bluuebunny/crossref_metadata_2025_split huggingface dataset:
Inadequate nutrient intake in people with disabilities: National representative sample in Korea
Authors: Park J E , Kim S Y , Park J H 
Published: October 2023

Abstract

Background
Individuals with disabilities often face significant issues related to nutrition such as food insecurity. However, only few studies have investigated whether people with disabilities have relatively poorer nutritional status than those without disabilities.

Methods
To compare the differences in the nutritional adequacy of diets between people with and without disabilities, 5296 adults aged ≥19 years from the 2013 Korea National Health and Nutrition Examination Survey were included in the analysis. Diet adequacy was assessed with the nutrient adequacy ratio (NAR) for 10 nutrients and the corresponding mean adequacy ratio (MAR). A multivariate logistic regression model was used to assess the likelihood of having nutrient inadequacy in people with disabilities.

Results
NAR for energy, protein, vitamin B2, niacin, calcium, and phosphorus, excluding vitamin A, B1, C, and iron, was significantly lower in people with disabilities compared to in those without disabilities (all P &lt; 0.05). MAR of 10 nutrients was also lower in people with disabilities (P = 0.003). The proportion of overall nutrient inadequacy, defined as having a MAR below 0.75, was 40.6% in people with disabilities versus 27.5% in those without disabilities (P &lt; 0.001). In a multivariate logistic regression model, people with disabilities had a higher odds of having nutrient inadequacy than people without disabilities (odds ratio = 1.53, 95% confidence interval = 1.11-2.11).

Conclusions
People with disabilities are more likely to not meet nutritional adequacy. Therefore, it is necessary to develop a nutrition assistance policy to comprehensively support people with disabilities who have poor nutritional status.

Funding
This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIT) (No. 2021R1C1C2008683) and the Ministry of Education (No. 2019R1I1A1A01063639).

Key messages
• People with disabilities had a higher prevalence of nutrient inadequacy than those without disabilities.
• A support system to improve the access of people with disabilities to safe and healthy food must be ensured.
Tackling breast cancer where almost no care is available. A Europe-Africa partnership
Authors: Gajewski J , Pittalis C , Mwandira R , Schouten E , Brugha R 
Published: October 2023

Abstract

Background
African and European societies share similar challenges, such as the growing cancer burden, and are committed to equity and women's health, as highlighted at the 2022 EU - African Union summit. Breast cancer - the most common cancer worldwide and the leading cause of cancer death among women - disproportionately affects individuals in low-resource settings such as Malawi, where only 9.5% of patients survive beyond 18 months. Early detection and treatment could bring hope and extend the healthy lives of these women. The Akazi project, a collaboration between partners from Ireland and Malawi, is implementing a health systems platform to achieve this goal.

Methods
Based on the six WHO health systems building blocks framework, a mixed methods health systems capacity assessment was done in Malawi in 2022 to inform the development of a national breast cancer strategy.

Results
Major gaps were identified in all building blocks, critically in human resources, as no training in breast health was available in the country, and the number of trained health workers was critically low. Only five breast surgeons, five oncologists and one pathologist practice nationwide. In response, a breast health course was developed, tested and implemented with endorsement from MoH. Two cohorts of frontline workers have been trained (n = 37). Local health authorities have designed and implemented community breast care awareness activities.

Conclusions
This simple intervention provides the basis for critical improvements in national breast cancer services in Malawi. Akazi-funded breast health training needs to be rolled out country-wide by the Ministry of Health and significant infrastructure and human resources investments. Technical and financial support from the global North is essential to ensure progress towards Universal Health Care in Africa.

Key messages
• Bridging inequities in breast cancer outcomes requires systematic health systems strengthening.
• EU-Africa research collaborations can fill critical knowledge gaps through systems analyses to guide national cancer control strategies.
Impact of health education on sexual safety among Hungarian adolescents
Authors: Major D , Szabó K , Fazekas-Pongor V , Arva D , Falus M , Eörsi D , Terebessy A 
Published: October 2023

Abstract

Background
The aim of sexual health education is to raise awareness of sexual safety, i.e., to prevent unwanted pregnancies, sexually transmitted infections, and emotionally harmful experiences. The Balassagyarmat Health Education Program (BEP) is a comprehensive health education program covering different areas of health, including sexual health, targeting all high school students of a Hungarian town. The goal of our study is to measure the impact of BEP on adolescents' knowledge of sexual safety.

Methods
Tenth-grade students from three academic years (2018-2020) were included in our analysis. Since the class of 2018 received no intervention, it was considered as the control group. Tenth-grade classes of 2019 and 2020 each took part in the health education program (2 out of 10 sessions on sexual safety). After the intervention, students filled out an online questionnaire regarding their sexual attitudes and health behaviors. Open-ended questions were evaluated with quantitative content analysis done by two independent coders. Participants were asked to identify the safest form of protection, and those who offered an appropriate explanation were considered as “conscious” students. Proportions of answers within each academic year were compared with Chi-squared tests.

Results
768 students completed our questionnaire (group 2018: 315; group 2019: 274; group 2020: 179). Compared to the control group, a significantly higher proportion of students in the intervention groups considered the condom to be the safest protection method (76.2%; 90.9%; 81.0% respectively) and fewer considered the same for contraceptives (21.6%; 7.7%; 16.8%). The intervention groups also exhibited a significantly higher proportion of conscious students compared to the controls (21.6%; 49.8%; 30.3%).

Conclusions
Even though our study confirmed that adolescents' knowledge of sexual safety can be improved, a relatively low proportion of students is aware of the purpose of protection.

Key messages
• Health education programs are effectively able to improve knowledge of sexual health and safe sex practices with a higher proportion of health-conscious individuals as a result of the intervention.
• Since better knowledge is associated with more health-conscious behaviors, the purpose of protection should be emphasized more as students were not always able to explain their choice of protection.
Health literacy and health behaviors 3E 2S of Medical Profession
Authors: Mayod N 
Published: October 2023

Abstract

Background
Health literacy (HL) and health behaviors (HB) include skills needed to make appropriate health decisions and successfully navigate the health care system. However, the survey of HL and health behaviors of medical professionals is limited. This cross-sectional study aimed to assess the level of HL and health behaviors 3E 2S of the medical profession, Rajavithi hospital, and their association.

Methods
Two hundred and eighty-eight medical doctors were recruited and completed three parts of a self-administered questionnaire: demographics, HL, and health behavior 3E 2S scale of Thai adults (2018-revised edition). This HL questionnaire has six components with scoring criteria, and interpretation is designed by the Health Education Section, Health Service Support Department, and Ministry of Public Health. Pearson correlation coefficient was performed. The ethics committee Rajavithi Hospital approved this study.

Results
Of 288 medical doctors, 59% were female, and the mean age was 30.11±5.77 years. Most had overall HL at good and upper level 54.7%: cognitive skills 70.8%, access to health information 76.7%, health decision making 61.3%, media literacy 66%, and self-management 55.9%. A moderate level of health communication was 35.4%. Most subjects had a poor level of health behavior at 60.8%. HL was positively associated with health behavior (r = 0.483, p &lt; 0.001). Single status significantly related to HL (p = 0.002) and HB (p = 0.011).

Conclusions
Health literacy was at a good level. Health communication requires improvement. Health behaviors 3E 2S were poor. The organization should formulate a policy. A role model and health program should be proposed to develop health literacy skills best suited for the target group.

Key messages
• Health literacy can help us prevent health problems, protect our health, and better manage health problems when they arise.
• Improved health literacy skills are something that anyone can benefit from, especially if you are dealing with a chronic condition or illness.
Evaluation of a nutrition education program at the Dutch out-of-school care during summer holidays
Authors: Battjes-Fries MCE , Hoefnagels F A 
Published: October 2023

Abstract

Background
School-based nutrition education has increasingly been used to teach children about nutrition. With over half a million children attending out-of-school care in the Netherlands, this might be a suitable setting for nutrition education as well. The aim of this study was to evaluate the implementation of the program ‘Spoony's Gezonde Smikkelweken’ for out-of-school care among staff and parents.

Methods
The program consists of 4 cooking, play and eating activities, a home-workbook and an online platform to promote vegetable consumption during the holidays. In July 2022, 585 out-of-school care locations for 4-12 year-olds across the Netherlands implemented the program. All locations received digital questionnaires to be distributed among the staff and parents on appropriateness, implementation, appreciation and perceived effects. Also semi-structured interviews were conducted with 11 employees for more detailed feedback.

Results
The questionnaire was filled out by 410 employees before the program and by 327 employees and 79 parents after the program. The 4 activities were implemented by 77%-96% of the locations. The staff was generally positive about the program; easy to fit into their daily routine (90%), suitable for the children (82%), well-organised (92%) and willing to implement it again (99%). Besides, they reported a higher number of children willing to taste vegetables after the program than before (57% vs. 37%) and vegetables eaten more often as a snack and at lunch (+17%). A majority of the children took the workbook home (82%) and did one or more activities from it (84%). Parents were generally positive about the program (4.6±0.8) and the attention to healthy eating at this setting (99%).

Conclusions
This program has been successfully received by staff and parents as a suitable form of nutrition education at out-of-school care. Despite a low response rate among parents, it appeared promising to also reach children's home situation.

Key messages
• Nutrition education provided by out-of-school care seems suitable, similar as provided at schools.
• Spoony’s ‘Gezonde Smikkelweken’ appeared a suitable program for Dutch out-of-school care.
Prevalence of major noncommunicable diseases and their associated risk factors in Afghanistan
Authors: Noormal A S , Winkler V , Busari S , Horstick O , Louis V R , Deckert A , Antia K , Elkhoury Z , Dambach P 
Published: October 2023

Abstract

Objective
Afghanistan is dealing with a double burden of diseases and yet there has been no evidence synthesis of the scientific literature on noncommunicable disease (NCDs), thus this study fills the gap by systematically analysing the prevalence of four major NCDs and the associated risk factors.

Methods
We performed a systematic review and meta-analysis of the studies published since 2000, reporting the prevalence of diabetes, chronic respiratory diseases (CRDs), cardiovascular disease (CVDs) or cancer, and their risk factors in Afghanistan. Four online databases (PubMed, Web of Science, Cochrane, and Google Scholar) and two local peer reviewed journals in Afghanistan were systematically searched using the predefined keywords. Two reviewers independently screened and appraised the quality of the papers. Data extraction and data synthesis were carried out using tabulated template. Stata 13 was used to perform the meta-analysis.

Results
58 articles included in this review of which 13 focused on cancer, 10 on diabetes, 7 on CVDs, 5 on CRDs, and 23 on any of the risk factors as primary outcome. Very few articles reported the prevalence of 4 NCDs in general population where cancer was reported 0.15%, asthma ranged between 12.5% to 17.3% and no evidence on CVDs. The pooled prevalence for diabetes, hypertension, and overweight were 12%, 31%, and 35% respectively. Central obesity was almost twice prevalent in females (76% vs 40%). Similarly, the pooled prevalence of smoking and snuff use were 14% and 25% in males, and 2% and 3% in females respectively.

Conclusions
Less evidence is available on the prevalence of major NCDs in Afghanistan, however, the risk factors for NCDs are prevalent across the country. The quality of the available data specially those of the local resources are poor, therefore, further research should be conducted to generate reliable evidences to inform the policy makers on prioritization of the interventions for the control of NCDs in Afghanistan.

Key messages
• The prevalence of NCDs is escalating in Afghanistan, and the local data show higher estimates of NCDs and their associated risk factors.
• Prevalence of NCD risk factors is relatively high in Afghanistan, and considering the political emergency situation, if preventive measures are not taken properly, the burden of NCDs may increase.
The burden of breast cancer attributable to modifiable risk factors
Authors: Todorovic J , Santric-Milicevic M , Stevanovic A , Devleesschauwer B , Stoisavljevic S , Bjegovic- Mikanovic V , Terzic-Supic Z , Stamenkovic Z , Vojvodic K 
Published: October 2023

Abstract

Introduction
Breast cancer (BC) is a preventable non-communicable disease and the most common cancer among women of reproductive age. Although largely associated with non-modifiable risk factors, the prevention of modifiable risk factors for BC (smoking, alcohol use, physical inactivity, and dietary risks) can help decrease society's burden. The aim of this study was to examine the BC burden among women of reproductive age attributable to these risk factors in the ten leading countries in the World Health Organization (WHO) European region, in order to describe the potential burden which can be avoided.

Methods
Within the EU CA 18218, we analyzed Disability-Adjusted Life-Years (DALY) rates of BC per 100,000 among women aged 15-49 years attributable to the four modifiable risk factors: smoking, alcohol use, physical inactivity and dietary risks. Estimates were taken from the Global Burden of Disease Study 2019, for ten countries with the highest DALY rates of BC in WHO European region in 2019: Monaco, Georgia, Bulgaria, Montenegro, Ukraine, North Macedonia, Armenia, Serbia, Greece and Romania.

Results
The highest DALY rate for BC was in Monaco (758.37) and Georgia (708.99). The highest DALY rate attributable to the four modifiable risk factors combined was in Monaco (178.89) and Bulgaria (171.68). The highest attributable DALY rate to smoking was in Bulgaria (49.04), and Monaco (44.67). The highest attributable DALY rate to alcohol use was in Ukraine (87.24) and Bulgaria (83.25). The highest attributable DALY rate to physical inactivity was in Monaco (9.88), followed by Bulgaria (3.49), as was the DALY rate attributable to dietary risks (48.51, and 35.90, respectively).

Conclusions
The variable burden of BC attributable to the modifiable risk factors between the examined countries calls for strengthening regional activities. The proportion of BC burden attributable to these risk factors is non-negligible, given its impact on the total burden of the disease.

Key messages
• A combination of four modifiable risk factors significantly contributes to the burden of breast cancer.
• Regional collaboration on risk factors is needed to prevent the burden of breast cancer.
National Health Index shows an increase and marked regional differences in diabetes burden in Finland
Authors: Jousilahti P , Lindström J , Koponen P , Lindell E , Sarnola K , Luoto R , Koskinen S 
Published: October 2023

Abstract

Background
The National Health Index contributes to the data bases needed for monitoring population health and development of health promotion policy and social and healthcare services. It includes a Morbidity Index and a Work Ability Index. The Morbidity Index is built on seven sub-indexes estimating the prevalence of the main components of the overall disease burden. The aim of this study is to describe the five-year time trend and regional differences in diabetes burden in Finland.

Methods
Diabetes index is based on four register data sources: (1) diagnosis in out-patient care, (ICD-codes), (2) hospital discharge diagnosis (ICD-codes), (3) purchase of diabetes medication (ATC-codes), and (4) special reimbursement for diabetes medication. Both non-standardized and age-standardized indexes were calculated. The time trend analysis is based on three three-year periods: 2017-2019, 2018-2020 and 2019-2021 for the whole country and separately for 22 regions. Index value 100 represents the average national level in the last period.

Results
National diabetes index increased from 94.9 in the first to 100 in the last follow-up period. The age-standardized values were 96,7 and 100, respectively. In 2019-2021 Åland region had the lowest index value (64.2) followed by Helsinki city (72.6). The highest index value (134.5) was observed in South Savo region. Age-standardization reduced the differences between regions which, nevertheless, remained remarkable: 63.2, 84.8 and 106.7, respectively. Furthermore, the highest age-standardized index value (117,5) was observed in South Ostrobothnia region.

Conclusions
Diabetes burden is still increasing in Finland, and there are marked differences between regions. The increase and regional differences are partly explained by changes and differences in age-structure but also other (preventable) factors play an important role. In general, diabetes burden is highest in eastern and northern parts of the country.

Key messages
• Diabetes burden is still increasing in Finland, and there are marked differences between regions.
• The increase and regional differences are partly explained by changes and differences in age-structure but also other (preventable) factors play an important role.
Assessing knowledge, attitude, practices and vaccine hesitancy in nurses: a pilot study
Authors: Renzi E , Covelli A , Patania F , Baccolini V , Migliara G , Marzuillo C , De Vito C , Villari P , Massimi A 
Published: October 2023

Abstract

Background
The use of a validated and reliable tool to assess knowledge, attitude, practices (KAP) and vaccine hesitancy (VH) in nurses is critical to developing tailored public health strategies to implement adherence to recommended vaccines for healthcare workers (HCWs) and reduce the chance of spreading vaccine-preventable diseases. The aim of this study is to develop and validate a tool to assess nurses’ vaccine hesitancy and KAP regarding recommended vaccines for HCWs.

Methods
Following a systematic review of the literature (PROSPERO ID:CRD42020212252), a new tool was built to assess vaccine hesitancy using the framework of the WHO Strategic Expert Advisory Group on Immunization. The pilot study collected responses from a random sample of nurses and nursing students. The content validity (including face-validity) was evaluated with a panel of experts. Internal reliability was tested using Cronbach's alpha (α).

Results
The final questionnaire consisted of three sections and forty items. A total of 124 individuals, 40 nurses and 84 nursing students were enrolled. Regarding KAP: only ten nurses (26.3%) reported adequate knowledge of recommended vaccines for HCWs, while no students reported knowing the vaccines included in the recommendations. 40% of nurses and 63% of nursing students discuss safety and efficacy of vaccinations during clinical practice. Twelve (32%) nurses and 42 (50%) students reported VH for at least one of the recommended vaccines for HCWs, with particular regard to flu vaccination and COVID-19 vaccine for which, despite being vaccinated, half of nurses and students reported concerns mainly about efficacy and safety. The reliability of vaccine hesitancy scales in nurses (α = 0.82) and nursing students (α = 0.85) could be considered good.

Conclusions
Following the validation of this tool, a multicenter cross-sectional study will be conducted involving three universities (Sapienza, Bicocca, Turin) on a national sample of nurses and nursing students.

Key messages
• Systematically measuring vaccine hesitancy in at-risk populations with a nationally validated tool enables implementation of targeted public health strategies.
• Identifying nurses’ knowledge, attitudes, and practices regarding vaccination and vaccine hesitancy enables organizations to adequately address the training needs of their health workers.