bluuebunny/crossref_metadata_2025 huggingface dataset:
Factors influencing the migration intention of dental and medical graduates in developing countries
Authors: Hajian S , Khoshnevisan M H , Yazdani S h , Jadidfard M P
Published: November 2019

Background

Migration of skilled health workers could result in shortage of human resources and rising inequalities in service provision in source countries. To date, most of relevant papers are focused on rate and reasons of migration while the need for conducting studies on modelling of factors is more vividly felt. The aim of this review was to determine the factors influencing the migration decisions of medical and dental graduates migrating from developing countries and to introduce a practical conceptual framework for health worker migration.

Methods

Electronic databases PubMed, Google Scholar and relevant Journals were systematically searched for English language publications from January 2009 to April 2019. The inclusion criteria were: 1) article stated factors affecting migration decisions of medical doctors and/or dentists, 2) the source country in the study was a developing country, 3) participants’ primary qualification country was in a developing country,4) the study used primary data both qualitative or quantitative.

Results

The search identified 814 articles from which we included 23 full-text studies after applying eligibility checklist. Push and pull theory was the most popular model to describe the migration driving factors. Poor socio-economic situation, political instability, lack of professional and educational opportunities together with family concerns found as strong common push factors that perpetuate migration. The most influencing pull factors were desire for better quality of life, career and training opportunities and financial gain.

Conclusions

Despite the fact that health workers migrate for different reasons, they follow a same route for decision to stay or leave their own countries. Un-fulfillment of expectations in mother land in addition to media reconstructed reality of life in foreign land can develop a positive attitude for migration Which should be considered before weighing up the push and pull factors of both sides.

Key messages

A better understanding of the migration motives of health professionals will help health authorities to improve their workforce recruitment and retention strategies and health service planning. Our simple yet comprehensive framework can mainly identify the development of migration desire through combining different models and concepts of migration, behavioral change, values, needs and so on.
Experiences of specialist social workers for asylum seeking patients at a large Swedish hospital
Authors: Svärd V , Nilsson M , Sernbo E
Published: November 2019

Background

In 2016, the Karolinska University Hospital introduced a one-year-project with a mobile team of five asylum social workers (ASW), specializing in migration. This study evaluates the ordinary hospital social workers (HSW) experiences of introducing ASWs for asylum seeking patients.

Methods

Descriptive analysis was made of answers from a questionnaire sent to all 144 HSW at the hospital (57% response rate). Qualitative content analysis was made of written comments.

Results

Of the HSWs, 51% always and 29% sometimes contacted an ASW in relation to asylum seeking patients. Of those who contacted an ASW, 74% stated that the ASWs increased the efficiency of care of asylum seeking patients. 65% agreed that ASWs had an improving effect on the quality of encounters between staff and asylum seekers. Also, 67% agreed that the ASWs off-loading function improved the HSWs working conditions. Even though the ASWs were working at two hospitals located in different parts of the region, 78% of HSWs found them to be available. The main reason to not always contact an ASW was that it was not necessary in the specific case (55%). A majority (66%) reported increased knowledge about asylum processes as an outcome of introducing the ASWs at the hospital. This was also highlighted in the written comments, where ASWs detailed and updated knowledge as well as established contacts with e.g. the Swedish Migration Board was emphasized. ASWs specialist competence enabled patients to quickly receive legally correct and accurate information, which decreased worries among patients as well as staff members.

Conclusions

The HSWs described the ASWs as being important to patients as well as to staff. The ASWs improved the quality of encounters between staff and asylum seekers and strengthened the patient’s right to health and social care. The HSWs also reported an off-loading function, improving the working conditions and the over-all efficiency of care.

Key messages

The HSWs found that the ASWs increased the efficiency of care and quality of encounters between staff and asylum seekers. ASWs detailed knowledge and established external contacts enabled patient to receive accurate information quickly, which decreased worries among both patients and staff members.
Optimum control of TB in the EU by addressing migrant health effectively in an interconnected world
Authors: Koster D M , Bootsma A J
Published: November 2019

Worldwide, tuberculosis is one of the top 10 causes of death. Although most EU/EEA countries are low-incidence, TB remains a public health issue. In this region, TB predominantly affects vulnerable populations, including migrants (ECDC/WHO, 2019). Since migration has been increasing over the last several decades, the health needs are considerable and merit great attention for several reasons. First, migrants have a right to health. Second, health promotion and disease prevention among migrants contributes to overall public health. Last, healthy migrants contribute to positive development outcomes (WHO, 2016) (IOM, 2017).

In order to meet the health needs of migrants, prevention is an important step. Part of preventive care is detecting illness at an early stage (for example by screening), so that treatment can be introduced when it works best (WHO Europe, 2018). However, screening of a population is only beneficial if a positive result leads to effective actions independent of geographic location (Jackson, 2017).

So, how does one facilitate a fluid care pathway for TB-elimination? In the Netherlands, the Community Health Services (GGDs) carry out TB-control non-geographically. All 25 GGDs use iTBC, a nationwide, integrated platform that supports and connects all TB processes, independent of place and time. The appropriate TB screening pathway is selected, based on prevalence in country of birth, for all migrants resulting in optimized screening, treatment and control. In a PPP between Topicus, the Dutch Association of GGDs (GGD GHOR Nederland) and the Central Agency for the Reception of Asylum Seekers, this process has been automated for asylum seekers. By safely sharing relevant data, migrants can be screened and treated effectively. Resulting in health needs of migrants being met and optimum control of TB in low-incidence countries. The aim is to screen, treat, control and end tuberculosis whilst scaling the Dutch blueprint across the EU/EEA region.

Key messages

TB-screening contributes to EU public health if follow-up actions are facilitated non-geographically. The Dutch blueprint for TB-control shows how migrant health needs are met in an interconnected world.
Asylum seekers’ healthcare in Italy: policies and practices among different regions
Authors: Milani C , Bianchi J , Bordin P , Bortoluzzi S , Gianfredi V , Mammana L , Paglione L , Salvia C , Corsaro A
Published: November 2019

Background

The Italian law provides for international protection and universal health-care coverage for asylum seekers (AS). Indeed, they are entitled to be regularly registered at the National Healthcare Service. Before submitting the application for refugee status, medical assistance to migrants is up to local administration. Our aim was to describe and compare policies and protocols regulating AS healthcare from their arrival to their application for refugee status, at national and regional level. Moreover, we investigated the daily healthcare practice addressing potential gaps between policies and practice.

Methods

The research team is a subgroup of the Inequality working group of the Italian hygiene society and it is composed of public health residents. The research involved also local health workers and other professionals belonging to regional groups of Italian migrant medicine society (SIMM). We collected national, regional and local policies and protocols and we compared them using a specific framework. Furthermore, we achieved a mapping of daily practice implementation at local health organization (LHO) level using a checklist.

Results

The most relevant findings were that regional policies themselves vary notably from each other and, as regard practices, LHO implement differently the same regional legislation. Furthermore, we found some critical issues: the delayed inclusion in primary care assistance and lack of continuity of care and of a computerized system of recording information.

Conclusions

The lack of uniformity concerning policies and practices of AS healthcare might also result in unawareness and uncertainty about how to access to healthcare services by migrants. An enhanced cooperation between groups dealing with migrants’ issues may lead to avoid variability at the implementation. Finally, a computerized system for data collection might facilitate the continuity of care and the assessment of the real health needs of the AS population.

Key messages

It is a priority challenge for health systems to strengthen the interventions aimed at overcoming the linguistic, economic, cultural and administrative barriers to the health services access. It is crucial to improve the recording information system to detect the real health needs of AS, their change and the inequalities in access and to improve collaboration between groups and university.
Understanding non-compliance with surgical antibiotic prophylaxis prescribing guidance, in Nigeria
Authors: Wood C , Kostkova P , Olufemi O , Soriano D , Ogunsola F , Lefevre-Lewis C , Kpokiri E , Shallcross L
Published: November 2019

Background

Antimicrobial Resistance is a prominent worldwide threat that is increasing in low-to-middle income countries. Good antibiotic stewardship (AMS) improves compliance with evidence-based antimicrobial prescribing guidelines but just 4% of LMICs have national AMS initiatives in place and only 15% have national policies. As high as 20-50% of surgical antibiotic prophylaxis prescription in Nigeria is thought to be non-compliant. Behaviour change theories can structure our understanding of why poor compliance occurs and can facilitate development of effective interventions to improve it.

Methods

The Theoretical Domains Framework (TDF; Michie et al. 2009) was used to develop an online survey and interview schedule for focus group discussions. Audio recordings were transcribed and analysed by two researchers using thematic analysis, TDF and the COM-B model of behaviour change (Michie et al. 2010).

Results

60 surgeons (59% male; 43% surgical consultant; 5-10 yrs experience) from Lagos University Teaching Hospital, Lagos University College of Medicine and Niger Delta University Teaching Hospital completed the survey. A sub-group of 14 surgeons (79% male; 86% surgical consultant; 10-15 yrs experience) participated in three focus groups. Whilst compliance with guidance was generally considered desirable, surgeons reported translating guidance to Nigerian practice and context was often difficult, time-consuming and restricted by not having access to recommended antibiotics.

Conclusions

Behaviour change theory can be used to further our understanding of key barriers and facilitators to non-compliance with surgical antibiotic prophylaxis prescribing guidance, amongst surgeons in Nigeria. This presentation will conclude with discussion of how findings from this project are being used to develop a cost-effective, scalable, decision-support smartphone app for prescribing behaviour change.

Key messages

Behaviour change theory can be used effectively to further understanding of barriers and facilitators to Nigerian surgeons’ non-compliance with surgical antibiotic prophylaxis prescribing guidance. We must form a comprehensive understanding of factors (social & environmental) driving non-compliant attitudes and behaviours, before creating interventions to change prescribing behaviour.
Identifying latent needs in elderly digital literacy: the PROADAS study
Authors: Prodromou M , Lavranos G
Published: November 2019

Background

According to the Digital Agenda for Europe (2014 - 2020) enhancing digital literacy, skills and inclusion is one of the main priorities. All European elderly people must become e-seniors as soon as possible. On the hand, active ageing means that senior citizens activate themselves in order to be as independent as possible. As a result, triggering these new digital tools and ICT skills can assist the elderly to be a more integrated part of our society. The Erasmus+ Proadas project promotion of Active Digital Ageing Skills aims at tackling the gap between ageing population and digital literacy and strengthening and reinforcing the stakeholders, experts and practitioners, by identifying the needs of elderly people and their carers regarding technology.

Methods

The study was conducted in January 2019 in all six countries participating in the Proadas project. 35 carers and their assigned seniors were selected via convenience sampling by a minimum of three best practices- centres of excellence per country. A twelve-question close format questionnaire was developed, using a Delphi approach and completed by all participants. All data was analysed using SPPS 20.

Results

A total of 188 responders from all six countries agreed to participate response rate 89.5% of which 51.5% women. Age varied significantly between 20-75 years. Regarding existing ICT skills participants in all countries were familiar with basic use of computer and internet but very few used advance services. There was unanimous agreement that learning is facilitatedwith the help of family or friends. A combination of traditional and digital learning format was deemed most appropriate. The main obstacles involved lack of trainers, motivation and suitable educators.

Conclusions

There is latent need for the integration of ICT in elderly care. The development of suitable learning material and the involvement of motivated carers are key strategies for the successful implementation of such a reform.

Key messages

ICT is insufficiently used for elderly health education. Digital health can be beneficial for the elderly and their carers.
Maternal health care for refugee women in Germany: A qualitative approach on the interaction level
Authors: Kasper A
Published: November 2019

Background

In the recent past, the number of forcibly displaced people increased worldwide. About 1/3 of the persons seeking asylum in Germany are female. The majority of all refugee women who are coming to Germany are currently of childbearing age. Refugee women are considered a highly vulnerable refugee subgroup, as they frequently experience physical strains and psychological burdens while fleeing their home countries and being pregnant at the same time. Moreover, pregnancy and the following period require specialized care and support in order to allow a transition to maternity without complications. The aim of this project is to analyze maternal health care services for refugee women on the level of interaction with maternal health care professionals in Germany.

Methods

Maternal health care professionals in outpatient and clinical settings with experiences of caring for refugee women were recruited. Semi-structured interviews were conducted. The interviews are currently analyzed following the standards of qualitative thematic analysis.

Results

Maternal health care professionals experience challenges in executing particular maternal health care actions, such as taking the medical history where there is no communication possible or performing examinations where there is no or little privacy (e.g. in camps). In addition there are changes in tasks, which are no subject to originally maternal health care, such as organizing translation and transportation. Furthermore they face a shortage of resources (e.g. translators, time), which constrains them to find solutions on an individual level.

Conclusions

Maternal health care professionals provide maternal health care to refugee women under special circumstances (e.g. communication barriers, discontinuity of care). As there are limited resources (e.g. translators, time) they develop solutions and strategies on an individual level.

Key messages

Challenges and opportunities are disclosed by examining maternal health care professionals’ actions. Maternal health care improves through understanding maternal health care professionals’ strategies.
One-year activity of a “Casa de Espera” (Maternity Waiting Home) in the south of Angola
Authors: Fattorini M , Raguzzoni G , Cuccaro C , Nante N , Messina G , Ndilimondjo J M N , Ndapandula W , Tuitileni G , Caresia C , Putoto G
Published: November 2019

Background

Maternity Waiting Homes (MWHs) are structures usually located close to health facilities able to provide emergency obstetric care. Women can decide to be hosted in MWHs and when labour begins they move to the health facility for the delivery. Although the effectiveness of MWHs is debated, literature shows increasing findings about their importance. Aim of the study is to describe a one-year activity of a MWH located in Angola.

Methods

Since 2000, Italian Non-Governmental Organization (NGO) Doctors with Africa CUAMM supports the activities of the hospital of Chiulo in the district of Ombadja (Cunene province). Among the implemented projects, the NGO supports the local MWH (in Portuguese, “casa de espera”), providing dedicated staff and food for all the women hosted in the MWH. The MWH team routinely performs antenatal care visits and brief talks regarding maternal health. In case of pregnancy complications, the staff promptly refers women to the nearby hospital. The MHW team is also involved in routine data collection.

Results

In 2018, 703 women were admitted in the MWH. Three-hundred and forty-two (48.6%) were between 18 and 24 years of age. Four-hundred and eighty-two (68.6%) were invited to join the MWH by personnel of local health facilities, while 160 (22.8%) by family members and 61 (8.7%) by community health workers/traditional birth attendants. Age less than 18, previous abortion and/or caesarean were the most assessed factors for high risk pregnancy. In 2018, 1364 deliveries were performed in the hospital, and 593 (43.5%) concerned women hosted in the MWH.

Conclusions

To achieve the 2030 Sustainable Development Goals targets regarding maternal and neonatal mortality, the implementation of MHWs could represent an effective tool, especially in countries such as Angola where these indicators show a weak annual reduction. Regarding Chiulo’s MWH, an improvement of data collection could lead to a better comprehension of the efficacy of the facility.

Key messages

In the SDGs era, countries with a high burden of maternal and neonatal mortality should implement various and integrated approaches to achieve significant reductions of these indicators. Although the effectiveness of maternity waiting homes is still debated, increasing findings suggest that they could represent an effective tool to contain mother and child mortality.
Abortion among French students: result of a 15 years follow-up in a French university
Authors: Gerbaud L , Bourdet C , Chabanas B , Perrève A
Published: November 2019

Issue

The level of abortion in France is judged high, and since 2002 a policy is developed among students to lower it in this particular population

Methods

Since 2003, every 2 years we made an anonymous survey on abortion frequency, reasons and care in our university, which has between 12.000 and 12.000 she-students. We work on data from abortion centres of our area.

Results

Abortion rates are stable (5,3-8,5%0), half of the French rate for women (12,0-15,1%0).The risk is significantly lower for French students (6,3%0) compared to students from China (relative risk - RR 1,7, with a significant fall since 2011 - after a specific information campaign on contraception in France), North Africa (RR 2,0 stable) and Sub-Saharan Africa (RR 7,6 stable). ¼ had no contraception, ½ used condoms and 1/3 used oral contraception. 7,2% took emergency contraception. Medical abortion count for 1/3, but ¾ of the surgical techniques could have been replaced by medical drugs. After abortion, condoms are no more used and only 1% of the she-students decided not to take contraception. The main change is the fall down of the use of oral contraception after abortion (from 77% to 43%) replaced by intra-uterine device (IUD- from 1,7% to 22,5%) and contraceptive implant (CI- from 6,4% to 19,6%). Complete qualitative and quantitative results for 2018 will be also presented.

Lessons

General information on contraception did not change abortion rates, except for Chinese students. But, the increase use of hidden contraception (IUD and CI) after abortion encourage us to insist to the use of these hidden devices for the she-students belonging to social groups where contraception is discredited as a way to promote “bad habits”.

Key messages

Since 2003, abortion rates are stable among french students, and concerned mainly foreign students. The greater use ’hidden’ devices of contraception may improve this situation.
Cancer education support project: Spread of cancer education in Japan based on web search
Authors: Katayama K K , Sakaguchi M S , Ishikawa D I
Published: November 2019

Background

Since 2019, cancer education has been introduced in health classes from junior high school students in Japan. This research contributes to how “cancer education,” which is a newly launched cancer countermeasure plan, penetrates the general public.

Methods

In August 2018, the authors prepared an operation manual for classifying Web search results. A researcher majoring in informatics performed the operations outlined below. For the list (top 100 results of a Google search) of the Web search results using “cancer education” as the keyword, the link destinations starting from the top result were viewed in order using the browser.The name of the organization, the format of information media, summary of website information, and actions in case of a broken link were documented by the researcher.

Results

“Ministry of Education, Culture, Sports, Science and Technology Elementary and Secondary Education Bureau” occurred the most frequently at the rate of four times when the source word was “cancer education.” When this rate of occurrence was tabulated by the organization, the order was as follows: average companies (21.7%), prefectural (17.4), medical facility (12.0), and educational committee (9.8). In the format of information media, page link was the most common, followed by news articles and PDF files. The business type of the average companies were classified as follows: internet operations (30%), new website management companies (20), mail-order companies (15), and pharmaceutical companies (10).

Conclusions

Although public facilities and hospitals were more commonly involved in promoting cancer education, the holding of educational seminars by insurance companies and the creation and publication of cancer educational videos by pharmaceutical companies gradually trigger the interest of private companies in cancer education. The possibility of contribution to future development was demonstrated. This work was supported by 14th Hakuho Research Grant.

Key messages

In Japan, cancer education was introduced to school education from 2019. Private companies are expected to entry into cancer education in the future.
Health related behaviours of secondary students living in dormitory in Hungary
Authors: Skerlecz P , Gulyás B , Nedeczky L , Takács J , Rákosy Z s
Published: November 2019

Background

Previous studies have shown that unhealthy eating habits and lack of exercise are still widespread among high school students. Hungary and many other countries have attempted to introduce campaigns and health education programs among adolescents to promote healthier lifestyle, but the effectiveness of these programs is unclear. Our aim was to investigate the consistency between knowledge and behavior in adolescents.

Methods

A self-administered questionnaire survey was conducted in 9 secondary schools’ student dormitories, involving 163 students. Descriptive statistics were estimated and chi2- test was used to compare the prevalence between groups.

Results

Of the participants 69.3% reported their health status good, girls and those students who studied in vocational school frequently considered their own health bad (p = 0.002). Almost all of them highlighted the importance of regular physical activity, but 27.7% had low physical activity. Daily consumption of fruit and vegetables seems to be characteristic just half of the students, the structure of their daily snacks consists more in sugar-sweetened snacks (21.7%) and energy dense beverages (22.8%). Students with higher level of health-consciousness rated better their own health status and took exercise more frequently, but the higher level of health-consciousness had not positive effect on the healthy food consumption (p = 0.143).

Conclusions

Our findings suggest lack of exercise and unhealthy eating habits were still widespread among high school students. The results of the study showed that adolescents have sufficient knowledge about healthy lifestyle, however, it has little impact on their health-related behaviour.

Key messages

The most important characteristic of an effective health promotion programme is its ability to change behaviour. Health promotion programmes should continue in schools, especially focus on behaviour changing interventions to effectively influence the health of the students.
Teenage mothers: a long-term view on their well-being
Authors: van Tintelen A M G , Bolt S H , Jansen D E M C
Published: November 2019

Background

This study aims to address the lack of information about teenage mothers in different stages of their lives by exploring how they are doing in the long term and the social support they receive.

Methods

From December 2018 to February 2019 teenage mothers in the Netherlands were recruited by Fiom (an expert centre for unintended pregnancy), via social media and a website for teenage mothers (n = 248). Using an online survey, data were obtained to assess various outcomes, such as well-being, education, work, income, housing and social support. Respondents were divided into three groups: 0-3 years after teenage childbearing (short-term), 4-12 years (medium-term), >12 years (long-term). Results were analysed using univariate and bivariate descriptions in SPSS.

Results

Almost 80% of the respondents reported that they were doing well and were satisfied with their life. 63.3% had a job, and 17.0% was enrolled in education. Short-term mothers worked fewer hours per week compared to long-term mothers (p < 0.001). 85.1% of the respondents reported that they received benefits, short-term mothers receiving more benefits than long-term mothers (p < 0.001). The majority (78.2%) was satisfied with their living conditions; short-term mothers were less satisfied than long-term mothers (p = 0.031). 36.3% of the respondents smoked cigarettes. Most support was given by family (83.1%), mainly from female relatives. About 24% of the respondents received formal support.

Conclusions

This study shows that teenage mothers, on average, were doing well and were satisfied with their life, in both the short and long term. Regarding income and housing, short-term mothers were in a less favourable position. These results suggest that as the years pass, teenage mothers overcome difficulties. Since the association between well-being and social support on the long term is unknown, we advise investigating the effect of social support on the outcomes of teenage childbearing.

Key messages

Both in the short-term and the long-term, most teenage mothers were doing well and satisfied with life. Regarding housing and income, short-term mothers function less well compared to long-term mothers.
Caesarean Delivery Rates in Birth Centres: confrontation using Robson Classification
Authors: Bocci G , Nante N , Napolitani M , Scinicariello I , Kundisova L , Messina G , Alaimo L
Published: November 2019

Background

A caesarean section (CS) is a life-saving procedure, reducing perinatal mortality and morbidity, over last decades CS rates are increasing. In 2015 the Robson classification (RC) was introduced by WHO as a global standard for assessing, monitoring and comparing CS rates within healthcare facilities and between them. The aim of this cross-sectional study was to identify the most numerous groups according to RC.

Methods

All women, who delivered by CS from January 2015 to June 2017 in two hospitals in the province of Siena (Italy): I level Birth Centre of Grosseto (GR) and II level Birth Centre of Siena (SI) were included. Age, type of hospital and group based on RC were extracted from Medical Register. The RC divides women into 10 groups based on 5 basic obstetric characteristics (parity, number of foetuses, previous CS, onset of labour, gestational age, foetus presentation). The percentages of the group’s contribution to the overall CS rate were calculated and confronted for two birth centres. All analysis was performed with Stata.

Results

A total of 2115 women was analysed, 50.5% from SI. Average age was 34.3±5.7; significantly higher for SI (34.7±5.6vs33.9±5.8). Most contributing groups were group V: multiparous, singleton, cephalic, term, with previous CS (24.2%), group II: nulliparous, singleton, cephalic, term, induced labour or CS (24%), group I: nulliparous, singleton, cephalic, term, spontaneous labour (11.45%), group VIII: multiple pregnancy (10.7%) and group X: singleton, cephalic, pre-term (10.4%).

Differences for type of birth centre were observed for groups I, II, V and VIII: I and VIII were more numerous in SI, II and V in GR (chi2; p < 0.05).

Conclusions

The most numerous groups were I, II e V, concordant with literature. Reduction of CS rates in group V could be obtained through lowering of primary CS rates and by promotion of Vaginal Birth After CS. Healthcare professionals could help to reduce labour-related anxiety and elective CS rates.

Key messages

The most contributing groups to overall caesarean section rates were groups I, II e V, as reported in literature. Reduction of CS rates could be obtained through lowering rates of primary CS, but also by promotion of Vaginal Birth After CS.
Adolescent health literacy in 3 European cities and its association with smoking and smoking beliefs
Authors: Lindfors P , Kinnunen J M , Paakkari L , Rimpelä A , Richter M , Kuipers M A G , Kunst A E
Published: November 2019

Background

Beliefs about smoking have been found to be associated with smoking behaviour. Similarly, health literacy (HL) as a competence to make health-related decisions has been identified as an independent factor to explain differences in smoking. However, little is known about adolescents’ HL in different countries, and how HL is associated with health behaviour and health-related beliefs. The aim of this study is to describe the levels of HL in three European cities, and how HL is associated with smoking and beliefs about smoking consequences.

Methods

In 2016 as part of SILNE-R study, 5,088 adolescents aged 14 to 16 years answered a school survey in Amersfoort (NL), Hanover (GE) and Tampere (FI). Health Literacy for School-aged Children (HLSAC) covering five components (theoretical knowledge, practical knowledge, critical thinking, self-awareness and citizenship) was used. Questions on smoking and five statements on beliefs about smoking consequences were asked. The analyses were conducted with multinomial logistic regression, and with generalised linear mixed models.

Results

HL was the highest in Tampere (Finland), then in Amersfoort (the Netherlands), and the lowest in Hanover (Germany). HL was not associated with smoking, but it was positively associated with beliefs about smoking consequences, overall and when stratified by city.

Conclusions

Health literacy level was the highest in Tampere (FI), which may be due to Health Education as a curriculum-based school subject. In other cities, the education on health is not offered so systematically. Highly health literate students also know more about smoking consequences, but it does not affect their smoking behaviour. Systematic and compulsory health education in schools can be recommended in order to enhance adolescents HL.

Key messages

Adolescents’ high health literacy was associated with more accurate believes on smoking consequences. Health literacy was not associated with smoking behavior.
Adolescents’ use of an online question-answer service to gain health knowledge
Authors: Lassemo E , Sand K
Published: November 2019

Background

Adolescents prefer to collect information online. However, research has also shown than adolescents lack competency in googling information. Furthermore, boys are less likely than girls to seek help and to discuss their problems. Hence, an online information and question-answer (QA) service staffed by professionals, like ung.no, may provide what adolescents desire. The ung.no QA service is open to ages 13-20, and all questions and answers are publicly available in a searchable database.

The aim of the present study is to investigate who the users of the ung.no QA-service are and what their main concerns are.

Methods

Data consisted of all questions posted to ung.no 2016-2018. Descriptive analyses were performed using categorization of questions established by ung.no.

Results

The data consisted of N = 128 289 questions. Overall 68.5% of questions were posted by girls (p < 0.01). The gender option ’other’ was chosen by 1.7%. Younger adolescents aged 13-16 posted 66.1% of the questions (p < 0.01). The age imbalance was most pronounced among girls. The age distribution suggests that users <13 and >20 present themselves as 13- and 20-year olds respectively. Three categories contained 80% of questions, these concerned: body and health (48.1%); school and education; and friends and love. While 52.4% of girls’ questions concerned body and health, boys’ questions were more evenly distributed among categories. Boys had, relatively, more questions regarding laws and rights, intoxicating substances and school, education and work.

Conclusions

Analyses reveal that 7 out of 10 users of the ung.no QA service are girls, and that the main area of concern is body and health. Results indicate a need for this QA service for wider age-range. The outreach of the ung.no QA service is universal, and hence has great potential public health impact. The results call for action identifying ways to reach boys and in turn efface gender inequality in help seeking behaviour and improve public health.

Key messages

Seven out of 10 users of a public digital QA service for adolescents ages 13-20 are girls, and seven out of 10 are in the youngest age group 13-16. The main areas of concern posted to a public digital QA service are regarding body and health, and school and education.
The role of maternal psychological control and pressure on body image in a child's drive for thinness
Authors: Hricova L , Bacikova-Sleskova M , Benka J , Orosova O
Published: November 2019

Background

The drive for thinness (DFT), an indicator of disordered eating, is strongly predicted by body dissatisfaction (BD). In early adolescence, there are other predictors of DFT which rise from the mother-child relationship such as maternal psychological control (PC) and the motheŕs pressure on the child's body image (MP). The explanation of DFT by the child's self-perception of BD and PC as well as the mother’s perception of MP among early-adolescent boys and girls has great importance for public health and is therefore the aim of this study.

Methods

The research sample consisted of 191 Slovak adolescents (53.4% of girls, Mage=12.54, SD = 0.58) who completed the Children’s Body Image Scale, DFT subscale of Eating Disorders Inventory, Psychological Control Scale-Youth Self-Report; and their mothers (Mage=40.45, SD = 4.71) who completed the Parental Influence Subscale. Structural equation modelling was performed.

Results

A hypothesized model was tested to explain DFT by PC and BD, associated with four sources of MP. The tested model did not fit the data well enough. A modified model, where three insignificant sources of MP were excluded, fitted the data well (SRMR=.06, CFI=.95, RMSEA=.04, PCLOSE=.74) and explained 22% of the variance in DFT. The model was statistically equivalent for both genders. DFT was associated with BD (β=.42; <.001), PC (β=.2; <.05) and indirectly with the source of MP - child's body image preoccupation (CBI) (β=.15; <.05), through BD. CBI was associated with BD (β=.27; <.05).

Conclusions

The results point to the importance of BD, PC and CBI - a factor reflecting motheŕs direct pressure on the child's body image, in explaining DFT among early adolescent boys and girls. Other sources of MP (reflecting the motheŕs concern about her own body image) were not significant in this context. BD and disordered eating prevention strategies for adolescents indicate a respectful mother-child relationship, avoiding pressure and control.

Key messages

A motheŕs direct pressure on child's body image, psychological control and body dissatisfaction are significant in explaining the drive for thinness among early adolescents. Body dissatisfaction and disordered eating prevention strategies for adolescents indicate a respectful mother–child relationship, avoiding pushing a child to think, feel, or act as the mother wants.
How early childhood services address health inequalities and child wellbeing in France
Authors: Guével M R , Cury P , Bissège F , Pironom J , Dollet A , Quidu F , Porcherie M , Gasquet-Blanchard C , Simar C ,   The Récits project
Published: November 2019

Early childhood (0-6 years old) is a key period when talking about health inequalities (HI) and child wellbeing. Over the past decades, research has shown the importance of early investment. In France, early childhood is a period covered by different public policies and different stakeholders from different sectors, i.e. health, education, childcare facilities, social affairs, recreational activities, etc. Both coverage of 0-6 years and intersectorality, are rarely connected in the literature. Based on Bronfenbrenner ecological approach, the Récits project aims to better understand how issues related to HI and child wellbeing are addressed at a local level within local policies as well as by professionals from the different sectors. It also aims to better understand the relations established by families with those professionals.

Two French départements are studied: Allier (03) and Ille-et-Vilaine (35); both are characterised by social and spatial HI. Within these departments, two local authorities were selected as case studies for in depth analysis: secondary analysis of social and health indicators are carried out and qualitative data are gathered through the collection of institutional documents, observations and interviews with local decision-makers, professionals and families.

First results, focusing on local public policies and how they are implemented by local stakeholders, highlight the diversity of the strategies developed according to the local social context and to the sector. Partnership between the different sectors is valued in policies however the way they work varied, notably, depending on the history of the collaboration.

By clarifying the issues related to the articulation between public policies, local interventions and individual and collective practices of early childhood professionals, this research will contribute to improve and develop strategies to reduce HI and support children and families with respect to their expectations.

Key messages

Thanks to its ecological and intersectoral approach, this project will highlight how early childhood services may contribute to tackle health inequalities and to improve child WB. Addressing the complexity of the interactions between public policies, professionals and families will lead to a better understanding of the current challenges crossing the field of early childhood.
External resources of resilience in association with the alcohol use among early adolescents
Authors: Abrinkova L , Orosová O , Bacikova-Sleskova M , Štefaňáková M , Gajdošová B
Published: November 2019

Background

This study aimed to explore the role of external resources of resilience in explaining the alcohol use in past 30 days among early adolescents.

Methods

A representative sample of 653 (52.9% girls) early adolescents (mean age =11.72 at T1; mean age = 13.09 at T5) was collected within a five wave repeated measure design with a baseline(T1), 3-month follow up(T2), 6-month (T3), 12-month(T4) and 18-month follow-up(T5). Alcohol use (AU) in the past 30 days was measured by a questionnaire of the international study ESPAD. School support (SS), school activities participation (SAP), home support (HS) and home activities participation (HAP) were measured by the Resilience Youth Development Module and represented external resources of resilience. Respondent's AU (dichotomized: 0-not used, 1-used) served as the outcome variable and external resources of resilience served as the independent variables. Binary logistic regressions were used to analyze the data.

Results

At T1, SS (95% CI = 0.77-0.96; p<0.01) was associated with lower AU while SAP (95% CI = 1.00-1.36; p<0.05) was associated with higher AU. At T2, SS (95% CI = 0.73-0.94; pα<0.01) and HS (95% CI = 0.70-0.98; pα<0.05) were associated with lower AU. AT T3, no significant association was found with AU and finally at T4 and T5 only HS (95% CI = 0.81-1.00; T4=pα<0.05), (95% CI = 0.78-0.96; T5=pα<0.01) remained significantly associated with lower AU at T4 and T5 while controlling for alcohol use at T1. AU increased significantly across the five waves (pα<0.01). Gender differences in AU were found only at T1 (p<0.01) with boys scoring higher.

Conclusions

The 5 measurement revealed a trend of the external resources of resilience in AU shifting from the school environment to the home environment. Moreover, it seems that SAP is associated with a higher probability of AU through more opportunities for group activities which are often associated with AU.

Key messages

School environment plays an important role in explaining AU in younger early adolescents. Home environment plays an important role in explaining AU in older early adolescents. The results point to an increasing trend in alcohol use among early adolescents.
Childhood life events and disturbed eating behaviors in a population-based cohort in the Netherlands
Authors: Thomas R , Diemer E , Siliquini R , Jansen P W
Published: November 2019

Background

Adversities such as maltreatment and physical and emotional abuse are recognized risk factors for eating disorders (EDs) in adolescents and adults, but whether such adversities are also associated with eating behaviors in childhood has been less explored. Our aim was to examine whether a wide range of life events can predict emotional overeating and restrained eating in childhood, which are potential precursors of EDs.

Methods

The study is embedded in Generation R, a prospective population-based cohort. The sample included 4653 children aged 10 years. Emotional overeating was assessed with the Children’s Eating Behavior Questionnaire, and restrained eating with the Dutch Eating Behavior Questionnaire. Mothers reported the occurrence of 24 adverse events in their offspring’s childhood. Regression analyses were conducted, both unadjusted and adjusted for gender, ethnicity, and parental education and psychopathology.

Results

Unadjusted models showed that a higher number of life events is associated with more emotional overeating and more restrained eating; effect estimates attenuated slightly in the adjusted model, but remained significant (per 1 more life event: B = 0.05, 95%CI 0.02-0.08; B = 0.04, 95%CI 0.02-0.07, respectively). Particularly, participants who experienced at least 3 life events had high levels of emotional overeating and restrained eating (adjusted model: B = 0.20, 95%CI 0.06-0.33; B = 0.21, 95%CI 0.08-0.33, respectively). The specific maltreatment related life events were not significantly associated with eating behaviors, probably due to low prevalence of these events (n = 149).

Conclusions

This novel, population-based study shows that early life adversities may predict disordered eating behaviors in childhood. The results are in line with clinical studies on life events and EDs. If the studied eating behaviors are indeed precursors of EDs, these results may offer potential for prevention and early intervention to avoid the development of full-blown EDs.

Key messages

Eating disorders account for more than 2% of the global disease burden, thus representing a major Public Mental Health topic in the EU; more and new measures are required for early detection purposes. Life adversities predict disordered eating behaviors in childhood, which are considered precursors of eating disorders: early detection of this association may avoid development of eating disorders.
Raising young people’s awareness on sexual and reproductive health issues
Authors: Papadakaki M , Plevri M , Vagionaki K , Papadomanolakis G , Androulaki R , Tsiritas G , Koutroumanou L M , Aleiferis G , Vasilakis M , Chliaoutakis J
Published: November 2019

Issue/problem

Despite the high prevalence of sexually transmitted diseases(STIs) and abortions among Greek youth, sexuality education is not yet part of the curriculum of Greek schools and the Greek family is not ready to address these issues with comfort.

Description of the problem

A “one-stop information point” was organized for one week in major cities of Crete Region as part of a community health program, which was funded by the Regional Authority of Crete to address “Gender Equality in the Region of Crete within 2018-2020”. The project aimed at increasing young people’s awareness of sexual health issues using a “peer education” approach and a youth-friendly information package. Undergraduate students from health, mental health and social care professions acted as volunteers upon receiving a rigorous 2-day training by sexual and reproductive health experts. The questions to be answered by the project were: “What are the main concerns of adolescents regarding their sexual health? How much satisfaction could adolescents gain by a “one stop information point” and a youth friendly “information package” offered by peers?

Results

Serious information gaps regarding contraception and STI’s and a number of stereotypes regarding healthy relations and sexual orientation have been recorded. Gender dysphoria is still an issue that remains unaddressed among young people. A youth-friendly website (LaHeRS Lab) and short videos are now available as part of the project to facilitate young people’s access to information. A large social media network of young people interested in sexual health issues has been formed locally and is growing nationally. The intervention was received with satisfaction.

Lessons

“One-stop information centres” and “peer education” have been an ideal combination to address sensitive issues among young people.

Key messages

Knowledge gaps and unsafe sexual practices are prevalent among adolescents. Sexuality education should be offered in early school life.