bluuebunny/crossref_metadata_2025_split huggingface dataset:
Strengths and Difficulties Questionnaire (SDQ) as an assessment tool for measuring emotional and behavioural problems in young children
Authors: Dahlberg A , Fält E , Sarkadi A , Fabian H , Salari R 
Published: October 2020

Abstract
Evaluation of new initiatives to tackle mental health problems in children requires instruments that are both valid and reliable. One such instrument is the Strengths and Difficulties Questionnaire (SDQ), an assessment tool for child emotional and behavioural problems. The instrument was developed by Goodman in the 1990's and is being used worldwide in both clinical settings and research projects.
However, previous studies on the SDQ have mainly focused on school-aged children and adolescents. We know very little about the usefulness of the SDQ for measuring preschool children's mental health problems. Using data from a large number of parents and preschool teachers of children aged 3-5 (&gt; 11 000 questionnaires), we tested the psychometric properties of the SDQ, examined the inter-rater agreement and provided cut-off points.
The original five-factor model of the SDQ was supported and it was shown to be a reliable instrument in the hands of mothers, fathers and preschool teachers. We also found significant, albeit poor, agreement (ICC) between parent and teacher ratings and good agreement between parents' ratings. Teachers reported lower levels of problems compared to parents. Compared to girls, boys were generally reported to have more problems. Thus, we provided separate cut-offs for each age group, gender and rater category.
The results suggest that SDQ can reliably be used for measuring emotional and behavioural problems in young children in community settings. They also suggest that parent and teacher reports are complementary; hence, reports from both types of informants should be considered when using the SDQ as a method to identify mental health problems within the child health services. However, inter-rater agreement between mothers and fathers was good, meaning that it may be sufficient to obtain data from a single parent informant.
Using a simple direct-to-consumer marketing strategy to increase participation in parenting programs
Authors: Salari R , Dahlberg A , Sarkadi A , Fängström K 
Published: October 2020

Abstract
Low participation in evidence-based parenting programs not only presents a major challenge for population trials where a minimum level of intervention exposure is necessary to detect population-level impact, but also undermines the incorporation of these programs into routine practice settings. As part of a large population trial, we aimed to increase participation in a series of parenting seminars by using a simple direct-to-consumer marketing strategy, i.e., redesigning the program flyer.
We captured parents' attention by affirming that “parenting is not always easy”, highlighted the potential benefits of participation, clarified what participation entailed, and addressed some of the common barriers such as the stigma associated with participation in parenting programs. Because fathers and mothers were shown to have different needs, we tailored the flyers to mothers and fathers separately.
Testing the flyers on a small sample of parents showed that both mothers and fathers perceived the flyers as relevant. As expected, mothers were more likely to express interest in the program when they saw the flyer which focused on benefits related to dealing with child behavioural problems and featured a mother-child dyad, while fathers preferred the flyer which highlighted the benefits related to dealing with emotional problems, and featured a father-child dyad.
Next, following the same procedure that was used to deliver the original flyers over the first 18 months of the project, we used the new flyers to inform parents about the upcoming seminars over the next 24 months. The preliminary results showed that although the average number of parents participating in each seminar had initially decreased from about seven to four, after the introduction of the new flyers, the number increased consistently and reached an average of nine parents during the last 6-month period.
The results shows that program uptake can be increased using simple direct-to-consumer marketing strategies.
Influence of ultra-processed foods on prevalence of inadequacy in Portuguese adults and elderly
Authors: Costa de Miranda R , Rauber F , Moraes M , Rodrigues S , Bertazzi Levy R 
Published: October 2020

Abstract

Background
Ultra-processed foods (UPF) consumption has been widely associated with low diet quality. We aim to investigate its energy contribution and influence on prevalence of nutrient inadequacy in Portugal.

Methods
Cross-sectional representative study involving 3102 adults and 750 elderly enrolled in the 2015-2016 National Food, Nutrition and Physical Activity Survey. Dietary intake was assessed by two non-consecutive 24h recalls. Food items were classified according to the NOVA system. Total energy intake and energy contribution provided by UPF group were determined. Inadequate intake was evaluated across quintiles (Q) of UPF consumption by adjusted Poisson regressions. We adjusted the usual intake estimate by Multiple Source Method and considered the World Health Organization (WHO) recommendations.

Results
UPF contributed with 24% and 16% of daily energy intake in adults (1904 kcal/day) and elderly (1603 kcal/day), respectively. In both age groups, practically all individuals had inadequate intake of sodium, while about a half or more of population had inadequate intake of fibre and potassium. As the dietary share of UPF increased, the prevalence of inadequacy of free sugars (PR = 1.53 for adults and 1.56 for elderly) and saturated fat (PR = 1.18 and 1.15, respectively) increased significantly. In adults, this same trend was also seen for fibre (PR = 1.03) and potassium (PR = 1.12). Particularly relevant was the increase in prevalence of inadequacy of free sugar from 10.5% (Q1) to 67.6% (Q5) in adults and 5.8% (Q1) to 41.8% (Q5) in elderly. Prevalence of inadequacy of saturated fat raised from 27.3% (Q1) to 68.9% (Q5) in adults and 29.4% (Q1) to 46.8% (Q5) in elderly.

Conclusions
Effective strategies are needed to reduce UPF consumption among Portuguese adults and elderly in order to prevent them from diet-related non-communicable diseases.

Funding
FAPESP 2018/07391-9, 2019/05972-7 (MCR), 2016/14302-7 (FR); POCI-01-0145-FEDER-032090.

Key messages
Ultra-processed food contributes with 24% and 16% of daily energy intake in Portuguese adults and elderly. As the ultra-processed food consumption increases, the prevalence of inadequacy of free sugars and saturated fat increases for both, while inadequacy of fiber and potassium also increases for adults.
Unraveling community engagement in health promotion among vulnerable families: a multiple case study
Authors: Hogeling L , Vaandrager L , Koelen M 
Published: October 2020

Abstract
Community engagement has since long been promoted among health promotion practitioners, policy-makers and scientists. However, many uncertainties remain when it comes to the workings and effects of community engagement in health promotion. The aim of this study is to provide in-depth insights into the workings and effects of community engagement.
In a multiple case study, we investigate three health promotion projects among vulnerable families in The Netherlands. The projects are all funded by the Healthy Futures Nearby Programme. Data was collected by group interviews, telephone interviews and written progress reports. We adopted a realist approach, in which we first identified assumptions about community engagement. We then analysed the qualitative data for context-mechanism-outcome configurations to test and refine this programme theory.
Preliminary results show that active engagement can strengthen social networks, empowerment and perceived health among vulnerable families. However, specific contexts, in combination with the project interventions, may or may not trigger positive responses (mechanisms). Vulnerable families may feel they matter when asked to actively contribute in a project, which in turn can enhance their self-confidence. In another context, we found vulnerable families overwhelmed by the responsibilities given to them in the project, leading to feelings of stress and withdrawal from the project. We will present a full list of context-mechanism-outcome configurations that describe possible effects of community engagement of vulnerable families.
The two sides of the assumptions project teams hold about effects of community engagement, show that tension exists around actively involve communities in health promotion projects. In-depth insights into the workings and effects of community engagement will provide health promotion scientists and practitioners with knowledge to shape and optimize community engagement in health promotion projects.

Key messages
The study shows that, in practice, tensions exist between expected effects of community engagement and actual unclarity about what community engagement can do in for vulnerable people. Contexts of health promotion projects, in combination with specific interventions, may or may not trigger positive responses to active involvement among vulnerable families.
Inequalities in life expectancy by place of residence and its changes in Lithuania during 1990-2018
Authors: Sauliune S , Mesceriakova-Veliuliene O , Kalediene R 
Published: October 2020

Abstract

Introduction
Health inequalities have emerged as a big issue of public health in Lithuania. Recent studies have demonstrated increasing mortality differentials between different socio-demographic groups of the population. Urban/rural place of residence is related with a set of socio-economic characteristics, different access to material resources, presence or absence of social support, and attitudes to health-related behavior.

The aim of the study
To determine inequalities in life expectancy and its changes by place of residence (urban/rural) in Lithuania during 1990-2018.

Methods
Information on deaths and population numbers for the period of 1990-2018 was obtained from National Mortality Register and Population Register. Life expectancy for males and females of urban and rural populations was calculated using life tables. Changes in the magnitude of life expectancy inequalities by place of residence were assessed using rate differences (urban-rural); while trends in inequalities were estimated by conducting the Joinpoint regression analysis.

Results
Life expectancy among males and females was longer in urban compared to rural areas throughout the entire study period. Life expectancy increased statistically significantly for urban and rural males and females with the most notable increase for males, especially those living in rural areas (on average by 0.4% per year from 64.1 years in 1990 to 70.05 years in 2018). Inequalities in life expectancy by place of residence decreased statistically significantly among Lithuanian males from 3.48 years in 1990 to 1.39 years in 2018, while among females only the tendency of decrease was estimated.

Conclusions
Inequalities in life expectancy of males and females by place of residence decreased significantly in Lithuania throughout the period of 1990-2018, mainly due to positive changes in life expectancy among rural males.

Key messages
Inequalities in life expectancy of males and females by place of residence decreased significantly in Lithuania throughout the period of 1990-2018. Life expectancy increased for Lithuanian urban and rural males and females with the most notable increase for males, especially those living in rural areas.
Oral health status and treatment needs of school going children in a tribal area in Southern India
Authors: Thomas S , Chacko R , Khanapur G D , Kattula D , Rose A 
Published: October 2020

Abstract

Background
Children suffer a significant burden of oral diseases which impacts their quality of life, and general health. Many epidemiological studies have looked at oral health status and treatment needs among children in urban and rural areas across different age groups. There was limited literature assessing the oral health status among children in tribal areas, which presents unique challenges in terms of: topography, availability of health services, and complex socio-cultural health practices.

Methods
Cross-sectional study was conducted among 655 children across six schools between 12-15 years in Jawadhi Hills, Tamil Nadu, India. World Health Organization's, Oral Health Surveys were used for clinical and risk factor assessments. Clinical examination was conducted, and self-assessed questionnaire was administered to the children to assess the risk factors to poor oral health. Since dental fluorosis was common, drinking water samples were collected to assess fluoride levels in the community.

Results
Prevalence of dental caries and gingivitis (gum disease) was found to be 22.3% and 87.3% respectively. Dental Pain was reported by 57% of children as the most common reason to visit the dentist. Prevalence of dental fluorosis was found to be 53.6%. Multiple logistic regression showed: gender, dental fluorosis, diet, and maternal education significantly associated (p &lt; 0.005) with dental caries. Fluoride levels in water was found to be higher than permissible limits (&gt;1.5 ppm).

Conclusions
Children requiring treatment (∼ 200) were referred to the local hospital, and treatment was done free-of-cost. School authorities were informed about the current oral health status of children and advised to conduct regular health education & dental camps; the importance of girls' education was emphasized. Local authorities were alerted about the fluoride-rich water situation in the community and educated about defluoridation methods that the community can employ at household level.

Key messages
Evidence-based burden of oral diseases was presented to the local authorities for the first time, with a call for action. A referral system was established between the schools and the local hospital, to ensure continuity of oral health care for the children.
Efficiency of groups of primary healthcare centres: a frontier analysis of primary care in Portugal
Authors: Santos J V , Souza J , Pinto A , Ramalho A , Pereira A , Pestana J P , Camanho A , Freitas A 
Published: October 2020

Abstract

Background
Primary health care (PHC) is the cornerstone of several health systems. The Portuguese PHC is organized in five mainland regions (ARS), that oversee 55 local groups of primary healthcare centres (ACES). We assessed the efficiency of all 55 ACES in mainland Portugal, as well as organizational and socioeconomic determinants of the efficiency.

Methods
A cross-sectional non-parametric frontier analysis was performed for 2017. The first model included two inputs (i.e. number of physicians and number of nurses) and a single output (i.e. number of PHC visits), while the second model included an additional output, i.e. Prevention Quality Indicator (PQI) overall composite (avoidable hospitalizations) adjusted for age and sex - as undesirable output. In a second stage, a (multivariate) Tobit regression was used to assess organizational and socioeconomic determinants of efficiency.

Results
In the first model, only 8 ACES (14.5%) were on the efficiency frontier, while 25 ACES should readjust their human resource balance. In the second model, 9 ACES (16.4%) were considered efficient. When considering quality, one ACES previously considered inefficient moved to the frontier and two ACES lost their benchmark position. The second-stage analysis indicates that groups with a higher proportion of PHC units with pay-for-performance incentives were associated with higher efficiency.

Conclusions
Most ACES have the potential to improve their production levels., A better management of human resources can contribute to improve overall efficiency. ACES with a higher proportion of units with pay-for-performance schemes seem to be more efficient. These findings contribute to the evaluation of policies to integrate and scale up PHC services locally, such as the recent primary care networks in the NHS UK.
This work was financed by FEDER funds through the COMPETE 2020 - POCI, and by Portuguese funds through FCT in the framework of the project POCI-01-0145-FEDER-030766 “1st.IndiQare”.

Key messages
Most Portuguese ACES have the potential to improve their outputs given their current level of human resources. Local groups that aggregate more PHC units with pay-for-performance schemes are associated with high efficiency.
Primary Health Care for Municipalities with High Rural Dispersion
Authors: Jaramillo-Mejia M C , Cancelado-Carretero H M , Bermúdez Jaramillo P C , Osorio Murillo O , Gil J C , Nuñez-Cabrera A , Blandón-Lotero L C 
Published: October 2020

Abstract

Background
The production, delivery of services and scope of health outcomes have generated new forms of organization of the Colombian Healthcare System. Complex solutions developed with a focused techno vision have not been functional, nor adaptable to territories of scattered high rurality (TARD), mainly on the Colombian Pacific coast.

Objective
To build a differential PHC model for rural communities (TARD), ensuring access to quality health care services and improving social determinants.

Methodology
Four municipalities of the Pacific coast were selected. Based on the analysis of the implementation of PHC and RISS, the innovation and problem-solving method -design-thinking- was used to generate knowledge in a practical way. The method was developed with communities and experts.

Results
The prototype model is based on Healing the Territory as its core, and governance in health, intersectoral, social capital, own health, health services and interculturality as its differential elements. The model requires serving the population based on risks and complementary actions, with new hiring models, access routes to services and traditional practices. Another actor is institutionally, which from governance and public policy must define guidelines for service delivery, accountability and incentives. Finally, intersectorality as a binding node for defining cross-sectoral development and joint intervention policies that facilitate the improvement of social determinants of health.

Conclusions
The health model in TARD contributes to reflection and generates social innovation from the territories so that decision makers propose changes in public policy for its implementation. The post-conflict brought hope to the community, to build a better, more equitable society, with access to quality health services and improved living conditions.

Key messages
The model makes a theoretical contribution on the role of innovation in health, to provide solutions to problems in the territories of scattered high rurality. The model requires serving the population based on risks and complementary actions.
Ambiguity in Swiss vaccine mandate legislation
Authors: Deml M J , Tarr P E 
Published: October 2020

Abstract

Background
The Swiss Epidemics Act 2016 foresees no vaccine mandates in routine settings. Only in certain settings can the federal government, after consulting with Swiss cantons, “declare vaccinations mandatory for risk groups, persons at threat of particular exposure, and persons exercising certain activities once a serious danger has been established.” Parliament proposed this Act in March 2012 arguing that recent infectious disease outbreaks required stronger preparedness plans clearly delineating responsibilities of the Confederation, cantons, and third parties. Swiss naturopath Trappitsch gathered &gt;75,000 signatures to launch a referendum contesting the law. Main criticisms dealt with ambiguous language around mandates, infringement upon individual liberty, and fear of an overreaching federal government. Nevertheless, the Swiss populace voted to pass the law (60% in favor) in September 2013.

Methods
Qualitative interviews with key informants (N = 5 public health officials-PHO) and analysis of press coverage of the legislation/referendum allow for an investigation of the ambiguity of the mandate language and the referendum's consequences on this issue in public discourses.

Results
Several PHOs/politicians stated during the referendum that “nobody would be vaccinated against their will” and implied that the law would apply, for example, to non-vaccinated healthcare professionals who could be transferred to different care units to protect patients. Such specificities never appeared in the law. Ambiguous language around mandates served as a point of contention around which vaccination critics united and gained political traction. Such criticisms put State actors in the position of needing to more clearly articulate their perspectives.

Conclusions
With neighboring countries enacting vaccine mandate policies (France, Italy, Germany) in response to resurgence in measles cases, current legislative language leaves the question of mandates open to interpretation
The challenges of aging in China: is healthy ageing a key for medium-long term sustainability of care?
Authors: Yang Y 
Published: October 2020

Abstract
Unlike developed countries, which are 'being rich while being old' and 'being rich before getting old', China was in a state of 'being rich before getting old' when it first entered an aging society. With the arrival of an aging society in 2026, even with the current economic development trends, it is difficult for China to reach the level of 'richness', that is, the population aging process is ahead of the economic development process, which makes the risks and challenges facing China more severe. It is estimated that by 2050, the proportion of GDP spent on pensions, medical care, care, welfare and facilities in China's GDP will increase from 7.33% to 26.24%, an increase of 18.91 percentage points. Faced with such a severe aging challenge, China urgently needs to develop a path to actively respond to aging with Chinese characteristics, and provide experience for countries that have also stepped into the ranks of “before getting rich”. The 'Healthy China Strategy' is one of the important national strategies emphasized in the report of the 19th National Congress of the Communist Party of China, which aims to provide the people with a full range of full-cycle health services. This marks a major shift in China's top decision-makers' understanding of the issue of aging: without 'healthy aging,' there can be no truly 'healthy China.' However, in the face of basic national conditions such as a large population, a weak foundation, few resources, and inadequate development, healthy aging in China still needs to break through a series of bottlenecks and obstacles. The welfare state is not the only reference for China, let alone a model that should be copied. In this regard, the article will put forward a number of targeted policy recommendations.