bluuebunny/crossref_metadata_2025 huggingface dataset:
Influence of social media for sexuality of adolescents
Authors: Sousa M A , Oliveira P A , Lima M D O , Freitas M I F
Published: October 2020

Background

Adolescence is a phase of life of great emotional, cognitive, social and body changes. Also noteworthy are the changes related to the emotional relationship between young people and sexuality. Recent research indicates that the use of Social Media (MS) has increased dramatically among adolescents in the last 10 years, and they have a tendency to seek information on health, sexual health and STIs including AIDS in these media.

Objective

To understand the influences of social media for sexual health and sexuality in adolescents.

Methods

This is a research with a qualitative approach, based on the Theory of Social Representations. The study included 28 adolescents aged between 15 and 18 years old, high school students from two public schools in Belo Horizonte. Data collection took place through open and in-depth interviews, with a semi-structured script. The data were interpreted based on the Structural Analysis of the Narration, proposed by Demazière; Dubar.

Results

The results found point to positive and negative representations in relation to the interviewees' point of view on the influence of social media on the sexuality of these adolescents. The positive representations found revolve around the ease of access to information and the privacy of being able to search and answer your questions through the internet and other means of communication. The aforementioned negative representations point to the little media approach on the subject, in addition, they indicate sporadic approaches centered on festive periods and dates such as carnival, a unique focus on AIDS and aimed specifically at adult audiences.

Conclusions

It is necessary to rethink how adolescents and young people today experience their sexuality and how to reach them comprehensively, understanding the need to guarantee appropriate and quality information to adolescents.

Key messages

The present work leads to reflections on the ways that adolescents experience sexuality today. Currently, teenagers are involved in digital media, including social media, where they can express issues related to sexuality and the way they experience it.
Localising evidence for decision-making: participatory approach to inform schistosomiasis control
Authors: Fergus C A , Allen T , Parker M , Pearson G , Storer L , Dawson K
Published: October 2020

Background

The linear theories of change which ground many interventions do not account for the complex processes and systems in which they are implemented. This reductionist approach prioritises statistical methods which do not accommodate the stochastic, non-linear, dynamic interactions between humans and their environment. The inclusion of practitioners in the process of evidence development and utilisation of complex systems methods mitigates these issues and results in locally relevant, timely evidence for decision-making.

Methods

The aim of this work was to develop localised evidence for decision-making for schistosomiasis control in Uganda, Malawi, and Tanzania. Workshops were conducted with practitioners from the Ministries of Health at various levels and partner organisations to identify evidence needs for their decision-making processes and perceptions of disease transmission and control activities. Participatory systems mapping was used to identify factors directly and indirectly related to transmission. The maps were synthesised to a master complex systems map, which served as the blueprint for a generalised spatial agent-based model and specific ABMs tailored to the evidence needs of decision-makers.

Results

There was a gap in available evidence for practitioners to advocate for resources within the MoH and government budgets, as well as intervention efficacy and resource allocation. The adaptable and data-inclusive characteristics of the AMBs made them well-suited to produce localised outputs. Converted to NetLogo with a tailored user interface, these models were appropriate and responsive to the needs of decision-makers from village to national levels and across country contexts.

Conclusions

Used together, participatory and agent-based modelling resulted in the development of responsive and relevant evidence for practitioner decision-making. This process is generalisable and transferable to other diseases and locations outside of those in this study.

Key messages

The use of participatory systems mapping to develop agent-based models resulted in relevant and timely evidence for practitioner decision-making. The approach used here is transferable and generalisable outside schistosomiasis control and the contexts in this study.
Digital module of a complex school-based health education program tries to maintain equality
Authors: Eörsi D , Árva D , Herczeg V
Published: October 2020

Issue

Health education of adolescents requires digital communication channels besides the traditional interpersonal setting. Use of e-learnings can be beneficial in multiple aspects when targeting positive health behavior change.

Description

A complex, school-based health education program is operated by Semmelweis University in a North-Hungarian town, Balassagyarmat, given, that the vast majority of students have proper internet access. Ongoing peer education is completed by e-learning modules in order to improve the continuity of the program, repeat key statements, deliver more information and create a private channel to discuss intimate issues. The online system was built on novel educational techniques in gamification and rewarding to enhance motivation and engagement of participants. The same e-learning modules are available for all students from different type of education and sociocultural background. We try to assess if this concept provides equality.

Results

41 multimedia e-learning modules consisting of 12 types of interactive game-like activities has been developed in 10 topics. Each of them are used by around 60-70% of the participants of the program (about 240 students per year). High school students showed slight difference from vocational school students in activity and in performance. According to their feedback, pupils welcome this channel regardless to their type of education.

Lessons

While developing the digital health education program based on new pedagogical methods, the concept was not modified for students of different school types, but all of them participated in the same educational and rewarding system. We believe, that the project trends to maintain equality.

Key messages

Multimedia digital modules are favorable in health education for adolescents. Health education statements can be the same for students of different educational settings.
The exposome and meet-in-the-middle as tools in addressing open questions in air pollution research
Authors: Demetriou C A , Esposti D D , Fedinick K P , Russo F , Robinson O , Vineis P
Published: October 2020

Ambient particulate matter is the environmental factor with the highest contribution to global disease burden and mortality. Open questions remain regarding causality at low doses and the effects of specific pollutants. Establishing causality in regards to air pollution is methodologically challenging, affecting the establishment of regulatory policies.

In an effort to address this problem, we suggest combining the concept of the exposome with the Meet-in-the-Middle approach (MITM). This approach consists of measuring molecular fingerprints and relating them retrospectively to measurements of external exposure and prospectively to a health outcome. Markers robustly associated with both ends of the exposure-to-disease continuum, validate a causal hypothesis5. In the context of carcinogenesis, this approach allows establishing the relationship between the middle-to-outcome nature of the hallmarks of cancer with the bottom-to-middle approaches of the key characteristics of carcinogens. We recently demonstrated proof of principle of this approach, by investigating the temporal sequence of hallmarks of cancer from the point of view of pathological specimens of cancer (branched mutational spectra), and then by considering the key characteristics of the carcinogen, benzo(a)pyrene. The main cancer pathways affected follow a generally common sequence: resisting cell death, insensitivity to anti-growth signals, sustained proliferation (almost simultaneous), deregulated energetics, replicative immortality, and activation of invasion and metastasis. Angiogenesis and avoiding immune destruction display a varying position in the above sequence. At the same time, “key characteristics” of BaP were found associated with most hallmarks of cancer, supporting its carcinogenicity.

A MITM approach, using exposomic evidence, is a promising approach that can successfully address causality concerns in regards to air-pollution toxicology and the need for regulatory policies.

Key messages

Investigation of tumour mutational spectra and of the mechanisms of action of a carcinogen, reveals an overlap between the hallmarks of cancer and the key characteristics of the carcinogen. This investigation provides proof of principle that the exposome/meet-in-the-middle approach can address concerns in air-pollution toxicology and provide evidence to support regulatory policies.
Metabolic syndrome and endocrine disrupting chemicals: exposure and health effects
Authors: Haverinen E , Lange R , Tolonen H
Published: October 2020

Increasing prevalence of metabolic syndrome (MetS) is causing significant health burden among the European population. Current knowledge supports the notion that endocrine disrupting chemicals (EDCs) interfere with human metabolism and hormonal balance, contributing to the conventionally recognized life-style related risk factors for MetS. In relation to the Human biomonitoring initiative (HBM4EU) five priority substances (Bisphenol A, Per- and polyfluoroalkyl substances (PFASs), Phthalates, Cadmium and Arsenic) and their association with adverse metabolic health effects were examined.

A methodological framework for scoping reviews was followed to increase consistency and transparency throughout the process. A literature review was conducted to identify epidemiological studies focusing on the association between MetS or its individual components and the five HBM4EU priority substances.

Human biomonitoring studies have been able to present evidence supporting EDC exposure and development of individual MetS components; however the strength of the association varies between the components and EDCs. Most of the identified literature examined Bisphenol A and Phthalate exposure, usually targeting obesity, anthropometrics or glucose metabolism. Evidence suggests a positive association between Bisphenol A and Phthalate exposure and obesity-related components. The substance group of PFASs indicated weakest association, as the results were inconsistent and were suggestive only for a positive association with development of dyslipidaemia.

Current evidence on metabolic disturbances and EDCs are inconclusive and fragmented, hence establishing harmonized and standardized human biomonitoring procedures among the European population are needed. Rigorous and ongoing human biomonitoring in combination with health monitoring could provide comprehensive information on EDC exposure and association of metabolic disturbances.

Key messages

EDC exposure is ubiquitous within European population, hence more human biomonitoring in combination with health surveys is needed to strengthen knowledge on human’s metabolic health. MetS is an increasing global health concern, which requires novel approaches to tackle the challenge.
Air pollution health risk assessment: the role of benzene
Authors: Lanza T , Carini E , Villani L , Ricciardi W , Moscato U
Published: October 2020

Benzene is an aromatic polycyclic hydrocarbon (C6H6) ubiquitously present in the environment which results from the emissions of fires and volcanoes. However, the primary source is anthropogenic, mainly from industrial emissions and combustion. The aim of this study is to summarize the current evidence on benzene exposure in the Italian regions and the main health effects.

A retrospective observational study was conducted. Environmental data provided by ISPRA (Higher Institute for Environmental Protection and Research) relating to benzene pollution and the trend of national emissions of substance by region and sector of origin were analyzed.

Data available to date (1990-2016) show a significant decrease, over 91%, mainly due to the reduction in the transport sector. In 2016, the main share of substance relates to road transport (1,492 t), followed by use of solvents (1,100 t), and production processes (463 t). Much lower are the emissions due to the extraction and distribution of fossil fuels/geothermal (19 t) and combustion in the energy and transformation industries (5 t). The highest absolute values in 2015 were recorded in the Italian regions of Lombardia (751.4 t), Lazio (367.2 t), and Puglia (339.0 t). The lower values were in Valle d'Aosta (7.9 t), Molise (15,5 t) and Basilicata (25,3 t). The largest decrease in benzene exposure between 1990 and 2015 was recorded in Campania (-94.5%), Calabria (-93.9%) and Valle d'Aosta (-93.4%).

All Italian regions recorded a significant decrease in the absolute values of benzene emissions, mainly due to both the decrease of benzene in fuel composition during the 1990s and to the renewal of circulating cars equipped with energy saving systems (start and stop) and more optimized for low fuel consumption. The global reduction of energy sources based on fossil fuels, as well as a primary environmental objective to reduce Global Warming, would certainly constitute a way to decrease the impact of benzene on the environment.

Key messages

Additional efforts are needed to reduce energy sources based on fossil fuels. An information, training and health education policy through the environment aimed at implementing awareness and empowerment of the population would be desirable.
Perspective of low-cost biosensors for genotoxic potential evaluation of urban air
Authors: Traversi D , Pignata C , Anedda E , Gilli G
Published: October 2020

Background

Biosensor technology can potentially revolutionise the area of air pollution monitoring by providing data on early biological effect induction. Such data can be developed for supplementing routine pollution monitoring, improving exposure estimation, including a potential effect estimation and raising community awareness about air pollution. Especially in consideration of complex biological effect such as mutagenic, genotoxic and other proved effects due to the air mixture exposure. The aim of the study is to propose a short-time biosensor for the mutagenic properties evaluation of air pollution.

Methods

A simple biosensor was developed using genetically modified microorganisms. A first sampling session was conducted in one of the most air-polluted city of Italy using the biosensor and collecting the data of the usual monitoring system, including PM2.5, PM10, NOx, PAHs and metals concentrations.

Results

The biosensor is able to answer to polluted air mixture indicating a valuable genotoxic effect. Such effect - expressed in relation to the air sampled volume - is comparable to that recorded by traditional genotoxicity in vitro assay on organic extract of particulate matter. Moreover, a comparison with reference measurements is conducted. Repeatability, reproducibility, stability, limit of detection as the impact of environmental factors on biosensor output have been discussed.

Conclusions

Due to copious difficulties arising when airborne emissions are sampled, biological assays have been applied only sporadically. Aerosol particles are generally collected on a filter and following extraction procedure and bioassay were performed. Monitoring using the biosensor require low sample quantity, directly colliding with the microorganism, and supply good choice when air genotoxicity are to be determined.

Key messages

Low-cost biosensors can empower high density monitoring of air pollution. The proposed biosensor is able to evaluate genotoxic properties of the air mixture even if data quality is a major concern for its employment.
Regional analysis of pediatric admissions with complex chronic conditions in mainland Portugal
Authors: Lacerda A F , Oliveira G , Cancelinha C , Lopes S
Published: October 2020

Background

The expected rise in the number of children living longer with complex chronic conditions (CCC) and the social relevance of this group prompt the study of the patterns of their inpatient care utilization. We aimed to compare the utilization of inpatient care by children with CCC between regions of mainland Portugal.

Methods

Observational longitudinal retrospective study using anonymized administrative data for mainland Portuguese public hospitals. We selected admissions within the pediatric age limit (<18yo), 2011-15. The variable of interest was the patient region of residence [Alentejo, Algarve, Centre, Lisbon Metropolitan Area (Lisbon MA), or North]. Variables related to condition (number and categories of CCC) and to care utilization [admission type, hospital type (I- community, II- regional, III- tertiary & university, IV- specialized), inpatient days, expenses] were described by region.

Results

A total of 64,918 pediatric admissions with CCC were included (ranging from 2,839 to 23,194 by region). The percentage of admissions with 2 or more CCC ranged from 16% to 22%. Haematologic & Immunologic and Metabolic categories were the ones with the highest range between regions (8%-19%; 5%-10%); the smallest range was seen in Cardiovascular (15%-18%). Urgent admissions ranged from 48% to 70%. Hospital type varied considerably, especially for type II (8%-69%). Median length of stay was 4-5 days, and median expense ranged from €1,256 to €1,467.

Conclusions

The utilization of inpatient care by children with CCC in mainland Portugal varied by region, mainly on type of admission, type of hospital, and distribution of CCC categories. Possible explanatory factors may include differences in CCC prevalence, patterns of care, and available care in each region.

Key messages

Differences in the percentage of urgent admissions require further analysis, aiming at reducing the disruption that healthcare needs may cause in the life of children with CCC and their families. There are considerable differences in the type of hospital where children with CCC in each region receive care. Healthcare system must ensure appropriate resources are available where needed.
Effectiveness of an educational manual to promote infant feeding practices in primary health care
Authors: Relvas G R B , Buccini G S , Potvin L , Venancio S I
Published: October 2020

Background

Breastfeeding and adequate complementary feeding in the first years of life provide short- and long-term benefits for child health. However, breastfeeding and adequate complementary feeding prevalence's are low. In Brazil, the Estratégia Amamenta e Alimenta Brasil (EAAB) aims to improve the quality of the assistance provided by primary healthcare teams to ultimately improving infant feeding practices in the Brazilian population. In primary healthcare units, continuing education in breastfeeding and complementary feeding is facilitated by EAAB tutors. A Manual to Support EAAB Tutor (the Manual) was developed following a problem-based learning methodology. This study aimed to evaluate the effectiveness of using the Manual by analyzing exclusive breastfeeding and complementary feeding indicators.

Methods

A before and after study was conducted at primary healthcare units in Embu das Artes, Brazil. The intervention consisted in the use of the Manual by EAAB tutors who performed some comprehensive training activities with healthcare teams, in a period of 8 months. Subjects consisted of mothers of infants under one year of age attended at primary healthcare units. 561 mothers before and 598 mothers after intervention were interviewed about breastfeeding and complementary feeding practices. Multivariate analysis was performed using Poisson multilevel regression to test the hypothesis.

Results

Lack of minimum food diversity (before 62.9%; after 50.3%) and lack of food adequacy (before 77.5%; after 63.3%) decreased significantly. Regression analysis confirmed that infants after the intervention had lower prevalence of inadequacy of complementary feeding. While the intervention did not show significant association with exclusive breastfeeding, it showed association with the improvement of complementary feeding practices.

Conclusions

The Manual is a continuing educational strategy that improved complementary feeding practices in primary health care.

Key messages

The use of a continuing education strategy grounded on a problem-based learning methodology was effective to produce improvements in complementary feeding practices in primary health care. The 'Manual to Support EAAB Tutor' consists of a tool that has the potential to be adapted for different contexts and easy to disclose to all EAAB tutors in the country.
Is depression a cause of metabolic abnormality? A European Small State experience
Authors: Cuschieri S
Published: October 2020

Background

A relationship between depression and metabolic syndrome has been reported. Considering the diabesity rates effecting the small state of Malta it was considered appropriate to explore for links between these diseases, their metabolic determinants with depression.

Methods

A national health examination survey was conducted. A validated questionnaire note down (1) self-reported depression (2) anti-depressive medication (3) PHQ-9 depression symptoms score (>5 positive for depression). Participants with the presence of one or more of these variables were labelled as having depression. Body mass index (BMI), waist circumference (WC) and blood pressure (BP) were measured. Blood testing for fasting blood glucose (FBG) and lipid profile were performed. The biochemical (FBG, Lipid profiles) and anthropometric profiles (BMI, WC, BP) of the depression population were compared to those without this disease. Univariant and multivariant binary logistic regression models were performed.

Results

The depression population (17.2% of the total population) had significantly higher median LDL, triglyceride (TG) and total cholesterol (TC) levels when compared to those without the disease (p = <0.01). On univariant modelling each variable (LDL OR:1.15 p = 0.01; TG OR:1.16 p = 0.01; TC OR:1.64 p = <0.01) showed a positive association with having depression even after adjusting for confounding factors (sex, age, education, smoking, alcohol habits). On multivariant modelling only an increase in TC was associated with increased risk of having depression (OR: 1.36 CI95%: 1.05-1.76 p = 0.02) after adjusting for confounders.

Conclusions

The various components of the metabolic syndrome appeared not to be associated with a diagnosis of depression. Only high cholesterol level exhibited a metabolic link with depression. Although further research is merited, it is suggested that physicians incorporate a depression screening tool as part of their consultation when examining high-risk patients.

Key messages

A metabolic syndrome profile is not linked with depression. A high cholesterol level is linked with depression, making these individuals susceptible to potential cardiovascular disease.
Mental health status among male and female methamphetamine-dependent inmates in Japan
Authors: Ohnishi M , Kawasaki R , Nakane H
Published: October 2020

Background

Although the prevalence of drug addiction in Japan is lower than that of in European and/or American countries, the number of methamphetamine-related arrests in this decade has exceeded 10,000 every year, with 66.2% of the arrests made in 2017 being of re-offenders. This study was performed to assess the mental health status among prison inmates whose sentences were related to methamphetamine use.

Methods

Face-to-face individual interviews using a questionnaire including self-rated health questions (answered on a 4-point Likert scale) and the Kessler 6-item psychological distress scale (K6, range: 0-24) was established by the authors and conducted with 30 methamphetamine-dependent inmates (15 male and 15 female inmates) in Japan.

Results

The age of inmates ranged from the 20s to the 70s. The median time served in adulthood was 5 (range: 2 - 12) among male inmates, and 4.5 (range: 2 - 12) among female inmates (Mann-Whitney U test, P = 0.202). The median K6 scores were 4 (0-8) for the male inmates and 6 (1-17) for the female inmates (Mann-Whitney U test, P = 0.074). The cut-off point for K6 exhibited variation, and the authors considered a participant psychologically distressed if K6 was 10 or higher. Six (40.0%) female inmates were found to be psychologically distressed, which was a higher proportion than among the male inmates (0.0%) (Fisher's exact test, P = 0.017). Regarding self-rated health, 13 (86.7%) of both male and female inmates reported being in “very good/good health” (Cochran-Armitage Test, P ¬= 1.000). There was no statistical correlation between the K6 scores and the self-rated health scores among the male inmates (ρ = 0.148, P = 0.599) or the female inmates (ρ = -0.499, P = 0.058).

Conclusions

Although the interviewees were not representative samples, the male inmates demonstrated better mental health status than the female inmates did; however, there was no difference in self-rated health between the two genders.

Key messages

The male inmates demonstrated better mental health status than the female inmates did; however, there was no difference in self-rated health between the two genders. Gender differences in mental health status among inmates, should be considered when a drug addiction recovery program is implemented to ensure the successful prevention of relapse.
Characteristics of supported living – a perspective of professionals and potential residents
Authors: Overmars-Marx T , Wessel R
Published: October 2020

Background

Policies are increasingly decentralized, and people with a demand for support often live in familiar environments and regular neighborhoods instead of institutions. To meet the demand for support, the local government aims to offer supported living facilities in Staphorst, Netherlands. Accordingly, this study aimed to provide insight into the characteristics of supported living from the perspective of professionals and potential residents.

Methods

Semi-structured interviews were conducted with professionals and potential residents to obtain insight about their perspectives regarding supported living. First, ten interviews were conducted with professionals (i.e. local government, care, welfare, and housing corporation), followed by six interviews with potential residents and/or their parents. The interviews were transcribed, coded and analyzed by two researchers.

Results

A small amount of the residents in Staphorst would benefit from supported living. This concerns mainly (young) adults with a mild intellectual disability and/or a mental illness who need practical, social and emotional support in order to live on their own. Composing the support, it is important to acknowledge the religious identity of the potential residents and their families. Furthermore, the interviews with professionals and potential residents revealed that the following options should be considered: time-out, short- and long-term support, daycare and open house facilities, various types of support (i.e. volunteer and professional) and combining target groups (i.e. adolescents and adults).

Conclusions

This study reveals several options to consider when composing supported living in Staphorst. Accordingly, most participants emphasized the need for short-term support focusing on skills related to independent living. Furthermore, it is important to involve professionals and potential residents and/or their parents in order to offer sustainable supported living for the residents in Staphorst.

Key messages

Most participants emphasized the need for short-term support focusing on skills related to independent living. Both professionals and potential residents should be involved when composing supported living facilities.
Intersectoral actions for mental health care in areas of high vulnerability in São Paulo/ Brazil
Authors: Bezerra P
Published: October 2020

Background

The objective of this research was to analyze the results achieved after intersectoral actions carried out by primary health care teams working in areas of high socio-environmental vulnerability in the city of São Paulo / Brazil. The establishment of intersectoral partnerships to tackle social inequalities and inequalities can be a reality in vulnerable health territories and a way to give sustainability to expanded health care (De Andrade et al, 2015).

Methods

Primary data were obtained from August to October 2018 in four focus groups formed by a total of 24 health professionals, selected after quantitative analysis. The data were transcribed in full and the qualitative analysis was according to Van Den Hoonaard (2018): a) open coding of the transcriptions; b) identification of recurrent themes and respective subthemes and c) connection of themes and concepts interpreted in the light of social processes. The research was approved by the Research Ethics Committee of the Centro Universitário Saúde ABC.

Results

The themes found were: a) Search for partnerships for mental health assistance: in a personalized way, the teams entered into partnerships with the sectors of education, social assistance, leisure and justice for assistance; b) Effectiveness of treatment by intersectoral basis: the teams helped to insert people into public policy actions, they realized the reduction in the need to use psychotropics and specialized services in mental health.

Conclusions

Intersectoral collaboration was established and maintained to resume mental health care for people with psychological distress who were waiting in line for specialized treatment.

Key messages

Primary health care teams when looking for partners to assist patients in mental health have an expanded look at the citizen who should be embraced by public policies. There is a need to add community-based care for people with mental suffering to care based on intersectoral actions in health territories.
Risk and resource factors for the development of depression during adolescence and young adulthood
Authors: Wüstner A , Otto C , Klasen F , Westenhöfer J , Reiss F , Hölling H , Ravens-Sieberer U
Published: October 2020

Background

Depression is one of the most common mental disorders in adolescents and young adults worldwide, and causes severe impairments in psychological health, social functioning and employment. The identification of risk and resource factors for depression is an important research aim. The present study aims to investigate which individual, familial and social risk and resource factors in childhood and adolescence are associated with depressive symptoms five years later in a population-based cohort in Germany.

Methods

Analyses were performed using data from the longitudinal BELLA study. Data on risk and resource factors were collected among N = 632 children and adolescents aged 11 to 17 years. Depressive symptoms were measured five years later. The effects of risk and resource factors on depression were investigated using multivariate linear regression analyses. In subsequent models, we explored potential moderator effects of resource factors on the relationship between risk factors and depressive symptoms.

Results

A negative mother-child relationship was associated with stronger depressive symptoms in girls, while school stress was identified as a risk factor in boys. Peer competence was associated with fewer depressive symptoms in girls, and family cohesion served as a resource factor in boys. Moreover, self-efficacy moderated the association between negative mother-child relationship and depressive symptoms. Family cohesion acted as a moderator between peer problems and depressive symptoms.

Conclusions

Our findings provide evidence of gender-specific risk and resource factors for depressive symptoms. Individuals who are exposed to one of the identified risk factors must be monitored during the transition from childhood to adolescence and young adulthood. Gender-sensitive health promotion and early prevention programs are needed.

Key messages

Information concerning risk and resource factors for the development of depressive symptoms during adolescence and emerging adulthood are of high interest for public health, research and practice. The findings of the present study are of great relevance for the development of gender-sensitive health promotion and early prevention programs.
Ozone effect on inflammatory and proteomic profile of human macrophages and airway epithelial cells
Authors: Falcone L , Aruffo E , Di Carlo P , Del Boccio P , Cufaro M C , Pesce M , Patruno A , Ballerini P
Published: October 2020

Background

Reactive oxygen species (ROS) and oxidative stress in the respiratory system are involved in lung inflammation and tumorigenesis. Ozone (O3) is one of the main components of air pollution in urban areas able to act as strong pro-oxidant agent, however its effects on human health is still poorly investigated. In this study the effect of O3 has been evaluated in THP-1 monocytes differentiated into macrophages with PMA and in HBEpC (primary human bronchial epithelial) cells, two model systems for in vitro studies and translational research.

Methods

Cell viability, ROS and pro-inflammatory cytokines like interleukin-8(IL-8) and tumor necrosis factor(TNF-α) have been tested in the above-mentioned cell lines not exposed to any kind of pollution (basal condition-b.c.) or exposed to O3 at a concentration of 120 ppb. In HBEpC a labelfree shotgun proteomics analysis has been also performed in the same conditions.

Results

Ozone significantly increased the production of IL-8 and TNF-α in THP-1 whereas no changes were shown in HBEpC. In both cell lines lipopolysaccharide(LPS) caused an increase of IL-8 and TNF-α production in b.c. and O3 treatment potentiated this effect. Ozone exposure increased ROS formation in a time dependent manner in both cell lines and in THP-1 cells a decrease in catalase activity was also shown. Finally, according to these data, functional proteomics analysis revealed that in HBEpC exposure to O3 many differential proteins are related to oxidative stress and inflammation.

Conclusions

Our results indicate that O3, at levels that can be reached in urban areas, causes an increase of pro-inflammatory agents either per se or potentiating the effect of immune response stimulators in cell models of human macrophages and human airway epithelial cells. Interestingly, the proteomic analysis showed that besides the dysregulated proteins, O3 induced the expression of AKR1D1 and AKR1B10, proteins recognized to play a significant role in cancer development.

Key messages

This study adds new pieces of information on the association between O3 exposure and detrimental effects on respiratory system. This study suggests the need for further research on the mechanisms involved and for a continued monitoring/re-evaluation of air pollution standards aimed at safeguarding human health.
The importance of peer support in the recovery process of persons with mental disorders
Authors: Stimac Grbic D , Pavic Simetin I , Istvanovic A
Published: October 2020

Issue

Care for people with severe mental disorders requires approach that is focused on a person's strengths, not his weaknesses, and is a shift from a deficit model that is often associated with mental illness. Care users and their family members play an important role in this approach.

Description of the Problem

Mental disorders are the leading group of diseases in Croatia, according to the number of days of hospital treatment. The number of hospitalizations is high, and the rate of hospitalization for depression has tripled in the last twenty years. Such indicators highlight the need for reorientation of mental health care, from hospital-based to community-based, by organizing mobile community intervention teams.

Results

In Croatia, psychosocial peer teams were established by the NGO Ludruga, financed by local government, to provide peer support to persons with mental disorders. The main activities are: development of a personal recovery plan, home visits and providing psychological support to persons with mental disorders, organizing support groups and education of peer workers. The teams consist of a peer worker, social worker, psychologist, and operate under the supervision of a psychiatrist. The teams have been operating for five years, have had over a hundred users so far and are a significant help to the healthcare system in preventing rehospitalizations.

Lessons

The goal of therapeutic interventions in mental health care should be recovery. Recovery involves empowering a person to take responsibility for themselves and their health. Peer workers play an important role in the recovery process, providing hope for recovery. Their role must also be recognized by the health system.

Key messages

People with mental disorders and their families should be co-creators of care and recovery-oriented interventions. Only by comprehensive interventions, tackling all determinants of health, therapeutic goal can be achieved.
Psychosocial health of farmers
Authors: Wessel R , Kuijk J , Kunst A E , Olsen I G
Published: October 2020

Background

Studies from several countries have shown increased suicide mortality rates among farmers as compared to non-farmer citizens. Research has shown that farmers often face psychosocial problems resulting from business operations and financial problems. However, there are hardly European studies on these potential problems. Therefore, the study aimed to assess the psychosocial health and health services use among farmers in The Netherlands.

Methods

A qualitative study including 16 semi-structured interviews with farmers in eastern Netherlands. The interview guide was based on the health care use process model of Levesque. Interviews were verbatim transcribed and thematically analyzed in MAXQDA.

Results

This study identified several risk conditions for psychosocial health problems related to the social and occupational position of farmers, including: financial problems, persistently high work pressure, negative public views towards farming, uncertainties due to continuously changing regulations, traditional attitudes emphasizing stoicism and hard work, and lack of support from nearby farmers. Farmers are often not seeking help for psychosocial problems, due to underestimation of their own health needs, lack of knowledge and confidence in professional support, and difficult in using and finding support tailored to their needs.

Conclusions

This study for eastern Netherlands revealed several themes contributing to a high risk of farmers to develop psychosocial problems, and low use of appropriate mental health and social services.

Key messages

Farmers are at increased risk of psychosocial problems, due to social and work-related conditions. Nonetheless, these farmers were less likely to find and use health and social services. This implies an urgent need for the development of services that provide appropriate psychological support to farmers in the Netherlands.
Gender differences in perceived stress level among undergraduate students in Armenia
Authors: Harutyunyan A , Musheghyan L , Hayrumyan V
Published: October 2020

Background

Stress is an important issue in academic institutions and can have a negative impact on overall academic performance. This study was conducted as a research assignment during the Basics of Healthy Lifestyle course and aimed to investigate the stress level among undergraduate students at the American University of Armenia (AUA).

Methods

A cross-sectional survey was conducted among undergraduate students recruited by non-random convenience sampling. The study utilized a structured questionnaire to conduct face to face interviews. The questionnaire contained 40 close-ended questions on students' perceived stress level, the Student Stress Scale (SSS) (sum of scores of 31 questions) to measure actual stress, and socio-demographic characteristics. Data entry, descriptive and comparative statistics were performed using SPSS software. Secondary data analysis was conducted to explore gender differences in stress level.

Results

Overall, 111 AUA students participated and slightly over half of participants (59.5%) were female. The SSS revealed that 46.0% of students experience medium stress levels (self-perceived mean stress score =-5.8). Only 21.6% perceived themselves as having high stress levels; however, SSS showed that about one third had high stress. Female participants' perception of being highly stressed and having high stress level based on SSS were similar (28.8% and 27.3%, respectively). In contrast, less males perceived being highly stressed (13.3%), though, SSS showed that 40.0% of males experienced high stress levels.

Conclusions

The majority of AUA undergraduate students experienced medium or low stress levels. Male students experience higher stress levels, but their perceived stress level was much lower than in among females. Research is needed to explore the gender differences in stress levels and coping mechanisms among students. These findings may be useful for university administration for developing stress-reduction and stress-management strategies.

Key messages

There are disparities in perceived stress and actual stress levels between male and female students that warrant further exploration. Gender differences in stress level of the students should be considered for stress-reduction and stress-management strategies.
Increase in cocaine-related deaths in Slovenia
Authors: Jandl M , Rostohar K , Krek M
Published: October 2020

Background

In 2016, sudden increase in cocaine related deaths was reported in Slovenia. Study aims to provide data for understanding this new trend and results will serve to create responds to prevent those deaths in the future.

Methods

We used a trendspotter study methodology. Data from General Mortality Register with forensic autopsies and toxicological analysis were overviewed. For further analysis we linked mortality data with the treatment database for the history of treatment. Data from Early Warning System and national Police service were used.

Results

All 18 cocaine deaths in 2016 were men with average age 38.9 years. The highest number of deaths occurred in the 30-34 age group. Deaths in time periods can not be linked with seizures of cocaine with certainty. An autopsy was performed in 17 people. Cocaine with benzodiazepines was found in 7 deaths or with opiates in five deaths. Followed are combinations with amphetamines, alcohol and cannabis. 33% were included in the treatment programs.

Conclusions

No detailed data on cocaine related deaths was available in Slovenia until now. With analysis we got an important inside on this problem and the basis for setting trends regarding cocaine deaths in Slovenia.

Key messages

Sudden increase in cocaine related deaths was reported in Slovenia. Study aims to provide data for understanding new trend in cocaine related deaths.
School staff’s views on poor mental health among Swedish students in a rural setting
Authors: Svensson Å , Warne M
Published: October 2020

Background

School staffs' views on poor mental health in students is of interest when planning and evaluating mental health promotion in school. The aim of the present study was to explore school staff's views on poor mental health in students.

Methods

The study was carried out in a rural municipality in the northern part of Sweden in 2019-2020. The baseline data presented here was collected prior to a mental health promotion intervention (Youth Aware of Mental Health). Three focus group interviews were conducted with teachers/teacher assistants in grade 7-9 at three different schools, and one with the central student health team. One individual interview was carried out with a psychologist from the student health team. Thematic content analysis was used.

Results

Preliminary analysis resulted in three themes. In To discover and interpret poor mental health, the school staff discussed distribution, signs, and difficulties for school staff and students to detect and handle poor mental health. In The surrounding community, school staff reflected on the impact of students' contexts, including school, home, leisure activities, and social media, in the rural setting. Lastly, in What the school and students can do, school staff elaborated on conditions and possibilities to prevent and manage poor mental health in the local context.

Conclusions

School staff expressed that they and the students had difficulties interpreting and managing students' poor mental health. Students are surrounded by norms, and demands for responsibility, engagement and performance in different contexts. Inadequacies in the school organization put greater responsibility on the individual teacher.

Key messages

There are shortcomings in school staffs' as well as students’ knowledge of and management of poor mental health. In order to promote mental health among students, the rural school needs to create an organization that takes into account the conditions of sparsely populated areas.
Anticholinergic burden and cognitive functions in schizophrenia: a systematic literature review
Authors: Giannakou K , Georgiou R , Lamnisos D
Published: October 2020

Background

Cognitive dysfunction in schizophrenia forms the key cause of the disease's disability, leading in serious functional implications at the individual level and socioeconomic effects at global level. Dopaminergic-cholinergic balance is considered essential to cognitive function in schizophrenia while patients are often treated with many drugs with anticholinergic activity. This study aims to examine the association between high anticholinergic burden medication and cognitive function in schizophrenia patients.

Methods

A systematic review was performed on English language research studies published on PubMed from inception to December 2019 focusing on the effect of anticholinergic loads on cognitive domains in schizophrenia. No restrictions on study designs, age or geographical distribution were applied. Two researchers performed independently the screening and shortlisting of the eligible articles. A narrative synthesis of the main characteristics and the findings of included studies was reported.

Results

In total, fourteen articles of varying methodological design met the inclusion criteria. Three of them found significant improvement in cognition after anticholinergic discontinuation without adverse effects. Eleven studies found a significant association between high anticholinergic burden and cognitive impairment (e.g. verbal memory, information processing speed and working memory). However, the magnitude of the association in the largest study is statistically significant but of dubious clinical significance.

Conclusions

Medication with increased anticholinergic load has been found in most of the studies to affect the cognitive functions of people with schizophrenia. However, the lack of clinical and methodological homogeneity of selected studies, limit our interpretation and conclusions.

Key messages

There is some evidence indicating a negative effect of anticholinergic drug treatment on cognitive function of schizophrenia patients. Well-designed large prospective studies and randomized clinical trials are required to examine the effect of anticholinergic drug treatment in the cognition of schizophrenia patients.