bluuebunny/crossref_metadata_2025 huggingface dataset:
Antimicrobial stewardship program in one primary care hospital, a snapshot analysis
Authors: Cirillo P , Schiattarella A , Grande D , Annunziata V , Navarra M , Dyrda B , Mininni I , Dolce M , Benedetti P , Nasi G
Published: October 2024

Antimicrobic resistance (AMR) continues to rise, whereas development of new agents to counter it has slowed. A heightened need to maintain the effectiveness of currently available agents exists. Healthcare-associated infections (HAIs) are a significant cause of poor treatment outcomes and elevated healthcare and societal costs worldwide. At the beginning of 2024, we started a prospective, interventional, interrupted time-series study, based on Prospective Audit and Feedback in the Intensive Care Unit (ICU) and in the internal medicine ward of our hospital. The primary outcomes will be the difference in the antibiotic consumption, and the incidence of bloodstream infections (BSI) caused by multidrug-resistant (MDR) organisms. The secondary outcomes will include the hospital mortality rate, the mean length of stay and the antibiotic expense. We conducted a snapshot analysis of the first three months to assess the efficacy our program. In the first three months we registered a global reduction in antibiotic expense (almost by half in comparison of 2023 first quarter) and consumption, particularly in the use of carbapenems: (change in level, CL: -51,26 DDD/1000 PD,) and third- generation cephalosporins (CL: -6 DDD/1000 PD). We registered a reduction in the use of hydroalcoholic gel, probably due to the reducted perception after the waning of risk perception towards Covid-19, although no big difference was observed in BSI incidence due to MDR Gram-negative organisms (CL: +1,2 events/1000 PD). Albeit partial, once again these findings demonstrated that implementation of an antimicrobial stewardship program, no matter the level of healthcare, is critical for fighting the AMR and to lessen the burden on Public Health; in particular our program induced a significant reduction in antibiotic consumption that lead to more funds at disposal to improve our clinical practice.

Key messages

• Once again our findings demonstrated that implementation of an antimicrobial stewardship, no matter the level of healthcare, is critical for fighting the AMR.

• Our program induced a significant reduction in antibiotic consumption.
COVID-19 premature mortality in Serbia: Does the place of death matter?
Authors: Stevanović A , Šantrić-Milićević M , Todorović J , Rajović N , Rosić N , Bjelobrk G
Published: October 2024

Background

The COVID-19 pandemic has significantly impacted healthcare services provision in Serbia and globally. Many people did not seek or reach healthcare due to various reasons, and a significant number of COVID-19 deaths were not confirmed by laboratory testing. Within the project of the Laboratory for Strengthening Capacity and Performance of Health System and Workforce for Health Equity, we assessed the differences in years of life lost (YLL) of COVID-19 death cases according to the place of death.

Methods

The Statistical Office of the Republic of Serbia provided average life expectancy and anonymous individual mortality data of the Serbian population in 2020, 2021, and 2022, where COVID-19 was the underlying cause of death (ICD-X codes: laboratory confirmed - U07.1 and clinically diagnosed - U07.2), also disaggregated by the place of death (at home or in a hospital). Analytical statistics and nonparametric tests were used to assess the differences in premature mortality by place of death with a significance level set at p < 0.05.

Results

In all observed years, a total of 45,632 death cases due to COVID-19 occurred (94.3% in hospital and 5.7% at home). Most COVID-19 deaths were coded as U07.1 (93.8% in hospital, 91.3% at home). An average of 12.12±7.50 YLLs was estimated per death, with a median of 11.50. There was a significant difference (p < 0.001) in the median number of YLLs between those who died in the hospital (11.50) and those who died at home (6.78). Furthermore, deaths occurring at home had fewer YLLs but were more frequently coded as U07.2 (p < 0.001).

Conclusions

The place of death is relevant when assessing the impact of COVID-19 on premature mortality in Serbia. On average, persons who died at home due to COVID-19 had a lower number of YLLs compared to those who died in a hospital. More research is necessary on the other factors contributing to premature mortality and inequalities in the COVID-19 burden in Serbia.

Key messages

• During the first three years of the COVID-19 pandemic in Serbia, 5.7% of COVID-19 deaths occurred at home, resulting in an average of 9.89 years of life lost.

• The COVID-19 pandemic highlights the need to investigate deaths that occur at home and improve pandemic preparedness.
Determinants of crimean-congo hemorrhagic fever (cchf) outbreaks: a retrospective analysis
Authors: Sartaj M G , Tahir M R , Ali M
Published: October 2024

Introduction

Crimean-Congo Hemorrhagic Fever (CCHF), a viral tick-borne zoonotic disease with high mortality rates, poses a particular threat in Pakistan during religious event of Eid-ul-Azha as increased livestock contact. This study aims to analyze CCHF cases from three outbreaks, to identify transmission and disease patterns. Understanding these patterns can inform targeted interventions for future outbreaks.

Methods

A retrospective cross-sectional study was conducted to examine three CCHF outbreak investigations between July 2nd and August 12th, 2023 in Khyber Pakhtunkhwa, Pakistan. Multisectoral teams, including human and animal health departments, investigated these outbreaks. Data was collected through semi-structured case investigation tools. The healthcare providers, patients and family were subjects. During active case surveillance, 41 probable contacts were traced.

Results

Among positive cases, male predominance (71.4%) was observed. The highest proportion of cases occurred in the 15-29 year age group (42.9%, n = 6). Individuals involved in animal handling professions had the highest prevalence (50%, n = 7), followed by students (21.4%, n = 3). Common clinical manifestations included high-grade fever (100%), muscle pain (92.9%), and bleeding symptoms (85.7%), with 64.3% of cases reporting vomiting blood. The average recovery time was 7.1 days, while fatal cases had an average of 6.8 days from symptom onset to death. Recovery was observed in 64.3% of cases, with a mortality rate of 35.7%. Chi-square analysis showed significant associations between gender, occupation, and disease outcome (p < 0.05).

Conclusions

This study identified a higher risk of CCHF in males, young adults, and individuals involved in animal handling during outbreaks. Public health interventions targeting occupations, demographics, particularly education and protective measures for animal handlers during Eid-ul-Azha days, are crucial to mitigate future outbreaks

Key messages

• Young male adults, and individuals involved in animal handling are on greater risk of higher risk of CCHF infections in Khyber Pakhtunkhwa, Pakistan.

• One Health community can leverage these findings to develop better prevention and control strategies through collaboration between human and animal health sectors.
Enhancing cross-border contact tracing in Europe: Lessons learned from COVID-19 and future directions
Authors: Cesuroglu T , Baron R , van der Meer A , Lewis O , Molnar A , van der Steen S , Buis J , Swaan C , Stein M , Hansen J
Published: October 2024

Introduction

Health systems in the EU operate at the national level, granting Member States autonomy for outbreak preparedness and response within their territories whilst coordinating at EU level to combat serious cross-border threats. The EU’s Early Warning and Response System (EWRS) provides the platform to exchange personal data for contact tracing across 30/EEA countries and was extensively utilized during COVID-19. This study examines insights from EU/EEA countries and assesses the feasibility of integrating national digital systems with EWRS to increase its effectiveness.

Methods

A comparative case study surveyed representatives from 24 countries and interviewed nine, analyzing contact tracing processes, actors, digital technologies, and challenges/facilitators during COVID-19. Thematic analysis was complemented by two webinars engaging EU/EEA countries to validate findings and gather additional perspectives.

Results

EWRS was valued for safety and efficiency but faced challenges during peak pandemic periods due to the heavy manual workload. Integrating national digital systems with EWRS could enhance data quality, timeliness, and coordination between countries. However, countries have varied and incompatible digital contact tracing systems, limiting the feasibility of their integration with EWRS. Moreover, most countries organize contact tracing at the subnational level, with regional entities developing and managing their own digital technologies under national guidance. Smaller countries excluded, subnational contact tracing case management systems were often not integrated with each other to exchange personal data in an automated way at a national level.

Conclusions

While integrating national digital systems with EWRS could bolster efficiency of contact tracing across EU/EEA, the presence of diverse technologies and decentralized governance poses feasibility challenges. Other improvements are needed to enhance cross-border contact tracing during outbreaks.

Key messages

• Integrating national digital systems with EWRS promises enhanced efficiency for contact tracing across EU/EEA in line with Regulation (EU) 2022/2371 on serious cross-border threats to health.

• Diverse technologies and decentralized governance pose feasibility challenges, underscoring the need for further enhancements in cross-border contact tracing in EU/EEA during large outbreaks.
Insights from a hospital database: injuries among children under 6 years old due to falls
Authors: Pitskhelauri N , Akhobadze K , Chikhladze N
Published: October 2024

Background

Pediatric injuries represent a significant public health concern globally, contributing to substantial morbidity and mortality among children. In Georgia, limited data exists regarding pediatric injuries. The aim of the study was to analyze epidemiological characteristics and trends of pediatric injuries among children aged under 6 years who received treatment in hospitals across whole country.

Methods

NCDC hospitalization database for 2015-2022 was used for the study.

Results

Over the study period, a total of 5979 children under the age of 6 received treatment in all hospitals across Georgia. The highest number of hospital admissions were registered in 2019. 60% were boys and 40% were girls of the hospitalized patients. Boys were predominant across all age groups, with the highest proportion among children aged 5 years old. There was a significant variation in hospital admissions according to the seasons, with the highest admissions occurrence in summer. As for the cause of admission, 37% resulted from falls on the same level, 10% from falls between different levels, 7% involved falling from a bed, 4% from falling out or through a building, and 4% from falling down stairs. The cause of falls was unspecified in 23%. In 72% of cases, the injured body part was the head, 17% were upper extremity injuries, and 7% were lower extremity injuries. Of the patients, 90% recovered, 2% discontinued treatment, 8% were transferred, and the outcome was fatal for 0.23% of patients. Among the fatal cases, 36% resulted from falls from, out of, or through a building, 29% from falls between different levels, 14% from falling or jumping, 7% from falls involving a bed, and 7% from falls on the same level.

Conclusions

These findings underscore the importance of preventive measures, especially regarding fall prevention, to reduce the incidence of pediatric injuries in Georgia.

Key messages

• There was a significant variation in hospital admissions according to the seasons, with the highest admissions occurrence in summer.

• These findings underscore the importance of preventive measures, especially regarding fall prevention, to reduce the incidence of pediatric injuries in Georgia.
Innovative Approaches for Personalized Cardiovascular Prevention: the INNOPREV multicentric trial
Authors: Proto L , Russo L , Maio A , Farina S , Mazzucco W , Agodi A , De Waure C , Liuzzo G , Pastorino R , Boccia S
Published: October 2024

Background

Cardiovascular diseases (CVD) represent a major global health concern, requiring innovative primary prevention strategies. Personalized prevention, through the use of digital technologies and genetic risk scores (PRS), holds promise but requires further investigation to assess clinical efficacy. Consequently, the INNOPREV trial aims to investigate the efficacy of PRS and/or digital technologies in the uptake of CV preventive behaviors uptakes.

Methods

The INNOPREV trial is a multicenter randomized controlled trial conducted in Italy across three hospital centers in Rome, Catania, and Palermo. It aims to recruit 1020 participants aged 40-69 with a high 10-year CVD risk. Participants are allocated to traditional CVD risk assessment, or genetic testing, or digital interventions, or a combination of both. The study involves comprehensive CV risk assessments at baseline and follow-up visits at one, five, and twelve months. Data analysis will utilize mixed-effects models to analyze longitudinally collected data and explore potential moderators and mediators of behavior change.

Results

Preliminary results indicate good progress in recruitment, which currently stands at 250 participants (25% of expected). Recruited females have a mean age of 59 ± 6 years, while males have a mean age of 58 ± 6 years. Currently, PRS analyses indicate that 77% of participants have intermediate scores, and 23% have low scores. Follow-up will be essential to evaluate the efficacy of the proposed interventions.

Conclusions

We expect that the INNOPREV trial will provide evidence towards integration of innovative approaches based on PRS and digital devices, in the traditional preventive approaches for CVDs. Expectations are high based on the limited effectiveness of the current approaches in CV risk reduction based on lifestyle advice.

Key messages

• INNOPREV trial examines PRS and digital technology for CVD prevention, aiming to enhance preventive efficacy. Initial findings suggest promising potential for innovative CVD prevention strategies.

• The INNOPREV trial aims to investigate the efficacy of personalized prevention strategies, including PRS and digital technologies, in improving cardiovascular preventive behaviors.
Maternal employment characteristics as a structural social determinant of breastfeeding duration
Authors: Brugailleres P , Deguen S , Lioret S , Haidar S , Delamaire C , Counil E , Vandentorren S
Published: October 2024

Background

The European Region exhibits the world’s lowest exclusive breastfeeding rate at 6 months. Addressing work-related breastfeeding challenges is crucial, particularly for women navigating precarious work situations, compounding their adversity. This scoping review surveys research on maternal employment characteristics facilitating breastfeeding continuation post-return to work in the European Region.

Methods

Studies from 2013 to 2023 were gathered from Scopus, PubMed, and PsycInfo. Inclusion criteria comprised English or French quantitative/qualitative studies exploring links between maternal employment characteristics and breastfeeding status, duration, or experience. Participants were employed mothers of healthy children sustaining breastfeeding post-resumption of work. Key determinants included work-related factors contributing to socially diverse working conditions, encompassing type of employment, working conditions, and work environment. Geographic scope included World Health Organization European Region countries.

Results

Among 693 hits, 13 studies met criteria. Eight focused on work and breastfeeding, others explored broader breastfeeding determinants. Represented countries: Spain (n = 4), France (n = 4), UK (n = 2), Ireland (n = 2), Netherlands (n = 1). Findings highlighted methodological heterogeneity, indicating a lack of conceptual framework linking work, breastfeeding, and social health inequalities. Nonetheless, self-employment, non-manual professions with time flexibility, workplace breastfeeding facilities, coworker support, and breastfeeding workplace policies emerged as pivotal factors supporting working mothers’ breastfeeding.

Conclusions

Backing breastfeeding choices for working mothers is crucial amid adversities faced by mothers and children. These results underscore the need for targeted workplace interventions, including time flexibility, breastfeeding facilities, and promotion of breastfeeding-friendly policies.

Key messages

• Self-employment, non-manual occupations, time flexibility, breastfeeding facilities, support of co-workers and breastfeeding workplace policies promote continuation of breastfeeding.

• Policy directives targeting low skilled or precarious jobs are needed to reduce social health inequalities broadly, and in particular, in relation to breastfeeding practices.
Children eight to twelve years of age have clear opinions about Positive Health
Authors: De Bot C , Dierx J
Published: October 2024

Introduction

Positive Health (PH) focuses on the ability to maintain control over one’s own health, also for children. This study explores how primary school children eight to twelve years of age think about the concept of PH and the dimensions of PH as described in the child tool.

Methods

A qualitative research method was applied, in which 25 semi-structured interviews consisting of eight questions were conducted.

Results

Children mainly think of nutrition, exercise and ‘feeling good’ when asked what PG means. More specifically on the different dimensions, for ‘My body’ they mainly think about sleeping, healthy eating and exercise. For ‘My feelings and thoughts’, they mainly mention being happy, sad or angry and also for ‘feeling good about yourself’ they mainly talk about emotions and feeling good where appearance is important. The dimension ‘Now and later’ is mainly about occupation later, according to the children. Friends and bullying are terms mentioned in the dimension ‘Participation’ and being able to do what they feel like is most important in the dimension ‘Daily life’. For children, the dimensions ‘Feeling good about yourself’ and ‘My feelings and thoughts’ are most important. In addition, ‘Participating’ is important where having fun with friends is particularly mentioned by all children.

Conclusions

Children aged eight to twelve years of age perceive PH more than just the physical component and recognise all the dimensions of PH be it in their own words. Where children of all ages value the dimensions ‘Feeling good about yourself’, ‘My feelings and thoughts’ and ‘Participating’ most, these dimensions become even more important with increasing age. For teachers, youth health professionals and parents/carers this might imply, first, that the concept of Positive Health could be used as a tool when talking about being and staying healthy. Second, interventions might be more effective when aligned to children’s perceptions and language.

Key messages

• The concept of Positive Health could be used as a tool when talking about being and staying healthy.

• Interventions might be more effective when aligned to children’s perceptions and language.
Factors associated with the consumption of ultra-processed among Brazilian and Portuguese pregnant
Authors: de Lima M C , Sartorelli D S , Rodrigues SSP
Published: October 2024

Considering the recent evidence about the negative effect of the consumption of ultra-processed foods (UPF) on current and future generations, and pointing to the development of public food policies adapted to the needs of pregnant women, it is important to identify the factors associated with high consumption of UPF. Cross-sectional comparative study that used data from: 1) a randomized controlled clinical trial conducted with pregnant women treated at Health Units in a city in São Paulo (n = 350), Brazil; and 2) the National Dietary and Physical Activity Survey 2015-2016, Portuguese pregnant women (n = 226). Two 24-hour recall surveys were collected. The UPF were classified according to the Nova. Usual consumption was estimated using the Multiple Source Method software. The percentage of energy coming from UPF was calculated using the mean (±SD) and 95%CI. Adjusted and crude linear regression models were used. The analysis were conducted in SPSS (version 21), considering p < 0.05 as significant. The average age of the total sample was 29.4(±6.3) years and the BMI corresponded to 27.8(±3.4)kg/m². The average daily energy consumption from UPF among Brazilian pregnant women was 449.6(±207.6) kcal, representing 24.2(±8.8)% of the total energy consumed on a usual day; among Portuguese women the average corresponded to 484.2(±242.4)kcal and 22.3(9.3)%, respectively. In crude and adjusted linear regression models, the participation of UPF in total energy was higher among single Brazilian pregnant women compared to married women (3.2[0.8-5.5]p=0.009); Among Portuguese women, an inverse relationship was observed between weekly physical activity (PA) ≥150 minutes and UPF energy consumption (-3.2[-6.0 - -0.3]p= 0, 03). In the studied pregnant women, results showed that being single and practicing less than 150 minutes of PA weekly were factors associated with greater consumption of UPF, characterizing a priority group to receive nutritional interventions during prenatal care.

Key messages

• Public policies and strategies to reduce the consumption of ultra-processed foods during pregnancy.

• Promotion of healthy lifestyle habits and impact on current and future health.
Cannabis use, mental health and suicide attempts among adolescents in Puerto Rico
Authors: Reyes J
Published: October 2024

Cannabis is the most widely used illicit substance worldwide, with recent reports estimating an 11.6% annual prevalence of use in North America. Mental health, suicidal ideation, suicide attempts and completed suicides, has been the focus of several studies exploring its association with frequent cannabis use. The purpose of this study is to evaluate the association between cannabis use, mental health symptoms and suicide attempts among adolescent students in Puerto Rico. Consulta Juvenil X is a monitoring program that aims to study the prevalence of substance use, mental health and violent behavior as well as the risk factors associated with those practices. The survey was conducted during the 2018-20 academic year. The study utilizes a self-administered questionnaire. The sample included 4,668 (54%) females and 3,977 (46%) males. Half of the sample was between seventh and ninth grade with a median age of 15 years old. The majority of the sample was recruited from the public school system in Puerto Rico (70.3%). The prevalence of marihuana use in the public and private schools participating in the study was 9.4% and the suicide attempts was 7.6%. Multiple logistic regression analyses revealed that students who use marihuana during the last year were significantly more likely to report depressive and anxiety symptoms after controlling for sociodemographic variables. Moreover, adolescents who use marihuana were significantly more likely to report suicide attempts after controlling for depression symptoms (OR = 3.07; 95%CI: 2.53-3.72). Findings of this study suggest that adolescents who report marihuana use seem to be at higher risk for mental health problems and suicide attempts. Understanding who is most likely to report marihuana use is important in developing interventions to prevent mental health problems and suicidal behaviors.

Key messages

• Findings of this study suggest that adolescents who report marihuana use seem to be at higher risk for mental health problems and suicide attempts.

• Understanding who is most likely to report marihuana use is important in developing interventions to prevent mental health problems and suicidal behaviors.
Breast milk sharing practices in emergency settings
Authors: Tannenbaum-Baruchi C , Harari H
Published: October 2024

Background

In emergencies, breast milk sharing becomes essential to sustain infant nutrition when access to maternal breastfeeding is disrupted. This study examines donor motivations and assesses the impact of such initiatives on infant health outcomes during wartime.

Methods

This qualitative study investigated a community of breast milk donors on a Facebook platform for the month following the start of the war on October 7, 2023. We investigated two main groups participating in breast milk sharing through reflective thematic analysis of social media messages.

Results

A count of posts one month before and after October 7 revealed a doubling in post frequency post-7/10, emphasizing the surge in war-related posts. Two main themes emerged concerning the war:

1. Infant needs: Posts addressed various infant needs, including general necessities and those specific to war-related situations. Requests for milk sharing emerged from the second day of the war, particularly for infants whose mothers were missing or injured. Government information from the National Human Milk Bank was shared within these Facebook groups, encouraging donations for these infants.

2. Donor Motivation: Posts reflected both non-war-related and war-related motivations, with a notable emphasis on the latter. Authors, including both women and men, actively promoted the donation of human milk to conflict-affected areas. Suggestions included pumping milk specifically for war-affected infants or offering frozen human milk. Some posts also offered to collect and deliver human milk to needy infants within the affected regions.

Conclusions

Post frequency doubled in both Facebook groups compared to the previous month, mainly focusing on war-related topics, indicating an increased drive to share human milk with those affected by the conflict.

Key messages

• Breast milk sharing, crucial in emergencies, analyzed via social media, sheds light on donor motivations and impacts on infant health during conflicts.

• This qualitative study investigated a community of breast milk donors on a Facebook platform for the month following the start of the war on October 7, 2023.
Risk Factors for Unplanned Readmissions in Paediatric Neurosurgery: A Systematic Review
Authors: Sese L V , Guillermo M C
Published: October 2024

Background

Unplanned hospital readmission (UHR) after paediatric neurosurgery is an important indicator of surgical outcomes. As this field deals with complex cases, there is an increased likelihood of potential complications and the subsequent need for readmission. Hence, the study aims to identify factors contributing to 30-day and 90-day UHR rates in children undergoing neurosurgical procedures.

Methods

A systematic review (Prospero CRD 42023455779) was conducted, which included studies from Embase, Medline, CINAHL, and Global Index Medicus databases that reported unplanned readmissions within 30-/90-days of an index neurosurgical procedure. Quality and risk of bias assessment was done using the Newcastle-Ottawa scale. Data extraction and narrative synthesis were performed to identify significant factors associated with UHR.

Results

2593 titles were identified following the search strategy. 52 studies were included after screening and quality appraisal. Most studies were from the United States and are retrospective cohort in nature. Majority were cranial procedures (n = 30), with common ones being shunt procedures for hydrocephalus and cranial tumour resections. Aetiology-related, procedural complexities, and age emerged as the three most common significant risk factors. Age is a significant predictor (9/52), with younger children facing higher odds compared to their older counterparts across different procedures. While early readmissions can be due to disease progression, some are linked to preventable causes. The included studies also exhibited significant heterogeneity. Variations in definitions and examined variables, as well as the inclusion of studies from both national databases and single institutions, contributed to this heterogeneity.

Conclusions

Overall, findings from this study contribute to a collective understanding of factors affecting unplanned readmissions in paediatric neurosurgery.

Key messages

• Identified risk factors can help guide creating and refining surgical protocols for post-operative monitoring and follow-up.

• UHRs reflect the interplay among surgical complexity, patient characteristics such as age, and disease aetiology.
Association of childhood mental health and cardiovascular risk in adolescence and young adulthood
Authors: Büschges J , Beyer A-K , Schmidt-Trucksäss A , Berger K , Neuhauser H
Published: October 2024

Introduction

Mental health (MH), and in particular depression, is linked bi-directionally to cardiovascular disease through biological as well as behavioral pathways. Low MH has been associated with behaviors associated closely with cardiovascular risk (CVR) factors, such as reduced physical activity and sleep disturbances. It is not clear at what age the relation between MH and CVR begins to manifest and if MH in the young is also associated with vascular remodeling, operationalized as carotid-intima media thickness (CIMT).

Methods

We investigated the longitudinal association between childhood MH problems (age 3 to 17) and CVR factors as well as CIMT from carotid sonography in 4,361 14 to 28-year-olds of the KiGGS cohort. Using linear regression analyses adjusted for socioeconomic status, we analyzed the association of the Strength and Difficulties Questionnaire (SDQ) score with systolic blood pressure (SBP), body mass index (BMI), total cholesterol (TC), and CIMT in z-scores by sex and age. Additional cross-sectional analyses included scores of the Mental Health Inventory (MHI-5) and Patient Health Questionnaire (PHQ-9) in young adulthood.

Results

Childhood SDQ scores were significantly associated with SBP, BMI and TC one decade later (-0.03 ≤ ß ≥ 0.02). Cross-sectionally, no association of MHI-5 scores in young adults with CVR factors was found. PHQ-9 scores in young adults were associated significantly with SBP and BMI (-0.26≤ ß≥ 0.01). The investigated MH problems from childhood to young adulthood were not linked to CIMT.

Conclusions

Our results confirm an early association of MH with the examined CVR factors. However, we could not find evidence for an association between MH and vascular remodeling in this population-based sample of adolescents and young adults. Our results emphasize the importance of prevention strategies focusing on both, physical and MH of the young, in order to prevent vascular damage later in life.

Key messages

• Our results show an early association of childhood mental health with the examined cardiovascular risk factors systolic blood pressure, body mass index and total cholesterol one decade later.

• Our results confirm the importance of prevention strategies focusing on both, physical and mental health of the young.
Professional support for children or adolescents whose mental well-being is at risk
Authors: Putkuri T , Latva-Korpela I , Häkkinen M
Published: October 2024

Background

Children and adolescents’ mental health issues are globally among the most significant concerns. Research on the topic often focuses on already manifested mental health problems, and research concerning mental well-being and the preferences of service users regarding early-stage support is scarce. This study aimed to define what professional support experts-by-experience hope for a child or adolescent in situations where mental well-being is threatened.

Methods

The qualitative study with focus group interviews was conducted in Finland during the autumn of 2022. Participants (n = 26) were experts-by-experience who had experienced threats to mental well-being either during their own childhood (before the age of eighteen years) (n = 19) or through the perspective of being a parent (n = 3), or both (n = 4). The data was analyzed using inductive content analysis.

Results

In situations where the mental well-being of children or adolescents is at risk, professionals working with families were expected to 1) demonstrate an appreciative and compassionate attitude, 2) provide a daycare environment or school environment that supports mental well-being, 3) support the participation of children and adolescents, 4) involve and support family, 5) organize peer support, and 6) provide services that are seamless and need-adapted.

Conclusions

The results help to develop services supporting mental well-being, considering the perspective and preferences of service users. During the study, one model identified to meet the participants’ desires was the Open Dialogue Approach originally developed in Finland.

Key messages

• In services supporting mental well-being, ensuring the child’s or adolescent’s participation and involving parents is important.

• In addition to the support provided by professionals, the significance of peer support was highlighted. Professionals should actively refer service users to peer support.
Longitudinal analyses (2018-2022) of the COVID-19 impact on Swiss pediatric healthcare utilization
Authors: Dey M , von Rhein M , Volken T , Chaouch A , Laasner U , Seiler M , Dratva J
Published: October 2024

Background

The impact of COVID-19 on healthcare utilization in the early pandemic is well documented. However, studies on changes in both primary and tertiary pediatric healthcare utilization that considered data beyond the first pandemic year is lacking.

Methods

National health insurance data (primary care) and pediatric emergency department data (tertiary care) from Jan. 2018 - June 2022 and on 0-18-year-olds were analyzed with interrupted time series. The first lockdown was used to differentiate between pre-pandemic and pandemic periods.

Results

Several healthcare services yielded significantly lower average utilization rates during the pandemic vs. the pre-pandemic period, particularly in the youngest age groups. In primary care, the relative utilization, compared to the pre-pandemic mean, dropped in regards to regular (0-5y: 0.760 [0.644-0.896]; 6-10y: 0.850 [0.742-0.974]), well-child (0-5y: 0.871 [0.765-0.992]), and urgent visits (0-5y: 0.638 [0.500-0.813]; 6-10y: 0.810 [0.665-0.985]), and for the vaccination against measles/mumps/rubella (MMR; 0-5y: 0.841 [0.729-0.971]). Similarly, in tertiary care, this pattern emerged for non-urgent (Zurich: 0.55 [0.482-0.627]; Geneva: 0.526 [0.435-0.636]; Ticino: 0.502 [0.436-0.578]) and urgent visits (Zurich: 0.573 [0.498-0.659]; Geneva: 0.487 [0.375-0.632]; Ticino: 0.676 [0.57-0.802]). The utilization rates of most services dropped markedly after the lockdown and recovered to some extent over the pandemic phase. However, no recovery was found for the MMR-vaccination. In primary care, higher average utilization rates during the pandemic were identified for telephone consultations (0-5y: 1.394 [1.218-1.594]; 6-10y: 1.547 [1.387-1.726]; 11-15y: 1.578 [1.430-1.741]; 16-18y: 1.831 [1.614-2.076]).

Conclusions

The pandemic’s effect on utilization seemed to have occurred temporarily, but it cannot be ruled out that some children have not fully caught up on preventative measures (well-child visits and MMR-vaccinations).

Key messages

• Pediatric healthcare utilization dropped considerably immediately after the lockdown, with the most pronounced decrease observed in the youngest children.

• The heterogenous recovery over the pandemic period points to the necessity to continue to monitor utilization rates, catch-up visits, and vaccination statistics.
Long-term care facilities: what do we know about multidrug-resistant organisms in this setting?
Authors: Hidad-Nuh S , de Greeff S C , Haenen A , de Haan F , Leusink G L , Timen A
Published: October 2024

Background

People with intellectual disabilities (ID) are an often overlooked high-risk group for health-related issues. In the Netherlands, people with ID may reside at home, in small communities, or within long-term care facilities. This diverse living arrangement challenges the healthcare system, with responsibilities spread among multiple formal and informal caregivers. During an outbreak with multidrug-resistant organisms (MDROs), coordinated efforts should be made to prevent further spread throughout all healthcare settings. Therefore, adequate infection prevention and control (IPC) practices, are required to improve or maintain individual health outcomes. To understand the complexity of MDROs in long-term care for people with ID, it is important to gain insight into knowledge, attitudes and perceptions of involved healthcare professionals and, investigate innovative strategies that could play a role in surveillance or monitoring an outbreak within this setting.

Methods

We conduct several studies in long-term care for people with ID, using a wide scale of methodologies including a cross-sectional survey study and innovative quantitative methods, such as wastewater surveillance.

Results

We have identified several challenges in long-term care for people with ID related to IPC and MDROs. First, while IPC and MDRO guidelines exist, they lack specific context and applicability to the long-term care setting. Second, proper use of hand gloves among healthcare professionals demands increased attention as knowledge about this preventive measure seems to be insufficient. Finally, given the challenges in sample collection for MDRO screening, non-invasive strategies are needed to offer insight during outbreaks, serving surveillance or outbreak management purposes.

Conclusions

Insights from these studies could inform future strategies to prevent or respond early in case of an MDRO outbreak within long-term care for people with ID.
Long-term effects of unintended pregnancies carried to term on mothers and children
Authors: Beumer W Y , Koot M H , Vrijkotte T , Roseboom T J , van Ditzhuijzen J
Published: October 2024

Background

Research on psychological effects of unintended pregnancies that are carried to term presents mixed results, and evidence on long-term associations is scarce. The aim of the current study was to examine effects of unintended pregnancies carried to term on both mothers and children, up to 16 years postpartum.

Methods

This study is based on the Dutch population-based birth cohort study ‘Amsterdam Born Children and their Development’ (ABCD-study), which included pregnant people in 2003 (n = 7784) and is still following these mothers and their children. Structural Equation Models were analyzed per time-point, examining associations between unintended pregnancy and maternal psychosocial distress, and children’s internalizing- and externalizing problems, while controlling for co-occurring risks. Further, mediating effects via maternal mental health and bonding on children were assessed.

Results

Around 5 years postpartum, pregnancy mistiming was positively associated to maternal psychological distress. Antenatal psychological distress was a much stronger predictor of maternal psychological distress than unintended pregnancy. Pregnancy mistiming was a significant predictor of internalizing and externalizing problems and unwanted pregnancy of internalizing problems in the children from these pregnancies, around 5 years postpartum. These associations were mostly mediated by maternal mental health and poorer maternal bonding. All associations were no longer present at 12 and 16 years postpartum.

Conclusions

Unintended pregnancies often coincide with maternal mental health problems, and results showed that associations between unintended pregnancy and both mother’s and children’s psychosocial problems are strongly influenced by maternal mental health. Therefore it is important to improve maternal mental health for the benefit of both mother and child, rather than on the isolated effect of unintended pregnancy.

Key messages

• Carrying an unintended pregnancy to term impacts psychological health in both mothers and their children up to 5 years but no longer at 12 or 16 years postpartum.

• The effects of unintended pregnancy on psychological health in mothers and children are mostly explained by maternal mental health and bonding, so the focus should be on improving these.
Impact of Adverse Childhood Experiences on Child Development in South America: A Systematic Review
Authors: Cooklin Urbano S , Hurt L , Copeland L
Published: October 2024

Background

Adverse Childhood Experiences (ACEs) have garnered attention globally for their detrimental effects on children’s development, such as lower communication, gross and fine motor, and personal-social domains. While extensively studied in high-income countries, there remains a gap in understanding their prevalence and impact in low- and middle-income countries (LMICs). This review aimed to identify, evaluate, and summarize the findings of an association between ACEs and children’s developmental and mental health outcomes in South America

Methods

A systematic review was conducted to investigate the association between ACEs and childhood development in South America. Databases MEDLINE, PsycINFO, Web of Science, Applied Social Sciences Index and Abstracts, Literatura Latino Americana em Ciências da Saúde, IBECS and CINAHL were searched. Selection criteria encompassed studies from Brazil, Colombia, Argentina, Peru, Venezuela, Chile, Ecuador, Bolivia, Paraguay, Uruguay, Guyana and Suriname examining the effects of ACEs on developmental outcomes and mental health disorders in children under 18 years old. Quality assessment aligned with World Health Organization standards was employed.

Results

Twenty-four studies met the inclusion criteria, with most categorized as low or very low quality. While the majority demonstrated a significant association between ACEs and developmental or mental health outcomes, a few studies reported null findings. Challenges in study quality, such as small sample sizes and selection bias, were identified.

Conclusions

Despite limitations in study quality, findings underscore the impact of ACEs on child development and mental health in South America. Because of the low quality of the existent studies the next steps should be to grasp a greater understanding of the issue. This review also highlights the urgency for further research and targeted interventions to mitigate the long-term consequences of ACEs in this region.

Key messages

• ACEs profoundly affect child development and mental health in South America, necessitating urgent attention and intervention.

• Addressing the impact of ACEs in South America is critical for fostering healthier developmental trajectories and enhancing public health outcomes.
Influence of socio-economic factors on obstetric morbidity in Eastern India: A study based on NFHS 5
Authors: Gupta N , Raj P
Published: October 2024

Background

Obstetric morbidity encompasses health issues related to pregnancy or childbirth, excluding accidental causes. The whole process of childbearing is not just a biological phenomenon, rather it is governed by personal, social, cultural, and institutional factors. The entire eastern region of India including the four provinces of Bihar, Jharkhand, Odisha, and West Bengal is susceptible to high maternal mortality and morbidity. It presents a strong background to further envisage the factors responsible for such situation. Thus, the study aims to explore regional variations and socio-economic factors associated with obstetric morbidity among women in eastern India.

Methods

This study uses data from the 2019-2021 National Family and Health Survey (NFHS 5). The explanatory variable, obstetric morbidity, includes issues during pregnancy and delivery- vision difficulties, bleeding, swelling, convulsions, fever, breech presentation, and prolonged labor. Predictor variables include age, age at marriage and first birth, wealth index, residence, toilet facility, caste, working status, media exposure, religion, birth order, and education level. Bivariate and binary logistic regression analyses have been used as a methodological tool.

Results

In the eastern region, 53.76% women experience obstetric issues. Women belonging to 15-24 years with higher educational attainment increases the prevalence of obstetric morbidity. The probable reason is, with education, awareness about reproductive morbidity increases and in turn the reporting for morbidity increases. Therefore, the findings showed age, educational attainment, wealth quintile, media exposure, residence, work status, birth order and toilet facilities are highly associated with obstetric morbidity among women.

Conclusions

Implementing of targeted interventions, and awareness campaigns are crucial to reducing obstetric complications and maternal mortality in the eastern region of India

Key messages

• Socioeconomic correlates impact obstetric morbidity in eastern India in manifolds especially education, age, and wealth quintile of women in eastern India.

• Obstetric morbidity is a growing concern in eastern India, thus implementing targeted interventions and awareness campaigns are much needed.
Preparedness for and collaboration during regional outbreaks with multidrug-resistant organisms
Authors: Beishuizen B , Stein M L , Tostmann A , Rovers C P , Timen A
Published: October 2024

Background

Outbreaks with multidrug-resistant organisms (MDROs) are a significant burden on the healthcare system and the wellbeing of affected patients and carriers. Cross-institutional MDRO outbreaks require a concerted multidisciplinary effort for effective outbreak management. This presents challenges regarding cooperation, coordination and communication between stakeholders. In this study, we investigate collaborative structures and coordination roles in Dutch outbreak response networks and how Dutch healthcare professionals engage in preparedness activities relating to MDRO outbreaks. These findings form the basis for the development of a stress test exercise for improving professional and organizational collaboration and coordination during MDRO outbreaks.

Methods

Using a mixed-methods design, an online survey and qualitative interviews are conducted among healthcare professionals in two healthcare regions in the Netherlands. Social network analysis is used to gain insight in collaborative structures and brokerage roles. To investigate preparedness activities, the survey is combined with qualitative interviews to explore respondents’ experiences, preferences and needs regarding preparedness activities for MDRO outbreak management.

Results

During the workshop we will show the cross-organizational network structures, the strengths and weakness of the mutual connections and provide insight in positions in networks, roles and responsibilities. Also, we provide insight in how the use of and experience with training and exercise activities, such as stress tests, contribute to preparedness for MDRO outbreaks in vulnerable patient populations.

Conclusions

This study shows how healthcare professionals from different organizations collaborate during MDRO outbreaks, and how they engage with preparedness activities. This provides valuable input for development of a stress test specific to MDRO outbreak management, and other interventions to improve outbreak preparedness.