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© The Author(s). 2021 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data., Background: The COVID-19 pandemic has affected people's engagement in health behaviors, especially those that protect individuals from SARS-CoV-2 transmission, such as handwashing/sanitizing. This study investigated whether adherence to the World Health Organization's (WHO) handwashing guidelines (the outcome variable) was associated with the trajectory of the COVID-19 pandemic, as measured by the following 6 indicators: (i) the number of new cases of COVID-19 morbidity/mortality (a country-level mean calculated for the 14 days prior to data collection), (ii) total cases of COVID-19 morbidity/mortality accumulated since the onset of the pandemic, and (iii) changes in recent cases of COVID-19 morbidity/mortality (a difference between country-level COVID-19 morbidity/mortality in the previous 14 days compared to cases recorded 14-28 days earlier). Methods: The observational study (#NCT04367337) enrolled 6064 adults residing in Australia, Canada, China, France, Gambia, Germany, Israel, Italy, Malaysia, Poland, Portugal, Romania, Singapore, and Switzerland. Data on handwashing adherence across 8 situations (indicated in the WHO guidelines) were collected via an online survey (March-July 2020). Individual-level handwashing data were matched with the date- and country-specific values of the 6 indices of the trajectory of COVID-19 pandemic, obtained from the WHO daily reports. Results: Multilevel regression models indicated a negative association between both accumulation of the total cases of COVID-19 morbidity (B = -.041, SE = .013, p = .013) and mortality (B = -.036, SE = .014 p = .002) and handwashing. Higher levels of total COVID-related morbidity and mortality were related to lower handwashing adherence. However, increases in recent cases of COVID-19 morbidity (B = .014, SE = .007, p = .035) and mortality (B = .022, SE = .009, p = .015) were associated with higher levels of handwashing adherence. Analyses controlled for participants' COVID-19-related situation (their exposure to information about handwashing, being a healthcare professional), sociodemographic characteristics (gender, age, marital status), and country-level variables (strictness of containment and health policies, human development index). The models explained 14-20% of the variance in handwashing adherence. Conclusions: To better explain levels of protective behaviors such as handwashing, future research should account for indicators of the trajectory of the COVID-19 pandemic., The study was supported by grant number 2020/01/0/HS6/00059 from the National Science Centre, Poland.

Aims This paper explores the number and characterization of latent classes of adverse childhood experiences across the Evidence for Better Lives Study cohort and investigates how the various typologies link to prenatal substance use (i.e., smoking, alcohol, and illicit drugs) and poor infant outcomes (i.e., infant prematurity and low birth weight). Participants and setting A total of 1,189 mother-infant dyads residing in eight diverse low- and middle-income countries (LMICs) were recruited. Methods Latent class analysis using the Bolck, Croon, and Hagenaars (BCH) 3-step method with auxiliary multilevel logistic regressions with distal outcomes were performed. Results The LCA identified three high-risk classes and one low-risk class, namely: (1) highly maltreated (7%, n = 89), (2) emotionally and physically abused with intra-familial violence exposure (13%, n = 152), (3), emotionally abused (40%, n = 474), and (4) low household dysfunction and abuse (40%, n = 474). Overall, across all latent classes, there were low probabilities of prenatal substance use and poor infant outcomes. However, pairwise comparisons between classes indicate that class 1 and 3 had higher probabilities of prenatal illicit drug use compared to class 4. Additionally, class 2 had higher probability of low birth weight compared to the three remaining classes. Conclusion The results further our understanding of the dynamic and multifaceted nature of ACEs. More research grounded on LMICs is warranted with more attention to various parameters of risk exposure (i.e., severity, duration, chronicity).

BACKGROUND: Because there is high variability among European countries in prevalence levels of various alcohol consumption measures, the informational value of adolescent's alcohol consumption indicators is uncertain. The present study aimed to examine information capacity and measurement invariance of different alcohol consumption indicators in adolescents from countries of the former Soviet (Eastern) Bloc in Central and Eastern Europe (CEE). METHODS: Data were collected in 16 CEE countries, as part of the 2013/2014 wave of the Health Behavior in School-aged Children study. Data from adolescents (age 15) who reported having consumed alcohol at least once in their lifetime were analyzed. Four binary items selected for analysis measured the presence or absence of alcohol consumption in the last 30 days, lifetime drunkenness, weekly drinking frequency, and binge drinking on a typical occasion. Multiple group confirmatory factor analysis and item response theory analysis were used to examine the data. RESULTS: In most of the included countries, alcohol consumption in the last 30 days and lifetime drunkenness were indicative at lower severity levels, while binge drinking and weekly drinking frequency were informative at higher levels of alcohol use severity. A low proportion of the estimated intercepts and factor loadings were noninvariant, which indicated approximate cross-national invariance of these indicators. CONCLUSIONS: Adolescent alcohol consumption indicators are informative for different severity levels and enable cross-nationally invariant measurement. However, different indicators suggested the presence of diverging drinking cultures in the CEE regions, with the highest discrimination capacity at the lower and higher ends of the continuum of alcohol use severity.

Funder: Consuelo Zobel Alger Foundation, Inc., Funder: British Academy; FundRef: http://dx.doi.org/10.13039/501100000286, Funder: Cambridge Humanities Research Grants Scheme, Funder: University of Cambridge GCRF Quality Research, Funder: Jacobs Foundation; FundRef: http://dx.doi.org/10.13039/501100003986, Funder: Wolfson discretionary research, Introduction: Violence against children is a health, human rights and social problem affecting approximately half of the world’s children. Its effects begin at prenatal stages with long-lasting impacts on later health and well-being. The Evidence for Better Lives Study (EBLS) aims to produce high-quality longitudinal data from cities in eight low- and middle-income countries—Ghana, Jamaica, Pakistan, the Philippines, Romania, South Africa, Sri Lanka and Vietnam—to support effective intervention to reduce violence against children. EBLS-Foundational Research (EBLS-FR) tests critical aspects of the planned EBLS, including participant recruitment and retention, data collection and analysis. Alongside epidemiological estimates of levels and predictors of exposure to violence and adversity during pregnancy, we plan to explore mechanisms that may link exposure to violence to mothers’ biological stress markers and subjective well-being. Methods and analyses: EBLS-FR is a short longitudinal study with a sample of 1200 pregnant women. Data are collected during the last trimester of pregnancy and 2 to 6 months after birth. The questionnaire for participating women has been translated into nine languages. Measures obtained from mothers will include, among others, mental and physical health, attitudes to corporal punishment, adverse childhood experiences, prenatal intimate partner violence, substance use and social/community support. Hair and dry blood spot samples are collected from the pregnant women to measure stress markers. To explore research participation among fathers, EBLS-FR is recruiting 300 fathers in the Philippines and Sri Lanka. Ethics and dissemination: The study received ethical approvals at all recruiting sites and universities in the project. Results will be disseminated through journal publications, conferences and seminar presentations involving local communities, health services and other stakeholders. Findings from this work will help to adjust the subsequent stages of the EBLS project.

The aim of this study was to explore the construction of breastfeeding in public, as depicted in the stories and the opinions of women participating in discussions on public forums. There were 8 discussion forums selected, from which 769 messages were subjected to a narrative analysis further informed by recurrent themes identified in the literature and across messages. The emerging narratives were grouped based on their valence, and three broader categories of themes were formed, highlighting the predominant tone towards breastfeeding in public. The three broader themes, ‘public restraint of breast(feeding) as acknowledgement of the cultural status-quo’, ‘permission within boundaries’ and ‘breast(feeding) as a human right’, depict various meanings and experiences associated with public breastfeeding. People seeing breasts as mainly a cultural symbol of sexuality were more against public breastfeeding and more in favour of covering up or striving to discretion. Those arguing that breastfeeding is no more than exercising a fundamental right and pleading for breast as a primary maternal symbol were more in favour of breastfeeding in public. Aiming to understand personal and social perspectives on public breastfeeding is informative for understanding cultural differences in breastfeeding rates but also for designing effective interventions to promote it.

Background:Child mental health problems continue to be a major global concern, especially in low- and middle-income countries (LMICs).Parenting interventions have been shown to be effective for reducing child behavior problems in high-income countries, with emerging evidence supporting similar effects in LMICs. However, there remain substantial barriers to scaling up evidence-based interventions due to limited human and financial resources in such countries. Methods:This protocol is for a multi-center cluster randomized factorial trial of an evidence-based parenting intervention, Parenting for Lifelong Health for Young Children, for families with children ages two to nine years with subclinical levels of behavior problems in three Southeastern European countries, Republic of Moldova, North Macedonia, and Romania (8 conditions, 48 clusters, 864 families,108 per condition). The trial will test three intervention components: length (5 vs. 10 sessions), engagement (basic vs. enhanced package), and fidelity (on-demand vs. structured supervision). Primary outcomes are child aggressive behavior, dysfunctional parenting, and positive parenting. Analyses will examine the main effect and cost-effectiveness of each component, as well as potential interaction effects between components, in order to identify the most optimal combination of program components. Discussion:This study is the first factorial experiment of a parenting program in LMICs. Findings will inform the subsequent testing of the optimized program in a multisite randomized controlled trial in 2021. Trial registration:NCT03865485registered in ClinicalTrials.gov on March 5, 2019.

This study's aim was to examine the joint influence of self-reported weight and body weight dissatisfaction on weight control strategies and physical and psychological complaints. A number of 5404 Romanian adolescents, aged between 13 and 15 years (50.6% girls) participated in a larger study assessing health risk behaviors and attitudes in youth. Participants were asked to fill in their weight and height (in order to calculate the BMI). Questions regarding body weight dissatisfaction, unhealthy weight control and physical and psychological health complaints were also addressed. We used logistic regressions to test the associations between BMI, body weight dissatisfaction, unhealthy weight control behaviors, and health complaints. The proportion of adolescents who reported being too fat was 21% with 10% of normal weight boys and 20% of normal weight girls adolescents being dissatisfied with their body weight. The most common health complaints reported by adolescents were headaches (23.3%), sleep problems (16.7%) and feeling low (32%). There were significant interactions between BMI and body weight dissatisfaction in predicting unhealthy weight control and physical and psychological symptoms. Non-overweight adolescents who perceived themselves as being too fat were more likely to engage in unhealthy weight control behaviors and more likely to report both physical and psychological symptoms compared to their overweight or those who considered themselves as being too thin. The present study suggests that the use of unhealthy weight control methods is not uncommon among adolescents who believe they are too fat but who have BMIs within the normal range. Interventions informed by research should aim to address boy weight concerns and to equip adolescents with skills in order to critically appraise body weight ideals., El objetivo de este estudio fue examinar la influencia común del índice de masa corporal (IMC) e insatisfacción con el peso corporal en las estrategias del control de peso y quejas físicas y psicológicas. Un total de 5404 adolescentes rumanos a la edad de entre 13 y 15 años (50.6% chicas) participaron en un estudio más grande que examinaba las conductas y actitudes de riesgo de salud en los jóvenes. Los participantes tenían que dar su peso y altura (para calcular el IMC). También respondieron a las preguntas sobre su insatisfacción con el peso corporal, control de peso insalubre y quejas sobre molestias de salud física y psicológica. Hemos usado la regresión logística para examinar la relación entre el IMC, la insatisfacción con el peso corporal, el control de peso insalubre y las molestias de salud. 21% de adolescentes autoevaluaron que padecen sobrepeso, con 10% de adolescentes de peso normal insatisfechos con su peso corporal. Las molestias de salud más frecuentes reportadas por los adolescentes fueron dolor de cabeza (23.3%), problemas con el sueño (16.7%) y mal humor (32%). Hubo una interacción significativa entre el IMC y la insatisfacción con el tamaño corporal para predecir el control de peso insalubre y síntomas físicos y psicológicos. Los adolescentes sin sobrepeso pero insatisfechos con su cuerpo mostraban más tendencias a las conductas de control de peso insalubre y reportaban tanto síntomas físicos como psicológicos en comparación con sus compañeros con el sobrepeso o aquellos más satisfechos con su cuerpo. El presente estudio sugiere que el uso de métodos del control de peso insalubre no es poco común entre los adolescentes con niveles altos de insatisfacción, y que tienen el IMC dentro de lo normal. Las intervenciones deberían tratar de abordar las preocupaciones sobre el peso corporal y proporcionar a los adolescentes habilidades para valorar críticamente ideales de peso corporal.

Introduction and hypothesis Urinary incontinence is a common condition in women, with a reported prevalence ranging from 25% to 51%. Of these women, an estimated 38% suffer from stress urinary incontinence (SUI). A European research consortium is investigating an innovative system based on information and communication technology for the conservative treatment of women with SUI. When introducing a new intervention, implementation barriers arise and need to be identified. Therefore, we investigated healthcare providers’ experience with and attitude towards innovative care options. Methods We performed an online survey to assess (1) the characteristics and practice of healthcare providers, (2) current protocols for SUI, (3) current use of biofeedback, and (4) knowledge about serious gaming. The survey was sent to members of professional societies in Europe (EUGA), UK (BSUG) and The Netherlands (DPFS). Results Of 341 questionnaires analyzed (response rate between 18% and 30%), 64% of the respondents had access to a protocol for the treatment of SUI, and 31% used biofeedback when treating patients with SUI. However, 92% considered that biofeedback has a clear or probable added value, and 97% of those who did not use biofeedback would change their practice if research evidence supported its use. Finally, 89% of respondents indicated that they had no experience of serious gaming, but 92% considered that it could be useful. Conclusions Although inexperienced, European urogynecologists and physical therapists welcome innovative treatment options for the conservative treatment of SUI such as portable wireless biofeedback and serious gaming. Scientific evidence is considered a prerequisite to incorporate such innovations into clinical practice., published version, peerReviewed