bluuebunny/crossref_metadata_2025 huggingface dataset:
Situational context of home-based sexual education in urban slums of Ibadan, Nigeria
Authors: Aliyu T
Published: October 2023

Background

Little is known about how events in slum settings interfere with informal sexual education in Nigeria. This study explores the influence of situational context on parent-adolescent communication about sexual and reproductive health (SRH) issues in the urban slums of Ibadan, Nigeria.

Methods

A qualitative exploratory study was conducted in the Southeast and Northeast local government areas of Ibadan. Eight (8) vignette-based focus group discussions (FGDs) with parents and adolescents of both sexes were conducted in addition to four (4) key informant interviews (KIIs) with community and women's leaders. Interviews were audio-recorded, transcribed, and translated into English. Descriptive and interpretative analyses were conducted with the aid of ATLAS Ti 9 software.

Results

Findings portray SRH meanings and experiences, intergenerational cultural norms, and expectations for SRH, gender double standards in SRH discussion, streetwise SRH knowledge, and social media exposure to SRH as contexts that interfere with parent-adolescent communication on SRH issues. The findings show that although parents and teenagers understood SRH issues and their consequences, there was no effective communication about them. Also, the conversation between parents and adolescents promotes gender inequalities as different SRH information is passed to adolescent girls and boys. Streetwise SRH knowledge was identified to impede effective parent-adolescent conversation on SRH issues. Social media exposure had a significant impact on where teenagers got their unfiltered SRH knowledge, interfering with and distorting SRH discussion between parents and adolescents.

Conclusions

Interventions that enable parents to give and allow their children early access to appropriate SRH knowledge, considering their context, are urgently needed.

Key messages

• The study emphasizes the need for tailored sexual education programs that are culturally sensitive, age-appropriate, and accessible to parents and children in urban slums.

• The study highlights the absence of formal sexual education in schools and communities in urban slums of Ibadan, Nigeria.
Process evaluation of an intersectoral intervention for health equity in Munich, Germany
Authors: Voss S , Hummel J , Jung-Sievers C , Rehfuess E A , Coenen M
Published: October 2023

Background

Intersectoral partnerships can help building sustainable urban environments for children and adolescents that decrease the impact of socioeconomic inequities regarding health and development. However, facilitators for implementing these kinds of public health interventions have hardly been researched. This study conducted a process evaluation of the intersectoral network Präventionskette Freiham that was implemented in a new residential development area in the city of Munich, Germany.

Methods

We collected data in four different sub-studies following a mixed methods design: (1) qualitative interviews and ego-centered network maps with the network coordinators; (2) qualitative interviews with local professionals from institutions engaged with or relevant for the intervention; (3) a focus group with representatives of the three municipal departments guiding the intervention; (4) an online survey with local network members.

Results

The intervention was able to integrate stakeholders from different sectors quickly at the start of the implementation process. However, the early development status of the area and the ongoing COVID-19 pandemic were a challenge for working processes within the network. Sufficient funding and resources, support from local politics and administration, transparent communication and perceived benefits for the individual members of the network were considered as facilitators for a successful implementation.

Conclusions

The early development status of the area was a challenge for building an intersectoral network. Availability of resources is a key factor for implementing a sustainable support infrastructure promoting health equity for children and adolescents.

Key messages

• This study increases the knowledge on implementing public health interventions in new residential development areas and helps to build better chances for disadvantaged children.

• Implementing sustainable intersectoral partnerships for health equity in communities requires a long-term engagement by local stakeholders, especially in settings without established infrastructure.
Determinants of vaccine uptake in the elderly. Results from a mobile health clinic survey in Italy
Authors: Fonzo M , Miccolis L , Serpentino M , Penzo N , Tognon F , Russo F , Putoto G , Bertoncello C
Published: October 2023

Background

Vaccination is one of the most effective public health tools for improving the quality of life of adults and reducing healthcare utilisation. Despite numerous vaccination campaigns targeting this population, vaccine uptake is generally low. The aim of this study was to investigate the main determinants of vaccine uptake in people aged 65 years and over.

Methods

A mobile health clinic initiative for health promotion has been set up in a railway wagon in the Veneto Region, Italy, in October 2022. Access was free and voluntary. Information was collected on age, gender, nationality, education level, BMI, as well as on smoking, physical activity, vegetable consumption and presence of hypertension, hypercholesterolemia and diabetes. Uptake of flu, zoster, pneumococcal and tetanus vaccines was reported by participants, as was any recommendation by healthcare professional. The effect of the variables on uptake was assessed using a multivariable logistic regression.

Results

A total of 638 participants were included, of whom 50.9% female. Mean age 72.6±6.1. Uptake of flu vaccine was 61.8%, while zoster 17.1%, pneumococcal 21.6% and tetanus 10.0%. The main factor for uptake was having received a recommendation from a healthcare professional (flu: AOR=4.29 95%CI 2.77-6.63; zoster: AOR=3.12, 95%CI 1.52-6.40; pneumococcal: AOR=5.11, 95%CI 2.50-10.44; tetanus: AOR=14.23, 95%CI 4.20-48,35). Flu vaccine uptake was associated with hypertension (AOR=1.77, 95%CI 1.03-3.06) and smoking (AOR=1.84, 95%CI 1.04-3.25). No association was found with other comorbidities, lifestyle or SES.

Conclusions

Population growth and increasing average life expectancy in Europe make vaccine uptake by older adults an integral part of a healthy lifestyle. Among factors involved in the decision whether or not to vaccinate, the recommendation from a healthcare provider remains the most important determinant, and this is more evident in the absence of specific campaigns, as in the case of tetanus.

Key messages

• Among possible determinants, recommendation from a healthcare provider is associated with a significantly higher uptake for flu, zoster, pneumococcal and tetanus vaccine in the 65+ population.

• The magnitude of this effect is even greater in the absence of specific campaigns, as in the case of tetanus, when it increases uptake 14-fold.
Applying health behavior theories that explain elderly’ deprescribing behavior: a systematic review
Authors: Alves Jorge S , Van den Broucke S
Published: October 2023

Deprescribing is a strategy to optimize medication use. Despite the fact that behavioral theories have shown to be useful in explaining health behaviors, the literature on deprescribing relies almost exclusively on attitudes as an explanatory factor for this behavior. This systematic review aimed to assess the capacity of health behavior theories and concepts to explain patient's and caregivers’ deprescribe behavior. Two independent reviewers performed a search on Medline, Embase, Scopus, Psycinfo, Cochrane, and the grey literature, using the key words: older adults, informal caregivers, deprescribing, behavioral models, health belief model, theory of planned behavior, social cognitive theory, nudge, and health literacy, Interventional and non-interventional studies that applied at least one health behavior theory or at least one concept from these theories to older adults’ or their caregivers’ intention or deprescribing behavior were included. Quality screening of the identified records was done using the JBI critical appraisal tool. Ten non-interventional studies and twelve interventional studies were identified. Social Cognitive Theory was most often used to explain deprescribing intention, whereas self-efficacy was used most often to explain deprescribing behavior. Higher health literacy also predicted deprescribing intention, whereas internal locus of control was a barrier to deprescribing behavior. One study applied nudging to deprescribing but showed no significant effect. The only study involving informal caregivers revealed that the belief that relatives experienced side effects was a reason to support deprescribing. It is concluded that health behavior theories and concepts involved in these theories explain deprescribing intentions and behaviors more effectively than only relying on attitudes toward deprescribing.

Key messages

• Deprescribing behavior requires complexes changes to established patters of behaviors.

• Health behavior theories and concepts from these theories can explain deprescribing intentions and behaviors more effectively than relying only on widely studied attitudes toward deprescribing.
Health activation of patients in the face of a novel and unknown syndrome, Long COVID
Authors: León-Herrera S , Oliván Blázquez B , Méndez-López F , Samper-Pardo M , Magallón-Botaya R , Aguilar-Latorre A
Published: October 2023

Background

Long COVID can still be considered as a novel disease. Although several clinical guidelines on the management of this disease have already been published, treatment options are still limited. This has left these patients frustrated in seeking treatment, and they express a willingness to try anything to manage their symptoms. The objective of this study is to analyze the level of activation of these patients in their own health.

Methods

A cross-sectional study was performed. The sample consisted of 134 patients with Long COVID in Spain. The main variable was the activation of the patient in his own health. It was collected using the Patient Activation Measure (PAM). This tool evaluates the skills, knowledge and confidence perceived by the patient when carrying out health self-management activities. It consists of 13 items that are evaluated on a scale from 1 (totally disagree) to 4 (totally agree). The resulting score ranges from 13 to 52, and is stratified into 4 activation levels (level 1, poor activation - level 4, adequate activation). A descriptive statistical analysis was performed using the SPSS v.25 program. Frequencies and percentages were calculated for each of the ranges.

Results

Although there was a large percentage of participants with low levels of activation in health (28% within level 1, and 17% within level 2 activation), more than half of the study participants showed an adequate level of activation in the management and care of their own health (30% within level 3, and 23% within level 4 of activation).

Conclusions

Patients with Long COVID present an adequate activation in managing their own health, which can support the actions of the professionals involved in interdisciplinary treatments for this disease. However, excessive activation and the search for any resource for symptoms management (over-the-counter medications, dietary changes, supplements) without professional control could be harmful and worsen their symptoms.

Key messages

• Patients with Long COVID present an adequate degree of activation in managing their own health.

• People with Long COVID express a willingness to try anything in order to control and manage their symptoms.
The detection of high risk HPV genotypes by the PR-PCR method in the Republic of Serbia
Authors: Jovanovic S , Gospodinović H , Grego E
Published: October 2023

Introduction

The association between Human Papiloma Virus (HPV) positive cervical swabs and the development of cervical cancer has lead to extensive research. Studies employing the RT-PCR method for typization in the young women demographic worldwide. Based on their proven oncogenic potential 14 HPV types have been classified as carcinogenic (HPV16,18,31,33,35,39,45,51,52,56, 58,59,66,68). The imporatnce of HPV diagnostics is a result of the existing link between viral infection and relative risk of cervical cancer, while the detection complexity reflects the large variety of HPV genotypes.

Methods

The samples analyzed in our study were obtained from cervical swabs of women aged 19 to 25 years between the months of October and December 2022. All collected samples were routinely screened for high risk genotype positivity (HPV16 and 18). There were no other inclusion criteria, the samples used in the study were selected at random. After DNA isolation, genotype identification was done by L2 amplification for HPV 16, the L1 for HPV 18, E6 for HPV 35, 56 and 58, and E7 for HPV 31,33,39,45,51,52,59,66 and 68 genotypes, with specific primers and flourescently labelled probes.

Results

The results demonstrated that among the DNA positive individuals HPV genotype distribution was as follows: 50% (31,39,56); 40,90% HPV(52,59,68); 34,10% HPV16; 22,70% HPV(35, 58, 66); 15,90% HPV 18. Individually, by type, the highest prevalence was noted for the high risk genotype HPV 16 (34,1%), followed by HPV18 (15,90%). As for group clusters, HPV(31,39,56) were most frequent, followed by HPV(52,59,68).

Conclusions

Given the forementioned results of our study, the most prevalent HPV genotype in the Republic of Serbia among the women of pre-set demographic is HPV 16, which is in conconcurrence with epidemiological results for Eastern Europe. By comparative analysis of the HPV16 and 31 distribution, the results imply a similarity in sensitivity to infection.

Key messages

• The susceptibility of young adults to HPV infection entails a well-developed preventive medicine program is paramount, and not limited to this demographic.

• RT-PCR offers in-depth insight into the distribution of risk of cancer to the screening team.
An integrated evidence-based approach to provide a practicum-based learning experience to students
Authors: Nazaruk D , Telfair J , Cromley J , Chopak-Foss J , Palacios A
Published: October 2023

Background

Due to the challenges created by the COVID-19 pandemic, the public health field has an exceptional opportunity not only to address current challenges but also to rebuild and expand the workforce.

Objectives

The main objective of this presentation is to highlight the 2018-2022 academic year's progress of the practice-based learning experience of the JPH College of Public Health at Georgia Southern University in Georgia, USA. The College serves more than 59, mostly rural counties, and involves diverse practicum preceptors, students, and existing professionals from the USA and other countries. The College provides a unique opportunity for students to develop practice-based education and training to master public health competencies in the field. The Office of Practice and Research collaborates with two Practicum coordinators on the undergraduate and graduate levels to create, support, sustain, and expand practicum opportunities locally and globally.

Results

The Practicum has created more than 17 community partnerships that provide an ongoing Practicum opportunity on all three program levels (BSPH, MPH, DrPH). It fostered relationships between community organizations and academia to collaborate on research, interventions, and grants. It includes professional workshops, information sessions, and mentoring to adequately prepare students for the fieldwork. In addition, it incorporates 1) an advisory board committee; 2) supervisor's evaluations; and 3) alumni feedback. As a result of this program and other efforts, more than 80% of our students are employed or enrolled in further education within the defined period.

Conclusions

This scalable and adaptable program serves as a model for advancing academia-community efforts aiming to successfully prepare students for entering the workforce, as well as enhancing the knowledge and skills of those in the workforce, particularly those working in/plan to work in challenging rural and related settings.

Key messages

• Practicum is essential in the successful preparation of students for entering the workforce.

• Practicum provides a unique opportunity for collaboration between community organizations and academia.
Shaping a healthy workforce through training: the role of worker representatives in Belgium
Authors: Van Aerden K , Doms J , Vanroelen C
Published: October 2023

Background

The aim of this study was to look at the different roles worker representatives in Belgium play when it comes to promoting adequate and accessible training policies in their companies. This topic is highly relevant, given the importance of training for shaping healthy work environments and career perspectives for workers.

Methods

Two methodological approaches were used in this study. In first instance, a survey was sent to worker representatives in two Belgian sectors with specific issues regarding work-related health: the food industry and the social profit sector. In second instance, worker representatives and HR managers from ‘good practice’ companies in both sectors were interviewed to collect more in-depth information about the role worker representatives played in shaping a healthy work environment and career perspectives for workers through their impact on the companies’ training policies.

Results

Our study shows that training policies of companies in both sectors are mainly aimed at improving the more direct and tangible health and safety aspects, such as injury prevention. Also, a clear inequality in training opportunities became apparent from our study. Considering the attitude and role of worker representatives, we find that they mainly take on an advisory role on the topic of training, not because of a lack of interest but because of the time-consuming nature of their other responsibilities and sometimes due to the difficult relations with management.

Conclusions

This study clearly shows that, although worker representatives from the food industry and social profit sector in Belgium are well aware of the importance of training to create healthy work environments and career perspectives for workers, their actions are usually ad-hoc instead of structured initiatives. Based on the findings of this study, a tool for worker representatives was created on how to get started on the topic of training in their companies.

Key messages

• Worker representatives in Belgium can be key players in facilitating safe and healthy work environments and career perspectives for workers.

• Worker representatives are ideally placed to advocate for vulnerable groups of workers, who are generally offered fewer opportunities to improve their skills.
Company commitments and practices on nutrition and environmental sustainability in Belgium
Authors: Dastoum S , Vandevijvere S
Published: October 2023

Introduction

INFORMAS developed a Business Impact Assessment for benchmarking and monitoring company commitments and practices on nutrition and environmental sustainability (BIA-Obesity & BIA-Sustainability). The aim of this study is to assess the transparency, comprehensiveness and specificity of company commitments in Belgium, as well as their related practices.

Methods

We selected 38 companies across supermarkets, quick service restaurants, catering companies, and packaged food, infant formula and non-alcoholic beverage companies, according to market share data in Belgium. For BIA-sustainability, company commitments were assessed for a series of indicators in 10 domains (corporate sustainability strategy, packaging, emission, energy use, water and discharge, biodiversity, food waste, environmental compliance, animal-based products and sustainable products). For BIA-Obesity, company commitments were assessed for a range of indicators across 6 domains (corporate nutrition strategy, product reformulation, product labeling, product and brand promotion, product accessibility and relationships with other organizations). Performance metrics to evaluate the size of efforts undertaken by food companies to improve their practices, alongside their commitments are under development.

Results

There is a wide variation in scores for transparency, comprehensiveness and specificity of commitments related to environmental sustainability across companies within sectors. Most companies have some overarching commitments for reducing environmental impacts but increasing sustainable or plant-based products within portfolios were hardly addressed in the commitments. In general, scores for BIA-Obesity are lower than those for BIA-Sustainability in Belgium.

Conclusions

During the workshop detailed results of these assessments in Belgium will be presented, as well as linkages between BIA-Obesity and BIA-Sustainability and commitments in relation to practices.
3D scanning of foreign body causing injuries in children: an innovative approach to injury prevention
Authors: Lorenzoni G , Ibrišević A , Umihanić S , Trozzi M , Grasso D , Brkic F , Baldas S
Published: October 2023

Background

Foreign Body (FB) injuries in children are a relevant public health problem associated with significant morbidity and mortality. The characterization of objects causing the injuries is an essential step for developing effective prevention strategies. Scanning the objects causing the injuries would help identify characteristics that make the objects dangerous for young children. The study aims to use 3D scanning within a large series of FB injuries collected in the Susy Safe database to develop a system able to identify the risk profile of everyday objects based on information collected through the scanning study.

Methods

The Susy Safe is the largest international registry collecting data on FB injuries in children under the age of fifteen. It collects almost 35,000 cases. For each case, information about the child, the object, and the circumstances of the injuries are collected. Furthermore, whenever possible (according to the object type and the approach used for FB removal) also the object is collected. Such objects are undergoing 3D scanning with structured light technology, a common non-contact scanning method allowing for 3D digitization of all dimensions and appearances.

Results

Currently, 383 objects have undergone 3D scanning. Most objects were made of a stiff material (60%). The scanning of the objects is still ongoing. The digitalized information for each object is collected in a REDCap repository together with all information about the FB injury and the picture of the object.

Conclusions

The final aim of the project is to develop a web-based application able to identify dangerous objects, based on shape and size parameters, according to the data collected through the scanning. Its objective is to make people aware of the risks posed by particular objects, especially parents and guardians of children. Furthermore, through the web-based application, parents will be able to report injuries and share images on FBs.

Key messages

• 3D scanning would be a promising opportunity to improve primary prevention of foreign body injuries.

• Integrating data from 3D scanning and surveillance systems would represent the basis for the development of a web application able to assist families in identifying hazardous objects.
Migration and severe maternal outcomes in high income countries: systematic review and meta-analysis
Authors: Eslier M , Azria E , Chatzistergiou K , Stewart Z , Dechartres A , Deneux-Tharaux C
Published: October 2023

Background

Literature focusing on migration and maternal health inequalities is inconclusive. This is potentially explained by heterogeneous definitions and settings. Our objective was to assess migrants’ risk of severe maternal outcomes compared to native women in high income countries overall, according to host country, and by the migrant's region of birth.

Methods

Systematic literature review and meta-analysis using MEDLINE/Pubmed and EMBASE databases between 1990 and 25 March, 2022. Observational studies comparing the risk of maternal mortality or all-cause or cause-specific severe maternal morbidity in high income countries between migrant, defined by birth outside the host country, and native women, were included. Case-control and case studies were excluded. We performed random-effects meta-analyses when possible. Subgroup analyses were planned by host country and migrant's region of birth.

Results

From 2010 unique references, 36 studies reporting data from 32 databases were included. In Europe, migrants had a higher risk of maternal mortality than native women (RR 1.4;95%CI 1.1-1.6), but not in USA and Australia. Migrants born in sub-Saharan Africa (RR 3.3;95%CI 2.5-4.4), Latin America and the Caribbean (RR 2.8;95%CI 1.2-6.9), and Asia (RR 1.8;95%CI 1.3-2.4) were at higher risk of maternal mortality than natives, but not those born in Europe or the Middle East and North Africa. Patterns were similar for all-cause severe maternal morbidity.

Conclusions

The differential risk of severe maternal outcomes in migrant versus native women in high income countries varies by host country and by women's region of origin. Our findings provide insight into the mechanisms of these inequalities.

Key messages

• In high income countries, the differential risk of severe maternal outcomes in migrants (born outside the host country) compared to natives, varies by the host country and the region of birth.

• Our findings strengthens the evidence supporting the need to fight migrant’s health inequalities and to customise related health policies in each context.
Factors determining the motivation to breastfeed in the Lithuanian female population
Authors: Jonkiene G , Kaseliene S
Published: October 2023

Background

The benefits of breastfeeding (BF) are evident for both the baby and the mother, however, in Lithuania, on average, only around 49.3% of infants were breastfed exclusively for up to 6 months between 2017 and 2021. The aim of this study was to evaluate the BF motivation (BM) of mothers and the factors determining it in Lithuania.

Methods

A cross-sectional study was conducted in June 2022. A total of 572 women, who were raising an infant aged 2-6 months were anonymously surveyed in Lithuania (response rate 38.9%). BM was evaluated using 24-item scale developed by Kestler-Peleg et al. It was divided into 4 factors using exploratory factor analysis. The sum score, mean, and standard deviation (SD) of the motivation scale was calculated. Relationships between BM and various factors were determined using Mann-Whitney, Kruskal-Wallis, and Spearman's correlation tests.

Results

It was found that BM of mothers’ was average (69.6 (SD 14.2) out of 96 points). Mothers were most motivated to breastfeed their babies by factors related to their well-being and the health of their baby (3.47 (SD 0.59) out of 4 points), and the least by factors related to the pressure from others (2.23 (SD 0.67) out of 4 points). BM was statistically significantly increased by women's older age, interest in BF, attendance at BF courses, prior decision to breastfeed during pregnancy, greater BF experience, giving birth at the baby friendly hospital, while motivation was decreased by women's higher education, living in a larger city (P < 0.05). Women who have given birth to their first baby and women facing BF problems after childbirth were less motivated to breastfeed (P < 0.05).

Conclusions

Mothers’ BM was average. In Lithuania, especially in rural areas, it is necessary to increase mothers’ motivation to breastfeed their infants by enhancing their awareness and interest in BF, as well as by encouraging healthcare facilities to adhere to the WHO recommendations for successful BF.

Key messages

• The motivation of Lithuanian mothers to breastfeed their babies is insufficient.

• It depends on women's age, place of residence, self-determination, interest in BF, experience of childbirth and BF, and the nature of the hospital where they gave birth.
3.C. Skills building seminar: Guidance on using natural experiments to evaluate population health interventions
Authors:   Organised by: MRC/CSO Social and Public Health Sciences Unit, University of Glasgow (UK),   Chair persons: Ruth Dundas (UK)
Published: October 2023

There has been a substantial increase in the conduct of natural experimental evaluations since original guidance was published. There have been advances in relevant methodologies, greater availability of big datasets, and a rise in demand for ‘what works’ evidence amenable to natural experimental evaluation. Therefore, it is important that researchers, public health practitioners, funders, and users of intervention research are aware of recent developments and of the strengths, weaknesses, and applicability of natural experimental evaluations. Updated and extended guidance has been developed for using natural experiments to evaluate population health interventions. Guidance was developed from three international workshops and an online consultation with researchers, journal editors and end users of natural experimental evaluations. The project was funded by The UK Medical Research Council and the National Institute for Health and Care Research, and the project team comprised researchers with expertise in natural experimental evaluations. The project had a funder-assigned oversight group and an advisory group of independent experts, including researchers and practitioners with experience of commissioning natural experimental evaluations. This updated and extended guidance provides an integrated guide to the use of natural experimental methods to evaluate population health interventions, offering a range of tools to support its use and detailed, evidence-based information for researchers, funders, publishers, and users of evidence. The objective of this skills building seminar is to upskill public health researchers and practitioners on the design and use of natural experimental methods. The seminar will present key aspects of the guidance and provide the opportunity to discuss and explore each aspect. The first presentation will highlight important considerations when designing and planning a natural experimental evaluation and introduce recommendations for planning, commissioning, conducting, and using evidence from natural experimental evaluations. The second presentation will outline the value and roles of qualitative methods, explaining how qualitative evidence strengthens evaluations. There will then be a discussion and collaborative learning session, providing an opportunity for researchers and public health practitioners to share experiences and engage with the guidance. The discussions will be prompted by examples of natural experimental evaluations relevant to the presentations.

Key messages

• Natural experimental evaluations are valuable for assessing the impacts of population health interventions.

• This workshop provides an opportunity to engage with and discuss new guidance, highlighting good practice in the design, planning, conduct and use of evidence from natural experimental evaluations.
Mapping barriers to midwives’ educational role in Cyprus guided by the Theoretical Domains Framework
Authors: Kolokotroni O , Ioannou M , Hadjigeorgiou E , Nicolaou C , Middleton N
Published: October 2023

Issue

The high caesarean section (C/S) rate in Cyprus (>60%) led to the formation of a National Committee to address this Public Health priority. Among WHO recommendations for C/S reduction are midwifery-led educational interventions; yet, medicalization of birth in Cyprus is curtailing the autonomous role of midwives.

Description of problem

While midwives could “make every contact count” during routine appointments, antenatal education (AE) is reduced to a formal activity within the antenatal class space with documented low attendance. This formative research mapped barriers to the educational role of Cypriot midwives guided by behaviour theory. A context-specific understanding is needed to shape an appropriate intervention and promote a common understanding among stakeholders.

Results

One in three midwives islandwide (N = 119, response: 34%) rated 83 determinants (from 1=more to 6=less problematic), guided by the Theoretical Domains Framework (TDF). “Beliefs about AE importance” (M = 5.57, SD = 0.96) and “Professional role” (M = 5.58, SD = 0.57) received the highest scores. Lack of organizational resources (M = 3.39, SD = 0.97), institutional and inter-professional support (M = 3.77, SD = 1.4) and acceptance (M = 4.25, SD = 0.85) were identified as problematic. While perceived capabilities and intentions were rated favourably, achieving “Goals” was difficult, mainly due to competing priorities (M = 3.86, SD = 0.84). Self-efficacy and behavioural control were lower among less experienced midwives (p < 0.01) and in the private sector (p = 0.08), which accounts for >70% of births.

Lessons

Beyond the antenatal class, AE is a ‘bad fit’ with routine practice. The phenomenon pertains to organizational arrangements but also norms and perceptions of other providers and service users. While current Healthcare reforms present prospects in re-defining the role of midwives, the educational role is not adequately supported or promoted given the limited number of visits and reimbursement restrictions imposed.

Key messages

• Barriers to routine antenatal education originate from an unsupportive system and socio-cultural norms which alienate midwives in an already medicalized environment.

• This theory-driven formative study described the issue in behaviour terms in the context of shaping an intervention to strengthen the health education role of midwives.
Maternal healthy lifestyle score and psychological well-being: secondary analyses of the PEARS RCT
Authors: Philippe K , McAuliffe F M , Phillips C M
Published: October 2023

Background

The associations between lifestyle behaviours and well-being are still poorly understood, particularly in the antenatal period when women are potentially exposed to increased stress and anxiety. Moreover, lifestyle behaviours have often been investigated individually, while a Healthy Lifestyle Score (HLS) comprising low-risk protective lifestyle behaviours can be useful for studying links between overall lifestyle and health and psychosocial outcomes. Therefore, our aim was to study associations between maternal HLS in early and late pregnancy and psychological well-being. We focused on women with overweight and obesity (OWOB), as they may be at higher risk of psychosocial vulnerability.

Methods

Secondary analyses were conducted with data from the PEARS (Pregnancy Exercise And nutrition Research Study) trial, a randomized controlled trial of a diet and exercise lifestyle intervention with smartphone application support to prevent gestational diabetes. HLSs (scored 0-5) based on information about maternal diet (AHEI-P), exercise (MET-minutes), alcohol consumption, smoking, and sleep habits were created for 334 and 289 mothers in early (14-16 weeks gestation) and late pregnancy (28 weeks gestation), respectively. Higher HLSs indicate a healthier overall lifestyle. Correlations and regression analyses examined HLS associations with well-being (WHO-5, scored 0-100) in early and late pregnancy.

Results

Mean pregravid BMI was 29.2. Mean well-being score was 56.3 in early and 60.7 in late pregnancy. In early pregnancy, 18% of mothers scored 0-2 on HLS, 35% scored 3, and 47% scored 4-5. In late pregnancy, this was 27%, 34% and 39% respectively. Preliminary results show significant positive associations between HLSs and well-being at both time points (r's ranging between 0.16 and 0.29, all p < 0.05).

Conclusions

Higher adherence to healthy lifestyle behaviours in mothers with OWOB was linked with higher well-being throughout pregnancy.

Key messages

• Many pregnant women with OWOB do not adhere to a healthy lifestyle.

• Well-being and a healthy lifestyle are related throughout pregnancy.
Addressing influenza outbreaks in schools
Authors: Sá R , Garganta S , Borges C , Correia M , Emilio D , Rodrigues A P
Published: October 2023

The Public Health Unit (PHU) of Albufeira received a communication from the director of the a public school about the occurrence of flu-like symptoms in a large number of students. No response protocols were in place for laboratorial analysis and control measures in this specific situation. The PHU started the necessary procedures to assess the situation and act according to the information obtained. In collaboration with the school, control measures were implemented, a communication network was established, and informative materials, such as leaflets, on preventive measures against the flu were produced and distributed, as well as pediatric masks and hand sanitizer. In partnership with the national network of sentinel flu doctors, five nasopharyngeal samples (three students, one teacher, and one parent) were also collected for laboratory analysis. Epidemiological investigations have identified 4 confirmed cases of influenza B, 17 probable cases, and one case with missing information. The attack rates were found to be high, with 95% of both students and teacher becoming ill. The research findings indicate that a majority of students exhibited symptoms consistent with flu infection, with fever and cough being the most prevalent. In addition, one parent was tested at the school and was also diagnosed with influenza B, indicating the spread of the virus within the community. Gaps were identified in the scope of public health, including the lack of outbreak response protocols and an effective communication network with schools. In order to address these shortcomings, it is intended to develop action protocols for outbreak scenarios in the school environment and establish a closer response between public health services, and the school community. The innovative approach of the Albufeira PHU can serve as a model for other settings and countries.

Key messages

• Effective collaboration between healthcare providers and schools is essential to mitigate the impact of infectious disease outbreaks in the school environment.

• The development and implementation of outbreak response protocols is critical to ensure a coordinated response to infectious disease outbreaks.
Attitudes towards vaccination and HPV vaccine uptake among Croatian university students
Authors: Miskulin I , Dumic L , Pavic Z , Miskulin M , Dumic J , Simic I
Published: October 2023

Background

The attitudes that underlie vaccine hesitancy are important for predicting individuals’ vaccination behaviour but also for developing effective public health interventions. This study aimed to investigate attitudes towards vaccination among Croatian university students and to evaluate its possible association with human papillomavirus (HPV) vaccine uptake in the same population.

Methods

This cross-sectional questionnaire study was conducted from February to May 2021 period. A validated, anonymous questionnaire that contained questions regarding demographic data, data about HPV vaccine uptake, as well as the Vaccination Attitudes Examination Scale (VAX scale) was self-administered to a cross-faculty representative student sample of the University of Osijek in Eastern Croatia. The higher scores on the VAX scale reflect more negative attitudes toward vaccination.

Results

The study sample included 840 subjects with, a median age of 20 years (interquartile range 20-21), 45.8% males, and 54.2% females. The median VAX scale score was 39.0 (interquartile range 32.0-46.0). The prevalence of vaccination uptake in the studied population was 20.8%. The more negative attitudes towards vaccination were found in students who studied within the scientific area of the social sciences (p < 0.001), students who had a lower average grade of study (p < 0.001), and students who were not vaccinated against HPV (p < 0.001).

Conclusions

The Croatian university students had rather negative attitudes towards vaccination probably reflected by the observed HPV vaccine uptake in this population. Identifying factors that influence general attitudes towards vaccination in the studied population would enable the design of more adequate public health interventions intended to promote HPV vaccine uptake.

Key messages

• Croatian university students have shown strong general vaccine hesitancy as well as low HPV vaccine uptake.

• Better understanding of the attitudes that underlie vaccine hesitancy is important for developing public health interventions created to increase HPV vaccine uptake among Croatian university students.
Trends in incidence of main types of cancer in Bulgarian women (2010-2021)
Authors: Grancharova G , Aleksandrova-Yankulovska S , Draganova M , Saleva M , Anov A , Statev K , Seizov A , Stateva A
Published: October 2023

Background

The burden of cancer worldwide is increasing. In Bulgaria, a biggest problem concerns the cancers of women genital system and breast cancer. The aim of this survey is to analyze the recent trends in cancer incidence related to women genital system and breast cancer and to formulate appropriate conclusions.

Material and methods

The information for this descriptive study was retrieved from population-based cancer data collected by the National Center of Public Health and National Statistical institute. We analyzed the trends in incidence rate (per 1000000 of different types of cancer in women for 2010-2021. Data processing was performed by Microsoft Excel 2016 and IBM SPSS Statistics v.24.

Results

Since 1980 the incidence rate of cancer in Bulgaria has double - from 232.7 per 100000 to over 400 with the highest levels in 2011(448.7), 2013 (461.9) and 2015 (447.2). A slight decrease was observed in 2020-2021 related to lower visits to specialists during the COVID-19 pandemic. Since 2010 the highest incidence rates were registered for breast cancer (101.5 in 2013 and 103.5 in 2015) with no trend to decrease. The new cases of breast cancer account for about 11% of all new cancer cases (10.8% in 2019; 11.5% in 2021). These figures coincide with the average rates in EU-27. Cancer of the uterus takes the second rank. Its rate didn't change significantly during the last decade (varying around 30-31 per 100000). Cervical and ovarian cancers rank third and fourth. They both show slight trends of decrease since 2016: for cervical cancer - from 27.2 per 100000 to 22.5 in 2021; for ovarian cancer - from 20.4 to 15.7 per 100000 women.

Conclusions

Cancers of the genital system and breast cancer account for a large proportion of all new cancer cases in Bulgaria. The heavies burden belongs to cervical cancer and cancer of the uterus. Strong changes in policy actions are needed to tackle with the burden of cancer and to increase the effectiveness of preventive measures.

Key messages

• Bulgaria is among countries with very high incidence rates of cancer among women population, especially incidence rates of breast cancer, cancer of the uterus and cervical cancer.

• Due to economic and political instability, Bulgaria doesn’t have an effective national policy to cope with cancer. National Plan to Fight Cancer was published in 2022 but it is still a project.
Factors influencing the implementation of the EU School Milk Scheme in Irish primary schools
Authors: Greene E , Hunt E , Kilduff O , Murrin C
Published: October 2023

Background

Adequate calcium intake in childhood is essential in optimising peak bone mass, however, children's milk consumption is decreasing in Ireland and in other developed countries. The School Milk Scheme (SMS) promotes children's milk consumption by providing subsidised milk to schools. It is managed by the National Dairy Council in Ireland, who also design and distribute accompanying educational resources. The aim of this analysis is to identify the factors influencing the implementation of the SMS in Irish primary schools.

Methods

This research was conducted as part of an evaluation of the EU School Fruit, Vegetables and Milk Scheme in Ireland. Process evaluations of the implementation of the SMS were conducted through direct observation. Observational data were triangulated with data from feedback questionnaires, collected among school staff members, parents and children in 1st, 3rd and 5th class. Quantitative data were descriptively analysed. Qualitative data from observations and interview comments were coded deductively to domains of the Theoretical Domains Framework (TDF).

Results

SMS implementation was observed in eight schools. Questionnaires were completed by 15 staff members and 50 parent-child dyads from 17 schools. Factors influencing implementation of the SMS were identified across 10 TDF domains. Teachers’ awareness of the SMS educational resources was the most common barrier to their use. Reliability of milk deliveries and having adequate storage for the refrigeration of milk were key factors in influencing programme implementation and acceptability of milk among children.

Conclusions

This analysis identified a range of barriers and facilitators to the implementation of the SMS in Irish primary schools. Teachers are key stakeholders in the delivery of the SMS, highlighting the importance of clear communication between intervention managers and primary school staff members in supporting the implementation of the educational component of the SMS.

Key messages

• This analysis identified areas in which further support may be necessary for the future implementation of the SMS in Irish primary schools.

• The factors identified across 10 domains of the TDF may also be applicable to other dietary interventions implemented in school settings.
Experiences of menstrual health and hygiene in humanitarian and emergency settings
Authors: McCarthy L J , Roura M
Published: October 2023

Background

Menstrual health and hygiene is a crucial area of research, increasingly recognised as a public health and human rights issue. Still, the menstrual health and hygiene needs of some of the most disadvantaged groups, including populations in humanitarian and emergency settings are often unmet.

Aims

To examine through a sustainable development goal lens the current state of knowledge about menstrual health and hygiene needs, as experienced by populations in humanitarian and emergency settings.

Methods

Eligible studies were identified through systematic searching in PubMed, Embase, and Web of Science between March and July 2022, using a combination of terms relating to the experience of menstruation in emergency contexts. Included studies reported the lived experience of menstrual health and hygiene in humanitarian settings and presented qualitative findings. A conceptual framework connecting menstrual health and hygiene and sustainable development goals was employed to extract and analyze data. A qualitative meta-analysis approach was employed to aggregate and synthesize qualitative data.

Results

Eleven studies were included for review. Studies were conducted in Asia (n = 6), Africa, (n = 4), and Europe (n = 1) following natural disasters (n = 2), and in refugee camps among populations fleeing war or conflict (n = 9). Findings indicate an interconnection between menstrual health and hygiene and twelve sustainable development goals. Menstruation was reported as a negative experience. Barriers to adequate menstrual health and hygiene had significant commonalities despite geographical locations. Drying of menstrual products was reported as the most common barrier.

Conclusions

Menstrual periods do not cease to occur during conflict or natural disasters. The interconnection between experiences of menstrual health and hygiene and sustainable development goals should be considered if no one is to be left behind.

Key messages

• This review examines the lived experience of menstruation in populations in humanitarian and emergency settings, through a sustainable development goal lens, addressing a gap in the literature.

• This review identifies barriers to menstrual health in humanitarian and emergency settings, highlighting how they may facilitate or hamper progress in achieving numerous sustainable development goals.