bluuebunny/crossref_metadata_2025_split huggingface dataset:
The EVITA evidence action tool to improve evidence-based policymaking for public mental health
Authors: Votruba N , Grant J , Thornicroft G 
Published: October 2020

Abstract
The estimated global disease burden of mental illness is 32.4% of years lived with disability. Mental health is a critical determinant for public health, and government-level action is needed for integration of mental health into public health. But in many low/middle-income countries (LMICs) mental health is absent on the policy agenda, despite up to 90% of people with mental illness lacking treatment. Evidence on cost-effective treatments is available, but translation of research into policy is a 'wicked' problem and often fails. We investigate the inter-relationships of research evidence and mental health policymaking in LMICs and present a framework/advocacy tool to guide and support evidence-based public mental health policymaking.
Using a mixed-methods approach, we conducted a systematic review, based on which we developed a provisional framework (EVITA), revised and validated it through expert in-depth interviews. We then empirically tested the EVITA framework against three case studies (provincial, national, global level, South Africa). We collected qualitative data through expert interviews/documentary analysis, coded and analysed the data in NVivo, and finalised the framework and action tool.
We identified agenda-setting as a research theory gap in the context of mental health knowledge translation in LMICs. Thus we developed the EVITA framework for evidence-based mental health policy agenda-setting, and validated it against empirical case studies. Our findings suggest that behavioural methods can support interventions to improve research uptake.
The EVITA action tool has been theoretically and empirically validated, and includes policy agenda-setting and behavioural methods as a novel, effective mechanisms for improving evidence-based policymaking in public mental health. EVITA has the potential to improve the challenging process of research evidence translation into policy/practice in LMICs, and may be applicable to other neglected health areas/countries.

Key messages
The new validated EVITA framework uses agenda-setting and behavioural methods to improve knowledge exchange for better evidence-informed, potentially more effective, public mental health policymaking. The EVITA action tool helps researchers, policymakers & others to strategically take action for public mental health agenda-setting and advocacy interventions for evidence-based policymaking in LMICs.
Autism spectrum disorders – challenges and perspectives
Authors: Tzvetkova S , Tsvetanova K , Karcheva M 
Published: October 2020

Abstract

Background
According the latest data of ADDM in USA one from 59 children is identified with autism spectrum disorder (ASD). ADDM assessments of ASD frequency among children aged 8 years show that this disorder cases increased more than twice in 2012 (1:150) compared with 2002 (1:68). The survey in compliance with ASDEU program comprising 14 European countries shows ratio 1:89 among children aged 7-9 years.

Methods
The following methods were applied: documental (national and regional reports); C.L.A.S.S. -instrument assessing the social communication; IDC and DSM; descriptive and qualitative analysis; anamnestic data and observations. Results of a total 20 cases ranging from 2 yrs. 3 months to 4 yrs. 6 months are commented. The principles of confidentiality, correctness and professionalism were observed.

Results
Common features like disorders in social relations, communication, stereotype behavioral models were found among the surveyed children, as well as some specific features - adoring water 15 (75%), hyperactive 11 (55%), auto-aggressive 5 (25%), fearless in 17 (85%), lack of mutual game in 20 (100%), appearance of “synthetic language” in 6 (30%), cognitive disorders in 20 (100%). Challenges: No academic specialists for ASD therapy are trained in Bulgaria. Frequently the parents look for assistance late. Healthcare handbook - from diagnosis to the complex care, is not created yet. Perspectives: ASD items are already discussed in the sphere of human and medical education. In the sphere not reimbursed by the state function more and more NGO which offer paid social and special services and CSRI provide these services for free.

Conclusions
There is a change from a medical to a social model. In Bulgaria the early diagnostics, early intervention and provision of well-trained professionals are not developed sufficiently well. The increased number of disorders requires fast and adequate reaction.

Key messages
Autism Spectrum Disorders, Bulgaria. Challenges, perspectives.
Positioning work-related stress – General practitioners’ reasoning about a brief intervention
Authors: Hultén A-M , Dahlin-Ivanoff S , Holmgren K 
Published: October 2020

Abstract

Background
General practitioners (GP) can find it difficult to early detect and treat ill health due to work-related stress. In a randomized controlled trial, a brief early intervention using the work stress questionnaire (WSQ) combined with feedback at consultation was tested to reduce sick leave. This study explored GPs' reasoning about using the intervention.

Methods
A focus group study was performed with 23 GPs at six primary health care centers, each constituting one focus group. The discussions, lasting between 30-45 minutes, were analyses based on a method by Krueger.

Results
The GPs positioned work-related stress by making fundamental standpoints on stress and how it should be handled, in order to make sense of their work concerning work-related stress. In addition, they acted to the best of their ability with assigned resources to treat patients with ill health due to stress. Further, the GPs set their regular and preferred way of practicing daily work against the intervention's degree of intrusion and benefits. When the resources and daily work changed, the GPs formed a revised understanding of stress and how it should be handled.

Conclusions
The GPs found their ordinary way of working to be sufficient for early identification and treatment of patients with ill health due to work-related stress. However, when resources were scarce, the responsibility to handle these patients was questioned. Competence and interprofessional collaboration are therefore needed to early identify and treat ill health due to work-related stress. In addition, the GPs' responsibility in relation to other actors must be clarified.

Key messages
The primary health care’s role for patients perceiving work-related stress was not given. The GPs’ confidence in addressing ill health due to work-related stress depended on assigned resources.
Reliability and validity of ecological literacy scale for primary school students
Authors: Öcal E E , Önsüz M F 
Published: October 2020

Abstract

Background
Ecological literacy aims to build up a framework of view that identifies the association with nature and enhances the improvement of new areas to produce sustainable lifestyles. Today, this concept has become one of the important requirements for a sustainable community. The aim of the study was to develop the Ecological Literacy Scale (ELS) to determine the ecological literacy of primary school students.

Methods
This methodological study carried out in 233 primary school 4th grade students in an eco-school in the 2019-2020 academic year. By using literature 91 questions was collected including water, energy, transport and air, biodiversity, purchasing and waste topics which were main issues of ecological footprint. After taking expert opinions, a scale that consists of 32 questions and scored as I agree:3, undecided:2, I disagree:1 and was created named ELS. In order to evaluate the reliability of the scale, item total score correlation and internal consistency (Cronbach's alpha) analyzes and exploratory factor analysis was used for construct validity.

Results
Of the 52.8% students were male and their age ranges from 8-11, the mean was 9.5±0.6. After the scale development study, the scale consisted of 19 items and unidimension. Scale items explain 27.37% of total variance and factor loadings ranged from 0.42-0.64. The Cronbach's alpha coefficient was 0.846 for the scale. In the last form of the scale, the score that can be taken from scale range 19-57. It was accepted that by increasing of the score, ecological literacy level was increased. The mean score of the students was 51.73 ± 5.39 and the median was 53.0.

Conclusions
Ecological literacy could be considered as high level for primary school students in eco-school. ELS was found to be a valid-reliable tool for assesing ecological literacy in primary school students.

Key messages
Ecological literacy is an issue that students should be informed from the primary school period. In the literature, ELS seems the first scale about ecological literacy for primary school students and needs to be tested in large groups of students.
Sleep difficulties and alcohol use behaviors in adolescents and young adults: a systematic review
Authors: Hussain J , Ling L , Stranges S , Anderson K K 
Published: October 2020

Abstract

Background
Sleep disturbances and substance abuse are prevalent in adolescents, often associated with adverse behavioral outcomes and daytime dysfunction. While sleep problems are often seen as consequences to alcohol use, they are risk factors for alcohol misuse and related consequences. However, current evidence in adolescents and young adults (AYA) is mostly observational and is not well-documented in recent years. This systematic review aims to assess the literature surrounding sleep difficulties and their effects on subsequent alcohol misuse in AYA.

Methods
Medline, PsycINFO, and EMBASE were searched for observational studies assessing alcohol consumption, alcohol-related consequences, and self-reported sleep difficulties in AYA aged 16-25. Studies with clinical samples and randomized trials were excluded. Data on measurement tools, measures of association, and sample characteristics were recorded using a standardized form. Associations between sleep difficulties and alcohol misuse were qualitatively summarized by study type (cross-sectional and longitudinal studies). Risk of bias was assessed using CLARITY tools.

Results
Of 7706 records retrieved from databases, 24 studies met the inclusion criteria. Cross-sectional studies (n = 17) found insomnia-like symptoms (difficulties falling/staying asleep, frequent night-time awakenings) were significantly associated with alcohol use frequency and intensity (n = 16) and subsequent intoxication (n = 6). Among longitudinal studies (n = 7), persistent erratic sleep behaviors at baseline were associated with frequent binge-drinking (n = 2) and increased odds of interpersonal problems (n = 2) and risky behaviors at follow-up (n = 1).

Conclusions
The present review assesses the role of sleep difficulties in alcohol use behaviors and related consequences in AYA. Sleep inadequacies are involved in alcohol misuse, prompting investigations to clarify sleep's etiological role in alcohol use behaviors to prevent negative consequences in AYA.

Key messages
Sleep disturbances need to be investigated further as possible risk factors for incident alcohol misuse in young adults. Addressing sleep hygiene and promoting healthy sleep behaviors are important in evaluating the overarching public health issue of alcohol addiction and misuse in adolescents.
Life-style and occupational risk factors for early onset dementia in an Italian community
Authors: Adani G , Filippini T , Garuti C , Malavolti M , Vinceti G , Zamboni G , Tondelli M , Vinceti M , Chiari A 
Published: October 2020

Abstract

Background
Early onset dementia (EOD) is defined as dementia with symptoms onset before 65 years, deeply impacting on patients' employment and income, as well as on their families. Little is known about role of occupational and life-style risk factors, we aimed at assessing their role in disease etiology.

Methods
Using a case-control study design, we recruited all EOD cases resident in Modena province from October, 2016 to October, 2019, and a referent population drawn from patients' care-givers. We investigated residential, life-style history, and occupational and environmental exposures to toxics through a self-administered questionnaire. We used a multivariate unconditional logistic regression model adjusted for sex, age, and education to calculate odds ratios (ORs) and 95% confidence intervals (CIs) of EOD risk for exposed vs. non-exposed subjects.

Results
Overall, fifty-eight EOD cases and fifty-four controls agreed to participate. Possible life-style risk factors are to be widowed (10.3% of cases vs. 2% of controls), and to have a lower educational attainment. Also smoking (OR 1.3, 95% CI 0.6-2.9), playing football (OR 2.2, 95% CI 0.5-9.3) or cycling (OR 2.3, 95% CI 0.4-13.4) were associated with higher EOD risk, although overall sport practice appeared to be a powerful protective factor (OR 0.4, 95% CI 0.2-0.9), particularly swimming (OR 0.2, 95% CI 0.0-0.8). Among occupational factors, disease risk was associated with exposure to aluminum (OR 2.6, 95% CI 0.4-15.7), pesticides (OR 2.3, 95% CI 0.7-7.8), and dyes, paints or thinners (OR 1.7, 95% CI 0.6-5.0). Finally, disease risk was not associate to overall history of any trauma, while head trauma and especially upper arm trauma showed positive association.

Conclusions
Despite the study limitations, our results appear to support a role of modifiable risk factors in EOD etiology, particularly of some chemical exposures and professional sports, while overall sports practice may have a beneficial effect.

Key messages
Some modifiable environmental, occupational and life-style risk factors seem associated with EOD onset. Awareness of EOD environmental and occupational risk factors, as well as life-style ones, is advisable on a public health perspective.
Burnout among preschool teachers in Serbia
Authors: Terzic-Supic Z , Piperac P , Maksimovic A , Karic S , Hacko B , Todorovic J 
Published: October 2020

Abstract

Background
Pedagogical work has been one of the most stressful professions, especially work with pre-school children. Working with each age group has particular challenges, in which educators participate in the development of healthy lifestyles in children, their physical activity habits and their identity as social beings. The incidence of stress-related illnesses is more common among teachers than in the general population. The aim of this study was to examine the prevalence of burnout syndrome among preschool teachers in Serbia and factors associated with it.

Methods
The cross-sectional study was conducted between October 2018 and April 2019 and included National representative sample of 482 pre-school teachers in Serbia. The study instrument consisted of four sections: the socio-demographic, lifestyle and workplace characteristics; Copenhagen Burnout inventory; Beck Depression Inventory, and Zung Anxiety Scale.

Results
The average score on total burnout was 39.1±17.0, while the average score per scales on Copenhagen burnout inventory were: 41.3±18.7 for personal burnout, 41.2±15.9 for work-related burnout and 34.7±22.0 for client related burnout. The frequency of total burnout was 27.1%. Multivariate logistic regression analysis with total burnout as an outcome variable showed that being singe (OR: 0.18, 95% CI: 0.05-0.58), having poor (OR: 6.05, 95% CI: 1.05-34.91), or average (OR: 3.60, 95% CI: 1.57-8.25) self-rated health, not having didactic tools (OR: 2.71, 95% CI: 1.21-6.04), having higher score on Beck depression inventory (OR: 1.19, 95% CI: 1.09-1.29) or Zung anxiety scale (OR: 1.10, 95% CI: 1.03-1.18) was significantly associated with total burnout among our participants.

Conclusions
Our study showed the worryingly high prevalence of burnout among preschool teachers in Serbia. The results indicate its association with mental health problems, depression and anxiety, and yield for preventive action.

Key messages
There is a worryingly high prevalence of burnout among preschool teachers in Serbia. Total burnout was associated with mental health problems.
Anxiety among the Medical students at five Universities in Serbia
Authors: Terzic-Supic Z , Todorovic J , Divjak J , Kocic S , Radovic S , Ukropina S , Mijatovic-Jovanovic V , Mirkovic M 
Published: October 2020

Abstract

Background
Medical education is both academically and emotionally demanding. The demands of medical school can influence the development of anxiety among medical students. The aim of this study was to assess the prevalence of anxiety and factors associated with it among the fifth year medical students at the five universities in Serbia.

Methods
The cross-sectional study was conducted during December of 2019 and included a total of 493 students at the five Universities in Serbia (Belgrade, Novi Sad, Kragujevac, Nis, and Kosovska Mitrovica). The questionnaire used was developed based on the questionnaires from similar research and included the sections on social characteristics, lifestyle characteristics, study engagement, Beck depression inventory, Copenhagen burnout inventory, and Zung anxiety scale. Based on the score on Zung anxiety scale students were classified in two groups: with anxiety (scores ≥45) and without anxiety (scores 20-44).

Results
The mean Zung anxiety scale score was 35.39±8.31 (minimum=20, maximum=69). A total of 64/493 students (13%) was in the group with anxiety. The multivariate logistic regression analysis with the anxiety as an outcome variable showed that anxiety was associated with female sex (OR: 4.20, 95% CI: 1.41-12.50), higher scores on Beck depression inventory (OR: 1.18, 95% CI: 1.12-1.26), and total burnout (OR: 3.98, 95% CI: 1.66-9.54).

Conclusions
This study shows that students with anxiety have a higher likelihood of higher scores on Beck depression inventory and a higher likelihood of having burnout syndrome. The clustering of mental health problems, along with the high prevalence of anxiety among medical students is alarming.

Key messages
One in eight medical students in Serbia has scores on Zung anxiety scale indicative of at least mild anxiety. The anxiety was associated with female gender, higher score on Beck depression inventory and total burnout.
Evidence of content validity on the mental health care needs scale
Authors: Mendonca J M T , Freire A A , Rewa T , Zorzi D , Monteiro C N , Teles A , Paresque M A C , Oliveira I E , Bonfim D , Rebustini F 
Published: October 2020

Abstract

Background
The gap in care for psychological distress has been one of the greatest challenges for health systems. Stepped care models represent attempts to maximize the effectiveness and efficiency of decisions about resource allocation in therapy. In Brazil, there are no tools that support this process. The Hospital Israelita Albert Einstein executes the project entitled PlanificaSUS to organize the health care network and strengthen PHC. We aimed to develop and search for evidence of Content validity on the Mental Health Care Needs Stratification Scale.

Methods
The latent variable is the need for mental health care. The 130 items considered the literature and 73 experts' opinion. The items were categorized into six dimensions referred by users (social, autonomy, functionality, interpersonal relationship, spirituality, and clinical history) and a dimension evaluated by the professional (clinic). The invitation was made by the snowball method. Content validity was based on clarity, relevance, and semantics, and calculated by Content Validity Ratio (CVR), considering a critical CVR value&gt; 0.11. This study was approved by the research ethics committee.

Results
A total of 73 professionals including health service professionals, teachers, and psychometrists, from all regions of Brazil participated, most of them female (73%), the average age was 40 years old, most with specialization (47%). Most were nurses (36.8%), psychologists (15.8%), PHC doctors (10.5%), social workers (9.2%), with more than 10 years of experience in the service (28.9%). At the end of the content validation, the scale presented 43 items with CVR between 0.11 and 0.25.

Conclusions
There is evidence of content validity of the scale, and it will supports professionals in making decisions about which is the right therapy, at the right time, for the right patient.

Key messages
The scale will be a powerful tool for the coordination of care between Primary Health Care and Mental Health specialized services. For practice use, it still is necessary to validate the internal structure.
Addictions and mental health disorders among adolescents: a cross-sectional study; Tunisia 2020
Authors: Amara A , Ghammem R , Sahli J , Alouani D , Dziri F , Maatoug J , Ajmi T 
Published: October 2020

Abstract

Introduction
Adolescence is a period of significant and rapid development, marked by the growing influence of peers, individual behavioral choices and increased risk taking, including addictive behaviors. Furthermore, association between these behaviors and mental health disorders such as anxiety, depression and low self-esteem, has been demonstrated in literature. In accordance with this need, we conducted this study to determine the prevalence of addictive behaviors and screen for mental disorders among adolescents.

Methods
We conducted a cross sectional study in Enfidha (a town in the Sousse governorate; Tunisia). The setting of the study was in high and middle schools. Data collection was done during January and February 2020. A structured self-administered questionnaire was used in this aim. It included socio-demographic characteristics, screening for mental health problems and addictive behaviors (self-esteem, depression, anxiety, facebook addiction and video game addiction). The scales are self-report validated instruments.

Results
We included 1195 participants with a median age of 14 years (IQR 13-16). Females represented 54.2 % of the sample. Concerning depression and anxiety, it was reported among 71.3%, 62.4% of participants, respectively. We noted that self-esteem was low among 49.5% of respondents. The pooled prevalence of internet gaming disorder and Facebook addiction was 37.4% and 32.3%, respectively. Our finding yield that girls were more prone to be Facebook addict. Meanwhile, internet gaming disorder was more common among boys. Regarding tobacco and alcohol use, it was reported among 16.7% and 3.2% of students, respectively. Our results pointed out that illicit substances' experimentation was disclosed among 2.1% of our sample.

Conclusions
Our study is one of rare and recent research in our country interesting the striking issue of addiction and mental health disorders among adolescents.

Key messages
Tobacco and alcohol use was reported among 16.7% and 3.2% of students. Illicit substances’ experimentation was disclosed among 2.1% of our sample.