curriculum differences.

Key messages

Support of student’s mental health should be an integral part of the educational policies of all Medical Universities worldwide. Depression among medical students has to be prevented by comprehensive approach.
PALOMA Centre of Expertise for refugee mental health – from research to action
Authors: Somersalo L , Mäki-Opas J , Castaneda A E
Published: October 2020

Issue

Previous migrant population studies have shown that immigrants experience higher level of psychological load than the overall population. This is especially prevalent in those with refugee background. The PALOMA project (Developing National Mental Health Policies for Refugees) was launched in 2016 to tackle this wellbeing cap. One outcome of the project was a PALOMA handbook, which includes recommendations as well as methods and tools for decision-makers, supervisors and professionals for promoting refugees' mental health and preventing, identifying and treating the problems. During the PALOMA project, the need for national coordination, establishing regional Centre of Expertises and support on refugees mental health work was recognized.

Results

To fulfill this need, the PALOMA2 project (National support system for refugee mental health work and the knowhow dissemination) started in February 2019. The PALOMA2-project establishes a Centre of Expertise for mental health work among refugees. The project personnel includes five regional experts, that each know the specific strengths and challenges of their region, and an expert from the 3rd sector, that ensures that the target group's and the 3rd sector's voice is heard throughout the project. Each of these six experts also pilot two tools from the PALOMA handbook.

Lessons

As a result of the PALOMA work, the mental health and mental health work with the refugees will be improved. The PALOMA Centre of Expertise will be a place of consultation, influencing, education, networking, developing and work guidance, and it will help all professionals that work in the field.

Key messages

The PALOMA Centre of Expertise is involved in developing different services in ways that improve refugee’s mental health and equal access for the developed services. The PALOMA Centre of Expertise will be a permanent part of the Finnish social and health care structure.
Sports participation for mental health promotion among socially vulnerable youth: a study protocol
Authors: Haavanlammi M , Appelqvist-Schmidlechner K , Kekkonen M , Ruiz-Ariza A , Fröjd S
Published: October 2020

The benefits of participation in organized sports on mental well-being of young people are well-known. However, there is lacking evidence on the relationship between participation in organized sports and positive mental health among socially vulnerable young people. Also, little is known about the mechanisms of sports-based programmes that may promote positive mental health among socially vulnerable young people.

The aim of this PhD study is to investigate the association between participation in organized sports and positive mental health among socially vulnerable children (7-12 years) and adolescents (13-15 years) using multiple methods and several databases.

I will present the study protocol of a PhD study focusing on use of sports participation as a tool for mental health promotion. Article 1 will be a systematic literature review and the data will be gathered from multiple databases. Article 2 is based on the School Health Promotion Study carried out in 2017 (ages 14-15; n = 73 680). Article 3 is based on Icehearts longitudinal study (n = 46 children participating Icehearts programme and n = 180 controls) and article 4 is based on observations (n = 5 Icehearts teams including 50 children and 5 coaches) and interviews (25 Iceheartś children and their 50 parents).

Preliminary findings of the systematic literature review indicate that there is a lack of evidence how to promote mental well-being through sports participation among socially vulnerable young people.

The study will provide valuable knowledge which can be utilized to prevent mental health problems and to promote positive mental health. This knowledge can be used both in municipal and political decision-making, and in developing targeted, sport-based interventions for socially vulnerable children and adolescents in order to reduce health inequalities.

Key messages

Observational data on interventions including perspectives of children is rare but crucial to develop effective programmes for promoting positive mental health among socially vulnerable youth. Knowledge obtained from this study can be used to develop targeted, sport-based interventions for socially vulnerable children and adolescents in order to reduce health inequalities.
Well-being of families of people with psychosocial disabilites in context of deinstitutionalization
Authors: Austys D , Bendikaitė S , Arlauskas R , Jakubauskienė M , Stukas R
Published: October 2020

Background

A large part of disabled people have psychosocial disabilities. Importance of their inclusion is stated in many strategic documents. However, this group of people still faces many barriers in societies. Currently, deinstitutionalization is carried out in Lithuania. Well-being of people with psychosocial disabilities and their family members is affected by this process. Thus, we aimed to assess changes in well-being of family members of people with psychosocial disabilities during deinstitutionalization in Lithuania.

Methods

Data was collected during two stages of deinstitutionalization, in 2016 and 2019. Family members living with people with psychosocial disabilities answered anonymously to questions of Lithuanian psychological well-being scale. Respectively, 334 and 391 adults participated (13.8% of males and 86.2% of females each time). T scores and levels of well-being were calculated and compared according to socio-demographics of respondents and stage of deinstitutionalization.

Results

Generally, distribution of the participants did not differ by level of overall well-being between the stages of deinstitutionalization (p-value more than 0.05). Differently, place of residence, younger age, higher income and employment were associated with higher well-being. In the second phase, rural, younger, employed and full-time employed respondents had higher estimates of overall well-being (p-value less than 0.05). Also, younger and employed population had higher satisfaction with physical health, income, employment and life in Lithuania (p-value less than 0.05). In most counties of Lithuania, overall well-being of family members of people with psychosocial disabilities was in line with the average level.

Conclusions

Although distribution of family members of people with psychosocial disabilities by level of overall well-being had not changed from 2016 to 2019, an increase in well-being among rural, younger, employed and those with higher income was observed.

Key messages

Generally, overal well-being of family members of people with psychosocial disabilities had not changed during the process of deinstitutionalization in Lithuania from 2016 to 2019. Living in rural areas, younger age, higher income and employment were associated with an increase in well-being of family members of people with psychosocial disabilities.
Cognition, loneliness and social isolation: A cross-national, longitudinal exploration
Authors: Hannemann T-V , Bristle J , Wagner M
Published: October 2020

Background

One of the challenges to ageing individuals and health care systems is the decline in cognitive function with increasing age. The present study investigates in which way loneliness and social isolation is associated with cognitive decline in an aged population in Europe. Furthermore, it investigates how these relationships vary across different cultural and social settings.

Methods

The study employs panel data from the Survey of Health, Ageing and Retirement in Europe (SHARE). Data from respondents aged 50+ from 16 European countries were collected from 2011-2017 at up to four points in time. Loneliness was operationalized as the perception of feeling lonely, while social isolation was operationalized by a summary index of social network size and social interaction. The cognitive function measures included tests of verbal fluency, as well as immediate and delayed recall. A linear panel fixed-effects modelling approach was used, while controlling for potential time-variant confounders from the areas of demographics, mental and physical health and survey methodological characteristics.

Results

Preliminary results show that loneliness and social isolation are associated with cognitive decline, while the extent varied by the measure of cognitive functioning measured. Loneliness, social isolation and cognition descriptively all show substantial cross-national variation.

Conclusions

The study illustrates the impact of loneliness and social isolation on cognitive functioning across a number of European countries. Cognitive functioning is an important determinant to successful ageing, preventing its decline promotes self-sufficient, independent living in the elderly and good quality end-of-life. This can support the development of implementable and accessible prevention for at risk individuals.

Key messages

Investigating the impact of social isolation and loneliness on the cognitive functioning can help tailor easily accessible prevention measures of cognitive decline in the elderly. The study allows for the assessment of cross-cultural differences and need for targeted measures across a number of European countries.
Adolescent mental health: analysis using YP-CORE test in School health services in Croatia
Authors: Jureša V , Posavec M , Latković Prugovečki S , Musil V , Majer M , Vidović Petričević T
Published: October 2020

Issue

Adolescent mental health problems are a leading health problem in this population and remain unrecognized for a long time. The aim of this study was to examine the mental health problems with YP-CORE test as a part of regular school health periodic examination of first-year secondary school students (ages 15-16).

Description of Problem

Study included 392 first-year Zagreb secondary school students (74.5% girls) academic year 2019/2020. Data were collected by YP-CORE test ten questions about feeling over the last week. The students provided informed consent, and testing was done during regular periodic examinations. Data were analyzed using descriptive statistics.

Results

At risk of mental health problems were 7.5% of girls (22/292) and 2.0% of boys. Nine girls (3.1%) had a low overall score, ≤ 19 points, which would mean little risk but had a positive answer to the question 'I've thought of hurting myself'. Ten girls (3.3%) had a score of ≥ 20, which meant an increased risk and a particularly positive answer was the 'I've thought of hurting myself' question. Three girls (1%) had a score of ≥ 20, which meant an increased risk with no additional risk of auto-aggression. The results in the boys are completely different. Two students, 2% (2/100) had a total score of ≥ 17, which meant an increased risk and a particularly positive answer was the 'I've thought of hurting myself' question. All recognized risk students are immediately involved in the counseling of the School and University Medicine Counseling Services provided by every secondary school in Croatia.

Lessons

The results of the study showed that mental health problems have 6.1% secondary school students with gender differences, girls 7.5%, boys 2%. School health service developed a protocol for students at increased risk. The first step is school medicine specialist interview with the student, then with the parents and the student, and second step including school staff and other professionals.

Key messages

Early identification of mental health problems, timely intervention and continuous monitoring of mental health among secondary school students in Croatia. Counseling service for students should be available within the school health service, implementing preventative measures and working closely with other services and professionals.
Local policy for managing the risk of the proliferation and spread of Legionella in the Girona area
Authors: Vilà I , Esparraguera C , Arjona L , Castro P , Redondo M , Soms D , Macau A , del Acebo X
Published: October 2020

Issue

The towns in the Girona area are mostly small (70% have fewer than 1.500 inhabitants) and employ few public health technicians. Difficulties exist in municipal facilities when it comes to carrying out self-assessment tests and fulfilling regulatory requirements.

Description

In 2009, Dipsalut designed a programme to offer support to local councils in the management and control of the sanitation of municipal facilities at risk of transmitting Legionella.

Main Objectives

To improve the control of the health risk, to ensure the technical capacitation of personnel and to achieve territorial equity in health protection. The programme methodology comprised: a service provision programme with structured actions, a network of public health stakeholders and an information system shared between the stakeholders. The programme includes the structural description of the facilities, the study of the risk factors for the proliferation and spread of Legionella, the drawing up of control plans based on the HACCP system, analyses to determine and quantify Legionella, preventive cleaning and disinfection, on-site advice for workers, and training courses.

Results

Regarding the improvement in the control of the health risk: - In 2019, 905 facilities were controlled in 105 towns. In the last 8 years, the refurbishment of 239 facilities has been carried out, involving a total investment of 2,075.857€.Reduction in the concentration of Legionella where more exhaustive sampling is carried out.

Regarding the technical capacitation of personnel: 2.012 people on courses and 10.121 people in visits on-site.

Lessons

Realising the importance of ensuring the co-responsibility of facility managers. Adapting actions to be carried out in facilities according to risk: the greater the risk, the greater the effort.

Key messages

The application of an area-wide programme improves facility risk management. Ensuring technical capacitation, incorporating improvements based on common experiences and optimising resources.
Trends in selected socio-economic determinants of depression in Italy, 2013 through 2017
Authors: Acuti Martellucci C , Montagna V , Acquaviva G , Masiero A , Biardi L , Ciotti M , Lombardi M , Mariotti A
Published: October 2020

Background

In Italy, in 2015 suicide rate was 6.5/100,000 inhabitants, while in 2017 depressive disorders were estimated to represent 2.3% of total DALYs. The indicator for monitoring mental health is the suicide rate, but surveys such as the European Health Interview Survey (EHIS) of 2015 have identified several predictors of depression. We aim to assess trends in factors associated to depression in Italy, from 2013 to 2017.

Methods

Data from the Aspects of Daily Living survey (AVQ) carried out by the Italian Statistics Institute, from years 2013 to 2017, were used in this analysis. Investigated factors were those identified as predictors of depression in Italy according to the EHIS 2015: (1) education until middle high school and (2) high school, (3) poor social support (single-person households without friends, neighbours, or relatives to count on), (4) unemployment, (5) chronic disease, (6) moderate limitations of daily activity due to poor health, and (7) severe limitations. We calculated the prevalence of these factors, and 95% Confidence Intervals (CI), by sex and year.

Results

The prevalence of poor social support rose, differing significantly in men between 1.5% (95% CI 1.3% - 1.8%) in 2013 and 2.1% (95% CI 1.9% - 2.3%) in 2017. Unemployment decreased in men, from 12.7% (95% CI 12.0% - 13.4%) to 10.4% (95% CI 10.0% - 10.8%), whereas chronic diseases and moderate limitations grew significantly in both sexes, at respectively 24.6% (95% CI 24.0% - 25.2%) and 16.1% (95% CI 15.6% - 16.6%) for men, and 29.0% (95% CI 28.4% - 29.6%) and 19.4% (95% CI 18.9% - 19.9%) for women in 2017.

Conclusions

The growing proportions, in Italy, of people with poor social support, chronic diseases, and moderate limitations of daily activities, suggest that health care programming at the national level should prepare for a rising burden of mental disease in these groups, and take into account measures to promote well-being.

Key messages

Among factors associated with depression, poor social support, chronic diseases, and moderate physical limitations due to disease showed a growing trend in Italy from 2013 to 2017. The Italian yearly AVQ survey investigates predictors of mental disease, particularly depression, and could provide early data for effective health care programming and mental health promotion.
Perfluoroalkyl substances and blood pressure in exposed young population in the Veneto Region, Italy
Authors: Canova C , Jare Zeddi M , Barbieri G , Gion M , Daprà F , Russo F , Fletcher T , Pitter G
Published: October 2020

Background

Residents in a large area of the Veneto Region (North-Eastern Italy) were exposed to perfluoroalkyl substances (PFASs) via drinking water. Studies on the association between PFASs and blood pressure (BP) levels are limited and results are inconsistent. Using cross-sectional data from the Regional health surveillance program, we aimed to quantify the associations between PFAS serum concentrations and blood pressure and hypertension prevalence.

Methods

The study included 16,224 individuals aged 20-39 years. Pregnant women (n = 327), participants with self-reported diagnosis or under treatment (n = 296) or with missing information on the selected covariates (n = 114) were excluded, leaving 15,487 subjects. Hypertension (HYP) was defined as any self-reported diagnosis, use of antihypertensive drugs, or raised systolic/diastolic blood pressure (SBP)≥140, DBP ≥90 mmHg). Serum PFASs were measured by HPLC-MS. Generalized additive models were used to investigate the relation between each PFAS (perfluorooctanoic acid (PFOA), perfluorooctane sulfonic acid (PFOS), perfluorohexane sulfonic acid (PFHxS), and perfluorononanoic acid (PFNA)) ln transformed and by decile, and SBP, DBP, HYP, adjusted for potential confounders.

Results

Both SBP and DBP increased significantly with an increase in the ln-transformed serum PFASs concentration in a monotonic way. The predicted increase in SBP and DBP were 1.62 (95% CI = 0.69, 2.55), 1.64 mmHg (95% CI = 0.96, 2.31) from lowest to highest decile of PFOA. The associations were stronger for SBP in men and DBP in women. One unit increase in each ln-PFAS was positively associated with an increased odds of HYP in men: PFOA OR = 1.07 (1.01-1.14), PFOS OR = 1.18 (1.05-1.32), PFHxS OR = 1.11 (1.03-1.19), PFNA OR = 1.19 (1.01-1.41).

Conclusions

Our findings suggest that exposure to PFAS is associated with increased blood pressure and thus may contribute as a risk factor for the development of cardiovascular diseases.

Key messages

Serum PFASs were associated with raised systolic blood pressure in men and diastolic blood pressure in women in a large highly exposed young adult population. Serum PFASs were associated with raised prevalence of hypertension in men.
Depression screening program tailored to the primary health care settings
Authors: Strkic D , Niskanovic J
Published: October 2020

Issue

Depression is the leading cause of disability worldwide. People with mental health problems often do not feel comfortable to seek help from mental health professionals. Depression is often 'covered' with physical symptoms and patients first seek help from family medicine doctors.

Description of the Problem

Primary health care organized through mental health centers and family medicine service was base for planning of depression screening program. Program is supported by the Ministry of Health and Social Welfare in the Government of Republic of Srpska and the Mental Health Project in BiH (implemented by Association XY with support of the Government of Switzerland). Methodology and promotional materials were developed in the Public Health Institute. Outcome was improved health of the adult population at increased risk of depression. Program was implemented from June 2018 till December 2019 in ten primary health care centers. Mental health centers (MHC) sensitized and trained family medicine teams (FMT) for screening. FMT used Patient Health Questionnaire 9 (PHQ 9), MHC used the Hamilton scale for confirmation. Confirmed cases were measured for quality of life with the Q-LES-Q-SF. Both of questionnaires were used for control measurement after three months of treatment.

Results

Screening of 1037 patients resulted in 445 of them were referred, of which 310 patients came to the MHC, where depression was confirmed in 289 patients. In control measuring, 30% of the patients showed the absence of depression, with a significant improvement in the self assessment of the overall quality of life.

Lessons

Clear methodological guidelines and program adjusted to the organization of health care services, along with monitoring and evaluation, was crucial, and appreciated from health professionals involved. Regular communication of mental health centers and family medicine services was important in overcoming obstacles to get patients in the program, and maintain them.

Key messages

Stigma still prevents patients who need help to get to the mental health services. Sensitized and trained family medicine doctors, as first contact with patients, are crucial in early detection of depression and convincing patients to accept help and stick to treatment.
Non-communicable disease risk factors among a cohort of mine workers in Mongolia
Authors: McCarthy A , Damiran N
Published: October 2020

Background

Prevalence of non-communicable diseases (NCD) are growing among working populations globally. The World Health Organization (WHO) estimates NCD are responsible for 80% of all premature deaths (Lancet, 2016). The purpose of this study is to determine baseline level of NCD and risk factors among mine workers and to identify intervention strategies based on results. The collected results will be compared with a NCD study on the general population of Mongolia.

Methods

A cross sectional design was used for this study. 684 employees were randomly recruited to the study. We utilised WHO questionnaire to collect anthropogenic measurements, health behaviours, alcohol consumption, smoking, NCD and work related information.. The study focused on four (4) key risk factors of hypertension, obesity, drinking habits and smoking habits. These factors are key contributors to NCD and decreased life expectancy.

Results

Results of the study showed prevalence's of hypertension 12.9%, obesity 64.1%, alcohol users 22.1% and smokers 38.8%. The general population prevalence's are 27.5%, 56.8%, 15.5% and 24.8% respectively. Differences between gender in the study cohort for smoking rate (men = 43.3%, women = 8.9%), alcohol consumption (men = 29.9%, women = 16.1%) and central obesity (men = 78.3%, women = 35.1%) were statistically significant (p < 0.05).

Conclusions

Prevalence of arterial hypertension for the mine worker cohort was lower than general population, however, obesity, drinking and smoking rates were higher. The study findings allow us to target intervention strategies to mitigate the risk of NCD development in the future.

Key messages

Understand the risk factors and control measures available to mitigate the risk of the development of NCD. Comparison of the mine site cohort with the general population to understand similarities and differences.
Innovative prototypes for cervical cancer prevention in low-income primary care settings
Authors: Arrivillaga M , Bermúdez Jaramillo P C , García-Cifuentes J P
Published: October 2020

Issue

In 2018, the mortality due to cervical cancer rose by 6.9 compared to the previous year, with 311.365 deaths in total. By 2030, it is estimated that there will be a 21.3% increase in incidence and 26.7% in mortality. In Colombia, cervical cancer is the second cause of death by cancer in women.

Description of the Problem

We present the design process of innovative prototypes for cervical cancer prevention in primary care centers located in low-income settings in Cali, Colombia, using the Human-Centered Design (HCD) approach. The practice was developed in collaboration with a public healthcare network comprised of 38 urban and rural centers with women between the ages of 25 and 65 years, healthcare providers of the cancer program, healthcare managers. We conducted five HCD stages: research, need synthesis, ideation and co-design process, prototyping and in-context usability testing. We used observations, open-ended interviews and conversations, multi-stakeholder workshops, focus groups, systematic text condensation analyses and tests in real contexts.

Results

We designed four prototypes: (1) 'Encanto': An educational manicure service, (2) 'No le des la espalda a la citología': A media-based strategy, (3) An educational wireless queuing device in the waiting room, and (4) Citobot: A cervical cancer early detection device, system, and method.

Lessons

The tests carried out with each prototype showed their value, limitations and possibilities in terms of subsequent development and validation through public health research or clinical research. We recognize that a longer-term evaluation is required in order to determine whether the prototypes will be used regularly, integrated into cervical cancer screening services and effectively improve access to cytology as a screening test.

Key messages

HCD is a useful methodology for design-based prevention in the field of cervical cancer. Integration of HCD with public health practice would allow the generation of evidence prior to the formulation of policies and programs as well as optimize existing interventions.