bluuebunny/crossref_metadata_2025_split huggingface dataset:
University students’ predictors of vaccine intention toward routine vaccination: a systematic review
Authors: Mussetto I , Bernucci M C , Isonne C , Kaminska A E , Iera J , Migliara G , Marzuillo C , Villari P , Baccolini V 
Published: October 2023

Abstract

Introduction
Vaccine hesitancy is a major challenge for national immunization programs, especially after the COVID-19 pandemic, which disrupted routine coverage for many vaccinations. Therefore, we systematically examined the determinants of vaccination intention among university students, an age group undergoing training, and for this reason particularly receptive to educational campaigns.

Methods
We searched PubMed, Scopus, and Web of Science. Studies were considered eligible if they analyzed vaccination intention(s) (i.e., sure/willing vs. unsure/unwilling) through multivariable logistic regression analyses in university students. All routine vaccines were considered. Study quality was assessed using the Newcastle-Ottawa scale. Determinants were grouped into three categories: contextual, individual and group, and vaccine/vaccination-specific influences. A narrative synthesis of the results was performed.

Results
A total of 14.940 articles were retrieved. Of these, 40 were included, 34 regarded the Human Papillomavirus (HPV) vaccine, and 6 on influenza (flu) vaccine. Out of the 282 factors found, 231 regarded the HPV vaccine. Among the contextual influences, age, gender, and sexual behavior were the most studied, whereas “HPV knowledge” (N = 44) and “awareness” (N = 16) were the most investigated among individual and group influences, showing also higher rates of statistical significance with the outcome. Lastly, among vaccine-specific influences, “healthcare professionals’ recommendation” was the most studied. As for the flu vaccine, 51 factors were found, with ‘Previous flu vaccination’ (N = 5) being the most investigated and always positively associated with vaccine intention.

Conclusions
Our study highlights that among university students HPV knowledge and awareness, and previous flu vaccination are the main predictors of HPV and flu vaccine intention, respectively. These results should be used in planning educational campaigns to increase vaccine uptake in this subgroup.

Key messages
• Vaccine Hesitancy (VH) is a major public health issue and a challenge for national immunization programs.
• Our study highlights that among university students HPV knowledge and awareness, and previous flu vaccination are the main predictors of HPV and flu vaccine intention, respectively.
Negotiating healthy food retail initiatives: An ethnographic study of a partnership with supermarkets
Authors: Duus K S , Tjørnhøj-Thomsen T , Krølner R F 
Published: October 2023

Abstract

Background
The health promotion literature advocates for partnerships with private actors, but scholars have called for detailed knowledge on the development of interventions in studies using such co-approaches. This study aims to increase our understanding of how such partnerships influence intervention development and content. In 2019, researchers at the National Institute of Public Health, Denmark, established a partnership with the food retailer Salling Group and the Danish Cancer Society, which will be the case used in this study. The vision of the partnership was to develop and test healthy food retail initiatives to make the healthy choice the easy choice for customers.

Methods
We performed a focused ethnographic study from the initiation of the partnership (2019) until the feasibility test of the initiatives (2021). We used participant observation of meetings and intervention development activities, interviews with partners, and document analysis of e-mail correspondences and project materials. We analysed data abductively with inspiration from a chronological narrative analytical approach and concepts of partnerships, negotiation, and institutional logics.

Findings
We identified six phases of the development process, characterized by randomness, compromises, fear, conflicting logics, and unforeseen events. We show how 1) a random meeting and initial verbal agreements between a few persons affect the mindset and decision-making of the partners, 2) conflicting logics can both hinder and facilitate the development of initiatives, and 3) the process is shaped by unforeseen events i.e., Covid-19 restrictions, and organisational changes.

Conclusions
This study highlights how fragile public-private partnerships are and the significance of each step taken. To succeed with effective health promotion in the retail setting partnerships may benefit from being flexible and investing time in forming a shared understanding based on discussions of different perspectives.

Key messages
• Partnerships between academics and non-academics are fragile and unpredictable.
• Negotiation of healthy food retail initiatives is facilitated and hindered by differences in institutional logics.
Is the education of the parents differently associated with their children health literacy?
Authors: Rosário R , Silva M J , Duarte A , Martins J , Martins S , Lopes C , Augusto C 
Published: October 2023

Abstract

Background
Parents with higher levels of education tend to have better abilities in searching and integrating health information, which can ultimately benefit their childreńs health literacy. We aim to analyse the associations between childreńs health literacy and parents’ education in families with school-age children.

Methods
A total of 735 children (51.7% boys) with a mean of age (SD) of 7.7 (1.2) years old, participated in this study. Childreńs health literacy was measured with the HLS-Child-Q15, which contained 15 items assessing the child's perceived ease or difficulty in finding, understanding, appraising, and applying health information (α = 0.7). A mean of all items was conducted along with a median split (limited and sufficient health literacy). Parents self-reported their education (e.g., primary school, secondary schools and higher education) and family income. Binary regression models were used, adjusting for age and income.

Results
Boys whose mothers had a higher education degree had lower odds of achieving sufficient health literacy (adjusted odds ratio (aOR)= 0.4, 95% confidence interval (CI)=0.1; 0.9). In contrast, boys whose fathers had a secondary or higher education degree had a significantly higher odds of achieving sufficient health literacy (aOR=2.3 (1.1; 4.7) and 2.9 (1.2; 6.9, respectively), irrespective of their age and income.

Conclusions
The indirect association between mothers’ education levels and their sons’ health literacy, and the direct association of fathers’ education levels on their sons’ health literacy, could be explained by previous research that has linked a motheŕs education level to the quality of everyday childcare and a fatheŕs education level to the access of higher social positions and resources, that ultimately can be invested in the child's health literacy. Future intervention studies should take into account the important role of fathers in improving childreńs health literacy, mainly in boys.

Key messages
• Parents with higher levels of education tend to have children with better health literacy.
• There are significant associations between parentśeducation and childreńs health literacy, mainly in boys.
Health literacy, quality of life and burden of informal caregivers in Portugal
Authors: Pedro A R , Avelar F G , Raposo B , Brandão D , Amaral O , Escoval A 
Published: October 2023

Abstract

Background
The process of informal caregiving may have significant impacts on physical, psychological, social and economic conditions of informal caregivers. Worldwide lower levels of health literacy are associated with worse informal care, reduced quality of life and higher burden of informal caregivers. The aim of this study is to assess the correlation between health literacy score (HL), quality of life (QoL) and informal caregiver burden in Portugal.

Methods
A cross-sectional study was conducted through an online survey directed to informal caregivers. Three validated scales were applied in Portuguese versions: a) European Health Literacy Survey (HLS-EU-PT-Q16); b) European Quality of Life Questionnaire (EQ-5D-5L), c) Modified Caregiver Strain Index (M-CSI). Overall statistical analysis and the Pearsońs correlation test at 5% significance level were performed in SPSS®.

Results
In total, 760 informal caregivers were surveyed, mean age 57 years (±9.9), 92.5% female, 62.6% married or living with a partner, 41,5% at least university level, 44.4% works full or part-time. Regarding the process of care, 78.9% takes care of one person, 85.2% have been caring for more than 1 year, 54.3% feel that are not supported at all, and 20.3% do not feel competent to care. The mean HL score of informal caregiver (n = 673) was 31.9 (+7.8), QoL (n = 733) was 0.8 (+0.2), and burden (n = 760) was 14.8 (+5.3). HL Score is directly correlated with QoL (r = 0.215; p &lt; 0.001) and inversely correlated with informal caregiver burden (r=-0.150; p &lt; 0.001).

Conclusions
A higher health literacy score is associated with better quality of life and lower informal caregiver burden. Improving health literacy may be strategic to promote health conditions and quality of life and care for both the informal caregiver and the person being cared for.

Key messages
• A higher health literacy score is associated with better quality of life and lower informal caregiver burden.
• It is crucial to invest on the definition of an integrated strategy, between Health and Social Security, to provide better health conditions to informal caregivers.
Italian translation and cultural adaptation of health literate organisation self-assessment tool
Authors: Paladini A , Ancona A , Unim B , Lombardo C , Cadeddu C , Cacciuttolo M G , Specchia M L , De Castro P , Palmieri L 
Published: October 2023

Abstract

Background
The International Working Group Health Promoting Hospitals and Health Literate Healthcare Organizations has developed an English-language self-assessment tool for Organizational Health Literacy of Hospitals, designed to quality managers of healthcare organizations. It aims to diagnose strengths and weaknesses of the organization's health literacy, and our goal is to translate and culturally adapt it for Italy.

Methods
We have been following the Translation, Review, Adjudication, Pretesting, and Documentation team model for cross-cultural translation of questionnaires. Initially, two separate teams of translators worked independently to translate the tool from English to Italian. Next, the national coordinator organised six meetings to discuss, integrate, and unify the two versions, and any translation difficulties and suggested solutions were reported in the supporting tool that will be sent along with final agreed version of the tool to the International Coordination Centre. Finally, two experts will review the translation for the cultural adaptation.

Results
Difficulties related to comprehension in translation can arise from ambiguity in word choice, the need for contextual precision, and a lack of cultural appropriateness. The translation of English words that have become part of Italian language (e.g. ‘feedback', ‘stakeholder', ‘management', ‘standard') was also hugely discussed between the teams. Finally, to categorize the information entered into the supporting tool, 50% pertains to adaptation to context, 30% to simplification or clarification, and 20% to non-applicable items.

Conclusions
Cultural adaptation will improve the translation by reducing ambiguities, providing contextual clarifications, and rephrasing items to make them more appropriate for Italy. The Italian version of the tool will be piloted in local hospitals to support healthcare operators, patients, and the community in better managing the complexities of healthcare organizations.

Key messages
• Translation of health literacy self-assessment tool for Italian hospitals, aiming to reduce ambiguity and increase appropriateness for local context.
• Culturally adapted tool to diagnose organizational health literacy in Italian hospitals will help healthcare organizations deal with complexity of healthcare and improve patient outcomes.
Addiction prevention & mental health support in Hungarian elementary schools: a mixed-methods study
Authors: Árva D , Vokó Z , Sápi M , Cselkó Z , Rákosy Z 
Published: October 2023

Abstract

Substance and behavioural addictions are growing problems of children and adolescents, and prevention requires reducing risk factors and strengthening protective factors, such as mental health support (MHS). The current Hungarian policy emphasises the role of schools in addiction prevention (AP), but few data exist on school-level implementation. This was a mixed-methods study supported by the Scientific Foundations of Education Research Program of the Hungarian Academy of Sciences, investigating the implementation of AP and MHS in Hungarian elementary schools (N = 2892) with a nationwide cross-sectional survey-based study and by focus groups on teachers’ views about such programmes and ways to improve them (37 teachers from 21 schools). Schools covered the topics of tobacco (74%), drugs (71%), alcohol (62%), and electronic devices (61%) most commonly. Of schools, 55% had regular MHS programmes, and this differed significantly by school type and size. More addiction-, and mental health-related topics were covered with greater diversity of implementers (p &lt; 0.001). A school environment conducive of MHS was more prevalent with higher frequency of community building within the teaching staff (p &lt; 0.001). Logistic regression revealed that school type, support for teachers’ work, and diversity of implementers were significantly associated with the quality of implementation of AP and MHS. Six themes emerged from the focus groups: development of addictions and mental health, health education, role of teachers in addiction prevention, cooperation, factors hindering addiction prevention at schools, and factors supporting it. Teachers claimed that they can do the most for children's health at school, but they need support for effective implementation. Our results indicate the importance of school characteristics in AP implementation and call for the support and empowerment of teachers and greater organisational capacity to ensure the effectiveness of school-based AP and MHS.

Key messages
• Multistakeholder engagement approaches are necessary to address a wider, more diverse range of addiction-related topics in the school curricula.
• The training and mental health support of teachers and their collectives are important intervention points that should be invested in to increase the effectiveness of addiction prevention.
Value and roles of qualitative methods in natural experimental evaluations
Authors: Green J 
Published: October 2023

Abstract

Background
For natural experimental evaluations that estimate effect sizes of population health interventions, qualitative evidence contributes multiple benefits. Incorporating qualitative methods strengthens natural experimental evaluations, particularly when studying interventions in complex systems, and contributes to minimising evaluation design weaknesses.

Methods
Guidance was developed from three international workshops and an online consultation with researchers, journal editors and end users of natural experimental evaluations. The project team comprised researchers with expertise in natural experimental evaluations. The project included an oversight group and an advisory group of independent experts, including researchers, a journal editor, and scientific and public health advisors on central and local government.

Results
The guidance recommends that most evaluations of natural experiments will require the inclusion of qualitative evidence. Qualitative methods are valuable when describing the natural experiment intervention, the system and context it exists within, and theories of change. Qualitative work can help appropriately define exposed and unexposed groups, investigate causal mechanisms, facilitate meaningful selection of outcomes, and understand stakeholder perspectives on the intervention and its effects.

Conclusions
Gaining an understanding of the value and application of qualitative evidence will help producers and users of natural experimental evaluations conduct and identify robust evaluations. To fully benefit the evaluation, qualitative methods should be integrated throughout.
Schools: First Promoters of a Good Visual Health
Authors: El Harrak Y 
Published: October 2023

Abstract

Vision plays an important role in the physical, cognitive and social development of children. Uncorrected vision problems can harm a child's development and interfere with learning. Visual functioning is a strong predictor of academic performance in school-aged children. Early detection and treatment are essential. The objective of our work is to establish the prevalence of visual disorders in children and to investigate the motivations for a consultation. This is a descriptive study carried out at the Vision Clinic of Tetouan-Morocco, including all pediatric patients (&lt;16 years old) who presented to the consultation of the same doctor, between July 2022 and December 2022. All patients underwent a complete ophthalmological examination with measurement of refraction after cycloplegia. The study involved 450 children, including 254 girls and 196 boys. The average age was 9 years old. One of two children was consulting for the first time in ophthalmology. The average age at the first consultation is 8.5 years. The ophthalmological examination was requested by the school in 46% of the cases. In 34%, it is requested following observations made by the parents. In 10%, it is the child who reports the visual disturbance (these children were all over 8 years old). In 3% of cases, the ophthalmological examination is requested by the attending physician. 93% of these children required optical correction after measurement of refraction under cycloplegia and 45% had amblyopia of variable importance. One out of three amblyopic children was over 10 years old when the visual impairment was diagnosed. This work highlights the essential role of schools in the detection of visual impairment in children. Routine vision screening and eye exams are critical to detect vision problems before a child's development is compromised. Schools and teachers are the first and essential actors in a solid public health approach to children's vision and eye health.

Key messages
• Systematic screening for ametropia in children of school age & Awareness of parents for the recognition of visual disorders.
• A child who does not complain is not necessarily in good visual health.
FGM experience and training needs of Italian Gyn&Obs medical staff: results from a pilot study
Authors: Sisti L G , Pacillo C , Farina A , Marino C , Ricciardi M L , Giovannini C , Moscato U , Malorni W 
Published: October 2023

Abstract

Background
Female genital mutilation (FGM) includes removal or other injuries of the external female genitalia for non-medical reasons. The practice roots in cultural customs and is reported in over 90 countries. It is performed in the child and adolescent age and can cause physical and psychological consequences. In Italy, 60-80,000 are estimated to be affected and despite guidelines on FGM care in place since 2007, Gyn&Obs’ perspective has not yet been adequately analysed.

Methods
Based on literature review and focus groups, a questionnaire targeting Gyn&Obs’ FGM clinical experience (e.g. patients’ features; FGM complications; barriers in relating with patients; defibulation requests, etc.) and training needs was conceived followed by content and clarity validation by experts and a pre-test assessing its reliability. A web survey using the tool was launched in 2022 via Gyn&Obs’ associations.

Results
129 Gyn&Obs participated in the survey. 86.8% stated to have visited FGM patients, in particular from Sub- Saharan Africa and aged 18-34 yo. Type II and I (58.9 and 52.7%) are the most frequently observed and urinary issues and dyspareunia are the symptoms most commonly reported. 57.3% had difficulty relating to patients mainly for cultural and linguistic issues, and 56.6% had perceived patients’ difficulties in relating also for fear to be judged. 27.1% received defibulation requests and 25.7% found the referral challenging for lack or unknowing devoted facilities or professionals. 67.4% consider Gyn&Obs’ training inadequate and 79.8% that residency is the optimal time to deliver it.

Conclusions
Results highlighted Gyn&Obs’ difficulties in relating to FGM patients and in providing adequate referral. Moreover, FGM training is strongly perceived as inadequate. The survey offered hints to inform a large-scale study among Italian Gyn&Obs and other health professionals aiming to detect gaps and improve FGM patients’ care through training and health services strengthening.

Key messages
• Italian Gyn&Obs’ training on FGM seems to be inadequate.
• Language and cultural barriers are perceived as the main barriers to interacting with FGM patients.
Loneliness among the elderly in Baltic nations during the beginning of the Covid-19 pandemic
Authors: Pasupathy R , Sazevari R , Queen C 
Published: October 2023

Abstract

Background
The population in the Baltic states of Estonia, Latvia, and Lithuania is ageing rapidly. Loneliness is one of the most disruptive transformations facing older adults. Loneliness implies a lack of meaningful social relations or absence of human contact, and adversely impacts the health and quality of life of older adults. Loneliness is associated with an increased risk of premature death, dementia, heart disease, depression anxiety and suicide. This study is based on the Cacioppo Evolutionary Theory of Loneliness (ETL), that posits, that an individual's perception of loneliness triggers nonconscious evolutionary behavior that may have long term deleterious consequences. There is evidence of the heritability of loneliness as a population parameter.

Research Objectives
To determine the nature of loneliness experienced by older adults in Baltic states, specifically is loneliness among older adults the same across countries, genders, age and employment status.

Study Design
Data from Wave 9, COVID-19 Survey 2 (Summer 2021) of the of the cross-national panel dataset of the Survey of Health, Ageing and Retirement in Europe (SHARE) were examined using a sample of 6303 adults over 50 years old from Latvia, Lithuania and Estonia. Analysis: Nonparametric one-way ANOVA (Kruskal-Wallis test) was performed to test the null hypothesis that the rate of loneliness is equal across gender, age, and country in Baltic states.

Principal Findings
There was a statistically significant difference in the loneliness reported by country. The indicate that country is a significant factor [χ2= 77.14, df = 2; p&lt; .001], and the rate of loneliness varies significantly by gender [χ2= 93.94, df = 1; p&lt; .001, and age [χ2= 187.80, df = 6; p&lt; .001].

Conclusions
These finding suggest that age and gender are significant predictors of loneliness. Implications for Policy and Practice: Care of older adults should aim at alleviating loneliness difficulties faced by this population.

Key messages
• Age and gender was a significant predictor of loneliness among the elderly in Baltic states at the beginning of the Covid-19 pandemic.
• Policy initiatives that aim to alleviate loneliness among older adults should address age and gender factors.