bluuebunny/crossref_metadata_2025_split huggingface dataset:
Using the Middle-Out Perspective to augment advocacy for smokefree legislation
Authors: Mindell JS , Bartington S , Janda KB , Stoll L , Barlow J , Parag Y 
Published: October 2021

Abstract

Issue
Complementing ‘Bottom-up' and ‘Top-down' approaches, the Middle-Out Perspective (MOP) conceptual framework focuses on how middle actors can influence action by enhancing other actors' interest and ability to act. Middle actors exert influence sideways on other middle actors, upwards on policymakers and downwards on individuals. Middle actors can be immediate targets as potential allies or communication channels.

Description of the problem
Successive governments' longstanding voluntary agreements with industry have not protected children and non-smokers from secondhand smoke. Can the MOP enhance effectiveness of small organisations whose voices are ignored?

Results
The NGO Action on Smoking and Health (ASH) built a coalition of NGOs, practitioners' organisations, and others to advocate for smokefree legislation. Aggregating these voices made them more visible and their demand more influential. Involvement of trade unions and lawyers threatened legal action by exposed employees. Local government support and threats of local legislation changed the hospitality trade's opposition to support. Middle actors' supporters and members lobbied their MPs. ASH's professional expertise and reputation made them a trustworthy actor with legitimacy. The consortium led to the national government in England passing smokefree legislation in 2006.

Lessons
Middle actors can be agents of change, promoting desirable public health goals in a middle-out manner. Formal MOP mapping at the start of work can help public health staff identify potential non-traditional ‘allies' to expand the range of who are considered potential middle actors for a particular issue, enlisting powerful additional leverage in improving the public's health. However, middle actors are not neutral. They can contribute to better public health, but they may also be exploited by commercial interests to block healthy policies or promote a health-diminishing agenda.

Key messages
The Middle-Out Perspective (MOP) provide a lens to examine how actors positioned between government (top) and individuals (bottom) act to promote changes in a middle-out manner. Using MOP as a formal approach can help public health organisations and practitioners consider potential ‘allies’ from outside traditional health-related bodies or professions.
Recreational cannabis consumption: a public health perspective
Authors: Gaspar da Rocha A , Queiroz Almeida D , Almeida MA 
Published: October 2021

Abstract

Introduction
The misuse of psychoactive drugs is an important public health problem. It's estimated that there are between 120-224 million users worldwide. In 2001, Portugal started the legal process to decriminalize the use of narcotic drugs and psychotropic substances.

Objectives
To analyze the recreational use of cannabis from a Public Health perspective, to summarize the adverse health effects, to describe the situation in countries where it's legal, and to assess the impacts of its legalization.

Methods
A literature review was carried out using the main databases of scientific articles. Additionally, legal documentation, institutional reports, journalistic pieces, interviews and books were also consulted.

Results
Individual possible effects of punctual used found were: Temporary feeling of euphoria and relaxation; Distortion of perception; Changes in short-term memory and concentration; Altered motor coordination; Paranoia and psychosis. Effects of regular consumption or products with a high THC content: Dependency; Changes in brain development; Cognitive impairment; Decreased life satisfaction and personal fulfilment; Depression. Population level effects described were: increased number of consumers, increased risk of dangerous driving and accidents; decreased suicide rate and death from opioid overdose, decline in black market and in criminality near trading posts. The legalization of consumption in certain countries has allowed us to realize that the price, the quantity of product and the definition of sales locations are relevant topics for the successful implementation of policies in this area.

Conclusions
As the cannabis legalization policy is changed, it is expected the consumption will increase. An investment in prevention campaigns and increase in health literacy should begin before this change focusing particularly on younger people and drivers. This way, the negative health and social effect that can arise from this change will be minimized.

Key messages
Campaigns to prevent cannabis use must begin before legalization. Campaigns to prevent cannabis use should target teenagers and young people and drivers.
COVID-19 vaccine acceptance among primary care residents in Middle-Black Sea Region of Turkey
Authors: Yilmazel G 
Published: October 2021

Abstract

Background
Family Health Center residents fights against infectious diseases at the forefront in primary care. This study aimed to identify COVID-19 vaccine acceptance and associated factors among FHC residents of primary care Middle-Black Sea Region of Turkey.

Methods
A-web based cross-sectional study was conducted with family health center residents in Turkey between October-November 2020. The main outcome variable was acceptance of a potential COVID-19 vaccines. Also COVID-19 Fear scale was used. The associated factors with acceptance were identified through a multiple logistic regression analysis. In evaluations p &lt; 0.05 value were considered significant.

Results
A total of 443 family health center residents were enrolled in the study. In the study group, 65.7% were women, 44% were doctors and 56.0% were other family health staffs. Among the residents, 60.9% reported to willing and 39.1% reported to hesitant to COVID-19 vaccine. Major reasons for acceptance and hesitancy were expection of high protection of vaccines (76.4%) and lack of scientific studies (37.5%) respectively. Men (ORa=1.54), non-smokers (ORa=2.12), those with vaccinated to influenza (ORa=0.33), those with non-infected with COVID-19 (ORa=2.36), and residents who had high level of COVID-19 fear (ORa=2.69) were more likely to be accepted to vaccinate.

Conclusions
More than half of the family health center residents had COVID-19 vaccine acceptance. The way to strengthen the process of vaccination is to well informed of family health center residents with newly emerging scientific data and evidence.

Key messages
Acceptance of a potential COVID-19 vaccine was not desired level. Informing about current evidence on COVID-19 may be needed in order to achieve better vaccine coverage.
Living conditions, lifestyle habits and health among adults before and after the COVID-19 outbreak
Authors: Molarius A , Persson C 
Published: October 2021

Abstract

Background
Studies on the public health consequences of COVID-19 pandemic based on robust data and methods are scarce. The aim of this study was to investigate mental and physical health as well as living conditions and lifestyle habits in the general population before and after the COVID-19 outbreak in Sweden in spring 2020.

Methods
The study is based on 2,273 persons 16-84 years who responded to the national public health survey in spring 2020 in Värmland county (overall response rate 45%). The differences between early (n = 1,711) and late (n = 562) respondents were studied using multivariate logistic regression, adjusting for background characteristics age, gender, educational level, and country of birth. Similar analyses were also completed in the corresponding survey carried out in spring 2018.

Results
Statistically significant differences between the groups were obtained for economic difficulties and worry about losing onés job, which were more common among late respondents, and for sleeping difficulties, which were more common among early respondents. There were no differences in other living conditions nor in lifestyle factors. Prevalence of good self-rated health, high blood pressure, aches in shoulders or neck, anxiety or worry and stress did not differ between the groups. In 2018, the only statistically significant difference between early and late respondents concerned economic difficulties.

Conclusions
Very few differences in living conditions, lifestyle factors and health were observed in the study population before and after the COVID-19 outbreak when adjusted for background characteristics. The results suggest that, in addition to a possible decrease in sleeping difficulties, the prevalence of being worried about losing one's job increased among the employed after the outbreak.

Key messages
The results suggest that the prevalence of being worried about losing one’s job increased among the employed after the outbreak. More research on the short- and long-term public health consequences of the pandemic in the general populations and in different subgroups, using robust data and methods, is needed.
Associated factors to SARS-CoV-2 infection among dental professionals
Authors: Peres Neto J , Fini de Souza M , Martins Camargo Barbosa A , Marsico Loschiavo L , Barbieri W , da Costa Palacio D , Bonfim D , Nascimento Monteiro C , Cintra Nunes Mafra AC , Ferreira Silva Junior M 
Published: October 2021

Abstract

The objective of this study was to analyze associated factor to SARS-CoV-2 infection among dental professionals. This was a cross-sectional study carried out from February to September 2020 in the municipality of São Paulo, Brazil. We included all dental team working at 11 basic health units. Professionals included were from the three different categories oral surgeon-dentist, dental technician, dental assistant. The analysis included SARS-CoV-2 infection and independent variables (sociodemographic, labor and behavior) with descriptive analyses with absolute (n) and relative (%) frequencies, inferential analysis by chi-squared and Fisher exact test (p &lt; 0.05). There was a prevalence of 20.3% of infection by SARS-CoV-2 between dental professionals. However, in the analysis by professional category the infection rate was 3.8 among oral surgeon-dentist, 30.0% among dental technician, 33.3% for dental assistant. The diagnostic of SARS-CoV-2 infection was associated with lower income (p = 0.027), lower level of formal education (p = 0.011), technical professional category (p = 0.025), and the use of public transportation (p = 0.009). The higher prevalence of COVID-19 in technical professionals than oral surgeon-dentists may suggest that infection had occurred outside the working environment, once professional had personal protective equipment available as well as the training for their professional activity. In addition, professionals reported to feel safe and prepared to perform their activities in the work environment.

Key messages
Transmission of SARS-CoV-2 in oral health in the public service. Promotion and prevention of SARS-CoV-2 transmission in oral health in the public service.
Impact of mandatory institutional quarantine on sleep quality: A cross sectional Tunisian study
Authors: Cherif I , Kharroubi G , Haj Amor S , Zribi M , Ouali U , Bettaieb J 
Published: October 2021

Abstract

Background
Given the COVID-19 pandemic, Tunisian authorities have imposed quarantine in dedicated centers mainly for travelers coming from countries with highest coronavirus infection rates. Such restrictive measures may have a detrimental impact on people's mental health and can thus affect sleep. We aimed in this study to assess the impact of mandatory institutional quarantine on sleep quality in Tunisia and to determine factors associated with clinical insomnia.

Methods
Data were collected through a cross sectional study conducted from April to November 2020 among individuals who were in quarantine for 14 days including at least a week in a Tunisian quarantine center. Sleep quality was assessed using the Insomnia Severity Index. Factors associated with clinical insomnia were assessed using bivariate and multivariate analysis.

Results
In the present study, 506 participants were included with a mean age of 37.6±13.6 years. Majority (66.4%) were men. Nearly one fifth (19.2%) of surveyed individuals had symptoms of clinical insomnia. In multivariate analysis, we found that being a woman, spending longer time on covid-19 news per day, having experienced stigma during the quarantine period, financial difficulties due to the coronavirus pandemic and dissatisfaction by the accommodation conditions of the quarantine facility were independently associated with clinical insomnia.

Conclusions
Nearly one fifth of participants had clinical insomnia during the quarantine period. Providing a good sleep environment, educating sleep healthy behavior and giving adequate psychological support to quarantined individuals in quarantine centers is necessary.

Key messages
Among surveyed participants, 19.2% had symptoms of clinical insomnia. Providing a good sleep environment in quarantine centers and providing mental health support to quarantined individuals is essential.
Myths of ‘good motherhood’ and the wellbeing of mothers during the Covid-19 pandemic
Authors: Batram-Zantvoort S , Wandschneider L , Razum O , Miani C 
Published: October 2021

Abstract

Background
Measures to contain the Covid-19 pandemic had major impacts on families, e.g., due to the unpredictable closing of childcare facilities and schools. Parents had to re-arrange their work, childcare and household obligations.

Methods
We conducted 17 email interviews with mothers having at least one child aged &lt; =6 years. Topics included adjustments to the pandemic situation, views on motherhood and wellbeing. We analysed data through content analysis.

Results
We found differing consequences on the wellbeing of the interviewees. One group articulated a deceleration of daily life and increased satisfaction due to doing more justice to their role as mother. Another group felt highly stressed and overloaded. Some expressed having shaky hands and heart palpitations, others felt mentally exhausted. The idea of not being a ‘good mother' was expressed by many, provoking guilt and self-doubt. Most interviewees referred to ideological myths of motherhood, picturing mothers as caring and sacrificial, yet well-organized managers of the family. Norms imposed on ‘working mothers' require their full effort and an ability to manage employers' demands. These conflicting norms reveal tensions between the roles mothers find themselves in, potentially leading to adverse (mental) health outcomes.

Conclusions
Our analysis shows that myths of ‘good motherhood' act as a perpetuation mechanism of traditional gender roles and increase the social burden many mothers are expected to carry, adding to the challenges the global pandemic brought on families. Negative consequences on (mental) health require mitigation strategies, putting mothers at the centre of Covid-19 response policies.

Key messages
The Covid-19 pandemic exacerbates traditional gender roles and the multiple social burdens that mothers are expected to carry. Conflicting norms imposed on mothers reveal tensions between the different roles they find themselves in, potentially leading to adverse (mental) health outcomes.
Assessment of COVID-19 vaccine literacy among cancer patients: A cross sectional Tunisian study
Authors: Cherif I , Khiari H , M'ghirbi F , Mallekh R , Mezlini A , Hsairi M 
Published: October 2021

Abstract

Background
In the context of the COVID-19 pandemic, Vaccine literacy (VL) is considered as an important determinant of vaccine hesitancy and uptake. Cancer patients constitute a target group for COVID-19 vaccination. Thus, we aimed in this study to assess COVID-19 VL among cancer patients in Tunisia.

Methods
A cross sectional study was conducted, during the month of February 2021, in the Salah Azaiez institute of cancer including all inpatients aged ≥18 years. A standardized VL scale was used, composed of two dimensions: functional VL and interactive-critical VL, using a four point Likert scale. A global score was calculated for each scale (ranging from 1 to 4); A cutoff of 2.5 was defined according to the literature. The students' t and Anova tests were used for comparison of VL mean scores according to the studied characteristics. A p value &lt;0.05 was considered as statistically significant.

Results
A total of 200 patients were enrolled in this study with a mean age of 54.4±12.7 years. A low VL score (≤ 2.5) was observed among 27.5% and 81.0% participants for functional and interactive critical scales respectively. Higher functional VL score was associated with a higher educational level (3.7±0.5 among individuals with a university degree level vs 2.5±1.2 among illiterate, p &lt; 0.001). Interactive critical VL significantly increased with educational level (p &lt; 0.001) and was significantly higher among healthcare workers (2.5±1.3 vs 1.7± 0.9, p &lt; 0.001), those who accepted to get the COVID-19 vaccine (2.0±0.9 vs 1.6±0.8, p = 0.002), who did not believe that vaccines are unsafe (1.9±0.9 vs 1.4±0.7, p &lt; 0.001) and that there is no need to be vaccinated since natural immunity exists (2.1±1.0 vs 1.7±0.8,p=0.016).

Conclusions
Vaccine literacy among cancer patients included in this study is weak. Effective communication strategies about COVID-19 vaccination should build VL and consider the level of patient's health literacy to redress vaccine hesitancy and uptake.

Key messages
This study showed a low interactive-critical vaccine literacy score. Communication strategies in vaccination campaigns should be aligned with people’s vaccine literacy.
Subjectively perceived healthcare provision during the first wave of the COVID-19 pandemic
Authors: Hannemann N , Götz NA , Schmidt L , Babitsch B 
Published: October 2021

Abstract

Background
An OECD benchmark (2020) shows that Germany has, in effect, an above-average healthcare infrastructure to face COVID-19. Nevertheless, at the beginning of the pandemic, there were restrictions and uncertainties in the use of health-related services. The following analysis examines the subjective perception of respondents with their healthcare provision whether there were sociodemographic differences.

Methods
Data from an online cross-sectional survey conducted between 29 April and 8 May 2020 were used (N = 1,570; 18-74 years). Bivariate test methods were used for analysis, stratified by age group, subjective social status (SSS) and chronic illness. The subjective perception was assessed via subjects' subjectively perceived worries, fears and difficulties of not receiving an adequate healthcare provision during the COVID-19 pandemic. Thus, an index was constructed with a range of values from 3 to 12 (Cronbach's α = 0.886). A higher index implies a poorer perception of the healthcare provision.

Results
Compared to the groups 50-59-year-olds and 60 years and older the 18-29-year-olds (MRank 431.1) had a significantly (p &lt; 0.05) poorer perception of their healthcare provision during COVID-19. In addition, probands with low SSS were found to have a significantly (p &lt; 0.05) worse perception (MRank 423.0) than subjects with medium SSS (MRank 374.1). Chronically ill subjects suffered significantly poorer perception (MRank 406.1; p &lt; 0.05) compared to healthy subjects (MRank 366.0).

Conclusions
Vulnerable groups with poorer perceptions of their health care provision during COVID-19 can be identified. More investigation is needed to identify subjective or COVID-19 related predictors that cause this subjective perception.
Reference
OECD (2020). Beyond Containment: Health systems responses to COVID-19 in the OECD.
Available: https://read.oecd-ilibrary.org/view/?ref=119_119689-ud5comtf84&title=Beyond_Containment:Health_systems_responses_to_COVID-19_in_the_OECD (Accessed: 14.04.2021)

Key messages
It was found that respondents perceived their subjective healthcare provision during COVID-19 differently, according to sociodemographic stratification. Especially younger, chronically ill, and socioeconomically deprived respondents experienced a poorer perception of their healthcare provision during the first wave of the COVID-19 pandemic.
Impact of Covid-19 on incident reporting
Authors: Doimo A , Bianchet B , Moretti V , Mellace F , Favero B , Longobardi G , Bellomo F , Degan S , Farneti F , Cocconi R 
Published: October 2021

Abstract

Background
Incident reporting (IR) is a system of spontaneous and voluntary reporting of events, important for assessing safety risks and for improving safety and quality of care. Since Covid-19 pandemic led to a change on the hospital organization, related to an overload of work and an increase of pressure in the wards, this study aims to evaluate the impact of Covid-19 on IR and on safety culture.

Methods
This retrospective study analyzed the data of IR in 2019 and 2020 in the academic hospital of Udine. Number of IR, severity of the events (near miss, events with no harm and events with harm) and IR'S topic were compared. Inappropriate IR were excluded from severity analysis. The chi-square test was used for statistical significance.

Results
IR in 2020 showed a reduction of 17.7% compared to 2019 (1097 vs 1334, p &lt; 0,05). Furthermore, we observed a reduction in near misses (276 vs 390, - 4,81%, p &lt; 0,05) and an increase in events with harm (226 vs. 219, + 4,52%, p &lt; 0,05). Events with no harm showed no significant increase. The analysis of topics revealed an increase in 2020 of problems concerning assessment of patient (+ 4.47%), especially swab's results delays, organizational aspects (+ 4.88%), due to staff reassignment and ward reorganization, and infection prevention and control (+ 4.65%). This increase is significantly associated with Covid-related IR (p &lt; 0,05).

Conclusions
In 2020 were collected fewer IR than 2019 and with an higher level of severity. This change may be associated to the increased workload of the staff who had less time to report incidents. Nevertheless 2020 showed an increase in reporting Covid-19 related issues concerning delay of diagnostic test, new work condition and infection prevention and control measures. This analysis suggests that the decreased number of IRs and near miss during the first year of the pandemic could represent a reduction in safety culture. Additional data are needed.

Key messages
Covid-19 disease influenced the safety culture by reducing the number of IR and near misses reported. New Covid-related issues emerged as critical during the pandemic.