bluuebunny/crossref_metadata_2025_split huggingface dataset:
Protocol of a study to evaluate a lifestyle intervention during pregnancy
Authors: Nawabi F , Lorenz L , Krebs F , Alayli A , Lück I , Bau A M , Stock S 
Published: October 2020

Abstract

Background
The risk of developing obesity and chronic diseases (e.g. diabetes mellitus) in children is influenced by the mother's lifestyle during pregnancy (prenatal programming). This study evaluates a computer-assisted preventive lifestyle counseling carried out during prenatal visits and infant check-ups. GeMuKi (acronym for 'strengthening health promotion: enhanced check-up visits for mother and child') is a complex intervention consisting of multiple components implemented by different cooperating healthcare providers.

Methods
GeMuKi supplements regular prenatal visits and infant check-ups with an additional counseling regarding physical activity, nutrition and alcohol and tobacco use. Providers, who carry out the counseling, receive communication training using motivational interviewing techniques. Pregnant women in 4 intervention regions in Germany receive GeMuKi from gynecologists, midwives and pediatricians, while participants in the 4 control regions receive standard care. As part of a hybrid effectiveness-implementation trial with 1860 participants, questionnaires are filled in at 4 time points. Weight development and health data of the mother and child are recorded. Health services use will be analyzed using statutory health insurance claims data. Interviews will be conducted to evaluate the implementation process.

Results
Targeted preventive measures at the beginning of pregnancy intend to reduce the risk of inadequate gestational weight gain (primary outcome). Secondary endpoints are amongst others maternal lifestyle, infant weight development and body composition.

Conclusions
GeMuKi is set up as a long-term, low-threshold, multimodal intervention in living environments and existing structures. Findings will add to the evidence on lifestyle interventions during pregnancy to reduce the risk for overweight and obesity. Results will contribute to the prevention of early programming of chronic disease and will inform decisions about scale up and public funding.

Key messages
Lifestyle interventions provided from the beginning of pregnancy intent to be beneficial for the health of both mother and child to prevent obesity and chronic diseases. Low-threshold interventions embedded in regular prenatal visits are accessible for the complete pregnant population, including vulnerable groups.
Cardiotocography monitoration in antepartum care: analysis of controls
Authors: Napolitani M , Kundisova L , Giannini B , Moirano F , Alaimo L , Nante N 
Published: October 2020

Abstract

Introduction
WHO does not recommend the routine prenatal cardiotocography (CTG) during pregnancy to improve maternal and perinatal outcomes. Instead, Italian guidelines consider CTG after the 41st week of pregnancy to be useful. The aim of this work was to identify the variables associated with CTG performed before the 40th week.

Materials and Methods
A retrospective study was conducted at the Hospital of Siena (Italy), all females that accessed to CTG from 2016 to 2018 was included. The variables were: nationality, pregnancy associated pathology(PAP), gestational age(GA), parity, type of access (urgent/programmed), n° of accesses, active fetal movements (AFM), amniotic fluid index (AFI) and necessity of recovery. The statistical analysis was carried out using Stata 12.

Results
The women included were 4010, mean age was 32.8±5.6 years (75% Italian; 62.4% primiparous). A mean GA was 38 ± 3 weeks; 47.5% had one access, 27% two accesses, 14% three accesses. The 22% were urgent accesses, 11.5% had PAP (70% diabetes mellitus). The 58% showed up before the 40th week, the probability was higher for non-Italian women (OR 1.3), multiparous (OR 1.32), women with urgent access (OR 7.9) and women with PAP (OR 3.4). In 5.4% the CTG was altered, 23% had absent AFM and 2% had alterated AFI. Females that came before 40th week were more likely to have absent AFM (OR 4.5) and AFI (OR 2). The 3% needed an immediate hospitalization, mainly in non-Italian (OR 1.7), urgent accesses (OR 4.4), those that came before 40th week (OR 2.44), absent AFM (OR 21.8), and altered AFI (OR 15.8),

Conclusions
Our analysis shows the association between precocious access to CTG and urgent medical condition and PAP as expected, but also with other variable as parity and nationality. The low GA without an indication of high risk at the moment of the access suggests the possible overmedicalization of pregnancy. It seems useful to review clinical practices to ensure obstetric care close to best practice.

Key messages
As literature reports, to avoid overmedication of pregnancy cardiotocography should not be performed before the 41st week of pregnancy. In some situations the CTG is anticipated and for this reason it seems useful to review the clinical practices implemented in order to ensure obstetric care close to best practice.
In utero opioid exposure and birth outcomes: a systematic review and meta-analysis
Authors: Graeve R I , Balalian A A , Richter M , Kielstein H , Martins S , Philbin M M , Factor-Litvak P 
Published: October 2020

Abstract

Background
The nonmedical use of opioids during pregnancy, either those prescribed or obtained illegally, is a worldwide public health issue. Opioids pass through the placental barrier, which can expose the fetus to maternal opioid use; opioid-exposed babies may experience Neonatal Abstinence Syndrome (or Neonatal Opioid Withdrawal). We conducted a systematic review and meta-analysis to investigate how maternal opioid use during pregnancy may impact infants' birth outcomes.

Methods
We searched PubMed, Embase, PsycInfo, and the Web of Science, and identified 90 articles that met our inclusion criteria. Cohort, case-control and cross-sectional studies comparing birth outcomes of any opioid-exposed group (prescribed or obtained illegally) and a non-exposed comparison group were eligible for our systematic review. An adapted version of the Newcastle-Ottawa-Scale was used for quality assessment of the studies. Due to high heterogeneity between studies, we used random effects models to estimate pooled effects.

Results
In meta-analyses, opioid-exposed infants had lower birthweight (mean difference (MD):-405.9 grams, 95%CI: -472.26,-339.54, N = 37 studies), smaller head circumference (MD:-1.19 cm, 95%CI:-1.41, -0.96,N=22 studies), shorter gestational age (MD:-0.93 weeks, 95%CI: -1.20, -0.66,N= 34 studies), and shorter birth length (MD:-0.97 cm, 95%CI: -1.20, -0.74, N = 15 studies). The pooled relative risk of fatal outcomes was higher among the exposed infants: (RR:2.64, 95%CI: 1.06,6.59). Almost half of the studies were rated as poor, based on the Newcastle Ottawa Scale.

Conclusions
Our meta-analysis provides evidence of a link between opioid use during pregnancy and multiple adverse infant birth outcomes. Efforts should focus on increasing awareness about risks associated with opioid use and provide access to harm reduction measures for people who use opioids preconceptionally and in pregnancy.

Key messages
This meta-analysis provides insight into the magnitude of effects of in-utero opioid exposure on birth outcomes among the included studies. The findings highlight the importance of access to harm reduction measures in the periconceptional period and during pregnancy for people who use opioids.
Environmental factors and physical activity among youth in rural Japan: a 1-year prospective study
Authors: Abe T , Kitayuguchi J , Okuyama K , Okada S , Nabika T , Tanaka C 
Published: October 2020

Abstract

Background
Although moderate-to-vigorous physical activity (MVPA) has multiple health benefits, current global activity levels among children are quite low. Environmental influences on MVPA levels among children and adolescents in rural areas are unclear. The present study examined if environmental factors were associated with MVPA in children and adolescents in rural Japan.

Methods
Two school-based serial surveys were conducted in 2017 and 2018 for 1,461 children and adolescents (10-14 years old) in Unnan City, Japan. If meeting the WHO recommended MVPA levels: at least 60 minutes/day was assessed via the Japanese translation of the WHO Health Behaviour in School-aged Children survey questionnaire. Environmental factors, namely habitable land area, population size, and population density were calculated for each individuals' residential town, and categorized into three levels (small, medium, and large). Logistic regression was used to determine odds ratios (OR) and 95% confidence intervals (CI) of engaging in the recommended level of MVPA after 1 year by each environmental factor, adjusting for sex, school grades, body mass index, screen time, preference for PA, and MVPA level at baseline.

Results
Only 22.4% of children and adolescents were engaging in the recommended MVPA levels in 2018. Engaging in the recommended level of MVPA after 1 year was significantly associated with medium (OR = 1.63; 95%CI, 1.08-2.46) and large (OR = 1.69; 95%CI, 1.15-2.47) compared to small habitable areas, and with medium (OR = 1.01; 95%CI, 0.61-1.67) and large (OR = 1.75; 95%CI, 1.09-2.81) compared to small population size. Population density was not associated with MVPA.

Conclusions
This prospective study found that habitable area and population size were positively associated with MVPA at 1-year follow-up in rural Japan. In rural areas, habitable land areas and population size itself may be a better predictor for MVPA among children than population density.

Key messages
Habitable area and population size was positively associated with physical activity among children and adolescents in rural Japan. Population density as an environmental factor was not associated with physical activity.
Systems approach for assessment of maternal deaths in Rajasthan: A feasibility study
Authors: Raghav P , Gupta M K , Rustagi N , Mishra N , Garg S 
Published: October 2020

Abstract

Background
High maternal mortality in the state like Rajasthan, which is at second rank in terms of high Maternal Mortality Ratio (MMR) in India, require concentrated efforts in this direction The objectives of this study were to assess the magnitude and trend of maternal death and underlying factors contributing to maternal deaths in Rajasthan and to identify barriers and challenges in reporting maternal deaths in Rajasthan.

Methods
Data related to maternal deaths, cause of deaths and live births were retrieved from official Government sources and MMR was calculated. To find out the underlying factors contributing to maternal deaths, Verbal Autopsies were conducted through household surveys. In-depth interviews of health care staff were conducted to carry out the 'SWOT' analysis in order to identify the barriers in reporting maternal deaths. Data was analysed using SPSS version 23.

Results
A total of 7185 maternal deaths were reported from Rajasthan in last five years. The mean age of mothers was 25.18±4.98 years. Haemorrhage were reported as most common cause of maternal death (17%) followed by Severe hypertension or fits (8%) and obstructed labour (2%). The median duration of hospital stay was 23 hours (IQR=7.5-70). Maximum deaths were reported during post-partum period (61%), while around one fourth of the deaths happened during delivery.

Conclusions
The discrepancies were observed in the reporting of number and causes of maternal deaths. The trend and forecasted figures were quite different from the published National and State level reports in this regard.

Key messages
need to streamline and strengthen the Maternal Deaths Surveillance and Response to track the number of deaths and get the exact information about the underlying factors contributing to them. Effective strategies can be developed to reduce the Maternal Deaths in the State.
Empowering adolescent girls and creating lifelong champions to improve immunization coverage
Authors: Mehmood M , Siddiqi D A , Abdullah S , Baig Q , Khan A J , Chandir S 
Published: October 2020

Abstract

Background
Despite the global imperative to 'leave no child behind', one in every 5 children remain deprived of life-saving vaccines. Low immunization coverage is in part due to the weak linkages between community and health system, inaccessibility of outsiders to closely-knit societies and low parental awareness regarding immunizations. The Kiran Sitara (Shining Stars; KS) Adolescent Health and Leadership Program (AHLP), was implemented using adolescent girls (Kiran Sitaras-KSs) as the agents of change, who by virtue of belonging to the community were able to cause a ripple effect in boosting uptake for WHO-recommended immunizations for children under 2 years of age. Our research evaluated the feasibility of the KS community mobilization and validated KS's ability to accurately identify under-immunized and zero-dose (never-vaccinated) children.

Methods
AHLP was implemented in grades 8-10 of two public secondary schools in Shikarpur and Lakhi Town, Pakistan. From April-May, 2017, a door-to-door survey was conducted by KSs followed by visits of trained staff to verify the immunization statuses identified by KSs.

Results
KSs (N = 45) screened 207 children and identified under-immunized and zero-dose children with an accuracy of 74% and 94% respectively.

Conclusions
Our strategy of mobilizing girls from within the communities provides a promising avenue to provide immunization services in high-risk areas that cannot be penetrated through conventional mechanisms. We are actively scaling-up our sustainable solution by implementing AHLP in 250+ schools and creating a force of 100,000+ KSs who can promote health equity today and champion the cause in their capacity as tomorrow's mothers.

Key messages
The Kiran Sitara initiative via its community-centered approach leverages the force of adolescent school girls to boost demand and provide referrals for immunization in unreached geographical pockets. The Kiran Sitara initiative utilizes the power of youth engagement to identify zero-dose and under-immunized children, link them to immunization services and improve knowledge among caregivers.
Maternal diabetes during pregnancy and carotid intima-media thickness in children
Authors: Chiolero A , Epure A , Rios-Leyvraz M , Anker D , Mivelaz Y , Di Bernardo S , Da Costa B R , Sekarski N 
Published: October 2020

Abstract

Background
Cardiovascular risk over the life course may be related to intrauterine risk factors, for instance, the exposure to maternal diabetes. Our objective was to systematically review studies that assessed the association of maternal diabetes during pregnancy and carotid-intima media thickness (CIMT), a marker of cardiovascular risk, in children.

Methods
We followed methods outlined in a published protocol for a systematic review on risk factors and determinants of CIMT in children (PROSPERO registration: CRD42017075169). Standardized mean differences in CIMT between offspring of women with and without diabetes during pregnancy were computed. Random effects meta-analyses were performed. The reliability of CIMT measurements was assessed.

Funding
SNSF 32003B-163240.

Results
Three observational studies involving 658 children were retained. Two studies were conducted in Europe and one in Australia. Age at CIMT assessment ranged from 2 days to 8 years. Two studies evaluated gestational diabetes during pregnancy and found no difference in CIMT among exposed children compared to controls (0.00 (95% CI: -0.41 to 0.41); 0.00 (95% CI; -0.28 to 0.28)). One study, that did not specify the type of diabetes evaluated, identified a higher CIMT (0.46 (95% CI; -0.07 to 1.00)). The pooled standardized mean difference in CIMT between offspring of women with and without diabetes during pregnancy was 0.08 (95% CI: -0.16 to 0.33; I2: 17.1%).

Conclusions
Overall, there is no clear association between maternal diabetes during pregnancy and offspring's CIMT. The degree of confidence in results is limited by the low number of studies, with relatively small sample sizes and a low number of participants exposed to maternal diabetes.

Key messages
Children exposed to maternal diabetes have no substantial alterations in vascular structure. More research is needed to inform primordial prevention of cardiovascular disease among these children.
Primary school children’s diet assessment with a 7-day diary – comparison between Italy and Poland
Authors: Kawalec A , Piscitelli G , Pawlas K , Dallolio L 
Published: October 2020

Abstract

Background
Dietary habits acquired in childhood are often followed in later life, and if unfavourable may result in negative long-term health consequences. The study aimed to assess diet of primary school children with an interactive 7-day food diary in the form of a colouring book.

Methods
At first the study was conducted among 428 primary school children from Calderara di Reno (Italy). After questionnaire's translation and adjustment, the study continued as a pilot-study among 83 children from Wałbrzych (Poland). Under supervision of parents and teachers children completed a 7-day food diary. The quality of diet was evaluated with KIDMED test. Composition of breakfast was rated due to content of water (+1), carbohydrates (+1), proteins (+1), fibre (+1), vitamins/minerals (+1), free sugars (-1), assuming adequate breakfast if scored &gt; =3 points and contained source of protein or carbohydrates. Statistical analysis with chi-square test was performed.

Results
Adherence to the model diet was medium or high among 64.49% of Italian and 40% of Polish children (p &lt; 0.001). Significantly more Italian children had adequate breakfast each day during a week (51.17% vs 27.71%, p &lt; 0.001) and each school day (51.40% vs 34.94%, p = 0.006). There was no difference in number of children consuming well-balanced breakfast during a weekend (p = 0.749). Consumption of fruits and vegetables in both groups was far below recommended level- 75.9% of Italian and 81.9% of Polish children ate less than 3 portions of fruits and vegetables per day.

Conclusions
The study underlines the need for improvement of children's diet and increase in parent's awareness of family eating habits. This 7-day diary is a innovative tool, which allows identification of incorrect dietary behaviours among children and enables school professionals to design adapted health promotion activities and educational programmes for pupils and parents, aiming to increase knowledge about the role of diet and nutrition in health.

Key messages
There is a constant need for nutritional education and healthy lifestyle promotion among children, parents and teachers. Assessment of children’s diet and screening for unfavourable dietary habits may be helpful in planning health promotion and preventive activities at schools.
Sexual harassment and psychological complaints: student- and class-level associations
Authors: Brolin Låftman S , Bjereld Y , Modin B , Löfstedt P 
Published: October 2020

Abstract

Background
Students who are subjected to sexual harassment at school report lower psychological well-being than those who are not exposed. Yet, it is possible that the occurrence of sexual harassment in the school class is stressful also for those who are not directly targeted, with potential negative effects on well-being for all students. The aim was to examine whether sexual harassment at the student- and at the class-level was associated with students' psychological complaints.

Methods
Data from the Swedish Health Behaviour in School-aged Children (HBSC) of 2017/18 was used, with information from students aged 11, 13 and 15 years (n = 3,720 distributed across 209 classes). Psychological complaints were constructed as a summative index of four items capturing how often the student had felt low, felt irritable or bad tempered, felt nervous, or had difficulties to fall asleep, during the past six months (Cronbach's alpha=0.78). Sexual harassment at the student-level was measured by one item concerning bullying at school: “Other students have exposed me to sexual jokes”. Students who reported that this had happened at least “2 or 3 times a month” were classified as exposed to sexual harassment at school. Sexual harassment at the class-level was defined as the school class proportion of students exposed to sexual harassment, reported in per cent. Two-level linear regression analysis was applied.

Results
Students who had been exposed to sexual harassment had higher levels of psychological complaints (b = 2.74, p &lt; 0.001). The proportion of students in the school class who had been exposed to sexual harassment was also associated with higher levels of psychological complaints, even when adjusting for sexual harassment at the student-level, gender and grade (b = 0.03, p = 0.015).

Conclusions
Sexual harassment is harmful for those who are exposed, but may also affect other students negatively. Thus, a school climate free from sexual harassment will profit all students.

Key messages
Using data collected among students aged 11, 13 and 15 years, this study showed that sexual harassment at the student- and class-level was associated with higher levels of psychological complaints. Sexual harassment is harmful for those who are exposed, but may also affect other students negatively. Thus, a school climate free from sexual harassment will profit all students.
Implications of violence experience in postpartum depression
Authors: Fraga D , Marabotti F , Leite Costa , de Cássia R , Lima Duarte , Carvalho Andrade M A , de Fátima E , Almei daLima M V , da Silva Cordeiro , de Brito Martins G , Ferreira B Heintze , Pacheco J , Barbosa Moreira , FernandesMagalhães F Bersot 
Published: October 2020

Abstract

Introduction
The violence against women is an exacerbating factor in public health that affects a third of the world's female population, and the intimate partner is the main perpetrator. Researches show the impact of violence in the victims' health, such as: postpartum depression (PPD). In this context, considering the importance and magnitude of the experience of violence and its impact on health, as well as depression negatively impacted on the health of the mother and baby, justify it to carry out this study.

Objective
To identify the prevalence of symptoms of PPD among puerperal women and to examine the association with violence experience.

Methods
This is a cross-sectional study, performed with 330 puerperal women admitted to a municipal maternity hospital in Cariacica - State of Espírito Santo, Brazil. Data collection was conducted by duly trained interviewers, using a form containing data on socioeconomic, behavioral and clinical characterization. In order to track violence acts, in life and in pregnancy, practiced by the intimate partner, we applied the World Health Organization instrument, which enables the identification of psychological, physical and sexual violence acts. The identification of the outcome under study, postpartum depression, was obtained by means of the Edinburgh Postnatal Depression Scale. The data collected were analyzed through the Stata 13.0 program, where the following tests were performed: Pearson chi-squared test and Poisson regression.

Results
a rate of 36.7% of participants (95% CI: 31.6-42.0) showed symptoms of postpartum depression. Women who experienced violence from their partners throughout their lives had 1.9 times more prevalence of symptoms of depression. Those who experienced aggression during pregnancy showed an increase of 38.0% of this illness (p = 0.037).

Conclusions
The data presented reveal the high prevalence of women with symptoms of PPD and that violence experience was associated with higher frequencies of this event.

Key messages
Women who experienced violence from their partners throughout their lives had 1.9 times more prevalence of symptoms of depression. The data presented reveal the high prevalence of women with symptoms of postpartum depression and that violence experience was associated with higher frequencies of this event.