bluuebunny/crossref_metadata_2025 huggingface dataset:
Elizabethkingia miricola: an opportunistic pathogen in ICU
Authors: Soler E , Marín E , Guerrero I , Martínez S , Fernández MA , Valero C
Published: October 2022

Background

The Elizabethkingia genus is formed by a group of bacteria which are widely distributed in nature. Elizabethkingia is not part of human microbiota, therefore is considered to be an opportunistic pathogen. In the last years, it has become a cause of potentially fatal disease, becoming an emerging bacteria of increasing relevance. The objective of this study is to describe the impact of Elizabethkingia bacteria in infected patients in the ICU of a hospital in Granada.

Methods

Descriptive study. Patients who have been isolated in a biological sample of Elizabethkingia miricola throughout the year 2.021 in the ICU of San Cecilio University Hospital in Granada. Date and place of isolation were registered. Other variables registered were sex, age, length of ICU stay, days between ICU admission and bacterium isolation, days between bacterium isolation and death, infection, cause of admission or cause of death.

Results

Bacterium was isolated in 15 patients. Cause of admission was COVID-19 in 73.3% of patients. 73.3% were men and 26.6% women.The average age was 56.9 years. The average length of ICU stay was 43.8 days. 4 patients were diagnosed with ventilator-associated pneumonia and 5 patients were diagnosed with tracheobronchitis.The average days between ICU admission and bacterium isolation was 26,4 days. The average days between mechanical ventilation and bacterium isolation was 25.9 days. 53.3% of patients died. The average days between bacteria isolation and death was 18.2 days.

Conclusions

Elizabethkingia miricola is an emerging bacterium under special vigilance due to its capacity to cause major morbidity and mortality in admitted patients in ICU. The rapid identification and the study of the antibiotic susceptibility is considered of special relevance so they can be correctly managed to avoid infections and complications resulting from this microorganism.

Key messages

• Elizabethkingia is a special surveillance bacterie due to its morbidity and mortality effects.

• Elizabethkingia could be a severity indicator in admitted patients to the ICU.
Vaccines for older adults; the low-hanging fruit of disease prevention
Authors: Wennekes MD , Eilers R , Caputo A , Gagneux-Brunon A , Gavioli R , Nicoli F , Quatrehomme MMM , Vokó Z , Timen A
Published: October 2022

Background

The COVID-19 pandemic highlighted the significance of vaccination for older adults (OA), however, more health benefits could be gained with vaccination against influenza, pneumococcal disease, herpes zoster and tetanus as their uptake remains rather low. As healthcare professionals (HCP) play an important role in the vaccination decision making of OA, this study identifies obstacles in vaccination communication between HCP and OA.

Methods

80 in-depth structured interviews have been conducted with HCPs in Hungary (HU), Italy (IT), the Netherlands (NL) and France (FR). Participants were general practitioners, medical specialists, public health physicians, occupational physicians, pharmacists, geriatricians, specialists elderly care and nurses. The interview included questions on HCPs’ perceptions regarding information provision to OA on vaccines. Data were analyzed cross-country, using thematic analysis.

Results

Preliminary results reveal that a factor hindering HCPs to initiate conversations with OA on vaccines was lack of time (FR, IT, HU, NL). In hospitals this was often due to (acute) clinical problems taking precedence over discussing vaccines (IT, NL). In ambulatory settings the high number of patients waiting to be seen prevented discussing vaccines with OA (HU). Moreover, HCPs sometimes forgot to discuss vaccines with OA (NL, HU, IT). Patient factors hindering the conversation of HCPs on OA vaccines were a negative attitude (IT, HU) and lack of understanding the information provided (IT, HU). Also, misinformation on vaccines (FR, HU), as well as anti-vax beliefs from patients (NL) or their relatives (FR, IT) hampered the conversation on vaccines. HCPs mentioned their need to learn communication skills to convince OA on vaccines (FR, IT, HU).

Conclusions

HCPs encounter various obstacles in communicating with OA about vaccines. Lack of time and not recognizing the opportunity to discuss vaccines are important barriers for initiating vaccine conversations.

Key messages

• Providing HCPs with communication strategies is important to support HCPs in discussing vaccines with OA.

• Reminder systems are important to help HCPs remember address vaccination.
Integrated monitoring of AMR and enterotoxins genes of S. aureus isolated in Lombardy
Authors: Spinelli E , Magagna G , Tilola M , Rossi F , Filipello V , Guarneri F , Formenti N , Ianieri A , Alborali GL , Finazzi G
Published: October 2022

Background

S. aureus is a widespread pathogen responsible for mild to severe human and animals’ infections. The abuse of antimicrobials provides the potential for selection of resistant strains in livestock, which represents a public health concern. S. aureus can carry several virulence factors of which staphylococcal enterotoxins (SEs) play a key role during food poisoning in human populations. The aim of this study is to monitor the prevalence of antimicrobial resistance factors in S. aureus isolates and their ability to produce enterotoxins.

Methods

Within an ongoing monitoring plan for the assessment of antimicrobial resistance in S. aureus strains, a total of 83 isolates collected from food, and swine and dairy farms, between 2020-2022, were characterized using MLST and then screened for the presence of methicillin resistance and SEs genes. The isolates were tested for susceptibility to a panel of 14 antimicrobial agents using the disc agar diffusion method on Mueller-Hinton agar.

Results

Among 83 S. aureus isolates, 53% carried at least one SEs gene. Eighteen isolates were methicillin-resistant of which 17 were no-enterotoxigenic strains belonging to ST398, and one was a food origin ST8 strain and harbored SEs genes. Among the ST398 isolates, only one was a food origin strain, while the others were from swine farms. The antibiogram showed that a few isolates were susceptible to nalidixic acid, and 42% resulted multidrug-resistant.

Conclusions

Our results showed that more than half of S. aureus isolates were enterotoxigenic, the majority belonging to food industries. Numerous tested isolates resulted multidrug-resistant, confirming that antimicrobial resistance is a critical public health threat in a food safety perspective.

Key messages

• The antimicrobial resistance profiles of S. aureus isolates underlines the importance of monitoring plans with a One Health perspective.

• The prevalence of enterotoxins genes in S. aureus strains in Lombardy confirms the relevance of the microorganism as a foodborne pathogen.
Social differences in COVID-19 vaccination rates–Findings from a German nationwide study
Authors: Bartig S , Müters S , Hoebel J , Schmid-Küpke NK , Hövener C
Published: October 2022

Background

The COVID-19 vaccination aims to prevent the transmission of the novel coronavirus (SARS-CoV-2) as well as to reduce severe courses of the disease and deaths. But various studies indicate social differences in willingness to be vaccinated. This study aims to examine the influence of different social determinants on COVID-19 vaccination in Germany.

Methods

The analyses are based on data from the sixth follow-up survey of the German Health Update (GEDA 2021), a nationwide cross-sectional telephone survey of the adult population living in Germany. COVID-19 vaccination rates are analyzed considering age, education, income, urban-rural residence and migration background. Poisson regressions were used to examine associations of each social determinant with COVID-19 vaccination rates. Adjustments were made for age, sex, (education) and date of participation.

Results

Overall, the rate of COVID-19 vaccination for the survey period was 86.7%, with significant differences in vaccination rate by social determinants. The vaccination rate increases significantly with age (94.2% for over 60-year-olds), higher level of education (91.5%) or income (93.0%). In addition, people living in rural areas in Germany (83.5%) and people with an own migration experience (79.1%) had a significantly lower vaccination rate. An age-differentiated analysis also showed the social differences in COVID-19 vaccination rate are significantly lower among those over 60-years old.

Conclusions

The results suggest social differences in COVID-19 vaccination especially in younger age groups. This should be considered when designing targeted measures to overcome potential barriers to vaccination. However, a large number of other factors affecting vaccination behavior must be taken into account like structural barriers, confidence in decision-makers, the safety of vaccination, and a sense of responsibility towards the community.

Key messages

• Sociodemographic and socioeconomic determinants affect COVID-19 vaccination rates.

• The social differences in COVID-19 vaccination are lower among those over 60-years old.
Seroprevalence and SARS-CoV-2 antibodies distribution in Portugal following mass vaccination campaign
Authors: Kislaya I , Gonçalves P , Gaio V , Matos R , Barreto M , Melo A , Guiomar R , Rodrigues A P , ISNCOVID-19 group PT
Published: October 2022

Introduction

Information on post-infection and vaccine-induced SARS-CoV-2 seroprevalence is important for public health policies. A 3rd wave of National Serological Survey (ISN3COVID-19) was conducted to measure SARS-CoV-2 seroprevalence and characterize specific antibodies distribution in Portuguese population in September - November 2021, following a mass vaccination campaign.

Methods

ISN3COVID-19 was a cross-sectional epidemiological study that collected serum samples and questionnaire data on a sample of Portuguese residents aged 1 year or older (n = 4545). SARS-CoV-2 IgG anti-nucleoprotein and anti-spike antibody levels were measured using Abbott Chemiluminescent Microparticle Immunoassays. Seroprevalence was estimated for the overall sample and stratified by age group, sex, region and self-reported chronic conditions. Medians and respective 95% confidence intervals (95%CI) were used to describe the distribution of SARS-CoV-2 antibodies in specific population subgroups.

Results

The overall seroprevalence of SARS-CoV-2 (post-infection or vaccine-induced) was 86.4% (95%CI: 85.2 to 87.6%), post-infection seroprevalence was 7.5% (95%CI: 6.6 to 8.5). Higher seroprevalence was observed among 50-59 years-old (96.5%), women (88.3%), and those with two or more self-reported chronic conditions (90.8%). Higher IgG (anti-Spike) levels were estimated for individuals vaccinated with the booster dose (median=12601.3 AU/ml; 95%CI: 4127.5 to 19089.1) and for those vaccinated with two doses of Spikevax® vaccine (median=7012.7 AU/ml, 95%CI: 5568.8 to 8456.6).

Conclusions

The SARS-CoV-2 seroprevalence was high and consistent with vaccine coverage in Portugal. Seropositivity was associated with sex, age and previous chronic conditions. The anti-SARS-CoV-2 anti-spike IgG levels varied according to vaccine brand and number of doses. These results show that monitoring seroprevalence and SARS-CoV-2 antibody distribution is of paramount importance to guide public health policies.

Key messages

• Significant increase in SARS-CoV-2 seroprevalence following the mass vaccination campaign consistent with the high vaccine coverage achieved in Portugal.

• Continuous monitoring of the population-level IgG response after vaccination remains important to guide further public health measures.
Prevalence of injected drug use and access to OAT in prison: survey in 7 EU countries, 2014-2018
Authors: Mazzilli S , Royuela L , Tavoschi L , Vandam L , Montanari L
Published: October 2022

Background

People in prison report high rates of drug use and drug-related problems and people who use or inject drugs (PWUD) have higher rates of offending and an increased likelihood of spending part of their lives in prison. They represent a vulnerable population with high burden of diseases, socio-economic disadvantages and limited access to healthcare. In this study, we aimed to describe the lifetime prevalence (LTP) of heroin use, injected drug use and opioid agonist therapy (OAT) among people living in prison.

Methods

Individual data collection was carried out in seven European countries (Czech Republic, Latvia, Lithuania, Poland, Portugal, Slovenia, Spain) between 2014 and 2018 with a model European Questionnaire on Drug use among people in Prison. Risk factors analysis was carried out using multivariate logistic regression model.

Results

The analysis of EQDP data found that the LTP of heroin use was overall 22.4% (ranged from 7.3% in Poland to 27.5% in Spain). Female, recidivist offenders, individuals aged below 44 and with an history of mental health condition had a higher likelihood of being heroin user (p-value<0.05). The LTP of injected drug use was overall 20.6%(2176/10,587), while the prevalence of injected drug use in prison was 8.1%(745/9273) (with higher prevalence in countries that did not allow OAT initiation in prison: 17.5% in Latvia, 22.1% in Lithuania and 26.7% in Czech Republic). Among those who used heroin, 44.5%(772/1735) had access to OAT and among them 95.8(566/591) had access to OAT in prison.

Conclusions

Despite the heterogeneity of the results, there is a clear evidence that people in prison have a high prevalence of heroin and injected drug use. Prisons are an important point of access to OAT, and where treatment is available there is a reduction in risk behaviour. It is also important to implement tailored preventive interventions among vulnerable social groups at the community level.

Key messages

• People in prison in Europe have a high prevalence of heroin and injected drug use. Prisons can represent a point of access to integrated prison-community healthcare and social services for PWUD.

• In order to plan adequate healthcare interventions, there is an urgent need to assess and monitor the prevalence of drug use also in other European countries.
Integrated system for the proactive analisys of risk infection in patient’s surgical route
Authors: Montella E , Iodice S , Bellopede S , Frangiosa A , Giovagnoli A , Mazia G , Triassi M
Published: October 2022

Background

The most common hospital safety incidents are Hospital-Acquired-Infections (HAI) and among these Surgical Site Infections (SSIs). Our study proposes the use of a proactive system to manage risk combining the new Risk Identification Framework by WHO (IPCAF), the Lean method and the hospital’s Procedure Analysis. Each of the methods has pros and cons, and there is no existing literature that researches the concurrent use of all three methods. We focused on analysing patients’ surgical route to demonstrate that using an integrated system for preventing SSIs delivers enhanced results and significantly contibutes to a reduction in occurence of SSIs.

Methods

We conducted a retrospective observational study from 18 March 2019 to 20 April 2019 at Azienda Ospedaliera Universitaria Federico II di Napoli, Italia (Europa). The study is structured in 3 phases:

Phase 1- application of proactive risk management tools (18 March- 15 April 2019);

Phase 2-integration of results with the elaboration of a single system for proactive risk management (15-20 April 2019);

Phase 3- collection of epidemiologic data concerning SSI. We used the incidence of surgical site as efficiency indicator (1-10 March 2022).

The endpoints identified were:

Primary Endpoint: a reduction of infection occurrence in surgical sites

Secondary Endpoint: identification of critical points and control points within the surgical process with relevant corrective measures

Results

The rate of incidence of SSIs was selected as the efficacy indicator for the system. Our study recorded a 2.40% incidence rate for SSIs in 2020, compared to an incidence rate of 3.80% in 2018 and of 3.5% in 2017.

Conclusions

Considering the economic impact of the infections, along with the increased incidence of mortality and morbidity, employing all available tools to try and reduce SSIs incidence becomes paramount. A small reduction can produce significant cost savings that can be invested in other prevention programs.

Key messages

• Integrated system in proactively and promptly identifying risks related to patients’ surgical routes is effectiveness.

• The system can be adapted to different healthcare settings, to prevent adverse incidents by employing a risk management strategy, and to further enhance existing strategies.
A 6 years trends in hospitalization: retrospective study of Traumatic Brain Injury
Authors: Chikhladze N , Burkadze E , Pitskhelauri N , Tsiskaridze A , Peek-Asa C , Coman M
Published: October 2022

Introduction

Traumatic Brain Injury (TBI) is a significant public health issue globally, and the mortality and morbidity burden is particularly high in low- and middle-income counties (LMICs). The WHO predicts a disproportionately large increase of TBI burden in LMICs. The aim of this study was to identify trends in hospitalization associated with TBI in Georgia from 2015-2020.

Methods

The study was designed in the framework of the project INITIatE: International Collaboration to Increase TBI Surveillance in Europe, funded by the US National Institutes of Health (NIH/NINDS R21NS098850). The surveillance database of National Center for Disease Control and Public Health of Georgia was used for the study.

Results

During the study period a total 51 147 patients were admitted in hospitals throughout the country. In 2015-2019 the hospitalization increased and highest number of cases was in 2019 (n = 11779; 23,0%), in 2020 hospitalization decreased in comparison with the previous year (n = 9228; 18,0%). The highest number of burn injuries (n = 22963; 45,0%) occurred in the capital of Georgia (Tbilisi). Among hospitalized patients about 61,0% were males (n = 31162) and 39,0% females (n = 19985), retrospectively with ratio 1,6:1. The modal age of hospitalized patients was 25-44 and the highest hospitalization was in the age group of 15-24. 92,5% of cases were unintentional. The leading cause of Traumatic Brain Injury in all years were falls with some variations (57%-71%), followed by road traffic injuries (12%-25%). The average of LOS was 3 days, the highest LOS was 702 days. 1,6% (n = 805) of patients died. The most common mechanism of fatal injuries were falls.

Conclusions

The study provide important information about trends in hospitalization, size of the TBI problem, which is crucial for elaborating relevant policy and establishing priorities in order to reduce the burden of Traumatic Brain Injury in Georgia, as well to identify directions for further TBI related research.

Key messages

• Epidemiological data are essential for designing relevant preventive programs.

• Prevention is a key component of public health efforts to reduce TBI burden.
The association between Chorionic Villus Sampling and preterm birth: A systematic review
Authors: Giannakou K , Mastrou L
Published: October 2022

Background

Preterm birth is defined as a syndrome that can be initiated via various mechanisms. During the past few decades, it has been an emerging health issue worldwide and thus, several actions to benefit public health have been undertaken to reduce its rate. Chorionic Villus Sampling (CVS) is one of the methods that are performed prognostically for prenatal diagnosis. However, several complications can occur after this invasive method is performed. The aim of this review is to identify whether CVS may result in preterm birth as a complication, compared to other invasive or non-invasive methods.

Methods

A systematic literature review was conducted in PubMed and Scopus from inception until December 2021, to identify studies examining the above association. The research strategy included a combination of search and MESH terms related to CVS and preterm birth, Inclusion and exclusion criteria were set. The research was conducted by two researchers that thoroughly screened the articles and extracted the data.

Results

37 studies met the inclusion criteria. Comparisons were performed between CVS and amniocentesis or control group or between the different weeks that CVS was performed. No significant difference was observed in most of the studies when CVS was compared to amniocentesis, control groups, or between different weeks of gestation that was performed.

Conclusions

The risk of preterm birth of women undergoing CVS was relatively lower or had no difference compared to the other methods or controls investigated. Therefore, CVS is considered as a safe prenatal diagnostic procedure with minimum rates of preterm birth as a complication.

Key messages

• The risk of preterm birth of women undergoing CVS was found to be relatively lower with no significant differences compared to the other methods or controls.

• Future studies should be performed recruiting a large sample with women of different age and compare it with a control group that will not undergo any invasive method.
Associations between breastfeeding and the “10 Steps for Successful Breastfeeding”
Authors: Economou M , Kolokotoni O , Hadjigeorgiou E , Paphiti-Demetriou I , Hadjiona V , Kouta C , Lambrinou E , Hadjipanteli I , Middleton N
Published: October 2022

Background

The Baby-Friendly Hospital Initiative’s (BFHI) ‘‘Ten Steps for Successful Breastfeeding'’ has been the cornerstone of national and international strategies for decades; however, adherence is suboptimal. Despite successive National Strategies, breastfeeding rates remain low in Cyprus.

Methods

The overall experience of a consecutive sample of 568 mother-baby dyads (response: 70.8%) across all public (N = 5) and 29 (of 35) private maternity clinics was operationalized as the sum score of full, partial or no implementation of each WHO/UNICEF BFHI self-assessment questionnaire item, with the exclusion of Step 6 (exclusivity). Associations with initiation and continuation of any (BF) and exclusive breastfeeding (EBF) up to the 6th month were explored in logistic regression after adjusting for potential confounders, including breastfeeding self-efficacy.

Results

At mean score 5.6 (SD = 2.4), the overall 10 steps experience was low (theoretical range 0-14), even among those who breastfed exclusively (M = 6.9, SD = 2.1; p < 0.001). EBF and BF initiation and continuation showed a stepwise association with self-reported experience of the 10 steps. Across quartiles of increasing scores, the prevalence of EBF was 7.1%, 15.1%, 17.0% and 35.6%. The quartile of mothers who assessed their experience more favourably were 8- (adjOR: 8.4, 95% CI 1.5-48.0; p = 0.017) and 4-times (adjOR: 4.1; 95% CI 1.7-9.8, p = 0.002) more likely to initiate BF and EBF, even though only 6.5% continued EBF by the 6th month. Step 7 (rooming-in) and step 9 (no pacifiers) were least practiced but more strongly associated with EBF initiation.

Conclusions

While breastfeed intention may determine the actual experience of the 10 steps, implementation across maternity clinics appeared fragmented, despite clear association with successful initiation and continuation of BF, at the same time that the Cyprus National Committee for Breastfeeding is embarking on the first BFHI accreditation of maternity clinics.

Key messages

• Despite successive National Strategies identifying breastfeeding as Public Health priority, adherence to the WHO/UNICEF’s 10 Steps appears fragmented across Cypriot maternity clinics.

• Despite low overall adherence, mothers reporting experiencing more of the 10 steps were more likely to initiate and continue breastfeeding.
Forced migrant women’s Mental Health in the perinatal period in Germany- A mixed-method study
Authors: Al Munjid R , Teschemacher L , Mohr E , Engelhardt M , Breckenkamp J , Borde T
Published: October 2022

Background

After forced migration, pregnant women and new mothers face specific challenges in the host country. Little research focuses on the impact these challenges have on forced migrant (FM) women’s mental health (MH). The study’s aim shed light on FM women’s mental wellbeing in the perinatal period.

Methods

For this mixed-method study 15 individual problem-centered interviews were carried out in Arabic with FM mothers living in Germany within the postnatal period to one year postpartum. The transcripts were analysed using the Framework Analysis. In addition, structured quantitative interviews with 3070 new mothers were conducted on 3 obstetric wards in Berlin over a period of 23 months using an adapted version of the MFMCQ and the PHQ4. FM women (n = 187) were compared with immigrant (n = 1192) and non-immigrant women (n = 1673). A Kruskal-Wallis-Test was performed to compare the three groups.

Results

In the qualitative interviews mothers stated having depression and varied emotions (e.g. unavoidable sadness, relief). Most FM mothers indicated contextual factors (e.g. bad housing conditions) and structural barriers in perinatal healthcare as negatively impacting their MH. The preliminary quantitative analysis of the interviews conducted in birth clinics directly after birth showed no significant differences in the mean scores of the PHQ-4 within the compared groups (mFMW= 2.83; mimmi=2.61; mnonimmi= 2.5; p=.72).

Conclusions

While the quantitative study part indicates that PHQ-4 scores are independent of FM experience, the qualitative part shows that FM new mothers face particular burdens in their living conditions that make them vulnerable to MH issues. Inconsistent results could be attributed to the different timing in which the structured questionnaires and qualitative interviews were conducted.

Key messages

• To promote Mental health of new mothers, we advocate for a diversity oriented, responsive healthcare system.

• Effective approaches must be provided to include FM mothers in existing Early Childhood Intervention programs.
Feeding preterm infants with breast milk – the role of maternal pressure
Authors: Schwab I , Okumu I , Ohnhäuser I , Dresbach II , Scholten I
Published: October 2022

Background

Motheŕs own milk (MOM) is the best nutrition for preterm infants because of its preventive effects. Nevertheless, current research shows that mothers have problems getting into continuous lactation, especially after preterm birth. Breastfeeding-related pressure after prematurity has not been measured yet. It's relevance for the lactation is thus unclear, as well as the role of the NICU staff's attitudes. The aim of this study is to gain more knowledge about breastfeeding-related pressure in order to enable mothers to have a positive breastfeeding experience and to sensitise NICU staff about this topic.

Methods

The written survey included mothers of preterm infants with a birth weight under 1500g and an age from 6 to 24 months at the time of the survey. Descriptive and bivariate testing was used for analyses.

Results

Data of 506 mothers was included (32% response rate). One third totally agreed to perceive pressure regarding breastfeeding their child with MOM (36%). A milk volume over 500ml/day 14 days post-partum was reported in 60%. That the nutrition with MOM was promoted by the physicians in the NICU was totally agreed by 44% of the mothers. To the promotion by nurses, 50% totally agreed. Pearson Chi2-Test showed a significant correlation between milk volume and breastfeeding-related pressure (p = 0.005). Spearman’s correlation test showed a significant correlation between a high promotion of MOM by physicians (Spearman’s rho: -0.1150, p = 0.0109) and nurses (Spearman’s rho: -0.0949, p = 0.0362) and lower breastfeeding-related pressure.

Conclusions

Our findings indicate that breastfeeding-related pressure seems to affect most of the mothers of preterm infants and correlates with lactation, even if no direction of effect can be stated. A more breastfeeding promoting NICU staff is related to lower breastfeeding-related pressure. Therefore, NICU staff should be sensitised to breastfeeding-related pressure with regard to communication with mothers.

Key messages

• Noticing breastfeeding-related pressure as an important factor for mothers within their lactation process may have the potential to enhance mothers to achieve their breastfeeding goals.

• NICU staff should be aware of breastfeeding-related pressure to enable more mothers to have a positive breastfeeding experience.
Designing active breaks in secondary school, results from focus group with teachers: the brave study
Authors: Longo G , Masini A , Ricci M , Marini S , Sansavini A , Scheier LM , Ceciliani A , Dallolio L
Published: October 2022

Background

Many adolescents are unable to accomplish the daily 60 minutes of moderate to vigorous physical activity (PA) recommended by WHO. Secondary school is a critical period for developing healthy habits and PA interventions have the potential to promote healthy development. Active Breaks (ABs) are a school-based intervention consisting of short bursts (5-15 minutes) of PA made part of the academic routine. Primary school has been ABs main setting, while secondary school interventions received less attention. The aim of the BRAVE Study is to investigate teachers’ opinion about the feasibility of ABs in Italian secondary school.

Methods

In November 2020 20 teachers from two secondary schools located in Bologna province (Italy) were enrolled in two focus groups (FGs). FGs were held online, recorded, and transcribed. Questions were asked about the role of PA in the school routine and related experiences, perceived barriers and facilitators of the intervention, suggestions regarding the intervention design. Final expectations were then discussed.

Results

Despite limited experience with PA interventions, participants felt ABs would improve psycho-physical well-being for both students and teachers. Lack of time and space and a wary attitude towards ABs were listed as barriers. Program flexibility regarding content, administration time frames and implementation mode was listed as a great facilitator: program should be adaptable to participants’ needs, favoring easy and quick exercises. Overall, expectations emphasized improving classroom behavior and promoting healthy habits.

Conclusions

Teachers felt that inclusion of ABs in secondary school was promising and could lead to many health benefits. ABs were deemed feasible given their short duration and adaptability, since the program can be implemented with current personnel resources and space configurations. Co-design is essential to overcome personal barriers and create an effective and sustainable intervention.

Key messages

• According to secondary school teachers, PA interventions have the potential to improve psycho-physical well-being and classroom environment, promoting healthy habits among students.

• ABs are deemed as a feasible and sustainable PA intervention thanks to program flexibility regarding contents, administration time frames and implementation mode.
The Brave study: promoting active breaks in secondary school from students’ point of view
Authors: Ricci M , Masini A , Longo G , Sansavini A , Scheier LM , Marini S , Ceciliani A , Dallolio L
Published: October 2022

Background

According to the WHO recommendations, children and adolescents should perform at least 60 minutes per day of moderate to vigorous physical activity (PA). Active Breaks (ABs) interventions, short physical activity breaks of 5-15 minutes during school hours, have been examined in primary school children as a potential strategy to counteract a sedentary lifestyle, with minimal disruption to school learning activities. The aim of the BRAVE STUDY is to investigate the feasibility of ABs in a secondary school setting from the students’ point of view.

Methods

In December 2020, 10 students (age 12-13, 6 females and 4 males) attending the second and third grade of secondary schools located in Bologna province (Italy) were involved in a focus group (FG). The FG was conducted online because of COVID-19 and the answers transcribed for a later analysis. Students’ opinions were probed on the role of PA in school and possible facilitators/barriers to implementation of ABs in the school.

Results

Students reported they wanted to be more active as a consequence of time spent in class sitting at a desk. Students also reported that an organized activity like ABs conducted in the classroom setting provides an excellent opportunity to improve social relations with classmates. Students also highlighted the possible psycho-physical well-being benefits arising from PA. Among the potentially negative aspects reported, students underlined the possible confusion that would be created in classroom and the time subtracted from academic learning activities.

Conclusions

The FG represents an ideal mean to obtain in-depth information on how people feel about a pending program or a change in their routine. The current FG reinforces positive outcomes from exposure to a PA program that can be intertwined with their daily classroom activities. ABs programs can help to reconcile the needs of students that arise during the day with the PA objectives recommended by the WHO.

Key messages

• ABs can be a zero-cost intervention strategy to achieve WHO recommendations and would create conditions for a greater psycho-physical benefits in classrooms.

• A qualitative approach, such as FGs, provides a mean to collect information not obtainable with quantitative methods, that could be useful to co-design interventions for children and adolescents.
Multisectoral approach to address Female Genital Mutilation: a case study from Portugal
Authors: Vareda R , Valente J , Alho AM , Carmona A , Chaves D , Silva L , Ribeiro S , Paixão M , Leite A
Published: October 2022

Issue

Female genital mutilation (FGM) comprises all procedures that injury female genital organs for non-medical reasons, with several health impacts. Due to global migration, FGM has been increasingly recognised as a healthcare issue in Europe, affecting nearly 1 million women. In Portugal it is estimated that 5483 migrant women have undergone FGM in the Lisbon region. Intervention is required to tackle this issue.

Description

Portugal launched the “Healthy Practices: End of FGM”, a multiagency project targeting Lisbon and Tagus Valley region. Project implementation started in Nov 2018 at 5 local public health units (PHU) and was scaled-up to 5 more in Feb 2020. Project comprises 3 main axes: 1) inclusion in public policy instruments; 2) professionals’ education and awareness; and 3) community intervention. We describe inclusion of FGM in public policy, professionals training and changes in FGM recording before and after intervention.

Results

Between 2018-2022, inclusion of FGM in municipalities’ migration policies doubled. Between 2019-2021, 110 training sessions (n = 1722 professionals) were promoted. During pandemic years, only 344 (2020) and 202 (2021) were trained. Raising awareness and empowerment to risk communities happened mainly through local/online open sessions, workshops, flyer distribution, video projections. These occurred in all 10 PHU, mostly through partnerships with Non-Governmental Organizations and municipalities. According to the Portuguese Health Records, until 2018 there were only 300 women registered with FGM. Between 2019-2021, 363 more were added.

Lessons

The multisectoral approach allowed PHU professionals to collaborate directly with external organizations from different society sectors. COVID-19 pandemic posed a challenge to implementation, especially in the community intervention axis. Notification numbers increased after interventions, though causality could not be established and impact evaluation is yet to be performed.

Key messages

• Multisectoral projects for FGM intervention have specific implementation challenges, including how to justify and evaluate them, that must be considered in each setting.

• Training health professionals might increase identification and notification of FGM, but the impact in preventing FGM in the Portuguese reality is still largely unknown.
Comparing perspectives on research needs from stakeholders vs. researchers in an exposome project
Authors: Benz S , Weber M , van den Hazel P , Jansen S , Arat A , White M , Riedel N , Ristovska G , van Kamp I , Schreckenberg D
Published: October 2022

Background

Exposome research looks into how combined exposures affect human health. The EU-funded Equal-Life project focuses on physical and social exposures in a child’s environment and its effects on children’s mental health and cognitive development in the life course. Perspectives and priorities on what to study in particular might differ between practitioners and researchers. Therefore, collaboration with external stakeholders from various fields is encouraged to integrate practical experience and link it to the researchers’ aims.

Methods

Two Delphi studies were conducted collecting and evaluating research questions to be studied in the project among a) the researchers within the project and b) among external stakeholders from various European countries. The exercise was to evaluate the research questions for group a) based on relevance and testability and for b) e.g. regarding practitioners’ work and options for policies. Involved stakeholders work in health care, and urban planning, among others. Prioritised questions are collated.

Findings

Within the researchers’ group, top-rated questions were mainly mechanism-directed in terms of how and to what extent certain factors affect children’s mental health and cognitive development, cumulative effects in different settings, among others. Stakeholders most value research questions on practical issues, e.g. effects of early experiences of discrimination, critical windows in children’s lives that are most sensitive regarding the impact of exposures on mental health and cognitive development, or impact of exposures in early stages of life.

Discussion

In comparing approaches of stakeholders and researchers, stakeholders’ input from the practical field can shape the approach of the research process. The second benefit is to derive implications for creating effective interventions and policies to prevent adverse effects of environmental exposures and to foster positive health in children and later on in life.

Key messages

• Bi-directional exchange between researchers and external stakeholders can make gaps visible.

• Engaging stakeholders into a research process can help sharpening the aim and outcome of a project.
Parents’ experiences of an antenatal visit being part of a home visiting program in deprived areas
Authors: Lönnberg G , Edvardsson K , Leissner J , Salari R , Warner G , Sarkadi A
Published: October 2022

Background

There are considerable health divides between residential areas in many Swedish cities. In more disadvantaged areas children grow up with poorer health outcomes than the country average. To meet the greater needs of children growing up in these areas through proportionate universalism, an extended home visiting program has been delivered. A novel part of this program has been the social worker and nurse later conducting home visits meeting the parents at the maternity care clinic before childbirth. The aim of this study was to explore parents’ experiences of that antenatal visit.

Methods

Semi-structured interviews were carried out with nine mothers and three fathers around 3 months postpartum. Nine of the participants were foreign-born and a translator was used for four of the interviews. The interviews were recorded and transcribed verbatim and the data was analyzed with thematic analysis with an inductive approach.

Results

The parents’ overall experiences are comprised in the main theme: ‘A feeling of security and care for the whole family'. This main theme is derived from the three following themes: 1) ‘Staff - a trustworthy source of information'. Parents perceived the staff as experienced and knowledgeable and appreciated obtaining information about practical things and about the Swedish system; 2) ‘Access to emotional support'. Several parents expressed the need for emotional support and valued that by meeting the staff they knew they had someone to turn to; 3) ‘Becoming familiar with the staff'. It was appreciated to know who will come to your home as this gave parents an increased sense of security.

Conclusions

Initiating the program through introducing home visiting staff at a scheduled antenatal visit benefited parents, by giving them useful information and social support. The visit also seems to be indirectly beneficial as it contributes to building trust for the staff and the rest of the program.

Key messages

• Initiating an extended home visiting program at a scheduled antenatal visit benefited parents, by giving them useful information and social support.

• Initiating an extended home visiting program at a scheduled antenatal visit contributed to building parents’ sense of trust for the staff and the rest of the program.
Low birth weight in Angola and its socioeconomic determinants
Authors: da Silva Maia J , Teixeira JP , Queiroz G , Félix China J
Published: October 2022

Background

In low-income nations, low birth weight (LBW) is still a major public health concern, which accounts for 96.5 % of global LBW cases. Any newborn weighing less than 2500g is considered LBW, which is associated with a 20-fold increase in the chance of dying during infancy. Despite the severity of the problem, in Sub-Saharan Africa the high rates of LBW have not diminished in the recent decade. The goal of this study is to evaluate the prevalence of LBW and its risk factors in Angola, as there is a pressing need to address LBW and its substantial health and social implications.

Methods

We used secondary data from the Angola Children’s Record Database of Demographic and Health Survey from 2015 to 2016. A binomial logistic regression model was used to investigate the prevalence of LBW and its related risk variables.

Results

From the 3738 children selected, 9.2% were born with LBW. The complete lack of formal maternal education (p = 0.011; adjOR=4.56, 95%CI 1.41-14.74), the absence of maternal iron supplementation during pregnancy (p = 0.017; adjOR=1.42, 95%CI 1.07-1.89) and women living in rural areas (p = 0.016; adjOR=1.37, 95%CI 1.06-1.78) were associated with LBW.

Conclusions

Education appears to have a significant impact on LBW, emphasizing the importance of addressing literacy in Public Health policies. Lack of iron supplementation and rural residence can also be used as indicators of poor health-care access. Understanding the factors informs decision-makers and should pave the way for more targeted intervention and more efficient LBW policy.

Key messages

• Intervention in socioeconomic factors and health access during pregnancy might have a high impact on the LBW problem.

• Addressing literacy as a major health determinant can guide a more efficient policy making and help stakeholders target their interventions.
Suicide as a public health concern: Confronting the means, motives, and opportunity
Authors: Overholser J , McGovern C , Silva C , Gomez S
Published: October 2022

Issue

Suicide continues to present a major public health concern in many societies. Suicide prevention efforts have failed to reduce the rate of suicide in most countries. A change of intervention strategy can help to prevent these deaths from despair.

Description of the problem

Suicide prevention strategies are examined through an integrative review combined with more than 30 years of experience conducting research on suicide attempters and psychological autopsy research on adults who had died by suicide. Journal articles published since 2005 were reviewed for strategies designed to prevent death by suicide.

Results

Suicide risk is examined by confronting the means, motives and opportunities for suicidal behavior. Prevention strategies that limit access to lethal means can have a beneficial impact if the method is easily accessible and not easily replaced. Unfortunately, some individuals merely shift to a different method for their suicidal act. Prevention strategies that restrict the opportunity for self-injury provide time to confront underlying disorders and initiate treatment. Unfortunately, many patients do not continue treatment beyond the acute crisis, and there is often a resurgence of suicidal behavior after discharge from the hospital. Prevention strategies that aim to confront the person’s motivation to die may reduce the underlying cause. It is important to provide interventions to help reduce the desperation and isolation that underlie suicidal urges. These intervention strategies hold potential for making lasting changes that could eliminate, instead of temporarily suppressing, the desire to die.

Lessons

Restricting access to lethal methods and limiting times when a suicidal person is left alone can temporarily block suicidal urges. However, the motive underlying the suicidal urges remains intact. The motivation to die can be addressed through interventions that focuses on helping clients to build a life worth living.

Key messages

• Suicide prevention strategies can confront the desire for death by helping to build a life that is worth living.

• Comprehensive interventions aimed at reducing depression, isolation and addiction hold potential for reducing the rate of suicide.
Assessment of Psychological Impact of Covid Pandemic on Frontline workers at Points of Entry,Pakistan
Authors: Noreen N , Habib Ullah S , Ali Khan S , Ullah Faiz A
Published: October 2022

Background

The unprecedented public health crisis of the COVID-19 pandemic has caused heightened levels of stress and fear among health care workers.With the advent of COVID-19 in Pakistan,frontline workers of POEs have been under physical and psychological pressure including a high risk of infection, abnormal levels of workload, prolonged working hours, lack of personal protective equipment for safety from contagion, isolation, exhaustion, and lack of contact with family.The study aims to assess the impact of Covid-19 on the mental health of frontline healthcare workers.

Methods

A descriptive study was conducted among HCWs across points of entry from 1st October 2020 to 31st December 2020.Data was collected using a structured questionnaire.Depression, anxiety, and stress scale (DASS-21)was used for the assessment of depression, stress, anxiety. Descriptive analysis of socio-demographic and professional factors was done. Multivariable logistic regression analysis (MLRA) was performed using SPSS version 23.0.

Results

A total of 628 participants (586 males and 42 females) completed questionnaire.The mean age of the participants was 42.6 ± 45.9 years. The majority of the respondents were married (94.3%). The frequency of depression, anxiety, and stress in the HCWs was 12.1%, 42.3%, and 22.1 %, respectively. Multivariable logistic regression analysis found that the depression in HCWs was significantly associated with the profession and age (P < 0.001). The anxiety in HCWs was associated with their age and gender (P < 0.005). The stress in HCWs was significantly associated with their age (P < 0.05).

Conclusions

The HCWs at the Points of entry across Pakistan showed mild to moderate symptoms of DAS. The COVID-19 pandemic has caused a heavy psychological impact among the frontline healthcare professionals. Timely psychological counseling and early psychological intervention need to be implemented for HCWs to alleviate their anxiety and stress and improve their general mental health.

Key messages

• The COVID-19 pandemic has caused a heavy psychological impact.

• Timely psychological counseling and early psychological intervention.