Menstrual hygiene management in schools: midway progress update on the "MHM in Ten" 2014-2024 global agenda.

Progress has been made in recent years to bring attention to the challenges faced by school-aged girls around managing menstruation in educational settings that lack adequate physical environments and social support in low- and middle-income countries. To enable more synergistic and sustained progress on addressing menstruation-related needs while in school, an effort was undertaken in 2014 to map out a vision, priorities, and a ten-year agenda for transforming girls' experiences, referred to as Menstrual Hygiene Management in Ten (MHM in Ten). The overarching vision is that girls have the information, support, and enabling school environment for managing menstruation with dignity, safety and comfort by 2024. This requires improved research evidence and translation for impactful national level policies. As 2019 marked the midway point, we assessed progress made on the five key priorities, and remaining work to be done, through global outreach to the growing network of academics, non-governmental organizations, advocates, social entrepreneurs, United Nations agencies, donors, and national governments. This paper delineates the key insights to inform and support the growing MHM commitment globally to maximize progress to reach our vision by 2024. Corresponding to the five priorities, we found that (priority 1) the evidence base for MHM in schools has strengthened considerably, (priority 2) global guidelines for MHM in schools have yet to be created, and (priority 3) numerous evidence-based advocacy platforms have emerged to support MHM efforts. We also identified (priority 4) a growing engagement, responsibility, and ownership of MHM in schools among governments globally, and that although MHM is beginning to be integrated into country-level education systems (priority 5), resources are lacking. Overall, progress is being made against identified priorities. We provide recommendations for advancing the MHM in Ten agenda. This includes continued building of the evidence, and expanding the number of countries with national level policies and the requisite funding and capacity to truly transform schools for all students and teachers who menstruate.

Race, ethnicity, and the relevance of obesity for social integration.

OBJECTIVE: To examine race and ethnic differences in the importance of obesity for social integration using the National Longitudinal Study of Adolescent Health (Add Health). DESIGN: A cross-sectional study utilizing survey-adjusted statistics and multivariate logistic and linear regression models. Models were stratified by sex and included interaction terms capturing race, ethnicity and obesity. SETTING: United States of America. PARTICIPANTS: A nationally representative sample of 15,355 respondents grades 7 through 12 who participated in both the In-School and In-Home Wave I surveys of Add Health. MAIN OUTCOME MEASURES: Four self-reported and schoolmate-reported indicators of social integration. RESULTS: The consequences of obesity for social integration are greatest for White adolescents, who were selected by almost 2 fewer schoolmates as friends and had half the odds of having their friendships reciprocated compared with non-obese White adolescents. The social disadvantage of obesity was lower for non-White adolescents; though they are selected by significantly fewer schoolmates as friends and were less likely to have their friendships reciprocated, they did not face additional discrimination from being both obese and minority. CONCLUSIONS: There are significant differences between obese and non-obese adolescents by race and ethnicity in friendships. As friendships are among the most valued assets in adolescence, understanding the impact of obesity on access to friendships for diverse adolescents is a necessary component to understanding the complex motivations that guide health-related behavior at these formative ages.

The More You Know, the Less You Stress: Menstrual Health Literacy in Schools Reduces Menstruation-Related Stress and Increases Self-Efficacy for Very Young Adolescent Girls in Mexico.

Improving the menstrual health literacy of girls and boys is a key strategy within a holistic framework of Save the Children's school health and comprehensive sexuality education programming. As menstrual health is an emerging area of study and programming, Save the Children continues to learn and adjust its interventions using program evaluations and rigorous monitoring. This paper will examine program-monitoring data from three cohorts, representing 47 public schools in Mexico City, Puebla, and Mérida, Mexico. The study focuses on female students in 5th and 6th grade who participated in We See Equal, a school-based program centered on gender equality and puberty education, between September 2018 and December 2019. This study used a cross-sectional quantitative cohort approach to document changes in girls' experiences and perceptions around managing menstruation in school. The analysis compares girls' knowledge and experiences before and after participation in We See Equal to understand how knowledge changes over the program and how those changes may contribute to menstruation-related school engagement, stress, and self-efficacy (MENSES) outcomes. Multivariate regression models explored relationships between MENSES outcomes, knowledge and socioeconomic status (SES). Overall, results show that the more knowledge girls acquired, the higher their self-efficacy score and the lower their stress score, however, certain MHH knowledge was more predictive of MENSES outcomes and varied by SES. Among girls from lower SES, we observed significant relationships between knowing what their period was prior to menarche and the three MENSES outcomes. Decreases in menstruation-related stress were driven by items related to the practical knowledge of how to dispose of sanitary pads and reduced feelings of nervousness on days they had their period at school. Increases in self-efficacy were primarily driven by girls' confidence in their ability to track their period from month to month, feelings that they could still do well on an exam if they had their period at school, and security that they could ask a friend to lend them a pad if they needed one. Implications for future menstrual health literacy programming and targeting populations for menstrual health education, as well as priorities for future research will be discussed.

Family presence in final moments: a precious gift.

The experience of a family and nurse who shared the acute illness of a teenager illustrates advocacy for family presence in the ICU and during resuscitation as well as integration of spiritual care in complex nursing practice. Family participation supports physical, emotional, and spiritual needs, allowing for open communication and the comfort of knowing that a loved one is receiving care. Although critical care, heart, and emergency nursing associations support family presence and holistic care, family presence remains controversial.