bluuebunny/crossref_metadata_2025_split huggingface dataset:
Does the ehealth card facilitate access to healthcare from the point of view of refugees in Germany?
Authors: Rolke K , Wenner J , Razum O 
Published: November 2019

Abstract

Background
The municipalities in the federal state of North Rhine-Westphalia (NRW) decide autonomously how to organize access to health care for refugees: either with electronic health card (eHC model) or with health care voucher (HcV model). The eHC model is often expected to facilitate access to health care and to reduce bureaucratic barriers. However, there are only few analyses of how refugees perceive the two models and their corresponding access to health care.

Methods
A total of 28 problem-centered interviews with refugees were conducted in three municipalities in NRW (two with HcV and one with eHC model). Sampling was purposive, aiming to achieve a maximum variation of interview partners with regard to age, gender, chronic illnesses, pregnancy and parenthood. The interviews were conducted with the support of translators in the language of the respondents’ choice. Interviews transcripts were evaluated by content analysis using the software atlas.ti.

Results
Refugees using both the eHC and HcV models report mostly positive experiences when seeking care - both in terms of treatment and interaction with physicians or non-medical staff. The first contact with the health care system was rarely organized by refugees themselves in both models, but mostly with the support of social workers, friends, or family members. The main perceived difference between the models was that in the HcV model, urgent treatment required additional waiting time.

Conclusions
Access to care is assessed similarly well by refugees in all municipalities. The additional approval process for treatment by the social welfare office in HcV municipalities may lead to a delayed treatment. Formal and informal support is particularly important for newly arriving refugees to help them navigate the complex German health system.

Key messages
The implementation of one access model alone does not facilitate access to health care for refugees. Formal and informal support is necessary for refugees to gain access to the health system.
Factors associated with self- and other-directed aggression in Slovak adolescents
Authors: Janovska A , Gajdosova B , Kalina O 
Published: November 2019

Abstract

Background
We investigated differences in intrapersonal and interpersonal characteristics of adolescents with and without reported aggressive behaviours (AB). We distinguished two types of intrapersonal factors (self-esteem (SE), self-control (SC)) and three types of interpersonal factors (prosocial peers (PP), supportive relationships at home (SRH), supportive relationships at school (SRS)). We separately examined self-directed aggressive behaviours (self-destructive thoughts, self-destructive behaviour) and other-directed aggressive behaviours (using vulgar words, fighting, physical harm, intimidation, mockery of classmates).

Methods
A representative sample of 1101 adolescents (50.1% female, mean age of 13.5 years) was collected from primary schools in Slovakia. The respondents completed the SE Scale, the SC Scale, the Resilience and Youth Development scale and they were also asked about the frequency of AB. In each form of AB (self- and other-directed) two groups were created: those who reported some AB and those who did not report any AB. Descriptive statistics and nonparametric tests were used for the data analysis.

Results
Almost 75% of the adolescents reported some AB towards others and 41% reported self-harming thoughts or behaviours. Statistically significant differences were observed for both self-directed AB (SE: p&lt;.001, SC: p&lt;.001, PP: p&lt;.001, SRH: p=.013, SRS: p&lt;.001) and other-directed AB (SE: p=.034, SC: p&lt;.001, PP: p&lt;.001, SRH: p=.039, SRS: p=.016). In all cases adolescents who reported AB typically had a lower level of intrapersonal and interpersonal variables compared to those who did not report AB.

Conclusions
The study contributed to the understanding of factors linked to aggressive behaviour of adolescents and confirmed the associations with self-esteem, self-control, supportive relationships at home and at school and having prosocial peers.

Key messages
Aggressive behaviour of adolescents can be linked to interpersonal and intrapersonal relationships. The above holds for both self- and other-directed aggression.
What should parents do to emphasise their disapproval of adolescents’ substance use?
Authors: Bacikova-Sleskova M , Hricová L , Kalina O , Benka J 
Published: November 2019

Abstract

Background
Previous research has shown that one of the strongest predictor of smoking and alcohol consumption in early adolescence is perceived parental approval of such behaviour. The aim of the present study is to explore which parenting practices predict the probability of perceiving parental disapproval of smoking and alcohol consumption in adolescence.

Methods
A representative sample of 1133 early adolescents (mean age = 12.9, SD 0.77) filled in questionnaires including sociodemographic characteristics (3 items), perceived parental risk behaviour (alcohol consumption at least once a week, drunkenness once a month and daily smoking); substance specific conversations with parents (1 item); both emotional and controlling aspects of parenting (6 items), and perceived parental disapproval of adolescents’ smoking and alcohol consumption as dependent variables. Logistic regression was used to analyse the data.

Results
The most important predictor of perceived parental disapproval of alcohol use was behavioural control (setting rules) (OR 2.34), followed by parental non-drinking (OR 1.81) and alcohol specific communication (OR 1.28). Regarding smoking disapproval, the significant predictors were parental non-smoking (OR 1.92); behavioural control (OR 1.79); time spent with a child (OR 1.44) and lower psychological control (guild induction, pressuring, manipulation) (OR 0.69).

Conclusions
Decreasing adolescents’ substance use via increasing their perceived parental disapproval of such behaviour seems to be substance specific. The most salient strategy both for smoking and drinking seems to be the use of behavioural control characterized by clear rules setting and lack of parental own substance use.

Key messages
Decreasing adolescents’ substance use via increasing their perceived parental disapproval of such behaviour seems to be substance specific. The most salient strategy to increase perceived parental disapproval of smoking and alcohol consumption seems to be the use of behavioural control characterized by clear rules setting.
Adolescent tooth brushing frequency evolution (2006-2014), risk factors and causality hypothesis
Authors: de Grado G Fernandez , Offner D , Godeau E , Nabet C , Musset A M 
Published: November 2019

Abstract

Objectives
To analyze the evolution of tooth brushing frequency (TBF) as well as the impact of socio-economic status and health behaviors between 2006, 2010 and 2014 among adolescents from the French Health Behavior in School-aged Children (HBSC) cross-sectional studies.

Methods
We included 18727 adolescents aged 11, 13 or 15 years old (y/o). The relationship between TBF and variables such as eating habits, health and socio-economic status markers as well as their evolution over the 3 studies were analyzed using logistic regression. We used directed acyclic graphs (DAGs) to represent the potential chain of causality between TBF, its associated factors, as well as latent variables such as the risk for oral diseases.

Results
Proportion of adolescents brushing twice a day increased from 68.8% in 2006 to 70.8% in 2010 and 78.8% in 2014 (p &lt; 0.0001). Notable predictors (p &lt; 0.0001) were being a girl (adjusted Odd Ratio = 1.5) and even more an older girl (aOR 1.5 for 15y/o vs 11 y/o girls), having breakfast and fruits daily (aOR 1.4 and aOR 1.6), excellent perceived health (aOR 1.2), obesity or overweight (aOR 0.6), being bullied at school (aOR 0.8) and perceived family wealth (aOR 1.4 for High vs Low). Impacts of these predictors were stable over the 3 studies. DAGs highlighted the fact that a low TBF and its associated risk factors described a high-risk population for poor oral and global health. Variables at the origin of those risks seemed to be age, sex, familial environment, socio-economic environment and education.

Conclusions
TBF among French adolescents improved from 2006 to 2014. This may be linked with global prevention programs developed during this time period. These programs should be associated with more specific ones targeted towards and adapted to disadvantaged populations to diminish inequalities. The use of DAGs is a powerful tool to identify the origin of those inequalities as well as the right factors to target in order to achieve efficient prevention.

Key messages
Global and specific prevention programs should be associated to allow a global improvement in tooth brushing as well as a diminution of inequalities. Use of specific statistical tools can help identify specific trends in health behaviors and alterable risk factors.
Association between positive mental health and family background among young people in Finland
Authors: Appelqvist-Schmidlechner K , Tamminen N , Solin P 
Published: November 2019

Abstract

Background
Positive mental health (PMH) is an important construct for understanding the full continuum of mental health. The aim of this study was to examine the association of family background with the level of PMH among adolescents and young adults in Finland.

Methods
Data from population-based Finnish School Health Promotion Study targeted at year 8. and 9. students of comprehensive school and year 1. and 2. students of upper secondary school and vocational schools was used (n = 134684) for the study. PMH was measured with short Warwick-Edinburgh-Mental-Wellbeing-Scale (SWEMWBS) and examined on a continuum from languishing (low level of positive mental health) to moderate to flourishing mental health (high level of positive mental health). Associations between flourishing/languishing mental health and family background variables were analysed with logistic regression analysis, school level and gender were adjusted.

Results
Flourishing mental health was associated with intact family background, higher education of parents and better financial situation of family. In contrast, languishing was associated with non-intact family conditions (single parent family, parents divorced, stepfamily) and parents’ unemployment, lower level of education and financial problems.

Conclusions
Family structure and socioeconomic status of parents have an impact on PMH of young people. Young people with non-intact family structure and/or poorer socioeconomic status may lack positive sense of well-being, in other words they have challenges to enjoy their life, to believe in their own abilities, to cope with normal stresses of life, to study productively and to enjoy interacting with others. Targeted interventions and promotive actions should be directed for young people with challenging family conditions in particular.

Key messages
Investigating positive mental health (PMH) is essential for understanding the full continuum of mental health. Family structure and parents’ socioeconomic status have an impact on PMH of young people.
Effectiveness of a drug use prevention program on alcohol use and drunkenness among schoolchildren
Authors: Štefaňáková M , Kulanová-Dobrowolska M , Orosová O , Abrinková L 
Published: November 2019

Abstract

Introduction
Unplugged is a universal drug prevention program consisting of 12 lessons and intended for primary schools. In the school year 2017/2018, Unplugged was implemented in the Slovak Republic in the 7th grade.

Objective
To examine the effectiveness of Unplugged on lifetime prevalence of drunkenness and alcohol use during the last 30 days as well as the moderation effect of gender in these relationships. Furthermore, the role of smoking in relation to alcohol use and drunkenness was monitored.

Methods
The study has been designed as a cluster randomized controlled trial with data collection before the program implementation and immediately after the implementation. In total, 486 schoolchildren participated in the trial (M = 13.05; 49.6% boys) and were randomly assigned to either an experimental (N = 277) or control group (N = 209). Binary logistic regression was applied and adjusted for gender and baseline risk behaviour.

Results
There was no significant effect of Unplugged and no moderation effect of gender with regard to lifetime prevalence of drunkenness. However, smoking was also reported by those schoolchildren who reported drunkenness (OR 6.735; 95%CI 3.210-14.132). A significant program effect was found regarding the prevalence of alcohol use during the last 30 days. The schoolchildren in the experimental group had lower alcohol use in comparison to the control group (OR 0.501; 95%CI 0.253-0.993). The moderation effect of gender showed that the program had an effect on alcohol consumption in boys. After completing Unplugged, alcohol consumption in boys decreased significantly (OR 3.222; 95%CI 1.158-8.962). The results also confirmed that smoking is related to the prevalence of alcohol use during the last 30 days (OR 3.109; 95% CI 1.226-7.885).

Conclusions
The findings confirmed that Unplugged reduced alcohol use among boys. It has been also shown that smoking is a significant predictor of alcohol use and drunkenness.

Key messages
The findings point to the role of gender differences in the effectiveness of a prevention program. The effectiveness of the preventive program is more pronounced for those schoolchildren who are more likely to use alcohol before the program, especially boys.
Effects of educational policy on unhappiness of middle and high school students in Korea, 2006-2016
Authors: Eun S J , Kim H-S 
Published: November 2019

Abstract

Background
Educational policies may have a substantial impact on health and well-being of students, who spend most of their daily lives at school. Policies on secondary education in Korea has changed in the late 2000s, which diversified college entrance exams (CEEs) and made the National Curriculum (NC) more autonomous to mitigate students’ burden of preparing for CEEs. This study aimed to estimate effects of educational policy changes on unhappiness, which is known to be associated with health status such as mortality, morbidity, and prognosis, of students in secondary education.

Methods
Using repeated cross-sectional self-reported data of 773,362 students in the Korea Youth Risk Behavior Web-based Survey during 2006-2016, cross-classified random effects models were fitted to estimate the fixed cohort effects of educational policy changes on unhappiness while considering individual factors and random effects of periods and grade cohorts.

Results
Students’ unhappiness increased when the NC began to become autonomous (odds ratio [OR] 1.21, 95% confidence interval [CI] 1.03-1.42), but it increased less after the autonomous NC was fully applied (OR 1.14, 95% CI 0.92-1.42). Two times of diversification of CEEs increased unhappiness (OR 1.21, 95% CI 1.06-1.38 for the first diversification and OR 1.33, 95% CI 1.07-1.67 for the second diversification). Unhappiness was high in students with high stress level (OR 7.59, 95% CI 7.43-7.75), low academic performance (OR 1.48, 95% CI 1.44-1.52), and low household economic status (OR 2.32, 95% CI 2.26-2.39).

Conclusions
Enhancement of autonomy of the NC and diversification of CEEs increased students’ unhappiness. Educational policy changes that diversified competencies required for college admission might result in an increase in academic burden in the context of Korea, where entrance into prestigious universities is crucial for success in life. Improvement of educational policy is needed to increase students’ happiness.

Key messages
Educational policies may have a substantial impact on health and well-being of students, who spend most of their daily lives at school. Education policy changes in Korea increased students’ unhappiness, which might be due to an increase in academic burden resulted from diversification of competencies required for college admission.
Risks and success conditions for the French sanitary service of health students
Authors: Gerbaud L , Pizon F , Odoul J , Clavelou P 
Published: November 2019

Abstract

Background
French sanitary service of health students was a pledge of the French Presidency. It is mainly presented as a massive information campaign on good practices in health made by “thousands of health students going into the enterprises and schools”. We tried to skip this orientation and to go to actions in favor of people’s empowerment and ability in health choices.

Objectives
Our program was designed to change students’ ideas on prevention, by focusing on reflexivity, motivational approaches, education and ethic in health promotion, of peer-to-peer effects and concrete use of educational tools for teen-agers groups. We developed students’ autonomy and ability to negotiate their project with the prevention structures. Training was 11 workshops (2 hours each), of 15 to 20 students (mixing medical, pharmaceutical, dental and midwives), and e-learning. Then they had 5 months to negotiate with their place of intervention (secondary schools and apprenticeship centers) and create their own new project. Intervention lasted for one week, full time, in various teen-agers settings, so that to reduce social and territorial inequities in health.

Results
After a first test (28 students in 6 settings), 250 students acted in 72 teen-agers’ facilities. Problem occurs in 1 case (lack of negotiation and preparation before the intervention) and satisfaction of both students and facilities are high. At the same times, we had to face constraints due to double bind policies of the state authorities (i.e. as asking for more training time and reducing training financing, asking to send students in deprived or isolated areas and reimbursing scarcely the costs).

Conclusions
An educational program on training and students’ autonomy works if we take care on five points: learning of educational process in health, control of peer-to-peer effects, reduction of health inequities, and reinforcement of local health promotion policies. This also needs state policies that are ready to play the game.

Key messages
Training of health students to develop their autonomy and ability in health education works. Inconsistency in State policies is the major problem.
The trends in health behaviour of the first-year students from Kaunas universities, 2000 - 2017
Authors: Petkeviciene J , Kriaucioniene V 
Published: November 2019

Abstract

Background
First-year university students are exposed to different factors affecting their lifestyle. The aim of the study was to evaluate the trends in health behaviour of first-year students from four Kaunas universities over 17 years.

Methods
The study was carried out in 2000, 2010 and 2017. In total, 689, 739 and 1062 randomly selected first-year students participated (response rates &gt;90%). During the lectures, participants filled in the anonymous questionnaire that included information on nutrition, physical activity, harmful habits, height, and weight.

Results
The reduction in daily smoking was observed: from 30.2% in 2000 to 18.4% in 2017 among males and from 21.1% to 15.9% among females, respectively. The proportion of male students drinking alcohol at least once a week declined from 62.7% in 2000 to 31.6% in 2017 and the proportion of females - from 41.5% to 27.3%, respectively. There was an increase in the proportion of students who have tried or are taking drugs: from 15.9% in 2000 to 27.8% in 2017 among males and from 4.8% to 18.8% among females, respectively. The changes in the nutrition habits of the students were observed: the proportion of students who consumed red meat every day decreased (up to 35.6% in 2017). In 2017, more students consumed cereals, fresh fruits and vegetables every day and fewer sweets, confectionery and soft drinks at least once a week than in 2000. There was a decline in meantime students spent sitting as well as in the average duration of the sleep. The proportion of students who take part in sports activities has increased by 17.1%. However, the prevalence of overweight and obesity increased from 11.7% in 2000 to 23.7% in 2017 among males, and from 4.2% to 9.0% among females, respectively.

Conclusions
Over 17 years, most health behaviours of the first-year students have changed in a positive direction; however, some unhealthy habits are still common and the prevalence of overweight has increased.

Key messages
This study highlights the importance of implementing preventive programmes among students after starting university. Monitoring of changes in health behaviour of students helps timely respond to the challenges.
Presence of intimate family and cancer screening behavior: a cross-sectional study of 4237 workers
Authors: Miyamatsu N , Shima A , Morino A , Azuma S , Ichikawa M , Godai K , Kawatsu Y , Nishikawa T , Tanaka H , Okamura T 
Published: November 2019

Abstract

Background
Presence of intimate family is considered as one of the related factors of health behaviors. The study aim was to clarify the relationship between the presence of significant others and having a colorectal cancer screening.

Methods
This study used data of baseline survey of intervention study regarding breast cancer screening at worksites. A total of 6827 workers, aged 40 and over of the retail company, were required to fill out a self-administrated questionnaire related to cancer screening. the intimate family was defined as a person’s spouse or partner and children. Logistic regression analyses were performed to estimate odds ratios [ORs] and 95% confidence intervals [CIs] of undergoing an annual screening for colorectal cancer by the presence of spouse or partner adjusting for age. The same analysis was performed regarding the presence of children.

Results
Response rates were 70% in men and 71% in women. After excluding participants with a past history of cancer and lack of information about colorectal cancer screening or the presence of significant others, 4203 remained for the analyses. A total of 1777 participants reported that they had undergone screening for colorectal cancer within a year (42% in men and 42% in women). Screening rates of participants with/without a spouse were 45% and 30% in men, 44% and 38% in women. Screening rates of participants with/without children were 45% and 33% in men, 43% and 38% in women. ORs of undergoing annual colorectal cancer screening by the presence of spouse were 1.8 (1.3-2.5) in men and 1.3 (1.1-1.5) in women. ORs by the presence of children were 1.6 (1.2-2.1) in men and 1.1 (0.9-1.3) in women.

Conclusions
This study indicated that health behavior in cancer screening could be affected by having a spouse in both men and women. The presence of children positively related in men. Male workers with children might be under some pressure to keep their health, from a sense of responsibility of main income earner.

Key messages
Health behavior in cancer screening could be affected by having a spouse. Health behavior in cancer screening could be affected by having a child only in men.