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Abstract Background The period of early childhood bears significant importance from the lifespan perspective. Children from marginalized Roma communities face several risk factors that endanger their early development. Based on the gaps in available evidence, the aim of the RomaREACH research project (Research on Early Childhood in marginalized Roma communities) is, therefore, to explore the complex mechanisms influencing psychomotor development in the first 3 years of a child’s life in marginalized Roma communities, and to translate and adapt instruments for measuring development and parenting in marginalized Roma communities and assess their psychometric qualities and suitability Methods The project comprises two parts. The first part is a validation study of the translated Caregiver-Reported Early Development Instrument (CREDI) and the Comprehensive Early Childhood Parenting Questionnaire (CECPAQ), tools for the assessment of early development and of parenting strategies and practices. The second part is a longitudinal cohort study, in which the relationships of risk and protective factors with development are explored. Discussion The RomaREACH project is a multicomponent study of social determinants of health and development in early childhood that can provide new evidence on the relationship of risk and protective factors with early development. Such young children from difficult-to-reach marginalized Roma communities are rarely included in research, and information about the scope and the extent of inequities in health and development in the period of early childhood is scarce. The expected results of the RomaREACH project have the potential to influence policy and practice by providing validated tools and evidence-based insights that can help mitigate the developmental risks faced by children in marginalized Roma communities and contribute to improving developmental outcomes and equity.

Abstract Background The COVID-19 pandemic posed an enormous challenge on the public health workforce, leading to the hiring of much temporary staff. Temporary staff may experience poorer working conditions compared to permanent staff. From a public health perspective, we need to know how working conditions are experienced when there is an acute pressure on recruiting sufficient public health care staff. This study aimed to investigate differences in job demands and work functioning between temporary and permanent public health care staff, during the fourth wave of the COVID-19 pandemic in the Netherlands and compare it with available pre-pandemic data from the general working population. Methods This cross-sectional study included temporary (n = 193) and permanent (n = 98) public health care staff from a municipal health care service in the north of the Netherlands. The participants completed a questionnaire with items about quantitative, cognitive, emotional demands (Copenhagen PsychoSOcial Questionnaire, COPSOQ, range 1-100) and work functioning (Work Role Functioning Questionnaire, WRFQ, range 1-100). The participants’ scores were compared to the general working population and differences between temporary and permanent staff were investigated using linear regression analysis. In addition, explorative analyses were conducted with temporary staff stratified by task and permanent staff by department. Results Permanent staff had relatively high scores on job demands compared to the general working population, whereas temporary staff had relatively low scores. On work functioning, permanent staff had similar scores as the general working population and temporary staff had better scores. Compared to permanent staff, temporary staff had lower, i.e. better, scores on quantitative (regression coefficient (B)=-26.7; 95% Confidence Interval (CI) -30.8 to -22.5), cognitive (B=-24.4; 95% CI -29.0 to -19.9), and emotional demands (B=-11.8; 95% CI -16.0 to -7.7), and better scores on work functioning (B = 7.8; 95% CI 4.5 to 11.3). Conclusions Temporary staff experienced lower job demands and reported better work functioning than permanent staff. The acute expansion of the public health workforce did not seem to negatively impact the job demands and work functioning of temporary public health care staff.

Abstract Background Mental health literacy (MHL) is crucial for early recognition of and coping with mental health problems, and for the use and acceptance of mental health services, leading to better health outcomes, especially in adolescence. The prevalence of mental health problems among adolescents is seen as a major public health concern and MHL is an important factor in facilitating positive mental health outcomes. However, the availability of valid measurement instruments for assessing the multifaceted nature of MHL is limited, hindering the ability to make meaningful comparisons across studies. The Knowledge and Attitudes to Mental Health Scales (KAMHS) is a promising comprehensive instrument for measuring adolescents’ mental health literacy but its psychometric properties have not been explored in any other contexts than the Welsh. The aim of this study was to translate the KAMHS into Dutch, adapt it in this context, and evaluate its psychometric properties. Methods We performed a cross-sectional study with Dutch adolescents between the ages 11–16. We translated the KAHMS and assessed its content validity using cognitive interviewing with n = 16 adolescents. Next, n = 406 adolescents were asked to fill in the translated KAMHS-NL and reference scales, on mental health (SDQ and WHO-5), resilience (BRS), and mental health help-seeking behaviors. We assessed construct validity based on a priori hypotheses regarding convergent and divergent correlations between subscales of KAMHS-NL and the reference scales. Finally, we assessed structural validity via confirmatory factor analysis and exploratory structural equation modeling. Results The KAMHS-NL showed good content validity and satisfactory construct validity. In total, 28 of the 48 hypotheses regarding convergent and divergent correlations between the KAMHS and reference scales were confirmed. Contrary to our expectations, weak, but significant associations were found between MHL and resilience. The KAMHS showed an acceptable to good internal consistency (McDonald’s omega ranging from 0.62 to 0.84). Finally, we could generally confirm the postulated structure of the KAMHS-NL in the Dutch sample with a 5-factor solution (RMSEA = 0.033; CFI = 0.96). Conclusions The Dutch version of the KAMHS is a valid measure for detecting differences in MHL levels in adolescents. The KAMHS is a promising instrument for assessing MHL in adolescents in a multifaceted manner in other countries which may facilitate rigorous global MHL research. The instrument therefore deserves further validation research in other settings and comparisons across various cultural contexts.

Purpose Clinical guidelines call for the inclusion of exercise interventions in every patient’s dialysis session, but these recommendations are rarely adopted. Healthcare providers play a key role in this. Therefore, the aim of this study was to explore how healthcare providers perceive the benefits, risks and barriers of intradialytic exercise (IDE). Methods We conducted 21 individual, semi-structured interviews with 11 nurses, 5 nephrologists, 3 training assistants and 2 managers from two dialysis centres in Slovakia. Verbatim transcripts of digitally recorded interviews were thematically analysed using MAXQDA®. Results Participants reported the benefits of IDE as improvements in patients’ physical and psychosocial functioning, independence and self-efficacy, clinical profile and quality of therapy. As risks of IDE, they most frequently reported exercise-related damage to vascular access, insufficient individualization of training and musculoskeletal injuries. The presence of psychological problems among patients was reported as a major barrier for initiating and maintaining patients’ exercise. Other reported barriers included limitations in financial and personnel resources of haemodialysis care. Conclusions Safe and sustainable implementation of IDE, which might improve a patient’s well-being, need to be prescribed in alignment with the patient’s clinical profile, be delivered individually according to the patient’s characteristics and requires adjustments in the available resources.

IntroductionResearch on adolescents’ academic performance has mostly focused on the contribution of objective factors, such as socioeconomic situation of the family or individual cognitive skills and school results. Evidence with a focus on adolescents’ subjective experiences is scarce. The aim of this qualitative study was to explore factors related to adolescents’ academic performance from their perspectives.MethodsWe used data from 11 group semi-structured interviews conducted in 2020/2021 with 45 adolescents in the first year of high school in Slovakia (mean age = 14.98; 22.2% boys). Participants were selected from three types of high school with regards to the graduation system. We analysed the data using consensual qualitative research and thematic analysis.ResultsBased on the statements of the adolescents, we identified five main themes of factors that affect their academic performance. Adolescents reported that the following contribute to their academic performance: the contents and methods of teaching; how teachers behave and do their jobs; the way in which adolescents study and what motivates them; support within and outside the school, and the environment and appearance of the school. Adolescents reported that improving the curricula and using teaching methods that balance theoretical information with practical skills training would help their academic performance immensely.ConclusionWe identified several factors related to adolescents’ academic performance using their own perspectives and experiences. Strengthening the capacities of teachers may largely benefit adolescents’ educational process and further academic performance.

Abstract Background The burden of non-communicable diseases is becoming unmanageable by primary healthcare facilities in low- and middle-income countries. Community-based approaches are promising for supporting healthcare facilities. In Vietnam, community health volunteers are trained in providing health promotion and screening in a culturally adapted training. This study aims to assess the change in knowledge, attitude and practice regarding NCD prevention and management after a culturally adapted training, and the potential mechanisms leading to this change. Methods The Knowledge Attitude and Practice survey was assessed before and after an initial training, and before and after a refresher training (n = 37). We used a focus group discussion with community health volunteers (n = 8) to map potential mechanisms of the training and applying learned knowledge in practice. Data were collected in the districts Le Chan and An Duong of Hai Phong, Vietnam, in November 2021 and May 2022. Results We found that knowledge increased after training (mean = 5.54, 95%-confidence interval = 4.35 to 6.74), whereas attitude and practice did not improve. Next, knowledge decreased over time (m=-12.27;-14.40 to -10.11) and did not fully recover after a refresher training (m=-1.78;-3.22 to -0.35). As potential mechanisms for change, we identified the use of varying learning methods, enough breaks, efficient coordination of time located for theory and practice, handout materials, large group size and difficulty in applying a digital application for screening results. Conclusion Culturally adapted trainings can improve knowledge among community health volunteers which is important for the support of primary healthcare in low- and middle-income countries. Using a digital screening application can be a barrier for the improvement of knowledge, attitude and practice and we suggest using an intergenerational or age-friendly approach, with the supervision of primary healthcare professionals. Future research on behavioral change should include additional components such as self-efficacy and interrelationships between individuals.

IntroductionThe association between neonatal intensive care unit (NICU) related stress in preterm infants and their health-related quality of life (HRQoL) in the first year following preterm birth remains unexplored. Understanding this association is crucial for enhancing preventive and supportive measures for infants and parents within and beyond the NICU.MethodsFrom a single center observational cohort study, we included infants with gestational ages below 30 weeks and/or birth weights under 1,000 grams. HRQoL was quantified using the Infant Quality of Life Instrument (IQI) at 3-, 6-, 9- and 12-months corrected age, covering seven domains. NICU stress was quantified using the Neonatal Infant Stressor Scale (NISS) for the first week of life. We performed Spearman's correlation analyses to test this association.ResultsOf the 45 included infants, the IQI was completed for 27 (60%) at 3, 15 (33%) at 6, 14 (31%) at 9 and 15 (33%) at 12 months. The HRQoL sum scores were related to neonatal stress at 9 and 12 months (ρ = 0.643 and 0.591, p = 0.013 and p = 0.019, respectively) but not at 3 and 6 months (ρ = −0.001 and −0.077 respectively, p > 0.05). Higher NICU stress tended to be associated with more respiratory and mood problems throughout the first year.DiscussionFrom a parental perspective on infant HRQoL, extremely preterm infants with higher stress exposure show more problems in the second half-year of life, mainly breathing and possibly mood-related problems. This knowledge may help improve our neonatal care, both during NICU stay and in follow-up clinics, by implementing targeted interventions.

BackgroundRoma living in marginalized communities often face poor living conditions and material deprivation, which may negatively impact parenting. Our aim is to compare the parenting behavior (support, harsh discipline, and stimulation) of mothers from marginalized Roma communities and the majority population in Slovakia. We also examine the role of socioeconomic disadvantage and related worries in the differences in parenting behavior between these groups.MethodsWe obtained cross-sectional data from mothers of children aged 14–18 months using the first wave of the longitudinal RomaREACH study dataset. Two groups were included in the sample: 93 mothers from MRCs and 102 mothers from the majority. We performed multiple regression and mediation analyses to assess whether the educational level of mothers, the degree of poverty, and poverty-related feelings of stress and worries explain parenting behavior differences between the groups of mothers.ResultsWe found significant differences in parenting, especially in harsh disciplining and stimulation. These two domains were significantly associated with maternal education, degree of poverty, and poverty-related stress and worries. The degree of poverty partially mediated stimulation differences between the two groups of mothers.ConclusionParenting in MRCs seems harsher and less stimulative than parenting in the Slovak majority. These differences are associated with the socioeconomic disadvantage of mothers. The degree of poverty partially explains why parenting in MRCs is less stimulative. These results may inform intervention efforts aimed at disadvantaged families.

Abstract Background This study evaluates changes in the neonatal morbidity, the neonatal care practices, and the length of hospital stay of surviving very preterm (VP) infants born in the Netherlands in the 1980s and in the 2000s; a period over which historical improvements were introduced into neonatal care. We, herein, also study whether these changes in neonatal morbidity, neonatal care practices and length of hospital stay are associated with sociodemographic, prenatal, and infant characteristics. Methods Two community-based cohorts from 1983 (POPS) and 2002−03 (LOLLIPOP) have provided the perinatal data for our study. The analysis enrolled 1,228 participants born VP (before the 32nd week of gestation) and surviving to 2 years of age without any severe congenital malformation. A rigorous harmonisation protocol ensured a precise comparison of the cohorts by using identical definitions of the perinatal characteristics. Results In 2003, mothers were older when giving birth, had higher multiple birth rates, and significantly more parents had received higher education. In 2003, less VP infants had severe intraventricular haemorrhage and sepsis and relatively more received continuous positive airway pressure, mechanical ventilation and caffeine therapy than in 1983. Antenatal corticosteroids and surfactant therapy were provided only in 2003. The length of the stay in the neonatal intensive care unit and in hospital had decreased in 2003 by 22 and 11 days, respectively. Differences persisted after adjustment for sociodemographic, prenatal, and infant characteristics. Conclusions Neonatal morbidities of the surviving VP infants in this study have not increased, and exhibit improvements for various characteristics in two cohorts born 20 years apart with comparable gestational age and birth weight. Our data suggest that the improvements found are associated with more advanced therapeutic approaches and new national protocols in place, and less so with sociodemographic changes. This analysis provides a basis for further comparative analyses of the health and the development of VP children, particularly with regard to long-term outcomes.

Abstract Background The COVID-19 pandemic endangered the quality of health care and the safety of patients and health care workers (HCWs). This provided challenges for HCWs’ resilience and for hospital management and probably increased risks for patient safety incidents (PSI). HCWs may also have experienced psychological consequences as second victims of PSI, but evidence on this is lacking. Therefore, we mapped HCWs’ experiences with PSI during the second wave of COVID-19, the associations of these experiences with the hospital management of patient safety culture and HCWs’ interests in receiving further training. Methods We obtained data from 193 HCWs working at the COVID-related departments of one large hospital in eastern Slovakia via a questionnaire developed in direct collaboration with them. We measured PSI experiences as various HCWs’ experiences with near miss and adverse events and the hospital management of patient safety culture using indicators such as risk of recurrence, open disclosure and second victim experiences. For analysis, we used logistic regression models adjusted for age and gender of the HCWs. Results One-third of the hospital HCWs had experienced PSI; these were more likely to expect adverse events to recur (odds ratio, OR = 2.7–3.5). Regarding the hospital management of patient safety culture, the HCWs’ experiencing openly disclosed PSI was associated with one negative outcome, i.e. conflicts among colleagues (OR = 2.8), and one positive outcome, i.e. patients’ acceptance of their explanation and apologies (OR = 2.3). We found no associations for any other essential domains after disclosure. PSI experiences were strongly associated with psychological indicators of second victimhood, such as sadness, irritability, anxiety and depression (OR = 2.2–4.3), while providing support was not. The majority of the HCWs would like to participate in the suggested trainings (83.4%). Conclusion HCWs with PSI experiences reported poor hospital management of the patient safety culture, which might reflect they missed the opportunities to strengthen their resilience, especially during the COVID-19 pandemic.

AimThe Strengths and Difficulties Questionnaire self-report (SDQ-SR) is a valid instrument for detection of emotional and behavioral problems. The aim of this study was to compare the psychometric properties of the SDQ-SR for low and higher educated adolescents, and to explore its suitability.MethodsWe included 426 adolescents. We compared internal consistency for low-educated, i.e., at maximum pre-vocational secondary education, and higher educated adolescents and assessed whether the five-factor structure of the SDQ holds across educational levels. We also interviewed 24 low-educated adolescents, and 17 professionals.ResultsOn most SDQ subscales the low-educated adolescents had more problematic mean scores than the higher educated adolescents. Findings on the invariance factor analyses were inconsistent, with some measures showing a bad fit of the five factor model, and this occurring relatively more for the low-educated adolescents. Professionals and adolescents reported that the SDQ included difficult wordings.DiscussionOur findings imply that the scale structure of the SDQ-SR is slightly poorer for low educated adolescents. Given this caveat, psychometric properties of the SDQ-SR are generally sufficient for use, regardless of educational level.

BackgroundThe fast development of digital technology and of its use at even younger ages is significantly shaping the current generation of adolescents. This is leading to an almost unlimited accessibility that provides a large number of opportunities, but also to many challenges that adolescents have to face. The aim of our study was to explore the perceptions adolescents have of the risks of digital technology.MethodsWe conducted online semi-structured interviews as a part of the international Health Behaviour in School-aged Children study. The sample consisted of 15 Slovak adolescents (mean age: 15.33; 20% boys). To analyse our data, we used consensual qualitative research and thematic analysis.FindingsOur findings confirmed that adolescents are aware of the risks associated with the use of digital technology. Regarding their specific types of the perceived risks, we identified four main themes: 1. dependence on the functionality of technology; 2. problematic control; 3. vulnerability in the virtual environment; 4. health risks. Adolescents thus want technology that is functional, safe and does not endanger their health.ConclusionDespite the fact that adolescents know of the risks they may experience due the digital technology, they still use it. Preventive strategies should focus on functionality, safety and healthiness; furthermore, they should support the constant development of adolescents’ digital awareness and raising their awareness about effective and non-threating use of technology.

Abstract Previous research shows the beneficial effects of an intradialytic resistance training (IRT) on muscle function in haemodialysis patients. However, patients vary highly in their functional responses to IRT, may be due to effects of age and sex heterogeneities in adaptation. Therefore, the aim of this study was to investigate the degree to which the effects of IRT on the muscle function of haemodialysis patients vary by age and sex. We included 57 patients who completed a 12-week IRT (EXG) and 33 patients who received no IRT (CNG) during haemodialysis. Muscle function (MF) was assessed using dynamometry before and after a 12-week intervention and after a 12-week follow-up. After the 12-week intervention, we found a moderation effect of age in the relative (%) change (p = 0.011) and absolute (Δ) change (p = 0.027) of MF, and a moderation effect of sex in %MF (p = 0.001), but not in ΔMF (p = 0.069). Regarding patients’ age, the change of MF was only significantly different between EXG and CNG patients aged 60–70 years (%MF, EXG: + 34.6%, CNG: − 20.1%, p

Abstract Purpose We assessed the association between trajectories of stressful life events (SLEs) throughout adolescence and changes in mental health from childhood to young adulthood. Further, we assessed whether family functioning moderated this association. Methods Data of the first six waves of the TRAILS study (2001-2016; n = 2229) were used, a cohort followed from approximately age 11 to 23. We measured SLEs (death of a family member or other beloved one, delinquency, moving, victim of violence, parental divorce, and sexual harassment) at ages 14, 16 and 19. Family functioning was measured at all six time points using the Family Assessment Device (FAD), and mental health was measured through the Youth/Adult Self-Report at ages 11 and 23. Latent class growth analyses (LCGA) were used to examine longitudinal trajectories and associations. Results We identified three SLE trajectories (low, middle, high) throughout adolescence, and found no significant associations between these trajectories and changes in mental health from childhood to young adulthood. Family functioning and SLE trajectories were significantly associated, however, the association of SLE trajectories and changes in mental health was not modified by family functioning. Mental health problems at age 11 increased the likelihood of high SLE trajectories during adolescence, and of experiencing negative family functioning. Conclusion Experiencing SLEs throughout adolescence does not have a direct impact on changes in mental health from childhood to young adulthood, but early adolescence mental health problems increase the likelihood of experiencing SLEs.

Abstract Physical activity is good for people’s health. The relationship between the built environment and physical activity has been well documented. However, evidence is both scarce and scattered on specific urban interventions, i.e., intentional redesigns of the built environment that promote physical activity accompanied by pre- and post-effect measurement. This umbrella review aims to synthesize the findings of systematic reviews focused on these urban interventions. We followed the PRISMA 2020 and JBI umbrella review protocol guidelines and searched seven databases covering the period between Jan 2010 and April 2022 using keywords relating to the built environment, health, physical activity, and interventions. This yielded seven systematic reviews, in which we identified several urban interventions that can promote physical activity. We found positive effects of urban interventions on physical activity regarding park renovations, adding exercise equipment, introducing a (new) pocket park, improving cycling environments, improving walking & cycling environments, as well as multi-component initiatives for active travel and enhancing the availability & accessibility of destinations. The findings suggest that the urban environment can effectively promote physical activity, especially by adding various facilities and destinations and by making the environment better suitable for active use.

Abstract Background Refractive errors are relatively common all around the world. In particular, early onset myopia is associated with a significant burden in later life. Little is known about refractive errors in preschool children. The aim of this study was to assess the prevalence of spectacle wear, visual acuity and refractive errors in young Dutch children. Methods We analyzed data of three prospective population-based studies: 99,660 3- to 5-year-olds undergoing vision screening at preventive child healthcare organizations, 6934 6-year-olds from the Generation R study, and 2974 7-year-olds from the RAMSES study. Visual acuity was measured with Landolt-C or LEA charts, spectacle wear was assessed, and refractive errors at age 6 and 7 were measured with cycloplegic refraction. Results The prevalence of spectacle wear ranged from 1.5 to 11.8% between 3 to 7 years with no significant gender differences. Among children with spectacle wear at 6 years (N = 583) and 7 years (N = 350) 29.8 and 34.6% had myopia respectively, of which 21.1 and 21.6% combined with astigmatism; 19.6 and 6.8% had hyperopia, 37.2 and 11.1% hyperopia and astigmatism, and 12.5 and 32.7% astigmatism only. Conclusions Spectacle wear in European children starts early in preschool and increases to a relatively frequent visual aid at school age. Advocating early detection and monitoring of refraction errors is warranted in order to prevent visual morbidities later in life.

BackgroundLow-and middle-income countries mostly have ageing populations with many unmet economic, social, or health-related needs, Vietnam being an example. Community-based support in Vietnam, organized as Intergenerational Self-Help Clubs (ISHCs) based on the Older People Associations (OPA) model, can help to meet these needs by the provision of services for various aspects of life. This study aims to assess the implementation of the ISHCs and whether successful implementation is associated with more member-reported positive health.MethodsWe used the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework to evaluate the implementation using multiple data sources: ISHC board surveys (n = 97), ISHC member surveys (n = 5,080 in 2019 and n = 5,555 in 2020), focus group discussions (6; n = 44), and interviews with members and board leaders (n = 4).ResultsReach ranged between 46 and 83% of ISHCs reaching target groups, with a majority of women and older people participating. Regarding Effectiveness, members indicated high satisfaction with the ISHCs. Adoption scores were high, with 74%–99% for healthcare and community support activities, and in 2019, higher adoption scores were associated with more members reporting good positive health. In 2020, reported positive health slightly decreased, probably due to the influence of the COVID-19 pandemic. A total of 61 ISHCs had consistent or improving Implementation from 2019 to 2020, and confidence in Maintenance was high.ConclusionThe implementation of the OPA model in Vietnam is promising regarding its promotion of health and may help to tackle the needs of an ageing population. This study further shows that the RE-AIM framework helps to assess community health promotion approaches.

Abstract Objective This study provides Dutch national norms for the parent-reported Strengths and Difficulties Questionnaire (SDQ) for children aged 3-14 years, and assesses the test performance of the SDQ Total Difficulties Scale (TDS) and impairment Scale. We further compared Dutch SDQ norms with those of the United Kingdom (UK), to determine potential variation in country-specific norms. Study design We analyzed data of 3384 children aged 3 to 14 years. The data were obtained in schools, and in the context of Preventive Child Healthcare. Parents completed the SDQ parent form and the Child Behavior Checklist (CBCL). We determined clinical (10% elevated scores) and borderline (20% elevated scores) SDQ TDS norms. We assessed the test performance (validity) of the SDQ TDS and Impairment Score using the CBCL as criterion. Results The clinical SDQ TDS norms varied between > 10 and > 14 depending on the age group. The SDQ TDS discriminated between children with and without problems, as measured by the CBCL, for all age groups (AUCs varied from 0.92 to 0.96). The SDQ Impairment Score had added value (beyond the SDQ TDS) only for the age group 12-14 years. For the Netherlands we found lower clinical SDQ TDS norms than those previously reported for the UK (i.e. > 16). Conclusion The clinical SDQ TDS norms varied between > 10 and > 14 depending on the age groups. We found good test performance at these proposed norms. Dutch norms differed somewhat from UK norms. In the Netherlands, the SDQ performed better with Dutch-specific norms than with UK-specific norms.

Abstract Background This study aims to assess which measures could improve the healthy early childhood development of children from marginalized Roma communities and to identify priority measures. Methods Concept mapping approach was used, using mixed methods. In total 54 professionals, including social workers, educators, health care providers, municipality representatives, and project managers participated in our study. Results Four distinct clusters of measures targeting living conditions, public resources, healthcare and community interventions, and 27 individual priority measures of highest urgency and feasibility were identified. The cluster ‘Targeting living conditions’, was rated as the most urgent but least feasible, whereas the cluster ‘Targeting health care’, was considered least urgent but most feasible. Among the 27 priority measures, ‘Planning parenthood’ and ‘Scaling up existing projects’ had the highest priority. Conclusion Our results reflect the public and political discourse and indicate significant barriers to implementation. Reducing inequalities in early childhood needs to be addressed through coordinated efforts.

Background: Non-communicable diseases, specifically the burden of hypertension, have become a major public health threat to low- and middle-income countries, such as Myanmar. Inadequate knowledge of hypertension and its management among people may hinder its effective prevention and treatment with some groups at particular increased risks, but evidence on this is lacking for Myanmar. The aims of this study were therefore to assess the level of knowledge of risk factors, symptoms and complications of hypertension, by hypertension treatment status, community group-membership, and sociodemographic and socioeconomic factors in Myanmar. Methods: Data was collected through structured questionnaires in 2020 on a random sample of 660 participants, stratified by region and existence of community groups. Knowledge of hypertension was measured with the ‘Knowledge’ part of a validated ‘Knowledge, Attitude and Practice’ survey questionnaire and categorised into ill-informed and reasonably to well-informed about hypertension. Results: The majority of respondents seem reasonably to well-informed about risk factors, symptoms and complications of hypertension. This did not vary by hypertension treatment status and community group membership. People with jobs (B=0.96; 95%-confidence interval 0.343 to 1.572) and higher education (B=1.96; 0.060 to 3.868) had more hypertension knowledge than people without jobs or low education. Adherence to treatment among hypertensive people was low. Conclusion: This study shows a majority of participants in this study in Myanmar seem reasonably to well-informed, with no differences by hypertension status, treatment status, and community group-membership. People without jobs and low education have less hypertension knowledge, making them priority groups for tailored education on health care level as well as community level, lowering the burden of hypertension. Almost half of the hypertensive patients did not take their medicines and therefore, adherence to treatment of hypertension should be an important element for future health education.

Mental health challenges in adolescence may affect labour market transitions in young adulthood. Policies addressing early labour market disconnection largely focus on early school-leaving and educational attainment; however, the role of low educational attainment on the path from adolescent mental health to labour market disconnection is unclear. Using the TRacking Adolescents' Individual Lives Survey from the Netherlands (n = 1,197), we examined the extent to which achieving a basic educational qualification (by age 22) in the contemporary Dutch education system, mediates the effect of adolescent mental health (age 11–19) on early adult labour market disconnection, defined as ‘not in education, employment, or training’ (NEET, age 26). We estimated the total effect, the natural direct and indirect effects, and the controlled direct effects of internalizing and externalizing symptoms on NEET by gender. Among young men, clinical levels of adolescent externalizing symptoms were associated with a 0.093 higher probability of NEET compared with no symptoms (95% confidence interval, CI: 0.001, 0.440). The indirect effect through educational attainment accounted for 15.1% of the total effect. No evidence of mediation was observed for the relationship between externalizing symptoms and NEET in young women. No evidence of mediation was observed for the relationship between adolescent internalizing symptoms and NEET in either gender. The findings imply that adolescent externalizing symptoms disrupts the achievement of a basic educational qualification, leading to a higher probability of NEET in young men. This mechanism may play a smaller role in the risk of NEET associated with internalizing symptoms and in young women.

Background: The persistence of health inequalities may be driven by differences in education and income, but also by other economic and non-economic factors. Our aim was to explore 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 attractiveness and personality capital. Methods: We used a capital-based approach to understand health inequalities. It presumes intertwined relationships between broadly measured health (‘health-related person capital’) and embodied resources (‘attractiveness and personality capital’) on the one hand, and ESC 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 and estimated correlations using partial least squares structural equation modelling. Results: The correlation between SES and health-related person capital (r = 0.15) was stronger than the correlations between SES and single-dimensional health (physical and mental health; r = 0.12 and r = 0.04, respectively). ESC capital, combining economic, social and cultural capital, showed a correlation of 0.34 with health-related person capital. This was stronger than the correlation between health-related person capital and economic capital alone (r = 0.19). Lastly, the correlation between health-related person capital and ESC capital increased when health related, attractiveness and personality resources were combined into a single person capital construct (from r = 0.34 to r = 0.49). Conclusions: This exploratory study shows the empirical interconnectedness of various types of resources, and their potential role in the persistence of health inequalities. 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.

Background The COVID-19 pandemic led to accepting a lot of various protective pandemic management-related measures (PanMan), which may have had a large impact on health care workers (HCWs) but evidence is scarce. We therefore explored the impact of measures during the second wave. We assessed the associations of PanMan with the Quality of Life (QoL) of hospital HCWs. Methods We collected data from 215 HCWs (77.7% females, mean age 44.4), who were working at the COVID-related departments of one large hospital in eastern Slovakia via a questionnaire, specifically developed in direct collaboration with them. We assessed PanMan related factors, such as COVID-19 experience, information overload, non-adherence of the public, work stress, barriers and facilitators of health care provision, and QoL related factors, such as impact on family life and activities, housekeeping, relationships with relatives and mental well-being. To analyse the data, we used logistic regression models adjusted for age and gender. Results PanMan greatly impacted the QoL of HCWs, in particular family life, housekeeping and mental well-being (odds ratio, 6.8–2.2). The most influential PanMan factors were COVID-19 experience (3.6–2.3), work stress (4.1–2.4) and barriers in health care provision (6.8–2.2). Perceiving work stress had a negative impact on all QoL domains, even on relationships with the greatest impact. Conversely, the PanMan factors reducing the negative impact on QoL were training and colleagues’ support (0.4–0.1). Conclusion PanMan had a strong negative impact on the QoL of hospital HCWs during the second wave of the COVID-19 pandemic.

BackgroundTechnology plays a significant role in the lives of adolescents. Our knowledge is predominantly based on research exploring the risks associated with it, but adolescents also feel that technology supports their lives. This has received less consideration. Therefore, we aim to examine how adolescents perceive the benefits of digital technology.MethodsWe used qualitative data collected as part of the international Health Behaviour in School-Aged Children study. We conducted online, semi-structured interviews with 15 Slovak adolescents who came from three different types of secondary schools based on their graduation systems (mean age: 15.33; 20% boys). The data were analyzed using consensual qualitative research and thematic analysis.ResultsWe identified five main themes based on the comments of adolescents: 1. I know (source of information, formal and non-formal education); 2. I can (smart device, helpful tool); 3. I am connected/included (social interactions); 4. I have my comfortable place (leisure time, creating my alternative world); and 5. I work on my future (self-development).ConclusionAdolescents perceived digital technology as mostly supportive and a helpful tool in their lives. The potential benefits of digital technology should be better reflected in public perception and policy, as the societal debate is mostly dominated by perceived disadvantages and risks.

Abstract Background In Southeast Asia, diabetes and hypertension are on the rise and have become major causes of death. Community-based interventions can achieve the required behavioural change for better prevention. The aims of this review are 1) to assess the core health-components of community-based interventions and 2) to assess which contextual factors and program elements affect their impact in Southeast Asia. Methods A realist review was conducted, combining empirical evidence with theoretical understanding. Documents published between 2009 and 2019 were systematically searched in PubMed/Medline, Web of Science, Cochrane Library, Google Scholar and PsycINFO and local databases. Documents were included if they reported on community-based interventions aimed at hypertension and/or diabetes in Southeast Asian context; and had a health-related outcome; and/or described contextual factors and/or program elements. Results We retrieved 67 scientific documents and 12 grey literature documents. We identified twelve core health-components: community health workers, family support, educational activities, comprehensive programs, physical exercise, telehealth, peer support, empowerment, activities to achieve self-efficacy, lifestyle advice, activities aimed at establishing trust, and storytelling. In addition, we found ten contextual factors and program elements that may affect the impact: implementation problems, organized in groups, cultural sensitivity, synergy, access, family health/worker support, gender, involvement of stakeholders, and referral and education services when giving lifestyle advice. Conclusions We identified a considerable number of core health-components, contextual influences and program elements of community-based interventions to improve diabetes and hypertension prevention. The main innovative outcomes were, that telehealth can substitute primary healthcare in rural areas, storytelling is a useful context-adaptable component, and comprehensive interventions can improve health-related outcomes. This extends the understanding of promising core health-components, including which elements and in what Southeast Asian context.

BackgroundParents play an important role in the psychosocial care of their children. Previous research has primarily examined their role in care entry, whereas evidence on their role in other stages of the care process is scarce and lacking particularly in regard to the perspective of care providers. Our aim was therefore to examine how psychosocial care providers perceive the role of parents in the process of psychosocial care for adolescents.MethodsWe used data from 25 semi-structured interviews with psychosocial care providers on the roles of parents in the care process. We analyzed data using consensual qualitative research and thematic analysis.ResultsFour main themes were identified: (1) parents as a source of adolescents’ problems; (2) parents trying to escape from responsibility for adolescents with problems; (3) parents as an active part of the care for adolescents; and (4) parents as a barrier to effective care.ConclusionPsychosocial care providers should specifically address the role of the parents in psychosocial care to improve outcomes. Specific interventions are needed to support the involvement of parents in care, as their role is important. Moreover, professionals can be better trained in working with multi-problem families also to resolve some of the negative perceptions of these parents.

BackgroundInjuries are the major cause of disability and death during adolescence, representing a significant public health burden among youth. Body-related factors such as body composition and cardiovascular fitness (CVF) may affect adolescents’ vulnerability to injuries. As evidence is lacking, we aimed to explore the associations of medically attended injuries with adolescents’ physical activity (PA) and body-related factors, and whether these associations are modified by age, gender and family affluence.MethodsWe used data on 888 11- to 15-year-old adolescents (mean age = 13.5, 56% boys) from the Health Behaviour in School-aged Children study conducted in 2018 in Slovakia. We used binary logistic regression analysis to assess the association of medically attended injuries with adolescents’ PA and body-related factors (body composition, CVF), considering age, gender and family affluence.ResultsAdolescents were more likely to report medically attended injuries if they were physically very active (odds ratio/confidence interval OR/CI:2.76/1.83–4.15) or active (OR/CI:1.91/1.27–2.87) rather than inactive. Body-related factors were not associated with medically attended injuries among adolescents. Moreover, age, gender and family affluence did not modify the association of medically attended injuries with adolescents’ PA and body-related factors. The only exception was the modifying effect of gender: the association of medically attended injuries with being very active was stronger in boys (OR/CI: 3.04/1.32–6.99).ConclusionVery physically active adolescent boys are the most vulnerable group of adolescents in terms of injuries. PA promotion programmes should further consider gender-specific strategies aimed at preventing injuries.

Objectives: The COVID-19 pandemic caused risks and burdens for health professionals and might result in job leaving intentions. To assess the potential risks, we explored the association of the job leaving intentions with exposure to COVID-19 risk, impact of pandemic management on professional and personal life, and personal coping resources among Slovak dentists in the first wave of the outbreak.Methods: We obtained data from 500 dentists (66.8% females, M/SD = 43.8) registered with the Slovak Chamber of Dentists using an online questionnaire. Data were analysed using logistic regression models adjusted for age and gender.Results: Nearly 40% of dentists reported job leaving intentions after the first wave of the pandemic outbreak. Job leaving intentions were associated with exposure to COVID-19 risks (odds ratios, ORs, varying from 1.6 to 4.7), impact of pandemic management on professional and personal life (Ors from 1.6 to 2.9), and personal coping resources (Ors from 0.4 to 0.6).Conclusion: Better management of exposures to risks and impact on professional and personal life, as well as building better personal coping resources may prevent the loss of a valuable workforce in dental care.

BackgroundGlobally, governments adopted protective measures to stabilize the worsening COVID-19 pandemic situation. These measures had a large impact on health care workers (HCWs) and could make the work environment more stressful for them. Therefore, we explored the associations of the psychological responses of HCWs and pandemic management among Slovak health care workers during the second wave of the pandemic.Materials and MethodsWe obtained data about psychological responses, COVID-19 experiences, information overload, non-adherence of the public, work stress and barriers and facilitators of health care provision from HCWs at the COVID-19-related departments of one hospital that mainly covered eastern Slovakia (215 health care professionals, 77.7% females, M/SD = 44.4). Data were analyzed using logistic regression models adjusted for gender.ResultsPandemic management was most strongly associated with psychological responses, such as irritability, sadness, anxiety, dizziness, and back pain, in health care workers. The non-adherence of the public had the strongest associated psychological impact on HCWs, mostly affecting anxiety and irritability (odds ratios, ORs varying from 3.9 to 7.0). From the barriers and facilitators of health care provision, the use of personal protective equipment had the most impact psychologically, whereas efficient department management was most protective, with ORs around 0.3.ConclusionPandemic management has a large impact on health care workers, and promoting resilience may seriously decrease job-related stress and associated psychological responses of HCWs.

Abstract We aimed to compare ratings of self‐reported and parent‐reported pain sensitivity between early preterm (EP), moderately‐late preterm (MLP), and full‐term (FT) adolescents. For EP adolescents, we aimed to determine whether pain sensitivity was associated with early‐life events. EP (n = 68, response rate 47.4%), MLP (n = 128, response rate 33.0%), and FT (n = 78, response rate 31.1%) adolescents and their parents (n = 277) answered an author‐generated question on pain sensitivity at 14‐15 years of age within a community‐based cohort study. Differences between groups were determined using the chi‐square test for trends. For EP adolescents, we assessed associations of treatment modalities (inotrope treatment, mechanical ventilation, and C‐section) and neonatal morbidities (sepsis/necrotizing enterocolitis, small‐for‐gestational age status, asphyxia, and cerebral pathologies) with adolescent pain sensitivity using logistic regression analyses. Increased pain sensitivity was reported by 18% of EP adolescents, compared with 12% of MLP adolescents, and 7% of FT adolescents (P = 0.033). Parent‐reported pain sensitivity did not differ by gestational age group. For EP adolescents, inotrope treatment was associated with increased pain sensitivity (odds ratio, 5.00, 95% confidence interval, 1.23‐20.4, P = 0.025). No other neonatal treatment modalities or morbidities were associated with pain sensitivity in adolescence. In conclusion, we observed higher proportions of increased pain sensitivity for EP and MLP adolescents. Physicians treating preterm adolescents should be aware of altered pain sensitivity.

Abstract Background Preterm infants are at risk for functional impairments in motor, cognitive, and behavioral development that may persist into childhood. The aim of this study was to determine the co-occurrence of cognitive impairments in multiple cognitive domains at school age in very preterm born children compared to term-born children. Methods Comparative study including 60 very preterm-born children (gestational age ≤ 32 weeks) and 120 term-born controls. At school age, we assessed intelligence with the WISC-III, and visuomotor integration with the NEPSY-II, verbal memory with the AVLT, attention with the TEA-ch, and executive functioning with the BRIEF. We investigated co-occurrence of various abnormal (

Abstract Background Moderately-late preterm (MLP) children (gestational age [GA] 32–36 weeks) are followed-up within community services, which often use developmental milestones as indicators of delay. We aimed to examine associations of parental report of smiling-age and walking-age with developmental delay upon school entry for MLP and full-term children. Methods This study regards a community-based cohort study, including 1241 children. Parent-reported smiling-age (n = 514) and walking-age (n = 1210) were recorded in preventive child healthcare. To determine developmental delay at school entry (at age 4) we used the Ages and Stages Questionnaire (ASQ) total and domain scores. We assessed the association of smiling-age and walking-age with dichotomized ASQ-scores, using logistic regression analyses. Results For MLP children, each week later corrected smiling-age was associated with a relative increased likelihood of delays of 31, 43, 36 and 35% in the personal-social, problem-solving, gross motor and general developmental functioning, respectively. Each month later corrected walking-age was associated with a relative increased likelihood of delays of 10, 15 and 13% in the personal-social, gross motor and general developmental functioning, respectively. All corrected smiling-ages and walking-ages were within normal full-term ranges. For full-term children, we only found that later walking-age was associated with delays in the personal-social and gross motor domains. Conclusions Smiling-age and walking-age are associated with developmental delay in several domains for MLP and full-term children. Professionals could use these milestones to identify children that may benefit from closer monitoring of their development. Trial registration Clinical Trial Registry name and registration number: controlled-trials.com , ISRCTN80622320 .

BackgroundAdverse childhood experiences (ACEs) can cause serious mental problems in adolescents and therefore may expected to be associated with higher use of psychosocial care, potentially varying by type of specific ACE. The aim of our study is to explore the association of the number of ACE and types of specific ACE with entering and using psychosocial care.MethodsWe used data from the Slovak Care4Youth cohort study, comprising 509 adolescents from 10 to 16 years old (mean age 13.2 years, 48.6% boys). We used logistic regression models adjusted for age, gender, and family affluence to explore the associations of number and type of specific ACE with the use of psychosocial care.ResultsHaving three or more ACE as well as experiencing some specific ACE (death of a mother/father, death of somebody else you love, problems of a parent with alcohol or drugs, conflicts or physical fights between parents, and separation/divorce of parents) increased the likelihood of using psychosocial care. Regarding experience with the death of somebody else you love, we found a decreased likelihood of the use of psychosocial care.ConclusionExperiencing ACE above a certain threshold (three or more) and parent-related ACE increase the likelihood of adolescent care use.

Abstract Background Growth Mixture Modeling (GMM) is commonly used to group individuals on their development over time, but convergence issues and impossible values are common. This can result in unreliable model estimates. Constraining variance parameters across classes or over time can solve these issues, but can also seriously bias estimates if variances differ. We aimed to determine which variance parameters can best be constrained in Growth Mixture Modeling. Methods To identify the variance constraints that lead to the best performance for different sample sizes, we conducted a simulation study and next verified our results with the TRacking Adolescent Individuals’ Lives Survey (TRAILS) cohort. Results If variance parameters differed across classes and over time, fitting a model without constraints led to the best results. No constrained model consistently performed well. However, the model that constrained the random effect variance and residual variances across classes consistently performed very poorly. For a small sample size (N = 100) all models showed issues. In TRAILS, the same model showed substantially different results from the other models and performed poorly in terms of model fit. Conclusions If possible, a Growth Mixture Model should be fit without any constraints on variance parameters. If not, we recommend to try different variance specifications and to not solely rely on the default model, which constrains random effect variances and residual variances across classes. The variance structure must always be reported Researchers should carefully follow the GRoLTS-Checklist when analyzing and reporting trajectory analyses.

Abstract Background Adverse childhood experiences (ACEs) and poor family support and communication can increase emotional and behavioural problems (EBP). Therefore, we assessed the association of difficult communication with mother and with father separately with both emotional and behavioural problems (EBP), and whether adolescents’ communication with mother and with father moderates the association of adverse childhood experiences (ACE) with the EBP of adolescents. Methods We used data from the Health Behaviour in School-aged Children study conducted in 2018 in Slovakia, comprising 5202 adolescents aged from 11 to 15 (mean age 13.53; 49.3% boys). EBP were measured using the Strengths and Difficulties Questionnaire. We used generalized linear regression adjusted for age, gender and family affluence to explore the modification of the associations between ACE and EBP by communication (easy vs. difficult communication) with mother and father. Results Difficult communication or a complete lack of communication due to the absence of mother and father increased the probability of emotional (exp (b): 0.96, 95% CI: 0.92|1.00; and 0.95, 95% CI: 0.91|0.99, respectively) and also of behavioural problems (exp (b): 0.96, 95% CI: 0.92|1.00; and 0.94, 95% CI: 0.90|0.97, respectively). We found a statistically significant interaction of communication with father on the association of ACE with EBP, showing that the joint effects were less than multiplicative. Conclusion Difficult communication with mother and father is related to EBP among adolescents, and adolescents’ communication with father moderates the association of ACE with both emotional and behavioural problems among adolescents.

Abstract Background The Internet may serve as a suitable environment for discriminated adolescents as they may consider the online space as the place where they have possibility to build social ties they are missing in their offline life or manage their self-presentation. Therefore, our aim was to explore the association between different types of discrimination by peers (because of gender, physical appearance, culture/skin color/language, unfavorable family situation) and excessive Internet use (EIU), and whether gender moderates this association. Methods We used data from a representative sample of 6,462 Slovak adolescents (mean age: 13.00, 49.6% boys) from the HBSC study conducted in 2018. Data were collected through online self-reported questionnaires. We assessed the association between various types of discrimination by peers and EIU using linear regression, and the role of gender as potential moderator. Results Discrimination because of physical appearance was most prevalent (18.0%). Adolescents exposed to discrimination by peers reported higher levels of EIU. We found an interaction of gender on the association of discrimination because unfavorable family situation with EIU. Boys who experienced this type of discrimination were at higher risk of EIU compared to girls. Conclusion Discriminated adolescents are more likely to use the Internet excessively, with some associations being stronger for boys than for girls. Prevention strategies focused on raising adolescent awareness of the risks and benefits of the Internet should target discriminated adolescents, especially boys, as they seem to be the vulnerable group.

Abstract Background Mental health problems often arise in childhood and adolescence and can have detrimental effects on people’s quality of life (QoL). Therefore, it is of great importance for clinicians, policymakers and researchers to adequately measure QoL in children. With this review, we aim to provide an overview of existing generic measures of QoL suitable for economic evaluations in children with mental health problems. Methods First, we undertook a meta-review of QoL instruments in which we identified all relevant instruments. Next, we performed a systematic review of the psychometric properties of the identified instruments. Lastly, the results were summarized in a decision tree. Results This review provides an overview of these 22 generic instruments available to measure QoL in children with psychosocial and or mental health problems and their psychometric properties. A systematic search into the psychometric quality of these instruments found 195 suitable papers, of which 30 assessed psychometric quality in child and adolescent mental health. Conclusions We found that none of the instruments was perfect for use in economic evaluation of child and adolescent mental health care as all instruments had disadvantages, ranging from lack of psychometric research, no proxy version, not being suitable for young children, no age-specific value set for children under 18, to insufficient focus on relevant domains (e.g. social and emotional domains).

Abstract Background More alternatives have become available for the diagnosis and treatment of cancer in low- and middle-income countries. Because of increasing demands, governments are now facing a problem of limited affordability and availability of essential cancer medicines. Yet, precise information about the access to these medicines is limited, and the methodology is not very well developed. We assessed the availability and affordability of essential cancer medicines in Mexico, and compared their prices against those in other countries of the region. Methods We surveyed 21 public hospitals and 19 private pharmacies in 8 states of Mexico. Data were collected on the availability and prices of 49 essential cancer medicines. Prices were compared against those in Chile, Peru, Brazil, Colombia and PAHO’s Strategic Fund. Results Of the various medicines, mean availability in public and private sector outlets was 61.2 and 67.5%, respectively. In the public sector, medicines covered by the public health insurance “People’s Health Insurance” were more available. Only seven (public sector) and five (private sector) out of the 49 medicines were considered affordable. Public sector procurement prices were 41% lower than in other countries of the region. Conclusions The availability of essential cancer medicines, in the public and private sector, falls below World Health Organization’s 80% target. The affordability remains suboptimal as well. A national health insurance scheme could serve as a mechanism to improve access to cancer medicines in the public sector. Comprehensive pricing policies are warranted to improve the affordability of cancer medicines in the private sector.

Abstract Background Questionnaires to detect emotional and behavioral problems (EBP) in Preventive Child Healthcare (PCH) should be short which potentially affects validity and reliability. Simulation studies have shown that Computerized Adaptive Testing (CAT) could overcome these weaknesses. We studied the applicability (using the measures participation rate, satisfaction, and efficiency) and the validity of CAT in routine PCH practice. Methods We analyzed data on 461 children aged 10–11 years (response 41%), who were assessed during routine well-child examinations by PCH professionals. Before the visit, parents completed the CAT and the Child Behavior Checklist (CBCL). Satisfaction was measured by parent- and PCH professional-report. Efficiency of the CAT procedure was measured as number of items needed to assess whether a child has serious problems or not. Its validity was assessed using the CBCL as the criterion. Results Parents and PCH professionals rated the CAT on average as good. The procedure required at average 16 items to assess whether a child has serious problems or not. Agreement of scores on the CAT scales with corresponding CBCL scales was high (range of Spearman correlations 0.59–0.72). Area Under Curves (AUC) were high (range: 0.95–0.97) for the Psycat total, externalizing, and hyperactivity scales using corresponding CBCL scale scores as criterion. For the Psycat internalizing scale the AUC was somewhat lower but still high (0.86). Conclusions CAT is a valid procedure for the identification of emotional and behavioral problems in children aged 10–11 years. It may support the efficient and accurate identification of children with overall, and potentially also specific, emotional and behavioral problems in routine PCH.

BackgroundThe aim of this study is to explore the association of family socioeconomic status (SES) and internal and external schoolwork support with adolescents’ school satisfaction and whether schoolwork support modifies these associations.MethodsData come from the cross-sectional Health Behavior in School-aged Children study collected in 2018 from Slovak 15-year-olds (N = 1127; 52.7% boys). SES was measured by Family Affluence Scale (low; middle; high). School satisfaction was measured via school engagement and attitudes toward education. Schoolwork support was measured regarding two groups of sources inside and outside the family, separately. Logistic regression models were used to explore the associations of SES and schoolwork support with school satisfaction as well as the moderating effect of schoolwork support.ResultsAdolescents with low SES were more likely to feel indifferent toward school and education (odds ratios/95%-confidence interval: 1.77/1.26–2.49), and similarly, adolescents who did not have schoolwork support inside or outside the family (1.38/1.02–1.87, and 1.50/1.01–2.22, respectively). Schoolwork support moderated the associations of SES with school satisfaction. Adolescents with low and middle SES without support inside or outside the family were more likely to feel indifferent than satisfied (2.72/1.21–6.10; 3.00/1.27–7.06; and 2.86/1.05–7.80; 6.04/1.72–21.24, respectively).ConclusionAdolescents from low and middle SES without schoolwork support inside or outside the family are more likely to feel indifferent toward school and education.

Objectives: To explore the role of resilience as a mediator in the association between adverse childhood experiences (ACE) and emotional and behavioural problems (EBP) among adolescents.Methods: We used data from the Slovak 2018 Health Behaviour in School-aged Children study, comprising 2,839 adolescents aged 13–15 (mean age 13.93; 49.6% boys). We used multivariate linear regression performed on 5000 bootstrap samples adjusted for age, gender, family affluence to explore mediation of the associations between ACE (measured using the adapted Adverse Childhood Experience Questionnaire) and EBP (measured using the Strengths and Difficulties Questionnaire) by resilience (measured with the Child and Youth Resilience Measure).Results: We found ACE [B = 0.78; 95% confidence interval (CI): 0.67|0.90] and resilience (B = −0.73; 95% CI: −0.79|−0.67) to be significantly associated with EBP. The association of ACE and EBP was mediated by resilience. The mediated indirect effect of resilience was ab = 0.25; 95% CI: 0.18|0.32.Conclusion: Resilience seems to play a mediator role in the relationship between ACE and EBP. Helping adolescents with ACE to build and use internal and external sources of resilience can decrease the negative impact of ACE on EBP.

Abstract Background The aim of this study is to understand the determinants of adherence to wrap-around care (WAC) by professional care providers working in child and family services. WAC is a care coordination method targeting families with complex needs. The core components of WAC involve activating family members and the social network, integrating the care provider network, and assessing, planning and evaluating the care process. WAC was introduced in the Netherlands using two approaches: the network approach (NA) and the team approach (TA). Methods A cross-sectional study was conducted using a digital questionnaire targeted at care providers. After imputation of missing data, univariate and multilevel regression analyses were conducted to study the associations between adherence to the core components of WAC, the determinants of adherence and background characteristics. Results In total 145 out of 275 care providers (52.7%) responded to the questionnaire. Multilevel regression analysis showed that self-efficacy of the care providers and the way WAC is organised (NA versus TA region) were significantly associated with adherence to core components of WAC. Self-efficacy was significantly associated with all WAC core components (activating family members and the social network: β (95% confidence interval, CI) = .27(.04–.50), integrating the network of care providers: β (95% CI) = .27(.05–.50) and assessing, planning and evaluating the care process: β (95% CI) = .30(.08–.52)). The way WAC is organised was significantly associated to two core components (activating family members and the social network: β (95% CI) = .18(0.1–.37) and integrating the network of care providers: β (95% CI) = .25(.09–.42)). Conclusion The way WAC is organised and the self-efficacy of care providers who use WAC are factors that are relevant for the redesign of the strategy for introducing WAC. Longitudinal research into the predictive value of determinants of adherence to WAC is advised.

Abstract Background When implementing an empirically supported intervention (ESI) arrays of influencing factors operate on the professional and organizational level, but so far dependency between these levels has often been ignored. The aim of this study is to describe the pace and identify determinants of implementation of the Self-Management of Well-being (SMW) group intervention while taking the dependency between professionals and organizations into account. Methods Pace of implementation was measured as the time between training of professionals and first use of the SMW intervention in months. Determinants of first use were derived from the Fleuren framework and assessed using web-based questionnaires and telephone interviews. First, univariate analyses, Fisher’s exact tests and t-tests, were performed to identify determinants of first use of the SMW intervention on the individual professional and the organizational level independently. Second, multilevel analyses were performed to correct for the dependency between professionals and organizations. Simple multilevel logistic regression analyses were performed with determinants found significant in the univariate analyses as independent variables, first use as dependent variable, professionals entered in the first level, and organizations in the second level. Results Forty-eight professionals from 18 organizations were trained to execute the SMW intervention. Thirty-two professionals achieved first use, at a mean pace of 7.5 months ± 4.2. Determinants on the professional level were ‘ownership’, ‘relative advantage’, ‘support from colleagues’ and ‘compatibility’. Determinants on the organizational level were ‘organizational size’ and ‘innovation-task orientation fit’. Multilevel analysis showed that ‘compatibility’, a factor on the professional level, was the only significant determinant contributing to first use in the multilevel model. Conclusions This implementation study revealed a strong dependency between professionals and organizations. Results showed that a majority of professionals used the SMW intervention in about 8 months. When the dependency between professionals and organization was taken into account, the professionals’ perception of compatibility was the only remaining determinant of implementation on the professional level. Organizational size and managers’ perception of ‘innovation-task orientation fit’ were determinants of implementation on the organizational level. It is advisable to discuss the compatibility between new and current tasks among managers and professionals before adopting a new intervention.

Objectives: Chronic kidney disease (CKD) strongly affects patients’ health-related quality of life (HRQoL), mostly in the advanced stages of CKD. Health literacy (HL) may affect this association, in particular for some aspects of HRQoL. The aim of this study is to compare the profiles of HRQoL in dialyzed patients with varying HL.Methods: We obtained data on HL using the Health Literacy Questionnaire (HLQ) and on HRQoL using the Kidney Disease Quality of Life – Short Form (KDQoL-SF 1.3) in a multicentre cross-sectional study in 20 dialysis clinics in Slovakia (n = 542; mean age = 63.6 years; males: 60.7%). We compared HRQoL for three HL groups using ANOVA and the Kruskal-Wallis test.Results: Patients with low HL reported worse HRQoL than patients with moderate and high HL. The greatest differences between HL groups were found in the scales Effect of kidney disease, Cognitive function, Quality of social interaction, Social support, Dialysis staff encouragement, Patient satisfaction, Physical functioning, Pain, Emotional well-being and Social function. p-values in all cases were

Objectives: To explore the association of family-related adversities with physical fighting, and whether this association is mediated by hopelessness.Methods: The sample consisted of 3712 Slovak adolescents (mean age: 13.9, 50.7% girls). Participants answered questions regarding experienced family-related adversities, involvement in physical fighting in the last 12 months and the Hopelessness Questionnaire. First, the association of family adversities in general with fighting and of each of family-related adversity separately was assessed using linear regression models and second, mediation was assessed using the a*b product method with bootstrapped 95% confidence intervalsResults: Adolescents who had experienced at least one family adversity reported more frequent fighting. Similarly, each of reported family adversities (death of a parent, substance abuse problems of a parent, conflicts/physical fights, divorce) was associated with more frequent fighting among adolescents. The mediation effect of hopelessness was found in each association of family-related adversity with fighting.Conclusion: These findings suggest that interventions to support adolescents who had experienced family adversities could among other things be directed at better coping with hopelessness.

Objective: We aimed to investigate the feasibility of live-performed music therapy for extremely and very preterm infants admitted to the neonatal intensive care unit (NICU), and their parents, starting the 1st−2nd week after birth. They may benefit from live-performed music therapy as comforting non-pharmacological intervention.Study Design: We included infants born before 30 weeks' gestation in a single center NICU study. Live-performed music therapy was provided three times per week, tailored to the infant's medical condition. Parents were actively involved. Feasibility was determined as a combination of participation, drop-out, overstimulation (based on COMFORT-Neo scores), and evaluations of the intervention by parents and nurses (using a questionnaire on perceived effects on the parent, their infant and the NICU sound environment).Results: We included 18 infants (90% participation rate), with a gestational age of median 27 weeks (IQR 26–28 weeks), 61% males. One infant (5.6%) dropped-out. Differences of COMFORT-Neo scores during and after sessions compared with before sessions were non-significant; overstimulation by music therapy did not occur. Parents reported high satisfaction (highest score possible of 7) with the interventions and reported improvements in both infant and their own respiratory rates. Nurses also reported high satisfaction with the intervention and perceived a quieter NICU sound environment during and after sessions.Conclusion: Live-performed music therapy for extremely and very preterm infants is feasible and well-tolerated, and is experienced as an added value to developmental care. Future studies should assess both short-term and long-term effects, to determine whether this intervention should be part of routine care at the NICU and whether it is most beneficial to start shortly after birth.

Humans and their gut microbiota have co-evolved over thousands of years, resulting in the establishment of a complex host–microbiota ecosystem. Early life environmental factors, such as delivery mode, nutrition, and medication use, have been shown to substantially affect both host–microbiota interactions and health outcomes. However, the effects of urbanization (characterized by the spectrum of rural and urban populations) on these early life events have been overlooked. A deeper understanding of the relationship between urbanization and microbiota development will allow for the identification of novel biological and social approaches that can be implemented to prevent and treat disease and promote maternal and infant/child health. The aim of this narrative review is to summarize how factors associated with urbanization differentially impact delivery mode, nutrition, and medication use, and how these changes subsequently affect the gut microbiota and health outcomes of infants. This narrative review also describes the important evidence gaps associated with these relationships and recommends actions that can be taken to improve the health of mothers and infants worldwide.

Abstract Background Guidelines on modifiable risk factors regarding cardiological patients are poorly implemented in clinical practice perhaps due to low health literacy. Several digital tools for improving lifestyle and behavioural intervention were developed. Our primary aim is to evaluate the effectiveness of a digital exercise prescription tool on the adherence to physical activity recommendations among patients with cardiovascular diseases. Methods A randomized controlled trial will be realized in cooperation with Cardiovascular Health Centres in Eastern Slovakia. Patients recruited through their cardiologists, will be randomised at 1:1 ratio to the three-months’ experimental condition or control condition. The experimental group will receive standard lifestyle consultation leading to individually optimized prescription of physical activity. The control group will receive standard, usual-cardio-care lifestyle counselling, also in the domain of physical activity. The digital system will be used for optimized exercise prescription. The primary outcome is a change in the patient’s adherence to exercise recommendations. Data will be collected in both groups prior to consultation and after 3 months. Discussion This study protocol presents background and design of a randomized control trial to investigate the effectiveness of a digital system-provide exercise prescription tool on the adherence to physical activity recommendations. An optimized exercise prescription that better reflects patient’s diagnosis, comorbidities and medication can have a significant impact on secondary prevention of cardiovascular disease. This trial can provide important evidence about the effectiveness of digital exercise guidance in everyday practice of cardiovascular healthcare. Trial registration The study was registered on 1st November, 2017 and is available online at ClinicalTrials.gov (ID:NCT03329053).

Abstract Background Many older adults have low levels of health literacy which affects their ability to participate optimally in healthcare. It is unclear how cognitive decline contributes to health literacy. To study this, longitudinal data are needed. The aim of this study was therefore to assess the associations of cognitive functioning and 10-years’ cognitive decline with health literacy in older adults. Methods Data from 988 participants (mean age = 65.3) of the Doetinchem Cohort Study were analyzed. Health literacy was measured by the Brief Health Literacy Screening. Memory, mental flexibility, information processing speed, and global cognitive functioning were assessed at the same time as health literacy and also 10 years earlier. Logistic regression analyses were performed, adjusted for age, gender, and educational level. Results Higher scores on tests in all cognitive domains were associated with a lower likelihood of having low health literacy after adjustment for confounders (all ORs 1.37, p-values

Abstract Background The World Health Organization recommends establishing and implementing a national pharmaceutical policy (NPP) to guarantee effective and equitable access to medicines. Mexico has implemented several policy approaches to regulate the pharmaceutical sector, but it has no formal NPP. This article describes the approach that the Mexican government has taken to improve availability and affordability of essential medicines. Methods Descriptive policy analysis of public pharmaceutical policy proposals and health action plans on the basis of publicly available data and health progress reports, with a focus on availability and affordability of medicines. Results The government has implemented pooled procurement, price negotiations, and an information platform in the public sector to improve affordability and availability. The government mainly reports on the savings that these strategies have generated in the public expenditure but their full impact on availability and affordability has not been assessed. Conclusions To increase availability and affordability of medicines in the public sector, the Mexican government has resorted on isolated strategies. In addition to efficient procurement, price negotiations and price information, other policy components and pricing interventions are needed. All these strategies should be included in a comprehensive NPP.