bluuebunny/crossref_metadata_2025_split huggingface dataset:
Nutritional status assessment using anthropometry and evaluation of school canteen menus in Tanzania
Authors: Callegaro D , Biasini B , Scazzina F 
Published: October 2023

Abstract

Background
According to the FAO, an estimated 767.9 million people faced hungry in 2021. To improve food sovereignty, it is necessary to investigate eating habits and assess the actual level of malnutrition. The study took place in two private schools, one primary and one secondary school in the Rukwa region, one of the poorest in Tanzania, with a human development index of 0.467.

Methods
Height and weight were measured from March to June 2022 on a sample of 235 students (52% male, age 9.9 ± 2.6) from the primary school and 297 (61% male, age 16.9 ± 2.8) from the secondary school. The menus of the canteens were evaluated by weighing the ingredients cooked for one week and dividing the estimated nutrients for each student attending the canteen, then comparing them with the EFSA Dietary Reference Values.

Results
The BMI by age of children from 5 to 19 years was compared with the WHO reference data for growth. 72.7% of primary school students were in the 50th percentile and 27.7% in the 15th percentile, while 68.7% of secondary school students were in the 50th percentile and 25.4% in the 15th percentile. The menu evaluation showed that carbohydrates provide 79.6% of the diet's energy, while lipids only 10.58%. Vitamin intake was particularly low for B7 (3.05μg), B12 (0.155μg), A (149.21μg), D (0.04μg) and K (0.57μg). Among the minerals, the greatest deficiencies are Calcium (290mg), Magnesium (39.95mg) Iodine (18.63µg), Copper (0.20mg), Selenium (1.38µg) and Manganese (0.46mg).

Conclusions
The results show that children and adolescents are growing less than recommended and malnutrition affects the youngest. The meals in the two canteens show a shortage of several nutrients, easily attributable to the low consumption of fruit and animal products. Although the situation appears critical, it should be emphasised that the schools surveyed were private, while in public schools the catering service does not exist, often condemning students to a single evening meal.

Key messages
• In a rural context of Tanzania, children and adolescents are growing less than recommended and malnutrition affects the youngest.
• A low intake of vitamins and minerals was detected in two school canteens in Tanzania.
Funding agencies’ complicity in advancing or impeding equity in and through global health research
Authors: Dixon J , Plamondon K , Elliott S , Graham I , Nixon S , Curty Pereira R , Khan S , Nunbogu A 
Published: October 2023

Abstract

Background
In Global Health Research (GHR), funding policies inform how health research is approached and structured, serving to distribute power and resources in ways that can either reinforce or take action on inequities. In essence, these policies incentivize the focus of GHR and are therefore among the political/structural determinants of health. Despite broad recognition of the need for equity in GHR, the role of funders receives relatively little scrutiny. We sought to better understand the place of equity across the international landscape of GHR funders.

Methods
Publicly accessible, current strategic (those that set the vision, mission and goals of funding) and operational (those that set the implementation rules and compliance requirements for funded research) policies were harvested from 23 purposely selected Global North and philanthropic funding agencies. Content and discourse analysis were used to examine the portrayal of GHR in inequitable contexts, declarations of equity intentions, and to assess alignment to the six CCGHR equity-centred principles.

Results
Funding agencies across the Global North made clear declarations on the importance of equity in GHR; however, operationalization was largely absent or incompatible with the best scientific evidence on advancing health equity. Most philanthropic funding agencies failed to make policies public meaning equity action remains unclear. Alignment with equity-centred principles presented in different forms from varying agencies, though no single agency demonstrated good alignment to all six principles.

Conclusions
Funder discourses suggest equity is a central priority in GHR. Given that funder policies are themselves determinants of equity, stronger alignment between strategic policies, intentions, and action on inequity (e.g., investing in interventional research that acts on upstream determinants) are critically needed for funders of GHR, specifically, and public health research, broadly.

Key messages
• Funding policy can determine equity possibilities, both in research processes and outcomes.
• Coherence between strategic intentions and operational policies is possible, and would promote more equity-advancing research.
Strengths and weaknesses of the South-South Learning Exchange: the experts’ perspectives
Authors: Triulzi I , Kabra R , Allagh K P , Kiarie J 
Published: October 2023

Abstract

Background
South-South learning exchange (SSLE) refers to an interactive learning process where peers exchange knowledge and experience to work towards a beneficial change. Despite organizations having recently increased the opportunity to run SSLEs, the SSLE processes are not well documented in the scientific literature. This study explored experts’ perspectives on SSLEs’ strengths, weaknesses and mechanisms leading to outcomes.

Methods
We conducted a qualitative study using semi-structured interviews on the experience of participants and organizers of SSLEs. Data were collected between 1st September 2021 to 26th November 2021. All data were digitally recorded, transcribed verbatim, and analysed. In the analysis, we adopted an inductive approach derived from thematic analysis.

Results
Sixteen experts who have participated in or facilitated one or more SSLEs were interviewed. Experts’ accounts demonstrated an appreciation of participants’ empowerment, positive peer-to-peer “mind change” and convincing and powerful hands-on learning of this approach as strengths in the successful implementation of the SSLE. Being resource-heavy, participant reluctance and the absence of a validated methodology emerged as the main weaknesses of the South-South learning approach, which could impair the effectiveness of this scheme.

Conclusions
The SSLE is a promising approach to exchange knowledge and experience to work toward a desired change. However, to enhance its effectiveness and credibility, it would benefit from adopting a validated and systematic methodology that supports all stages of the exchange process, including monitoring and evaluation (M&E).

Key messages
• South-South learning exchange is a promising approach to exchanging knowledge and experience among countries from the Global South.
• A robust and systematic methodology is likely to increase evidence on SSLE and demonstrate its success.
The impact of socio-economic status on infant deaths: a case-control study from Istanbul
Authors: Girgin S , Ayvaz I , Bakir Keser N , Gemici E , Sezerol M A , Batman M , Karabacak O , Davun S , Hidiroglu S , Ay P 
Published: October 2023

Abstract

Background
Socioeconomic disparities continue to impact child health. This study aimed to determine the association between socioeconomic status (SES) and infant mortality (IM) in a district in Istanbul.

Methods
This is a case-control study conducted in a district of Istanbul. The cases were all infants born alive who died before reaching the age of one between January 1, 2021, and December 31, 2022. The controls were randomly selected children who were born and survived their first year. The sample size was calculated as 83 cases and 166 controls assuming low SES doubled IM, with 80% power and an alpha error of 0.05. Data were obtained through health records and telephone interviews. SES was evaluated through a validated index that used parents’ education and occupation, households’ vehicles and ownership of electrical devices, house ownership, and the land value of the living area. SES was categorized into three groups: low, middle, and high. Logistic regression was used in the analysis.

Results
The response rate was 51.8%, with 42 cases and 87 controls. The multivariate model included mothers’ age, smoking status, presence of maternal chronic diseases and anemia, multiple gestations, antenatal visits (≥4 vs. &lt;4), premature membrane rupture, mode of delivery, parental consanguinity, baby's gender, and the SES index. When high SES was the reference category, low (OR:4.34, 95%CI:1.18-15.92) and middle SES (OR:1.59, 95%CI:0.49-5.13) increased the risk of IM. Having &lt;4 antenatal visits (OR:80.84, 95%CI:8.84-738.98), presence of maternal chronic diseases (OR:4.03, 95%CI:1.25-12.94), and anemia (OR:2.39 (95%CI: 0,86-6,64) also increased IM.

Conclusions
Low SES continues to be the root cause of IM. Infants of mothers who had &lt;4 antenatal visits, anemia, and chronic diseases were at increased risk for mortality. To address IM, it is essential to highlight why pregnant women underutilize antenatal care since these services are free.

Key messages
• Achieving equity should be the main target for decreasing infant mortality.
• There is a need to address underutilization of antenatal services for decreasing infant mortality.
A mixed methods study about health problems and drug use in Belgian prisons during 2021-2022
Authors: Plettinckx E , Harth N , Damian E , Degreef M , Dirkx N , De Smet S , Gremeaux L 
Published: October 2023

Abstract

Negative effects of imprisonment on quality of health and drug use are well known. Although the interference between social- psychological- and physical aspects of health seem obvious, in many prison settings an overall approach with respect to drug use is lacking. A mixed methods study collected data during 2021-2022 in five Belgian prisons. People in prison were randomly invited for a quantitative survey about drug use, violence, social contacts, loneliness, anxiety, depression and sleep. The survey was carried out in 13 languages using tablets. In total, 280 responses were analysed. Next, respondents of the survey that used illicit drugs were invited for an in-depth interview about personal insights on support needs of drug use and social-, physical- and emotional well-being (N = 38). Besides, persons released less than 1 year ago and who used illicit drugs (N = 12) were interviewed. Drug use and symptoms of anxiety, depression, sleep problems, loneliness, suicidal attempts and violence are 2 to 8 times higher in prison compared to community. Drug use inside prison was more prevalent (p &lt; 0.05) among people with a prison history. Respondents also mentioned the negative influence of drug use on physical, social and emotional health. Severe depression symptoms and the occurrence of suicide attempts were more reported among people who used drugs in prison in the past month. Although most respondents indicated having received visits during the past month, lack of social contacts and dependence on others were strongly present during the interviews. The results suggest that the prison context affects the interconnection of biopsychosocial health aspects as a whole to such an extent that the likelihood of drug use increases. This finding is essential to address the needs of people in prison in a more holistic way. Enlarging this scope in prison policy and more specific treatment initiatives enables increasing equity in care and will improve both security and health outcomes.

Key messages
• The results support an expansion of treatment initiatives that have been already implemented but in which the interconnection of the biopsychosocial health aspects with drug-use should be integrated.
• This study supports the idea to develop a more holistic prison policy by adding drug use, physical, social and mental health to the main concern of security.
Association of HDL subfraction profile with the progression of insulin resistance
Authors: Pikó P , Kósa Z , Sándor J , Kovács N , Seres I , Paragh G , Ádány R 
Published: October 2023

Abstract

Background
Type 2 diabetes mellitus (T2D) is a major global public health problem, as it is associated with increased morbidity, mortality, and healthcare costs. Insulin resistance (IR) is considered to be a condition characterized by disturbances in carbohydrate and lipid metabolisms that precede T2D. The correlation between IR and high-density lipoprotein cholesterol (HDL-C) levels is known, but the underlying mechanisms are not fully understood. The present study aimed to investigate the association between HDL subfraction profile and the development of IR.

Methods
The progression of IR was assessed using the Homeostatic Model Assessment for IR index (HOMA-IR), and IR was defined as those with a HOMA-IR greater than 3.63. The HDL-C was separated using the Lipoprint system, which identifies ten subfractions (HDL-1-10) and three classes: large- (HDL-L), intermediate- (HDL-I), and small-HDL (HDL-S). All analyses were performed on samples of 240 control subjects and 137 individuals with IR from the Hungarian general and Roma populations.

Results
The HDL-1 to -6 and the HDL-L and -I showed a significant negative association with elevated HOMA-IR and the presence of IR. Among them, HDL-2 (β = 42.2, p = 4.1 × 10-12) and HDL-L (β = 15.5, p = 2.2 × 10-10) showed the strongest correlation with the IR progression. The optimal cut-off value was found to be 0.264 mmol/L for HDL-L and 0.102 mmol/L and above for HDL-2. The risk of IR is 5.1 times higher for HDL-L levels below the cut-off (p = 2.2 × 10-7), and 4.2 times higher for HDL-2 (p = 3.0 × 10-6). Furthermore, the risk of early manifestation of IR are significantly higher in individuals with both HDL-L (HR = 3.5, p = 3.2 × 10-7) and HDL-2 (HR = 3.19, p = 2.0 × 10-6) levels below the cut-off.

Key messages
• HDL-2 and -L levels are strongly associated with the development of insulin resistance.
• Elevated risk of early onset of insulin resistance is associated with HDL subfraction profile.
Exercise as medicine: Physicians’ perceptions of physical activity and exercise for chronic diseases
Authors: Syrou N , Fatouros I G , Metsios G , Jamurtas A Z , Draganidis D , Angelopoulos , TJ , Loules G , Mastorakos G 
Published: October 2023

Abstract

Background
Although physical activity and exercise (PAE) offer several health advantages in the management of non-communicable diseases (NCDs), its systematic implementation in medical practice remains questionable. The aim of the study was to investigate Greek physicians’ knowledge, attitudes, intentions, abilities, and behavior (KAIAB) towards PAE in the management of NCDs.

Methods
A nationwide, cross-sectional, online study was conducted (October 2022 - March 2023) in Greece via a new questionnaire, which was developed and pilot-tested at an earlier stage of the study. The questionnaire's link was distributed to participants by email through their Medical Association. We computed physicians’ KAIAB total scale score as the sum of their responses. The three levels of Bloom's cut-off points were modified and were used to classify physicians’ KAIAB levels towards PAE.

Results
The physicians’ KAIAB levels in PAE were expressed as mean values (MV) and standard deviations (SD) respectively (MV/SD), as follows: 11.5/3.32 (low knowledge), 134.8/17.20 (moderate attitudes), 33.8/5.63 (high intentions), 19.48/5.76 (low abilities), and 30.81/7.23 (moderate behavior). Cronbach's alpha varied from 0.796 to 0.930 to achieve a high internal consistency to the scales of the new questionnaire.

Conclusions
Greek physicians definitely are willing to advise and prescribe PAE and demonstrate moderate attitudes and behavior on these issues that need further improvement. However, their knowledge and self-reported abilities are apparently low, particularly on PAE prescription. These results suggest that, in order to include PAE in medical practice, are needed future policies to develop strategies to promote physicians’ education and training to improve their knowledge and skills on PAE, the adoption of exercise prescription strategies, and the integration of PAE into health care services as an alternative way of preventing and treating chronic diseases and promoting public health.

Key messages
• The Greek physicians’ level of Knowledge and abilities in physical activity and exercise is low rendering their implementation in medical practice difficult for patients with non-communicable diseases.
• Empowerment of physicians is crucial in order to integrate physical activity and exercise prescription into the standard medical care of non-communicable diseases and thus promote public health.
Strengthening One Health through Health Management: Lessons and Opportunities
Authors: Rusanov A , Weller E , Jevtic M 
Published: October 2023

Abstract

Background
The One Health approach recognises the interconnection between human, animal, and environmental health, and emphasises collaboration and integration across these domains. While the “One Health” approach is increasingly being implemented in the health sector, the role of health management is still overlooked.

Objectives/Methods
Health management plays a critical role in facilitating the adoption and implementation of the One Health approach. In fact, health management provides the framework for planning, implementing, and evaluating One Health interventions, including the identification of priorities, resources allocation, and monitoring and evaluation of outcomes. Health managers also play a critical role in developing cross-sectoral partnerships. Through a literature review and focus group discussions with experts from the health, animal, and environmental sector, case studies and best practices were collected on the role and opportunities for health management to further strengthen the One Health approach.

Results
Results suggest that greater emphasis should be placed on incorporating the One Health approach into health management education curricula, building capacity for health management through life-long learning, strengthening interdisciplinary collaborations, and establishing effective communication channels to exchange best practices.

Lessons
Recognising the role of health management and fostering multi-stakeholder collaboration will create the proper conditions for the successful implementation of the One Health approach and will help create long-term, sustainable solutions.

Key message
• Health management plays a critical role in facilitating the adoption and implementation of the One Health approach and developing cross-sectoral partnerships.
• The role of health management can be strengthened through life-long learning, interdisciplinary collaboration and integrating the One Health approach into education curricula.
Complications associated with Type 2 Diabetes and concerns about treatment: a quantitative approach
Authors: Pedro A R , Avelar F G , Raposo B , Cunha A S , Cordeiro J V , Martinho H , Couceiro J , Pardal M , Bernardo F , Raposo J F 
Published: October 2023

Abstract

Background
Type 2 Diabetes (T2D) is a multidimensional disease with a major impact on quality of life and its associated complications influence these people disease management. This study aimed to analyse the main concerns about T2D treatment management in adults with and without reported T2D complications.

Methods
Cross-sectional study conducted through an online survey addressed to people with T2D followed-up in Portugal. Concerns regarding “T2D treatment” were compared between people with (n = 231) and without (n = 203) reported complications associated with T2D. The mean + SD concern was calculated from semantic differential scale ranging from 0 (not at all concerned) to 3 (very concerned). Statistical analysis and the Mann-Whitney U test were performed at 5% significance level.

Results
A total of 434 responses were analyzed. Respondents had a mean age of 62 years, and 53.2% (n = 231) have mixed complications associated T2D. Regarding the reported complications, 50.2%(n = 116) had more than 2 mixed complications, being the most common: sexual disfunction (n = 127;55.0%), eye (n = 98;42.2%), and vascular complications (n = 63;27.3%). Regarding the concerns about treatment, the items ‘side effects of medications'(p = 0.004), ‘the fact that some medications are injectable'(p = 0.029), and ‘start of insulin'(p = 0.018) showed divergence. Particularly, T2D-related complications ‘side effects'(2.02±0.76 vs. 1.75±0.91-no complications) and ‘being injectable'(1.30±1.05 vs. 1.08±1.08-no complications) showed a higher mean, as ‘like insulin initiation’ (2.27±0.99 vs. 2.01±1.08-with complications).

Conclusions
Concerns related to the treatment itself are higher in people with complications, particularly in the therapeutic management of multiple medications and associated side effects. The management of disease with complications is more difficult and problematic. Demystifying insulin initiation can be a challenge to be added to the healthcare process and an important intervention strategy.

Key messages
• Concerns related to the treatment itself are higher in people with complications, particularly in the therapeutic management of multiple medications and associated side effects.
• Demystifying insulin initiation can be a challenge to be added to the healthcare process and an important intervention strategy.
Exploring the Burden of Colorectal Cancer in Georgia: A Population-based Cancer Registry Analysis
Authors: Nonikashvili M , Kereselidze M , Beruchashvili T , Toidze O 
Published: October 2023

Abstract

Background
Colorectal cancer (CRC) is a significant public health issue in Georgia, with high incidence and mortality rates. CRC screening rates in Georgia have improved over time, but are still low. This study aims to assess the distribution of CRC in the Georgian population through an analysis of the national cancer registry.

Methods
Data from the national cancer registry was analyzed for 795 adults diagnosed with CRC in 2021. Univariate and bivariate descriptive statistical analysis were performed using contingency tables and the Pearson chi-square test.

Results
Among the study sample, 50.57% (n = 402) of CRC cases occurred in males and 49.43% (n = 393) in females. Only 5.40% of CRC cases were detected through screening uptake. Malignant neoplasm of the rectum was the most commonly detected subsite, with localized stage being the most common stage at diagnosis. CRC subsite was significantly associated with TNM stage (X2= 31.24; p &lt; 0.008). The mean age of patients was 65.89±11.27 years.

Conclusions
The study highlights the need for increased CRC screening efforts in Georgia to facilitate the transition from curative to preventive cancer care. Improved screening rates could aid in the early detection and prevention of CRC.

Key messages
• Malignant neoplasm of the rectum was the most commonly detected subsite, with localized stage being the most common stage at diagnosis.
• Improved screening efforts could aid in the early detection and prevention of CRC, facilitating the transition from curative to preventive cancer care.