bluuebunny/crossref_metadata_2025 huggingface dataset:
Bridging Generations: Sharing stories from the past with the future
Authors: Brisbois M , Silva H , Soares R , Cabral L , Canasta H , Feno A , Santos A
Published: November 2019

Background

As the immigration population continues to grow; little is known about this phenomenon from the immigrants’ perspective. In recent years, nurses have embraced narrative inquiry to better understand the human experience. When relaying their stories, vulnerable groups legitimize their behavior, share their emotional experiences, and amplify their voices that may have otherwise remained silent.

Objective

Eight elderly Portuguese women who immigrated to the United States (US) were interviewed about their experience of immigration by nursing students from Portugal and U.S., as part of a student exchange. The objective of this project was to better understand the impact of immigration through narrative inquiry.

Results

On average, the women lived in the US for approximately fifty years; immigrating in their early twenties. Most women arrived alone or accompanied by spouse and/or children. Their first memories were related to snow, and solitude of being in a new country. The participants attended classes to obtain documents or learn English. All worked in the textile industry; their greatest accomplishment was buying their own house. Challenges faced were related to language and difficult jobs. Overall, they had no regrets except in leaving family members behind. Their message to the students was that love and family are most important in the world. Students were able to realize emigration and immigration from their respective countries.

Conclusions

Rich descriptions provided an in-depth understanding of the details of the women’s experience. Student nurses gained valuable skills and knowledge to understand the impact of immigration among Portuguese women using narrative inquiry.

Key messages

The use of narrative inquiry proved to be a valuable method to interview Portuguese immigrant women. Every immigrant has a unique narrative to share that allowed for nursing student’s appreciation of the experience across generations.
Health-Related Quality of Life in resettled refugee youth
Authors: Dangmann C , Andersen P A , Fjeld-Solberg Ø , Steffenak A K , Høye S
Published: November 2019

Aim

Millions have fled from the Civil unrest in Syria and half of these are children and youth. Although they are a population with elevated risk for health problems due to adverse pre-migratory and post-migratory experiences, few studies have explored their Health-Related Quality of Life (HRQoL). This is considered a fundamental construct in public health and might provide complementary descriptions of their health and wellbeing after resettling in a new country.

Methods

A cross-sectional survey of 160 Syrian youth aged 13-24 years recently resettled in Norway, was carried out in 23 schools. Using KIDSCREEN-27, results from five dimensions of HRQoL (physical and psychological wellbeing, parental relations, school environment and friends) was compared to norm populations and analysed with associated sociodemographic factors and war related adverse events.

Results

Preliminary results indicate that for most participants the overall HRQoL was good, but lower in the dimensions for physical and psychological wellbeing and friends than in norm populations. Satisfaction with parental relations and the school environment was high and the main contributors to a positive HRQoL in the participants. Age and number of reported Stressful Events had the greatest impact of all the the included variables, but all correlations were small to moderate and therefore accounted for little of the total variance.

Conclusions

The findings suggest that HRQoL is a relevant and non-invasive measure for refugee youth. Interventions focussing on general psychological wellbeing and networks could be beneficial for the group, and need to be explored. These interventions could potentially be based in schools or in family work, to benefit from these being seemingly safe environments for the majority of the group.

Key messages

Health Related Quality of life in young Syrian refugees was good, but lower in the dimensions for friends and psychological wellbeing than for norm populations. Satisfaction with parental relations and school environment was high among the Syrian youth and the main areas that contribute to a positive Health Related Quality of Life.
The influence of culturalisation on GP consultations and in research on GP care
Authors: Stern A , Razum O
Published: November 2019

Background

General practitioners (GPs) have a gatekeeping function in the healthcare system. Research shows that patients of Turkish origin in Germany manage to access specialist care less often than non-immigrant patients. Underlying could be problems related to interactions with the GP. Focusing on interaction instead of individual patients’ characteristics might help identifying underappreciated barriers in health care.

Methods

We conducted a scoping review to identify research on interaction-related aspects of GP consultations of people of Turkish origin. Goffman’s interactional theory was used for operationalisation. Analysis focused on the process of consultation from the perspectives of patients, GPs, and interpreters. Additionally, noticeable issues in researchers’ perspectives on migrants’ utilization of health care were identified.

Results

Patients of Turkish origin expect similar professional performances from their GPs as patients without a migration background. If informal interpreters take part, misinformation might remain unrecognised. Frequently, GPs experience insecurity, which sometimes results in lower empathy and prejudice-based, unprofessional reactions or misdiagnoses. Researchers’ interpretations refer partly to unfounded explanations such as a homogeneous Turkish culture or somatization tendencies of Turkish patients.

Conclusions

Difficulties in GP care of patients of Turkish origin, and access barriers to specialist care, arise less from culture-bound performances of these patients as from culturalising expectations and performances of GPs. Researchers often show similar expectations and interpretations. Such culturalising interpretations should be avoided in future research.

Key messages

Difficulties in GP care of patients of Turkish origin, and access barriers to specialist care, arise less from culture-bound performances of these patients as from culturalising expectations of GPs. Future research should avoid culturalising interpretations.
Characteristics of specialist consultations regarding immigrant patients at a large Swedish hospital
Authors: Svärd V , Sernbo E , Nilsson M
Published: November 2019

Background

After an increased number of asylum-seeking patients, the Karolinska University Hospital in 2016 introduced a one-year-project with five asylum social workers (ASW). This study analyzes the characteristics of patients, issues and performed tasks.

Methods

The data consists of five months anonymized case documentation of ASWs direct patient contacts and documented telephone consultations with staff. Descriptive statistics and qualitative content analysis were made.

Results

Of direct patient contacts, 56% were with asylum seekers, 7% undocumented, 7% EU citizens and 30% had various forms of migration status. Tasks consisted of 39% external cooperation, 15% writing certificates, 20% applying for e.g. social assistance for patients’ basic needs.

Analysis of telephone consultations with staff showed that 24% concerned patients with unclear migration status, 17% undocumented, 14% asylum seekers, followed by various forms of migration status. The issues related to patient rights (17%), housing and discharge problems (17%), subsidized health care (11%), costs for care (10%), social assistance (8%) and national registration and establishment (8%). Performed tasks by ASWs were legal advice (19%), referral for further management (19%), advice about cooperation with e.g. the Swedish Migration Board (14%), costs for health and social care (13%), social support (11%), health care administration (10%), application for visa or passport (8%) and the right to subsidized health care (7%).

Conclusions

ASWs performed tasks concerning cooperation and advisement regarding care-planning and legal concerns, helping both patients and staff. Staff were often insecure about immigrant patient’s legal status and right to health and social care. To optimize support to staff regarding asylum-seeking patients, it is recommended to use a broader definition of migration status to include unclear cases.

Key messages

The hospital staff were often insecure about immigrant patient’s legal status and consultation should thus address various forms of migration status among patients. The hospital staff needed consultation regarding legislations, discharge, housing, social assistance and costs for and right to health and social care.
Health system resilience – a conceptual and empirical review of health system literature
Authors: Wahedi K , Biddle L , Bozorgmehr K
Published: November 2019

Background

The concept of health system resilience has gained popularity in the global health discourse, featuring in UN policies, academic articles and conferences. The term is commonly used to refer to the ability of health systems to respond to challenges. However, there has been no comprehensive overview of how the concept is understood and assessed in health systems research (HSR).

Methods

We conducted a conceptual and empirical review in 3 databases using systematic methods. Quantitative and narrative synthesis was used to trace the introduction of the concept to HSR, identify relevant definitions and examine its use in research.

Results

From 4063 references, we identified 96 articles concerned with health system resilience from 2007 - 2017, with a recent increase in literature (45% of studies published since 2016). Many articles take a general perspective; others focus on specific HSR building blocks (e.g. 28% on service delivery) or a particular type of crisis, such as climate change (12.5%) or natural disasters (10.4%). While the concept was developed from the ecological sciences, its meaning has been adapted in HSR, with a shift towards people-centred and process-oriented definitions. We identify three frameworks operationalising resilience: the “attributes” framework by Kruk et al. (2017), the “everyday resilience” framework by Barasa et al. (2017) and the “complex adaptive systems” framework by Blanchet et al. (2017). However, we find a mismatch between these frameworks and how the concept is assessed in 13 quantitative and 8 qualitative empirical studies.

Conclusions

The HSR literature has converged around a definition of resilience focusing on the system’s ability to mitigate ongoing challenges. Differences in emphasis remain, resulting in a variety of operational frameworks. The frameworks require further adaptation and testing in empirical studies to demonstrate the usefulness of “resilience” as an analytical category in HSR.

Key messages

There is a mismatch between conceptualisation and operationalisation of resilience in the HSR literature. Existing operational frameworks of resilience require further adaptation and testing in empirical studies to demonstrate the usefulness of “resilience” as an analytical category in HSR.
The meaningfulness of open data in Public Health and Healthcare
Authors: Pita Costa J , Fuart F , Cleland B , Wallace J , Staines A , Belar O , Bidaurrazaga J , Pääkkönen J , Epelde G , Poliwoda P
Published: November 2019

Background

The growing challenges and opportunities of Big Data for Public Health have revealed the potential to improve the efficiency and cost-effectiveness of public policy, for example through better targeting of resources with regard to General Practice (GP) prescribing. Open data has an important role due to its easy access and potential to complement proprietary data sources from, e.g., regional hospitals, and also itself be complemented with social data acquired by specialized approaches.

Methods

MIDAS pipeline of open source tools aiming integrating, analysing and visualising Open Data enabling health professionals and decision-makers to: (i) improve the usability of open data in combination with proprietary data through combining multiple visualisation tools in an integrated dashboard (ii) to explore the meaning of data in a global/local context based on new information using tone analysis and natural language techniques; and (iii) to have better informed decision-making based on evidence from trusted knowledge-bases. Specific data sources used have included information extracted from the biomedical database MEDLINE, worldwide news and government open data. Social media sources have also been used to gather information from the general public.

Results

Results include a strong correlation between antidepressant prescribing and economic deprivation, and a wide variation in how individual GP practices respond to demographic conditions. Automated anomaly detection based on the Local Outlier Probability has also been shown to be an easily understood and controllable approach to identifying prescribing outliers.

Conclusions

MIDAS demonstrates the significant value of open data from heterogeneous sources as basis decision-making in public health and healthcare, particularly when it is combined with proprietary or closed datasets. A key challenge in this regard is the ability to integrate and utilize data from diverse sources in a variety of formats and standards.

Key messages

MIDAS is exemplar on tackling the need for improved standards of open data, and new software architectures, tools and platforms addressing a complex ecosystem of heterogenous data sources and formats. MIDAS demonstrates the significant value of open data from heterogeneous sources as basis decision-making in public health and healthcare, particularly when combined with proprietary datasets.
StopBlues: a French e-health device to prevent suicide in the general population
Authors: Le Jeannic A , Gandré C , Vinet M A , Turmaine K , Roelandt J L , Giraudeau B , Alberti C , Chevreul K
Published: November 2019

Background

France is one of the Western European countries most affected by suicide, an epidemiological burden and high societal cost of several million euros/year. Several European projects have either implemented web-based interventions for care of mental disorders or recommended online actions which have demonstrated their effectiveness for suicide prevention.

The objective of the project was the construction of an application and website to prevent suicide in the general population, with its promotion being supported at the local authority level.

Methods

The detailed content of the devices and promotional tools available to local authorities was determined through literature reviews and expert groups (psychiatrists, local authorities’ workers and potential users).

Results

An application and website were constructed with two parts: a public interface with videos (psychological suffering, coping strategies and help available), an emergency button, a map with local resources and contact information (psychiatrists, psychologists, associations...), tips and videos to overcome a period of psychological suffering; and a private interface requiring registration giving access to self-assessment questionnaires and a safety plan to fill in case of crisis. 40 local authorities are involved in StopBlues promotion, with a referent each, responsible of contact with our team, and local organization of promotion.

Conclusions

Since 04-2018, StopBlues is available at www.stopblues.fr and can be downloaded on iOs and Android. Its promotion is part of a cluster randomized trial with 3 arms: a control group with no promotion, a group with promotion by local authorities, and a group with promotion by local authorities and general practitioner’s waiting room. As promotion could have different intensities depending on budgets and referent’s involvement, we decided to extend it for another year, with local authorities of group control receiving additional financial and organizational support.

Key messages

As the first e-health program for suicide primary prevention in the French general population, StopBlues’ main goal is to help people find solutions that suit them and direct them to the right help. Local authorities are a key level to promote primary health prevention programs.
The use of E-sexual health as a way of lowering help-seeking barriers for sexual dysfunctions
Authors: Van Der Heijde C M , Bunte I , Hilverda F , Vonk P
Published: November 2019

Background

The prevalence of sexual dysfunctions is not negligible and experiencing a sexual problem is often accompanied by psychosocial effects, increasing the risk of comorbidities such as depression, greater levels of anxiety and lower self-esteem. Less than half of the individuals who experience sexual problems seek professional help, partially because of stigma and ignorance. Therefore a solution is required. E-sexual health has potential to help individuals with sexual dysfunctions, but little is known about its’ use.

Methods

We examined the predictors of E-sexual health usage using the Technology Acceptance Model (TAM). Perceived usefulness, ease of use, attitude, and intention to use E-sexual health were explored as potential predictors in a cross-sectional survey (N = 426). 413 of them were female, 180 male, aged from 18 to 72 years (M = 24.5, sd = 7.8). Structural equation modeling (SEM) was used to test the model.

Results

The results showed that TAM can effectively predict whether patients adopt E-sexual health. The model demonstrated a good fit (χ2 = 1197.73, df = 500, χ2/df = 2.40 TLI = .913, CFI = .927, IFI = .927, RMSEA = .048). Notwithstanding, it appeared that the current use and implementation of E-sexual health is much lower compared to several other E-health services.

Conclusions

It should be taken into account by healthcare providers that people are hesitant to disclose sexual problems. Further research is necessary to find out how to increase awareness of the relevance of treating sexual problems and how to increase knowledge about the possibilities of E-sexual health and its’ usefulness.

Key messages

E-sexual health has the potential to reach more patients with sexual dysfunctions. Increasing awareness for the relevance of treating sexual dysfunctions, and the potential of E-sexual health can lower the barriers for help-seeking behavior.
Primary care providers’ beliefs and practices on colorectal cancer screening in Kuwait
Authors: Tolma E L , Aljunid S M , Amrizal M N , Longenecker J , Al-Basmy A , Annaka M , Al-Wotayan R
Published: November 2019

Background

Colorectal cancer (CRC) is a major public health issue in the Arab region. In Kuwait, CRC is the second most frequent cancer, with an age-standardized (world) incidence rate of 13.2 cases/100,000 in 2018. Despite the national efforts to promote CRC screening the current participation rate is very low (5 to 17%). Primary Care Providers (PCPs) are considered as the gatekeepers of cancer screening globally. This is one of the first studies in Kuwait that examined the current beliefs/practices of PCPs on CRC screening.

Methods

This cross-sectional study was conducted at governmental primary care centers in Kuwait from 2015-2017. Of 564 PCPs invited to participate from all centers, 255 completed the self-administered questionnaires. The 14-page survey contained 75 questions on PCPs’ beliefs and practices of CRC screening. Data were analyzed by using descriptive statistics.

Results

The study sample consisted primarily of females (52.0%) and non-Kuwaiti (79%) physicians, with mean age =43.3 (SD: 11.2) years. Most respondents (92%) believed that colonoscopy is the most effective screening tool. The majority (78%) reported that they recommend CRC screening to their patients, with colonoscopy as the most frequent modality (87%) followed by the Faecal Occult Blood Test (FOBT) (52%). Around 40% of the respondents stated that they did not have time to discuss CRC screening with their patients. The majority (72%) believed that their patients did not complete their CRC screening tests. Health system related barriers included difficulties in obtaining test results from the gastroenterologist (61.4%), ordering follow-up test after a positive screening test (50.6%) and shortage of trained staff to conduct the screening test (44.2%).

Conclusions

A majority of PCPs in Kuwait recommend CRC screening to their patients, but not all patients follow through their recommendation. More research is needed to find out how to further enhance patient uptake of CRC screening.

Key messages

Colonoscopy is the most frequent screening CRC modality used in Kuwait. Health system related factors can be important future intervention targets to promote CRC screening.
High-throughput profiling of health-associated political, economic, commercial and social factors
Authors: Sandoval J L , de Ridder D , Stringhini S , Guessous I
Published: November 2019

Background

Political, economic, commercial and social factors have considerable impact in shaping health outcomes. Yet, most research is hypothesis-driven and, probably, not fully exploring the available data. We aimed at adapting gene expression profiling methods to perform unsupervised high-throughput profiling analysis of large databases of country indicators associated with life expectancy at birth.

Methods

We analysed 464 World Bank development indicators for 217 countries using a Limma software R package. We established the differentially represented indicators (DRIs) between countries in the first and third terciles of life expectancy at birth. The analysis was stratified according to high (HIC), middle- (MIC) or low-income (LIC) status. Indicator profiles by development category were compared to determine overlaps and group-specific DRIs. Confounder-adjusted multivariable linear regression models were used to validate chosen DRIs.

Results

We identified 99 DRIs for HICs, 7 for MICs and 190 for LICs. One DRI was common to all categories - “particulate emission damage (% of GNI)” (adjusted p.value=7.3E-5). This DRI was negatively associated with life expectancy despite adjustment for GDP per capita (GDP), human capital index (HCI) and development classification (Beta=-2.7, p < 0.001). We also analysed the 7 identified gender-related DRIs. Only female murder rate (per 100 000 females) was negatively associated with life expectancy, independently of GDP, HCI, GINI index, education parity indexes, overall and male murder rates (Beta=-2.1, p = 0.001). This association was found in HICs (p = 0.001) and MICs (p = 0.03), but not in LICs (p = 0.4).

Conclusions

Bioinformatics methods could help to analyse large country level datasets, allowing the profiling of DRIs and identify potential new determinants of health or health-associated indicators.

Key messages

Using bioinformatics tools can be useful in uncovering health-associated indicators for global health. Particulate emission damage or female murder rate could represent potential important determinants of health or health-associated indicators.
A practical guide to make the case for sustainable investment in well-being and health
Authors: Stielke A , Ashton K , Dyakova M , Bellis M
Published: November 2019

Growing health, inequity, economic and environmental challenges threaten the well-being of present and future generations. Current investment policies and practices are unsustainable and result in high human, social, economic and environmental costs. Countries require the tools to build the case for investment in areas of greatest need by applying evidence-informed practice.

A practical guide with tools and resources was developed on how to develop an evidence-informed product to make the case for investment in well-being and health equity.

Stakeholder interviews with national and international experts in health policy, equity, economics and social sciences were conducted to inform the outline of the guide and identify enablers for creating evidence-informed products. An evidence review gathered tools and resources on how to translate and communicate public health evidence into policy and practice. An international cross-sector expert consultation assured relevance and transferability of the guide across countries, contexts and policies.

The guide aims to prevent disinvestment in health and increase investment in prevention as well as mainstream cross-sector investment to target the wider determinants of well-being and health equity. It outlines how to synthesise, translate and communicate public health and health economic evidence into policy and practice and proposes a step-by-step approach following four key phases (i) project scoping and planning, (ii) evidence gathering, synthesis and design, (iii) dissemination and communication, (iv) monitoring and evaluation.

The guide presents information to develop an evidence-informed product to make the case for sustainable investment in an innovative and informative way for use by a range of stakeholders. It accounts for policies and contexts and is communicated in a way that is accessible for decision-makers, easy to use and available as hard copy and interactive version.

Key messages

Investing in well-being and health equity drives and enables sustainable development. Making the case for investment in health equity requires a well-planned, evidence-informed approach.
Stress perceived by pregnant and decision-making factors of maternal caesarean section request
Authors: Riquet S , Coste C , Monguillon M , Zakarian C
Published: November 2019

Background

Pregnancy is a time of psychological vulnerability which can generate intense stress. This represents a maternal and child public health problem. Prenatal stress has harmful impacts on the foetus, the newborn and can cause an increased maternal request for caesareans sections, with nonmedical grounds. The perceived level of prenatal stress factors was assessed in women, as well as mothers’ incentives and decision-making factors for a caesarean section on maternal request.

Methods

A descriptive study on 203 pregnant women, then a comparative study between primiparas (n = 72) and multiparas (n = 131) were carried out with the Antenatal perceived stress inventory. Incentives and decision-making factors for a caesarean on the mother’s demand were studied by in-depth interviews with primiparas mothers (n = 16) who had made this choice.

Results

The perception of stress level during pregnancy is higher at the first quarter regarding the foetus’ health, medical and obstetric risks and reverses with the perception of projections linked to giving birth at the last quarter. Primiparas are significantly (p < 0.001) more stressed. All the elements of the three assessed factors are very significantly (p < 0.001) correlated for the whole population. Among them, 75% choose a caesarean section on maternal request during the first quarter. This choice is confirmed at the end of the second quarter or during the third one for 50% of them, with a one-month time to think for 58.3% of them. The main incentives are tokophobia (66.7%) and preserving the baby’s health (50%).

Conclusions

Pregnancy causes important stress, which is pronounced in primiparas. In France, these results speak in favour of screening tokophobia and an earlier start of birth and parenthood preparation classes in order to handle stress from the first quarter of pregnancy, when medical and prenatal exams are initiated. Birth preparation should be taken on at the last quarter.

Key messages

Investigate stress perceived and identification incentives and decision-making factors of maternal caesarean section request it’s a solution to building bridge for solidarity with tokophobic women. The relation enter stress perceived by pregnant women and decision-making factors of maternal caesarean section request, represents a maternal and child public health problem.
Induced abortions in Estonia, 1992-2017: registry-based study
Authors: Veerus P
Published: November 2019

Background

In Estonia, termination of pregnancy is allowed until 12 gestational weeks on request or for medical reasons, and until 22 gestational weeks only for women under 15 or over 45 years of age and for severe medical illness of the mother or the fetus. Information about all induced abortions is collected in the central digital Abortion Registry since 1996. The source document for collection of data is the Abortion Card which is filled in for every abortion that has taken place in a health care institution by all health care institutions (incl. private doctors) who do abortions or provide medical care to women who have had an abortion. The choice of contraceptive devices is large and their price is affordable. Sexual education is included in school curriculum. Councelling about contraception is free for all citizens until 25 years of age. Termination of pregnancy is free only for medical reasons, in other cases there is a small fee.

Methods

Data for the analysis was obtained from the Estonian Abortion Registry.

Results

The total number of induced abortions in Estonia decreased from 25803 in 1992 to 4017 in 2017. The abortion rate per 1000 women aged 15-49 declined from 69.6 in 1992 to 14.0 in 2017. The abortion rate among women under 20 has declined from 43 in 1996 to 10.8 in 2017. The abortion rate has always been the highest in the age group from 20 to 24 years. Abortion rates in 2017 varied in different counties from 7.4 to 17.3. In 1996, 97.8 % of preganancies were terminated surgically, in 2017, only 22.3%.

Conclusions

Although induced abortion is legal and not restricted in Estonia, the abortion rate has fallen rapidly due to sexual education at school, free youth councelling services and easily available contraceptive devices. Abortion Registry database is a valuable source of information for evaluating and planning public health interventions. Regional differences in abortion rates deserve further interventions.

Key messages

Abortion rates in Estonia have fallen rapidly due to sexual education, free councelling and available contraceptive devices. The Estonian Abortion Registry is a valuable source of information for public health interventions.
School Health Programme in Sri Lanka: Assessment using WHO’s ‘4S’ Framework
Authors: Wickramasinghe N , Lokubalasooriya A , Vithana C , Hemachandra N
Published: November 2019

Background

Sri Lanka has one of the oldest school health programmes (SHP) in the region, which was started in 1918, and at present caters for 70% of adolescents in the country. This study assessed the implementation status of the Sri Lankan SHP.

Methods

This review was conducted by a panel of experts adopting a participatory approach. Policies and supporting documents were collected from the relevant sectors of the Ministry of Health and Ministry of Education using electronic and manual search and by visiting institutions/resource persons. The WHO’s ’4S’ Framework; consisting of strategic information (S1), supportive evidence-informed policies (S2), strengthening services for adolescents (S3) and strengthening collaboration with other sectors (S4); was used as the guiding framework to analyse the strengths and weaknesses of the SHP.

Results

Having a comprehensive national health information system was the main strength on S1, gaps in timeliness, completeness and accuracy of the data, and the lack of evidence on perceived health needs of school children were the main weaknesses. On S2, Sri Lanka has a strong unifying policy platform supportive of the SHP, but the timeliest need is to finalise the School Health Policy. More than 90% island-wide coverage of school medical inspection was the main strength on S3, while focusing more on physical health and less emphasis on promoting mental health in the existing service package and gaps in the referral/follow-up were the weaknesses. On S4, school staff focusing more on achieving academic-related outcomes and focusing less on health-related activities, undue media and industry influence hindering the promotion of healthy behaviours in school settings were the main challenges.

Conclusions

Despite several emerging challenges, the SHP in Sri Lanka is one of the best school health programmes in the region with more than 90% island-wide coverage of health services.

Key messages

The SHP in Sri Lanka, which is one of the oldest and the best school health programmes in the region, caters for 70% of adolescents in the country. Assessment of Sri Lankan SHP according to the WHO’s ‘4S’ Framework revealed multiple strengths such as comprehensive national health information system and high island-wide coverage.
eDelphi survey to shape the content of a digital resource to enhance parental health literacy
Authors: Kolokotroni O , Hadjigeorgiou E , Gourounti C , Christodoulides V , Sarantaki A , Nicolaou C , Lykeridou K , Karanikola M , Kouta C , Middleton N
Published: November 2019

Background

Information-seeking on the internet is very prevalent, in contrast to low attendance of antenatal classes. In addition to varying quality, few digital resources are developed using participatory research approaches.

Methods

Antenatal learning needs were explored in a modified Delphi survey among the professional community and parents-to-be/new parents. A list of 174 topics was developed using the Nominal Group Technique among antenatal educators and representatives of local professional associations. In an online survey, the relative importance of each was rated on a 5-point scale by the wider professional community and general public. Topics rated by ≥ 80% as at least “very important” or by ≥ 50% as “essential” by either group were shortlisted and re-rated by delegates of the annual Midwifery conference.

Analysis

193 health professionals (77.7% midwives) and 275 mothers-to-be/new mothers (56.4% attendance of antenatal classes) participated in the online survey. Based on pre-set criteria, 95 topics (54.6%) were identified, 55 (31.6%) nominated by both groups. Among 18 themes, those with the highest number of nominated topics were: Breastfeeding, Prematurity, Giving birth, Caring for Baby and Mental health & well-being. There was good agreement between the two groups (r = 0.88) and in the top 20 single topics, thirteen were common. Priorities were largely unchanged in the last round, but a number of new topics emerged, including pre-eclampsia and domestic abuse. On a 1-10 scale, health literary of expectant parent was rated at M = 5.7 (SD 1.5) by professionals.

Conclusions

In a “changing landscape” of antenatal education, new technologies provide opportunities for broader reach. This formative research study explored the perceived learning needs and local priorities in order to shape the content of Baby Buddy, a public health digital intervention to enhance the health literacy of new parents and support the educational role of health professionals.

Key messages

Local needs and priorities for a digital parenthood platform were identified using a Delphi method. Participatory formative research can maximize the potential though co-creation and co-ownership.
The effect of Women’s decision-making autonomy on family Planning acces in Senegal in 2017
Authors: Sougou N M , Bassoum O , Leye M M M M , Tal-Dia A
Published: November 2019

Background

The impact of access to decision-making on women’s health in the choice of fertility control has been highlighted by research. The aim of this study was to analyze the impact of access to decision-making for women’s health on access to family planning in Senegal in 2017.

Methods

The analyses of this study had been done on the Individual Records file of Senegal’s Demographic Health Survey 2017. This data covered 8865 women aged 15 to 49 years. The propensity scores matching method had been done. The variable access to the decision was considered as the variable of interest. Matching was done using variables that were not modified by the effect of the treatment. These were religion and socio-economic level. The outcome variables were modern contraceptive use, the existence of unmet needs and the type of modern contraceptive method used. Significance was at 5%. The condition of common support had been respected. The analysis was done with the STATA.15 software.

Results

Six percent (6.26%) of women could decide about their health on their own. Access to decision-making increased significantly with the woman’s age (p < 0.05). Fifteen percent (15.24%) women used a modern contraceptive method. Women using a contraceptive method were more numerous in the group with access to decision-making (29.43%) with a significant difference with the other group of 8% (p < 0.05). After matching, there was no significant difference between women in terms of modern contraceptive use and the existence of unmet needs. There was a significant difference in the type of contraceptive method used between the two groups of women. These differences were 23.17% for Intra Uterine Device, 52.98% for injections, 08.9% for implants and 10.79% for condoms.

Conclusions

Access to decision-making for health would facilitate women’s access to long-acting contraceptive methods. These findings show the importance of implementing gender transformative interventions in improving access to family planning.

Key messages

Access to decision-making for health would allow better access to modern contraceptive methods, especially those with a long duration of action. Better consideration of gender disparity reduction could improve access to family planning in Senegal.
“Shared learning in action” - model of early prevention program on drug abuse in primary schools
Authors: Grujičić A , Mladenović Janković S , Matijević D , Kovačević N , Stefanović N
Published: November 2019

Issue/Problem

In Serbia, 12,8% of younger adults and 16,5% of sixteen years old adolescents have tried some of the illegal drugs. “Creative workshop with schoolchildren on prevention of drug abuse” program was developed as a part of National strategy against drug abuse, aiming to improve capacities of teachers and children in primary schools.

Description of the practice

Program based on educational approach “Shared learning in action” changes traditional school roles, transforming teachers into facilitators, allowing full expression of children’s ideas, thus enhancing development of their emotional intelligence. Children’s research about drugs mobilizes an extensive list of supporters in gathering relevant information: health workers, police, psychologists, teachers, parents and media. This information is then shaped into a variety of products with strong public health messages: songs, posters, comics, brochures, short plays and videos.

Results

Since 2010, around 450 teachers and nearly 7000 children in 115 Belgrade primary schools were included. Children’s knowledge about drugs has an upturn of over 50%, concurrently with improvement of their teamwork skills, self-confidence, research and creative potentials. Both teachers’ and children’s evaluation grades show a high level of satisfaction with the program.

Lessons

This program is an example of cooperation between educational and health sector, followed by a well implemented monitoring system and quality improvement. Its universal and flexible approach made it a part of official curricula in several schools. It was acknowledged as good practice by the Institute for improvement of education in 2012 and The City of Belgrade in 2018. Since 2014, the program has its Facebook page “Tvoje znanje menja sve”.

Key messages

High grade of children autonomy, supported by teachers and community, makes the learning process amusing and effective. Program achievements demonstrate its potential for systemic implementation to a wide range of public health topics.
Prevalance of Using Cigarette,Alcohol,Substance Among High School Students and Factors Affected Them
Authors: Levent Y , Ozer A , Gokce A
Published: November 2019

Background

Usage rate of cigarette, alcohol, and substance is increasing day by day.Protectiv efactors have primary importance for prevention of substance use.The aim of this study is to investigate the prevalance of using cigarette, alcohol and substance and research relationship between risk factories and substance using, among high school students.

Methods

Ä°n Malatya city there are 17866 Anatolian, 14381 Vocational,10362 Religious high school students.Totally all of this 42629 students form the universe of this cross-sectional study. When the prevalance of using cigarette accepted as 25 % in high school students; sample size in Anatolian high school,Occupatioanal high school and Religious high school was found 283, 283 and 280 respectively.This survey was conducted in 9 different high schools which choosed by stratified sampling method, and 975 high school students have been reached in this survey.Ä°n the statistical analysing of data,Chi square test, logistic regression test were used.

Results

The prevalance of cigarette, alcohol and substance using found 34%, 14.3% and 4.2% respectivey among students participating in the survey.Cigarette using; in male students is 2.2 times higher (Cl 95%,1.661-3.073), in alcohol users is 7.6 times higher(Cl 95%,4.919-11.834)(p < 0.05).Alcohol using is 9.6 times higher(Cl 95%, 5.712-16.250) in cigarette smokers(p < 0.05).And alcohol using in students with alcohol use in their families is 26.8 times higher(Cl 95%,12.489-57.711)(p < 0.05).Substance using; found 12.2 times higher(Cl 95%,4.900-30.566) in alcohol users,2.4 times higher(Cl 95%,5.712-16.250) in cigarette smokers and 5.6 times higher(Cl 95%,1.366-23.068)in students with substance use in their families (p < 0.05).

Conclusions

Cigarette using is more common in males and alcohol users.Alcohol use increses in smokers and students with alcohol use in their families.Substance use among students increases when student uses cigarette or alcohol and if there are substanceuse in their families.

Key messages

Alcohol use increses in smokers, smoking increses in alcohol users. Substance use increses in smokers, alcohol users and in the students with substance use in their families.
Cesarean delivery and its social determinants in women of childbearing age: analysis of Benin’s DHS
Authors: Kpozehouen A , Glèlè Ahanhanzo Y , Klikpo E , Azandjeme C , Metonnou C , Mongbo V , Ouendo E M
Published: November 2019

Background

Caesarean delivery, usually performed on a medical indication, is intended for maternal or fetal rescue. Accessibility issues justify setting up a so-called model of “free caesarean” in several developing countries, including Benin, in order to reduce social inequalities and contribute to the reduction of maternal and neonatal mortality. The study aimed to identify the determinants associated with caesarean delivery in women aged 15-49 in Benin.

Methods

This is a secondary analysis of data from Benin’s Demographic and Health Survey (DHS) 2017 - 2018. It was limited to mothers aged 15 to 49 who gave birth to at least one child in the 5 years preceding the survey. The socio-demographic characteristics of the mother and the variables related to pregnancy were the independent variables. Association between cesarean delivery and its determinants was assessed by odds ratios and their 95% confidence interval using a logistic regression.

Results

The percentage of mothers who gave birth by caesarean was 6.84%, 95% CI = [6.07; 7.59]. The average age was 29.37 years, 95% CI = [29.20; 29.55]. The probability of cesarean delivery was higher with women aged 45 years and older (OR = 3.33, 95% CI = [1.85, 6.01]), living in urban areas (OR = 1.41, 95% CI = [1.08 1.84]), from rich or very rich households (OR = 1.98, 95% CI = [1.29, 3.05], OR = 1.87, 95% CI = [1.19, 2.96] respectively) and educated (OR = 1.63 95% CI = [1.19, 2.24] and OR = 1.81, 95% CI = [0.97, 3.39] for the secondary and upper levels respectively).

Conclusions

This analysis shows that cesarean delivery remains associated with the socio-demographic characteristics of the mother, including the level of economic well-being. The current financing model of cesarean should be evaluated for effectiveness and further interventions need to be implemented to account for other factors of disparity.

Key messages

Benin health authorities should improve the geographical accessibility of Cesarean section, especially in rural areas. The strategies proposed to improve the financial accessibility of cesarean section do not seem effective, so the Beninese authorities should think about revising them.
Pregnancy warning labels on alcohol packaging: results of an exploratory study
Authors: Millot A , Gallopel-Morvan K
Published: November 2019

Background

In 2017, approximately 11% of pregnant women in France consumed alcohol despite its harmful consequences on the fetus (Andler, 2018). Our research aims at exploring the impact of warnings displayed on alcohol packaging: the current pictogram and alternative possible messages that differ regarding content and design will be explored.

Methods

In-depth interviews were conducted with 20 French women, including women who did not drink alcohol during their pregnancy, women who drank alcohol, women in pregnancy planning and breastfeeding mothers.

Questions were asked about the participants perception of drinking alcohol during pregnancy, alcohol warnings: the current pictogram, new contents (negative and positive) for warnings and new designs (different pictograms combined with or without text). A thematic content analysis was carried out.

Results

The current pictogram lacks visibility and has no impact on the behaviour of the women.

New suggested contents were on the whole welcomed. It can be noted that some participants felt that specific messages (e.g. intellectual disabilities, facial malformations etc.) were a more effective way of preventing alcohol consumption during pregnancy than general ones. On the contrary, other participants felt that a general message such as ’Zero alcohol during pregnancy’, or positive messages such as a cessation service message, was more effective.

The majority of participants believed that pictograms with a better visibility; more eye-catching; vivid images of fetuses, etc., would have a greater impact on alcohol consumption.

Conclusions

This study highlights the need for changes to pictogram currently used on alcohol packaging in France. Our results show that recent changes proposed by the French government (a slight increase in the size of the current pictogram) will most likely have little effect on preventing alcohol consumption during pregnancy.

Key messages

The current pictogram on alcohol bottles in France has little or no effect. The French government should implement new warnings both in terms of content and design.