bluuebunny/crossref_metadata_2025 huggingface dataset:
The use of digital tools to promote health in children: A systematic review of intervention studies
Authors: Dallagiacoma G , Ferrara P , Alberti F , Vecchio R , Vigezzi GP , Odone A
Published: October 2022

Background

Early childhood health interventions and educational programs are key to keeping children healthy and preventing disease during adulthood. Since several preventive strategies and campaigns targeting children have been proposed, the aim of this systematic review is to evaluate the effectiveness of digital-based interventions (e.g., cartoons, videos, video games, mobile apps, etc.) in promoting healthy behaviours in primary school-aged children.

Methods

Following PRISMA guidelines, we searched three electronic databases (Medline, Embase, and Scopus) up to April 11, 2022. We included randomized and non-randomized experimental studies quantifying the effectiveness of digital or audio-visual-based health promotion interventions in childhood (up to 12 years of age).

Results

The search strategy yielded a total of 1640 articles. Retrieved studies covered a wide range of health interventions - including a healthy diet, physical activity promotion, oral hygiene, skin cancer prevention, and different educational approaches (such as cartoons, interactive video games, etc.), mainly implemented in a school setting and comparing digital interventions to teacher-led interventions or no intervention at all. Data pooling suggests that digital and audio-visual-based health promotion interventions targeting children are effective in improving health literacy and healthy behaviours.

Conclusions

This systematic review adds to the body of knowledge on health promotion in children and provides actionable measures to implement straightforward educational approaches in this specific population, empowering them to adopt preventive behaviours, and ultimately promoting health at the household and societal level.

Key messages
(Un)safety of LGBT+ asylum seekers in asylum accommodations in Germany
Authors: Gartner F , Giacomozzi M , Helberg-Proctor A
Published: October 2022

LGBT+ asylum seekers face multiple challenges in their countries of origin as well as in their host countries. Violence and structural discrimination against this community are common and affect their whole asylum process. Violence and structural discrimination based on sexual orientation and gender identity stress the needs of LGBT+ asylum seekers in particular in regards to reception accommodations. In this study we investigated factors that contribute to the (un)safety of reception accommodations for LGBT+ asylum seekers in Germany. Qualitative semi-structured interviews were conducted with 11 participants from two groups, namely, professionals, and former and current LGBT+ asylum seekers. Thematic analysis was used to analyze the data and revealed multiple factors influencing the safety of LGBT+ asylum seekers in accommodations. These were clustered according to the used frameworks in the categories individual level, physical and social environment, and policies. The factors for (un) safety included amongst others interpersonal violence based on sexual orientation and gender identity, gender-neutral sanitary areas or lockable rooms, community support, and policies that govern where asylum seekers are accommodated, and which protection measures are set up in accommodations. Applying an intersectional lens, transgender asylum seekers were described as more vulnerable than other LGBT+ individuals. The analysis concluded that binding policies are necessary to guarantee safer accommodations for LGBT+ asylum seekers in Germany. Besides, the social cisheteronormative structures that manifest in discrimination of LGBT+ asylum seekers must be structurally deconstructed by, among others, training staff on LGBT+ needs and increase inclusivity among the asylum seeker community and in the host country.

Key messages
Knowledge of HIV prevention biomedical tools among African immigrants in France: the Makasi project
Authors: Coulibaly K , Gosselin A , Carillon S , Ravalihasy A , Bousmah M , Taeron C , Mbiribindi R , du Loû A Desgrées
Published: October 2022

Background

In France, post-exposure prophylaxis (PEP) and pre-exposure prophylaxis (PrEP) have been available for several years. However, there is still no evidence on the level of knowledge of these HIV prevention tools among immigrants from sub-Saharan Africa living in precarious situations, a population particularly affected by HIV. The aim of this study is to describe the knowledge of these tools in this population and analyse the factors associated with this knowledge.

Methods

The data mobilized are from the Makasi interventional research that was conducted between 2018 and 2020 among immigrants from sub-Saharan Africa in precarious situations in the greater Paris area. Using data collected from 601 participants, we described levels of knowledge of HIV treatment effectiveness, treatment as prevention (TasP), post-exposure prophylaxis (PEP), and pre-exposure prophylaxis (PrEP), by sex with a chi2 test. We investigated factors associated with their knowledge with logistic regressions adjusted for sociodemographic characteristics, living conditions and sexual behaviors (p ≤ 0.2).

Results

The population surveyed was predominantly men (76%), from West Africa (61%) and in a precarious situation: 69% were unemployed, 74% were undocumented, 46% had no health coverage and 13% were homeless. In this population, knowledge of antiretroviral treatments for HIV prevention was heterogeneous: the effectiveness of HIV treatment was well known (84%), but only half of the respondents (46%) were aware of TasP and very few knew about PEP and PrEP: 6% and 5% respectively. Multivariable-adjusted models showed that these tools was better known by educated people, those who had a social network in France, those who have had access to the health system and those who were exposed to sexual risks.

Conclusions

While sub-Saharan African immigrants know the effectiveness of HIV treatment and use certain prevention tools such as HIV testing, they are not aware of PEP and PrEP.

Key messages
Health Status and Self-Perception of Health in Czech Roma Community
Authors: Volevach E , Ely M , Maršálková H , Gulová L , Mikulik R
Published: October 2022

Background

The Roma population is reported to have a lower life expectancy in several European countries. The reasons for this are not well described, which limits the development of effective health promotion programs. This report investigates some possible reasons: self-perception of health risks and discrimination in a sample of Czech Roma. The study is a part of a complex health awareness program.

Methods

This is a pilot descriptive, cross-sectional survey conducted in Brno, Czech Republic in March 2022. Respondents were identified by community gatekeepers using quotas of gender and education. Data on disease incidence, lifestyle, attitudes to health care and risk perception were collected.

Results

In the sample of 30 participants, 60% were female, average age 42±5, 60% primary education. 57% daily smokers, with an average 17 cigarettes daily during 18 years. 35% had 1 chronic disease, another 38% had 2 and more. The most prevalent diseases were hypertension (43%) and obesity (41%). 60% of respondents with hypertension as compared to 23% without hypertension considered their stroke risk as medium. 43% smokers as compared to 21% non-smokers consider their risk of COPD as medium (for lung cancer 41% vs. 0%). Roma report not visiting a doctor due to a lack of time (33%), expecting the problem to resolve itself (33%), long waiting time (33%), but not discrimination (0%).

Conclusions

The Roma with risk factors correctly identify their risk of stroke, COPD, lung cancer as higher. None of them feel discriminated from physicians, but they limit contact with them due to other reasons. It appears that the prevalence of risk factors is higher in the Roma when compared to Caucasians based on the European Health Interview Survey (16% female, 31% male hypertension; 14% female, 29% male obesity). Self-perception of health and feeling of discrimination in Roma communities should be taken into account when designing health interventions.

Key messages
Risk factors associated with depression among French university students during covid-19 lockdown
Authors: Sabatier T , Godefroy C , Tavolacci MP , Ladner J
Published: October 2022

Background

During the COVID-19 pandemic students’ lives changed drastically, especially regarding their mental health. Social isolation, induced by lockdown, could be the cause of the development of mental disorders in this population. Therefore, the aim of this study was to identify factors associated with depression during French first Covid-19 lockdown among university students.

Methods

This cross-sectional study, which is a part of the COVID-19 International Student Well-Being Study (ISWS consortium), used the validated CES-D 8 score (Center for Epidemiologic Studies - Depression Scale) to measure depression levels. Data on socio-demographics, curriculum, living condition, academic environment and social interactions were collected few days after the first lockdown in France, from 13 to 31 May 2020. The potential impact of risk factors on depression was studied by multinomial logistic regression.

Results

A total of 3593 students were included. The CES-D 8 mean score was 8.65 (SD = 5.08). Literature students had the highest average CES-D 8 score (9.47, SD = 5.16). Independent factors associated with the higher scores of depressions included having limited financial resources (AOR=2.49, 95% CI = 1.84-3.38) having academic concerns, including students worried about not completing the academic year (AOR=2.93, AOR=2.37-3.64) and stressed with changes in teaching methods (AOR=3.55, 95% CI = 2.82-4.46). Otherwise, living with parents during lockdown and being in a relationship were significant protective factors against depression.

Conclusions

This study highlights the impact of changing social network, living conditions, and academic environment on depression among university students. Preserving students from social isolation must be a critical priority for universities. Future universities’ policy strategy could combine on-site teaching with online courses and consider the role of students’ social contacts, with a particular emphasis on mental health.

Key messages
Burden of Depressive disorders in Balkan countries
Authors: Todorovic J , Santric-Milicevic M , Stevanovic A , Terzic-Supic Z , Stamenkovic Z , Albreht T , Stoisavljevic S , Terzic N , Scepanovic L
Published: October 2022

Background

Depressive disorders are one of the leading causes of disability and are significant contributor to total Global Burden of Disease (GBD). Globally, according to the 2019 GBD study, the 1.85% of all Disability adjusted life years (DALYs) was associated with depression. The aim of this study was to describe the age-standardized DALYs in ten Balkan countries and the changes observed between 1990 and 2019.

Methods

The study included the data on age-standardized DALY rate per 100,000 for depressive disorders in the period between 1990 and 2019 for ten Balkan countries (Albania, Bosnia and Herzegovina, Bulgaria, Croatia, Greece, Montenegro, North Macedonia, Romania, Serbia and Slovenia) from the Institute of Health Metrics and Evaluation. We acknowledge the support from the COST Action 18218 - European Burden of Disease Network.

Results

The highest age-standardized DALY rate/ 100,000 throughout the observed period was in Greece in the 1990- 914.48 (95% CI: 620.19-1287.16) and 927.75 (95% CI: 626.5-1295.7) in 2019, while the lowest age-standardized DALY rate per 100,000 was in Albania in the entire observed period (1990- 369.032, 95% CI: 253.52-518.04 and 2019- 386.42, 95% CI: 266.46- 536.31). Greece and Albania are only two countries in the Balkans in which the age-standardized DALY rate per 100,000 increased in the period between 1990 and 2019, in all other countries there was a slight decrease in age-standardized DALY rates in the period between 1990 and 2019.

Conclusions

Age-standardized DALY rates per 100,000 decreased in eight out of ten countries in the Balkan region. However, age-standardized DALY rate per 100,000 increased in the country with the highest burden of depressive disorders in the region- Greece. In the period between 1990 and 2019 the lowest burden of depressive disorders measured in age-standardized DALY rate /100,000 was in Albania, but Albania also recorded the increase in burden.

Key messages
Temporal trends in adolescent sport participation in the south-east of France from 2001 to 2019
Authors: Luiggi M , Travert M , Gatouillat C , Griffet J
Published: October 2022

Background

Adolescents playing sport are more likely to reach the recommended levels of physical activity. In 2001, 2006, 2011 and 2019, four successive French national plans were launched to “develop physical and sports activity and limit sedentary living”. Monitoring sport participation rates (SPR) is one of the essential components to evaluate these plans. To date, information on temporal trends in SPR has mainly come from the national population. However, due to sample size, it was impossible to measure trends among adolescents on the territory level. Given the various economic and geographical disparities between territories, it is likely that territory specific trends exist. The main objective of this study was to measure temporal trends in adolescent SPR in the third biggest French department (South-East of France).

Methods

Four retrospective studies were conducted in high-schools between March and April 2001, 2008, 2015 and 2019 (n = 4367). A quota sampling design was used to obtain geographically and socially representative samples. They were invited to report their sex, their socioeconomic status (SES) and their sport participation. A sports player was defined as an adolescent playing sport for at least one hour a week. SPR were calculated by sex and SES with 95% confidence interval (95% CI).

Results

A decline in SPR, from 79.0% (95% CI = 76.4-81.7) to 64.5% (95% CI = 61.7-67.3), accompanied with a growth of social inequalities, were observed. SPR of low-SES adolescents declined from 67.7% (95% CI = 61.1-74.3) to 42.6% (95% CI = 36.7-48.4). SPR also declined from 72.5% (95% CI = 66.2-78.8) to 69.9% (95% CI = 64.5-75.3) for high-SES girls, from 87.2% (95% CI = 82.5-92.0) to 65.2% (95% CI = 59.6-70.9) for low-SES boys and from 91.0% (95% CI = 87.0-95.0) to 83.0% (95% CI = 78.5-87.4) for high-SES boys.

Conclusions

Temporal trends in adolescent SPR in this territory are in decline since 2001. Governmental plans to improve SPR seems to have had a limited success in this territory.

Key messages
Enhancing the understanding of parental burnout from an empirical and psychometric perspective
Authors: Prandstetter K , Murphy H , Olderbak S , Foran H
Published: October 2022

Background

Parental burnout (PB) is a relatively new syndrome resulting from chronic parenting stress. Besides efforts to enhance scientific and public understanding of PB, little is known about its link to intimate partner violence (IPV), and the psychometrics of German measures for PB remain an under-researched topic. This study aims to address these gaps by 1) testing the interplay of PB, parenting, couple satisfaction, and IPV, 2) examining the psychometrics of the German version of the Parental Burnout Assessment (PBA).

Methods

Data were collected online as part of an international PB study including Austrian parents aged 18 or older with at least one child at home (0-18). Overall, N = 121 mothers from a community sample reported on family functioning, PB, couple quality and gender roles. Structural equation modeling was applied to assess the fit of the theoretical model. Furthermore, data from N = 220 Austrian and German parents on PB and familial variables during the Covid-19 pandemic were collected to analyze the psychometrics of the German PBA. Confirmatory factor analyses were performed to test the validity of the PBA.

Results

SEM indicated a good model fit, χ^2(37) = 35.51, p = .54; CFI = 1.00; RMSEA = .00, (95% CI = .00 -.06). Furthermore, an indirect effect of couple satisfaction on the link between IPV to PB and IPV to parenting was found.

Conclusions

This study provides preliminary evidence for the importance of couples’ relationship satisfaction in understanding links between IPV and PB as well as parenting in German-speaking mothers. On the basis of these findings, future public health efforts may be organized to focus on preventing PB indirectly or directly by targeting couples’ relationship. Additionally, psychometric results of this study can inform researchers and practitioners about the applicability of the German PBA, improving screening of at-risk parents, and offering support for parents at early stages.

Key messages
Managing Minds at Work: development of a digital line manager training programme
Authors: Blake H , Vaughan B , Bartle C , Yarker J , Munir F , Marwaha S , Russell S , Meyer C , Hassard J , Thomson L
Published: October 2022

Background

Mental ill health is the leading cause of sickness absence with high economic burden. Workplace interventions aimed at supporting employers with prevention of mental ill-health in the workforce are urgently required. Managing Minds at Work (MMW) is a digital intervention targeting support for line managers in any work setting to promote better mental health at work through a preventative approach.

Objectives

To describe the design and development of the MMW digital training programme, prior to feasibility testing. We adopted a collaborative participatory design involving co-design (users as partners) and principles of user-centred design (pilot and usability testing). Agile methodology was used to co-create intervention content with a stakeholder community of practice. Development processes were mapped to core elements of the Medical Research Council (MRC) framework for developing and evaluating complex interventions.

Results

The program covers five broad areas: (i) promoting self-care techniques among line managers; (ii) designing work to prevent work-related stress; (iii) management competencies to prevent and reduce stress; (iv) having conversations with employees about mental health; (v) building a psychologically safe work environment. Pilot and usability testing (n = 37 surveys) aligned with the Technology Acceptance Model (TAM) demonstrated that MMW was perceived to be useful, relevant, and easy to use by managers across sectors, organization types and sizes. We identified positive impacts on manager attitudes and behavioural intentions related to preventing mental ill-health and promoting good mental well-being at work.

Conclusions

MMW is a digital training programme for line managers that has been co-created using rigorous development processes and aims to support employers with primary prevention in mental health. The next step is to explore the feasibility and acceptability of this intervention with line managers in diverse employment settings.

Key messages
Transformation of the long-term care system in Poland in the light of the maps of health needs
Authors: Olminski J , Koziol-Rostkowska M , Smiglewska A , Strozyk-Kaczynska M
Published: October 2022

As the inevitable ageing of the population progresses, the pressure on the public health system increases. The predicted rise in the share of people aged 65 and more from 19% in 2020 to 33% in 2050 jeopardises the capacity of the long term care in Poland. It demands immediate actions in public policies to strengthen the system and to provide the silver generation with the proper and adjusted services. That topic is one of the main issues for the map of health needs, developed by the Ministry of Health in Poland. The analyses investigate the current and future state of this part of the system, e.g. the number of visits, average length of stay, types of services, care-giver support ratio. Conclusions drawn from the data allowed to formulate a number of challenges, which include:

In line with these information, the actions and strategic frameworks have been established at the national level and included:

Key messages
Tobacco outlet availability in Dutch rural and urban areas
Authors: van Deelen T , Belmonte S , van denPutte B , Kunst AE , Kuipers MAG
Published: October 2022

Background

The Netherlands aims to reduce the availability of tobacco outlets by implementing a sales ban for vending machines (2022) and supermarkets (2024). The government intends to further phase out tobacco sales by petrol stations and small outlets after 2030. This study aims to understand its impact on tobacco outlet availability in the Netherlands, with particular attention to rural areas.

Methods

An audit of tobacco retailers was held between Sept 2019-June 2020 in four cities (Amsterdam, Eindhoven, Haarlem, and Zwolle) and between March-Apr 2022 in seven rural municipalities (Aa en Hunze, Ermelo, Dinkelland, Montferland, Simpelveld, Veere, and Waadhoeke). Each identified retailer was visited and mapped using Global Positioning System (GPS). Tobacco outlet availability was calculated in terms of density per population and km2, and residents’ proximity to the nearest outlet.

Results

In the rural areas, we found a total of 98 tobacco outlets, of which supermarkets (n = 57), petrol stations (26), small outlets (13) and tobacco specialist shops (2). In the four cities, we found a total of 870 outlets. Tobacco outlet density was much lower in rural areas than the four cities: 0.09 vs. 2.2 per km2 and 5.05 vs. 6.2 per 10,000 capita. The average shortest distance from an address to a tobacco outlet was much higher in rural areas (1.23km) compared to cities (0.31km). After implementation of all sales bans, tobacco outlet availability will reduce to 2 outlets in rural areas and 61 in urban areas which represents 0.1 and 0.4 per 10,000 capita, respectively. The distance will increase in cities (to 1.42km), but particularly in rural areas (to 5.28km) where 5 of the 7 municipalities did no longer include a tobacco outlet.

Conclusions

The proposed restrictions on tobacco sales will strongly decrease tobacco outlet availability, and might even disappear in some rural areas. These results call into question how the tobacco industry would respond to the proposed restriction.

Key messages
Preparing for the unexpected: Comparing plans for post-terror health response in Norway and France
Authors: Nilsen L , Stene LE
Published: October 2022

Background

How healthcare systems should respond to health and psychosocial needs in the population after terrorism is debated. Still, there has been recent interest for more coordinated health threat governance in Europe. Studies comparing approaches to health emergency contingency in different countries are thus needed. This poster will present a comparative study of how France and Norway planned for disaster follow-up prior to four major terrorist attacks, and how differences in the approaches can be understood.

Methods

National plans and guidelines from France and Norway, planning the response to mass casualty incidents relevant to four terrorist attacks in 2011, 2015 and 2016 were analyzed, by document analysis. Walt and Gilson's health policy model, focused on context, process, content and actors guided the analysis.

Results

The countries’ approaches were similar regarding identified target groups of prescribed measures and contents of some measures, however historical and systemic differences shaped approaches to post-terror needs. The countries deviated particularly on who the actors responsible for providing care were, and also the content of some measures. For instance, in France specialized mental health care were more involved in early psychosocial care than in Norway, where primary care approaches were more salient.

Conclusions

Contextual factors appear to affect how healthcare contingency is planned, and finding one approach applicable in all national contexts appears challenging. Still, the presentation will discuss the potential for identifying core elements for psychosocial and healthcare follow-up that can be relevant in different contexts.

Key messages
The role of socioeconomic status and political attitudes in the spread of Covid-19 in Austria
Authors: Stradner A
Published: October 2022

This study investigates the role of socioeconomic status (SES) and political attitudes marked by populism and libertarianism in the spread of Covid-19 infections across Austria. A spatial regression approach is adopted based on official registry data on Covid-19 cases at the municipality level, granted by the Austrian National Public Health Institute. This allows the consideration of spatial dependencies between observations in close geographic proximity. Moreover, to uncover potential temporal (in)stabilities in the effects, the associations are examined over two pandemic phases, namely the second (06/20 to 02/21) and third wave (02/21 to 07/21) of infections. The analysis shows that low educational attainment and income led to higher infection rates during both periods under investigation. In contrast, unemployment was negatively related to the Covid-19 incidence. While the findings for income and education were more pronounced during the third wave of infections, unemployment had a more significant impact during the second wave. Contrary to what was expected, the findings report that populist attitudes were associated with lower case numbers during the second wave. This association reversed and became positive in the third wave but was no longer significant. A positive yet non-significant relationship was detected between libertarian attitudes and Covid-19 cases for both periods studied. The findings suggest that low-income and less-educated groups carry a higher Covid-19 disease burden in Austria. This provides vital information for policymakers to develop targeted public health strategies to protect vulnerable groups and achieve a more equitable distribution of health in society. Only limited evidence was provided regarding the impact of populist and libertarian sentiments on the spread of Covid-19. As polarisation has increased throughout the pandemic, further research on attitudes characterized by skepticism towards state intervention and science is needed.

Key messages
Flu and Covid-19: is there adherence to vaccination in target groups?
Authors: Marconi D , Botarelli L , Gennari M , Cartocci A , Vigiani N , Nante N , Messina G
Published: October 2022

Background

In Italy, the flu vaccine is recommended and free for target groups (adults≥60 years old, fragile people, healthcare workers, pregnant women). During the 2020/2021 flu season, an increased vaccination coverage (+6,9%) was observed compared to the previous season, also due to the Covid-19 pandemic. We aimed to investigate how strong the adherence to the flu vaccine was by the vulnerable groups and assess if the Covid-19 vaccination campaign may have influenced the rate of flu vaccines.

Methods

At the beginning of autumn 2021 we conducted an online survey among the population of Tuscany. We collected data on demographics, health status (pregnancy, vulnerable), flu and COVID-19 vaccinations coverage and health information sources. In addition, we performed a descriptive and a risk factors analysis to assess correlation between our variables with R v 4.0.0. Significance level was set at p < 0.05.

Results

Among 408 participants, 248 (61%) belong to a vulnerable group and are recommended to receive the flu vaccine, 229 (56%) usually get the flu vaccine, 386 (95%) got the Covid-19 vaccine, 267 (65%) choose and trust the general practitioner (GP) as their health information source. There is a statistically significant association between being part of a vulnerable group and getting the seasonal flu vaccine (OR 6.63 95% CI 4.26-10.3 p < 0.001). In addition, getting the Covid-19 vaccine increases the likelihood of receiving the flu vaccine (2.90 95% CI 1.16-7.28 p = 0.018). Moreover, participants who trust their GP as their health information source (OR 1.63 CI 1.08-2.46 p = 0.019) are more likely to receive the flu vaccine; other information sources (TV, newspaper, social media) are not associated with the flu vaccine.

Conclusions

Our research shows that vulnerable groups get vaccinated against the flu. The increase in flu vaccine coverage may be due to the COVID-19 vaccines campaign. GPs play a crucial role in the health promotion, prevention and health literacy of patients.

Key messages
Fear of infection or fear of protection – driving factors of COVID-19 vaccine uptake in Bulgaria
Authors: Rohova M , Pancheva R , Mihaylov NL , Radeva N , Ivanova E , Chamova R , Paunov Ts , Kolarova M , Hadzhieva S
Published: October 2022

Background

Bulgaria faced significant COVID-19 morbidity and mortality rates, but many people underestimated the risk of transmission and severity of infection. Rising vaccine-related fear and misinformation exacerbated existing hesitancy and mass vaccination remained a challenge. This study aims to investigate the factors influencing COVID-19 vaccination uptake in Bulgaria.

Methods

A cross-sectional study was conducted in April 2022 in a sample of 1,200 respondents. Data were collected via an online self-administered questionnaire, measuring perceived risk of COVID-19, vaccine attitudes, trust in health system, and sociodemographics. Results were analyzed using bivariate and multivariate statistical methods.

Results

Bivariate analyses showed that the majority of vaccinated respondents (81.9%) expressed concern about infection, compared to 47.1% of non-vaccinated. Significant differences were related to perceived risk of COVID-19 vaccine: 61.0% of vaccinated assessed risk as small versus 7.4% of refusers. Non-vaccinated participants demonstrated distrust in vaccine benefits and lack of trust in health system, science and pharmaceutical companies. The multivariable regression revealed associations between age, income, vaccine perception, and vaccination uptake. The 45-54 and 55-64 age groups were less likely to refuse vaccination compared to the youngest age group (OR = 0.34, p = 0.009 and OR = 0.38, p = 0.036). Odds of refusing the COVID-19 vaccine decreased as income increased (OR = 0.33, p = 0.036). A high perceived risk of adverse effects increased the odds of vaccine refusal by 7.02 (p<.001).

Conclusions

The lack of confidence in the vaccine safety and effectiveness, coupled with an underestimation of the coronavirus disease, formed a critical barrier to the vaccine uptake. The misinformation fueled vaccination fear. Public health campaigns should address vaccine-related concerns and promote vaccination adherence in more consistent manner targeting also the spread of fake news.

Key messages
Dietary habits of pregnant women in Bulgaria
Authors: Chamova R , Panteleeva M
Published: October 2022

Background

The optimal nutritional status of the mother is one of the most influential non-genetic factors for the healthy development of the fetus. In recent years, more and more scientific evidence has been accumulating that her dietary habits and nutritional status determine the fetal development and the health of the offspring.

Methods

A cross - sectional study of pregnant women's dietary habits was conducted online. A questionnaire is attached, including questions about the diet, the frequency of consumption of certain food groups, application of alternative eating patterns and more. The analysis of the results is done with a software statistical package Jamovi ver. 2.3.0.

Results

The servey is conducted among 117 women with a mean age of 30.4 ± 4.88 years. The majority of them have changed their dietary habits after registering a pregnancy (72.6%). Among all respondents, 18.8% haven't got a fixed diet. 67% of the respondents eat 3 - 4 times a day, and 5.1% - less than three times a day. The relative share of pregnant women who consume milk and dairy products every day is 41% and 47%, respectively. None of the respondents restrains from consuming dairy products. Only 5.1% of the respondents do not consume milk. Six of the surveyed women (5.1%) do not eat meat and 14 (12%) do not eat fish. The relative share of women who eat fish 1 - 2 times a week is 29.9%. The majority of women (88.9%) doesn't consume alcohol during pregnancy. The relative share of vegetarians is 6%. There are no vegans among the women surveyed.

Conclusions

The majority of pregnant women surveyed follow the recommendations for healthy eating. There are women at risk of developing nutritional deficiencies among the respondents - macro - and micronutrients, which is a threat for maternal health, the course of pregnancy, as well as the growth and development of offspring.

Key messages
Late antenatal care initiation and neonatal outcomes in an ethnically diverse maternal cohort
Authors: Puthussery S , Tseng Pc , Sharma E , Harden A , Leah L
Published: October 2022

Background

Ethnic minority status and maternal socio-economic deprivation are linked to delayed access to health care during pregnancy. The link between late antenatal care initiation and neonatal outcomes in settings with high ethnic diversity and social disadvantage is seldom explored. This study examined associations between late antenatal care initiation (first antenatal appointment >12 weeks gestation) and neonatal outcomes of preterm birth (<37 weeks gestation) and low birth weight (<2500 g) in an ethnically diverse socially disadvantaged maternal cohort.

Methods

A retrospective cross sectional study using routinely collected anonymous data of singleton births between April 2007 - March 2016 from a large UK National Health Service maternity unit in an ethnically diverse, socially disadvantaged area. Univariate and multivariate logistic regression models were used to examine the associations between late antenatal care initiation and prevalence of preterm birth and low birth weight.

Results

Of the 46,307 singleton births recorded, more than one third (34.8%) were to mothers from Black African, Black Caribbean, Indian, Pakistani, and Bangladeshi mothers. Gestational week at first antenatal appointment was available for 99.31% births among which 79.2% had their first appointment at ≤ 12 weeks, 12% at 13-20 weeks, and 8.8% at > 20 weeks. Mothers who booked at 13+ weeks were significantly more likely to have a preterm and/or low birth weight baby. Compared to mothers who booked at ≤ 12 weeks, those booking at > 20 weeks were 4.08 times (95% CI: 3.29,5.07) as likely to have an extremely preterm baby (<28 weeks of gestation) and 3.12 (CI 2.66, 3.67) times as likely to have a baby born with extremely low birthweight (<1500g).

Conclusions

Mothers in ethnically diverse socially deprived areas who started antenatal care late were at increased risk of adverse neonatal outcomes. Targeted intervention programmes and services are needed to support these mothers.

Key messages
Breastfeeding and allergic disease at age nine in Ireland: An Irish prospective cohort study
Authors: Cosgrave E , Fitzpatrick P
Published: October 2022

Background

Despite well-recognised benefits, Irish breastfeeding rates remain suboptimal. Although associations between breastfeeding and allergic disease are well-researched in younger children, evidence for continued effect in older children is sparse. This Irish prospective cohort study investigated associations between breastfeeding and allergic disease at age nine.

Methods

The study sample included all nine-year-old children enrolled in the Growing Up in Ireland Infant Cohort Study whose mothers had participated in both Wave 1 and Wave 5. Mothers self-reported infant feeding practices at nine months and allergic diseases at nine years. Multiple logistic regression was used to generate adjusted odds ratios (aOR) for associations between breastfeeding and allergic diseases; re-weighting was applied to enhance generalisability.

Results

Response rate was 72% (N = 8,006). Most mothers (53%) had ever-breastfed their child; younger mothers, smokers and those of lower socioeconomic status were significantly less likely to have ever-breastfed. Compared to never-breastfeeding, ever-breastfeeding was protective against asthma (aOR 0.74, 95%CI 0.62-0.87) and eczema (aOR 0.72, 95%CI 0.55-0.93) at age nine. Ever-breastfeeding increased the risk of atopic rhinitis (aOR 1.44, 95%CI 1.07-1.94); the association with food allergy was inconclusive (aOR 1.17, 95%CI 0.83-1.64). Breastfeeding ≥6 months was protective against asthma (aOR 0.57, 95%CI 0.39-0.82) and any allergic disease (aOR 0.72, 95%CI 0.55-0.96). Exclusive breastfeeding (3-5 months) was protective against asthma (aOR 0.67, 95%CI 0.50-0.89) and eczema (aOR 0.54, 95%CI 0.34-0.86).

Conclusions

This study provides new evidence suggesting breastfeeding may be protective against asthma and eczema but may increase the risk of atopic rhinitis in older Irish children. Results must be considered in light of high Irish allergic disease prevalence and action in support of breastfeeding prior to and following birth prioritised accordingly.

Key messages
Assessment of maternal and newborn services in Uganda based on the Effective Coverage framework
Authors: Bertoncello C , Bordin P , Fonzo M , Dall’Oglio G , Lochoro P , Putoto G , Tognon F
Published: October 2022

Background

The implementation of a health service does not necessarily equate to a health gain. Effective Coverage (EC) aims to capture the potential benefits of a health intervention by adjusting the crude coverage for quality. The aim of this study was to assess the EC of Antenatal Care (ANC), Institutional deliveries and Postnatal Care (PNC) in Oyam district, Uganda, considering the input (drugs and equipment) and the process dimension (components of care provided).

Methods

The study involved 19 Health Centers (HC), 12 type II, 6 type III and 1 type IV, having a catchment area of 15.603 expected deliveries per year. The analysis covered the period between April and September 2021. Data on crude coverage were retrieved from the District Health Information Software-2. Data used to assess quality domains were extracted from checklists compiled during Supportive Supervisions and were summarized by readiness and likelihood of quality care indices. The crude coverage of the interventions was adjusted to calculate the input-adjusted and the quality-adjusted coverage.

Results

The readiness index was 0.81 for ANC, 0.82 for institutional delivery and 0.88 for PNC, while the likelihood of quality of care was 0.73, 0.88 and 0.89 respectively. In all three areas, the loss of coverage was mainly due to lack of materials and equipment; HCs II showed lower quality indexes than HCs III, particularly for ANC (P = 0.007). Compared to the target population, EC was 40% for ANC4 visits, 48% for institutional deliveries and 77% for PNC visits. The gap between crude and EC was higher for ANC4 (-30%) compared with the one for institutional deliveries (-18%) and PNC (-23%).

Conclusions

EC is a useful indicator for monitoring maternal and neonatal services in low-resource countries, bringing gaps in crude coverage to the surface. Supportive Supervision provides an opportunity to assess EC at the facility level without additional resources and to support health authorities in setting priorities.

Key messages
Health-related quality of life among five-year-old extremely preterm children with motor disorders
Authors: Aubert AM , Costa R , Johnson S , Ådén U , Pierrat V , Cuttini M , van Heijst AF , Maier RF , Sentenac M , Zeitlin J
Published: October 2022

Background

Motor disorders resulting from extremely preterm birth (EPT; <28 weeks’ gestation) can limit daily activities, schooling and social relationships. Cerebral palsy (CP) affects about 10% of children and non-CP movement difficulties (MD) are highly prevalent, although they tend to be under-diagnosed, especially in children without other developmental difficulties. We investigated the association between motor disorders and health-related quality of life (HRQoL) among five-year-old children born EPT.

Methods

We included children at age five from a population-based EPT birth cohort born in 2011-2012 in 11 European countries (N = 1,021). Children without CP were classified using the Movement Assessment Battery for Children - 2nd edition as having significant MD (≤5th percentile of standardised norms) or being at risk of MD (6th-15th percentile). Parents reported on CP diagnoses and HRQoL using the Pediatric Quality of Life InventoryTM. We used linear regression to compare HRQoL scores by motor status adjusting for social characteristics.

Results

Children born EPT with CP, significant MD and at risk of MD had lower adjusted HRQoL total scores [95% confidence intervals] than those without MD: -26.1 [-31.0; -21.2], -9.1 [-12.0; -6.1] and -5.0 [-7.7; -2.3]. Decreases were greater for physical scores: -35.3 [-42.7; -27.9], -11.9 [-16.1; -7.8] and -5.4 [-9.1; -1.6] than psychosocial scores: -20.6 [-25.2; -16.0], -7.4 [-10.3; -4.5] and -4.9 [-7.6; -2.1]. These differences persisted after exclusion of children with other developmental difficulties.

Conclusions

Motor disorders among 5-year-old children born EPT were associated with lower HRQoL, even among children with less severe motor difficulties and without other developmental difficulties.

Key messages
Knowledge and use of antibiotics among health care users in Institute of public health of Belgrade
Authors: Belamaric G , Matijevic D , Vukovic D , Bukumiric Z , Mladenovic Jankovic S , Markovic G , Tamburkovski G , Vojvodic K , Jakovljevic M
Published: October 2022

Background

Antimicrobial resistance (AMR) is one of the major global public health threats that may lead to severe illness, hospital admissions, treatment failure and increasing of the health care costs. In order to address those challenges, the aims of this study were to examine the antibiotics consumption among the population of health care consumers in the Institute of Public Health of Belgrade, and their knowledge and attitudes regarding antibiotics compared to the inhabitants of EU and Japan.

Methods

A cross-sectional study was conducted on a sample of 321 respondents who visited the Institute of Public Health of Belgrade in July 2021. The basic survey instrument was a Eurobarometer questionnaire (with the permission of the Directorate General for Communication European Commission). The obtained data were analyzed by methods of descriptive statistics, which included frequency distribution with percentages. In addition, the Chi-square test was used to examine the difference in frequencies.

Results

More than half of all respondents used antibiotics in the previous 12 months (56.6%), majority of them with a doctor's prescription and 57.1% did some pre-testing (blood or urine test, swab) before or at the same time as using antibiotics. They used antibiotics most often for urinary infections (9,3%) and common cold (8,1%). We discovered that the knowledge of our respondents is somewhere in between comparing to the knowledge of the people from EU and Japan. 37.4% of our respondents knew that antibiotics are ineffective against cold and flu; 68.9% knew that unnecessary use of antibiotics makes them ineffective; 55.9% knew that taking antibiotics often leads to side effects such as diarrhea and 50.7% knew that antibiotics don't kill viruses.

Conclusions

Knowledge about the antibiotics is insufficient and interventions of education, better informing and awareness of general public are necessary to encourage rational use of antibiotics.

Key messages

• It is important to take evidence based interventions to reduce unnecessary use of antibiotics.

• This is the first study about antibiotics in Serbia which used the Eurobarometer model of research.
Personal budget: integration of social and health resources of frail elderly in supported discharge
Authors: Giusti M , Simoni S , Persiani N
Published: October 2022

During COVID-19 pandemic, health and social condition of frail elderly got worse at worldwide level. This aggravation was due both to isolation and higher mortality rate for COVID-19, influenced by the widespread condition of comorbidity in this segment of population. The progressive change of needs in this target weren't matched with a prompt and adequate response, which could guarantee the taking charge of frail elderly. Personal budget is a tool for integrating public health, social assistance and family efforts on the international scene. In the Italian context, it is emerging as means to program and coordinate economic and professional, institutional, and personal resources, finalising them to provide a personalised pathway. Research aims to value the contribution of personal budget association to effectiveness and efficacy of personalised pathway for frail elderlies in early supported discharges. A research-intervention approach was done. Personal budget was applied to a significant sample of cases of personalised pathways for frail elderly in supported discharge in the Local Health District of Teramo. The study compared used resources and obtained health outcomes between the sample and a control group. The application of the personal budget permits the immediate maximisation of resources use and the quantification of the deviation between the available and the needed resources for provision of personalised pathway. Moreover, this tool supported the planning of services, the integration of health and social actions, the monitoring of adherence to planned programmes and the application of corrective mechanisms, if these are necessary, improving the health outcomes. Personal budget contributes to increase the integrated and continued taking charge of frail elderly in supported discharges in the short-medium term. Globally, this tool could be an organisational and economic answer for responding in a sustainable way to international increasing of life expectancy.

Key messages

• Personal budget manages and controls both health and social activities and resources.

• Personal budget supports the establishment of an integrated and continuous taking charge system of the frail elderly.
Does community HIV combination prevention (HPTN 071 (PopART)) impact healthcare inequity?
Authors: Hansen C , Miraldo M , Hauck K
Published: October 2022

Background

This research explores the impact of the HIV Prevention Trials Network (HPTN) 071 combination prevention (PopART) trial on horizontal inequity in Zambia and South Africa. Evidence suggests there is often inequality in healthcare utilisation in relation to socioeconomic characteristics, such as wealth. This paper is the first to address such distributional outcomes and inequities in a randomised trial setting.

Methods

We utilise horizontal inequity as a key performance metric to make value judgements with regards to the distribution of healthcare utilisation in a health system. Additionally, we supplement this index by estimating the impact of PopART on inequality in healthcare utilisation and HIV prevalence, estimating concentration curves and indices.

Results

We find a pro-rich inequity in healthcare utilisation, as ranked by wealth, before and after the trial is implemented. Pro-rich implies, for example, the 20% poorest make up less than 20% of healthcare utilisation. This suggests the trial enabled the wealthier subset of the population to take better advantage of accessing healthcare.

Conclusions

Given the high prevalence of HIV in lower-income households in Zambia and South Africa, these results strengthen the case for interventions tailored to informing poorer households about the benefits of prevention and after-care.

Key messages

• The PopART trial demonstrates as with any intervention, there is a risk of exacerbating an underlying inequity. Policies directed at these problems specifically may help alleviate such burdens.

• This paper shows one example of a distributional imbalance in the HIV population. Given the absence of work on RCT interventions, the findings may also be used to inform future trial design.