bluuebunny/crossref_metadata_2025 huggingface dataset:
Assessing knowledge, attitude, practices and vaccine hesitancy in nurses: a pilot study
Authors: Renzi E , Covelli A , Patania F , Baccolini V , Migliara G , Marzuillo C , De Vito C , Villari P , Massimi A
Published: October 2023

Background

The use of a validated and reliable tool to assess knowledge, attitude, practices (KAP) and vaccine hesitancy (VH) in nurses is critical to developing tailored public health strategies to implement adherence to recommended vaccines for healthcare workers (HCWs) and reduce the chance of spreading vaccine-preventable diseases. The aim of this study is to develop and validate a tool to assess nurses’ vaccine hesitancy and KAP regarding recommended vaccines for HCWs.

Methods

Following a systematic review of the literature (PROSPERO ID:CRD42020212252), a new tool was built to assess vaccine hesitancy using the framework of the WHO Strategic Expert Advisory Group on Immunization. The pilot study collected responses from a random sample of nurses and nursing students. The content validity (including face-validity) was evaluated with a panel of experts. Internal reliability was tested using Cronbach's alpha (α).

Results

The final questionnaire consisted of three sections and forty items. A total of 124 individuals, 40 nurses and 84 nursing students were enrolled. Regarding KAP: only ten nurses (26.3%) reported adequate knowledge of recommended vaccines for HCWs, while no students reported knowing the vaccines included in the recommendations. 40% of nurses and 63% of nursing students discuss safety and efficacy of vaccinations during clinical practice. Twelve (32%) nurses and 42 (50%) students reported VH for at least one of the recommended vaccines for HCWs, with particular regard to flu vaccination and COVID-19 vaccine for which, despite being vaccinated, half of nurses and students reported concerns mainly about efficacy and safety. The reliability of vaccine hesitancy scales in nurses (α = 0.82) and nursing students (α = 0.85) could be considered good.

Conclusions

Following the validation of this tool, a multicenter cross-sectional study will be conducted involving three universities (Sapienza, Bicocca, Turin) on a national sample of nurses and nursing students.

Key messages

• Systematically measuring vaccine hesitancy in at-risk populations with a nationally validated tool enables implementation of targeted public health strategies.

• Identifying nurses’ knowledge, attitudes, and practices regarding vaccination and vaccine hesitancy enables organizations to adequately address the training needs of their health workers.
Public health staff during the COVID-19 pandemic: a comparison of temporary and permanent staff
Authors: van Dijk Y , Janus SIM , de Boer M R , Zuidema S U , Roelen CAM
Published: October 2023

The COVID-19 pandemic posed an enormous challenge on the public health workforce, particularly the need for substantial numbers of temporary staff. Temporary staff may experience poorer working conditions compared to permanent staff. This study aimed to investigate differences in job demands and work functioning between temporary and permanent public health staff during the fourth wave of the COVID-19 pandemic in the Netherlands. This cross-sectional study included temporary (N = 194) and permanent (N = 98) public health staff from a municipal health service and an employment agency respectively. The participants completed a questionnaire with items about quantitative, cognitive, emotional demands (Copenhagen PsychoSOcial Questionnaire, COPSOQ) and work functioning (Work Role Functioning Questionnaire, WRFQ). Differences between temporary and permanent staff were investigated with linear regressions. To investigate differences between temporary staff performing testing, vaccination or client services and contact tracing, exploratory descriptive analyses were performed. Compared to permanent staff, temporary staff had better scores on quantitative (-26.51; 95% CI -30.64 to 22.38), cognitive (-24.31; 95% CI -28.86 to -19.76), emotional demands (-11.67; 95% CI -15.82 to -7.53) and work functioning (7.66; 95% CI 4.20 to 11.30). None of the task groups within temporary staff had consistently higher scores. Temporary staff had better scores on job demands and work functioning than permanent staff. The relatively better scores of temporary staff were not expected, but might be explained by a healthy worker effect and they may be less affected by poor working conditions due to short-term exposures. From a public health perspective, it is important to know how temporary staff experience working conditions when the public health workforce suddenly needs to increase. Our study encourages to not only focus on tasks within the public health system but also on working conditions.

Key messages

• To our knowledge this is the first study that compared the experienced working conditions of temporary and permanent public health staff during COVID-19.

• Employing temporary staff appeared an adequate solution to strengthen the public health workforce during a pandemic, according to our result that temporary staff is not affected by working conditions.
Impact of the reform adding new sickness allowance checkpoints on rehabilitation and employment
Authors: Laaksonen M , Perhoniemi R , Rinne H , Blomgren J
Published: October 2023

Background

In 2012, new sickness allowance checkpoints after 30, 60 and 90 sickness absence days were introduced in Finland to improve earlier detection of long-term work disability and to fasten return to work after illness. We examined whether the reform affected participation in rehabilitation and employment outcomes one year after the start of sickness allowance.

Methods

We conducted an interrupted time series analysis among working-age persons accumulating at least 30, 60 and 90 sickness allowance days and starting their SA during a time span covering three years before the reform and two years after the reform. Poisson regression analysis controlling for seasonal variation, gender, age, and education level was used.

Results

After the reform, the probability of receiving rehabilitation within one year after the start of a sickness allowance period lasting at least 30 days was increased by 5.1% (IRR 1.051, 95% CI 1.015-1.086). The increase after the reform was slightly larger regarding the 60 and 90 day checkpoints. Looking at the type of rehabilitation, vocational rehabilitation from the earnings-related pension scheme increased the most. Regarding the rehabilitation provided by the Social Insurance Institution of Finland, vocational rehabilitation, medical rehabilitation, and discretionary rehabilitation increased, but only the latter increase was statistically significant. In contrast to rehabilitation, changes in employment outcomes (employment, unemployment, sickness allowance and disability pension) after the reform were negligible.

Conclusions

The introduction of new sickness allowance checkpoints increased participation in rehabilitation but did not affect employment outcomes one year later. The results indicate that the reform only partly succeeded in fulfilling its goals. Future policy changes should seek to find measures to help people enter the labor market after rehabilitation.

Key messages

• The introduction of new sickness allowance checkpoints after 30, 60 and 90 sickness absence days increased rehabilitation but did not affect employment outcomes one year later.

• Future policy changes should seek to find measures to help people enter the labor market after rehabilitation.
Health care use and costs attributable to cardiovascular disease in Ireland: a cross-sectional study
Authors: Stamenic D , Fitzgerald A , Gajewska K , O'Neill K , Bermingham M , Cronin J , McHugh S , Buckley C , Kearney P , O'Keeffe L
Published: October 2023

Cardiovascular disease (CVD) is the leading cause of mortality and disability in Europe but the use of health services and costs associated with CVD are poorly quantified. We examined health service use attributable to CVD and corresponding costs in Ireland. Data on 8113 participants aged 50+ of the first wave of The Irish Longitudinal Study on Ageing was used. CVD was defined as having a self-reported doctor diagnosis of myocardial infarction, angina, heart failure, stroke, atrial fibrillation or transient ischaemic attack. Outcomes were the self-reported number of general practitioner (GP) and outpatient department (OPD) visits, accident and emergency department (A&E) attendances and hospitalisations over the 12 months preceding the interview. Negative binomial regression adjusted for socio-demographic confounders and other chronic conditions was used to study the effects of CVD on the outcomes. Average marginal effects (AME) were estimated to examine the additional use of health services attributable to CVD. We estimated the total additional costs attributable to CVD at the population level using Census 2022 data. Participants with CVD reported higher utilization of all health services. In adjusted models, having CVD was associated with additional 1.19 (95% CI: 0.99, 1.39) GP and 0.79 (95% CI: 0.65, 0.93) OPD visits over the past year. There were twice as many additional hospitalisations attributable to CVD in males compared to females (AME: 0.20 (95% CI: 0.16, 0.23) in males vs AME: 0.10 (95% CI: 0.07, 0.14) in females), with no difference observed in the additional use of other healthcare services by gender or age groups. The population-level costs of the additional healthcare service use attributable to CVD were an estimated €352.2 million (95% CI: €272.8, €431.7), 93% of which was due to use of secondary care services. There is a substantial additional use of health services due to CVD in Ireland, with hospital admissions being the biggest contributor to costs.

Key messages

• The vast majority of additional costs attributable to CVD in Ireland are generated through use of secondary care services.

• While a shift is being implemented in Ireland to manage uncomplicated CVD cases in primary care, sustained efforts aimed at CVD primary prevention are required to contain health service costs.
Tobacco cessation attempts among Turkish adolescents: a structural equation model analysis
Authors: Bakar M T , Kesen C H , Peker S , Ay P
Published: October 2023

Background

The Turkish Global Youth Tobacco Survey (GYTS) 2017 revealed that 17.9% of students aged 13-15 used tobacco products and 7.7% smoked cigarettes. Given the prevalence of smoking, it is important to evaluate the factors associated with quit attempts among adolescents. This study aimed to identify the factors associated with Turkish adolescents’ attempts to quit smoking.

Methods

This study utilized the data from GYTS 2017, which is a cross-sectional, nationally representative, school-based study carried out among adolescents. The study population (n = 18,985) consisted of students who had smoked cigarettes within the past year. After excluding inconsistent responses, 9,735 students remained for analysis. The outcome was an attempt to quit smoking within the past year. Structional Equation Model was used for analysis. The model included dependence level, sociodemographic factors, exposure to second-hand smoking, promoting factors for tobacco use (exposure to advertising in stores, at events, or on the internet), and anti-tobacco policies (sale restrictions, exposure to anti-tobacco media messages, TV spots) as latent factors. (The model fit; CFI=0.917, TLI=0.900, RMSEA=0.032).

Results

Students were 11-17 years and 66.4% were male. In the past 12 months, 56.3% (95%CI:55.3%-57.3%) of smokers attempted to quit. Dependency (ß=0.037, p = 0,008) and exposure to anti-tobacco policies (ß=0.114, p < 0.001) had positive direct effects, whereas sociodemographic factors (ß=-0.086, p < 0.001) and exposure to second-hand smoke (ß=-0.051, p < 0.001) had negative direct effects on quit attempts. Promoting factors weren't significant (p = 0.14).

Conclusions

More than half of smokers attempted to quit, and nicotine dependence predicted quit attempts. Exposure to second-hand smoke decreased cessation attempts. Anti-tobacco policies as sale restrictions and warnings of the dangers of tobacco should be enforced fully since they are the strongest predictors of quit attempts.

Key messages

• Quit attempts are prevalent, highlighting the need for cessation programs for adolescents in Turkey.

• Anti-tobacco policies are the most accurate predictor of quit attempts and should be fully enforced.
Sex-specific aging patterns of gut microbiota guild in urban Chinese adults
Authors: Fu J X , Yu D X , Zheng W , Wang L , Cai H , Shu X O , Xu W H
Published: October 2023

Background

The loss of gut microbial stability has been observed during aging. Previous studies have noted changes in the diversity of gut microbiota and richness of specific bacteria along with age, but rarely focused on alternations in microbial guild.

Methods

Included in this study were 2944 middle-aged and elderly Chinese adults (1473 men and 1471 women) from the Shanghai Men's and Women's Health Studies, of whom 1419 healthy subjects (747 men and 672 women) self-reported no common non-communicable diseases (NCD) were selected for evaluating the healthy aging pattern. Microbiome was profiled by 16S rRNA sequencing. A guild-based method was adopted to cluster operational taxonomic units (OTU) into co-abundance groups (CAG) as functional units. PICRUSt2 were used to predict metagenome functions. The aging trend were assessed by linear regression. A random forest model incorporating significant CAGs with chronological age was developed to fit microbial age in the healthy and subsequently applied to those with NCDs.

Results

The age of all participants ranged from 51.4 to 89.3 years (mean of 70.2). A decline in Chao1 index and an increase in Pielou evenness with aging were observed among healthy women but not men. The microbial drift based on Bray-Curtis distance appeared driven by age and differed significantly by sex. Eleven CAGs were identified as potential aging markers in men, and twelve in women; wherein only CAG_6 (Bifidobacterium sp. dominated) and CAG_118 (Veillonella dispar dominated) were positively related with age in both genders. The 1,4-dihydroxy-2-naphthoate biosynthesis served as the core metabolic pathway that increased with age in both men and women. Subjects with metabolic diseases had an older microbial age than the healthy, particularly among men.

Conclusions

This study indicates the importance of gut microbiota in healthy aging among Chinese men and women. The aging related sex-specific patterns of gut microbiota can be modified by prevalent NCDs.

Key messages

• The aging patterns of gut microbiota guild were different in middle-aged and elderly Chinese men and women.

• The microbial age was older in subjects with metabolic diseases than those without.
Associations between metabolic syndrome and Plant-Based diet Indices in the NutriNet-Santé study
Authors: Prioux C , Baudry J , Berthy F , Reuzé A , Touvier M , Deschamps V , Verdot C , Wagner S , Kesse-Guyot E , Allès B
Published: October 2023

Background

Prior studies have shown that plant-based diets are associated with lower risk of cardiovascular diseases but the risk seems to differ according to the nutritional quality of plant food intakes.

We aimed to investigate the cross-sectional association between metabolic syndrome (MetS) and healthful and unhealthful Plant-Based diet Indices (hPDI and uPDI).

Methods

This study included 16,358 participants from the NutriNet-Santé study who underwent a clinical visit, allowing to collect blood samples for the measure of total cholesterol, LDL and HDL, triglycerides and anthropometric measurements. The MetS was assessed following the joint interim definition. The consumption of food such as fruits and whole grains to the diet compared to animal food can be reflected by hPDI, and its opposite uPDI reflecting the consumption of food such as refined grains and desserts were estimated using data from 24-h dietary records. The association between these plant-based diet indices and MetS were estimated by multivariable robust Poisson regression models with robust errors.

Results

In both women and men, a higher contribution of healthy plant food to the diet was associated with a lower prevalence of MetS (women: PR hPDI 0.74; 95% CI: 0.69, 0.80, men: PR hPDI 0.82; 95% CI: 0.76, 0.89). Similar trends were observed for all the MetS components (abdominal obesity, elevated blood pressure, elevated triglyceridemia, low HDL and elevated glycaemia) and BMI, except for low HDL and elevated glycaemia in men. Only in women, a higher contribution of unhealthy plant food to the diet was positively associated with the prevalence of MetS (PR uPDI: 1.12; 95%CI: 1.03, 1.21) and elevated triglyceridemia (PR uPDI: 1.21; 95%CI: 1.09, 1.33).

Conclusions

In this large scale observational study, we observed that it is necessary to consider the nutritional quality of plant food: healthy vs. unhealthy plant food, to promote plant-based diets in prevention of cardiovascular diseases.

Key messages

• In men and women, a higher contribution of healthy plant food to the diet was associated with a lower prevalence of MetS and all its components only in women.

• An increase in the contribution of unhealthy plant food was associated with a higher prevalence of MetS and elevated triglyceridemia but only in women.
Time trends in sexual harassment exposure among adolescents in Norway between 2017 and 2021
Authors: Steigen A M , Stea T H , Dangmann C R , Granrud M D , Bonsaksen T
Published: October 2023

Background

Sexual harassment is linked to a range of negative psychosocial factors such as depressive symptoms, anxiety, self-harm, low self-esteem, and substance-use. Preventing and reducing sexual harassment is therefore important in a public health perspective. There is a large variety in the reported prevalence of sexual harassment among adolescents, and knowledge about the development over time is limited. The aim of this study is to study time trends in sexual harassment between 2017 and 2021 among adolescents (aged 16-19) in Norway.

Methods

This study is based on cross-sectional data from the Ungdata Survey carried out in upper secondary schools in Norway from 2017 to 2021. Adolescents completing the survey these years were respectively; 2017: n = 43 163, 2018: n = 30 400, 2019: n = 54 981, 2020: n = 17 467, 2021: n = 56 544. Descriptive analysis and Chi-square test were used to study changes in sexual harassment exposure across years according to sex, age and sexual experience. Logistic regression was used to study possible changes in the association between sexual harassment and depressive symptoms.

Results

Preliminary results indicated a stable trend in exposure to all types of sexual harassment (touching, sexual name calling and negative sexual rumours). Approximately 31 % of the adolescents had experienced one or more of the types of sexual harassment (2017 30.7 % - 2021 30.5%). The time trend was stable according to sex, age, and sexual experience. Adolescents exposed to sexual harassment had higher odds for depressive symptoms than adolescents not exposed to sexual harassment (ranging from OR: 1.4, 95% CI:1.2-1.6 to OR:2.3, 95% Cl: 1.8-2.9), and this association was also stable over the years.

Conclusions

The prevalence of sexual harassment among adolescents is high and surprisingly stable between 2017 and 2021. More knowledge about time trends in sexual harassment is needed, and new public health strategies to prevent sexual harassment should be developed.

Key messages

• The prevalence of exposure to sexual harassment among adolescents seems to be stable over time.

• Being aware the negative public health consequences of sexual harassment more effort needs to be made in developing effective prevention strategies.
Assessing the Impact of Energy and Fuel Poverty on Health: A European Scoping Review
Authors: Champagne S N , Phimister E , Macdiarmid J I , Guntupalli A M
Published: October 2023

Background

The burden of energy and fuel poverty (EFP) in Europe is increasing in the face of the cost-of-living crisis, Russian invasion of Ukraine, COVID-19 pandemic, and climate emergency. While the health impacts of EFP are often the driving reason for addressing it, EFP's association with health is poorly delineated. This review aims to scope the evidence of EFP's association with health in Europe.

Methods

A scoping review based on Arksey and O'Malley's framework was conducted using search terms relevant to EFP, health, and Europe. Five databases were searched, in addition to hand searching. Review selection was performed by two independent reviewers and articles were thematically analysed.

Results

Thirty-five articles published between January 2000 and March 2022 were included. The literature varied in definitions and measurements of EFP, and in the health indicators examined. The review revealed a negative association between EFP and health, specifically, general unspecified poor health (9 articles), excess winter mortality (3 articles), communicable disease (3 articles), non-communicable diseases (11 articles), mental health (15 articles), and wellbeing (11 articles). While women were reported to be at higher risk of EFP than men, children and older adults were identified as particularly vulnerable to EFP's adverse health repercussions.

Conclusions

This scoping review illustrates a significant and complex association between EFP and various domains of health. Though heterogeneity across research makes it difficult to compare findings, our review supports the use of health as a justification to address EFP and urges public health to be more involved in EFP mitigation.

Key messages

• This scoping review revealed a clear association between EFP and various domains of health, including mental (e.g., anxiety and depression) and physical health (e.g., cardiovascular disease and flu).

• We recommend health systems, health professionals, and public health broadly as a field be more involved in working to confront EFP.
Barriers and interventions for healthy and climate-friendly living for vulnerable groups
Authors: Lampl C , Aigner E , Schmidt A E , Krisch A
Published: October 2023

Background

The climate crisis constitutes the largest threat to public health in the 21st century. Against this background co -beneficial measures for climate mitigation and health promotion can offer the opportunity for necessary transformative change, especially in terms of active mobility, sustainable food systems and spatial planning. Vulnerable groups are in particular affected by health burdens and limited in their scope of action regarding climate-friendly and healthy practices, making the identification of barriers and necessary structural changes especially important for vulnerable groups.

Methods

Within the framework of a narrative literature review, a policy analysis, and a complementary co-production workshop with representatives of vulnerable groups have been conducted. To identify essential measures amongst the core themes mobility, food system and spatial planning, the analysis included actual barriers and necessary structural changes for more health equity and climate mitigation.

Results

Based on our analytical framework different measures, especially requirements in terms of infrastructure, for all three fields of action (mobility, food system, and spatial planning) are needed. At the policy level, insufficient integration of public health aspects in other policy areas is evident, in particular due to a closed silo structure of different public authorities.

Conclusions

To shape transformative changes toward healthy and climate-friendly living, at policy level, long-term goal-oriented thinking that goes beyond legislative and funding periods is needed in order to be able to implement structural changes. Likewise, there is a need for fiscal policy measures in the sense of a socially just and ecological transformation. Also investments in physical infrastructure (e.g. bicycle parking, low-priced offers of healthy and sustainable restaurants) are essential for a social-ecological transformation.

Key messages

• Healthy and climate-friendly environments for vulnerable groups are in the need for the needed transformation.

• Using co-benefits between health promotion and climate mitigation measures.
Exposure to sunlight and allergic morbidity in children (Pollution and Asthma Risk: an Infant Study)
Authors: Lefebvre L , Rancière F , Amazouz H , Roda C , Momas I
Published: October 2023

Background

Sunlight relationship with allergies is poorly studied in children. Thus, we examined how early exposure to solar radiation is associated with allergic morbidity in the PARIS birth cohort.

Methods

This study dealt with children who attended at least one of the two health check-ups: 18 months (n = 2012) and 8/9 years (n = 1080). Early exposure (prenatal and during the first year of life) to solar radiation was assessed using meteorological data (solar radiation, temperature, relative humidity). Children with similar exposure trajectories were grouped by longitudinal and multidimensional cluster analysis. Association of solar radiation exposure with allergic morbidity (i.e. allergic sensitisation at 18 months and 8/9 y., current asthma, rhinitis, and eczema at 8/9 y.) was quantified by multivariable logistic regression models adjusted for potential confounders. The effect modification of maternal vitamin D (VitD) supplementation during pregnancy was also tested.

Results

Four exposure trajectories were found. The trajectory with the highest exposure to early solar radiation had a reduced risk of sensitisation at 8/9 y. compared to the trajectory with the lowest exposure (p = 0.06). This association was statistically significant in the VitD supplemented subgroup. Solar radiation during pre- and post-natal period was significantly associated with a lower risk of sensitisation at 8/9 y. (for ↗IQR, aOR: 0.47; 95%CI: 0.25-0.87 and 0.84;0.70-1.00, respectively). Increased prenatal exposure to solar radiation was significantly associated with a lower asthma risk at 8/9 y. (for ↗IQR, 0.32; 0.10-0.96).

Conclusions

Early sunlight exposure may reduce the risk of sensitisation and asthma in school-aged children, especially in those prenatally exposed to VitD intake. These findings highlight the importance of VitD in preventing allergic diseases in children, either through supplementation or sunlight exposure.

Key messages

• Pre-natal and early postnatal exposure to sunlight could reduce the risk of sensitisation and asthma among school-aged children.

• The association may be explained by vitamin D immunomodulatory effect, highlighting its importance in preventing allergic diseases in children through supplementation or sunlight exposure.
Waste incineration and cancer mortality: a longitudinal controlled population-based study
Authors: Capitão C , Feteira-Santos R , Fialho M , Virgolino A , Santos O
Published: October 2023

Background

Waste incinerator emissions have been associated with the possibility of increased risk for some cancers. Indeed, emissions are usually composed of heavy metals, dioxins, and furans, including carcinogens. Although emissions levels of incineration activity are considered safe, evidence about the impact of long-term human exposure to low dosages is lacking. We performed a longitudinal population-based study to compare cancer mortality rates between a geographical area exposed to pollutant emissions due to waste incineration and combined local industry activity, a non-exposed control area, and a reference (larger) area.

Methods

Exposed area was defined according to pollutants dispersion models, considering predominant wind intensity and direction. The control area was defined as near-to-the-exposed parishes unaffected by the pollutants emitted at the location where the incinerator is situated. Another larger area (“Large Lisbon”) was also considered as the reference area. Data about cancer mortality was provided by the Portuguese National Statistics Institute. Relative risks (RR) compared standardized (age and sex) specific mortality rates due to malignant neoplasms (ICD-9 and ICD-10) between the exposed area and (a) control are and (b) reference area.

Results

In the first five years of the waste incinerator activity (2000-2004), the RR for each cancer-related mortality was not statistically significant (considering either control or reference areas). Considering the average mortality rates between 2015 and 2019 for exposed versus control area, we found increased RR for hepatic and biliary tract (RR = 1.50; 95%CI:1.15-1.85), pancreatic (RR = 1.37; 95%CI:1.06-1.67), and respiratory tract cancer (RR = 1.24; 95%CI:1.07-1.41). No significant RR was found when comparing the exposed with the reference area.

Conclusions

Strengthening public health surveillance systems is pivotal to assess air pollution's impact on health.

Key messages

• Exposure to emissions from an industrial region including a waste incinerator plant was found to have increased risk for hepatic and biliary tract, pancreatic, and respiratory tract cancer mortality.

• Surveillance systems are needed to continuously monitor how long-term exposure to low concentrations of carcinogenic substances from waste incinerator emissions impacts on population’s health.
Motheŕs own milk (MOM) feeding in preterm infants in Germany – A status quo of personal attitudes
Authors: Schwab I , Ohnhaeuser T , Scholten N
Published: October 2023

Background

The best nutrition for all new-borns and especially vulnerable groups like preterm infants is motheŕs own milk (MOM). Nevertheless, recent research showed that many preterm infants receive formula in neonatal intensive care units (NICU) in Germany. In order to achieve MOM feeding in preterm infants, a MOM-friendly clinical environment is crucial. In Germany, no data is yet available on the attitudes towards MOM of physicians and nurses in NICUs and mothers.

Methods

Written surveys were conducted to assess attitudes and the current status of MOM-feeding from different perspectives (medical and nursing staff and mothers of preterm infants). Questions included personal attitudes towards MOM and perceived lactation support in NICUs. Descriptive statistics and bivariate tests (Spearman's rho, Pearson chi2) were examined.

Results

Data of 158 leading physicians (response rate: 76%), 143 nurses (response rate: 68%) and 533 mothers (response rate: 32%) was included. The personal importance of MOM feeding is slightly higher in both physicians and nurses than their attitude towards the effects of feeding with MOM on the medical outcome of preterm infants (M: 9.5/9.5 vs. 8.3/8.9; [1-10]). Mothers predominantly perceived the NICU staff as MOM promotive (M:4.7,4.9; [1-6]) and reported an overall positive attitude towards feeding preterm infants with MOM (M:5.6; [1-6]). Their attitude showed no significant differences between educational levels (p = 0.635), age (p = 0.079) or ethnicity (p = 0.184), whereas the MOM promotive NICU staff was significantly correlated to the motherś attitude (p = 0.001, p = 0.001).

Conclusions

The status quo of attitudes towards MOM in Germany is rather positive in both health care professionals and mothers, independently of sociodemographic characteristics. Presumably, the challenge in achieving MOM feeding seems to occur in transferring positive attitudes to actual interventions.

Key messages

• To enhance MOM feeding in preterm infants, future interventions should focus on the transmission of positive attitudes to actual strategies.

• NICU staff that is MOM promotive is eminent for the maternal attitudes towards MOM.
Group Antenatal Care (gANC) for Somali-speaking women in Sweden – a process evaluation
Authors: Ahrne M , Byrskog U , Essén B , Andersson E , Small R , Schytt E
Published: October 2023

Background

Language supported group antenatal care (gANC) for Somali-born women was implemented in a Swedish public antenatal care clinic. Seven 60-minute sessions were offered, facilitated by midwives and starting with a presentation of a selected topic, with an additional 15-minute individual appointment before or after. The aim was to assess the feasibility for participants and midwives of implementing language supported gANC, including implementation, mechanisms of impact and contextual factors.

Methods

The Medical Research Council guidelines for evaluating complex interventions was used as a framework. Both qualitative and quantitative data sources including observations, in-depth and key-informant interviews (women n = 6, midwives n = 4, interpreters and research assistants n = 3) and questionnaire data (women n = 44; midwives n = 8) were used.

Results

gANC provided more comprehensive ANC and addressed knowledge gaps related to pregnancy, birth and the Swedish health care system. The majority of women thought listening to other pregnant women was valuable (91%), felt comfortable in the group (98%) and supported by the other women (79%), and they said that gANC suited them (79%). The intervention seemed to enhance cultural understanding among midwives, thus contributing to more women-centred care, but was not successful in involving partners.

Conclusions

Language-supported gANC was acceptable to participants and midwives, but did not lead to greater partner inclusion. Main mechanisms of impact were more comprehensive ANC and enhanced mutual cultural understanding. The position of women was strengthened, and the way in which the midwives expanded their understanding of the participants and their narratives was promising. To be feasible at a large scale, gANC might require further adaptations and the “othering” of women in risk groups should be avoided.

Key messages

• Group antenatal care seemed to enhance knowledge and cultural understanding among midwives, thus contributing to more women-centred care.

• The “othering” of women in risk groups should be avoided.
The use of digital health services and its predicting factors among health maintenance organizations
Authors: Gur A , Mashiach-Eizenberg M , Lavy I , Obid S
Published: October 2023

Background

In line with insights whereby digital health services (DHS) can increase the accessibility and availability of health services, health maintenance organizations (HMO) have developed various DHS, with the aim of improving services and reducing disparities in health. Specifically, the COVID-19 crisis forced HMO to accelerate the use of DHS, to allow for remote health services. Yet, the implementation of technology-based services in healthcare is complex, due to a range of obstacles related to technological, ethical, and human aspects. This study aimed at identifying and comparing the predicting factors of DHS use, including digital health literacy and attitudes towards DHS, to understand its implementation among the four HMO in Israel.

Methods

The study included a correlative cross-sectional design. Data was gathered via a closed-end questionnaire, distributed through an online panel to 609 Israeli respondents, aged ≥20, regarding demographics and attitudes towards DHS, digital health literacy, and the extent of DHS use. Hierarchical regression was performed to examine whether the research variables predict DHS use. One-way ANOVA was conducted to compare between HMO.

Results

Higher use of DHS was found to be predicted by ethnicity (Jews), income (average and above), belonging to a certain HMO (Maccabi and Leumit Health Services), positive attitudes towards DHS, and higher digital health literacy (R2=.26). In addition, significant differences were seen between HMO in the degree of use (moderate effect) and attitudes towards DHS (weak effect): members of Maccabi and Leumit Health Services held more positive attitudes towards DHS, and made greater use of them, compared to members of Clalit and Meuhedet Health Services.

Conclusions

As use of DHS differs across HMO, the latter should act to adapt DHS to meet the characteristics and needs of certain target groups among their members, as a means for increasing the use of digital services.

Key messages

• HMO should adapt their DHS to meet members’ demographic characteristics and needs.

• Adjusting DHS may improve members’ attitudes towards such services and increase their involvement in using them.
The implementation of an electronic medical record (EMR) and its impact on quality of documentation
Authors: Wurster F , Cecon-Stabel N , Hansen T , Jaschke J , Köberlein-Neu J , Okumu M R , Rusniok C , Pfaff H , Karbach U
Published: October 2023

Background

The German healthcare system is still poorly digitized. With the Hospital Future Act, the government now mandates hospitals to implement an institutional electronic medical record (EMR). While multiple benefits are described for its adoption, knowledge on its impact on actual documentation is lacking. However, a documentation that is of good quality is, additionally to its patient safety aspect, required to enable benefits such as big data analyzability. The completeness of documentation is a dimension of quality most often researched in this context. The purpose of the present study is therefore to analyze a change in completeness of documentation after the implementation of an EMR.

Methods

Data were collected on an orthopaedical ward of a German academic teaching hospital before and after the implementation of the EMR. Paper-based and electronic medical records were compared, each representing all treated patients of a three-week period. Our analysis focused on ten items that were commonly documented in both record types (e.g. documentation of pain). T-tests, χ2-tests and Odds Ratios were calculated to compare the average completeness per record type and the percentage of completeness per item.

Results

A total of N = 180 records were analyzed. Average completeness rose from 6.25 out of 10 (SD = 2.15) in the paper-based record type to 7.13 (SD = 2.01) in the electronic record type (p=.014). Of the ten analyzed items, three showed higher rates of completeness and another three lower rates of completeness in the EMR. Four items retained a constant rate of completeness in both record types.

Conclusions

The implementation of an EMR can influence the quality of documentation with both, positive and negative impacts. Further research is needed on what determines the direction of the impact. Doing so could make it feasible to increase quality of documentation and simultaneously reduce staff's burden caused by documentational tasks.

Key messages

• The present study strengthens evidence, that implementing an institutional electronic medical record can have an impact on the quality of clinical documentation in the inpatient setting.

• Understanding the mechanisms influencing documentation could help increase the quality of documentation and reduce the burden caused by documentational tasks at the same time.
Use of technology among older adults in Baltic states during the Covid-19 pandemic
Authors: Pasupathy R , Sazevari R , Queen C
Published: October 2023

Background

The population in the Baltic nations of Estonia, Latvia, and Lithuania is ageing rapidly. Technology is a potential resource in enhancing the health and wellbeing of the elderly. The use of technology reduces social isolation through the facilitation of communication and facilitates access to healthcare resources. This study is based on the theory of reasoned action that aims to explains the relationship between attitudes and behavior of individuals.

Study Aim

Determine nature of the use of technology by older adults in the Baltic states across countries, genders, age, and employment status.

Methods

Data from Wave 9, COVID-19 Survey 2 (Summer 2021) of the of the cross-national panel dataset of the Survey of Health, Ageing and Retirement in Europe (SHARE) were examined using a sample of 6303 adults over 50 years old from Latvia, Lithuania and Estonia.

Analysis

Nonparametric one-way ANOVA (Kruskal-Wallis test) was performed to test the null hypothesis that the rate of use of technology is equal across gender, age, and country in Baltic states.

Findings

There was a statistically significant difference in the use of technology reported by country [= 15.7, df = 2; p< .001], and age [= 1471.64, df = 6; p< .001.

Conclusions

These finding suggest that country and age are significant predictors of use of technology.

Implications for Policy and Practice: Initiatives for the care of older adults should not only aim to increase the use of technology by older adults but also increase the utility of information and ease of navigation of websites targeted towards this population.

Key messages

• Country and age are significant predictors of use of technology among the elderly in Baltic states.

• Policy initiatives that aim to alleviate social isolation among the elderly through use of technology, need to increase the ease of navigation of websites targeted towards this population.
Negative social media experiences and lower self-efficacy are associated with depressive symptoms
Authors: Bonsaksen T , Steigen A M , Stea T H , Kleppang A L , Lien L , Leonhardt M
Published: October 2023

Background

Social media are an integral part of adolescents’ daily lives, and reviews have suggested an overall small association between more social media use and mental health problems. However, researchers have commonly investigated social media use solely in a time use perspective, rendering nuances in adolescents’ social media experience less well explored. This study examined depressive symptoms in adolescents in relationship to time spent on social media, negative social media-related experiences, and general self-efficacy.

Methods

Cross-sectional data collected in a national survey of adolescents aged 13-19 years in Norway, Ungdata 2021 (n = 139841), was used. Depressive symptoms were measured with a six-item scale based on the Depressive Mood Inventory. Associations with depressive symptoms were analyzed with multivariate linear regression analyses.

Results

Time spent on social media was associated with depressive symptoms (β = 0.09, p < 0.001). However, negative social media-related experiences were more strongly associated with depressive symptoms (β ranging 0.09-0.22, all p < 0.001), and their inclusion weakened the initial association between time on social media and depressive symptoms. General self-efficacy was directly associated with lower symptom levels (β=-0.29, p < 0.001) but did not change the associations between social media use and depressive symptoms.

Conclusions

The findings imply that not only time spent on social media, but in particular negative social media-related experiences, are related to depressive symptoms in Norwegian adolescents. General self-efficacy is an important resource for adolescents’ mental health. Public health initiatives should include efforts to monitor and prevent negative events related to adolescents’ social media use, as well as efforts to increase adolescents’ general self-efficacy.

Key messages

• Negative social media-related experiences are related to depressive symptoms in Norwegian adolescents.

• Public health initiatives may focus on monitoring and preventing negative social media-related experiences among adolescents.
Are internet users with high risk for internet addiction prone to substance use?
Authors: Selak Š , Žmavc M , Makivić I
Published: October 2023

Background

Similar to psychoactive substances, certain internet activities can produce highly rewarding sensations, leading to addictive use. Previous research reported associations between internet addiction (IA) and substance use. Our aim is to identify key differences between internet users with low and high IA risk in terms of which substances they consume (alcohol, tobacco, illicit drugs) and in terms of internet activities they engage in.

Methods

The National survey on the use of tobacco, alcohol and other drugs was conducted in 2018 in Slovenia on a nationally representative sample (age range: 15-64 years; 62.4% response rate). Among people who used internet at least once per week (N = 7,413), we distinguished between internet users with low IA risk (n = 6,929; 93.6%) and high IA risk (n = 484; 6.4%), based on latent profile analysis of responses on the Internet disorder scale (IDS-15).

Results

Higher IA scores were associated with lower age (r = - .310), but not with gender. Significantly more users in the high risk group were using internet to access social media (%L = 54.4; %H = 73.1), pornography (%L = 7.8; %H = 18.2), video content (%L = 42.7; %H = 61.0), and videogames (%L = 13.1; %H = 25.8), compared to the low risk group. Higher IA scores were associated with frequency (r = .040) and volume (r = .179) of drinking alcohol, while no associations were found with tobacco smoking measures. Lastly, smoking marihuana (%L = 6.3; %H = 12.7) and using any other illicit drugs (%L=2.2; %H = 5.6) in the past 12 months was significantly more common in the high risk group.

Conclusions

The present study underlines the addictive potential of four internet content categories (social media, pornography, video content and videogames). People who are sensitive to the rewarding potential of internet content may also be more prone to seeking rewarding sensations associated with consuming psychoactive substances, in particular alcohol, marijuana and illicit drugs, but not tobacco.

Key messages

• Using internet to access social media, videogames, video content and pornography is significantly more common among individuals with high risk for internet addiction.

• High risk for internet addiction is associated with consuming alcohol, marijuana and illicit drugs, but not with tobacco use.
Factors of the changes in depressive symptoms among retirees: a 3-year follow-up study in Taiwan
Authors: Huang N C , Hung Y T , Hu S C
Published: October 2023

Background

Depression is a critical mental problem for middle-aged and older adults. In addition, retirement and its adjustment may further affect their physical and psychological health. Hence, this study aims to explore the risk and protective factors associated with the changes in depressive symptoms among retirees.

Methods

A 3-year follow-up study was designed to examine the factors affecting the changes in depressive symptoms in retired people. A total of 2,379 participants aged 50 to 74 years were recruited from the Taiwan Health and Retirement Study during 2015-2019 (two waves). Three types of study variables were included: (i) sociodemographic factors: 9 items, (ii) health-related variables: 7 items, and (iii) psychosocial factors: 6 items. The changes in the 10-item CESD score after three years were measured as the outcome variable. The score change was divided into three groups: maintenance, deterioration, and improvement. Multinomial logistic regressions were used to analyze risk and protective factors related to changes in depressive symptoms in retirees.

Results

After adjusting for all covariates, this study found that retirement time ≥ 10 years, unskilled occupation before retirement, and having stressful life events after retirement may worsen depression scores three years later. Instead, getting a good night's sleep prevented worsening depression scores after three years. For the improvement group, the results showed that being a volunteer could improve the depression score; however, living alone and having poor health may hinder improving depression scores after three years. Furthermore, we found that factors associated with changes in depressive symptoms showed gender differences.

Conclusions

Future interventions to prevent depression should consider the diverse needs of different risk and protective factors and gender differences.

Key messages

• Retirees over ten years, with unskilled occupations and recent stressful events, were at high risk for depression. However, good sleep quality can help prevent depression.

• For male retirees, regular physical activity was an enabling factor for improving depression, whereas women benefited from social connections.