bluuebunny/crossref_metadata_2025 huggingface dataset:
Implementing Indigenous cultures and Indigenous knowledges: A public policy dilemma
Authors: Parter C D R , Skinner J C
Published: October 2020

In Australia, governments are committed to integrating the cultures of Indigenous peoples into the decisions and actions of governments - known as public policies. The National Aboriginal and Torres Strait Islander Health Plan 2013-2023 has culture central to its policy framework making it permissible for Indigenous peoples to practice their cultures and knowledges.

While there is a readiness to implement Indigenous cultures, regrettably there still remains deep-seated resistance due to institutional and systemic racism, and racist attitudes. These factors along with unconscious biases prevent the realisation of Indigenous people's cultures and their knowledges.

A system-wide translational model of practice (the model) has been developed that aims to support the implementation of Indigenous cultures and knowledges. The model adopts a system thinking approach that considers complex social phenomenon's involving paradigms, structures and actors within and across systems and sub-systems. Similarly, the model targets system leverage points aimed to embed Indigenous cultures and knowledges into policy practice.

Indigenous people's cultures and knowledges could be the answer to the global challenges facing the public health community. However, as is the case in Australia, Indigenous people's cultures and knowledges are devalued and often dismissed as irrelevant. The model of practice offers a framework to enable, embed and enact the cultures and, in deed the knowledges held by Indigenous peoples. The model could be beneficial for other countries who are searching for solutions to address complex problems like global warming.

Critically, a key requirement of the model is to listen and learn from Indigenous peoples along with acknowledgement that Indigenous cultures is innately related to the knowledges held by Indigenous people. Finally, using leverage points in systems to embed Indigenous people's cultures and knowledges into global solutions is a necessity.

Key messages

Indigenous cultures is their knowledges and their knowledges count. Have an open heart and an open mind to listen and learn.
If the dolphin come to help: Education and Health without Boundaries for transversal competences
Authors: Rubba F , Scamardo M S , Di Mauro F , Egidio R , Avati P , Passione A , Giulierini P , Continisio I G , Iervolino A , Triassi M
Published: October 2020

Aims

Italy is a veritable bridge to the Mediterranean that peoples, civilizations and cultures pass through. The exchange, confrontation and interaction are key element that could lead to greater well-being of the communities. The project called: “If the dolphin come to help: Education and Health drive the orientation path for transversal competences toward reception and integration with the aim to promote the educational development and cultural growth of students and, at the same time, to provide schools with the opportunity to enhance their educational offerings.

Methods

The geographical position leads our country to a particularly heavy task: to provide in a timely and appropriate way for the reception and livelihood of a very large number of people. Question assessed were.” Who are the migrants and what happens when they land in Italy? Where are they detained and for how long? What are the reception services that take care of migrants? The first step was to clarify the subject starting from the difference between asylum seekers, refugee, beneficiary of humanitarian protection / applicants for international protection, illegal immigrant, going through the process of entry in Italy at one of the four hotspots. The students worked in 3 groups creating one short story. The second step it was to encourage students, through the role playing tool, to reflect on what it feels like to be a migrant and what feelings you feel in front of a migrant. The third step was to ask to the student to describe with only one word the feelings.

Results

The stories were synthesized in a word cloud, through a string analysis algorithm in which the semantic fields of integration, acceptance and empathy prevailed. Immigration is perceived not as a problem but as a resource

Conclusions

Educational and health projects shared with high schools may be a useful tool to promote integration, acceptance and social cohesion beyond the limits of fear.

Key messages

Immigration today in our country is a very complex subject that is difficult to address in a few lines. Italy is on the route of the migratory flows of Africa and the Middle East. The project may be a trigger to create a place where everyone is equal and can access education, health and knowledge, not being denied because of the origin.
A qualitative study on mental health and wellbeing of Syrian refugees in the UK
Authors: Tattan M , Paudyal P , Cooper M
Published: October 2020

Background

The Syrian conflict has resulted in an estimated 5.3 million registered Syrian refugees in various parts of the world. Evidence suggests that these individuals are at considerable risk of developing common mental disorders. This study aimed to explore the mental wellbeing of Syrian refugees, identify their coping mechanisms and pathways towards integration into new communities, and formulate recommendations for better access to mental healthcare services.

Methods

We conducted a qualitative study using in-depth semi-structured interviews with adult refugees (>18 years old) who are currently residing in Southeast of England. Interviews were conducted in Arabic, recorded, transcribed and translated verbatim. Translated transcripts were analysed using thematic analysis. Ethical Approval was obtained from the Brighton and Sussex Medical School Research Governance Ethics Committee (ER/BSMS9DAP/1).

Results

Twelve participants (3 females and 9 males) took part in the study; all were born in Syria and the majority (n = 9) were over 45 years of age. Participants described symptoms of reduced psychological wellbeing. Preliminary findings shows that almost all participants talked about psychological distress resulting from previous trauma, loss of and separation from family members and challenges adjusting to their host country. Barriers to accessing the healthcare system in the UK included fear of stigma, being misunderstood by healthcare staff and language issues. Communicating with loved ones, connecting with nature, practising faith and pursuing hobbies were reported as coping strategies.

Conclusions

For Syrian refugees in the UK, mental wellbeing embraces living with past traumatic experiences, achieving social integration and facing challenges accessing healthcare. Understanding differences between refugee and host communities is key to appropriately cater to the specific needs of each community and achieve equity in healthcare access.

Key messages

Syrian refugees in UK described symptoms of reduced psychological wellbeing. Understanding the needs of refugee communities is necessary to achieve equity in healthcare access.
Management of chronic diseases and healthcare use among the elderly in Turkey and Turkish migrants
Authors: Erdsiek F , Aksakal T , Padberg D , Özcebe H , Üner S , Gershuni O , Westerling R , Daryani A , Brzoska P
Published: October 2020

Background

Turkish migrants are one of the largest groups of migrants in Germany, the Netherlands and Sweden. Particularly older migrants face different barriers in the health system that may limit their access to and quality of health care. The aim of this study was to examine how elderly people in Turkey and Turkish migrants in Germany, the Netherlands and Sweden manage chronic conditions, including how they utilize the respective healthcare systems.

Methods

A qualitative study design was used. A total of 20 in-depth interviews with individuals in Turkey and 10 semi-structured in-depth interviews each with Turkish migrants in Germany, the Netherlands and Sweden were conducted during 07/2018 and 05/2019. The interviews were based on a topic guide and were analyzed using qualitative content analysis.

Results

Participants from all groups experienced barriers in accessing health services and described difficulties in managing chronic conditions in their daily life. Pathways to care and patterns of utilization strongly depended on the structure of the respective health systems and differed between all groups. Circular migrants to Turkey relied on health professionals from their respective host countries to treat their chronic diseases, consulting professionals in Turkey mostly for emergencies or acute illness.

Conclusions

Turkish migrants and elderly adults in Turkey experience similar barriers and challenges in managing chronic diseases. How they access and utilize health services is dependent on the respective health system structures. Circular migrants use the Turkish health system differently than health systems in their host countries and elderly adults from Turkey. These results can contribute to the development of diversity-sensitive health care strategies.

Key messages

Turkish migrants and adults in Turkey experience similar challenges in managing chronic diseases. How Turkish migrants and adults in Turkey access healthcare depends on the respective systems.
Polypharmacy and drug misuse in elderly migrants: care practice and interprofessional collaboration
Authors: Tezcan-Güntekin H , Bird R , Özer-Erdogdu I
Published: October 2020

Background

Polypharmacy is associated with an increased risk of falls and adverse events in the elderly. Factors such as inappropriate infrastructure for resolving language barriers can make people with migration backgrounds more vulnerable to polypharmacy. This study aimed to assess barriers in the drug therapy of elderly migrants and to obtain input for an e-health application supporting medication management and interprofessional communication.

Methods

10 expert interviews were conducted with health professionals working with chronically ill patients of Turkish descent. The sample included physicians, pharmacists, social workers and nursing professionals. The interviews were analyzed using structuring content analysis.

Results

Respondents perceived language barriers and discontinuities in medication prescription as key problems in the drug therapy of elderly migrants. Changes in the brand of medication prescribed were highlighted as particularly damaging to patient-provider relationships. Interprofessional communication was deemed important, with physicians and pharmacists expressing dissatisfaction in this area. Some respondents saw potential in the e-health application, while others cited concerns about data protection or the digital capabilities of elderly migrants.

Conclusions

Healthcare professionals may require support in providing information in a variety of languages. Additionally, more interprofessional collaboration is desired but it is necessary to first establish better channels of communication. An e-health application could help achieve clearer communication between stakeholders. However, it is necessary to work in close cooperation with professionals when designing the application to ensure that it can be implemented in practice.

Key messages

Language barriers and inconsistent prescription practices harm patient-provider relationships. Better channels of communication are needed to provide less fragmented care to elderly migrants.
Vitamin D related knowledge, attitudes and behaviors among ethnic minority women
Authors: Cantarero Arevalo L , Jacobsen R , Özel E
Published: October 2020

Background

Vitamin D (VD) deficiency may increase the risk of developing nutritional rickets, metabolic, autoimmune, infectious, cardiovascular and mental disorders. VD status in reproductive age is of special importance, as it may determine health outcomes not only for women but also for their offspring. Danish health authorities recommend VD supplementation for groups at risk of VD deficiency. In Nordic countries, persistent high prevalence of VD deficiency among non-Western ethnic minority women suggests that health information may not reach the population in need.

Aim

to assess VD related knowledge, attitudes and behaviors among non-Western ethnic minority women living in Denmark in 2019.

Methods

A validated VD knowledge, attitudes and behaviors questionnaire was translated into Danish, piloted and distributed via relevant Facebook groups using online SurveyXact platform. The responses were analyzed with SPSS statistical package, using both parametric and non-parametric tests for bivariate analyses.

Results

254 women who considered themselves having a non-Western ethnic minority background answered the questionnaire. Median age (IQR) was 26 (23-33) year old; 81 (39%) had professional, 71 (28%) high school and 56 (22%) university education. Age was associated with VD nutrition knowledge (p = 0.048) and VD behaviors (p = 0.026): older women had better knowledge about VD rich nutrition and reported more VD friendly behavior. Education was associated with both VD general (p = 0.034) and VD nutrition (p = 0.034) knowledge. Women with university education had better knowledge about VD generally, and women with professional education had better knowledge about VD rich nutrition.

Conclusions

Aged and education were associated with VD related knowledge and behaviors in young women with non-Western ethnic minority women. Further examining of VD related knowledge and behaviors focusing among less populations is warranted.

Key messages

Education was associated with both vitamin D general (p = 0.034) and vitamin D nutrition (p = 0.034) knowledge. Aged and education were associated with vitamin D related knowledge and behaviors in young women with non-Western ethnic minority women.
”Little girl, where do you think you go with this method?”: shame and use of emergency contraception
Authors: Cantarero Arevalo L , Merchant E
Published: October 2020

Background

In England in 2018, 45% of pregnancies were unplanned at the time of conception. In 2017, there were 192,900 abortions carried out for women residing in England and Wales, with the highest rate of abortion being for women aged 20-24 (28.2 per 1000 resident women).

Aim

To understand social and cultural influences which affect ethnic minority young women's utilization and experience of emergency contraception in the United Kingdom.

Methods

Qualitative in-depth interviews following an interview topic guide were conducted with seven young women currently living in the UK, whose parents were born outside the UK. Interviews were recorded, transcribed and input into NVivo version 11.4.3. Transcriptions were coded to identify themes and these themes were then analyzed to identify commonalities and establish connections to understand perceptions and experiences of the participants. The themes coded were “Knowledge of emergency contraception”, “relationships” “concerns about obtaining and using EC”, “balancing risks” and “religion and culture”.

Results

Participants were often not open with their parents about sexual health related topics. Cultural taboos still persist towards sex before marriage which could translate into guilt and shame about using EC. When asked about concerns surrounding EC, participants mentioned concerns relating to obtaining EC, generally involving privacy embarrassment or shame. Stigma and concern about what others may think was a fairly frequent theme throughout the interviews, with participants being worried about what friends, family or service providers would think about them.

Conclusions

cultural awareness in healthcare reiterate the need for interventions which take into consideration sociocultural contexts. This is essential to ensure that young women have access to emergency contraception in order to prevent unwanted pregnancy.

Key messages

Despite availability of emergency contraception, young women still face the risk of going through an unwanted pregnancy becuase of embarrasment and shame. Cultural taboos towards sex before marriage still persists and this is translated into guilt and shame about using emergency contraception.
Socioeconomic status and self-perceived barriers to leisure time physical activity in Finnish Roma
Authors: Nykänen S , Wennman H , Korpelainen R , Majaniemi P , Kuusio H
Published: October 2020

Introduction

Finnish Roma are at unequal socioeconomic position compared to the main population. Inequality has a key impact on the well-being and lifestyles of the Roma. The main aim of this study was to examine the prevalence of leisure time physical activity (LTPA) in the Finnish Roma. In addition, we investigated the relationship between socioeconomic factors and self-perceived barriers to leisure time physical activity to leisure time physical inactivity.

Methods

This study was based on cross-sectional data on the Roma Wellbeing Study (Roosa) collected in 2017-2018 (n = 365). Data of the study was collected by a long or a short questionnaire, with structured interview or completed by the respondent. The subsample of this study was limited to adult Roma living in Finland, identifying themselves with Roma culture (n = 344; men n = 134 and women n = 210). The data was analyzed by cross-tabulation, χ2-test and using logistic regression analysis. Men's and women's results are presented separately as odds ratios (OR) and with 95% confidence intervals (CI).

Results

In this study 46.7% of men and 64.3% of women did not engage leisure time physical activity. The self-perceived barriers to leisure time physical activity differ between men and women. Common barriers were lack of motivation, fatigue and low mood. In men, self-perceived barriers to leisure time physical activity were also illness or injury, lack of money and exercise guidance. In women, other self-perceived barriers were lack of exercise skills, suitable exercise group and form of exercise.

Conclusions

The low prevalence of leisure time physical activity in the Finnish Roma calls for actions. The socioeconomic inequalities and differences between men's and women's self-perceived barriers to leisure-time physical activity should be taken into account in measures to promote physical activity.

Key messages

In this study, nearly half of the Finnish Roma men and three out of five women did not engage in leisure time physical activity. The socioeconomic inequalities and self-perceived barriers to leisure time physical activity between Finnish Roma men and women should be taken into account in measures to promote physical activity.
Economic analysis of the stand-by emergency treatment (SBET) for malaria in travellers
Authors: Ferrara P
Published: October 2020

Background

Stand-by emergency treatment (SBET) is a possible approach for malaria prevention in travellers to low transmission areas (such as South-Eastern Asia [SEA]), but current evidence casts doubts on its feasibility and does not allow to decide whether this strategy is economically rational. Thus, this research aimed to appraise SBET in terms of cost-benefit/cost-effectiveness analysis from the perspective of the National Health Service (NHS).

Methods

To design a specific model, SBET benefits (valued as avoided direct and indirect costs of illness) were weighted against the costs associated with SBET doses to be prescribed in order to avoid one imported case of malaria. Direct healthcare costs were obtained allocating last surveillance data for imported malaria to the charge of the corresponding diagnosis-related group category and estimating outpatient care costs. Indirect social costs were calculated in terms of lost productivity. The economic framework was adjusted for the probability of malaria transmission in SEA region and weighed on the Italian context.

Results

In the model, for five malaria cases estimated to be imported from SEA to Italy in 2017, it was calculated that NHS would be charged with around € 22,487·50. Social costs were determined at € 7,100. Thus, the total Italian public expenditure for malaria cases in SEA travellers was of € 29,587·50 in 2017. In contrast, 50,000 doses were considered to be carried to avoid one malaria imported case, with a cost of € 2.5 million.

Conclusions

At cost-effectiveness analysis, reimbursement strategy does not lead to a favourable gain owing to the total cost of the SBET doses to be prescribed for avoiding one malaria case. The appraisal of costs and benefits brings into question the economic validation of SBET, also calling for further strategies to be reassessed for travellers to low-risk areas.

Key messages

Besides the evidence of incorrect SBET use among travellers, the appraisal of costs and benefits brings into question the economic validation of this strategy. Reimbursement for SBET seems to be not cost–effective from the perspective of National Health Services.
The impact of mortality for infectious diseases on life expectancy at birth in Tuscany, Italy
Authors: Kundisova L , Nante N , Martini A , Battisti F , Giovannetti L , Messina G , Chellini E
Published: October 2020

Introduction

The epidemiologic transition describes the reduction of mortality for infectious diseases (ID), followed by an increase in prevalence of non-communicable diseases. During recent years the situation has changed; an increase in mortality for sepsis was observed. Italy is amongst the countries with the highest prevalence of microorganisms resistant to antimicrobial therapy in Europe. The aim of the present work was to evaluate the impact of mortality for ID on life expectancy (LE) in the Tuscany region(Italy).

Methods

Mortality data relative to residents that died during the period 2000/2002- 2013/2015 were provided by the Tuscan Regional Mortality Registry. At first the analysis was performed for whole territory, then for geographic area (Nord-Est:NE, Centrum:C, South-East:SE). The analysis was realized with software Epidat,using the Pollard's method of decomposition of variations in LE for age and cause

of death.

Results

The overall gain in LE was 2.9 years for males and 2.6 years for females. The increase in mortality for ID was responsible for the loss of 0.11 years of LE for males vs. 0.16 years for females. The loss was observed in males aged 45-89, for females from 69 years onwards, with the highest loss between 79-89 years. After analysis for area, geographical differences emerged, for both males and females the highest loss of LE was observed for NE (-0.23 years vs.-0.19), followed by C (-0.15 years vs. -0.16) and SE (-0.12 vs. -0.11).

Conclusions

The result can be partially explained by the transition from ICD-9 to ICD-10 (in 2010), which improved the sensitivity of codification, but also by diffusion of pathogens resistant to antimicrobial therapy. The highest impact of ID was observed in elderly, probably due to the existence of predisposing clinical condition. The ID deserve major attention; the programmes of hospital infection control and antimicrobial stewardship have to be potentiated in order to contain the phenomenon.

Key messages

During the study period an increase in mortality for infectious diseases comported the loss in terms of LE years. The growing diffusion of microorganisms resistent to antimicrobial therapy could have contributed to the higher mortality rates observed during the last period.
New decade, new response: Altering the public health response to toxigenic cutaneous diphtheria
Authors: Marshall N C , Baxi M , MacDonald C , Sikora C , Tyrrell G J
Published: October 2020

Background

Classical diphtheria is a potentially fatal respiratory disease mediated by the diphtheria toxin of Corynebacterium diphtheriae. Due to high vaccination rates against this toxin in Canada, the national incidence of respiratory diphtheria is near zero, and the toxin plays no recognized role in cutaneous diphtheria. Therefore, in this study, we assessed the diagnostic and public health benefits of diphtheria toxin testing and cutaneous diphtheria investigations in a highly vaccinated population.

Methods

Over the last 10 years, we retrospectively determined: the number of C. diphtheriae isolates identified in the province of Alberta, Canada; the disease state of each individual tested (disease vs asymptomatic carrier); the source (cutaneous vs respiratory); and the number of toxin tests performed.

Results

In 10 years, zero cases of respiratory diphtheria and three cases of toxigenic cutaneous diphtheria were identified. Despite zero cases of respiratory disease, diphtheria toxin testing significantly increased (p = 0.0001), with 86% of toxin tests performed on cutaneous isolates. Subsequent public health investigations of each case of toxigenic cutaneous diphtheria mandated the collection of 315 total specimens from 92 individuals, revealing low rates of C. diphtheriae colonization among contacts and no further cases.

Conclusions

This study challenges the value of reflexive diphtheria toxin testing in uncomplicated cutaneous diphtheria among highly vaccinated populations. Cutaneous diphtheria investigations demanded disproportionate public health and laboratory resources and demonstrated a discrepancy between toxin pathophysiology and disease. Therefore, we recommend stewarding diphtheria toxin tests for toxin-mediated disease forms and ensuring adequate vaccination. This approach would spare public health and laboratory resources by customizing responses around the role of the diphtheria toxin in each form of disease.

Key messages

Investigations for cutaneous diphtheria increased demand for toxin testing in Alberta, Canada, though the toxin plays no role in this form of disease. In populations with high vaccination rates against diphtheria toxoid, cutaneous diphtheria cases do not require additional laboratory testing for the presence of the diphtheria toxin.
Monitoring of HIV pregnant women for evaluating mother-to-child transmission in Sao Paulo, 2010-2018
Authors: Domingues C S B , Fonsi M , Tancredi M V , Loch A P , Rocha S Q , Gianna M C , Gonçalves A , Pereira G F M
Published: October 2020

Issue

In the state of São Paulo (SSP), the rate of mother-to-child transmission of HIV (MTCT) was estimated at 2.7%, in 2006. However, for reaching elimination, its level should be < 2%. From 2000 to 2018, the SSP concentrated 21.3% (26,427/125,144) of the total cases of pregnant women living with HIV (PWLH) in Brazil.

Description of the Problem

The occurrence of MTCT cases shows failures of healthcare system. The aim of this study was to assess the response of the Sao Paulo State STI/AIDS Program to prevent MTCT, from 2010 to 2018. A descriptive analysis of clinical monitoring indicators of the PWLH was performed. The National Surveillance Data System was used to estimate the underreporting of cases. Data from antiretroviral drug delivery, viral load (VL) and genotyping results were used to calculate the indicators and were obtained through database of the National Antiretroviral Drug System, Laboratory Control System and Genotyping System.

Results

In the period, despite identifying 15,463 PWLH in the systems, only 11,316 were notified (26.8% underreporting). Comparing 2010 and 2018, there was an improvement in accessing combined antiretroviral therapy (cART) from 81.2% (1,366/1,683) to 86.6% (1,543/1,782); in performing of VL before delivery from 70.8% (1.192/1.683) to 72.8% (1.298/1.782); in VL suppression <50 copies/mL from 39.9% (671/1,683) to 53.4% (951/1,782); and in the pretreatment genotyping from 0.2% (2/992) to 22.4% (154/688). In 2016, the loss of follow up of cART in 6 and 18 months after delivery was 20% and 24%, respectively. Additionally, the number of children born with HIV decreased 79.7%, from 64 to 13 cases.

Lessons

The decrease in the number of cases suggests improvement in preventing MTCT in the SSP. However, many challenges remain, such as breaking down individual, social and programmatic barriers to expand access to cART, pretreatment genotyping, VL suppression before delivery, retention in care and adherence to cART over time.

Key messages

The National Systems of surveillance, antiretroviral drugs, laboratory and genotyping network are important for performing clinical monitoring, reducing treatment gaps and underreporting. The integration of the Sexually Transmitted Infections and HIV/AIDS Program with the Primary Care and the Maternal and Child Health Program is essential to achieve the goals of eliminating MTCT.
Sexually transmitted diseases: what is the knowledge of college students in Tunisia?
Authors: Bannour I , Bannour B , Frigui R , Bannour R , Kheiri H
Published: October 2020

Introduction

In Tunisia sexuality education is a subject that is little discussed in institutions and schools, hence its marginal place in the school curriculum and even if it is addressed, it mainly concerns reproduction and risk prevention. The purpose of this study was to evaluate the knowledge, attitudes, and behaviors of law university students regarding sexually transmitted diseases.

Methods

A cross-sectional survey was conducted among 300 law school students in Sousse, Tunisia. The instruments used for assessment was a pretested questionnaire contained questions evaluating knowledge and attitude towards STD and AIDS. Questions had multiple responses from which each respondent was asked to select the most appropriate one.

Results

Our sample consisted of 300 students, the majority were female (75.3%). The mean age was 22.30 years old. More than 75% of surveyed students did not discuss the subject of sexuality with their parents. The main sources of information for the students were the internet 48.3% followed by media 47% and friends 20%; health professional represents only 10.3%. Concerning the identification of risky sexual behavior 56.6% of the students identified multiple partner's sex and 45.7% the non-use of the condom. AIDS comes first among the STD cited by the majority of students surveyed (92%) followed by syphilis (6%). Despite that the majority of our participants knew the signs of STD; such as genital ulcer, urethral / vaginal discharge. False beliefs persist such as chest pain (13.3%) and headache (13.1%). 60.7% f our student reported genital cancers as complication to STD, 32.7% infertility. Some minorities (2.7%) thought that STD could be complicated by blindness.

Conclusions

Despite the high prevalence of STD among young adults, most students knew very little about those infections. Implementing sexual educational programs and measuring their effectiveness should be a priority.

Key messages

There is a huge lack of knowledge about sexually Transmitted diseases among Tunisian college students. Implementing sexual educational programs and measuring their effectiveness should be a priority.
A “Flower” to improve the lunch at school
Authors: Troiano G , Servegnini M , Cirrincione M L , Frittoli E , Firmi A M , Clasadonte V
Published: October 2020

Background

Children consume at least one main meal a day at school so ATS Val Padana (Italy) conceived a project called “Un fiore in mensa” (A flower in canteen) as an acknowledgment of the quality of the school catering service.

Objectives

The aim of the project is to assign an award - “The Flower” - after an inspection during which the entire lunch (from preparation of meal to the consumption) is examined. It is necessary to reach at least 10 points to have the 'flower ' in all 3 essential sections (the “petals”): Quality of the menu, Organization and cleaning of the kitchen and / or other locals, Collaboration of the teachers. The complete flower (with 6 petals) is reached with 60 points (in the sections: General presentation of the refectory, Collaboration between all the personnel during lunch, Children's behavior).

Results

In the 2018-19 edition of the project 79 schools were examined: 20 (25.32%) were nurseries; 34 (43.04%) were kindergartens; 25 (31.65%) were elementary school. 36 (45.47%) were private schools. 16 on 79 schools (20.25%) obtained the flower. In particular: 1 school obtained a 3-petals certificate; 6 schools obtained a four-petals certificate; 7 schools obtained a five-petals certificate; 2 schools met all the requirements and obtained the complete six petals certificate. There wasn't a statistically significant difference due to school typology (p = 0.70) or to their management (p = 0.69). There was a statistically significant difference due to the examined year (p < 0.01), with better performances in 2019 compared to 2018.

Conclusions

The interest demonstrated by some schools that didn't receive the full flower to resolve some critical aspects confirmed the utility of the project.

Key messages

The project “A flower in canteen” is a way to reward the school catering service. Some schools tried to resolve some critical aspects after the inspection.
Risk factors of illicit substance use among Tunisian adolescents of Sousse
Authors: Ghali H , Bhiri S , Ben Cheikh A , Khefacha S , Tourki Dhidah M , Dhidah L , Ben Rejeb M , Said Latiri H
Published: October 2020

Background and aims

Adolescence is a period of physical, psychological and socio-cultural transformation, but also of curiosity, experimentation and acquisition. It is mainly during adolescence that people are introduced to the use of legitimate psychoactive substances, such as alcohol and tobacco, as well as illicit substances such as cannabis. Studying its predictors could help deal with this problem more efficiently. We aimed to determine the prevalence of life time illicit substance use and its predictors among Tunisian adolescents.

Methods

We conducted a cross-sectional study in two public schools in the governorate of Sousse during the 2017/2018 school year. The data were collected by anonymous self-administered questionnaire, then processed and analyzed using the SPSS software version 20.

Results

A total of 294 students were included. The mean age was of 17.03 years (standard deviation = 1.51). Females represented 56.1% of participants (sex ratio was 0.78). Among respondents: 60 (20.4%) had used illicit substance at least once. Cannabis was the main substance used by 35 (58.3%) students. The average age of the illicit substance use initiation was 16.3 (±1.1) years while it was 15.7 (±1.5) and 14.7 (±1.8) years for alcohol and tobacco use initiation respectively. Proportions of male students and academic failure were significantly more important among illicit substance users than among non users. While the most influential factors on illicit substance use were: alcohol use, and tobacco use (p < 10-3). However, no significant association was found between illicit substance use and video games and internet use.

Conclusions

This study highlights the strong association between the other risk behaviors and illicit drug use. Future interventions should focus on the whole risk behaviors simultaneously at late adolescence with regard to the environmental context.

Key messages

Our results highlight the need to better understand behaviors at risk in Tunisia and the perceptions of prevention policies among students. Mainly during adolescence that people are introduced to the use of illicit substances.
Excessive gaming behaviour in primary school children in Belgium
Authors: Van Hal G , Niemann J , Van Hiel A , Van Dongen S
Published: October 2020

Background

The use of electronic devices (smartphones, laptops,...) has gradually become a common activity among primary school children. Especially children's excessive use of elec-tronic games has been increasingly considered an important Public Health issue. This study explored the effects of personal and social factors on gaming behaviour in primary school children.

Methods

A survey was conducted in primary school children in Flanders (Belgium), 2016. Overall 8,444 children, mainly 9 to 11 years old, were included. First, descriptive and bivariate analyses were conducted. Subsequently, a multinominal logistic regression was performed to analyse gaming behaviour.

Results

Overall, 27% (n = 2,277), 25% (n = 2,108), 29% (n = 2,453) and 19% (n = 1,606) of the participating children showed a low, moderate, frequent and very frequent level of gaming behaviour, respectively. Gender differences were statistically significant, with boys showing more moderate, frequent and very frequent gaming behaviour. Further, chances for gaming were higher among children with a more frequent consumption of high sugar content soda, chips and candies.

Conclusions

More frequent gaming in boys can already be observed in primary school. How-ever, further research is needed to explore the development of this behaviour over longer time periods. Further results might provide useful information for developing effective prevention strategies concerning excessive gaming behaviour among primary school children.

Key messages

Excessive gaming behaviour is already present in 9 to 11 years old children. It might be useful to develop effective prevention strategies regarding excessive gaming in primary school children.
Virtual and reality: risk and protective factors of cyber and offline relational victimization
Authors: Wu W C , Tsai W L , Lee M J
Published: October 2020

Background

Cyber victimization (CV) and offline relational victimization (ORV) both impede adolescent development and might pose self-harm or suicide. The aim of this work is to examine the risk and protective factors of the two experiences across gender.

Methods

A total of 1,712 junior and senior high school students who came from 34 schools randomly sampled from northern Taiwan. The study included multi-facet supports (i.e. maternal, paternal, grandparent, peer, and teacher supports), positive and negative peer connections, smartphone addiction and family characteristics (i.e. parental marital status and self-perceived financial status) as predictors.

Results

10.3% of the participants reported CV more than once (56.8% girls) and 35.2% of them reported ORV more than once (52.4% girls) in the last three months. Results of logistic regression models showed that smartphone addiction positively related to CV (boys: OR = 1.3, 95% CI = 1.1-1.6; girls: OR = 1.6, 95% CI = 1.3-2.0) and ORV (boys: OR = 1.2, 95% CI = 1.1-1.4; girls: OR = 1.2, 95% CI = 1.1-1.3) regardless gender. Negative peer connection related to ORV only among boys (OR = 1.4, 95% CI = 1.7-1.7). Low-level self-perceived financial status related to having CV (OR = 2.8, 95% CI = 1.4-5.5) and ORV (OR = 2.0, 95% CI = 1.2-3.4) only among girls. Interestingly, paternal support is the only significant protective factor among three family supports. Paternal support negatively associated with CV (OR = 0.8, 95% CI = 0.6-0.9) and ORV of boys (OR = 0.8, 95% CI = 0.7-0.9) as well as ORV of girls (OR = 0.8, 95% CI = 0.6-0.9). Furthermore, teacher support negatively associated with girls' CV (OR = 0.8, 95% CI = 0.6-0.9) and boys' ORV (OR = 0.8, 95% CI = 0.7-0.9).

Conclusions

The study identified a few gender-specific risk factors. For both gender, to prevent CV and ORV, supporting adolescents to avoid smartphone addiction is critical. Enhancing paternal support and teacher support can be effective in preventing adolescents' cyber and offline relational victimization.

Key messages

Paternal and teacher supports, rather than other sources of supports, are protective factors of cyber victimization and offline relational victimization among adolescents. Smartphone addiction, regardless of gender, not only positively associated with cyber victimization but also positively related to offline relational victimization.
Universal newborn hearing screening: the Belgian experience
Authors: Lerut E , Van Overmeire B , Scholtissen S , Guérin C , Pereira T , De Schutter I
Published: October 2020

Issue

Worldwide 466 million people suffer from hearing loss (HL), of whom 34 million children. Early detection of HL in newborns through screening and subsequent intervention significantly improve their developmental and psychosocial outcome. The WHA adopted a resolution on prevention of deafness and HL (2017), urging the member states 'to develop, implement and monitor screening programs for early identification of ear diseases'. Population based newborn hearing screening (PNHS) by automated otoacoustic emission (AOAE) and/or automated auditory brainstem response (AABR) is considered good practice.

Description of the Problem

Flanders (FL): PNHS by AABR at the age of 2-3 weeks (pass/refer), repeated in case of 'refer'. At 2x 'refer', referral to a tertiary hearing center. French speaking community (FSC): newborns with risk factors for congenital HL are immediately referred to ENT. Others undergo AOAE at day 2-3 (pass/refer with retest in case of 'refer'). At 2x 'refer', referral to ENT for AABR. German speaking community: no data available.

Results

Coverage rate: FL (birth cohort 2014): 96-98%. FSC (birth cohort 2016): 94.9% of newborns without risk factors had a 1st test. 8.7% of newborns with risk factors didn't have any test.

Detection rate/1000 tested newborns

FL: 2.1 newborns with congenital HL. FSC: 2.33 newborns with HL (0.30 perceptive/0.36 permanently conductive/0.75 temporary conductive/0.1 conductive NOS/0.06 mixed type/0.77 NOS).

Lessons

Belgium has at least 2 quality PNHS programs. Due to program differences (different tests/age of testing/registration/financing) in depth comparative analysis on their performance, outcome and cost effectiveness is currently lacking (future perspective).

Key messages

PNHS is common in high income countries, but is not yet integrated worldwide. In the light of the 2017 WHA resolution Belgium might inspire regions and countries starting up PNHS. An in depth comparative analysis of the current Belgian PNHS programs is needed.
Unsafe abortion in Brazil: a systematic review
Authors: Domingues R , Fonseca S , Leal M , Aquino E , Menezes G
Published: October 2020

Background

In Brazil, abortion is legally allowed in cases of risk to the woman's life, pregnancy resulting from rape and cases of fetal anencephaly. Despite the restrictive legislation, studies estimated that around 1 million abortions took place in the country in 2005. Abortions occurred regardless of womeńs socioeconomic position, race, age and religion, but unsafe practices were more common among young women, with low educational levels, single, students or domestic workers. This study sought to update knowledge on unsafe abortion in Brazil.

Methods

We carried out a systematic review with study search on Medline and LILACS, with no language restriction, from 2008 to 2018. We evaluated article quality using the Joanna Briggs Institute instruments. We evaluated 50 articles.

Results

There was a decrease in the ratio of induced abortions by 1,000 women of reproductive age reaching 16 per 1,000 in 2013. However, direct estimates do not indicate a decrease in the prevalence of induced abortion, estimated to be 13% in 2016. Higher prevalences were observed in more socially vulnerable populations. Half of all women reported using medications for terminating pregnancies and the number of hospital admissions due to complications from abortion decreased from 1992 to 2009. Maternal morbimortality from abortion had a reduced frequency but it is likely that maternal deaths from abortion are under-reported.

Conclusions

Abortion is frequently used in Brazil, especially in less-developed regions and by more socially-vulnerable women. Access to safer methods probably contributed to the reduction of complications, hospitalizations and morbimortality from abortion. However, half of all women still used other unsafe methods and the number of admissions due to complications from abortion is still high. The small scientific production and lack of methodological adequacy led to the development of a special issue on Abortion in Brazil in the jornal Reports in Public Health.

Key messages

Restrictive legislation does not prevent abortion, but limits access to safe abortion and makes it diffiult to prevent morbidity and mortaliity from abortion. Restrictive legislation and the stigma associated with abortion make studies difficult to estimate the rates, complications and factors associated with abortion.
Changes in contraception use among Brazilian women after childbirth, 2006-2013
Authors: Felisbino-Mendes M , Barrozo Siqueira B
Published: October 2020

Introduction

There are gaps in knowledge regarding the neglected and vulnerable subgroups of FP actions in Brazil, such as postpartum women and women in general, regardless of their marital status.

Objective

To assess changes in the prevalence of use and in the contraceptive pattern of Brazilian women up to two years after pregnancy, between 2006 and 2013.

Methods

Cross-sectional, descriptive and analytical study which used secondary data from national surveys. We studied Brazilian women with up to 2 years postpartum, of reproductive age, sexually active, non-pregnant and menstruating, and compared them with all the other women. We estimated the prevalence of use, contraception pattern of contraception and ranking of modern methods. Percentual change in indicators between the years was evaluated by calculating the difference between estimates.

Results

85% of Brazilian women used CM, remaining stable in 2006 and 2013, with a high prevalence of modern methods use. An increase in the use of CM was observed among those with up to six months postpartum (71.0% to 89.0%). Pills and condoms accounted for about 60% of modern methods used in the postpartum period in both surveys. There was an increase in dual protection (2.9% to 10.1%) and contraceptive insecurity (1.6% to 5.7%) and a reduction in sterilization (16.2% to 13.4%) and traditional methods (2.1% to 1.4%).

Conclusions

Even with the maintenance of a high prevalence of use of CM and with the increase in contraception among women with up to six months postpartum, regional inequalities in access to CM and low prevalence of the use of other methods made available by the Unified Health System (SUS) persist, pointing out the maintenance of the insufficient care, failures in the means to regulate fertility and that public policies still hinder to guarantee the sexual and reproductive rights of the most vulnerable population.

Key messages

Regional inequalities in access to contraceptive methods and low prevalence of other methods made available by the Unified Health System (SUS) persist. There was an increase in contraception use among women with up to six months postpartum in Brazil.