bluuebunny/crossref_metadata_2025 huggingface dataset:
Racial inequality and periodontal condition in Brazilian adolescents
Authors: Moreira R S , Santos L D R
Published: October 2020

Background

Oral health, such as other health conditions, reflects social inequalities. These inequalities are fed back by oral diseases, generating a vicious and sustainable circle. Racial issues play a prominent role, once they are associated with oral diseases as risk markers. Among the different oral diseases, periodontal disease associated with racial inequalities in adolescents is emblematic. Thus, this study aimed to analyse the race differentials associated with the levels of periodontal disease, regardless of other risk factors.

Methods

Data from the 2010 national epidemiological survey on oral health were used, with 5445 adolescents (15 to 19 years old). Multinomial logistic regression models were used. Dependent variable was the Community Periodontal Index. Independent variable was self-declared race/colour, categorized as white, pardo (mixed-race identity) and preto (black). The effect of race was controlled in the presence of the covariates sex, years of study, decayed, missing and filled permanent teeth (DMFT index), toothache and self-reported need for dental treatment. Odds Ratio (OR) was estimated and sample weights were considered.

Results

The simple model showed preto with 2.7 (p < 0.05) and 8 (p < 0.05) times more likely to have shallow and deep periodontal pockets, respectively, compared to white. Pardo was 1.5 (p < 0.05) times more likely to have periodontal calculus. In the multiple model, even in the presence of all independent covariates, preto showed association with shallow pockets (OR = 2.51, p < 0.05) and pardo showed association with the presence of calculus (OR = 1.37, p < 0.05).

Conclusions

Regardless of sex, education, perception of pain and need for treatment and the DMFT index, race/colour was associated with periodontal problems. It should be noted that skin colour is not a biological risk factor for periodontal disease. However, the findings of this study revealed racial inequities regardless of socioeconomic variables.

Key messages

Raises the need to guarantee health as a resource for social development, with science having a fundamental role in recovering the citizenship of this historically forgotten population. The findings of this study revealed racial inequities regardless of socioeconomic variables.
Challenges in meeting patient assessment international standards in ambulatory tuberculosis services
Authors: Aslanyan L A , Truzyan N T
Published: October 2020

Background

Limitations of tuberculosis (TB) diagnostic tools and measures restrict proper TB control in places with high drug-resistant TB prevalence. This study aimed to explore gaps in the primary health care (PHC) TB services in Armenia compared to international standards on Assessment of Patients (AOP).

Methods

We applied mixed methods to assess the AOP standards in 30 outpatient TB centers using observational and documents/medical records review's standardized checklists, in-depth interviews, and focus group discussions. Evaluation was conducted in all 10 regions of Armenia and the capital city Yerevan. Joint Commission International Standards for Ambulatory Care, International Standards for TB Care, and WHO framework, served as a guideline for this assessment.

Results

PHC physicians are qualified for a set of examinations to diagnose TB. Planned reassessments are conducted continuously, though defined writings for the scope and content of reassessments administered by each clinical discipline is absent. Laboratory departments provide high quality services to the TB patients with the defined timeframes for reporting the results. Laboratory and radiology services staff is qualified and experienced. The biosafety rules are compliant with local and international standards. However, the location and conditions of the laboratory departments are mostly non-compliant with the standards. Lack of modern equipment restricts maintaining proper environmental controls, including ventilation systems. Laboratory technicians have little knowledge of the organization's safety management program and its relation to the laboratory safety program. The facilities have neither formal quality control programs regulated by documents and policies nor an identified radiation safety program protocol.

Conclusions

On the level of AOP standards, the PHC TB services in Armenia have satisfactory performance. However, assessed standards for this function required certain improvements.

Key messages

In Armenia, the tuberculosis care in PHC facilities presents high level of compliance for patient assessment international standards. To fully meet the standards, facilities need to reconstructed/renovated laboratories and establish the radiology and diagnostic equipment management, quality control and radiation safety programs.
20 years of Malaria notifications in Bologna AUSL
Authors: Canal V , Ubiali A , Resi D , Pandolfi P , Fantini M P
Published: October 2020

Background

Notification of confirmed or suspected cases of Malaria is compulsory in Italy. It is essential to optimize control measures in case of imported and indigenous events, considering that the main local vector, Anopheles labranchiae, is still present in Italy.

Methods

Descriptive analysis of malaria cases notified from Bologna local health authority (AUSL) from January 2000 to December 2019.

Results

In the period 2000-2019, out of the 248 Malaria cases notified to the AUSL, 161 were males, and 87 were females, with median age of 33 (IQR: 42-25). All the cases were sporadic and travel-related. The main reasons for travelling were: return to the country of origin (n = 139, 56,0%), tourism (n = 39, 15,7%), work (n = 30, 12,1%), and immigration (n = 13, 5,2%). 86 (34,7%) cases were born in Italy, 43 (17,3%) in Nigeria, 27 (10,9%) in Cameroon, and 17 (6,9%) in Ghana. The cases were imported from Nigeria (n = 56, 22,9%), Cameroon (n = 30, 12,2%), Ghana (n = 26, 10,6%), Ivory Coast (n = 24, 9,8%). Most of the cases were not taking any drug for Malaria chemoprophylaxis (n = 214, 86,6%), 20 cases (8,1%) properly completed the prophylaxis, while 13 cases (5,3%) started chemoprophylaxis but they didn't complete it. The etiological agent identified was Plasmodium falciparum in 176 cases (71,0%), P. vivax in 26 cases (10,5%). Among the former cases 49 (32,2%) were contracted in Nigeria, 29 (19,1%) in Cameroon, 23 (15,1%) in Ghana, 20 (13,2%) in Ivory Coast, 10 (6,6%) in Senegal. 11 (68,8%) cases of P. vivax were contracted in Pakistan.

Conclusions

Epidemiological data collected from Bologna AUSL are consistent with those described from Istituto Superiore di Sanità: the majority of cases was comprised of foreigners, the great majority of cases was imported from Africa. P. Falciparum was prevalent in Africa while P. vivax was prevalent in Asia.

Key messages

The knowledge of the epidemiological situation allows public health workers to advise international travelers focusing on those most at risk of contracting Malaria. Periodic assessment of local epidemiology is necessary to evaluate if data are consistent with those described from international literature.
Is it or is it not? Lessons learned from a case of suspected vaccine strain measles
Authors: Lord H , Kok J , Fletcher-Lartey S , Alexander K
Published: October 2020

Background

Measles continues to be a threat to Australia. While post eradication risks are low, imported measles cases from overseas travellers who are non-immune can cause small outbreaks. This case report discusses the challenge of identifying wild-type measles in an individual who was recently vaccinated with measles - containing vaccine (MCV).

Methods

A positive polymerase chain reaction (PCR) result for measles for an adult who had recently received a measles -containing vaccine was notified. Investigation revealed no known epidemiological link, recent overseas travel or contact with recent measles cases during the incubation period.

Results

The results of the initial sequencing to distinguish between wild-type and vaccine-strain measles were inconclusive. A decision was made to re-run the genotyping, collect additional specimens, and quarantine the case until a definitive result was obtained. Sequencing and genotyping revealed that this indeed was a wild-type measles strain.

Conclusions

Changing epidemiology of measles means distinguishing between wild-type and vaccine-strain measles has become a new challenge. The reflection of the public health management of this case has provided is a valuable teaching tool for public health professionals globally, particularly in low incidence measles countries.

Key messages

The lack of an epidemiological link can create confusion for public health staff when investigating possible measles cases. Changes in the epidemiology of measles means distinguishing between wild type and vaccine strain measles is a challenge.
Tuberculosis and HIV among homeless persons in Rio de Janeiro
Authors: Gioseffi J , Brignol S
Published: October 2020

Background

Tuberculosis is the first cause of death among infectious diseases worldwide (WHO, 2019). People with HIV have 28 times more chances to be infected with TB (MS, 2018) and it represents 29% of the TB deaths in Brazil (SANTOS, 2018). In 2017, the TB incidence ratio in HIV+ patiences was 5.3 out of 100.000 inhabtants in Brazil WHO, 2019). Among homeless persons, socially excluded and disregarded by the public authorities, the scenario of these diseases are even worse, considering that the greater exposure of TB occurs in people with lower incomes (UN, 2016), more vulnerable at the social and programmatic level. The aim of this article is to present the epidemiological profile for TB and HIV infection in homeless persons in the city of Rio de Janeiro between 2014 until 2018.

Methods

The data to this research are of public acess from 2014 to 2018 for the analysis of vulnerability factors in the notification form for TB and HIV in homeless persons. The data are originate from SINAN NET provided by the Rio de Janeiro Municipal Health Department.

Results and Conclusions

There were 1644 notifications for TB, among whom 15.8% had AIDS co-infection and 15,9% had HIV co-infection. Co-infected with TB and HIV 45,5% were brown people, followed by 36.2% black and 18.3% white. Among the homeless people with TB and HIV co-infection (262), were in the 20 to 39 age group 58%, followed by 37.4% in the 40 to 59 age group. Among the TB notifications, 30,8% achieved a cure, 60,4% abandoned treatment and 4,2% died due to TB. General speaking about the city population, the proportion of TB/AIDS coinfection in Rio de Janeiro is 11,5% and 12,2% for TB and HIV. Brown people (41,7%) between 20 and 39 years old (91,2%) were the majority infected as well. About the outcome, 65,8% achieved cure, 12,4% abandoned treatment and 3,5% died from TB. According to the analyzed data, homeless persons presents worst results when compared to the general citizens of Rio de Janeiro.

Key messages

Homeless persons presents worst TB and HIV results when compared to the general citizens of Rio de Janeiro. Study of witch social vulnerabilities are associated with this health conditions.
Challenges of ongoing Covid and Ebola epidemics amidst violence and other epidemics in DR Congo
Authors: Amorim Tomaz A , Bastos F I P M , Santos R S , Mossoko M
Published: October 2020

The world has seen outbreaks of emergency and re-emergency of infectious diseases very often in the past years, many of them with devastating consequences for low-income countries with fragile or nonexistent health system, covid-19 being by now the last of a long series of global challenges. Although it is a huge challenge for the whole world, one country is facing it together with a current Ebola outbreak plus violence and some other diseases. The Democratic Republic of Congo is facing the immediate effects of both epidemics as illness and death, however its consequences at the political and economic level are usually more complex and may be protracted. Following the debate on why poor countries remain poor, it is maybe useful to rethink poverty and inequality keeping in mind Amartya Sen's seminal concepts: development must comprise freedom and respect for human rights and institutions at the price of fostering a vicious circle of (re)emerging diseases and structural violence. Ebola epidemics, that usually face some challenges when they happen alone, now together with malaria, measles, plague and covid, on top of violence in some areas, the disease sees its protocols harmed: for covid the orientation is to stay isolated, for Ebola the response includes tracking contacts. What means coming with a team to field to do the mapping in the middle of a confinement. The surveillance for such many epidemics on top of violence and humanitarian crisis makes the Democratic Republic of Congo one of the most worrying countries in terms of consequences of the Covid outbreak.

Key messages

Study of the association between the Covid, Ebola virus disease outbreak and the at-risk population living in the conflict zone in Eastern Democratic Republic of Congo. The study presents the difficulties that the population encountered in the face of restrictions imposed by armed groups to reach health services during an Ebola outbreak, in a conflict zone.
Representations of adolescents on HIV/AIDS with a focus on sexuality and vulnerability to infections
Authors: Sousa M A , Oliveira P A , Lima M D O , Freitas M I F
Published: October 2020

Background

The highest increase in AIDS cases in Brazil is among 15-24 years old. In the last eight years, there have been almost 30,000 new cases in this population group, which represents an average of 10 new cases per day. This chart highlights the importance of promoting health and prevention of sexually transmitted infections (STIs) and AIDS for this population group. The purpose of the present study is to understand representations of adolescents of both sexes on HIV/AIDS, focusing on sexuality and vulnerability to sexually transmitted infections.

Methods

This is a research with a qualitative approach based on the theory of Representations and included in the study 28 adolescents high school students of two state public schools. Data collection took place through open interviews, held individually at agreed times and locations between the researchers and the direction of the schools. The interviews were of the in-depth type, with a semi-structured script, containing questions that allowed the participant to narrate facts, express their points of view, value judgments, and evaluate actions and ways of thinking about sexuality, sexual health and risk of infection HIV and other STIs, yours and others.

Results

The data were interpreted based on the Structural Analysis of Narration, being grouped into two categories: Sexuality; Risks involved in sexual intercourse. This study highlighted the complexity that involves issues related to sexuality and adolescence, just as adolescents deal with the risks of becoming infected with an STI. There are differences between representations of sexual relations for adolescent females and males.

Conclusions

The representations of adolescents about sexuality and about HIV/AIDS prevention are structured more in their exchanges and experiences in the social space, with colleagues and friends, than in family institutions and in school. It is necessary that there be continuous actions and not only in specific periods.

Key messages

Understanding how adolescents experience sexuality can be the starting point for more effective health promotion actions for this population group. Since the beginning of the AIDS epidemic, there have been different ways of coping with this infection. Thus, it is important to know the representation of adolescents today about this theme.
Tuberculosis’ surveillance in a group of primary healthcare centres of Lisbon district
Authors: Gomes F A , Duarte S , Lopes D G , Moreira A , Pereira M B , Cunha I , Gil M M , Pinto C S
Published: October 2020

Background

Tuberculosis (TB), a communicable disease, is the leading cause of death from a single infectious agent and one of the top 10 causes of death worldwide. Its burden varies among different countries. In the 31 European Economic Area member states, in 2017, the TB notification rate was 10.7/100,000 population; in Portugal, this rate was 17.5/100,000 population and the majority of the notified cases occurred in two districts: Lisbon and Oporto. The aim of this study is to analyse TB's notifications in a group of primary healthcare centres of Loures-Odivelas (ACES LO), between 2015 and 2019.

Methods

An observational, descriptive, retrospective, quantitative study was performed. Data was collected in January 2020, from the National System of Epidemiological Surveillance Database. Variables included were: age, sex, TB's presentation, antimicrobial susceptibility testing, HIV testing. Descriptive analysis was performed for all variables.

Results

In ACES LO, notified cases of TB dropped 18.0% between 2015 and 2017, having since increased by 54.8% (n = 113), a notification rate of 32.3/100,000 population in 2019. The male to female ratio was 1.7 and the most affected age group was the 30-40 year old group (n = 25). Notified cases in children <10 years old have increased from 0 in 2016 to 7 in 2019. Pulmonary TB was reported in 73.5% (n = 83) of the notified cases; in 56.6% (n = 64), antimicrobial susceptibility testing revealed that first-line treatment would be effective; HIV testing was positive in 10.6% (n = 12).

Conclusions

Surveillance is the first step towards taking action to control and eliminate TB. ACES LO has a high notification rate of TB, therefore effort should be made in order to reduce TB's incidence. More investigation should be performed in order to evaluate the possibility of reintroduction of Bacille Calmette-Guérin (BCG) vaccine to the general population, instead of only risk groups, as it happens in ACES LO since 2016.

Key messages

Surveillance is one of the ten essential Public Health operations, allowing us to measure and analyse health problems in a certain population. Tuberculosis’ incidence is still high in some populations; it is a critical issue to raise awareness about.
Determinants of neonatal, postneonatal and maternal mortality on models of primary health
Authors: Guerra A B , Guerra L M , Probst L F , Castro Gondinho B V , Bovi Ambrosano G M , Azevedo Melo E , Vilela Bulgareli J , Cortellazzi K L , Octaviani J V , Pereira A C
Published: October 2020

Background

The state of São Paulo recorded a significant reduction in infant mortality, but the desired reduction in maternal mortality was not achieved. Knowledge of the factors with impact on these indicators would be of help in formulating public policies. The aims of this study were to evaluate the relations between socioeconomic and demographic factors, health care model and both infant mortality and maternal mortality in the state of São Paulo, Brazil.

Methods

In this ecological study, data from national official open sources were used. Analyzed were 645 municipalities in the state of São Paulo, Brazil. For each municipality, the infant mortality and maternal mortality rates were calculated for every 1000 live births, 2013. The association between these rates, socioeconomic variables, demographic models and the primary care organization model in the municipality were verified. We used the zero-inflated negative binomial model. Gross analysis was performed and then multiple regression models were estimated. For associations, we adopted “p” at 5%.

Results

The increase in the HDI of the city and proportion of Family Health Care Strategy implemented were significantly associated with the reduction in both infant mortality (neonatal + post-neonatal) and maternal mortality rates. In turn, the increase in birth and caesarean delivery rates were associated with the increase in infant and maternal mortality rates.

Conclusions

It was concluded that the Family Health Care Strategy model that contributed to the reduction in infant (neonatal + post-neonatal) and maternal mortality rates, and so did actors such as HDI and cesarean section. Thus, public health managers should prefer this model.

Key messages

Implementation of public policies with specific focus on attenuating these factors and making it possible to optimize resources, and not interrupting the FHS. Knowledge of the factors with impact on these indicators would be of help in formulating public policies.
Factors associated with car safety seats’ use
Authors: Sargsyan Z , Harutyunyan T , Sahakyan S
Published: October 2020

Background

Road traffic injuries are the number one cause of death in children aged 5-14 years. The evidence shows that, if correctly installed and used, child restraints can reduce infants' death by approximately 70%, and deaths among children by up to 80%. In the absence of compulsory car safety seat (CSS) legislation in Armenia, parents play the decisive role in child passenger safety. This study aimed to investigate the practice of CSS-s among Armenian parents and to find the determinants of CSS use.

Methods

In 2018, the study team conducted a self-administered survey among parents of children 0-6 years old living in Yerevan, the capital of Armenia. Using two stage cluster sampling, 33 kindergartens were chosen as clusters by simple random sampling and from each cluster 10 parents received a questionnaire. The study team applied a multivariable logistic regression model using the backward elimination approach to finalize the independent predictors of CSS-s use.

Results

Overall, 263 parents returned completed questionnaires, of which 26.2% (69) were CSS users. The CSS non-users included those who did not have a CSS (163) or had a CSS but used it sometimes, seldom or never (31). The study results showed that the factors associated with the CSS-s use among Armenian parents in the adjusted analyses were age in children (OR = 0.61, p = 0.003), attitude score (OR = 1.53, p = 0.003), knowledge score (OR = 1.45, p = 0.011) regarding CSS-s, consistent driver's side seatbelt compliance (OR = 3.4, p = 0.005), and monthly expenditures (OR = 3.35, p = 0.024).

Conclusions

This study was the first exploration of Armenian parents' practice of CSS-s. Our findings might serve as a starting point for further research on proper use of CSS among Armenian parents not only in Yerevan, but across all regions of the country. The revealed predictors of parental CSS-s use might be used for the development of fruitful interventions to enhance the practice of CSS-s in Armenia.

Key messages

This was the first-time exploration of CSS-s practice and predictors of CSS-s use in Armenia, where there is no CSS law and parents play the sole role in child passenger safety. Educational interventions for children and their parents on the importance of age and size appropriate CSS-s usage will help increase CSS-s use among Armenian parents.
Equipping Religious Leaders as Family Planning Champions
Authors: Bormet M
Published: October 2020

Faith-based organizations and faith-based health facilities are crucial providers of healthcare. They help ensure religious leaders (RLs) are equipped with the proper information and training to address barriers and myths about family planning (FP). A low-literacy booklet was adapted from “Facts for Family Planning” that religious leaders could use to talk about FP with community members with lower levels of formal education. They also included Biblical passages, definitions and reasons why it is important for Christians to discuss these issues. The English version was translated into seven languages.

These guides have been shared with at least 1,000 faith leaders in Uganda and Kenya. Religious leaders in Uganda held 168 awareness-raising events and reached 4,335 people with this information and referred individuals to health facilities for further information about FP methods. These low-literacy booklets gave RLs the confidence to speak in churches, at weddings and markets, etc about this issue, partly due to their training and partly due to the confidence that these booklets were being distributed among RLs in multiple countries and languages. Taking the time to build a system to test translated materials is also important. CCIH worked with FHI360/APC to develop testing protocol, which was IRB approved. These materials were tested via Focus Groups and In-depth-Interviews and materials (we recommend translating all materials into the language being tested) are available for public use.

Ensuring mother-tongue language and education level appropriate materials are available for community-based programs is critical for community ownership and application of training. In addition, ensuring such materials are not just available for one project in one place is key for information sharing digitally for anyone to use and translate the English version into further languages.

Key messages

Demonstrate the capacity of religious leaders to break down barriers and myths about family planning in their communities. Being responsive to community needs via low-literacy materials in local languages.
Supplementation in pregnancy: determinants of the compliance with guidelines in Portugal, 2019
Authors: Ribeiro C , Silva D a , Pinto E
Published: October 2020

Background

Folic acid (FA) and iodine supplementation in pregnancy are nutritional interventions recommended by the World Health Organization, which are widespread in Portugal. Since there isn`t available reimbursed medicine containing only 400µg of FA and the increasing evidence that excessive supplementation in FA can lead to adverse outcomes for mothers and their offspring, make interesting to assess the clinical practice. Therefore, it`s important to understand the actual adherence to FA and iodine supplementation in periconceptional period, as well as to identify its determinants.

Methods

Telephonic interviews (n = 140) were conducted with mothers enrolled in Primary Health Centers, recruited in their children's vaccination appointment (aged 0-6 months). Among the variables studied are sociodemographic, medical and obstetric history, diet and supplements used during pregnancy. Data were analyzed using the Statistical Package for Social Sciences® program.

Results

The prevalence of iodine and FA supplementation among mothers was high (98%). About 3/4 of the interviewees reported having planned their pregnancy, and of these, 1/4 did not have a preconception consultation. The first pregnancy consultation took place at 6-10 weeks, on average. FA supplementation has the greatest discrepancies with the guidelines: only 29% (n = 40) started at the recommended time, 3% (n = 4) stopped at 12 weeks of pregnancy, and only 33% (n = 34) had 400µg of FA. Fifty one percent of the mothers indicated that they were unaware that they should start supplementation before the interruption of the contraceptive method.

Conclusions

These results suggest the need for enhanced antenatal care and interventions that increase women's health literacy. Public Health strategies in order to increase preconception consultations are needed as well as a national joint effort towards the homogenization of clinical practices regarding the prescription of supplementation in pregnancy.

Key messages

Folic acid (FA) and iodine supplementation in pregnancy are widespread practices in Portugal despite the fact that no available reimbursed medicine containing the recommended 400 µg of FA is available. Antenatal care and women's health literacy should be improved in order to comply with the recommendations, as well as the availability of a reimbursed medicine containing 400µg of folic acid.
10 years evolution of induced abortion practice in Paris region
Authors: Matulonga Diakiese B , Menguy C , Desplanques L , Féron V , Grémy I
Published: October 2020

Background

In France, induced abortion (IA) has first been authorized in 1975. To improve access to abortion care services, several legislative reforms have been adopted with the most recent consisted of removal of the mandatory cooling off period before abortion, reimbursement of all expense related to abortion and approval for midwives to perform medical abortion. All these changes could affect practice of IA. The objective of the present research was to describe the evolution of abortion practices in Paris region from 2007 to 2017

Methods

Exhaustive data from Paris region healthcare insurance system was use to account for all abortions performed among women living in this region

Results

More than 50,000 abortions are performed in Paris region each year, which represents over one-quarter of national IA. This number decreased from 58,319 in 2007 to 52,080 in 2017 and the abortion rate has decreased over the past decade (19 IA per 1000 reproductive age women in 2007 and 17‰ in 2017). However, there was found territorial disparity with higher rate of abortion in the lower incomes municipalities (22‰ in the poorer Paris region municipality in 2017). This rate remained higher among women aged 18-34 (27.8‰ in 2007 vs 24.6‰ in 20017). Abortion methods have shifted over the years, with increase of medical abortion (47% in 2007 vs 67% in 2017) and decrease of surgical abortion. The analyses have also shown that the average gestational age at the time of abortion decreased with 65% of abortion performed before 9 weeks of amenorrhea in 2007 and 80% in 2017. There rate of abortion performed by liberal practitioners increased from 15% in 2007 to 33% in 2017

Conclusions

The measures such as removing the mandatory cooling-off period, increasing number of medical professional involved in abortion have improved access to abortion care services result in much early IA and higher rate of medical abortion. Improved access to contraception might partly explain the decline in IA rate over time

Key messages

Legislative reforms such as removing the mandatory cooling-off period have improved access to abortion care services. In this last decade, abortion among Paris women are performed much early and there are increasing number of medical professional involved in abortion.
Demographic echoes of the maternity data in the Split-Dalmatia County, Croatia
Authors: Marasovic Šušnjara I
Published: October 2020

Background

The demographic situation in the Split-Dalmatia County (SDC) is characterized by negative trends in the new millennium. Such a demographic picture entails many societal challenges. Considering the far-reaching consequences of population decline, the goal is to show what maternity data have been like in the SDC in the last decade.

Methods

Individual birth reports from health institutions in the SDC were used in the presentation of the maternity data. Demographic indicators were calculated based on data from the Croatian Bureau of Statistics.

Results

In 2018, in the SDC were reported 4,438 deliveries (13% less vs 2009; 5,103 deliveries) with a total of 4,577 children delivered, whereof 4,561 were live births and 16 were stillbirths. From a total of 4,516 live births, 13 live-born neonates died during the first week of their life. Most of women in labor (89%) were residents of the SDC. The average age of the new mothers was 28.9 years (in 2009; 26.9 years). Childbirth was most frequently recorded in the maternal age group 30 -34 (1,556 deliveries, i.e. 110,9/1,000 women of said age group; 92/1,000 in 2009). Among childbearing women with known data on earlier deliveries (4,431), 2,029 or 45.8% had their first deliveries, 1,549 or 35% had their second deliveries, 808 or 18% had their third or higher birth order deliveries. According to an estimate in 2018, 448,071 people lived in the SDC, less 1.5% from the last census (2011). The live birth rate was 9.5 /1,000 in 2018 (2009; 10.9/1,000). The total fertility rate was 1.53 in 2018 (2009; 1.6). The natural increase rate in 2018 was negative at -1.8 (-830 persons) (2009; 0.5 (250 persons)).

Conclusions

Depopulation, low birth rates and fertility, are the demographic reality of Split-Dalmatia County as well as Croatia, which requires adoption and implementation of various public policy measures that positively affect fertility to improve the demographic picture.

Key messages

Depopulation, low birth rates and fertility, are the demographic reality of Split-Dalmatia County as well as Croatia. Adoption and implementation of various public policy measures that positively affect fertility to improve the demographic picture are needed.
Thirty year trends in cardiovascular risk factors prevalence among Siberian adolescents (1989-2019)
Authors: Denisova D
Published: October 2020

Background

Aim of the study was to assess trends of cardiovascular risk factors among Siberian adolescents during the last 30 years including period of Russian reforms (1989-2019).

Methods

Seven cross-sectional surveys of representative samples of school children aged 14-18 since 1989 (every 5 years) were carried out. Body mass index (BMI), systolic and diastolic blood pressure, serum total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) were measured. Self-reported smoking and physical activity rates were obtained. To define overweight the sex- and age-specific IOTF cutoffs for BMI were used. Hypertension (HT) and lipid disorders were revealed according to international criteria.

Results

Prevalence of high TC significantly decreased from 22 to 4% (p < 0,01) in males and from 32 to 17% (p < 0,05) in females. High LDL-C showed similar trends. Prevalence of low HDL-C was stable with some fluctuations. In the period of Russian reforms (1989-1999) the prevalence of overweight significantly decreased from 12% in boys and from 14% in girls in 1989 to 4% in 1999 (p < 0,01). Since 2003 rapid increasing of overweight was observed. Trends of HT have shown double decreasing during the reform period and stabilization in the post-reform time. So, since 2003 discordant trends in HT and overweight were revealed. Physical activity was stably low in boys (49-55%) and girls (83-73%). Average weekly screen time doubled from 15 (2009) to 30 h/w (2019), p < 0,05. Cigarette smoking rates in boys dramatically decreased from 45% (1989) to 3% (2019), in girls - from 19% to 5% (p < 0,01). Smoking of electronic devices was registered in 2019: 6% among boys and 3% among girls.

Conclusions

Obtained data indicate on trends to reduction in CVD risk profile among Siberian adolescents during the period of Russian reforms. Discordant trends of HT and overweight were revealed.

The study was supported by RFBR grant 19-013-00800.

Key messages

Long time changes in cardiovascular risk profile among Siberian adolescents were registered. Against the background of a decrease in combustible smoking among adolescents, electronic smoking began to register.
Risk behaviors among adolescents participating youth movements - The role of social norms and support
Authors: Bord S , Tesler R , Mashiach M , Schor A , Harel-Fish Y
Published: October 2020

Background

Risk behaviors such as smoking, alcohol consumption, and drug use are prevalent among adolescents worldwide, and are a major concern due to their harmful effects. Scientific literature presents no agreement as to whether belonging to a youth movement is a risk factor or a protective factor for risk behaviors. The current analysis aimed at evaluating the role of participating in youth movements (i.e., protective or risk factor) in substance use among Israeli adolescents.

Methods

Based on the 2015 Health Behavior in School-aged Children Survey (HBSC), The current analysis included 2197 participants aged 16-18, who answered the questions addressing participating in youth movements and questions regarding their risk behaviors.

Results

Overall, 17% of respondents reported smoking cigarettes, 39% consuming alcohol, 14% getting drunk, and 6% using drugs in the past 30 days. Of those respondents, 27% were members or guides in youth movements. Multiple logistic regression analysis showed that members of youth movements were significantly more at risk for drug use (OR = 3.54, 95%CI: 1.41, 8.90), and guiding was significantly associated with higher risk for alcohol consumption (OR = 1.90, 95%CI: 1.24, 2.91) and drunkenness (OR = 2.39, 95%CI: 1.50, 3.81) among 16-year-old respondents. No association was found between participation in youth movements and risk behaviors among 17-18year-olds. Family support was found to be a protective factor for cigarette smoking (OR = 0.83, 95%CI: 0.72, 0.97) and drug use (OR = 0.70, 95%CI: 0.58, 0.86) among 16-year-olds. Social norms were associated with all four risk behaviors among all age groups, showing, as expected, that the greater the social pressure, the higher the risk for participation in risk behaviors.

Conclusions

Social and family influence play an important role in the prevention of risk behaviors among adolescents. Youth movement settings should be monitored to ensure they do not become a supportive environment for risk behaviors.

Key messages

Social and family influence are important in preventing risk behavior in adolescents. Youth movements should be monitored to ensure they do not become a supportive environment for risk behavior.
Effectiveness of an app for perinatal home visitation by nurses in preventing infant abuse in Japan
Authors: Isumi A , Doi S , Fujiwara T
Published: October 2020

Background

In Japan, public health nurses provide home visitation with pregnant women who are at high risk for child maltreatment, but its effectiveness in preventing child maltreatment has not been evaluated because contents and quality of home visitation vary from municipality to municipality. This study aims to evaluate whether the tablet app developed to standardize and assist perinatal home visitation by public health nurses is effective in preventing child maltreatment.

Methods

An intervention study was conducted in 2018 in Adachi City, Tokyo, Japan. Public health nurses at two public health centers used the tablet app when they support high-risk pregnant women through home visitation and interviews, while public health nurses at the other three public health centers provided support as in the past. Because two public health centers were different in usage of the app, the treatment group was further divided into two groups: active and inactive. As fatal abuse among infants, frequency of shaking and smothering was assessed as an outcome through a self-reported questionnaire at the 4-month health check, and compared between the active treatment group, inactive treatment group, and control group, using multiple logistic regression (N = 5,651).

Results

Prevalence of infant abuse was 0.82% in the active treatment group, 1.34% in the inactive treatment group, and 1.50% in the control group. When adjusted for parental demographics and parenting situations, mothers in the active treatment group were less likely to shake or smother their baby than those in the control group (Odds ratio: 0.51, p = 0.093).

Conclusions

It possibly suggests that the tablet app developed to assist perinatal home visitation by public health nurses was effective in preventing infant abuse.

Key messages

An intervention study was conducted at public health centers in Adachi City, Tokyo, Japan, using the tablet app developed to standardize and assist perinatal home visitation by public health nurses. The finding suggested that the tablet app may be effective in preventing shaking and smothering among 4-month old infants.
Pregnant women and risk factors: a cross-sectional study
Authors: Fauci V L a , Squeri R , Genovese C , Alessi V , Facciolà A
Published: October 2020

Background

Many investigations have shown the important role played by risk factors such as tobacco and alcohol in the development of congenital anomalies.

Methods

Through the administration of an hoc questionnaire, we evaluated the attitude towards smoking and alcohol of a sample of 200 pregnant women at the University Hospital of Messina. The questionnaire was structured to collect information about socio-demographic characteristics, type of gynaecological assistance and their lifestyles (smoking and alcohol). Statistical analysis was performed using version 10 of StatSoftVR software.

Results

14% of the women continued to smoke despite pregnancy; the majority of these were young adults, divorced, employed and with a high educational level. Correlating the smoking habit with the socio-demographic characteristics of the studied women, we found a statistically significant difference for the marital status, with a higher number of smokers among the single women (p < 0.05).Moreover, we found a statistically significant difference also for the profession with a higher number of smokers in the worker women (p < 0.05). About the drinking habit, the 4.3% declared to be moderate drinkers (occasional use of alcohol equal to 2-3 glasses a week) despite pregnancy, the 34.4% stated they do not drink alcohol during pregnancy and the 56% stated do not usually drink alcohol. Particularly, about the drinkers' socio-demographic characteristics, the 50% of them were 24-25 years old and the 75% were married. About the type of alcoholic beverages consumed, 86% stated they usually drink bier during the weekend.

Conclusions

Our study shows that the awareness of the women about the importance of these risk factors is still rather poor. In order to improve the awareness of pregnant women on the importance of avoiding these risk factors and prevent CAs, health education campaigns at various levels surely represent the public health cornerstone.

Key messages

In our sample 14% of the pregnant women continued to smoke and 4.3% to drink despite pregnancy and they generally were young or young adults and with a high educational level. Our results highlight the importance of continuous health education about the risk to smoke and drink during pregnancy.
Transition of care from paediatric to adult age for rare chronic disorders: an Italian experience
Authors: Olivero E , Bert F , Corezzi M , Corsi D , Dominici S , Scarmozzino A , Siliquini R
Published: October 2020

Background

Transition of care represents the transfer from child to adult care. An effective transition maintains continuity of care and presents better clinical outcomes. Thanks to improved survivorship of chronic paediatric patients to adulthood, this process has assumed growing relevance. Aim of the study was to evaluate quality and effectiveness of transition of care model of one of the biggest Hospitals of Northern Italy, that has organised a common structured model, differentiated according to patients' clinical and social complexity.

Methods

The sample consisted of patients with chronic rare diseases transited within the Hospital in the years 2016-2019. To analyse the evolution of all pathologies, for each patient the medical record was consulted; questionnaires were then administered to patients to investigate their illness perception and quality of life.

Results

The average age at transition of the retrospective study patients was 19.8±4.7 years. For most disorders, 100% of patients made the first post-transition visit. More than 90% of patients who did not make further post-transition visits were patients with Neurofibromatosis 1. Only 7 out of 18 patients with NF1 continued their treatment to the indicated specialist. One-year drop-out was 13%. Regarding the perception of one's own illness, 78% of respondents consider their health status from good to excellent, but more than 30% of respondents believe not to have currently adequate psychological and social support.

Conclusions

Transition of care represents an important phase in chronic diseases management. The proposed model assures a multidisciplinary approach, involving all specialists of both paediatric and adult teams. Preliminary data were positive and showed how this model could be an example for other institutions in Europe. Anyway, the transition model might be still be improved. Our data underlined the importance of a complete taking charge, with peculiar attention to psychological and social support.

Key messages

The study shows to the European Healthcare Providers the importance of a personalized planning of transition of care, that considers the complexity of clinical situation and concomitant social issues. A successful strategy of transition of care requires a multidisciplinary approach, that guarantees a complete taking charge, with peculiar attention to psychological and social support.
Tobacco smoking prevalence in pregnant women: metanalysis of cross sectional studies
Authors: Restivo V , Pizzo S , Marrella A , Caracci F , Vitale F , Casuccio A
Published: October 2020

Background

Notwithstanding tobacco smoking during pregnancy is associated with negative health outcomes, its prevalence was not included by worldwide surveillance system. The main objective was to estimate the number of women who had smoked at least one cigarette during her pregnancy in comparison to not smoking women.

Methods

A systematic review and metanalysis was conducted searching on MEDLINE, Pubmed and Scopus on the 2 January 2020. Keywords were searched with English language limits from 2017 to 2019. Three authors independently screened all titles and abstracts applying the inclusion criteria, extracted the data, filled a database and two other authors assessed doubt eligibility. Quality was assessed by the NOS scale and the prevalence of smoking during pregnancy was assessed dividing the number of women smoking by the total number of pregnant women reported in the studies.

Results

A total of 1424 articles were screened and 726 were evaluated to be included in the final database of 234 articles. Of these, 85 were properly designed as cross-sectional, 85 were conducted as secondary analysis of cohort, and 64 were population-based studies. The overall smoking prevalence during pregnancy was 12% (95% CI 11%-13%) with an increase to 14% (95%CI 12%-15%) for studies that had smoking as the primary endpoint. In the metaregression analysis, the risk of smoking increased in South America (meta regression coefficent [MC]=0.46, p = 0.02). On the other hand, smoking prevalence decreased during time (studies conducted from 2000 to 2010 MC=-0.15, p = 0.008 and studies conducted after 2010 MC=-0.11, p = 0.04).

Conclusions

This study revealed a high prevalence of smoking during pregnancy worldwide with higher values than reported in another metanalysis conducted from 1985 to 2016. However, prevalence decreased during the three years considered and was higher in some countries that need more preventive interventions.

Key messages

Women of childbearing age need to be educated about the potential detrimental effects of tobacco use on the developing fetus and infant. Evidence-based smoking cessation interventions should be integrated into routine prenatal care.