bluuebunny/crossref_metadata_2025_split huggingface dataset:
Assessment of Adolescent and Youth Friendly Health Services in Sri Lanka using WHO’s ‘4S’ Framework
Authors: Wickramasinghe N , Vithana C , Lokubalasooriya A , Hemachandra N 
Published: November 2019

Abstract

Background
The Adolescent and Youth Friendly Health Services (AYFHS) in Sri Lanka (SL) are provided via three service models, viz., hospital-based, field-based and centre-based. This study assessed the implementation status of AYFHS in SL.

Methods
A panel of experts conducted the review by adopting a participatory approach. Policies and supporting documents were collected from the relevant sectors of the Ministry of Health using electronic and manual search and by visiting institutions/resource persons. The strengths and weaknesses of the AYFHS were identified using the WHO’s ’4S’ Framework consisting strategic information (S1), supportive evidence-informed policies (S2), strengthening services for adolescents (S3) and strengthening collaboration with other sectors (S4).

Results
While recent development of guidelines, standards and protocols in line with WHO/UNAIDS ’Global Standards for Quality Health-care Services for Adolescents’ was the main strength on S1, gaps in timeliness, completeness and accuracy of the data; and the gaps in effective utilization of sub-national level data addressing area specific problems were the main weaknesses. On S2, SL has a strong, supportive policy environment to promote adolescent health. Lack of coherence in existing health related policies was the main gap. A comprehensive health care package was a strength on S3, while difficulty in reaching the vulnerable groups, curative service oriented service package and underutilization of the health services by adolescents were the weaknesses. On S4, lack of sustained political commitment identifying adolescent health as a priority development issue across multi-stakeholders and their silo mentality to maintain the accountability/ownership of cross-cutting programmatic activities were the weaknesses.

Conclusions
Despite numerous imposing challenges, with mainstreaming and constructive monitoring, the AYFHS in SL will remain as one of the best adolescent health programmes in the region.

Key messages
Assessment of Sri Lankan AYFHS according to the WHO’s ’4S’ Framework revealed multiple strengths such as updated guidelines, supportive policy environment and comprehensive care package. Despite numerous imposing challenges, with mainstreaming and constructive monitoring, the AYFHS in SL will remain as one of the best adolescent health programmes in the region.
Smoking and substance abuse prevalence in adolescents in a city of Turkey
Authors: Mete B , Pehlivan E , Söyiler V 
Published: November 2019

Abstract

Background
The aim of this study was to determine the prevalence of smoking and abuse of substance among young people aged 14-18 in a city of Turkey and to determine the relationship between smoking and substance abuse risk.

Methods
This cross-sectional study was conducted on high school students studying in Bingöl city center. The universe of the study consists of 14000 students studying in 14 high schools. The minimum sample size required to be reached in the sample size analysis with reference to 80% power and 99% confidence interval was found to be 1235. According to the stratified sampling method, the students were randomly reached in schools and questionnaires were conducted under supervision by taking their consent. Chi-square test, Binary Logistic Regression test were used for data analysis.

Results
The mean age of the students was 15.71 ± 1.16 (min-max: 14-18) and 49.5% were male. The prevalence of smoking among all students is 15.8%, addictive substance use / trial frequency 5% except smoking. The prevalence of smoking among male students is 24.1%, in female students 7.7%. The rate of using addictive substance was found to be 8.2% for male students and 1.9% for female students except smoking. According to the results of Logistic Regression; substance abuse increases 8 (95% CI:3,32-19,95) fold in smokers (p = 0,001) and 2.5 (95% CI:1,10-5,38) fold in men (p = 0,027). The risk of substance use increases 1.05 (95% CI:1,02-1,08) fold as the number of cigarettes smoked daily (p = 0,001). Substance abuse risk of 18-year-olds shows increase 1.5 (95% CI:1,06-1,93) fold according to 14 years old (p = 0,021).

Conclusions
Smoking and addictive substance use in adolescents are particularly remarkable in male students (8.2%). This result is higher than the data reflecting Ä°stanbul (7%). This may be due to the fact that the province is located at the crossing point of drug traffic. Smoking increases the risk of other addictive substances (marijuana, heroin, etc.).

Key messages
Smoking and substance abuse is an important health problem in adolescents according to this study. Male students smoke are at risk of substance abuse more than female.
Sequence of cigarette and e-cigarette initiations and daily smoking in adolescents (HBSC 2018)
Authors: Dujeu M , Lebacq T , Pedroni C , Desnouck V , Holmberg E , Moreau N , Castetbon K 
Published: November 2019

Abstract

Background
Electronic cigarette may help adults quit smoking. For adolescents, the concern is whether e-cigarette initiation is a gateway to subsequent smoking. Our objectives were to describe the sequence of conventional cigarette and e-cigarette initiations among adolescents who had already used both products, and to analyse the current smoking behaviour according to the first experienced product.

Methods
Analyses were based on a two-stage random sample of 9,937 12-20-year-old adolescents included in the French-speaking Belgian 2018 Health Behaviour in School-aged Children cross-sectional survey. Cigarette and e-cigarette initiations and its sequence, current daily smoking and other characteristics were collected through a self-administered questionnaire. Associations, adjusted for demographic data, were estimated using logistic regression and weighted. Sampling design was considered in analyses.

Results
In 2018, 66.0% of adolescents reported never having tried a cigarette and e-cigarette, 8.1% having experimented cigarettes only, 9.2% e-cigarette only and 16.6% having experimented both. Among adolescents who tried both products, eight out of ten smoked cigarettes before trying the e-cigarette (78.2%). In the whole sample, 6.8% of adolescents were smoking every day. Daily smoking was observed in 19.8% of adolescents who initiated e-cigarette and cigarettes and in 6.4% of those who initiated cigarettes only. Adolescents who first smoked cigarettes were more likely to further smoke daily (aOR: 2.48 [1.69-3.64]) than those who first used e-cigarette. The risk of daily smoking was not different between adolescents who first used e-cigarette compared with those who tried cigarettes only (aOR: 1.23 [0.76-2.00]).

Conclusions
In French-speaking Belgium, conventional cigarette was the first step in the initiation and continuation of tobacco smoking. These findings help understand smoking patterns among adolescents and will support the development of smoking prevention strategies.

Key messages
Our findings suggest that health promotion interventions should remain focused on conventional cigarette. Based on a cross-sectional study, they should however be confirmed by prospective studies.
How do male students perceive their role in contraception and the protection against STDs?
Authors: Van Der Heijde C M , Veldhoven M , Vonk P 
Published: November 2019

Abstract

Background
A lot of research has been done on women and contraception. How men perceive their role regarding contraception is largely unknown. Previous research shows that factors like intentions, communication and knowledge are of importance. The aim of this study is to get more insight that could provide us with more starting points for preventing unwanted pregnancies and STDs.

Methods
Eight semi-structured interviews with male students from Amsterdam, The Netherlands (aged 18-25, different study programs) were conducted based on a, previously developed, topic list. Convenience sampling was used to select respondents. The interviews were processed with thematic content analysis. Open, axial, and selective coding was used to analyze the interviews.

Results
Four themes emerged from the data: openness of parents, making an informed decision, prevention of pregnancy and STDs and durance of relationship. Men do not have a clear view on their role in contraception regarding responsibility and are still struggling with the autonomy of their partner, also in relation to the length of the relationship. When in a relationship they feel their role should be to support and communicate with their partner, but not to make the final contraceptive choice. When not in a committed relationship, men feel their role is solely to protect themselves against fatherhood and, to a much lesser extent, STDs.

Conclusions
Communication is key in preventing unwanted pregnancies and STDs, and working towards a shared responsibility. Following up on the role of parents in communicating well about these subjects, both men and women should take their responsibility in communicating. Furthermore, fear of unwanted pregnancy seems much larger than fear for STDs for male students. These subjects can be addressed in a university institutional context in a variety of ways (f.i. via flyers, projects, student counselors, student health services).

Key messages
More attention for the role of both men and women in communicating about contraception and STDs is necessary in a student population within the university institutional context. More attention for the dangers of STDs and the importance of protection against STDs is necessary in a student population within the university institutional context.
Risk factors of pregnancy morbidity in migrant women from Subsaharan Africa
Authors: Bezanahary H , Gutierrez B , Dumonteil S , Coste Mazeau P , Eyraud J L , Preux P M , Fauchais A L , Ly K , Aubard Y 
Published: November 2019

Abstract

Reduction of maternal mortality remains a major public health issue worldwide. In France, the latest national confidential enquiry regarding maternal mortality (2010-2012) stated a ratio of 10 /100 000 livebirths whereas the goal was 5/100 000. The risk of death among pregnant women from Subsaharan Africa (SSA) was 3 times higher.
We performed a monocentric observational retrospective study from 01/01/2009 to 01/09/2016 in order to better understand the factors of maternal morbidity among SSA pregnant women. Demographic characteristics as well as pregnancy outcomes were collected. Antenatal clinics attendance was scored (+1 if positive, +1 if done following the recommended schedule). A total 1 489 (7%) out of 20 755 pregnancies were registred among SSA women. Mean age was 29 years (14-48), mean gestity/parity were respectively 3.5 and 1.8. About 38% of pregnancies occured in overweight or obese women. Obstetrical complications were seen in 542 (36%) pregnancies: gestational diabetes (n = 206, 36,4%), hypertensive disorders (n = 122, 8,2%), 19 had both. Pre-eclampsia represented 4%, sepsis 5%, premature rupture of membrane 5% and post partum haemorrhage 3%. Livebirths was high (97%) with a mean gestational age of 37(22-41), a mean birth weight of 3150g (500-5000). The unique maternal death in this cohort was due to amniotic fluid embolism. Complication risk factors were age (30 versus 28 years; p &lt; 0.0001), BMI (26 versus 25 kg/m2; p &lt; 0.0001), past history of chronic hypertension and pregestational diabetes (p &lt; 0,001). Furthermore, the score of antenatal care attendance was low in those who presented pregnancy morbidities (p = 0.0006) (adjusted with age, BMI&gt; 25 and chronic hypertension).
Higher risk of maternal morbidity among SSA women is not only explained by individual risk factors but also by a lack of compliance to the recommended antenatal care even if they live in France. Further investigations including sociological studies are therefore needed.

Key messages
Maternal mortality and morbidity are higher among migrant women from Subsaharan Africa. Our study highlights a non compliance to the recommended antenatal care surveillance among risk factors.
Improving maternal healthcare in Georgia
Authors: Skhvitaridze N , Gamkrelidze A , Lobjanidze T 
Published: November 2019

Abstract

Improvement of reproductive health is a worldwide priority. Maternal and perinatal mortality and morbidity are frequently used as measure of quality of the healthcare. Thus, reduction of maternal morbidity and mortality are important goal for the SDGs. Hence, maternal and new-borns health are crucial to report accurately. The key requirement for progress is to have as much precise data as it is possible. Several tools are developed for quality surveillance; among them is the medical birth registry.
Georgia is a developing country which recently had healthcare in transition. Over the last decade, Georgia’s health sector has improved quality and embraced evidence-based medicine. Transformation and progress attributed reproductive healthcare. Country elaborated strategic plan and set achievable target for maternal and children’s mortality ratios for 2030. Georgia developed national maternal surveillance system. However, country has been lacking precise, comprehensive, and longitudinal data dealing with the reproductive health. Thus far, data on associated health services mainly derived from the sporadic on-demand surveys. Routine info on mortality and morbidity were available as aggregated data with a lack of epidemiological analysis.
In order to provide proper reproductive health profile, Georgia created a nationwide medical birth registry (GBR). GBR has made it possible to create a precise epidemiological analysis and to ensure the evidence-based reporting. To improve epidemiological research capacity, PhD projects were implemented a year after the GBR started operation, in the frame of cooperation of Norwegian and Georgian Universities. Moreover, universities initiated tracks for master students to have internship and graduate thesis in GBR related topics.
Overarching goals of the GBR are numerous. Although compilations of statistics and ensuring scientific bases for advice through generated researches are beneficial for universities and country as well.

Key messages
Studies, based on transparency of highly accurate medical statistics gives possibility for effective implementation of evidence-based public health interventions. Recommendations provided by registry based studies have a pivotal role in formulation and revision of relevant public health strategies.
The importance of relationships in adolescent risk behaviour prevention
Authors: Cooper C , Lhussier M 
Published: November 2019

Abstract

Health risk behaviours are a key contributing factor to adolescent morbidity and mortality. Furthermore, evidence shows that health behaviours begun in adolescence can impact on wellbeing across the lifespan. Current evidence suggests it is advantageous to target multiple health risk behaviours simultaneously, however efficacy testing remains the key focal point for research, with few studies exploring common underlying causal and contextual factors which may contribute to the success or failure of a programme.

Methods
This review used a customised realist approach, to explore how, why, for whom, and in what circumstances programmes are most successful in preventing multiple health risk behaviours in adolescents. The review synthesised evidence from published literature, along with qualitative data from stakeholders collected through focus groups with young people (n = 28) and school nurses (n = 22), and interviews with adolescent health and wellbeing practitioners (n = 8).
Findings: Across all the realist programme theories developed, the role of relationships was the most commonly occurring theme. This theme goes beyond the expected impact of the relationship between programme deliverers and recipients, and familial and peer attachments, also taking in to consideration the relationships between programme and school leaders and staff, support networks and collaborative relationships between staff, and wider social connectedness within the community. These in turn were impacted upon by wider contextual factors, such as family, community, culture, socioeconomic status, intersectionality, and health inequalities.

Conclusions
These findings provide important insight in to understanding how, why, for whom, and in what circumstances multiple risk behaviour prevention programmes succeed or fail. Further to this they highlight key areas for consideration in the development of future adolescent public health interventions.

Key messages
Relationships built on trust and genuine care can improve adolescent risk behaviour prevention outcomes. Broader sociocultural context provide key explanations for variations in programme outcomes.
Women’s experiences with labor companionship in public facilities in Arab countries
Authors: Kabakian-Khasholian T , Bashour H , El-Nemer A , Nameh N 
Published: November 2019

Abstract

Background
Childbirth in the Arab region is characterized by over-medicalization and inequities in access to-and provision of care. Hospital practices do not provide choices for women and respond to the convenience of providers rather than women’s needs. Provision of maternity care is reflective of existing social inequities which is manifested through mistreatment and disrespect of women within the health care system. One such example lies in the restriction of birth companions in public facilities in Arab countries despite being practiced in private settings and the strong evidence supporting its implementation globally.

Methods
A phased mixed-methods implementation research study was undertaken in three public hospitals in Lebanon, Egypt and Syria with the aim of developing a tailored labor companionship model and evaluating its implementation. Data presented emanate from the qualitative component of the study. Semi-structured interviews were conducted with women giving birth (n = 59) and their labor companions (n = 57) in three facilities. Thematic analysis was used.

Results
Beyond the introduction of the model into the system, women reported improvements in dimensions of respectful maternity care. Changes made in shared labor rooms improved women’s privacy. The presence of labor companions improved communication between health care providers, women and their families. Women reported feeling “dignified” and “strong” in the presence of companions. There was a “feedback loop” from the facility to the community with word spreading about labor companionship “just like in private hospitals”.

Conclusions
The labor companionship model improved equitable access to dignified and respectful maternity care through better rapport between women and health care providers, preservation of women’s privacy and having access to birth companion of choice. The provision of evidence-based care has potential implications on women’s experiences with the health care system.

Key messages
This labor companionship model ensured positive experiences for women giving birth in public facilities in Arab countries. Women perceived the model as type of care that reduces differential treatment based on social status and enhances respectful maternity care.
Type2 diabetes:changing patterns of use of antidiabetic drugs 8 years after starting treatment(snds)
Authors: Aguadé A S , Gastaldi-Ménager C , Karsenty D , Fontaine P , Fagot-Campagna A 
Published: November 2019

Abstract

Objective
To describe the changing patterns in the use of the various classes of antidiabetic drugs in a cohort of patients newly treated for diabetes from 2008 to 2015 on the basis of comprehensive health insurance data.

Methods
General scheme beneficiaries 45 years and older were identified in the French National Health Data System (SNDS) as newly treated when antidiabetic drugs were dispensed on at least 3 different dates in 2008 and at least once during the last 4 months of 2008, but were dispensed less than 3 times in 2006-2007. Treatment regimens for the last 4 months of each year were defined for this cohort.

Results
158,000 people (53% men, mean age 62 years) initiated antidiabetic drug therapy in 2008: monotherapy (without insulin): 74%, dual therapy: 17%, treatment with 3 or more drugs: 3%, and insulin therapy: 7%. The proportion of patients taking monotherapy decreased by 13 percentage points during the second year and only 32% of the cohort was treated by monotherapy 8 years after starting treatment. The proportions of patients taking dual therapy increased by 4 percentage points (21% in 2015), triple therapy increased by 8 percentage points (11%), a combination of insulin+other antidiabetics increased by 4 percentage points (7%) and insulin alone remained stable (4%). At the last quarter of 2015, 12% of patients did not receive any antidiabetic drugs and 13% had died. The creation of a cohort of diabetic patients newly treated in 2013 demonstrated changing prescribing practices: a lower proportion of monotherapy in the first year of treatment, but a growing use of metformin.

Conclusions
Treatment was intensified during the first 8 years for one half of the cohort. The maximal dosage of Metformin is not used before introducing a second antidiabetic in 1 case in 2. Insufficient use of Metformin, in general and in terms of dosage, was observed, although this use is improving.

Key messages
Initiation of antidiabetic drug therapy in people 45 years and older consisted of monotherapy in 3/4 of cases in 2008. Insufficient use of Metformin, in general and in terms of dosage, was observed, although this use is improving.
Preventive actions for the gradual reduction of excessive salt intake and its monitoring in Italy
Authors: Donfrancesco C , Bellisario P , Galeone D , Noce C Lo , Russo O , Palmieri L , Giampaoli S , Strazzullo P 
Published: November 2019

Abstract

Issue
The WHO Global Action Plan for the Prevention of NCDs recommends a 30% relative reduction in mean population intake of salt/sodium. To this end, the Italian Ministry of Health (MoH) has strengthened prevention and health promotion through the “Gaining health: making healthy choices easy” Programme and the National Preventive Plan (NPP) 2014-2019, with the collaboration of the Interdisciplinary Working group for Salt Reduction in Italy (GIRCSI).

Description of the problem
According to the “Gaining Health” Programme, agreements between the MoH and the associations of artisan bakers and food industry companies were signed since 2009 to reduce the salt content in bread and in other food products. The reduction of excessive salt intake is one of the main objective of the NPP 2014-2019 pursued by the Regions through initiatives as local inter-sectors agreements and information activities for the population and training for food sector operators. The Italian Institute of Health conducts national surveys to estimate habitual salt intake in the general adult population by collecting 24h urine. Baseline assessment was in 2008-2012 from random samples of persons aged 35-79 years, resident in all 20 Regions. A new survey is ongoing (2018-2019) involving persons aged 35-74 years, resident in 10 Regions. Surveys are funded by the MoH-CCM; urinary sodium excretion is effected by a central lab at Federico II University of Naples, subjected to strict quality controls.

Results
The baseline survey showed a mean sodium excretion of 10.6 g/24h (95% confidence interval 10.5-10.8) in 1963 men and 8.2g/24h (8.1-8.4) in 1894 women. Results of the ongoing survey are expected in the coming months.

Lessons
In Italy preventive actions of salt reduction supported by the MoH have been implemented. Estimation of salt intake in diet by 24h/urine is included. Results of baseline and on-going surveys will allow to estimate the possibility of meeting the WHO salt reduction target by 2025.

Key messages
In Italy inter-sectors preventive actions of salt reduction are implemented. Results of the baseline and on-going surveys will allow to estimate in Italy the possibility of meeting the WHO salt reduction target by 2025.