bluuebunny/crossref_metadata_2025_split huggingface dataset:
An evaluation of spatial accessibility to mental health services in Porto, Portugal
Authors: Aluh DOS 
Published: October 2021

Abstract

Background
Access to mental health service is an important problem globally. The probability of using a particular health service is affected by increased distances to the location of care and reducing this distance can reduce travel time and cost of accessing these services. This study aimed to assess spatial distribution and accessibility to mental health care services in Porto, the second largest city in Portugal.

Methods
Data regarding the population statistics in Porto was obtained from the Population and Housing census in 2011 while datasets related to all the mental health facilities in Porto were obtained from ACES Porto Oriental and Carta social. Standard distance, Nearest neighbor index, average distance to a mental health service were all computed. All spatial analysis techniques were employed in ARC/GIS environment.

Results
The study findings indicated that the mental health services were clustered around three municipalities in Porto; Campanhã, Bonfim and Paranhos. The mean time to access a mental health service was 6.47±3.726 minutes and the maximum time to reach a service center among the residents was 19.44 minutes. Pearson correlation showed a significant negative moderate association between the population density and the average near distance to a mental health service (r = -0.617, p = 0.002). 77.7% of the population lived within 1 km of a mental health service.

Conclusions
Mental health services were clustered in some parishes in Porto. A significant proportion of the residents were living near a mental health service. However, certain areas did not have adequate numbers of mental healthservices. It is important to determine areas of mental health service shortage to help in planning the location of mental health services.

Key messages
Mental health services are clustered around areas of high population density in Porto. There is need for more mental health services to serve the needs of people living in sparsely populated areas.
Self-esteem and university students: Findings from a multi-center study
Authors: Ketata N , Ben Ayed H , Baklouti M , Trigui M , Yaich S , Abdelmoula M , Feki H , Damak J 
Published: October 2021

Abstract

Introduction
Self-esteem refers to the degree to which a person esteem himself or herself. Accordingly, low self-esteem has a remarkable impact on mental health that may influence successful development and life outcomes, especially for young people. The purpose of this study was to determine the prevalence and factors predisposing to low self-esteem among university students (US) in Southern Tunisia.

Methods
A cross-sectional study performing a stratified randomized sample of 8 universities was conducted in Sfax, Southern Tunisia, on April 2021. A structured an anonymous self-administered questionnaire including the 10-item Rosenberg Self-esteem Scale was applied for a total of 1071 US.

Results
Among 1071 US, 759 cases (71%) were females, giving a male to female ratio of 0.4. Their mean age was 22.2 ±2.5 years. There were 1035 single US (96.5%), 246 smokers (23%) and 140 alcohol consumers (13.1%). Students with low self-esteem were identified at a prevalence of 29.5%. Living in a urban region (OR = 1.7; p = 0.004), studying in a private university (OR = 2.5; p = 0.013), having a low monthly income (&lt;2 minimum wage) (OR = 1.6; p = 0.014) and a chronic disease (OR = 2.1; p &lt; 0.001) were major risk factors of low self-esteem. Moreover, daily TV time &gt;4 hours (OR = 5.9; p = 0.009) and absence of leisure activities (OR = 1.8; p = 0.006) were significantly associated with higher prevalence of low self-esteem. Otherwise, practicing physical activity 3 times/week (OR = 0.6; p = 0.04) and high academic performance (OR = 0.8; p = 0.004) were identified as protective factors of low self-esteem.

Conclusions
The findings from the current study highlighted that low self-esteem was ranking at an alarming rate among US. These results therefore suggested the need for a school-based or web-based provision aiming at proactively increasing students' self-esteem and skills for dealing with their academic career and self-confidence.

Key messages
Low self-esteem and its associated factors. University students.
Presence of resistance in building resilience of Health workforce in the COVID-19 crisis
Authors: Jevtic M , Tobi Strizovic M , Despotovic T , Jovicic V 
Published: October 2021

Abstract

In the extraordinary circumstances of the Covid pandemic, Group Analytic Society Belgrade (DGAB) devised and organized online support groups for health workers, health associates and student volunteers. Participation is devised to be voluntary, while respecting confidentiality and non-disclosure of content outside the group. Support groups for health workers aim to share experiences, feelings and mutual support that they invest in daily work. We assume that the groups as a space of integration understanding and common thinking, could impact the building of resilience of health workers in the given conditions of a pandemic crisis. Groups are organized two times a week - 1 h and 15' each. One may apply by filling out an online form, and choosing one of the offered dates, that provides access to the group once a week. Group leaders are experienced analysts, DGAB members and analysts in their final years of education. In the initial phase, they are open - it is enough to choose a day that suits the participant when filling out the application, and in the selected term to join via the link for the zoom meeting (the link is sent to the e-mail given in the application). The aim is to present challenges we encountered in forming the groups, from strong resistance in accepting the help offered, negating the need for support to the helplessness and hopelessness that any help is possible. Exploring ways to overcome noticed resistance and presenting experience in providing support to health professionals is vital to strengthen the capacity of human resources and health systems in general. The pandemic crisis has not only affected the conditions and needs of patients, but has created a need for complex approach and care for health workers (human resources), so health systems could achieve sustainability and overcome the crisis that has befallen them.

Key messages
The pandemic crisis has not only affected the conditions and needs of patients, but has created a need for complex approach and care for health professionals. Management of healthcare organizations should ensure to all health professionals support to overcome the crisis that has befallen them.
Validation of the Distress Thermometer Questionnaire for Parents of Children with Down syndrome
Authors: Ben Cheikh A , Bannour R , Dardour L , Tahri O , Mhamed A , Trabelsi M , Zemni R 
Published: October 2021

Abstract

Background
Down syndrome is the most common neuro-genetic disorder in the world. In Tunisia, the number of births of children with Down's syndrome is estimated at 200 each year. However, few studies have assessed the quality of life of these families and their specific needs. The most used tool to assess the distress of parents of a chronically ill child is the DT-P.

Aim
The aim of this study was to validate the DT-P in Arabic language and evaluate the degree of distress of parents having a child with a Down syndrome in Arabic-speaking members of the Tunisian union for assistance to intellectual disability in the city of Sousse and those consulting in the department of hereditary and congenital disorders at the University Hospital Charles Nicolle of Tunis during the period between June, 1st 2020 and July, 31st 2020.

Results
The translation was process according to the translation -back translation method. Two aspects of validity were tested: Content validity via pretest and judgment experts. The construct validity was tested in its external component via the convergent validity, by determining the correlations of the DT-P results with the results of the Hospital Anxiety and Depression Scale (HADS). Overall, the correlations were moderate to strong. Precision was tested using the Cronbach index and was globally satisfactory with indices greater than 0.8. The distress thermometer average was 5.19 ± 2.9. The majority of parents reported distress (75.3%). The emotional problems were the most reported and 67.7% of parents asked to be referred to a professional for psychological support.

Conclusions
The DT-P appeared to be a valid and reliable short screening-tool for identifying parental distress. Therefore, it would be easier to provide them with professional support.

Key messages
The quality of life of families with child with Down Syndrom is usually neglected. The DT-P can be used as a reliable short screening-tool for identifying parental distress and providing them with professional support.
Dterminants of medication adherence in Moroccan schzophrenic patients
Authors: Tsoumbou-Bakana G , Salihi I , Raoui S , Traore B , Mchichi Alami K , Nani S 
Published: October 2021

Abstract

Introduction
Schizophrenia is a psychiatric condition in which patient adherence is a key issue in its management.

Objectives
To estimate the prevalence and determine the factors associated with medication adherence in patients with schizophrenia.

Methods
This was a cross-sectional study conducted at the psychiatry department of the CHU IBN Rochd of Casablanca among schizophrenic patients followed from May 2019 to January 2020. The sample size was calculated apriori and the measurement of therapeutic compliance and Insight (patients' perception of the disorders related to their pathology) was made thanks to the Medication Adherence Rating Scale (MARS) and the Birchwood insight scale (BIS) respectively. Socio-demographic data and data on the management of schizophrenia were also collected. Statistical analyses were performed with RStudio software and the multivariate analysis method of logistic regression was used. The threshold of significance was set at 5%.

Results
A total of 370 were collected, the median age was 31 years and the most represented class was the over 28 years (26.25%). The female gender represented 28% and the majority was single (72%). Substance abuse was 68.8%, 46% were on dual therapy and 43.2% of patients were on regular follow-up. The prevalence of therapeutic compliance was 25.6% and 30.3% were aware of their pathology. The determinants of medication adherence in the schizophrenic patients included in the final model were: regularity of follow-up (p &lt; 0.001), insight (p &lt; 0.001), number of medications (p = 0.011), history of substance use (p = 0.008), place of residence (p = 0.082).

Conclusions
Therapeutic compliance was low, the knowledge of the factors associated with therapeutic compliance in schizophrenia allows us to put forward hypotheses in order to improve the management of patients.

Key messages
Patient adherence to treatment is important in the management of Schizophrenia. Therapeutic compliance is poor.
Epidemiological profile of women victims of domestic violence in Casablanca
Authors: Tsoumbou-Bakana G , Naitrobah A , Mchichi Alami K , Nani S 
Published: October 2021

Abstract

Introduction
Violence against women is a major public health problem because, whatever its form, it has an impact on the physical and psychological health of victims.

Objectives
To describe the socio-demographic characteristics of the victims and their partners as well as the different forms of violence observed and their impact on the victims.

Participants and Methods
This was a descriptive cross-sectional study conducted from January to March 2019 in two associations providing assistance to women victims of domestic violence.

Results
Our study collected 102 women whose average age was 33 +/- 10.8 years (18-67 years), 77% resided in urban areas, 54% had left the marital home. Regarding marriage, 86% were married and 37% had been married for more than 10 years. The average number of dependent children was 1.75 +/-1.3. Regarding employment status, 65% were housewives and 61% had no income; a quarter of the victims had a history of domestic violence. Regarding their spouses, the average age was 40 years old, 9% were unemployed; 41% had consumed alcohol at the time of the violence and one third of them had taken drugs. Physical and psychological violence were present in almost all cases, respectively 99% and 97%, economic violence in 73% of cases and sexual violence in 69% of cases. These incidents occurred mainly in the context of conflict with in-laws (66.7%).

Conclusions
Despite the measures undertaken by the authorities, domestic violence is a scourge that is not limited to any particular profile and has complex triggering mechanisms.

Key messages
Domestic violence is still a scourge today. The identification of strategic axes of prevention is essential.
Educational differences in alcohol-related mortality in Spain using multiple causes of death
Authors: Trias-Llimós S , Spijker J 
Published: October 2021

Abstract

Background
Socioeconomic inequalities in alcohol-attributable mortality are commonly studied using only underlying causes of death (UCOD). We aim to assess absolute and relative educational inequalities in alcohol-related mortality, and to estimate the role of alcohol in educational inequalities in both life expectancy and lifespan variation in Spain.

Methods
We used multiple cause-of-death (MCOD) mortality data for individuals aged 30 and over for Spain (2016-18) by educational attainment. We estimated by sex and educational attainment age-standardized alcohol-attributable mortality rates, relative and absolute indices of educational inequalities; and total life expectancy and lifespan inequality at age 30 for all-cause mortality and after eliminating alcohol-attributable mortality.

Results
The use of MCOD resulted in an additional 2,543 annual alcohol-related deaths (+75% among men, and +50% among women) compared to estimates derived from UCOD. In absolute terms, the most unequal age groups were those aged 45-84 among men and 45-65 among women. In relative terms, higher inequalities exist in working ages, whereas at older ages inequalities tended to be lower, although still important among men. Alcohol contributed to educational inequalities in life expectancy (men: 0.13 years (3.2%); women 0.02 years (0.7%)) and lifespan inequalities (2.1% and 1.4% for men and women, respectively).

Conclusions
Alcohol-related estimates derived from MCOD are more accurate compared to estimates derived from UCOD approaches, although these estimates are still underestimating the impact of alcohol on mortality in Spain. Alcohol remains an important lifestyle to be tackled in order to reduce mortality inequalities.

Key messages
Alcohol-related mortality estimates using multiple causes of death (MCOD) increased the death counts related to alcohol by 75% among men and 50% among women compared to underlying causes of death. This study confirms the role of alcohol on mortality in both mean indicators (life expectancy) and indicators of age-at-death dispersion (lifespan inequality).
Building sustainable research and data tools and partnerships for a healthy city for all
Authors: Marriott P , Hart M 
Published: October 2021

Abstract

Vancouver is located in a temperate rain forest surrounded by mountains and water. Indigenous communities, including the Nations whose homelands the city occupies, have recognized that the abundance of this place can build healthy communities for many generations. But contemporary Vancouver is not a healthy city for all. Since 2014, Vancouver has adopted a Healthy City Strategy, a master social sustainability plan to address inequities in the social determinants of health at a population scale. This includes a number of population health targets and indicators. However, implementation has been slow, with substantive integration of health into policy not yet achieved. With support from the Partnership for Healthy Cities, we have translated the Healthy City Strategy's indicators into an online dashboard, including disaggregated local data. In addition to public accountability, this tool enables data to be a platform for aligning city policy, action and investment toward common health outcomes. In parallel, we are also piloting more community-generated approaches to health data and indicators, with a focus on co-creating health indicators with Indigenous communities. Preliminary results have shown improvement in collaboration across city departments, leading to increased focus on upstream, preventive work. The dashboard is enabling frameworks for funding and working with the social service sector toward common health goals. Engagement efforts have shown the continued importance of a holistic strategy for health that is co-created with community knowledge and priorities. These interventions must be sustained and integrated into ongoing work. The technical work of developing the dashboard contributes to city-wide efforts toward data monitoring and reporting. Data has shown to be an important tool for beginning conversations, but sharing data about health inequities experienced by communities must be matched with an ongoing commitment to engagement and co-creation.

Key messages
Population health data can be leveraged through interactive tools to better integrate and align city policies, plans and investments to address the social determinants of health. Engaging and co-creating policy with communities supports upstream, preventive action on health inequities.
Discontinuation of chronic benzodiazepine use in primary care: a nonrandomized intervention
Authors: Fernandes Milene , Neves Inês , Oliveira Joana , Santos Osvaldo , Aguiar Pedro , Atalaia Paula , Matos Fátima , Freitas Maria Carina , Alvim António , Maria Vasco 
Published: October 2021

Abstract

Background
Chronic benzodiazepine use is a challenge in primary care practice. Protocols to support safe discontinuation are still needed, especially in countries with high utilization rates.

Objectives
To evaluate the feasibility, effectiveness, and safety of a benzodiazepine discontinuation protocol in primary care setting.

Methods
Nonrandomized, single-arm interventional study, at primary care units. Family physicians (FPs) recruited patients (18–85 years-old) with benzodiazepine dependence and chronic daily use ≥3 months. Patients with daily dosages ≥30 mg diazepam-equivalent, taking zolpidem, with a history of other substance abuse or major psychiatric disease were excluded. After the switch to diazepam, the dosage was gradually tapered according to a standardized protocol. Primary endpoint was the percentage of patients who stopped benzodiazepine at the intervention last visit. Dosage reduction, withdrawal symptoms, patients’ and FPs’ satisfaction with the protocol were evaluated.

Results
From 66 enrolled patients (74% female; 66.7% aged &gt;64 years; median time of benzodiazepine use was 120 months), 2 withdrew due to medical reasons and 3 presented protocol deviations. Overall, 59.4% of participants successfully stopped benzodiazepine (60.7% when excluding protocol deviations). Men had higher probability of success (relative risk = 0.51, P = 0.001). A total of 31 patients reported at least 1 withdrawal symptom, most frequently insomnia and anxiety. Most of participating FP considered the clinical protocol useful and feasible in daily practice. Among patients completing the protocol, 77% were satisfied. For the patients who reduced dosage, 85% kept without benzodiazepines after 12 months.

Conclusion
The discontinuation protocol with standardized dosage reduction was feasible at primary care and showed long-term effectiveness.
Endoscopic management of delayed bleeding after polypectomy of small colorectal polyps: two or more clips may be safe
Authors: Guo Xue-Feng , Yu Xiang-An , Hu Jian-Cong , Lin De-Zheng , Deng Jia-Xin , Su Ming-Li , Li Juan , Liu Wei , Zhang Jia-Wei , Zhong Qing-Hua 
Published: October 2021

AbstractBackgroundThe resection of small colorectal polyps (≤10 mm) is routine for endoscopists. However, the management of one of its main complications, namely delayed (within 14 days) postpolypectomy bleeding (DPPB), has not been clearly demonstrated. We aimed to assess the role of coloscopy in the management of DPPB from small colorectal polyps and identify the associated factors for initial hemostatic success.MethodsWe conducted a retrospective study of 69 patients who developed DPPB after the removal of colorectal polyps of ≤10 mm and underwent hemostatic colonoscopy at the Sixth Affiliated Hospital of Sun Yat-sen University (Guangzhou, China) between April 2013 and June 2021. Demographics, clinical variables, and colonoscopic features were collected independently. We applied univariate and multivariate analyses to assess factors associated with initial hemostatic success.ResultsGeneral colonoscopy without oral bowel preparation was successfully performed in all the patients, with a median duration of 23.9 (12.5–37.9) minutes. Among 69 patients, 62 (89.9%) achieved hemostasis after initial hemostatic colonoscopy and 7 (10.1%) rebled 2.7 ± 1.1 days after initial colonoscopic hemostasis and had rebleeding successfully controlled by one additional colonoscopy. No colonoscopy-related adverse events occurred. Multivariate analysis showed that management with at least two clips was the only independent prognostic factor for initial hemostatic success (odds ratio, 0.17; 95% confidence interval, 0.03–0.91; P = 0.04). All the patients who had at least two clips placed at the initial hemostatic colonoscopy required no further hemostatic intervention.ConclusionsColonoscopy is a safe, effective, and not too time-consuming approach for the management of patients with DPPB of small colorectal polyps and management with the placement of at least two hemoclips may be beneficial.
Cooperative planning in childcare centers to improve physical activity: a qualitative investigation of directors’ perspectives
Authors: Müller Christina , Hassel Holger 
Published: October 2021

Summary
Interventions to promote physical activity (PA) in childcare centers have been shown to increase children’s PA levels; moreover, a growing number of evidence-based best practice guidelines exist for this setting. However, there is a lack of knowledge on the facilitators of and barriers to the successful implementation of PA guidelines and interventions. We used Cooperative Planning to improve capabilities for PA in childcare centers. This qualitative study aimed to explore childcare center directors’ views on the Cooperative Planning process and identify the facilitators of and barriers to its implementation. We conducted guided semi-structured interviews with the directors of nine childcare centers after completion of the 12-month Cooperative Planning process. The interviews were recorded, transcribed and analyzed using qualitative content analysis with inductive category development. Facilitators and barriers were systematized according to the Consolidated Framework for Implementation Research (CFIR). Cooperative Planning was regarded as being helpful for structuring the process and involving all team members. Several facilitators within the CFIR domains inner setting (structural characteristics, networks and communications, implementation climate), outer setting (support from parents and provider), characteristics of individuals (intrinsic motivation of the staff) and process (individual drivers) were identified. The reported barriers included structural characteristics (e.g. lack of time), networks and communications (e.g. team conflicts) and characteristics of individuals (e.g. lack of willingness to accept change). Several contextual and interpersonal factors seem to influence the extent to which a Cooperative Planning process can be implemented by a childcare center’s team. Future research is needed to evaluate the strategies needed to overcome the identified barriers.