bluuebunny/crossref_metadata_2025 huggingface dataset:
Healthcare organization and management barriers and facilitators for health promotion in primary care
Authors: Rogers HL , Pablo Hernando S , Nunez Fernandez S , Sanchez A , Martos C , Moreno M , Grandes G
Published: October 2021

Background

There are challenges in translating evidence-based interventions into practice, and the need for health care organization, management, and policy changes to align with health promotion activities within the health and social care system is well-documented. This study aims to elucidate the role of these factors as barriers/facilitators influencing the implementation of an evidence-based health promotion intervention in primary care centers in the Basque Country, Spain.

Methods

Seven focus groups were conducted with 49 health professionals from 6 primary care centers participating in the Prescribing Healthy Life (PVS) program. Text was analyzed using the Consolidated Framework for Implementation Research (CFIR) focusing on those constructs related to health care organization, management, and policy.

Results

The health promotion intervention was found to be compatible with the values of primary care professionals. However, professionals at all centers reported barriers to implementation related to: (1) external policy and incentives, (2) compatibility with existing workflow, and (3) available resources to carry out the program. Specific barriers related to high caseloads, contracting issues, short consultation times, and lack of appointment times for lifestyle counselling. Other barriers/facilitators were related to CFIR constructs networks and communication, culture, relative priority, and leadership engagement. A set of nine specific barriers-facilitators emerged.

Conclusions

In some centers, certain facilitators addressed barriers identified in other centers influencing implementation of a health promotion intervention in primary care. Proactive identification and modification of barriers by healthcare managers and policy makers can help to ensure effective integration of health promotion into primary care.

Key messages

Implementation science methods for program evaluation can help identify barriers and facilitators to health promotion implementation in primary care. Policy and incentives, compatibility, available resources, networks and communication, culture, relative priority, and leadership engagement influenced successful health promotion implementation.
Online Health information, health literacy and therapeutic compliance: a theoretical framework
Authors: De Caro W
Published: October 2021

Introduction

The expansion of information sources and easy access to virtual sources are radically changing health information-seeking behavior. In the past, direct interaction with health care providers is rapidly decreasing. A high percentage of individuals are in the habit of checking their health online: information overload, fake news, misinformation and echo chambers effect will be encountered.

Methods

A review of the literature on health literacy, online health information and its influence on health status and therapeutic compliance was carried out in order to develop a new theoretical framework. The insight approach will allow health care providers to account for the complexity of the relationship between health status and online information and will be useful in moving to a different perspective to assess the field.

Results

The development of this theoretical framework focuses on the role of online information seeking behaviors' and its connection to levels of health literacy, health status and treatment compliance.

Evidence of the spread of misinformation, fake news and at the same time the echo chamber effect has an important effect on the health. An important debate is growing in the literature on the role of fact checking and institutional/expert information in really changing the health behavior of individuals.

Conclusions

The main development of this framework is certainly related to the need to assess the level of health literacy, also in order to ensure a comprehensive understanding of health information behaviors and their relation to health status. Furthermore, it would be desirable to develop innovative health promotion campaigns as well as to develop the role of nurses as health educators. There is a need to further evaluate the barriers that prevent individuals from having full compliance and an informed and critical understanding of health information.

Key messages

Adherence is a key factor. Health information online is the key for improve health literacy levels.
HIV/AIDS stigma among University students in Ancona (Italy) and Novi Sad (Serbia)
Authors: Fortunato C , Radić I , Barbadoro P
Published: October 2021

Background

Sigma associated with HIV/AIDS can be a considerable barrier to HIV prevention. The aim of the study was to assess factors associated with stigmatizing attitudes among university students.

Methods

The study was conducted as a cross-sectional study among 1305 university students in Ancona (Italy) and Novi Sad (Serbia) from October to December 2020 (67.7% females). The mean age of participants was 21.94 ± 2.45. The instrument of the study was an online questionnaire that included socio-demographic data and questions about attitudes toward HIV/AIDS. Stigma was analyzed using five questions and the stigma score was calculated (a lower score indicated a higher stigma attitude).

Results

Among University students 89.7% would share a classroom with a student with HIV/AIDS, 2.5% of students think that students with HIV/AIDS should have separate classes and 5.8% are not sure if they should be in separate classes. Only half of the students (50.1%) said that they would share a bathroom with HIV/AIDS positive students and 80.4% said that they would buy fruits from a HIV/AIDS positive person. Every second student (55.1%) thinks that HIV-positive women should have children. The mean stigma score of the respondents in this study was 3.66 ± 1.26. Stigma score was lowest among youngest participants and among students at lower study year. The stigmatizing attitude was less present among students of medicine (4.09), comparing to other faculties (3.33) (p < 0.001). There were no statistical differences according to gender, data about who they live with, material status of the family and between Universities.

Conclusions

Results of this study showed that there are some negative attitudes toward people living with HIV/AIDS among university students. The stigmatizing attitude was more common among younger students.

Key messages

Stigmatizing attitude toward HIV/AIDS is still present among younger generations. Need for more health promotion activities among students from both countries.
Determinants of eating disorders among morrocan medical students
Authors: Tsoumbou-Bakana G , Slith H , Traore B , Mchichi Alami K , Nani S
Published: October 2021

Introduction

Eating disorders (EDs) are multifactorial in origin. Medical students are a special population because they are particularly young and exposed to stress, workload and the experience of illness in the field.

Objective

To determine the prevalence of EDs and associated factors among medical students

Methods

This was a cross-sectional study conducted from November to December 2020 among medical students at the Faculty of Medicine and Pharmacy in Casablanca. Data were collected using a hetero questionnaire distributed online. The presence of EDs was measured using the SCOFF (Stick, Control, One stone, Fat, Food) scale and anxiety and depression were measured using the HAD (Hamilton Anxiety and Depression) scale. The sample size was calculated a priori and multivariate statistical analyses such as logistic regression were performed. The α threshold was set at 5%.

Results

A total of 315 students participated in the study, the mean age was 21.01+/- 2.5 years, the majority were female (68.7%), and undergraduates represented 61.7% of the sample. The incidence of EDs was 39.9%. Regarding BMI (Body Mass Index). In terms of BMI, 65.5% had a normal BMI, anxiety and depressive symptoms were absent in 48.4% and 72.2% of cases respectively. Factors associated with EDS were: use of weight control (OR: 7.14 [1.72- 32.519], p = 0.00), BMI (OR: 1.142 [1.06-1.22], p = 0.000) and anxiety symptoms (OR: 3.51 [51.98-6.23], p = 0.000).

Conclusions

The frequency of eating disorders is high among medical students. The knowledge of the potentially associated factors allows us to generate hypotheses in order to define the axes of prevention of these disorders.

Key messages

Eating disorders are a health problem among medical students. Eating disorders are multifactorial in origin.
Identifying barriers to care to inform Lassa Fever health policies in rural Nigeria
Authors: Tiv MH , Friant SR
Published: October 2021

Lassa fever (LF) is an emerging viral haemorrhagic disease endemic to West Africa that can potentially cause a global pandemic. Nigeria has experienced yearly LF outbreaks since 2012 and the 2018 outbreak recorded an unprecedented number of cases and deaths. A critical gap in controlling neglected tropical diseases such as LF is our limited understanding of how people access care and how structural and cultural factors constitute barriers to care. This study examines concepts of illness and healthcare-seeking behaviours to investigate these barriers. From October to December 2019, we conducted a mixed-methods community-based study consisting of 51 interviews, 21 focus groups, and direct observations, in 5 villages of a 2018 LF hotspot in Ebonyi state, Nigeria. Participants' perceived severity and frequency of diseases aligned with the current biomedical understanding. In contrast, some diseases were associated with witchcraft or bad behaviours. Most participants knew LF disease but denied its yearly recurrence. In addition, LF victims and caregivers suffered from a strong stigmatisation. We identified a mismatch between preferred and actual healthcare-seeking behaviours. Most participants preferred hospital care but defaulted to traditional healers and patent medicine vendors (chemists). Reasons reported were high care fees, life-sustaining jobs conflicting with commuting time to hospitals, and a low English literacy. Age and education correlated with healthcare-seeking behaviours: elder and less formally educated people preferred traditional healers. LF-related stigma reportedly impacted timeliness and adequacy of care during the 2018 outbreak. Participants had a good knowledge of the diseases and true barriers to care came from structural factors and LF-related stigma. This led to mismatches between disease knowledge and healthcare-seeking behaviours. Awareness campaigns may have a limited impact if they focus on disease knowledge without addressing barriers to care.

Key messages

To enhance LF detection and control, LF policies in rural Nigeria should focus on barriers to care through public health messaging addressing stigma and through bringing care closer to remote areas. This community-based study illustrates the importance of understanding the socio-cultural ecology of the diseases to inform evidence-based and locally adapted strategies for disease control.
Reduce speeding in times of COVID-19 in Buenos Aires, Argentina
Authors: Cordoba M , Sanguinetti C
Published: October 2021

Buenos Aires has a mortality rate due to road crashes of 3.6 per 100,000 habitants. 6/10 fatal incidents are due to speeding. Unfortunately, the City has an outdated electronic control system and a small, corps of traffic agents oversees the execution of mobile speed controls. Under the part of Partnership for Healthy Cities, the city implemented a speed reduction policy to strengthen the existing speed management by measuring speeds. The observation points were established from the sampling of 567 avenues segments according to their level of danger and # of traffic lights. 74 observation points were selected. The final sample (1,572,879 observations) obtained a representative balance of the vehicular circulation arteries according to the territory's geographical zones. 92.1% of the vehicles that circulate on the avenues respect the speed limits while 7.9% exceed the speed limit. In passenger transport and trucks, the average number of exceeding the speed limits more than doubled. During COVID-19 lockdowns, the vehicles that exceeded the maximum speed reached 9.1%. As movement and mobility changed in Buenos Aires due to COVID-19, they used this opportunity to reduce the speed limits and add cycling lanes. At the start of 2020, there were 300,000 daily trips by bicycle and during lockdown, trips rose between 24% and 114%. It is expected that by next year they will be 500,000 per day. 17 km of bicycle lanes were built in two of the largest avenues in the city and the speed limit was reduced to 50 km/h on these avenues. In addition, it was detected that both avenues were the ones on which the most trips were carried out outside the formal network of bicycle lanes, which is 250 kilometers long. On journeys that are made outside this circuit, the risk of a road accident increases by 86%. The planning process must carry out, even when in an emergency. Training and socialization of interventions for all road actors are necessary to promote road awareness.

Key messages

Cities are catalysts for actions to promote public health interventions on the front line to emergencies and they have the responsibility of continuing to manage the NCDI and injuries. Healthy, safe, and sustainable mobility are parameters to be met in interventions that promote road safety.
Psychosocial school conditions and students’ positive mental well-being
Authors: Brolin Låftman S , Modin B , Granvik Saminathen M , Östberg V , Löfstedt P , Rajaleid K
Published: October 2021

Background

School is a key social determinant of adolescent health. However, earlier research on psychosocial school conditions has largely focused on their relationship with aspects of adverse health, and fewer studies have examined the links with positive health. The aim of this study was to investigate boys' and girls' experiences of school demands, teacher support, and classmate support and their associations with positive mental well-being.

Methods

Data were derived from the Swedish Health Behaviour in School-aged Children (HBSC) study of 2017/18, with information collected among 1,418 students in grade 9 (∼15-16 years). School demands, teacher support, and classmate support were captured by indices based on multiple items. Positive mental well-being was measured by the Short Warwick-Edinburgh Mental Wellbeing Scale (SWEMBWS). Gender-stratified linear regression analyses were performed, clustering for school class.

Results

Higher demands were associated with lower mental well-being (boys: b=-0.36, p < 0.05; girls: b=-0.65, p < 0.05). Conversely, mental well-being increased with greater teacher support (boys: b = 0.53, p < 0.05; girls: b = 0.56, p < 0.05) and classmate support (boys: b = 0.70, p < 0.05; girls: b = 0.50, p < 0.05). Interactions between demands and the support variables showed that at the lowest levels of teacher and of classmate support, mental well-being was low and not associated with school demands. With increasing levels of teacher and classmate support, the overall level of mental-well-being increased and revealed an inverse association between school demands and mental well-being.

Conclusions

The findings indicate that psychosocial school conditions are important not only for adverse health among adolescents, but also for their positive health. The study contributes with knowledge about how psychosocial conditions in school may hinder or enhance positive health among students.

Key messages

School demands, teacher and classmate support were associated with mental well-being among both boys and girls, although the association with demands was seen only at higher levels of support. The findings indicate that psychosocial school conditions are important not only for adverse health among adolescents, but also for their positive health.
Egyptian HCPs’ awareness, attitudes and practice to SHS exposure among pregnant women and children
Authors: Hassanein Z , Langley T , Murray R , Bogdanovica I , Leonardi-Bee J
Published: October 2021

Background and aims

Around half of Egyptian pregnant non-smoking women and children are exposed to secondhand smoke (SHS), which cause serious morbidities. Health care professionals (HCPs) are well placed to help reduce SHS exposure by encouraging avoiding SHS. This study aimed to explore risk-awareness, attitudes and practice of HCPs in relation to SHS exposure among pregnant women and children in Egypt.

Methods

Cross-sectional survey of HCPs working in public maternal and child health clinics in Assiut city, Egypt. The survey included questions on risk-awareness, attitudes and counselling practice. Descriptive and regression analysis was performed to explore factors associated with high risk-awareness, supportive attitudes, and good counselling practice.

Results

367 HCPs participated in the survey with the majority being nurses (45%) and gynaecologists/obstetricians (21%). 12.5% of HCPs were smokers, and considerable proportion of HCPs reported being exposed to SHS at workplace (70.3%) and at home (51.7%). Just over half of all HCPs (55.9%) had high SHS risk awareness. Speciality, serving urban communities, and home SHS exposure were significantly associated with high-risk awareness. 52.9% of HCPs had supportive attitude towards preventing SHS exposure. Being female, serving rural communities, home SHS exposure were significantly associated with supportive attitudes. Only 51.8% of HCPs reported good counselling practice, which was explaining SHS hazards and advising to avoid it. Being female, serving rural communities, not exposed to SHS at home, and previous training on smoking cessation service were significantly associated with good counselling practice.

Conclusions

HCPs' awareness, attitudes and practice regarding the risks of SHS to pregnant women and children in Egypt are at low levels. Training is required for HCPs to improve their knowledge and skills and be able to help pregnant women and children to avoid SHS exposure and reduce consequent health burden.

Key messages

HCPs’ awareness and practice regarding risks of SHS to pregnant women/children in Egypt are inadequate. HCPs’ training is essential to help pregnant women/children to avoid SHS and reduce health burden.
Folic acid supplementation in the Congenital Anomalies population-based registry in a Spanish Region
Authors: Cavero-Carbonell C , Barrachina-Bonet L , García-Villodre L , Páramo-Rodríguez L , Guardiola-Vilarroig S , Zurriaga O
Published: October 2021

Background

The Congenital Anomalies (CA) population-based registry of Valencian Region (RPACCV) has identified 11376 cases, live births (LB) and stillbirths (SB), between 2007-2018 with at least 1 major CA, diagnosed prenatally or up to 1 year old. The Folic acid supplementation (FAS) during the pregnancy is also registered.

Aim

To identify differences in sociodemographic and clinical characteristics and in CA presentation, in cases from RPACCV according to prenatal FAS.

Methods

A cross-sectional study was performed using the RPACCV to identify exposure to FAS (yes/no) in pregnancies with a born (LB and SB) with CA between 2007-2018. Pregnancies with unknown exposure were excluded. Percentages and their 95% confidence intervals (95%CI) of the sociodemographic and clinical characteristics of the cases were determined and compared according to pregnant exposure to FAS. Frequency and its 95%CI of the different CA groups were identified by exposure.

Results

14.1% of pregnancies (1602) were exposed to FAS and 10.4% (1182) were not, 75.5% were excluded. Statistically significant differences weren't found for sociodemographic and clinical characteristics according to exposure. In children of women exposed 1777 CA were identified and 2019 CA in those unexposed. Statistically significant differences were found in these CA groups (shown as % in the exposed/% in the unexposed): Heart defects (7.1%/52.7%), Respiratory (0.2%/1.2%), Digestive (2.3%/5.3%), Genital (2.5%/4.8%), Urinary (3.9%/9.3%), Limb (6.8%/9.4%), Oro-facial clefts (25.4%/2.8%), Eyes, Ears, Face and Neck (3.8%/1.2%).

Conclusions

Several studies identified that FAS prevents from some CA. The fact that in only 25% of pregnant women there is information about FAS, highlight the difficulties of its registration in the clinical documentation. However, with the available information, it was identified that children of unexposed pregnant women presented more CA and from groups with a higher impact on morbidity and mortality.

Key messages

In Spain, Folic acid supplementation doesn’t require a prescription and, as its use is customary prior and during pregnancy, it doesn’t seem to be considered as significant drug exposure in pregnancy. Differences between pregnancies exposed and unexposed to folic acid supplementation were found regarding the number of congenital anomalies presented in their children and its severity.
Cervical cancer screening in pregnancy: a review of specific indications in the Italian regions
Authors: Catalini A , Acuti Martellucci C , Morettini M , Fraboni S , Massetti L , Giacomini G , Pasqualini F
Published: October 2021

Introduction

Cervical cancer represents the second most frequently diagnosed cancer during pregnancy. Screening programmes have allowed earlier diagnosis and greater treatment options. Many studies have confirmed that Pap smear testing is safe during pregnancy, but some healthcare workers are still reluctant to perform them in fear of adverse pregnancy outcomes. This work aims to systematically evaluate the presence of specific indications on Pap smear during pregnancy in the protocols of organized screening programmes across all Italian regions. These would reassure the healthcare professionals when screening pregnant women.

Methods

We carried out a research on Google and also on the official websites of all 21 Italian regions/autonomous provinces, gathering all cervical screening related documents. If the organized screening protocols did not include indications on Pap smear during pregnancy, clinical or technical documents with detailed descriptions of the cervical screening pathway were selected. Subsequently, we summarized the collected evidence for all regions: presence of a comprehensive protocol for cervical screening, the provision of indications for pregnant women, and their consistency with national guidelines.

Results

20 out of 21 regions had comprehensive protocols for the standardised provision of cervical screening within the organised, publicly funded, programmes. Only five out of these 20 included indications specific for pregnant women, and all these were consistent with the guidelines provided by national scientific societies.

Conclusions

Our comprehensive analysis of cervical screening documents provided by Italian regions showed an alarming lack of specific indications on the execution of screening Pap smears in pregnant women. Clear indications should instead be widely available to screening staff, in order to appropriately perform cervical screening of pregnant women.

Key messages

Only a minority of the Italian regions explicitly included indications for Pap smear execution during pregnancy. The presence of these indications is strongly warranted as it would allow timely, safe, and appropriate cervical screening also for pregnant women.
Apparent life-threatening events in infants
Authors: Ameayou S , Salimi S , Hassoune S , Nani S , Alaoui-inboui F
Published: October 2021

Background

The incidence of infant apparent life-threatening event (ALTE) was reported as 0.6-2.4 per 1000 live birth. The difficulty of the diagnosis lies in the delicate interpretation of the results of the clinical examination and the complementary examinations. The objectives of this study were to describe epidemiological, clinical and paraclinical characteristics of infants hospitalized for ALTE and to determine the most common diagnosis.

Methods

We conducted a case serie from January 2013 to April 2018 in the pediatric ward 2 at Abderrahim Harrouchi Children's Hospital, Casablanca of all infants aged less than 2 years hospitalized for malaise (newborn excluded). We obtained our data using a standardized form of service. We described our data by mean, frequency and percentages using SPSS 16.

Results

The mean age of onset of symptomatology is 4.8 months. Recurrence of discomfort was present in 30% of cases. The socio-economic conditions were unfavorable in more than half of the cases (63.3%). Clinical examination was abnormal in 6.6% of cases. Complementary examinations performed systematically in all patients were Blood cell count, blood ionogram, CRP, blood glucose and chest x-ray. Other examinations were performed according to the history and the clinic data. The most common diagnosis was gastroesophageal reflux (36.7%), cardiac problems (16.7%), lower respiratory tract infection (13.3%), and ‘'unknown'' (26.6%).

Conclusions

Few complementary examinations are systematically needed and their performance is increased if they are oriented by a careful history and physical examination which then allows to advance in the diagnostic procedure.

Key messages

Complementary examinations are largely inconclusive and only a history and complete clinical examination can make it possible to advance in the diagnostic procedure. Infants who demonstrate historical or physical examination elements suggestive of a specific etiology of their event, such as gastroesophageal reflux, should be evaluated and treated accordingly.
Chronological trends and causes of deaths among reproductive-age-women in Southern Tunisia
Authors: Maamri H , Ben Ayed H , Ketata N , Yaich S , Baklouti M , Karray R , Feki H , Damak J
Published: October 2021

Introduction

Mortality data of women with reproductive age (WRA) data are important indicators of the health system performance. This study aimed to determine the magnitude, trends and main causes of WRA deaths.

Methods

The study used longitudinal hospital-based surveillance design for the period 2014-2020 in Southern Tunisia including all WRA (15- 49 years) who died in public health facilities in this region.

Results

During the 7-year-period, there were 331 WRA deaths, and this number increased sharply with age (χ2= 21.7;p<0.001). Non-communicable diseases were the leading causes of deaths (41.7%) and were statistically more frequent in older women (52% vs 37.5%;p<0.001) and urban regions (48.9% vs 36.6%;p=0.025). Concerning communicable diseases and maternal deaths, they were statistically more common in rural regions (12.4% vs 5%;p=0.026 and 17% vs 8.8%;p=0.031,respectively). There were 45 maternal deaths, with an average maternal mortality ratio (MMR) of 51.39/100,000 Live births(LB)/year. There was a slowly declining trend in the MMR during the reference period, without significant change (χ2=0.7;p=0.4), with a peak of 97.37/100,000LB in 2016. Direct obstetric deaths constituted 73.9% of all maternal deaths, among which the leading causes were obstetric haemorrhage (66.7%) and eclampsia (14.3%). Among the indirect causes, cardiovascular diseases (37.5%) and infections (16.6%) were the most common.

Conclusions

Mortality indicators among WRA remained sustainably high in Southern Tunisia, despite the declining curve. The causes of death varied according to age groups and access to health facility. Strengthening community-based initiatives to promote the goal of ending preventable maternal deaths is urgently recommended.

Key messages

High mortality indicators among WRA remained sustainably in Southern Tunisia. Stregthening community-based initiatives to promote the goal of ending preventable maternal deaths is urgently recommended.
Feasibility of youth empowerment initiative for identifying never- and under-immunized children
Authors: Bengali R , Siddiqi DA , Mehmood M , Khan AA , Baig Q , Khan AJ , Chandir S
Published: October 2021

Background

One-in-every 5 children globally remains deprived of life-saving vaccines. We developed and implemented the Adolescent Health and Leadership Program (AHLP) among school girls from grades 8-10 (Kiran Sitaras (KSs); Shining Stars) to provide them with soft skills and community mobilization skills and equipping them to become community advocates for immunization. We evaluated the feasibility of KS community mobilization through validating KSs' ability to accurately identify and link never- and under-immunized children with immunization services.

Methods

We implemented a mixed-methods study in six public schools located in peri-urban areas of Karachi, Pakistan. After the development and roll-out of AHLP in schools, KSs conducted door-to-door visits in their neighborhoods to identify never-and under-immunized children. This was followed by verification visits by field staff to establish accuracy and immunization camps to vaccinate never- and under-immunized children identified by KSs.

Results

From January 28 to February 22, 2020, 591 KSs visited 10,330 households, screened 3,295 under-2 children and identified 7.5% (247/3,295) never- and 27.0% (889/3,295) under-immunized children, with an accuracy of 90.4% and 49.6%, respectively. In January 2021, 291 never- and under-immunized children were invited to immunization camps, of which 28.9% (84/291) received vaccinations, while 57.0% (166/291) did not respond to the invite and 14.1% (41/291) were deemed ineligible (illness, overage, etc.).

Conclusions

We demonstrated the feasibility of empowering adolescent girls to boost immunization uptake in LMIC settings. Engaging young women from within the community provides an organic and sustainable solution for promoting immunization coverage and equity today and ensuring they will continue to champion the cause in their capacity as tomorrow's mothers. We are actively scaling-up our solution across the country to create a force of 100,000+ KSs to magnify our efforts.

Key messages

The Kiran Sitara initiative, via its community-centered approach, leverages the force of adolescent school girls to boost demand and referrals for immunization in unreached geographical pockets. The Kiran Sitara initiative utilizes the power of youth engagement to identify never- and under-immunized children, and subsequently increase vaccine-uptake.
Attitudes towards vaccination among Croatian high school students
Authors: Miskulin I , Hac D , Domacinovic T , Kovacevic J , Pavlovic N , Miskulin M
Published: October 2021

Background

Due to the success of immunization, most of young people have little experience with vaccine preventable diseases. This inexperience may increase vaccine hesitancy in this population subgroup which can potentially jeopardize population vaccination coverage. Understanding young peoples' attitudes towards vaccination is important for vaccination uptake. The aim of this study was to evaluate attitudes towards vaccination among Croatian high school students.

Methods

This online cross-sectional questionnaire study was conducted during the January 2021 to April 2021 in convenient sample of high school students from north-western part of Croatia. Vaccination Attitudes Examination scale (VAX) was used to assess antivaccination attitudes in study population.

Results

The study included 1012 high school students; 29.2% males and 70.8% females; median age 17.0 (interquartile range (IQR) 17.0 - 18.0) years. Overall value of the VAX score in study sample was 50.4±11.1. Female students had more negative attitudes towards vaccination in comparison to male students (P = 0.001). When analysing differences between female and male students according to the VAX scale subcategories the study revealed that female students demonstrated more worries over unforeseen future effects of the vaccination (P < 0.001) while there were no differences between females and males according to the mistrust of vaccine benefits, concerns about commercial profit and preference for natural immunity (P = 0.155, P = 0.157 and P = 0.142, respectively).

Conclusions

The study revealed rather high antivaccination attitudes among Croatian high school students as measured by VAX score. Further studies are needed to better understand factors that influence such attitudes in study population because programs directed towards changing antivaccination attitudes in order to be efficient need to successfully tackle all of those factors.

Key messages

Public health interventions directed towards suppression of antivaccination movement should more involve younger population subgroups, such as elementary and high school students. Positive attitudes towards vaccination in younger population subgroups are one of the crucial preconditions for adequate vaccination coverage.
Prevalence of Tobacco use among Tunisian adolescents: a cross-sectional national survey
Authors: Ayedi Y , Harizi C , Skhiri A , Fahfakh R
Published: October 2021

Introduction

Tobacco use initiation mostly begins before the age of 18 years old. Being concerned by the increasing prevalence of smoking among adolescents, WHO developed the Global Youth Tobacco Survey. It focuses on youth addiction to tobacco products. This survey was carried out 4 times in Tunisia. GYTS 2017 is the most recent among them.

Aim

Describe the different tobacco products prevalence and access of smokers to tobacco products and to smoke cessation.

Methods

It is a school-based survey uses a two stages cluster sample design to produce a representative samples of students aged from 13 to 15 years old. It was conducted in April and May 2017 in 67 secondary school all over the country. The investigation tool was an anonymously answered questionnaire, which contained core questions about six majors tobacco related topics.

Results

One out of four students had ever tried to smoke a cigarette; 37.4% of boys vs. 10% of girls (p < 0.001). Lifetime cigarettes prevalence was 7.8%; 14.4% of boys vs. 1.6% of girls (p < 0.001). As for water pipe, 12.7% had ever tried to smoke, even for one or two snuffs. Lifetime water pipe use prevalence was 7.2% (13% of boys vs. 2.8% of girls, p < 0.001). Among cigarettes smokers, 62.5% were able to buy their own cigarettes. Therefore, 23.5% of cigarettes smokers and 41.5% of water pipe smokers were not able to buy their products because of their age. Sixty percent of smokers want to quit and 56.4% had already tried to stop during the year prior to the survey. Seventy-two percent had asked help to quit smoking. Eighteen percent had requested advice from a professional.

Conclusions

Cigarette and water pipe use prevalence among youth is alarming in Tunisia. Selling tobacco products to minors is not prohibited. Implementing such a law is necessary to reduce adolescents' access to cigarettes, and consequently, reduce tobacco use prevalence. Teenagers should benefit from smoke cessation programs, as well as adults.

Key messages

Tobacco prevalence among youth is alarming in Tunisia. Prohibiting tobacco sale to minors is necessary.
Analisys facial emotional expressions in attendees the recreovía program in Bogotá - Colombia
Authors: Rubiano Espinosa OF , Morales Eraso NS , Alvarado Melo JE , Riveros Medina MA , Rubiano Espinosa JF , Sarmiento Dueñas OL , Rubio Rojas MA , Galvis Leal P , Morales Garcia LY
Published: October 2021

Background

The Recreovía (PR) program promotes healthy habits and lifestyles through the practice of physical activity (PA) directed and musicalized in public spaces in Bogotá Colombia, with an average annual attendance of 800,000 participants. The objective of this study was to evaluate the changes in Emotional Facial Expression (EFE) during a PA session of the PR. The emotions evaluated were happiness, sadness, surprise, scare, disgust, and contempt, in addition, the neutral emotional state described by Ekman (1972).

Methods

Descriptive cross-sectional study, with 566 subjects aged 15 to 85 years (72.1% women and 27.9% men). The sample was estimated with a 95% confidence interval and a 5% margin of error. The facial expression analysis was performed with the FaceReader® facial recognition software and equipment. The data were analyzed through the techniques of Mann-Whitney U and Kruskal-Wallis with SPSS version 24 software.

Results

The age ranges were distributed as follows: 15-30 (22.8%), 31-45 (49.6%), 46-60 (26.9%) and 61-85 (0.7%). Users placed their emotions like this, neutral 47%, happiness 20%, sadness 7%, angry 6%, surprise 3%, scare 4%, disgust 8% and contempt 1%. The differences by gender were found, sadness (women 8%, men 5%, p = 0.007) and angry (women 5%, men 7%, p = 0.040). In the comparison by age, differences were found between 15-30 years and 46-60 years (neutral 35%, 47%, p = 0.000; happiness 27%, 13% p = 0.001; scare 2%, 6% p = 0.016).

Conclusions

Neutrality is an emotional state that does not show happiness or sadness, it is hypothesized that during this time the learning processes predominate. The most evoked emotion during the AF session was happiness followed by far by sadness, emotion related to the ambiguities of the movements in the process of learning motor gestures and happiness corresponds to the achievement in the execution that generates adherence to the program Recreovía that contributes to the mental and social health of the participants.

Key messages

Reduced levels of physical activity have a great impact on health. A sedentary lifestyle and emotional expressions is a more common risk factor that affects people's mental health. Mental disorders are a multifactorial condition that affects health, and in this case, physical activity for Bogotanos becomes a vehicle that transforms people's health and quality of life.
Long time psychological distress affected by the Great East Japan Earthquake after four years
Authors: Tsuchiya Y , Tsujiuchi T , Iwagami T , Ogiwara A , Tanaka Y
Published: October 2021

Background

On March 11th, 2011, the Great East Japan Earthquake hit the Tohoku area, and more than 15,000 people lost their lives by the tsunami and earthquake. People who survived natural disasters, terrors, or serious diseases reported long-time psychological distress such as PTSD (Post Traumatic Stress Syndrome) or depression. This study aims to elaborate on factors associated with PTSD post the Great East Japan Earthquake after four years.

Methods

Quantitative and qualitative analysis from a questionnaire survey conducted after four years of the earthquake in 2015. The questionnaires included participants' attributes, IES-R scale to evaluate PTSD, loss of their families by tsunami and earthquake, their own tsunami experience, many relocations after the earthquake, lost job after the earthquake. The open-ended question asked them to write about their challenges in their lives and others.

Results

We received 3465 responses. Among those who responded, the IES-R scale was significantly larger in women (n = 1397) (aOR=1.55, p = 0.001) than men (n = 1966). Higher in those with more their own tsunami experience (aOR=1.35, p = 0.014), in those with lost loved ones (aOR=2.1, p < 0.01), and in those with more economic difficulties (aOR=1.6, p < 0.001). In addition, those with less social connectedness (aOR=1.34, p = 0.017) and forced to live separately with family members after the earthquake(aOR=1.36, p = 0.014) were significantly higher in the scale. From a quality analysis, we observed much psychological distress from participants.

Discussion and Conclusions

In this study, more than half in the PTSD risk group reported that they had never cared for mental pain after the earth quake. We overlook PTSD frequently. However, long-range monitoring and care are necessary for those affected by a significant disaster.

Key messages

PTSD after disasters have been overlooked frequently. A long-range monitoring and care are necessary after a significant disaster.
Mobility and migration of health care workers
Authors: Corvo E , De Caro W
Published: October 2021

Introduction

The estimated shortage of about 15 million health and social care professionals, including over 6 million nurses, together with the significant phenomenon of international migration of such professionals, emerged, during COVID-19, with even more evidence. During the pandemic the danger of a collapse of health systems in many areas due to a shortage of staff was manifest. In addition to this, low-income countries are witnessing a decrease in their health and social care workforce resulting in further inability to ensure essential levels of professional coverage to deal with populations' needs.

Methods

An integrative review analysis, in 4 languages (English, Italian, Spanish, French) of trend in terms of legislation and policy documents were conducted using health and social database and gray literature. 29 different document were include in this review.

Results

A number of initiatives have been developed in order to establish international and/or bilateral obligations among countries; however, this showed to be insufficient. There is therefore the need to set up a joint effort/actions among different stakeholders such as Government, Higher Education institution, International Labor health market actors, and NGOs in the field of migration, labor and training of health and social care professionals in order to better meet health and social care needs worldwide.

Conclusions

It is timely to develop specific actions aimed at setting up a passport for health and social care professionals which allows to guarantee prior certification and accreditation of skills by independent agencies; countries should work together to improve retention of health care professionals in their job. Moreover, every effort should be done to enhance younger generation interest in health and social carrier, as opportunity to really makes difference in other lives and to play an active role in the development of society.

Key messages

Without health and social care professionals, there is no health. Migration is a serious issues and opportunity.
The future of the drug phenomenon and drug monitoring in Europe until 2030
Authors: Palczak K , Moreira M , Griffiths P
Published: October 2021

We are living in an era of fast and fundamental changes with an uneven impact on geographies and generations. The pace of the social transformations and technology innovations is accelerating and outpacing policies and responses in place. Also, the European drug situation and drug markets are becoming more complex and dynamic, with important implications for the EU drug monitoring system and research. Therefore the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) conducted the first ‘futures exercise' to inform the agency's strategic reflection on how to improve the response of the EU monitoring system in the context of rapid changes in the information environment and new information needs. The EMCDDA piloted the usefulness of the foresight approach for transforming the agency and its monitoring activities into a more sensitive and agile system, which could, in turn, help increase Europe's preparedness for future challenges in health and security areas. The ‘futures exercise' applied the horizon-scanning method to study events, issues, and trends affecting the drug area and went far beyond the drugs or the addiction field and the European region. It analysed global drivers of change that may have in the future implications for the drugs situation, drug monitoring and related responses. The methods applied ranged from literature review, thematic analysis, workshops and expert panels. It had a robust participatory component to enable stakeholders representing different disciplines and countries to contribute to and benefit from the process. Out of 14 Megatrends, five were selected as most significant for the drugs field, and the future EMCDDA work: technological change, climate change and environmental degradation, diversified inequalities, shifts in health challenges and population. Moreover, four categories of emerging changes in the drugs field were identified: shifts in drug policy, the discourse of addictions, drug markets and drug services.

Key messages

Foresight is a valuable tool for analysis going beyond specific areas of expertise and recognising that a single-issue focus is often insufficient in dealing with emerging threats and opportunities. A participatory approach contributes to building a shared vision of the major drivers of change impacting the drugs field, information needs and future developments in the EU drug monitoring system.
Older adults’ lifestyles are associated with their structural position, health and wellbeing
Authors: Jarosz E
Published: October 2021

The association between older adults' everyday activities, health and subjective wellbeing has mostly been examined using different activities as separate variables. It has not been analysed which activities are likely to come together in individuals' daily time use patterns, or in what context. Meanwhile, different combinations of activities and contextual variables may indicate distinctive lifestyles. This study looks at a broad range of spontaneously reported activities, their location and social context, and constructs latent behavioural classes. It examines how individuals' class belonging is linked with their structural position, health and wellbeing. The data used in the study came from a sample of 200 noninstitutionalized adults aged 65 and above. Activity data was collected using Experience Sampling Method. Generalized structural equation modelling (GSEM) was used to identify latent classes. Three behavioural classes were identified and labelled as: passive domiciliary, active functional, and social recreational. Lifestyles are related to individuals' structural characteristics and health status. Variables associated with class belonging are age, education, and detailed dimensions of health measured using the Nottingham Health Profile. Class differences in mean subjective wellbeing were statistically significant, but fully explained by sociodemographic and health-related variables. This study shows that behaviours and their settings form distinctive lifestyles, and that there is consistency between objectively measured lifestyles and subjective assessment of individuals' physical and emotional health.

Key messages

There is association between older individuals' daily behaviours and their subjective evaluation of detailed dimensions of their health. This study points to the life-long effects of education and suggests that individuals' socioeconomic characteristics may predict their lifestyle at older age.
Communications and public health
Authors:   Organised by: EUPHA, EUPHA-PHMR,   Moderators: Iveta Nagyova (EUPHA), Petronille Bogaert (EUPHA-PHMR)
Published: October 2021

Communications have always been a key part of public health. This plenary highlights current communication challenges and opportunities for public health.

At the same time as we have been experiencing a pandemic, the world is also experiencing an “infodemic”: an overabundance of information that occurs during an epidemic. This information may be accurate or not and spreads via digital and physical information systems. It can lead to mistrust in health authorities and undermines the public health response. An infodemic can intensify or lengthen outbreaks when people are unsure about what they need to do to protect their health and the health of people around them. It also impacts citizens in every country, and addressing them is a new and centrally important challenge in responding to disease outbreaks. The public health workforce needs to adapt to this changing environment and its growing digitization — an expansion of social media and internet use.

Once you have the right information, it’s time to change behaviour. In the second part of this plenary, we’ll dive into the theory of behaviour change, as well as present innovative interventions to change behaviour of populations. Behavioural insights combine insights from various disciplines, including psychology, cognitive science, and social science which can be used for policies that promote health and healthy environments.

Speakers

Tina Purnat ECDC Jose Alcami Pertejo Institute of Health Carlos III, Spain Susan Michie UCL Centre for Behaviour Change, University College London, UK