bluuebunny/crossref_metadata_2025 huggingface dataset:
Organizational peer support for second victims in Vienna, Austria: The KoHi-project
Authors: Klemm V , Rösner H , Krommer E , Strametz R
Published: October 2024

Background

Healthcare workers negatively affected by adverse events are known as Second Victims (SV). The Second Victim Phenomenon (SVP) is widespread globally and can result in various consequences, such as anxiety, loss of confidence, and defensive medicine. To address this, the KoHi-project offers organizational peer support for SVs at the Clinic Hietzing (KHI) in Vienna, Austria.

Methods

A five-hour training program prepared 122 volunteers as peer supporters (KoHis) at KHI. Initial assessment (KoHi-I) in 2019 using the SeViD-questionnaire was followed by a repeat (KoHi-V) in 2022. Additionally, peer supporters underwent quantitative evaluations after training (KoHi-II), each session (KoHi-III), and after three sessions (KoHi-IV). KoHi-I-III were descriptively analyzed, while KoHi-IV and -V await evaluation.

Results

Initial study showed a 43% SVP prevalence at KHI. Most KoHis joined for ethical reasons and skill improvement, displaying high motivation. Post-training, they reported increased competency in supporting SVs. KoHi-III showed 53.3% of sessions initiated by KoHis, often triggered by personal distress. KoHis rated their support as highly helpful (M = 8.57 on a ten-point Likert-scale) and felt minimal burden (M = 3.42 on a ten-point Likert-scale) afterward. No significant correlations were found.

Conclusions

SVP is widespread at KHI. The five-hour training adequately prepared KoHis. Underreporting or underutilization of the program is suspected, possibly due to self-stigmatization of SVs. Being a peer supporter appears safe for KoHis. Psychological safety of voluntary supporters should be prioritized in hospital peer support programs. European hospitals lack organizational support for SVs, highlighting the importance of interventions like KoHi.

Key messages

• The SVP is common among healthcare workers at KHI.

• The implemented organizational peer support seems to not negatively impact the voluntary peer supporters’ wellbeing.
Analysis of medical doctor supply in Bulgaria, Croatia, Romania, and Serbia in the last two decades
Authors: Stevanović A , Šantrić-Milićević M
Published: October 2024

Introduction

The shortage of medical doctors in Europe has become a priority issue, especially in the Eastern European region, where many countries are making large investments to ensure adequate supply. Training future medical professionals is a lengthy and costly process that significantly impacts healthcare accessibility and quality. As part of the project of the Laboratory for Strengthening Capacity and Performance of Health System and Workforce for Health Equity, we aimed to assess the changes in the medical doctor supply in several Balkan countries over the last two decades.

Methods

Data on the total number of graduated medical doctors (MD) and their rate per 100,000 population from 2000 to 2021 was retrieved from the Eurostat database. This open-access database contains the reported number of students who have graduated from medical schools for each year and selected countries (Bulgaria, Croatia, Romania, and Serbia). The standard methods of descriptive statistics were used to perform the analysis.

Results

During the observed period, the number of MDs graduating annually and their rates per 100,000 population have increased in all countries. Romania leads with the highest rate of MD graduates at 26.18 per 100,000 people, followed by Bulgaria (22.74), Serbia (19.15), and Croatia (16.56). From 2000 to 2021, Bulgaria experienced the highest increase in the number of medical doctor graduates, with a rise of 169.1% in absolute numbers and 200.9% in rate. In contrast, Serbia had the lowest increase, with only a 135.5% rise in the total number of medical doctor graduates and a rate increase of 152.3%.

Conclusions

In the last 20 years, Bulgaria, Croatia, Romania, and Serbia have seen an increase in the number of MD graduates and their rate per 100,000 population. Policymakers should consider the investments and education trends of medical professionals in relation to their employment and migrations to predict the future supply of doctors in this region.

Key messages

• Bulgaria, Croatia, Romania, and Serbia have seen an increase in the number of MD graduates and their rate per 100,000 population in the last twenty years.

• Considering the trends in the number of newly graduated doctors, policymakers should address additional factors to ensure an adequate supply of medical doctors.
A Good Practice for Learning with Public Health Professionals Globally: Humphrey Fellowship Program
Authors: Cavdar S
Published: October 2024

Background

International collaborations are valuable yet often undervalued assets that enhance the quality of public health education and bolster the development of the public health workforce.

Objectives

The Humphrey Fellowship Program, part of the Fulbright Exchange Program, facilitates mid-career professionals’ visits to US-based host universities for an academic year. Fellows engage in a semi-structured fellowship period to achieve self-defined goals, emphasizing professional development, expanded experience, and intercultural exchange. This study advocates for the program’s contribution to enhancing public health education.

Results

Currently, two universities host fellows in public health. Over decades, fellows have engaged with faculty and professionals, participated in classes and meetings, visited institutions for development purposes, and completed US-based affiliations, contributing significantly to their own and the public health workforce’s advancement. This interaction-based learning approach aids in navigating social and ethical challenges by fostering a deeper understanding of public and global health issues across countries.

Conclusions

The Humphrey Fellowship Program in public health stands as a commendable model. Similar initiatives could be beneficially replicated in the European region, leveraging local and global successes to strengthen ties with public health education institutions, student communities, and beyond.

Key messages

• Programs that facilitate international interactions can enhance public health professionals’ understanding of global perspectives.

• The Humphrey Fellowship Program in the US stands as a commendable practice for mid-career public health professionals, contributing significant value to the education at host universities.
Public Health In Conflict And War: A Response To An Ever Evolving Landscape
Authors: Conyard K F , Codd M B , Mason-Jones A , Cunningham C , Middleton J
Published: October 2024

Background

The bases for this proposal are the current and ongoing conflict and war situations around the world, causing turmoil for nations and hardship and public health crises for people. We can no longer ignore the critical and time-sensitive need to address issues of Public Health (PH) in conflict and war in our education and training programmes.

Objectives

To consider appropriate themes and topics in Conflict and War that should be included in PH education and training programmes; and to consider how and where they are best represented. Member schools of the Association of Schools of PH in the European Region (ASPHER) were asked to provide details of their curricula relating PH in Conflict and War. Submissions on this topic were received from over 10 schools. Information was collated into logical themes, to which elements of the curriculum were mapped. In a modified Delphi process, respondents were asked for their level of agreement for inclusion in a curriculum and at what level content should be delivered.

Results

Findings from the survey allowed identification of seven main themes from topics provided: Contextual Factors; Preventive Strategies; Emergency Preparedness; Impact and Response; Conflict Resolution and Solidarity, Rehabilitation and Recovery. Respondents had high levels of agreement that content should be included in curricula and be delivered at every level in PH education and training.

Conclusions

PH education and training have been deficient in not including PH in Conflict and War as a subject area in programmes. The knowledge and expertise developed of necessity in some places can be shared across the ASPHER network and beyond to increase awareness of the PH considerations of conflict and war.

Key messages

• Public health in war and conflict zones is critical due to unique challenges and urgent needs of affected populations.

• An Integrated curriculum is vital for addressing conflict’s long-term health impact and preparing skilled workforce for health, resilience, action and laying the path to peace.
Factors associated with the intention to vaccinate children: a Finnish population survey on influenza
Authors: Hussein I , Vänskä S , Sivelä J , Leino T , Nohynek H
Published: October 2024

Background

Influenza vaccination for children aged 6 months to 6 years is included in the national vaccination programme in Finland. Although all vaccines in the programme are free of charge, national coverage of influenza vaccination among children under 3 years and 3-6 years during 2020/21 was 43% and 35% respectively, with regional differences. Our aim was to assess factors underlying parental vaccination intention in order to increase influenza vaccine uptake among children in Finland.

Methods

We conducted a survey among parents (n = 17,844) of eligible children (aged 6 months-6 years), selected randomly from five Finnish municipalities. Children and their parents were selected from high and low coverage areas, and the study was conducted in February-March 2022. Logistic regressions were used to determine associations between vaccination intention and e.g., sociodemographic factors, attitudes and knowledge. Linkage to the national vaccination register was used to confirm realisation of vaccination intention after the study.

Results

Participation rate was 13% (n = 2,322 parents). Influenza knowledge, trust in official information, responding parent’s education level, adherence to the vaccination programme, number of children and changes in attitudes towards vaccination since COVID-19 were all associated with intention to vaccinate. Vaccination intention for children was 64% and realised vaccination 51%.

Conclusions

Despite the low participation rate, both vaccinated and unvaccinated children were represented. Influenza vaccine uptake is not dependent on a single factor. Our results identified the need for open dialogue between parents and healthcare professionals, as the lack of vaccine being offered by healthcare professionals was the most reported reason for not vaccinating.

Key messages

• Parental vaccine decision-making in settings where the vaccination is given free of charge is complex, and not always driven by intention to vaccinate.

• Most parents had the intention to vaccinate, but some children still ended up not receiving their influenza vaccine.
Epidemiological characteristics of the 2019 Measles outbreak in central Tunisia
Authors: Ben Nasrallah C , Maatouk A , Grira S , Kacem M , Dhouib W , Abroug H , Zemni I , Ben Fredj M , Bouanène I , Belguith Sriha A
Published: October 2024

Background

Measles is still an important public health problem worldwide causing significant morbidity and mortality. Measles represents a vaccine-preventable disease. In Tunisia, vaccination against measles was launched in 1983. In spite of the progress made towards measles elimination, Tunisia experienced an outbreak in 2019. We aimed to describe the measles outbreak in the central region of Tunisia in 2019.

Methods

We carried out a descriptive study using surveillance data from January to December 2019 in four governorates in Tunisia (Monastir, Mahdia, Kairouan, and Kasserine). All suspected measles cases and declared to regional directorate of primary health care were included. A suspected measles case was defined as any person with fever and generalized maculo-papular rash plus one of the following symptoms: cough or coryza or conjunctivitis. A laboratory confirmed measles case is a suspected case of measles that has been confirmed positive by testing (IgM+).

Results

A total of 2,688 suspected cases were recorded, of which 369 cases were (14.7%) were confirmed measles through serological testing. The sex ratio was 1.06 for suspected cases and 1.12 for measles cases. Infants under one year old accounted 42.2% of suspected cases. The majority of suspected cases (67.3%) were not vaccinated. Among confirmed measles cases, positivity rates were 81.8% for unvaccinated, 70.0% for those with one dose and 27.2% for those with two doses. The hospitalization rate was 61.5 %; highest rates were observed in infants under one year of age (65.7%) and in the age group over 38 years (69.0%). In total, 27 deaths were reported. The highest lethality rate was observed in the age group under 12 months (2%).

Conclusions

The 2019 measles outbreak in Tunisia highlighted that this disease remains a serious viral infection. Unvaccinated populations could be a potential source for new outbreaks, imposing substantial public health burdens.

Key messages

• The country needs to establish a national review committee to monitor measles elimination status.

• To address future challenges, immunity gaps in the population should be closed.
The disease severity and death outcomes of COVID-19 outpatient cases in Almaty, Kazakhstan 2021-2022
Authors: Kozhekenova N , Semenova Y , Santric-Milicevic M , Glushkova N
Published: October 2024

Background

The global pandemic COVID-19 presented a serious burden on primary health care. We analyzed the association between the age, sex, and comorbidity on the severity and outcomes of COVID-19 in outpatient care in Almaty, Kazakhstan, between 1.1.2021 to 31.12.2022.

Methods

We assessed Odds ratio and 95% Confidence interval (OR, 95% CI) in a retrospective analysis of data on 174.540 COVID-19 patients on outpatient follow-up collected from an primary care electronic database (108,234 women and 66,306 man). Among outpatients 88.9% (n = 155,127) had mild disease, 8.3% (n = 14,537) asymptomatic; and moderate/severe disease was observed in 2.8% of cases.

Results

Among the COVID-19 outpatients, the incidence of diabetes mellitus was significantly higher in women (3.1%) then man (2.4%) (p < 0.001), obesity was more common in women (0.6%) than in men (0.4) (p < 0.05), and arterial hypertension was more common in men (10%) versus women (6.2%) (p < 0.001). The probability of developing moderate/severe disease increased significantly with age, especially in those 60 years and older, where it was 9 times higher (p < 0.001, OR = 9.01, 95% CI: 7.7-10.5), and where the probability of lethal outcome was very high (OR = 61.8, 95% CI: 8.5-446.2, p < 0.001) too. The odds of developing moderate/severe COVID-19 were 1.4 times higher in patients with diabetes mellitus (p < 0.001, OR = 1.43, 95% CI: 1.27-1.6), 2.5 times higher in obese patients (p < 0.001, OR = 2.51, 95% CI: 1.9-3.15), and in patients with chronic obstructive pulmonary disease (p < 0.001, OR = 2.5, 95% CI: 2.13-3.02), and the presence of arterial hypertension increased the risk 1.2-fold (p < 0.001, OR = 1.16, 95% CI: 1.07-1.26).

Conclusions

In Almaty outpatients, an association between the moderate and severe COVID-19 and age and comorbidity (diabetes mellitus, obesity, arterial hypertension, and COPD) was found, which underscores the necessity of more research on primary care organization and delivery in health emergencies.

Key messages

• An increase of severe COVID-19 in elder outpatients and with comorbidity emphasizes the need for their effective protection.

• The research on the impact of various factors on the disease severity and outcomes in outpatients can assist in optimizing primary care.
Influenza vaccine effectiveness in Ireland during two influenza seasons, 2022/23 and 2023/24
Authors: Marron L , McKenna A , O’Donnell J , Domegan L
Published: October 2024

Background

Live Attenuated Influenza Vaccine (LAIV) is recommended in Ireland for all children aged 2-17 years. Quadrivalent influenza vaccine is recommended for all others eligible for vaccination, including those aged ≥18 years with underlying medical conditions and all aged ≥65 years. We aimed to estimate influenza vaccine effectiveness (IVE) against Acute Respiratory Infection (ARI) presentations to primary care due to influenza over two influenza seasons in Ireland, to inform vaccination recommendations and communication campaigns.

Methods

We undertook a test-negative design case control study within the national sentinel surveillance General Practice network, as part of the European Vaccine Effectiveness Burden and Impact Studies (VEBIS) network. We compared influenza vaccination status among influenza Polymerase Chain Reaction (PCR) positive cases with influenza PCR negative controls, amongst patients consulting with ARI. We verified vaccination status using the national influenza vaccination database. We estimated end of season IVE for 2022/23, and mid-season IVE (up to 7th April 2024) for 2023/24, using multivariable logistic regression and adjusting for age, onset time, medical condition, and sex.

Results

In 2022/23, there were 288 cases and 765 controls. In 2023/24 there were 515 cases and 1,482 controls. Overall vaccination coverage was 23% in both seasons. Coverage in 2-17 year-olds was 10% in 2022/23 and 12% in 2023/24. In 2022/23, overall IVE was 42% (95%CI 9-54) and 50% (95%CI -30-83) in 2-17 year-olds. Overall IVE in 2023/24 was 37% (95%CI 16-54) and was 67% (95%CI 28-87) in 2-17 year-olds.

Conclusions

Influenza vaccination reduced medical attendance to primary care with ARI due to influenza, demonstrating benefits of vaccination, particularly among children. Influenza vaccination should continue to be offered and promoted to recommended groups, including children.

Key messages

• This study suggests that influenza vaccination protected population health and the health service from medical attendance to primary care with acute respiratory infection due to influenza.

• Higher influenza vaccine effectiveness was observed in children aged 2-17 years. These findings can inform influenza vaccination programmes with LAIV for children in Ireland and internationally.
STI/HIV care in times of COVID-19 according to Dutch healthcare professionals: A mixed methods study
Authors: van Ditzhuijzen J , Reilingh AYAM , Albers TJA , Bos H , de Wit JBF
Published: October 2024

Background

Surveillance data from the Netherlands show that STI/HIV testing decreased at the start of the COVID-19 pandemic, suggesting barriers in access to STI/HIV care. However, the impact of the pandemic on STI/HIV care may be more complex, and key populations could be differentially affected. The aim of this study was to gain more insight into the impact of COVID-19 on STI/HIV care in the Netherlands from the perspective of STI/HIV care providers.

Methods

We investigated whether professionals in STI/HIV care experienced changes compared to pre-COVID in access to care, demand and provision of care, shifts online care, and quality of care. An online survey was completed by 192 STI/HIV care professionals. Additionally, semi-structured interviews were held with 23 STI/HIV care professionals.

Results

According to participants, specific subgroups of priority populations may have had difficulties accessing STI/HIV care during the pandemic especially during lockdowns and at public sexual health services. Professionals were concerned to have lost sight of subpopulations in vulnerable circumstances and that the pandemic may have magnified inequalities in access to STI/HIV care, which may be related to different levels of health and digital literacy required for telephone and video consultations. Furthermore, participants found online care provision was not up to standards and were concerned about follow-up care for patients using private online providers of remote tests.

Conclusions

Professionals experienced that COVID-19 measures may have compounded existing disparities. To minimize inequalities in access to STI/HIV care during a pandemic, it is recommended to prioritize services for people in vulnerable circumstances such as recent migrants and people with low health or digital literacy. More collaboration between and within sectors may help in better organizing healthcare and prevent overburdening of specific sectors.

Key messages

• According to STI/HIV care providers, the COVID-19 pandemic differentially impacted different STI/HIV care sectors, but also increased existing inequalities in access to care for vulnerable groups.

• Professionals experienced that COVID-19 measures impacted the provision of STI/HIV care, access to care for vulnerable populations, and quality of care.
Emergency Department admissions for Acute Respiratory Infections: a retrospective analysis
Authors: Di Serafino F , Zotti N , Carmisciano L , Baglietto L , Porretta A D , Cristofano M , Foltran F , Pistello M , Rizzo C
Published: October 2024

Background

Acute Respiratory Infections (ARIs) have a relevant impact on public health in terms of prevalence and costs associated with the diseases. The COVID-19 pandemic highlighted the need to adopt accurate surveillance systems to respond to new emergencies and meet the demand for access to care. The aim of our work is to describe the accesses at the Emergency Departement (ED) of the Pisa University Hospital (AOUP), Italy, for ARIs, from 2017 to 2021.

Methods

A retrospective analysis of electronic medical records from the AOUP was conducted from January 2017 to December 2021. The analysis focused on ED admissions and positive lab test results, examining their correlation with ED visits caused by ARI. Multiple linear regression models were used to understand the influence of viral laboratory results on ARI-related ED admissions, adjusting the results for age. The study also assessed the contribution of each virus incausing ARI within different age groups.

Results

33,101 (annual average 5,520) ARI admissions in ED were registered, resulting in 7,426 hospital admissions (22.8%, annual average 1,163) with a seasonal pattern between week 42 of each year and week 17 of the following year. The reduction in emergency room admissions in 2020 (weekly average of 78.2, compared to 144.3 in 2017-2019) may be due to the restrictions implemented for the COVID-19 pandemic. Nevertheless, the average weekly rate of ED admissions caused by ARI was 30.8% in 2020, as compared with 21.7% in 2017-2019. Analysis by age group showed a peak of accesses in the last weeks of 2021 for the <1 and 1-4 years old age groups.

Conclusions

Data on ARI-related admissions provide valuable insights into the dynamic patterns of seasonal air-borne infections and age-related vulnerabilities. This could be useful in directing health policies to identify indicators of future epidemic waves, contributing to the ongoing efforts to enhance preparedness and response strategies for respiratory infections.

Key messages

• It is important to create an integrated surveillance system to monitor and respond to ARIs.

• Strategies should prioritise vaccination campaigns, particularly for RSV and influenza.
Primary care nurses’ readiness to promote digital health technology use among patients
Authors: Virtanen L , Kainiemi E , Vehko T , Heponiemi T , Kaihlanen A M
Published: October 2024

Background

Digital health technologies (DHTs) aim to optimise resource allocation and improve public health outcomes as care supplements. However, many patients do not access them independently. Nurses, as central contacts for primary care patients, can integrate digital health assessments, patient portals, remote monitoring, and teleconsultations into practice. Insight into their readiness to promote patients’ use of DHTs is important for efficient dissemination strategies. We examined nurses’ referral of patients to use DHTs and whether digital dedication (enthusiasm, inspiration, and pride for DHTs) and service guidance skills were associated with referral behaviour.

Methods

In spring 2023, the national ‘2023 survey on information systems for registered nurses’ gathered data from 549 nurses in Finnish primary care, comprising registered nurses (62%) and public health nurses (38%). The outcome, frequency of nurses’ DHT referrals, was assessed on a scale ranging from never to daily. We used multivariable ordinal logistic regression to examine associations, adjusted for career length, unit, and location.

Results

Among the nurses, 31% never or seldom referred patients to DHTs, while 19% did so monthly, 32% weekly, and 18% daily. Multivariable model showed that with each one-point increase in digital dedication (scale 1-5), the odds of referring patients to DHTs more frequently increased by 43% (OR = 1.43, 95% CI 1.21-1.70). Nurses who rated their service guidance skills as good (OR = 1.76, 1.01-3.05) or excellent (OR = 2.89, 1.28-6.62) had greater odds of referring patients to DHTs more frequently compared to those with less advanced skills.

Conclusions

Referring patients to DHTs is not a common practice for primary care nurses and can undermine care equity. Nurses’ motivation and knowledge about DHTs should be fostered, which may enhance patient referrals. Developing guidelines to assess patients’ digital capability and needs for effective service coordination is paramount.

Key messages

• Digitally committed and service-aware primary care nurses may refer patients to use DHTs more often than their peers, but we could not consider if suitable DHTs were available for patients encountered.

• Nurses should be motivated to use digital tools and provided with instructions for proficiently coordinating services in order to address patients’ underutilisation of DHTs and promote equitable care.
Understanding Hand Hygiene Knowledge Gaps: Insights from Primary Healthcare in Portugal
Authors: Cachim A , Luz Fortes A , Fernandes I , Antunes M T , Pereira P , Canto S M , Paixão M M
Published: October 2024

Background

Healthcare-associated infections cause a significant burden of disease globally. Hand hygiene is crucial for preventing these infections but despite recommendations, compliance with hand hygiene protocols among healthcare professionals is often inadequate. In Portugal, there have been several initiatives aiming to increase awareness on the importance of hand hygiene practices amongst healthcare professionals including in primary healthcare facilities. Nationally, there are two models of organization of primary healthcare facilities with differences in funding and allocation of resources.

Methods

In this study, the World Health Organization’s Hand Hygiene Knowledge Assessment Questionnaire for Healthcare Professionals was translated into Portuguese and validated with infection control specialists. It was then distributed to primary healthcare professionals in the Northern Lisbon area, in March 2024 to assess knowledge on hand hygiene practices and highlight potential training needs. The responses were analyzed, with the Kruskal-Wallis test carried out, followed by the Mann-Whitney U test when required.

Results

A response rate of 21,5% (65/302) was obtained, with most participants being nurses (58%), followed by physicians (34%). There was a statistically significant difference depending on the model of organization of the primary healthcare unit to which the participant belonged (χ2 = 8.428, p = 0.014, df = 2)., There was no significant difference between the score and the professional category of the participant (χ2 = 5.76, p = 0.12, df = 3).

Conclusions

The findings of this study show that the model of organization of a primary healthcare unit can impact the knowledge of professionals and not just practices. This study also underscores the significance of comprehensive assessments of the context before interventions and the need for further studies to understand how we can better inform future training initiatives.

Key messages

• Organizational differences in primary healthcare units impact hand hygiene knowledge among professionals, emphasizing the need for tailored training initiatives.

• Comprehensive assessments of healthcare contexts, coupled with validated linguistic tools, are crucial for reliable intervention strategies in infection control.
Sleep difficulties as a universal risk factor for injury among adolescents in 46 countries
Authors: Pagnotta V F , Donnelly P D , Gobina I , Elgar F , Ng K , Pickett W
Published: October 2024

Background

Poor sleep is common among adolescents and associated with unintentional injuries. The current evidence base is limited by differences in measures of sleep and injury implemented across studies. We examined the potential universality of the relationship between poor sleep and injury cross-nationally using self-reports from 229,589 adolescents in 46 countries that were collected using common procedures and measures.

Methods

A cross-sectional study was conducted using records from the 2017/18 Health Behaviour in School-aged Children (HBSC): World Health Organization cross-national study. The prevalence of sleep indicators (difficulties in falling asleep, insufficient sleep, social jet lag) and medically treated injuries (overall, multiple) were described across countries and by gender. Multivariable modified Poisson regression analyses were conducted within and across countries to test the consistency of the association between poor adolescent sleep and injuries.

Results

Overall, indicators of poor sleep were reported by nearly half of adolescents, and varied by gender and across countries. Country-level analyses found consistently positive associations between indicators of poor sleep and injuries. Pooled (multi-country) analyses further demonstrated a universality of these relationships across sleep indicators and injury outcomes. The strength of relationships varied by gender, with more robust associations detected among girls compared to boys.

Conclusions

Poor sleep is a robust and mainly consistent risk factor for injury among adolescents across countries and regions. Public health officials and policymakers should therefore recognize adolescent sleep as a health priority. The promotion of sleep hygiene may represent a novel target for injury prevention at regional and national levels.

Key messages

• Poor sleep, in the form of sleep difficulties, insufficient sleep, and social jet lag, were robust and mainly consistent injury risk factors among adolescents across 46 countries.

• Public health officials should recognize sleep hygiene as a novel focus for adolescent injury prevention.
GRADE evidence to decision framework in genomics guidelines: systematic review & appraisal
Authors: Taha A , Russo L , Pezzullo A M , Boccia S
Published: October 2024

Background

Transparent development of clinical practice guidelines (CPGs) is important for genomic medicine, as this field promises to partially challenge the traditional hierarchies of evidence. The GRADE Evidence to Decision (EtD) framework has recently emerged as a transparent and rigorous tool to produce recommendations. Our aim was to survey the genomic CPGs that used the GRADE EtD and appraise the applicability of its criteria and the quality of produced CPGs.

Methods

We systematically searched PubMed, Scopus, Web of Science and the gray literature till 2023 for relevant CPGs. From each eligible CPG, we extracted the reporting of the GRADE EtD criteria: benefits, harms, resource use, cost-effectiveness, acceptability, feasibility, equity and values. The quality of the CPGs were appraised across various domains using the (AGREE) II instrument.

Results

Among 1,144 records, 15 CPGs met inclusion criteria between 2018 and 2023, comprising 66 recommendations. Reporting of GRADE EtD criteria varied. Benefits, harms and their balance were addressed in approximately half of the recommendations 48% and 52% respectively. Feasibility, acceptability and values were also 52%, 47% and 40% respectively, resource use 39%, cost-effectiveness 23%. Equity was addressed in 36% of the recommendations. Quality appraisal of the CPGs also varied, domains were reported as follows: scope and purpose, clarity of presentation, editorial independence 86%, 85% and 84% respectively, rigor of development 77%, stakeholder involvement 72%, while applicability was 59%.

Conclusions

GRADE EtD is applied heterogeneously in genomic medicine CPGs, with difficulty in applying all of its criteria, including benefits and harms. Quality varied across domains with applicability of the CPGs less demonstrated.

Key messages

• Transparent approaches are needed in developing CPGs for genomic medicine.

• Current genomic CPGs fail to address crucial aspects for producing recommendations, including benefits and harms.
Gambling Disorder among Croatian University Students
Authors: Miskulin I , Kovacevic J , Vukoja I , Nujic D , Candrlic S , Pavlovic N , Kotromanovic Simic I , Candrlic M , Bajrektarevic Kehic A , Miskulin M
Published: October 2024

Background

Gambling has become a routine form of entertainment for many young people studying in universities. This study aimed to investigate the prevalence and characteristics of gambling disorder among Croatian university students.

Methods

A cross-sectional study using an anonymous self-administered questionnaire with sociodemographic and socioeconomic questions along with the Croatian version of the South Oaks Gambling Screen questionnaire (SOGS-CRO) was conducted in a representative sample of Croatian university students from Osijek, Eastern Croatia during January, and February 2020.

Results

A total of 844 students participated in the study, 45.6% males and 54.4% females, with a median age of 19.00 years (interquartile range 19.00-23.00 years). Gambling activities were performed by 66.2% of the students, most commonly lotteries, sports bets, and bingo. The final scores of the SOGS-CRO suggested that 21.1% of students may have a gambling disorder, with 16.4% being “probable pathological gamblers” and 4.7% being “problem gamblers”. Playing cards for money, animal bets, stocks bets, slot machines bets, pull-tabs, and other gambling activities such as online or videogames or mobile games present a higher risk of gambling disorder (p < 0.001, p < 0.001, p < 0.001, p < 0.001, p < 0.001, p < 0.001, respectively). Being male, repeating the year of study, being a student in interdisciplinary or technical field of study, and having a mother with gambling disorder (p < 0.001, p = 0.029, p < 0.001, p < 0.001, respectively) were the revealed contributing factors to the development of gambling disorder in study participants.

Conclusions

The study points to the fact that gambling disorder is quite a prevalent public health issue in the Croatian university student population. Specific public health preventive programs need to be designed and implemented in the study population to successfully prevent the development of investigated behavioral addiction.

Key messages

• Public health interventions directed toward the prevention of gambling must involve younger population subgroups, such as university students.

• When designing the preventive programs for the successful prevention of gambling within the university student population selected sociodemographic variables should be considered.
Heterogeneity of postpartum bonding and maternity blues among mothers three days after delivery
Authors: Kozina S , Tomić N , Šunj M , Kaliterna M , Boraska Marasović T , Mastelić T , Kozina T , Pranić S M
Published: October 2024

Background

Findings about risk factors for postpartum depression (PPD) are often inconsistent. The variability could be due to the heterogeneity of characteristics of mothers at risk for PPD in certain populations, which has important mental health implications. We examined the heterogeneity of sociodemographic, pregnancy and labor characteristics in postpartum women referred to follow-up care on the third day after delivery.

Methods

We performed a nested cross-sectional latent profile analysis (LPA) on a convenience sample of women in a tertiary community hospital in Split, Croatia in 2020. Participants completed the first subscales of Postpartum Bonding and Maternity Blues questionnaires, as well as five subscales of the Questionnaire of Family Functioning According to Parents and 12 sociodemographic, pregnancy and childbirth-related variables. LPA identified profiles of mother-infant bonding and postnatal blues, and multinomial regression analysis was used to determine the influence of different profiles.

Results

Of the 318 participants, the best-fitting model had three latent profiles. First (n = 76, 24% of participants) and second (n = 216, 68% of participants) latent profiles showed good postpartum bonding, while second profile showed higher primary blues. Third profile (n = 80, 25% of participants) was characterized by poorer postpartum bonding and elevated primary blues. Only good youth experiences of mothers with their parents (relative risk [RR] 0.26; 95% CI 0.12-0.57; p = 0.001) and good present-day relationships with partners (RR 0.26; 95% CI 0.13-0.52; p < 0.001), significantly decreased the risk for third latent profile classification.

Conclusions

Postpartum bonding and primary blues of women who gave birth three days prior were heterogeneous. This heterogeneity could result in the well-documented heterogeneity of postpartum depression in women, and therefore, be the focus of mental health interventions in similar settings.

Key messages

• We found heterogeneity of sociodemographic, pregnancy, and labor characteristics in postpartum women after delivery, highlighting the variability in risk factors for postpartum depression.

• This heterogeneity could result in the well-documented heterogeneity of postpartum depression in women, and therefore, be the focus of mental health interventions in similar settings.
The role and needs of teachers/schools in infection, prevention and control post covid-19
Authors: Ochili R , Dyer C , Leaver S , Eastwood L , Taborn E , Brown C , Lecky D M
Published: October 2024

Introduction

COVID-19 highlighted the importance of infection prevention and control (IPC) across all settings. As children are important transmitters of infection, teachers and schools play an important role in infection prevention. The aim of this study is to understand attitudes towards, and knowledge of IPC in schools post-Covid, and highlight any gaps in the training and resources needed.

Methods

An online survey of 1000 primary and secondary school teachers was carried out across England. Pearson’s chi-squared test, corrected for survey design, was used to test for differences in proportions across levels of categorical variables. Two qualitative workshops with eight head teachers were carried out to gather more in-depth information.

Results

1000 teachers completed the survey across a range of teaching roles. Respondents reported that IPC measures are now less frequently implemented than during the pandemic. 71% of respondents say their role has changed since the pandemic, now having more responsibility for pupil health and hygiene; higher in primary versus secondary school teachers (31% v 25%; p < 0.05). 1/3 felt this change was permanent; 84% had no IPC training. Knowledge gaps were identified in the areas of IPC roles within schools, and IPC measures. 72% teachers claim they feel better prepared to deal with a public health outbreak compared to pre-pandemic, although 22% do not have an updated IPC policy; 35% had unmet needs.

Conclusions

Schools and teachers play a pivotal role in preventing the spread of communicable disease, highlighted during the COVID-19 pandemic. Teachers need, and more importantly want, more IPC training. Training and updated policies would support the educational workforce who feel their needs are not being met. Providing more streamlined, consistent, clear and concise information from trusted sources is required.

Key messages

• It is imperative to understand educators’ role in IPC in schools as they are key players in supporting local and national efforts to reduce the spread of infections.

• Teachers desire further training with comprehensive information, and up-to-date policies to support their infection prevention and control efforts in educational settings.
Sociodemographic and lifestyle correlates of energy drinks consumption in Serbian adolescents
Authors: Gudelj-Rakic J , Kilibarda B , Vasic M , Jovanovic V
Published: October 2024

Background and aim

Energy drinks (EDs) are non-alcoholic beverages that typically contain high levels of caffeine and sugar in combination with other ingredients known to have stimulant properties. Although there is growing evidence of the harmful physiological and psychological effects of energy drinks their popularity has increased during the past decade. While researchers point out variety of health consequences, data on prevalence and correlates of EDs consumption are scarce. Aim of the study was to determine prevalence of EDs consumption and to investigate sociodemographic and lifestyle correlates of EDs consumption among adolescents in Serbia.

Study design

Secondary analysis of data obtained from 2022 Health Behaviour in School-aged Children Study (HBSC) in Serbia. Study included 3962 students aged 11, 13 and 15 years. Students with missing values for one or more study variables were excluded from the analyses.

Methods

Multiple logistic analyses stratified by age and sex were performed to estimate the associations between consuming EDs and sociodemographic and lifestyle characteristics.

Results

Overall, 15.6% of students consumed EDs more than once a week (16.2% of boys and 15.5% of girls) with highest percentage among 15-year-old students (20.3%). For both genders, the percentage of adolescents consuming ED more than once a week was higher among adolescents with lowest family affluence (21.9%), those consuming soft drinks daily (39.5%) and alcohol weekly (47.6%). In boys only, consuming ED several times a week was more frequent among adolescents having at least 60 min moderate-to-vigorous physical activity (MVPA) daily than among those with lower levels of MVPA.

Conclusions

Different patterns of ED consumption were identified suggesting need for tailored interventions aimed at reducing ED consumption in adolescents.

Key messages

• Every fifth h 15-year-old student in Serbia consume EDs more than once a week.

• Higher EDs consumption among physically active boys indicate need for targeting interventions that will address this issue.
Predictors of social withdrawal among early adolescents in Korea: a latent growth class analysis
Authors: Lee J , Kim E , Kim H
Published: October 2024

Background

This study examines the trajectory of social withdrawal from the fourth grade of elementary school to the first grade of middle school in Korea. By classifying them, we identify individual differences such as individual, family, and school factors.

Methods

This study uses data from the Korean Youth Panel Survey (KYCPS) conducted by the Korea Youth Policy Research Institute, which includes data from the 1st-4th waves of KYCPS 2018, with a total of 2,607 participants (1,313 boys and 1,294 girls). A latent class growth analysis verifies the trajectory of youth social withdrawal, classifies latent classes, and identifies predictive. SPSS 24.0 was used to analyze the main variables’ characteristics, descriptive analysis, and reliability. Mplus 8.9 was used to test the research model.

Results

First, results indicated that three was the optimum number of latent classes. We identified three latent classes ‘high level of withdrawal continued (HL)’, ‘medium level of withdrawal increased (ML)’, and ‘low level of withdrawal increased (LL)’. Second, when compared the ‘LL’ and ‘HL’ groups, the higher the self-esteem, the higher the friendship, and the higher the dependence on smartphones, the more likely it was to be in the ‘HL’ group. Third, when comparing ‘LL’ and ‘ML’ groups, the more negative the parenting attitude, the more likely it was to be in the ‘ML’ group. On the other hand, higher self-esteem and more positive friend and teacher relationships were associated with a higher likelihood of being in the ‘LL’ group.

Conclusions

It is necessary to seek differentiated interventions to prevent social withdrawal among early adolescents. Parental education to understand the adolescent period and practical approaches to intervene in the negative psycho-emotional aspects of adolescents continuously are needed to enhance the healthy psychological development of early adolescents.

Key messages

• The higher the self-esteem, the higher the friendship, and the higher the dependence on smartphones, the more likely it was to be in the ‘high level of withdrawal continued’ group.

• Higher self-esteem and more positive friend and teacher relationships were associated with a higher likelihood of being in the ‘low level of withdrawal increased’ group.
Income inequality and risky health behaviors of affluent adolescents in the post-Communist Europe
Authors: Torchyan A , Houkes I , Bosma H
Published: October 2024

Background

We aim to study the “golden youth” hypothesis and examine the risky behaviors of adolescents with high socioeconomic position (SEP) in post-Communist countries of Europe (PCCE) in relation to income inequality.

Methods

Adolescents aged 11-15 years from 14 PCCE participating in the Health Behavior in School-aged Children survey 2017/18 were included. A K-means cluster analysis was conducted to group adolescents based on tobacco smoking, alcohol use, binge drinking, and bullying perpetration. Generalized linear mixed models were fitted.

Results

Four clusters of adolescents were identified. The percentage of high-SEP adolescents in Cluster 1 (low risky behaviors) was slightly less compared to middle and low-SEP groups (70.9% vs 73.1% vs 73.9%, respectively). High-SEP adolescents were more likely to be in Cluster 2, characterized by frequent alcohol consumption but moderate binge drinking (14.3% vs 12.6% vs 10.7%). The prevalence of risky behaviors was similar between high and low-SEP adolescents in Cluster 3 (high smoking, frequent alcohol use, binge drinking, and moderate bullying) (8.0% vs 7.7% vs 8.2%) and Cluster 4 (high levels of bullying perpetration) (6.7% vs 6.5% vs 7.2%). Countries with higher Gini index were at a greater risk of reporting risky behaviors. High-SEP adolescents were more likely to engage in risky behaviors in countries with high income inequality. The odds ratios comparing high- vs. low-SEP adolescents ranged from 0.89 in the least unequal to 1.67 in the most unequal countries for multiple risky behaviors (Cluster 3: P-interaction = 0.042) and from 0.61 to 1.19 for bullying perpetration (Cluster 4: P-interaction = 0.030).

Conclusions

High-SEP adolescents in PCCE might be at an increased risk for unhealthy and vicious behaviors, especially in countries with high income inequality. This study highlights the need for policies that address income inequality to ensure the well-being of adolescents across socioeconomic strata in PCCE.

Key messages

• High-SEP adolescents might be at an increased risk for unhealthy behavior in PCCE.

• Wide income inequality might contribute to risky behaviors among high-SEP adolescents.