bluuebunny/crossref_metadata_2025_split huggingface dataset:
Implementing a school-based comprehensive sexual health education intervention in Italy: experiences from the field
Authors: Martinelli D , Galipò R , Meli P , Farinella M , Chinelli A , Palamara AT , Suligoi B , Oldrini M , Colaprico L , Tavoschi L 
Published: October 2022

Abstract

Introduction
This study describes the preliminary results of a School-based sexuality education (SBSE) pilot activity developed and implemented within EduForIST project, funded by the Italian Ministry of Health.

Methods
The pilot activity (5 modules of 2 hours each delivered per classroom) targeted lower secondary schools students. A total of 20 schools located in 4 different Italian regions participated. The educators were staff of several HIV/AIDS civil society organisations operating in Italy. A 2-days intensive workshop for educators was performed. Pre and post tests were conducted.

Results
At the time of submission, pre-test results were available from 14 classrooms of 5 schools within 2 Italian Regions, for a total of 266 students. Among these, 37,4% were unsure that personal identity is built through social comparison; 21,8% reported that emotions don't get more intense during adolescence, while 18,1% were unsure about the response; 42,1% reported a higher level of uncertainty concerning the definitions of gender identity, sexual orientation and stereotype. The highest level of uncertainty were reported for STIs symptoms (58,7%), impact of treatment on HIV+ people (61,9%) and efficacy of contraceptive pills in preventing STIs (43,4%). The post-test results were available for 153 students. Pre/post analysis showed an increase of correct answers (p &lt; 0.05) for 12 of 15 items investigated. A total of 102 students responded to the satisfaction questionnaire, with preliminary positive results.

Conclusions
Since activities are ongoing, further data will be soon available for more exhaustive analyses. Early pre/post evaluations suggested that the pilot experience was effective in enhancing knowledge and decreasing uncertainty in the different domains addressed in the pilot. Evidence collected through this study shall raise awareness among decision makers on the urgency of introducing CSE in Italian school curricula and inform future policy options.
How to evaluate a sexual health education intervention: experience from an Italian pilot project
Authors: Ubbiali M , Mortari L 
Published: October 2022

Abstract

Introduction
Evaluation is an essential dimension of every educational activity, however it is a very crucial and problematic aspect to be considered. It is necessary to focus on some fundamental concepts: the idea of ‘measurement’, the definition of expected goals for the educational activity, whether they are measurable, and if not, how they can be evaluated. Finally, effectiveness may be assessed only after longer periods of time and by adopting coherent instruments. Outcomes of educational activities on sensitive themes such as sexuality education, are challenging to evaluate through causal relationships. So a fundamental question is: what is really possible to evaluate in the field of sexuality education (SE)?

Methods
A desk review was carried out to collect information about national policies, international literature and guidelines on SE evaluation. A literature review was performed to collect and collate reported field experience and evaluation data.

Results and discussion
In literature it is possible to find a consistent number of studies aimed at evaluating SE programs (in particular inspired by the models ‘abstinence-only’ and ‘abstinence-plus'), whose goal is to understand their impact on adolescents sexual health. Most of the studies reported limited evidences on SE efficacy on sexual health-related outcomes. This may be attributed to two different causes: methodological - evaluation instruments are epistemologically difficult to develop; and theoretical - the underlying philosophical frameworks they refer to may not fully reflect the complexity of sexuality education for adolescents.

Conclusions
Based on the findings, evaluation instruments were developed to collect experiences from educators performing school-based sexuality education within the context of EduforIST project funded by the Italian Ministry of Health. Analysis of the collected data were still ongoing at the time of submission.
A capital-based approach to understand health inequalities: empirical explorations
Authors: Qi Y , Vrooman JC , Almansa J , Ots P , Brouwer S , Reijneveld SA 
Published: October 2022

Abstract

Background
The persistence of health inequalities may not be merely driven by education and income, but also by other economic and non-economic factors. In this study we investigated how the association between single-dimensional health and socioeconomic status (SES) changes when including health-related person capital, economic capital, social capital, cultural capital and non-health related person capital.

Methods
The present study proposes a capital-based approach to understand health inequalities. It presumes intertwined relationships between a wide notion of health (‘health-related person capital’) and embodied resources (‘non-health related person capital’) on the one hand, and non-person capital, i.e. economic, social, and cultural resources on the other. We used cross-sectional data on 152,592 participants from the Dutch Lifelines cohort study. Correlations between capital constructs were estimated using partial least squares structural equation modelling.

Results
The correlation between health-related person capital and SES (r = 0.15) was higher than the correlations between single-dimensional health (physical and mental health) and SES (r = 0.12, r = 0.04, respectively). Non-person capital, combining economic, social and cultural capital, showed a correlation of 0.34 with health-related person capital. This was higher than the correlation between health-related person capital and economic capital alone (r = 0.19). Lastly, the correlation between health-related person capital and non-person capital increased when non-health (personality and attractiveness) and health related person capital were combined into person capital construct (from r = 0.34 to r = 0.49).

Conclusions
This exploratory observational study shows the empirical interconnectedness of various types of resources. Our findings corroborate the idea of considering health as a multidimensional concept, and to extend conventional SES indicators to a broader measurement of economic and non-economic resources.

Key messages
Assessment of needs-based usefulness of interventions to address system barriers to HPV vaccination
Authors: Schloemer T , Hecht H , Horstman K 
Published: October 2022

Abstract

Background
Adolescents of underserved communities face multiple health system barriers to access HPV vaccination. The Horizon 2020 project RIVER-EU will implement interventions to address these barriers in the migrant community in Greece, the Turkish and Moroccan communities in the Netherlands, the Ukrainian community in Poland and the Roma community in Slovakia. The objective of this study was to identify promising evidence-based interventions that potentially meet the specific contextual needs of the target groups, as a basis for assessing their transferability.

Methods
Based on the PIET-T models of transferability, we developed a methodology to assess the needs-based usefulness of an intervention for a target context. Criteria of intervention usefulness addressed specific aspects of the health issue, population, intervention content, outcomes, up-to-datedness, applicability, quality and usefulness of the evidence-base. Guided by methodological workshops, country members with their local advisory boards performed a rating of 32 interventions identified from a systematic literature search.

Results
Through independent assessment in each country, 5 of 32 interventions were selected as useful, with overlap: 2 interventions were selected by all countries, and 1 by 2 countries. In all countries, trained community members to support HPV vaccination were seen as promising. In Greece and the Netherlands, an educational programme in schools was included. Further, the Netherlands chose an intervention addressing providers’ HPV vaccine communication, and Slovakia a multilevel intervention.

Discussion
The feedback of the country members on the assessment emphasised the structured way to face complexity of understanding the potential usefulness of an intervention from the perspective of the target country. Critical discussions on the interventions enabled to specify needs for further clarification, for adaptations, and alternatives to consider for transferability analyses.

Key messages
The positive impact of a care–physical activity initiative for people with low socioeconomic status
Authors: Mulderij LS , Verkooijen KT , Groenewoud AS , Koelen MA , Wagemakers MAE 
Published: October 2022

Abstract

Background
Overweight and obesity rates are increasing worldwide, particularly among people with a low socioeconomic status (SES). Care-physical activity (care-PA) initiatives may lower overweight and obesity rates. A two-year care-PA initiative specifically developed for citizens with a low SES, X-Fittt 2.0, included 12 weeks of intensive guidance and sports sessions, and 21 months of aftercare. We answered the research question: what are the short- and long-term outcomes of participation in X-Fittt 2.0 in terms of health, quality of life and societal participation?

Methods
Questionnaires and body measurements were taken from 208 participants at the start of X-Fittt 2.0 (t0) and after 12 weeks (t1), 1 year (t2) and 2 years (t3). We also held 17 group discussions (t1, n = 71) and 68 semi-structured interviews (t2 and t3). Continuous variables were analysed using linear mixed-model analysis, while we used descriptive statistics for the categorical variables. Qualitative data were analysed using thematic analysis.

Results
Body weight was significantly lower at all three post-initiative time points compared with t0, with a maximum of 3.8 kg difference at t2 (p &lt; 0.05). BMI, waist circumference, blood pressure and self-perceived health only significantly improved during the first 12 weeks (p &lt; 0.05). A positive trend regarding paid work was observed, participants reported increased PA levels (including sports) and a few stopped smoking or drinking alcohol. Participants felt healthier and more energetic, reported improved self-esteem and stress levels, and had become more socially active. However, barriers to being physically active included a lack of money or time, or physical or mental health problems.

Conclusions
X-Fittt 2.0 improved the physical health, QoL and societal participation of the participants. Future initiatives should take into account the aforementioned barriers, and consider a longer intervention period for more sustainable results.

Key messages
European studies to evaluate COVID-19 vaccine effectiveness in HCWs: results from Italian hospitals
Authors: Agodi A , Rapisarda V , Bonfanti P , Rossi M , De Gaetano Donati K , Murri R , Barchitta M 
Published: October 2022

Abstract

Background
Evaluating COVID-19 vaccine coverage and risk factors is useful to develop public health strategies against COVID-19 pandemic. In the framework of two studies commissioned by the European Centre for Disease Prevention and Control (ECDC) and coordinated by Epiconcept, France, we reported findings about incidence and seroprevalence among healthcare workers (HCWs) enrolled from three Italian hospitals.

Methods
From July 2021 to date, the AOUP “G. Rodolico-San Marco” (Catania), the San Gerardo Hospital (Monza) and the Policlinico Gemelli (Rome) participated in the ECDC study to measure COVID-19 vaccine effectiveness. Catania and Rome also participated to the ECDC study of nosocomial transmission. HCWs were asked to complete a weekly questionnaire to report changes in health status and professional/personal exposures. At recruitment, a nasopharyngeal swab for RT-PCR and a blood sample for serology test were collected. Moreover, HCWs were followed-up with a weekly or bimonthly nasopharyngeal or saliva swabs. Blood samples were collected every one or two months.

Results
A total of 226 HCWs was enrolled from Catania, 330 from Rome and 132 from Monza in the COVID-19 vaccine effectiveness study. As of February 2022, PCR tests performed were 2270 in Catania, 5475 in Rome and 891 in Monza sites. Moreover, the serological tests performed were 845 in Catania, 760 in Rome and 395 in Monza sites. A total of 6 SARS-CoV-2 infections were identified in Catania, 34 in Rome and 4 in Monza sites. Interestingly, the study of nosocomial transmission reported the highest incidence rate in Catania (4 per 10,000 person-day), while 0.7 per 10,000 person-day in Rome. During the study period seroprevalence declined by 17% among HWCs enrolled in Catania.

Conclusions
Our findings revealed low number of COVID-19 infections, with high COVID-19 vaccine coverage among HCWs. However, further analyses are needed to provide more robust estimates of vaccine effectiveness.

Key messages
Gateways not gatekeepers – reaching seldom-heard groups to gather public health community insights
Authors: Lie M , Visram S , Cheetham M , Christie A , Hodgson P , Jasperse J , Logan M 
Published: October 2022

Abstract

Background
Each local authority in England must develop a Health and Wellbeing Strategy (HWS) in collaboration with NHS partners to plan and support delivery of local improvements in health and wellbeing. HWSs often draw on diverse sources but few are informed by consultative exercises involving citizens. South Tyneside Council in Northern England sought to ensure their new HWS was community-informed, specifically including seldom-heard groups and individuals. Specific objectives of this community insights research were to:
1.Target sampling and recruitment activities at typically marginalized, vulnerable or otherwise underrepresented groups
2.Explore the health and wellbeing-related views and priorities of these groups to address health inequalities

Methods
A mapping exercise was undertaken to identify organisations who might act as gatekeepers to accessing participants from underrepresented groups. Focus groups were held in settings-based venues where members would be comfortable and known to one another. Representatives of voluntary and community sector (VCS) organisations often helped to co-facilitate the discussions.

Results
119 participants took part in 16 group discussions. Three were held online, two were outdoors, while 11 involved community venues where the groups regularly met. We reached older and younger people, minority ethnic groups, and vulnerable men and women, including residents who had experienced homelessness, mental health issues, substance misuse, offending, domestic violence and learning disabilities. Participants were largely concerned with the wider determinants of health (such as poverty, employment, and leisure spaces), shifting the narrative away from individual lifestyle factors that tend to be the focus of much public health discourse.

Conclusions
Gatekeepers from the VCS were essentially gateways, enabling us to include underrepresented voices in local consultation processes and generate new insights to inform the South Tyneside HWS.

Key messages
Early adolescents’ sexual and reproductive health literacy in Lao PDR
Authors: Lee HK , Yang YS , Kim SK , Vongxay V , Lee YM 
Published: October 2022

Abstract

Background
Sexual and reproductive health literacy (SRHL) refers to the ability to access, understand, appraise, and apply information for decision-making related to sexual and reproductive health. The low level of SRHL in adolescents increases their sexually risky behaviors and endangers sexual health. Although early adolescence is a critical development period for forming initial views on sexuality and is often a time for attempting risky behaviors, studies on SRHL for early adolescents are fairly limited in Las PDR. As an initial step for the development of a global health project between Lao PDR and South Korea, this study assessed the level of SRHL and the differences in gender among early adolescents in Lao PDR.

Methods
Participants were 235 students conveniently recruited from one junior high school each in two provinces in Lao PDR. SRHL was measured using the 39-item Teen Pregnancy Health Literacy scale consisting of 4 subscales of finding, understanding, appraisal, and application. The scores were classified into inadequate, problematic, sufficient, and excellent using the SRHL index formula. The mean differences in gender were compared using t-test.

Results
The mean of the SRHL scores of the participants was 19.07 (±10.57). The mean score was significantly lower for girls, at 17.67 (±11.22) than for boys, at 21.37 (±9.05) (p = .006). Significant differences were further identified in all four sub-domains of SRHL: finding (p = .025), understanding (p = .005), appraisal (p = .041), and application (p = .029). The majority of participants (91.7%) were categorized as having an ‘inadequate’ or ‘problematic’ level of SRHL.

Conclusions
The level of SRHL among most early adolescents was found to be inadequate. The level of SRHL among girls was much lower than that among boys. The findings suggest a gender-specific approach to developing health education programs to improve SRHL among early adolescents and prevent future sexually risky behaviors in Lao PDR.

Key messages
Overview of national strategies for the prevention and management of non-communicable diseases
Authors: Reinsperger I , Gassner L , Zechmeister-Koss I 
Published: October 2022

Abstract

Background
Several countries have developed national strategies or policies for preventing and managing non-communicable diseases (NCDs) which are the leading cause of death worldwide. We aim to provide an overview of these strategies from selected countries and their implementation, focusing on chronic respiratory and cardiovascular diseases, diabetes and depression.

Methods
Using a comprehensive structured hand search, strategies from 8 countries (Germany, Switzerland, Netherlands, Finland, Ireland, United Kingdom, Canada, Australia) were identified and information on the main characteristics and implementation process of the strategies was extracted.

Results
A total of 18 strategies were included. Most of the strategies formulate rather broad overarching aims or visions (e.g., “stay healthy” or “living healthier lives”) as well as more specific targets that differ across strategies, e.g. focusing on improving quality of life and health literacy, reducing health inequalities or strengthening integrated care. The level of detail of information on implementation, monitoring and evaluation processes as well as financing is very heterogeneous. All strategies provide information on activities to achieve their aims, e.g. in the areas of health promotion/primary prevention, self-management, screening, integrated care, measures for specific risk groups or activities outside the health sector. Only a few strategies mention specific, already implemented (and evaluated) interventions, such as prevention or disease management programmes.

Conclusions
The included NCD strategies differ considerably in terms of level of detail, structure and implementation. We focused on interventions within the health sector and on adults as a target group. However, for the prevention and management of NCDs, it is important to start in early childhood and to adequately address the social determinants of health with a ‘Health in All Policies’ approach.

Key messages
A systematic review of multimorbidity patterns: social determinants and classification methods
Authors: Ramos-Fiol B , Ortega-Martin ME , Carretero-Bravo J , Suarez-Lledo V , Alvarez-Galvez J 
Published: October 2022

Abstract

Background
Governments and healthcare systems are facing multimorbidity (MM) as a major challenge due to the difficulties related to its proper identification and clinical management. Despite growing research on MM, its epidemiology is poorly understood due to the great complexity of underlying patterns of chronicity. The present review aims to identify the most frequent MM profiles and their social determinants.

Methods
A systematic review following the PRISMA statement was conducted. The search strategy was performed by combining three sets of keywords (MM, inequalities and patterns) that were searched in Pubmed, Scopus, Web of Science, OVID, CINAHL Complete, and PsycINFO. Primary studies analysing MM patterns and their relationship with social determinants were included. The quality of the studies was assessed using the Axis tool quality assessment.

Results
After the review process, 96 studies were selected from the 46,726 identified. The main methods used to identify MM patterns fell into five categories: latent class analysis (38.54%), cluster techniques (23.96%), factor analysis (19.79%), and machine learning (10.42%), and expert knowledge (7.29%). Latent class analysis was widely used, although in recent years the use of techniques based on machine learning has increased. The main patterns were cardiometabolic, cardiovascular, mental, musculoskeletal, complex MM, and respiratory diseases. Some MM profiles were more prevalent among lower-SES groups. In particular, patterns of mental multimorbidity were more prevalent among women and complex patterns were associated with low income.

Conclusions
Results show different disease combinations among disparate social determinants such as gender, age, education, and socio-economic status. Our results suggest that more and better designed studies are needed to improve clinical practice and health policies with the aim of enhancing the quality of patients with MM and their relationship to health system use and care.

Key messages
Dual task test: Screening procedure for early detection of cognitive impairment among healthy adults
Authors: Simi H , Guggenberger B , Holler P , Christova M , Pilz R , Staubmann W 
Published: October 2022

Abstract

Background
Early detection of cognitive impairment can slow progression to dementia when using appropriate therapy. For early detection of dementia dual task combining cognitive tasks and walking might be suitable, since individuals with cognitive impairment have shown greater changes in gait specific parameters on dual task test (DT) compared to single task test (ST). This study investigates whether these changes correlate with poorer cognitive function in healthy older adults.

Methods
In a cross-sectional study 174 healthy adults (66,48±4,26years; 40%female) completed the Cognitive Functions Dementia Test (CFD), with a lower CFD index indicating lower cognitive function. Participants performed ST (walking 20m) and DT (walking 20m & counting backwards), in which step frequency, stride length and gait speed were monitored by Pablo sensors. Cognitive cost (CC) was determined for each gait variable. CC represents a change score between SD & DT and quantifies cognitive demands, with higher CC indicating poorer cognitive function. Pearson correlations and stepwise linear regression adjusted for age and gender were applied to analyze the association between CFD Index (dependent variable) and CC gate variables (predictors) (α = 5%).

Results
Significant correlations were observed between CFD Index and CC step frequency (p=.014, r=-.187), CC stride length (p=.037, r=-.160) and CC gait speed (p=.002, r=-.232). Since gait variables were intercorrelated (multicollinearity), only gait speed was significant predictor for CFD Index (ß = -.243, p&lt;.001, R2 = .053) in a stepwise adjusted regression model.

Conclusions
Changes in gait speed might be sensitive enough to indicate differences of cognitive performance among older individuals. Therefore, DT could be included in screening procedures as alert for potential cognitive decline.

Key messages