bluuebunny/crossref_metadata_2025_split huggingface dataset:
Implementing a diversity sensitive curriculum in medical education – challenges and potentials
Authors: Sorensen J , Langer Primdahl N , Nørredam M , Krasnik A 
Published: October 2021

Abstract

Background
Migrant and ethnic minority populations in Europe are growing, consequently increasing the need for the health systems and health educations to adapt to an increasingly diverse population with diverse needs. Improving health professionals' diversity competences has been proposed as one of the solutions to tackle inequalities in health between different ethnic groups and ensure that all patients receive the care that they need. The objective of this study was therefore to investigate potentials and challenges for implementing diversity competences in medical teaching programmes.

Methods
Four focus groups interviews and one individual interview was conducted with three groups of stakeholders: medical students, course leaders and newly graduated medical physicians. The focus group and individual interviews were conducted physically and digital and one focus group used both. The interviews had a duration between 30-90 minutes and informed consent was obtained from all participants. The data was transcribed and were coded using content analysis.

Results
6 main themes and 14 sub-themes were identified in the analyses. One theme indicated that there was a general wish for more focus on diversity competences in the curriculum. Other themes pointed to challenges regarding competing priorities in the context of medical education, a condescending discourse about social and humanistic medicine and lack of support to medical students regarding challenges in relation to migrant and ethnic minority patients in the clinical settings. Another major theme focused on medical teachers' challenges when teaching a diverse classroom.

Conclusions
Our results showed that action in this area is needed. The themes indicated that many opportunities to implement diversity competence in curriculum exist, but also illuminated the challenges. The results suggested a need for focusing on individual competences for medical teachers and students, but also for organisational change.

Key messages
A widespread interest for implementing diversity competence in curriculum, but competence development for teachers is also needed. Important to focus on individual competences, but also on organisational change.
Students' self-assessment on the influence of research on their education in medical schools
Authors: Abduazhitova AM , Akanov AB , Koikov VV , Aubakirova AS , Otargalieva DD 
Published: October 2021

Abstract

Background
The reform of medical education and the introduction of the Bologna process into the higher medical school of the university changed the views on the research component in the process of studying a student in Kazakhstan following the principles of Soviet teaching of a medical school student.

Methods
A questionnaire was developed based on the AGREE methodology. The questionnaire is posted on the SurveyMonkey online questionnaire resource. A total of 1,439 university's students participated in the survey.

Results
About 85% of students in medical schools of universities in Kazakhstan agree on the trinity ‘science - education - practice' - the main principle of teaching students. When answering the question “Teachers at the university, when conducting lessons and lectures, always provide information about new research results,” 63% of respondents agree with this. About 77% of students believe that research is of high quality at the university. 78% of respondents noted the availability of research infrastructure at the university. About 80% of the respondents answered positively to the question of the relevance of research topics at the university. Students' participation in the research was assessed by them at a low level (about 45% of positive answers versus 51% of negative answers).

Conclusions
Analysis of the current situation on student participation in research in medical schools of universities in Kazakhstan shows an insufficient level of student involvement in research activities and an insufficient commitment of universities to the principle of the trinity of science, education and practice. Students who are actively and productively engaged in research have professional competencies in using the acquired knowledge, skills and abilities in practice than their colleagues who are not involved in research.

Key messages
The insufficient level of student involvement in research activities reflects the insufficient commitment of universities to the principle of the trinity of science, education and practice. Early involvement of students in research allows to generate their professional competence ispolzovanieya acquired knowledge and skills in practice.
Gender-differences in outcomes of patients in Intensive Care Unit: findings from the SPINUTI network
Authors: Favara G , Barchitta M , Maugeri A , Rapisarda G , Vinci R , Mura I , Agodi A ,   SPIN-UTI network
Published: October 2021

Abstract

Background
Achieving gender equality is one of the most important Sustainable Development Goals to guarantee health and wellbeing worldwide. Here, we aimed to assess gender-differences in risk factors and outcomes among patients admitted to Italian Intensive Care Units (ICUs).

Methods
Here, we included 12,534 patients from the “Italian Nosocomial Infections Surveillance in Intensive Care Units” (SPIN-UTI) project, who stayed in ICU for more than 48 hours. Firstly, characteristics at ICU admission were compared between males and females using the Mann-Whitney U or the Chi-Squared tests. Next, we compared the probability of death between genders by applying a logistic regression analysis. Results were adjusted for covariates (i.e., age, patient's origin, trauma, non-surgical treatment for acute coronary disease, surgical intervention and presence of intubation) and reported as Odds ratio (OR) and 95% Confidence Interval (CI). Finally, the Kaplan-Meier analysis was applied to assess gender difference in survival.

Results
Compared with male patients, females were older, more likely to come from other wards or healthcare facilities and to undergo a surgical intervention (p-values&lt;0.05). By contrast, they were less likely to be intubated or traumatized and to undergo non-surgical treatment for acute coronary disease (p-values&lt;0.05). Interestingly, a higher proportion of deaths was reported in female patients (p &lt; 0.001), so that their odds of dying was 13% higher than males (OR = 1.13; 95%CI=1.00-1.28; p = 0.046) after adjusting for covariates. Accordingly, females reported lower survival in ICU than males (median= 32.0 days vs. median= 34.0 days; p &lt; 0.001).

Conclusions
Our results pointed out gender-differences in patients' characteristics at ICU admission, which resulted into a higher risk of death and lower survival among females. In a Public Health point of view, these findings underline that is still important to sustain gender equality in ICUs and other hospital wards.

Key messages
There are several gender-differences in risk factors and outcomes among patients admitted to ICUs. Gender poses per se a higher risk for death in ICU, also considering other risk factors.
Behavioural change intervention for re-framing antenatal education to make “every contact count”
Authors: Middleton N , Kolokotroni O , Christodoulides V , Hadjigeorgiou E , Nicolaou C , Papadopoulou M , Kouta C , Karanikola M ,   Baby Buddy Forward team and Associated Partners, Erasmus+, Limassol, Cyprus
Published: October 2021

Abstract

Issue
A trusted source of information, the Baby Buddy webapp was co-created with parents and professionals to support the educational role of maternal healthcare providers. However, providers in Cyprus and elsewhere may not actively engage in antenatal education (AE) to make “every contact count”.

Description of Problem
The impact of Public Health digital interventions can be maximized when adopted in care pathways. To define barriers and enablers in behavioural terms complimentary methods were used guided by the COM-B model and related Theoretical Domains Framework: questionnaire survey (N = 49), focus group (N = 11) and round-table workshops (N = 40) among in-training and registered midwives.

Results
Beliefs about the benefits of AE are strong and viewed as a core function of the professional role, yet not supported nor prioritized by current practice. Many problematic areas relate to organizational context, such as weak interprofessional collaboration and lack of policy, protocols and resources. Medicalization of birth and socio-cultural norms are sustaining alienation of the midwife and conditions of power dynamics. AE was perceived as a means to enhance the autonomy of the profession but the phenomenon is complex and also pertains to perceptions and behaviours of service users. There are also issues with procedural knowledge and the need for skill development was identified.

Lessons
As a digital tool, Baby Buddy can enrich the user-provider exchange. However, AE beyond the formal setting of the antenatal class is perceived to be a ‘bad fit' with current practice. Training (e.g. skills strengthening), persuasion (e.g. reflection on professional identity), enablement (e.g. protocols) were identified as promising intervention functions. Modelling was identified as the most promising both in terms of “credible models” for the role itself as well as re-framing the concept of AE not as preparation for childbirth but in the context of shared decision-making.

Key messages
Barriers to being an effective antenatal educator are several, originating from an unsupportive system and wider socio-cultural norms of users and providers. In addition to designing a theory-driven research-informed intervention, the process functioned as a participatory learning experience through collective reflection.
Creating healthy food environments in family childcare settings
Authors: Kunkel K , Schroeder M , Jones R , Anderson D , Lien K 
Published: October 2021

Abstract

Background
Considering nearly two-thirds of preschool children in the United States are in some form of child care, child care settings are an opportunity to improve the food environments and reduce the risk of obesity in young children. University of Minnesota Extension developed a culinary nutrition education training for family child care providers. This is relevant for other countries whose child care system includes caring for children in home or center settings that prepare food for children.

Objectives
Start Strong: Cooking, Feeding and More (SS), consists of four two-hour culinary nutrition education sessions for family providers. The overall goals of SS are to 1) increase providers' knowledge and skills to procure and prepare healthy foods for children and 2) increase providers' knowledge and understanding of Federal food assistance programs to share the information with food-insecure families. Each session includes a cooking skill, nutrition topic, and food assistance program.

Results
Twelve rural participants who self-identified as female, non-Hispanic White participated in the SS sessions and completed pre, post, and three-month follow-up surveys, to assess the impact of the program on providers' knowledge, confidence, and practice. Based on the paired samples t-tests between pre-to-post and pre-to-follow-up surveys, there were statistically significant increases in providers' confidence in preparing whole grains, using beans and low-cost protein sources, and cooking techniques to reduce. The increase in confidence using cooking techniques to reduce salt was still statistically significant three months after the training. The providers' awareness of Federal food programs between pre-post increased and three months later increased.

Conclusions
SS increased family child care providers' skills and confidence to prepare healthy foods for children in their care. This increases the likelihood children will make healthy choices now and in the future.

Key messages
Start Strong is a culinary nutrition education training for family child care providers. Start Strong improves providers’ knowledge and skills to prepare healthy foods for children in their care.
The Effect of Spousal Military Deployment during Pregnancy on Birth Outcomes: A Systematic Review
Authors: Morris K 
Published: October 2021

Abstract

Background
Stress experienced during pregnancy is associated with adverse birth outcomes including pre-term delivery and low birth weight. Pregnant spouses and partners of deployed military personnel can experience heightened stress due to several factors associated with the military lifestyle which may increase the risk of pre-term delivery and low birth weight. This systematic review aims to establish the potential effect of spousal deployment on birth outcomes in a population who have increased psychosocial risks for birth complications.

Methods
A systematic review following the PRISMA guidelines was conducted of English language literature to assess the effect of deployment on the birth outcomes (pre-term delivery &lt;37 weeks; low birth weight &lt; 2500g) of babies born to partners of serving military personnel who were deployed at the time of delivery. Comparison was made to pregnant women whose military partners were not deployed at the time of delivery. EMBASE, Medline, Global Health, Web of Science and PubMed databases were searched for relevant articles using a keyword Boolean search strategy. A quality review and risk of bias was conducted on each of the three included studies.

Results
Three cohort or cross-sectional studies fulfilled the eligibility criteria. Each study was conducted in the US military, involved a total of 11,028 participants and were published between 2005 and 2016. Evidence suggests that spousal deployment may be a risk factor for pre-term delivery. No association between spousal deployment and low birth weight was found.

Conclusions
Pregnant partners or spouses of deployed military personnel may be at increased risk of pre-term delivery. There is a paucity of rigorous research in this area and more research is required to help inform healthcare professionals of the needs of this cohort of women and whether tailored public health interventions are required to reduce the risk of adverse birth outcomes in this population.

Key messages
Pregnant partners or spouses of deployed military personnel may be at increased risk of pre-term delivery due to psychosocial factors associated with the military lifestyle. Stress is a risk factor for birth complications. More research involving military spouses is required to understand the antenatal needs of this population.
Socioeconomic inequalities in health among Armenian adolescents: the role of bullying perpetration
Authors: Torchyan A , Bosma H , Houkes I 
Published: October 2021

Abstract

Background
Bullying perpetration might be an alternative way of hierarchy formation among adolescents. It can potentially suppress the socioeconomic inequalities in health or might compensate for the negative health influences of low socioeconomic status (SES), rewarding this unwanted behavior.

Methods
A nationally representative sample of 3679 adolescents aged 11-15 years participated in the Health Behavior in School-aged Children 2013/14 survey in Armenia. Complex samples multiple logistic regression were used to estimate the associations between two SES measures (family socioeconomic position [SEP], material well-being) and three health outcomes (perceived health status, psychosocial well-being, psychosomatic symptoms).

Results
Bullying perpetration was not associated with less than good health or low psychosocial well-being (P &gt; 0.05) but increased the odds of reporting high psychosomatic symptoms (P &lt; 0.05). Perpetration did not change the SES-health gradient substantially. However, in stratified analyses, socioeconomic inequalities in health were consistently weaker among perpetrators. The largest observed difference was in the relationship between low family (SEP) and less than good health (OR = 3.60, 95% CI = 2.77-4.67 vs. OR = 1.80, 95% CI = 1.06 - 3.04), whereas the smallest difference was in the relationship between low family SEP and high psychosomatic symptoms (OR = 1.27, 95% CI = 1.03-1.56 vs. OR = 1.04, 95% CI = 0.61-1.77).

Conclusions
Our findings suggest that bullying perpetration, as an alternative hierarchy, may be looked at as a compensatory but vicious strategy in the face of the negative health influences of low SES in Armenian adolescents. For high-SES adolescents, on the other hand, social, emotional, or psychological problems might contribute to bullying perpetration.

Key messages
Less vicious alternatives to bullying perpetration should be encouraged, especially for Armenian adolescents from low-SES families. Targeted health interventions might be necessary for bulling perpetrators from high-SES families.
Prolonged pregnancy, incidence and morbidity
Authors: Bannour I , Bannour R , Chahed S , Khairi H 
Published: October 2021

Abstract

Background
The classic term for a pregnancy is between 37 and 42 weeks of amenorrhea. In fact, the literature has shown that exceeding the term (LD, 42WG) is the cause of many maternal-fetal complications despite close monitoring and appropriate management. A new rigorous and adapted management is essential in view of the materno-fetal prognosis.

Objectives
To describe the complications and risks associated with exceeded pregnancies and to propose a new strategy indicating an appropriate course of action.

Patients and Methods
This is a retrospective study of 50 women who gave birth at 42 WG or more at the Maternity of the Farhat Hached University Hospital Center in Sousse.

Results
the average age of our patients was 30.56 years old, 70% of which were primiparous, 82% of our patients were monitored between 41 and 42 WG. Fetal complications demonstrated in our results were increased by macrosomia in 54% of cases, pathological FHR during labor in 48% of cases, fetal distress in 26% of cases. In addition, maternal complications were increased by cesarean delivery in 48% of cases, perineal tears in 40% of cases and forceps delivery in 20% of cases.

Conclusions
By comparing the expectation under supervision to induction of labour at 41WG, we concluded that induction of labour reduces maternal-fetal outcomes in a remarkable way. A new management including systematic induction of labour at 41 WG is essential to prevent complications and guarantee a reassuring maternal-fetal prognosis.

Key messages
Exceeding the classic term for a pregnancy may cause maternal and fetal complications. A new management including systematic induction of labour at 41 WG is essential to prevent complications and guarantee a reassuring maternal-fetal prognosis.
Early support: Evaluation of the pilot projects and the development of an implementation model
Authors: Mairhofer S 
Published: October 2021

Abstract

Early support is an overall concept of health promoting and preventive measures for families with children up to 3 years. This includes direct interventions for children as well as offers and measures for parents and other caregivers. Based on a first research project, which showed that health and social services are repeatedly confronted with stressful family situations, but that families are often only supported late or too late, there were implemented two pilot projects in an urban and rural area of Northern Italy (called South Tyrol). The projects were evaluated using a multimethod approach, analysing existing documentation, and through focus groups, interviews, and qualitative questionnaires. The results of all the different research methods show very uniformly that many professionals and responsible persons were insufficiently informed about the health promotional and preventive potential of early support and about the importance of a good collaboration and network for a healthy start in live at the beginning of the projects. It took two years of intensive process to improve cooperation, but also knowledge and competences in this area. Through the intensive coordinated cooperation in a core team of public social and health services and psychologists (family counselling), a significant improvement could be achieved not only for these members of this core team, but above all also for the entire departments of the collaborating services. Professionals reported that not only has the quality of their work improved significantly because of this process, but there is also a noticeable lightening of the workload, which must be of great importance in the burdening fields of social and health services. Building on the results of the evaluation of these projects a model was developed of how a system of early support that accompanies families in a healthy start can be implemented in the whole region. The implementation is approved for 2022.

Key messages
The aim of early support is to build systems to strengthen and support all families preventively. Interdisciplinary cooperation in early support teams led to improved quality of work and lower workloads.
Adolescent girls’ recommendations for designing Human Papillomavirus Vaccination Program in Pakistan
Authors: Ali RF , Offeddu V , Siddiqi DA , Mirza A , Naz N , Abdullah S , Lim JM , Kembhavi G , Tam CC , Chandir S 
Published: October 2021

Abstract

In Pakistan, cervical cancer is the third most frequent cancer among women. Most cases are caused by sexually-acquired infection with human papillomaviruses (HPV). Vaccination of adolescent girls against HPV significantly reduces the incidence of cervical cancer. HPV vaccination is available in Pakistan, but plans to develop a HPV vaccination program are currently at a very early stage. We conducted a formative study to explore adolescent girls' perspectives on HPV and cervical cancer, and collected their recommendations for implementing an HPV vaccination program. We conducted qualitative focus group discussions (FGDs), with unmarried adolescent girls aged 16-19 years, residing in Karachi. We conducted four FGDs with 12 participants each. The topic guide assessed i) girls' knowledge of cervical cancer and HPV vaccination, ii) vaccination decision-making dynamics within families, and iii) factors girls would consider essential for the successful implementation of HPV vaccination program. Overall, participants displayed a positive attitude towards the HPV vaccine. However, many basic concepts related to female reproductive health were unfamiliar to them. Female relatives were indicated as girls' preferred point of contact for discussions on HPV and cervical cancer, but fathers were portrayed as the definitive decision-making authority on vaccination. Girls gave critical input for the development of a HPV vaccination program. Eligible girls should be recruited through individual household visits and the vaccine should be administered at community-based camps, which would ensure both good accessibility and a large outreach. A solid foundation of trust between girls' families, program managers, and other stakeholders emerged as a key asset for the program's success. Adolescents demonstrated great capacity and shared recommendations for a future program's acceptability. Integrating their perspectives will be essential to design an effective program in local context.

Key messages
Adolescent girls’ perspectives should be incorporated to develop context-specific recommendations for the implementation of a HPV vaccination program. Community-based camps and household visits by adolescent girls to recruit the target population could potentially increase program penetration among communities.