bluuebunny/crossref_metadata_2025 huggingface dataset:
Seroprevalence of anti-pertussis antibodies and immunization status of pregnant women in Turin, 2019
Authors: Rainero E , Garlasco J , Scacchi A , Giacomuzzi M , Ditommaso S , Zotti C M
Published: October 2020

Background

Pertussis is an acute respiratory infection caused by B. pertussis. An acellular vaccine is available, but the protection it confers is estimated to wane after 5 years. Infants under 6 months have the highest risk of complications and mortality. In Italy, the first dose of vaccine is administered in the third month of life and maternal vaccination is recommended in the final weeks of pregnancy. This study aimed to evaluate the seroprevalence of IgG antibodies to pertussis toxin (IgG anti-PT) among pregnant women as a potential source of transplacental transfer of antibodies, which may reduce neonatal risk of disease.

Methods

An observational cross-sectional study was conducted. Two hundred women between the 33rd and 37th weeks of pregnancy were recruited among patients undergoing routine pregnancy check-up at the S.Anna Hospital of Turin, from May to December 2019. Participants were interviewed on their immunization status and a serum sample was collected. Anti-PT levels were assessed using ELISA “NovaLisa B. Pertussis toxin (PT) IgG”. Lacking a correlate of protection, we have distinguished contact with microorganism (10-39 IU/mL), exposure in the previous 2-3 years (40-99 IU/mL), recent infection or immunization <12 months ( > =100 IU/mL).

Results

The median age of participants was 35. Women who had anti-PT titers > =10 IU/mL were 120 (60%) (10-39 IU/mL: 26%, 40-99 IU/mL: 14%, > = 100 IU/mL: 20%). Around 70.5% of women declared previous vaccination (42.5% during pregnancy). Among women vaccinated in the previous 12 months, 7% presented antibodies titer <100 IU/ml. Two women not vaccinated had a titer > 100 IU/ml, indicative of recent pertussis exposure.

Conclusions

This study found 40% of women with antibody titers under cut-off (<10 IU/mL) and 1% prevalence of recent exposure. Despite the late introduction of vaccination against pertussis during pregnancy, a good adherence to the program offered is evident.

Key messages

40% of pregnant women in this study were lacking in antibodies against Pertussis and could not transfer anti-PT to their newborn for early protection. Improving maternal vaccination coverage against pertussis should be a public health priority in Italy; a good adherence to intervention was reported.
Educational aspiration mismatch and depressive symptomatology among Taiwanese mother-child dyads
Authors: Huang L-H , Chiang Y-L , Lin W-H , Chiao C
Published: October 2020

Background

International studies emphasize the importance of depression for women and adolescents. Yet few researchers have used family-based surveys to explore depressive symptomatology of mother-adolescent dyads, and less is known about this aspect in Asian community where education is highly valued. The present study builds upon an inter-generational framework by investigating the effect of educational aspiration mismatch on depressive symptomatology in mother-child dyads.

Methods

A total of 1108 Taiwanese mother-child dyads were surveyed when the child was 13 years old, and followed up to two years later. Depressive symptomatology is measured by Symptom Checklist-90 Revised for both mother and child. Comparisons of mother and child's educational aspiration are categorized into three groups: mothers' aspirations are equal to, lower, or higher than their children.

Results

Results from multivariate logistic regression shows that, when mother's education aspiration is higher than that of her child, both mother and child have lowered risks of being depressed (mothers: AOR = 0.60, p < 0.1; children: AOR= 0.42, p < 0.05). On the other hand, children whose mothers' educational level are higher (senior /vocational high school: AOR =1.42, p < 0.1; college and above: AOR =1.81, p < 0.01) and whose mothers emphasize academic achievement (AOR =1.77, p < 0.1) are at greater risks than those without.

Discussions: The results point to the protective role of mother's higher level of education aspiration than the child, although mothers who emphasize academic achievement seem to increase children's depressive symptomatology. Future interventions that aim to promote mental health of adolescents and parents should take the value attributed to education, and the comparison between parental and children's self-aspirations into consideration.

Key messages

Mother and her child lower risks of being depressed when mother’s educational aspiration is higher than that of her child's. Child increases risks of being depressed when his/her mother emphasizes academic achievement.
Empowering seizures awareness: knowledge, attitudes and fears of school staff trained in rescue drugs
Authors: Pompili E , Bert F , Corradi A , Gualano M R , Venuti S , Siliquini R
Published: October 2020

Background

The administration of rescue medication at school concerns, in all Europe, students suffering from chronic pathologies for which it may be essential, on doctor's prescription, to take therapy during school hours. About 16% of the school's emergency calls are related to a seizure crisis. In this case, since the parents are absent, the first rescuer is necessarily the school staff, who should be properly trained because prolonged seizures can cause severe harm and even death.

Methods

Every year, the Local Health Unit “TO3”, in Northern Italy, provides training for school staff to administrate rescue medication at school. A questionnaire survey on knowledge, attitudes and fears towards seizures was conducted during the school year 2019/2020. The same questionnaire was administered to school staff trained for seizures at the end of the course, while the staff trained for other diseases such as diabetes, allergies and asthma completed it before the course.

Results

110 questionnaires have been completed. About 60% of the sample had been trained in seizure management at least once in their lifetime. The respondents had a mean age of 48.7±9.6 years and a mean job experience of 17.4±11.2 years. Most of them were females (83%). Median knowledge score (10 points max) in subjects with no seizures training was 6, while it was 8.5 in subjects with seizures training (p < 0.001). The self-reported level of confidence in their own skills to administer rescue medication was high in 10.4% of subjects not trained for seizures and in 63.8% of those trained (p < 0.001).

Conclusions

Results suggest that medical training for school staff boosts knowledge scores and levels of self-confidence relating to the administration of rescue medication. Moreover, after the training, the school staff changed attitude towards seizures, no longer considered as a problem, and became more aware, less fearful, and more inclined to act in case of need, making school a safer place for all students.

Key messages

School staff trained in the administration of rescue medication are fundamental to guarantee the right to education for students suffering from chronic pathologies such as seizures. Empowering seizures awareness in schools is very important to change the attitude of school staff no longer considering seizures as a problem, making school a safer place for all European students.
Self-monitoring improved child feeding among low educated slum mothers in Bangladesh, a pilot study
Authors: Jannat K , Rahman M , Agho K , Parvez S , Merom D
Published: October 2020

Issue

Child undernutrition in urban slums is the most serious but least addressed health problem in many LMICs including Bangladesh. Slum children are deprived of adequate feeding as advocated by WHO. Face-to-face contact to monitor adherence to child feeding recommendations is costly. We aimed to identify if a visual aid for self-monitoring, in the form of a pictorial calendar, could assist illiterate slum mothers to self-regulate their child feeding behaviours and increase adherence to recommended child feeding practices.

Description of the practice: A mixed method study was conducted (Randomised Controlled Trial + semi-structured qualitative interviews) over four weeks in a slum area of Dhaka city. Thirty-four mothers to child aged 6-23 months having <5 years of education were recruited. Mothers randomized to intervention arm (n = 17) received an hour of complementary feeding education along with a pictorial calendar and color-coded stickers representing food groups. The control arm received the education session only. The primary outcome was Minimum Dietary Diversity (MDD: ≥4 food groups in past 24 hours); the Generalised Estimation Equations (GEE) with a log link and binomial family was used to test treatment by time interactions.

Results

The proportion of achieving MDD was more common (RR 1.2, 95%CI 0.8, 1.8) among mothers from intervention arm compared to control mothers. Intervention mothers were more likely to identify the appropriate food groups compared to control mothers. More than 80% of the mothers completed the calendar for all 28 days of study duration. During qualitative interviews, most mothers (4/5) stated that the pictorial calendar acted as a reminder for them.

Lessons

An encouraging tendency towards better complementary feeding and better knowledge was seen among the intervention mothers compared to controls. Future research with a larger sample is needed to establish the significance of effect size.

Key messages

Pictorial calendar appeared to help sustain knowledge and improve feeding practices. Self-monitoring using a pictorial calendar could be a good visual aid for low-educated mothers from low socio-economic status.
Measurement of violation of maternal integrity in childbirth: review from a multilevel perspective
Authors: Batram-Zantvoort S , Miani C , Wandschneider L , Razum O
Published: October 2020

Background

Violation of maternal integrity (VMI) during childbirth is reported by women and observed by researchers globally. It has serious health consequences for the mother and the infant in the short and long-term. The terminology to capture VMI ranges from disrespect and abuse to mistreatment and obstetric violence. This variety of terms and concepts is reflected in a multitude of operationalisation and measurement strategies.

Methods

In a scoping review, we examined how VMI has been measured in quantitative studies. Using a theoretically informed framework differentiating between the macro, meso, and microlevel, we reflected on the dimensions of VMI included as items in measurement instruments and categorised them in the framework, aiming to highlight the dominantly chosen approaches to VMI as well as the still under-researched fields and perspectives on drivers, expressions and consequences of VMI.

Results

The majority of scales and surveys described in the studies concentrated on the interactional aspects of VMI, located on the microlevel (e.g. verbal abuse, neglect by care providers). Only a few studies dealt with meso-level factors potentially associated with VMI (e.g. staff shortage). Macro-level perspectives on health policies and legislation, gender equity or societal norms remained rare. Instruments used to measure VMI were very heterogeneous and therefore non-comparable with regard to the outcomes and prevalence of VMI.

Conclusions

There is a need to adopt a multilevel perspective to identify further expressions and effects of VMI. Furthermore, the role of macro-level, structural determinants should be investigated. Last, the use of compatible instruments is required to obtain comparable data on VMI nature and prevalence.

Key messages

Measurement instruments of VMI mainly cover interactional aspects of the phenomenon. The meso-, and macrolevel dimensions of VMI are under-researched. The heterogeneity of the instruments measuring VMI hinders comparison of the outcomes and their prevalence.
Assessing late presentation for female adolescents and young women with HIV in 2019, South Africa
Authors: Cassim N , Coetzee L M , Glencross D K
Published: October 2020

Background

South Africa has the biggest HIV epidemic in the world, with an estimated 7.1million people living with HIV in 2018. In 2016, women aged 15-24 contributed 37% of new infections. Poverty, low status, gender-based violence (GBV) and intergenerational relationships possibly contribute to this disparate HIV prevalence. The objective of this study was to describe very advanced HIV disease (CD4< count <100cells/µL) amongst 15-24 year old females by interrogating routine laboratory CD4 data.

Methods

Specimen level CD4 laboratory data of female patients aged 15-24 was extracted for the 2019 calendar year. Patients were categorized as adolescents (15-19) or young women (20-24), in age categories of (i) 15-16, (ii) 17-19, (iii) 20-21 and (iv) 22-24 years. Frequency tables were used to report test volumes and the percentage of samples with counts <100 cells/µl.

Results

Amongst 259 088 CD4 outcomes extracted, 5.4% of samples had counts <100 cells/µl, with 75.4% of samples from young women and 24.6% from adolescents. Most samples reported an age between 22-24 (52.2%), with the lowest proportion (5.8%) noted in 15-16 year olds. Median CD4 was 485 cells/µL, with medians of 490 and 470 cells/µl noted for young women and adolescents respectively. Review of the <100 cells/µl group revealed a median of 43 cells/µL, with 38 and 46 cells/µL reported for young women and adolescents respectively. There was no significant association between the median CD4 and age category. Very advanced HIV disease by age categories of 15-16, 17-19, 20-21 and 22-24, comprised 7.0%, 5.6%, 5.0% and 5.3% respectively.

Conclusions

This study demonstrated unacceptable rates of very advanced HIV disease in female adolescents and young women, suggesting HIV seroconversion as teenagers or younger. Evidence-based specific health care interventions for these girls are urgently required, including tailoring social services and health facilities to secure the sexual health of girls and young women.

Key messages

Very advanced HIV disease presentation in female adolescents is unacceptably high. Young women and adolescents with late presentation.
The impact of the family on health inequalities in children – A systematic scoping review
Authors: Wachtler B , Hoffmann S , Blume M , Rattay P , Herr R , Deindl C , Sundmacher L , Richter M , Spallek J , Lampert T
Published: October 2020

Background

Health inequalities in school-aged children and adolescents were repeatedly reported across Europe but less is known about the contextual and compositional factors of families that might influence and reproduce those health inequalities. In this systematic scoping review we aim to provide a comprehensive overview of the available international literature on the mediating and moderating influence of the family on health inequalities in children and adolescents in Europe and North America.

Methods

This review follows the PRISMA guidelines for scoping reviews. After defining the research question a search strategy was developed in cooperation with a scientific librarian and the study protocol was registered. A search of three databases (Pubmed, Scopus, PsycINFO) was conducted to identify relevant literature in English or German published between the year 2000 and 2019. A qualitative data charting process was used to extract the relevant data.

Results

In total 11.838 records were identified through the multi database search (Pubmed n = 6370, PsycINFO n = 3505, Scopus n = 1963). After elimination of duplicates and records from excluded countries, 8862 abstracts were screened by two researchers independently. Different cluster of evidence of family influences on health inequalities were identified: Parental behaviors and children's obesity, parents' smoking and drinking habits and adolescents' risk behaviors, parenting style and children's common mental disorders, parental resources and children's quality of life.

Conclusions

There are different aspects of family's contextual and compositional characteristics on health inequalities identifiable in the international literature. These characteristics might be new targets for family-focused health promotion strategies.

Key messages

A systematic scoping review found different family aspects that influence health inequalities in children and adolescents. The identified family traits are promising targets for family-focused health promotion strategies to reduce health inequalities.
Maternal mortality in Brazil among adolescents between 2007 and 2017
Authors: Saldanha R C O , Abe G M , Abe A H M , Mariano M E O , Pierson I D S , Santana B F
Published: October 2020

Introduction

One of the Sustainable Development Goals is to reduce the amount of maternal deaths. This study is essential in Brazil.

Methods

Epidemiological descriptive study regarding maternal deaths between 10 to 19 years old, according to race, age group, marital status, year of occurrence, schooling status, and ICD-10 category, during 2007 to 2017 in Brazil. Data was obtained from DATASUS.

Results

In the period, there were 2,767 maternal deaths between 10 to 19 years old; 152(5,5%) of them between 42 days to one year postpartum. Regarding age, 2,582(93%) were between 15 to 19 years old, 185(6,6%) between 10 to 14 years old. Regarding race, 1,565(56,5%) were brown, 761(27,5%) were white, 236(8,5%) were black, 69(2,5%) were indigenous. Regarding marital status, 2,060(74,4%) were single, 240(8,7%) were married. Regarding the cause of death, 542(19,5%) were due to maternal diseases with labor and puerperium complications, 348(12,5%) due to eclampsia, 209(7,5%) due to puerperal infection, 152(5,5%) due to other causes of late maternal death, 150(5,4%) due to gestational hypertension, 115(4%) due to urinary tract infection. Regarding schooling status 1,062(38,3%) had 4 to 7 school years 809(29%) had 8 to 11 years, 207(7%) had 1 to 3 years, 44(1,6%) had no schooling. The total amount of maternal deaths and late maternal deaths, respectively, according to the year, were: 220 and 12(2007), 247 and 12(2008), 267 and 7(2009), 273 and 6(2010), 242 and 12(2011), 225 and 17(2012), 241 and 17(2013), 239 and 20(2014), 235 and 19(2015), 214 and 17(2016), and 212 and 13(2017).

Conclusions

The limited 0,03% reduction in the amount of maternal deaths in this age group between 2007 to 2017is worrisome. The deaths among mostly single girls with some schooling level reveals that the country needs to review its sexual education policies, and to enforce guidance regarding family planning, as well as enable the female youth to recognize and denounce sexual aggressions.

Key messages

Know the characteristics of adolescents who suffers with the risk of maternal death in Brazil, in order to create ways of reducing these risks. Alert to Brazilian government to take part in the awareness process and start investing in improving the specialized public health service and access to information for these women.
Effects of integrated interventions on growth and development of young children: A meta-analysis
Authors: Dulal S , Prost A , Saville N , Karki S , Merom D
Published: October 2020

Background

We did a systematic review to understand: (a) the effects of integrated versus usual care on the developmental outcomes and nutritional status of children under five years; and (b) which intervention characteristics are associated with positive effects.

Methods

We searched eight electronic databases for studies published between January 2013 and September 2019. Eligible studies were Randomised Controlled Trials (RCTs) and non-randomised controlled studies of integrated nutrition and stimulation interventions with child growth and developmental outcomes. We extracted data on intervention characteristics including delivery strategies, behaviour change techniques, intervention intensity and delivery personnel. We meta-analysed data for Length-for-age/Height-for-age Z scores (LAZ/HAZ) and cognitive, motor and language development scores, and conducted subgroup analyses by main intervention characteristics.

Results

Twenty-two unique RCTs met the inclusion criteria, of which 16 were included in the meta-analysis. Compared to the usual care, pooled Effect Sizes (ES) showed small to medium benefits of integrated interventions on cognitive (n = 15, ES 0.64; 95% CI: 0.39, 0.88) and language development scores (n = 10, ES 0.47, 95% CI: 0.21, 0.73) but heterogeneity was high (I2>75%). We found no significant effects of interventions on motor development scores (n = 12, ES 0.31, 95% CI: -0.02, 0.64) or LAZ/HAZ scores (n = 8, ES -0.03, 95% CI: -0.11, 0.03). The effects of interventions on developmental outcomes did not differ by intervention characteristics, and heterogeneity remained high in sub-group analyses.

Conclusions

Integrated nutrition and stimulation interventions had significant effects on cognitive and language development, but no detectable effect on motor development or linear growth. Our ability to identify intervention characteristics linked to positive effects can be improved by standardising the reporting of implementation processes.

Key messages

More high-quality trials with longer follow-up duration are needed to examine the role of integrated nutrition and stimulation interventions on growth and developmental outcomes. Future research should map the characteristics of integrated nutrition and stimulation interventions following standardised guidelines to understand their influence on the outcomes reported.
Accessible diagnostics along the care trajectory of children with a developmental disorder
Authors: Cloet E , Kimpe E , Van Ransbeeck T , Leys M
Published: October 2020

Background

20% of all children suffer a neurodevelopmental disorder (NDD) worldwide. Each child with a (suspected) NDD should have access to a specialised multidisciplinary diagnostic setting to pass a qualitative and adequate diagnostic trajectory. In Flanders, Belgium, 6 types of public organisations offer multidisciplinary diagnostics of NDD for children. However the objective of timely diagnostics for the population is not realized.

Methods

Literature review, document- and website analysis, surveys and focus groups were done. Results of the surveys have been analysed by SPSS, focus groups have been thematically analysed by a process of data- and researchers triangulation. Results were discussed and validated by experts in focus groups.

Results

The response on the survey was 155. 67 surveys were included for analysis. 71 professionals participated in a focus group. As a result of an historical dispersed development, the field of organisations offering diagnostics of NDD in Flanders is heterogeneous. Diagnostics are provided in each region, but not in every region the same competences, knowledge, expertise and capacity are available. Overall it lacks sufficient capacity. The accessibility, nature of the diagnostics, target groups, composition of the diagnostic teams and working processes differ between organisations and are not coordinated. There is no shared interorganisational opinion on the concept and content of diagnostics. An important hampering factor for interorganisational collaboration is the lack of trust in the quality of diagnostics by other organisations. Many ruptures in the overall trajectory hamper continuity of care for NDD.

Conclusions

Besides creating more diagnostic capacity according to a geographical planning, interorganisational collaboration will tackle the accessibility problem. A coordinated common framework grounded in the logics of cooperation and collaboration of a heterogeneous mix of organisations providing diagnostics, is needed.

Key messages

Development of collaborative networks of different types of services offering diagnostics will improve the accessibility of early and timely multidisciplinary diagnostics for children with NDD. A shared interorganisational opinion on the concept and content of diagnostics aiming to improve interorganisational trust in the quality of diagnostics, must be developed.
Prevalence and pattern of risky sexual behavior among undergraduates in Benin City, Nigeria
Authors: Omuemu V O , Ogboghodo E O , Okungbowa N H , Omonhiaokpa O V
Published: October 2020

Background

Risky Sexual Behaviours (RSB) describe sexual activities that increase the probability of experiencing negative consequences in the physical, psychological and social wellbeing of individuals. Research has documented an association between risky sexual behaviour and Sexually Transmitted Infections (STIs), including Human Immunodeficiency Virus (HIV). The objective of this study was to assess the prevalence and pattern of RSB among undergraduates in Benin City, Nigeria.

Methods

A descriptive cross-sectional study was carried out among undergraduate students in Benin City, Nigeria. The University of Benin is one of Nigeria's first generation federal universities with about 75,000 students. A minimum sample size of 689 was calculated using the appropriate formulae for a descriptive study. Respondents were selected using a multistage sampling technique. Data was collected using a pre-tested structured self-administered questionnaire adapted from the illustrative questionnaire for interviews-surveys with young people. Data analysis was carried out using IBM SPSS version 22.0 software. A p-value <0.05 was considered statistically significant.

Results

A total of 690 undergraduates with a mean age (SD) of 20.42 ± 2.7 years and a male: female ratio of 1:1.3 participated in this study. Two hundred and eight respondents (30.1%) were sexually active. Of these, 47 (24.0%) respondents admitted to have multiple sexual partners, 36 (23.5%) cross-generational sex, 29 (14.8%) troilism, 29 (14.8%) transactional sex, 22 (11.2%) homosexualism, and non-vaginal sex, 22 (11.2%). Overall, 196 (38.5%) of the respondents engaged in RSBs. Age group (p < 0.001), sex (p < 0.001), and residing off-campus (p = 0.047) were significantly associated with RSBs.

Conclusions

RSB in the studied population was high and having multiple sexual partners was the most reported type of RSB. Health interventions targeted at this age group are important for current and future sexual health.

Key messages

The prevalence of risky sexual behaviour is high among young persons. Health interventions targeted at this age group are important for current and future sexual health of young persons.
Perceptions of men aged 24-60 from three different socioeconomic level on child marriage, Ankara
Authors: Ors Reyhanioglu S , Arslan U E , Ozcebe H
Published: October 2020

Background

It is estimated that one in every five women has married before 18 year of age in Turkey. In majority of studies on child marriages the data have been collected from women. Number of studies conducted with men are limited and mostly qualitative. This study aims to determine some attitudes and perceptions of 24-60 age group men on child marriages in three neighborhoods with different socioeconomic status in Ankara.

Methods

A descriptive epidemiological study was conducted in three neighborhoods with low, middle and high socioeconomic status. The data was collected through a self-administrated questionnaire from 500 men aged 24-60 in each neighborhood through household visits. Ethics Commission permission was granted.

Results

The median age of first marriage increased both among men and their wives as the socioeconomic status improved (p < 0.001 and p < 0.001, respectively). From low socioeconomic status to high (respectively, 3.2%, 1.3%, 0.2%), men agreed women could marry before the age of 18 (p = 0.001). Men with low (69.2%) and medium (74.2%) socioeconomic status believed “marriage” was the most important experience in women's lives. Men with low socioeconomic status found marriage of their daughters and sons under 18 more acceptable compared to the men with high socioeconomic status (p < 0.001, p < 0.001, respectively). 14.0% of men whose wife was below 18 at the time of marrige, agreed women could marry before the age of 18, compared to 0.8% whose wife was 18 year old or older at the time of marriage (p < 0.001).

Conclusions

This is the first quantitative study in Turkey conducted to understand the perceptions and attitudes of men on child marriages. These findings confirm that socioeconomic status is an important determinant of child marriages, there are disparities in gender perspective among different socioeconomic levels and child marriage is carried over between generations.

Key messages

Traditional gender roles for women and men in the family have a continuing trend in all socioeconomic levels, but more significant in the low and middle socioeconomic level neighborhoods. Specific male groups including fathers need to be targeted in interventions to prevent child marriages. Specific male groups need to be targeted in interventions to prevent child marriages.
Being bullied and associated factors among middle school students in the region of Monastir, Tunisia
Authors: Ben Fredj M , Dhouib W , Bennasrallah C , Kacem M , Zemni I , Abroug H , Trimech F , Belguith Sriha A
Published: October 2020

Introduction

The phenomenon of bullying among adolescents is a worldwide issue. The trend of this behavior is increasing in developed countries as well as in developing countries, with the creation of new forms such as cyberbullying. This study aimed to determine the prevalence of being bullied and to analyze the association between being bullied and some individual and familial factors.

Methods

This is a cross-sectional study conducted in two middle schools belonging to the region of Monastir in Tunisia in December 2017 and January 2018. The Global School-based Student Health Survey (GSHS) was administered for students. All present students from the two recruited schools were included.

Results

A total of 802 students were enrolled in the study. Just under half of the study group (44.0%) reported having been bullied in the past month with 95% CI [40.66%-47.57%]. The predominant type of bullying was being made fun of with sexual jokes, comments or gestures (9.1%), followed by being kicked, pushed, shoved or locked indoors (3.6%). In multivariate analysis, physical fight was an independent associated factor with being bullied (OR [CI]95%: 2.04[1,77-3,25]), p = 0.001. Lonely students had nearly 3.38 higher risk of undergoing bullying (OR [CI]95%: 3.38 [2.05-5.57]), p = 0.001). In addition, being worried was also an independent factor associated with being bullied (OR [CI]95%: 2,23 [1,45-3,43]), p = 0.001.

Conclusions

Our results support an association between existing mental health problems and bullying. Additional studies are needed to understand the factors associated with school bullying and to

Key messages

In this study, the prevalence of bullying was relatively high. Program education in schools should focus on life skills education in order to develop the self-confidence and the self-esteem of students.
The family of a child with chronic illness and its social relationships
Authors: Souza M H N , Santos T J , Vasconcellos R N , Costa M M , Lira A S , Conceição N V M , Sodré V R D , Cavalcante D F B
Published: October 2020

Introduction

The family life of a child with chronic illness is marked by several determinants and demands for care. Within that context, the greater the support received, the greater the resources available to face vulnerability, and to respond positively to guidance and care.

Objectives

describing the social network of families of children with chronic illness, and understanding the meaning of the relationship of the family caregiver with the members of his/her social network.

Methods

Qualitative research with nineteen relatives of children with chronic diseases at a rehabilitation center in the city of Rio de Janeiro, Brazil. The theoretical framework of Sanicola's social network was used. Data were collected in November 2019 by semi-structured interviews and analyzed using the content analysis technique. The research was approved by the Ethics and Research Committee of the participating institutions. The social network map showed the presence of few members and mothers as the main caregivers. The main problems among children were: autism, Down syndrome, cognitive disorders and cerebral palsy. Among the most involved people with the caregivers, friends, sisters and grandparents stood out as the ones who offered material, financial and emotional support. Rehabilitation unit support (secondary level) and dissatisfaction with the primary health unit were mentioned.

Conclusions

The social network of children with chronic illness is a small family network marked by social vulnerability and the female gender as responsible for care. It is noteworthy that the weakness in the relationship with health professionals at primary care level can compromise care continuity. Therefore, it is recommended to professionals to know the social network of the clientele served, as well as interacting and strengthening this network in order to provide more effective actions for health protection, rehabilitation and supported self-care strategies.

Key messages

Chronic childhood disease is a major public health problem. Being aware of social network favors the implementation of more actions toward health protection, rehabilitation and supported self-care strategies.
A women’s right with limitations - global and European perspective on abortion decriminalization
Authors: Pires M , Vital Brito D
Published: October 2020

Background

The decriminalization of abortion is a controversial subject whose policies widely vary across the world. In some countries it is available upon request, at least up to the 24-week limit, while in others it is totally prohibited. This practice also raises ethical issues, since some defend access to abortion as a human right, while others condemn it, highlighting the embryo's right to life. This study aims to compare abortion decriminalization laws and the maximum gestational age limit for induced abortion in each country of the six WHO member states.

Methods

Data on abortion decriminalization laws and the maximum gestational age limit for induced abortion were collected from the Global Abortion Policies Database on the WHO website. Descriptive analysis of data considered absolute and relative frequencies. Comparison between regions considered the number of countries, including a deeper analysis for European context.

Results

Approximately 30% of reviewed countries have specific laws for abortion decriminalization, while in 48% it is still a prohibited practice. Among the 48 European countries, 29 have decriminalized abortion laws, a practice that is only considered in 5 of the 54 African countries. Considering abortion by women's request, accepted practices are valid between 8 and 24 weeks gestation, depending on each country. However, 12 weeks of gestation is the most frequent limit for abortion, and it is the threshold of increased bleeding risk for pregnant women.

Conclusions

No legal abortion practices are performed after fetal viability period, usually up to 24 weeks of gestation. There are relevant differences between six regions. While most high-income countries have decriminalized abortion, this practice is still prohibited in most South American and African countries, raising multiple public health issues. Cultural, sociological and healthcare context is expected to have a strong influence in decriminalization of abortion.

Key messages

Abortion is considered a human right but there are many countries that do not allow it, particularly in Africa and South America. Most European countries have abortion decriminalization laws.
Navigating contrasting liminalities: Women’s experience of childbearing while undocumented in Sweden
Authors: Opperdoes M , Greenbrook J T V , Danielsson L , Elden H , Ascher H
Published: October 2020

Background

Pregnant women living as undocumented migrants navigate multiple and layered liminalities, exacerbating their vulnerability, and accenting ambiguity and uncertainty in their lives. Whilst previous research has addressed these women's interactions with healthcare institutions, the present study's aim was to explore their experiences of daily life during pregnancy and early motherhood, when living undocumented in Sweden.

Methods

A qualitative phenomenological study was conducted, where 13 women from 10 countries were interviewed; all undocumented, with a forced migration background. The anthropological theory of liminality was applied in furthering interpretations.

Results

The central theme of navigating the contrasting liminalities of celebrating pregnancy and early motherhood while immersed in the acute uncertainties of undocumentedness emerged, including two categories: (1) Embodying systemic injustice, with the subcategories living in the shadows of society to maintain personal safety, fearing the inability to satisfy basic needs in motherhood, and experience of dissonance when suspended in existence; (2) coping strategies for tackling daily life, with the subcategories: the importance of social relationships in satisfying needs and rights, striving for normality in the present, and dreaming of belonging to the fabric of the host society.

Conclusions

Pregnancy and early motherhood both exacerbated and countered the burden of undocumentedness. Daily life constituted a paradox, where undocumentedness resulted in being consumed by harsh living circumstances; driving fears of common spaces and services and uncertainty and unpredictability in meeting basic needs. Simultaneously, the universal and inherently human experiences of joy and longing that pregnancy can foster still emerged in little moments allowing it. Dreams of belonging were, however, thwarted by exclusion, being continuously and forcibly confined to inhabiting the liminal space on society's threshold.

Key messages

Pregnancy and early motherhood both acutely exacerbate and counter the burden of undocumentedness, rendering navigating daily life heavily paradoxical. Undocumentedness results in being consumed by harsh living circumstances; simultaneously, the universal and inherently human experiences of joy and longing that pregnancy can foster still emerge.
Exploring district-level geographical variance of complete immunization coverage in India
Authors: Biswas M
Published: October 2020

India has been significantly progressed in full immunization care over the last few decades. Existing literature has not been unaddressed the potential spatial variations in relationships between full immunization coverage and its influence on socio-economic factors. The study aims to explore place-specific spatial dependencies and heterogeneities in the relationships of various factors on the district-level full immunization coverage in India. The study used a geocoded database for 640 districts of India, drawn from the 4th wave of the National Family Health Survey (NFHS) in 2015-16. Univariate Moran's I and LISA maps were used to confirm the spatial autocorrelation and geographical hotspots of the district-level full immunization coverage. Multivariate Ordinary Least Squares (OLS) and Geographically Weighted Regression (GWR) models were employed to examine spatial relationships and decrypt location-based district-level analysis. The prevalence of full immunization care was 62 percent as per the national figure. The GWR results revealed that the relationships between the outcome and set of cofactors were significantly place-specific and spatially clustering in terms of their respective magnitude, direction, and differences in due to local characteristics across India. In terms of model performance and prediction accuracy, the GWR model was performing better over OLS estimates through comparisons of R2 and Akaike Information Criterion (AICC) in both models. Furthermore, the GWR model also improves the reliabilities of the relationships by reducing spatial autocorrelations. The findings suggest that the local GWR model has the potential to explain complexities in place-specific variations that could be ignored by OLS on the local causes of immunization coverage. Thus, appropriate intervention should be devised to safeguard child from vaccine-preventable diseases reduce the geographical heterogeneity of full immunization coverage across India.

Key messages

This study aims to explore place-specific spatial dependencies and heterogeneities in the relationships of various factors on the district-level full immunization coverage in India. To explain local complexities in place-specific variations that could be ignored by the traditional model on the local causes of full immunization coverage across India.
“No papers. No doctor”: undocumented immigrant women’s access to maternity care services in Denmark
Authors: Boye M C , Funge J K , Johnsen H , Nørredam M
Published: October 2020

Background

In Denmark, undocumented immigrants have restricted access to health care including maternity care. Nordic studies describe that undocumented immigrant women face many barriers to access maternity care during pregnancy however, literature in a Danish setting is lacking. This study aims at exploring undocumented immigrant women's experience of and their access to maternity care services in Denmark.

Methods

The study setting was a non-governmental Health Clinic in Denmark, that provides primary health care, including maternity care, to undocumented immigrants. We recruited 21 undocumented immigrant women, conducted semi-structured interviews from 01.2018 to 01.2019. The data was analyzed through systematic text condensation.

Results

Undocumented immigrant women experience several barriers to access maternity care services in Denmark. We identified four themes with subthemes. i) Access to public maternity care services; the experiences with public maternity care providers, fear of deportation and concerns about having to pay for care. ii) Use of private and non-governmental maternity care services; the feeling of being safe at the Health Clinic, reaching care is challenged by logistics and choosing to pay for private health care services. iii) Perception of entitlements to care; wishing for a fair treatment, and uncertainty of what to expect when reaching a public health care facility. iv) Being dependent; dependency on the Health Clinic, social support from network and seeking information from other sources.

Conclusions

Our findings contribute with insights to understand the health behavior of undocumented immigrant women. Accessing public maternity care services is, apart from legal restrictions, dominated by fear of being reported to the immigration authorities, concerns about payment, and the management of rules from the health provider's perspective. Many of them depend on the Health Clinic as well as their personal networks for care and protection.

Key messages

Undocumented immigrant women face many barriers to access maternity care services. Inclusive policies for access to maternity care are needed to safeguard the health of the women and children.
Health consciousness during pregnancy: the association between dietary supplementation and lifestyle
Authors: Paulik E , Horváth E , Szabó A , Polanek E , Gyurkovits Z , Németh G , Orvos H
Published: October 2020

Background

Dietary supplements are recommended for pregnant women who cannot meet the daily dose through food intake, or who are at higher risk of deficiencies because of a substance abuse (e.g. smoking). Today, the preventive effect of folic acid (FoA) in the periconceptional period is evidence based, and there are studies about the positive effects of omega-3 fatty acids (n-3 FAs) during pregnancy. The aim of this study was to determine the association between FoA and n-3 FAs supplementation and health behavior - diet, physical activity, smoking - of pregnant women.

Methods

The cross-sectional study was conducted among women having their babies at the Department of Obstetrics and Gynecology (N = 1548). Data collection was based on self-administered questionnaire and health documentation. Uni- and multivariable logistic regression analyses were performed with IBM SPSS 26.0; the results are expressed in odds ratios (OR) and 95% confidence intervals (CI).

Results

Mean age of women was 31 years, most of them had university degree, nearly 90% of them lived in partnership. The prevalence of smoking during pregnancy was 6.5%, 39.8% did not consume fruits/vegetables daily, 58.5% ate fish less than weekly, 47.9% were physically inactive; 67.6% took FoA, and 30.6% n-3 FAs. FoA and n-3 FAs taking were more likely among those who ate fruits and vegetables every day (OR/CI: 1.30/1.01-1.66; 1.47/1.15-1.89) and among non-smokers (OR/CI: 1.73/1.06-2.83; 4.80/1.69-13.61), while FoA consumption associated with physical activity (OR/CI: 1.37/1.07-1.74) and n-3 FAs with fish consumption (OR/CI: 1.35/1.06-1.72).

Conclusions

Our results showed that a high proportion of pregnant women did not follow a healthy lifestyle, and the unhealthy behavior was significantly associated with the less frequent use of dietary supplementation. The results call the attention for the importance of counseling on healthy lifestyle and appropriate supplement use before and during pregnancy.

Key messages

Use of dietary supplementation is higher among pregnant women following a healthy way of lifestyle. The results reinforce the importance of lifestyle counseling during pregnant care.
Association between air pollution and Pediatric Intensive Care Units hospitalization rates
Authors: Comoretto R , Gallo E , Ocagli H , Lorenzoni G , Lanera C , Martinato M , Wolfler A , Pettenazzo A , Amigoni A , Gregori D
Published: October 2020

Background

In the last years air pollution has been linked to an increased risk of several children respiratory pathologies, especially low respiratory tract infections. In more severe cases, the child could be hospitalized in Pediatric Intensive Care Unit (PICU). The present study aims to evaluate the association between the exposure to air pollution and (i) PICU admissions and (ii) hospitalization rates among children with a previous PICU admission.

Methods

PICU admissions due to respiratory diseases were collected from 2010 to 2019 in Padua hospital (Italy) based on a large clinical Italian register. Furthermore, for subjects admitted in 2013, all subsequent hospitalizations have been tracked until 2019 from hospital discharge records. Environmental data were obtained from monitoring stations located within 20 km from the children residence. A conditional logistic regression based on a time-stratified case-crossover design will be performed to evaluate the association between hospital admissions and NO2, PM2.5 and PM10 in aerodynamic diameter.

Results

The registry contains data about more than 30000 PICU admissions, of which around 30 % are of children under one year of age. An increased prevalence for respiratory diseases' admissions, from 18% in 2010 to 24% in 2019 can be observed. More than 400 children were admitted to Padua's PICU in 2013. In the following years, all these subjects experienced at least one hospitalization (median 2, [IQR 1-5]) for more than 2000 hospital admissions from 2014 up to 2019.

Conclusions

Exposure of infants to air pollution could lead to more severe outcome as hospitalization as a result of a vulnerable lung condition that eases virus infections. This condition identifies a particularly frail population. With this approach, an association between air pollution and PICU admissions could be investigated in order to adopt public health policies aimed at safeguarding this frail population.

Key messages

The study would detect an association between air pollution and hospital admissions as severe outcomes in infants and children. Furthermore, this is the first study that would assess if there is an association between these two factors in more frail subjects already hospitalized in a Pediatric Intensive Care Unit.