bluuebunny/crossref_metadata_2025_split huggingface dataset:
Vitamin D related knowledge, attitudes and behaviors among ethnic minority women
Authors: Cantarero Arevalo L , Jacobsen R , Özel E 
Published: October 2020

Abstract

Background
Vitamin D (VD) deficiency may increase the risk of developing nutritional rickets, metabolic, autoimmune, infectious, cardiovascular and mental disorders. VD status in reproductive age is of special importance, as it may determine health outcomes not only for women but also for their offspring. Danish health authorities recommend VD supplementation for groups at risk of VD deficiency. In Nordic countries, persistent high prevalence of VD deficiency among non-Western ethnic minority women suggests that health information may not reach the population in need.

Aim
to assess VD related knowledge, attitudes and behaviors among non-Western ethnic minority women living in Denmark in 2019.

Methods
A validated VD knowledge, attitudes and behaviors questionnaire was translated into Danish, piloted and distributed via relevant Facebook groups using online SurveyXact platform. The responses were analyzed with SPSS statistical package, using both parametric and non-parametric tests for bivariate analyses.

Results
254 women who considered themselves having a non-Western ethnic minority background answered the questionnaire. Median age (IQR) was 26 (23-33) year old; 81 (39%) had professional, 71 (28%) high school and 56 (22%) university education. Age was associated with VD nutrition knowledge (p = 0.048) and VD behaviors (p = 0.026): older women had better knowledge about VD rich nutrition and reported more VD friendly behavior. Education was associated with both VD general (p = 0.034) and VD nutrition (p = 0.034) knowledge. Women with university education had better knowledge about VD generally, and women with professional education had better knowledge about VD rich nutrition.

Conclusions
Aged and education were associated with VD related knowledge and behaviors in young women with non-Western ethnic minority women. Further examining of VD related knowledge and behaviors focusing among less populations is warranted.

Key messages
Education was associated with both vitamin D general (p = 0.034) and vitamin D nutrition (p = 0.034) knowledge. Aged and education were associated with vitamin D related knowledge and behaviors in young women with non-Western ethnic minority women.
”Little girl, where do you think you go with this method?”: shame and use of emergency contraception
Authors: Cantarero Arevalo L , Merchant E 
Published: October 2020

Abstract

Background
In England in 2018, 45% of pregnancies were unplanned at the time of conception. In 2017, there were 192,900 abortions carried out for women residing in England and Wales, with the highest rate of abortion being for women aged 20-24 (28.2 per 1000 resident women).

Aim
To understand social and cultural influences which affect ethnic minority young women's utilization and experience of emergency contraception in the United Kingdom.

Methods
Qualitative in-depth interviews following an interview topic guide were conducted with seven young women currently living in the UK, whose parents were born outside the UK. Interviews were recorded, transcribed and input into NVivo version 11.4.3. Transcriptions were coded to identify themes and these themes were then analyzed to identify commonalities and establish connections to understand perceptions and experiences of the participants. The themes coded were “Knowledge of emergency contraception”, “relationships” “concerns about obtaining and using EC”, “balancing risks” and “religion and culture”.

Results
Participants were often not open with their parents about sexual health related topics. Cultural taboos still persist towards sex before marriage which could translate into guilt and shame about using EC. When asked about concerns surrounding EC, participants mentioned concerns relating to obtaining EC, generally involving privacy embarrassment or shame. Stigma and concern about what others may think was a fairly frequent theme throughout the interviews, with participants being worried about what friends, family or service providers would think about them.

Conclusions
cultural awareness in healthcare reiterate the need for interventions which take into consideration sociocultural contexts. This is essential to ensure that young women have access to emergency contraception in order to prevent unwanted pregnancy.

Key messages
Despite availability of emergency contraception, young women still face the risk of going through an unwanted pregnancy becuase of embarrasment and shame. Cultural taboos towards sex before marriage still persists and this is translated into guilt and shame about using emergency contraception.
Socioeconomic status and self-perceived barriers to leisure time physical activity in Finnish Roma
Authors: Nykänen S , Wennman H , Korpelainen R , Majaniemi P , Kuusio H 
Published: October 2020

Abstract

Introduction
Finnish Roma are at unequal socioeconomic position compared to the main population. Inequality has a key impact on the well-being and lifestyles of the Roma. The main aim of this study was to examine the prevalence of leisure time physical activity (LTPA) in the Finnish Roma. In addition, we investigated the relationship between socioeconomic factors and self-perceived barriers to leisure time physical activity to leisure time physical inactivity.

Methods
This study was based on cross-sectional data on the Roma Wellbeing Study (Roosa) collected in 2017-2018 (n = 365). Data of the study was collected by a long or a short questionnaire, with structured interview or completed by the respondent. The subsample of this study was limited to adult Roma living in Finland, identifying themselves with Roma culture (n = 344; men n = 134 and women n = 210). The data was analyzed by cross-tabulation, χ2-test and using logistic regression analysis. Men's and women's results are presented separately as odds ratios (OR) and with 95% confidence intervals (CI).

Results
In this study 46.7% of men and 64.3% of women did not engage leisure time physical activity. The self-perceived barriers to leisure time physical activity differ between men and women. Common barriers were lack of motivation, fatigue and low mood. In men, self-perceived barriers to leisure time physical activity were also illness or injury, lack of money and exercise guidance. In women, other self-perceived barriers were lack of exercise skills, suitable exercise group and form of exercise.

Conclusions
The low prevalence of leisure time physical activity in the Finnish Roma calls for actions. The socioeconomic inequalities and differences between men's and women's self-perceived barriers to leisure-time physical activity should be taken into account in measures to promote physical activity.

Key messages
In this study, nearly half of the Finnish Roma men and three out of five women did not engage in leisure time physical activity. The socioeconomic inequalities and self-perceived barriers to leisure time physical activity between Finnish Roma men and women should be taken into account in measures to promote physical activity.
Economic analysis of the stand-by emergency treatment (SBET) for malaria in travellers
Authors: Ferrara P 
Published: October 2020

Abstract

Background
Stand-by emergency treatment (SBET) is a possible approach for malaria prevention in travellers to low transmission areas (such as South-Eastern Asia [SEA]), but current evidence casts doubts on its feasibility and does not allow to decide whether this strategy is economically rational. Thus, this research aimed to appraise SBET in terms of cost-benefit/cost-effectiveness analysis from the perspective of the National Health Service (NHS).

Methods
To design a specific model, SBET benefits (valued as avoided direct and indirect costs of illness) were weighted against the costs associated with SBET doses to be prescribed in order to avoid one imported case of malaria. Direct healthcare costs were obtained allocating last surveillance data for imported malaria to the charge of the corresponding diagnosis-related group category and estimating outpatient care costs. Indirect social costs were calculated in terms of lost productivity. The economic framework was adjusted for the probability of malaria transmission in SEA region and weighed on the Italian context.

Results
In the model, for five malaria cases estimated to be imported from SEA to Italy in 2017, it was calculated that NHS would be charged with around € 22,487·50. Social costs were determined at € 7,100. Thus, the total Italian public expenditure for malaria cases in SEA travellers was of € 29,587·50 in 2017. In contrast, 50,000 doses were considered to be carried to avoid one malaria imported case, with a cost of € 2.5 million.

Conclusions
At cost-effectiveness analysis, reimbursement strategy does not lead to a favourable gain owing to the total cost of the SBET doses to be prescribed for avoiding one malaria case. The appraisal of costs and benefits brings into question the economic validation of SBET, also calling for further strategies to be reassessed for travellers to low-risk areas.

Key messages
Besides the evidence of incorrect SBET use among travellers, the appraisal of costs and benefits brings into question the economic validation of this strategy. Reimbursement for SBET seems to be not cost–effective from the perspective of National Health Services.
The impact of mortality for infectious diseases on life expectancy at birth in Tuscany, Italy
Authors: Kundisova L , Nante N , Martini A , Battisti F , Giovannetti L , Messina G , Chellini E 
Published: October 2020

Abstract

Introduction
The epidemiologic transition describes the reduction of mortality for infectious diseases (ID), followed by an increase in prevalence of non-communicable diseases. During recent years the situation has changed; an increase in mortality for sepsis was observed. Italy is amongst the countries with the highest prevalence of microorganisms resistant to antimicrobial therapy in Europe. The aim of the present work was to evaluate the impact of mortality for ID on life expectancy (LE) in the Tuscany region(Italy).

Methods
Mortality data relative to residents that died during the period 2000/2002- 2013/2015 were provided by the Tuscan Regional Mortality Registry. At first the analysis was performed for whole territory, then for geographic area (Nord-Est:NE, Centrum:C, South-East:SE). The analysis was realized with software Epidat,using the Pollard's method of decomposition of variations in LE for age and cause
of death.

Results
The overall gain in LE was 2.9 years for males and 2.6 years for females. The increase in mortality for ID was responsible for the loss of 0.11 years of LE for males vs. 0.16 years for females. The loss was observed in males aged 45-89, for females from 69 years onwards, with the highest loss between 79-89 years. After analysis for area, geographical differences emerged, for both males and females the highest loss of LE was observed for NE (-0.23 years vs.-0.19), followed by C (-0.15 years vs. -0.16) and SE (-0.12 vs. -0.11).

Conclusions
The result can be partially explained by the transition from ICD-9 to ICD-10 (in 2010), which improved the sensitivity of codification, but also by diffusion of pathogens resistant to antimicrobial therapy. The highest impact of ID was observed in elderly, probably due to the existence of predisposing clinical condition. The ID deserve major attention; the programmes of hospital infection control and antimicrobial stewardship have to be potentiated in order to contain the phenomenon.

Key messages
During the study period an increase in mortality for infectious diseases comported the loss in terms of LE years. The growing diffusion of microorganisms resistent to antimicrobial therapy could have contributed to the higher mortality rates observed during the last period.
New decade, new response: Altering the public health response to toxigenic cutaneous diphtheria
Authors: Marshall N C , Baxi M , MacDonald C , Sikora C , Tyrrell G J 
Published: October 2020

Abstract

Background
Classical diphtheria is a potentially fatal respiratory disease mediated by the diphtheria toxin of Corynebacterium diphtheriae. Due to high vaccination rates against this toxin in Canada, the national incidence of respiratory diphtheria is near zero, and the toxin plays no recognized role in cutaneous diphtheria. Therefore, in this study, we assessed the diagnostic and public health benefits of diphtheria toxin testing and cutaneous diphtheria investigations in a highly vaccinated population.

Methods
Over the last 10 years, we retrospectively determined: the number of C. diphtheriae isolates identified in the province of Alberta, Canada; the disease state of each individual tested (disease vs asymptomatic carrier); the source (cutaneous vs respiratory); and the number of toxin tests performed.

Results
In 10 years, zero cases of respiratory diphtheria and three cases of toxigenic cutaneous diphtheria were identified. Despite zero cases of respiratory disease, diphtheria toxin testing significantly increased (p = 0.0001), with 86% of toxin tests performed on cutaneous isolates. Subsequent public health investigations of each case of toxigenic cutaneous diphtheria mandated the collection of 315 total specimens from 92 individuals, revealing low rates of C. diphtheriae colonization among contacts and no further cases.

Conclusions
This study challenges the value of reflexive diphtheria toxin testing in uncomplicated cutaneous diphtheria among highly vaccinated populations. Cutaneous diphtheria investigations demanded disproportionate public health and laboratory resources and demonstrated a discrepancy between toxin pathophysiology and disease. Therefore, we recommend stewarding diphtheria toxin tests for toxin-mediated disease forms and ensuring adequate vaccination. This approach would spare public health and laboratory resources by customizing responses around the role of the diphtheria toxin in each form of disease.

Key messages
Investigations for cutaneous diphtheria increased demand for toxin testing in Alberta, Canada, though the toxin plays no role in this form of disease. In populations with high vaccination rates against diphtheria toxoid, cutaneous diphtheria cases do not require additional laboratory testing for the presence of the diphtheria toxin.
Monitoring of HIV pregnant women for evaluating mother-to-child transmission in Sao Paulo, 2010-2018
Authors: Domingues C S B , Fonsi M , Tancredi M V , Loch A P , Rocha S Q , Gianna M C , Gonçalves A , Pereira G F M 
Published: October 2020

Abstract

Issue
In the state of São Paulo (SSP), the rate of mother-to-child transmission of HIV (MTCT) was estimated at 2.7%, in 2006. However, for reaching elimination, its level should be &lt; 2%. From 2000 to 2018, the SSP concentrated 21.3% (26,427/125,144) of the total cases of pregnant women living with HIV (PWLH) in Brazil.

Description of the Problem
The occurrence of MTCT cases shows failures of healthcare system. The aim of this study was to assess the response of the Sao Paulo State STI/AIDS Program to prevent MTCT, from 2010 to 2018. A descriptive analysis of clinical monitoring indicators of the PWLH was performed. The National Surveillance Data System was used to estimate the underreporting of cases. Data from antiretroviral drug delivery, viral load (VL) and genotyping results were used to calculate the indicators and were obtained through database of the National Antiretroviral Drug System, Laboratory Control System and Genotyping System.

Results
In the period, despite identifying 15,463 PWLH in the systems, only 11,316 were notified (26.8% underreporting). Comparing 2010 and 2018, there was an improvement in accessing combined antiretroviral therapy (cART) from 81.2% (1,366/1,683) to 86.6% (1,543/1,782); in performing of VL before delivery from 70.8% (1.192/1.683) to 72.8% (1.298/1.782); in VL suppression &lt;50 copies/mL from 39.9% (671/1,683) to 53.4% (951/1,782); and in the pretreatment genotyping from 0.2% (2/992) to 22.4% (154/688). In 2016, the loss of follow up of cART in 6 and 18 months after delivery was 20% and 24%, respectively. Additionally, the number of children born with HIV decreased 79.7%, from 64 to 13 cases.

Lessons
The decrease in the number of cases suggests improvement in preventing MTCT in the SSP. However, many challenges remain, such as breaking down individual, social and programmatic barriers to expand access to cART, pretreatment genotyping, VL suppression before delivery, retention in care and adherence to cART over time.

Key messages
The National Systems of surveillance, antiretroviral drugs, laboratory and genotyping network are important for performing clinical monitoring, reducing treatment gaps and underreporting. The integration of the Sexually Transmitted Infections and HIV/AIDS Program with the Primary Care and the Maternal and Child Health Program is essential to achieve the goals of eliminating MTCT.
Sexually transmitted diseases: what is the knowledge of college students in Tunisia?
Authors: Bannour I , Bannour B , Frigui R , Bannour R , Kheiri H 
Published: October 2020

Abstract

Introduction
In Tunisia sexuality education is a subject that is little discussed in institutions and schools, hence its marginal place in the school curriculum and even if it is addressed, it mainly concerns reproduction and risk prevention. The purpose of this study was to evaluate the knowledge, attitudes, and behaviors of law university students regarding sexually transmitted diseases.

Methods
A cross-sectional survey was conducted among 300 law school students in Sousse, Tunisia. The instruments used for assessment was a pretested questionnaire contained questions evaluating knowledge and attitude towards STD and AIDS. Questions had multiple responses from which each respondent was asked to select the most appropriate one.

Results
Our sample consisted of 300 students, the majority were female (75.3%). The mean age was 22.30 years old. More than 75% of surveyed students did not discuss the subject of sexuality with their parents. The main sources of information for the students were the internet 48.3% followed by media 47% and friends 20%; health professional represents only 10.3%. Concerning the identification of risky sexual behavior 56.6% of the students identified multiple partner's sex and 45.7% the non-use of the condom. AIDS comes first among the STD cited by the majority of students surveyed (92%) followed by syphilis (6%). Despite that the majority of our participants knew the signs of STD; such as genital ulcer, urethral / vaginal discharge. False beliefs persist such as chest pain (13.3%) and headache (13.1%). 60.7% f our student reported genital cancers as complication to STD, 32.7% infertility. Some minorities (2.7%) thought that STD could be complicated by blindness.

Conclusions
Despite the high prevalence of STD among young adults, most students knew very little about those infections. Implementing sexual educational programs and measuring their effectiveness should be a priority.

Key messages
There is a huge lack of knowledge about sexually Transmitted diseases among Tunisian college students. Implementing sexual educational programs and measuring their effectiveness should be a priority.
A “Flower” to improve the lunch at school
Authors: Troiano G , Servegnini M , Cirrincione M L , Frittoli E , Firmi A M , Clasadonte V 
Published: October 2020

Abstract

Background
Children consume at least one main meal a day at school so ATS Val Padana (Italy) conceived a project called “Un fiore in mensa” (A flower in canteen) as an acknowledgment of the quality of the school catering service.

Objectives
The aim of the project is to assign an award - “The Flower” - after an inspection during which the entire lunch (from preparation of meal to the consumption) is examined. It is necessary to reach at least 10 points to have the 'flower ' in all 3 essential sections (the “petals”): Quality of the menu, Organization and cleaning of the kitchen and / or other locals, Collaboration of the teachers. The complete flower (with 6 petals) is reached with 60 points (in the sections: General presentation of the refectory, Collaboration between all the personnel during lunch, Children's behavior).

Results
In the 2018-19 edition of the project 79 schools were examined: 20 (25.32%) were nurseries; 34 (43.04%) were kindergartens; 25 (31.65%) were elementary school. 36 (45.47%) were private schools. 16 on 79 schools (20.25%) obtained the flower. In particular: 1 school obtained a 3-petals certificate; 6 schools obtained a four-petals certificate; 7 schools obtained a five-petals certificate; 2 schools met all the requirements and obtained the complete six petals certificate. There wasn't a statistically significant difference due to school typology (p = 0.70) or to their management (p = 0.69). There was a statistically significant difference due to the examined year (p &lt; 0.01), with better performances in 2019 compared to 2018.

Conclusions
The interest demonstrated by some schools that didn't receive the full flower to resolve some critical aspects confirmed the utility of the project.

Key messages
The project “A flower in canteen” is a way to reward the school catering service. Some schools tried to resolve some critical aspects after the inspection.
Risk factors of illicit substance use among Tunisian adolescents of Sousse
Authors: Ghali H , Bhiri S , Ben Cheikh A , Khefacha S , Tourki Dhidah M , Dhidah L , Ben Rejeb M , Said Latiri H 
Published: October 2020

Abstract

Background and aims
Adolescence is a period of physical, psychological and socio-cultural transformation, but also of curiosity, experimentation and acquisition. It is mainly during adolescence that people are introduced to the use of legitimate psychoactive substances, such as alcohol and tobacco, as well as illicit substances such as cannabis. Studying its predictors could help deal with this problem more efficiently. We aimed to determine the prevalence of life time illicit substance use and its predictors among Tunisian adolescents.

Methods
We conducted a cross-sectional study in two public schools in the governorate of Sousse during the 2017/2018 school year. The data were collected by anonymous self-administered questionnaire, then processed and analyzed using the SPSS software version 20.

Results
A total of 294 students were included. The mean age was of 17.03 years (standard deviation = 1.51). Females represented 56.1% of participants (sex ratio was 0.78). Among respondents: 60 (20.4%) had used illicit substance at least once. Cannabis was the main substance used by 35 (58.3%) students. The average age of the illicit substance use initiation was 16.3 (±1.1) years while it was 15.7 (±1.5) and 14.7 (±1.8) years for alcohol and tobacco use initiation respectively. Proportions of male students and academic failure were significantly more important among illicit substance users than among non users. While the most influential factors on illicit substance use were: alcohol use, and tobacco use (p &lt; 10-3). However, no significant association was found between illicit substance use and video games and internet use.

Conclusions
This study highlights the strong association between the other risk behaviors and illicit drug use. Future interventions should focus on the whole risk behaviors simultaneously at late adolescence with regard to the environmental context.

Key messages
Our results highlight the need to better understand behaviors at risk in Tunisia and the perceptions of prevention policies among students. Mainly during adolescence that people are introduced to the use of illicit substances.