The perceived mental health experiences and needs of postpartum mothers living in the United Arab Emirates : A focus group study.

BACKGROUND: After childbirth, mothers are particularly vulnerable to mental health problems including anxiety and depression, which often remain undetected and untreated. In the United Arab Emirates (UAE), recent figures revealed a substantial prevalence of postpartum depression. However, postpartum mental health remains largely understudied in the country's clinical and research settings. Therefore, given the paucity of literature in the UAE and building upon previous epidemiological findings, this study aimed to explore the perceived mental health experiences and needs of mothers during the postpartum period to guide the development of targeted interventions that address mothers' unique mental health challenges. METHODOLOGY: Four focus groups were conducted, involving a total of 27 Emirati and multicultural expatriate mothers aged 32.47 ± 4.56 years old, living in the UAE and within their first year postpartum. Descriptive interpretive thematic analysis was employed to analyze the data. ANALYSIS: Six themes were generated that capture the mothers postpartum experiences and mental health needs: (1) distinct postpartum experiences of primiparous and multiparous mothers, (2) experiences of emotional distress in the initial postpartum stage, (3) multifaceted challenges in breastfeeding, (4) multifactorial influences on postpartum mental health, (5) postpartum social support resources and providers, and (6) the need for formal and informal resources. CONCLUSIONS: The findings highlight the importance of considering the unique cultural and societal factors that impact maternal mental health in the UAE, given its diverse population. A collaborative multidisciplinary approach, integrating culture sensitivity, is vital to address the mental health needs of postpartum mothers and to guide the development of tailored evidence-based interventions.

Disease severity-based subgrouping of type 2 diabetes does not parallel differences in quality of life: the Maastricht Study.

AIMS/HYPOTHESIS: Type 2 diabetes is a highly heterogeneous disease for which new subgroups ('clusters') have been proposed based on disease severity: moderate age-related diabetes (MARD), moderate obesity-related diabetes (MOD), severe insulin-deficient diabetes (SIDD) and severe insulin-resistant diabetes (SIRD). It is unknown how disease severity is reflected in terms of quality of life in these clusters. Therefore, we aimed to investigate the cluster characteristics and cluster-wise evolution of quality of life in the previously defined clusters of type 2 diabetes. METHODS: We included individuals with type 2 diabetes from the Maastricht Study, who were allocated to clusters based on a nearest centroid approach. We used logistic regression to evaluate the cluster-wise association with diabetes-related complications. We plotted the evolution of HbA1c levels over time and used Kaplan-Meier curves and Cox regression to evaluate the cluster-wise time to reach adequate glycaemic control. Quality of life based on the Short Form 36 (SF-36) was also plotted over time and adjusted for age and sex using generalised estimating equations. The follow-up time was 7 years. Analyses were performed separately for people with newly diagnosed and already diagnosed type 2 diabetes. RESULTS: We included 127 newly diagnosed and 585 already diagnosed individuals. Already diagnosed people in the SIDD cluster were less likely to reach glycaemic control than people in the other clusters, with an HR compared with MARD of 0.31 (95% CI 0.22, 0.43). There were few differences in the mental component score of the SF-36 in both newly and already diagnosed individuals. In both groups, the MARD cluster had a higher physical component score of the SF-36 than the other clusters, and the MOD cluster scored similarly to the SIDD and SIRD clusters. CONCLUSIONS/INTERPRETATION: Disease severity suggested by the clusters of type 2 diabetes is not entirely reflected in quality of life. In particular, the MOD cluster does not appear to be moderate in terms of quality of life. Use of the suggested cluster names in practice should be carefully considered, as the non-neutral nomenclature may affect disease perception in individuals with type 2 diabetes and their healthcare providers.

Determinants of preventive sexual behaviours among first year university students in Beira city, central Mozambique: a cross-sectional study.

BACKGROUND: Understanding determinants of preventive sexual behaviours is important for intervention efforts to support these behaviours and, thereby, reduce STIs and HIV burden. In general, there is limited insight into determinants of preventive behaviours among university students in Mozambique. Therefore, this study set out to assess both the prevalence and the determinants of condom use and voluntary counselling and testing (VCT) service use in first year university students. METHODS: We conducted a cross-sectional study in May-September 2021, at the Universidade Católica de Moçambique and the Universidade Licungo, in Beira central Mozambique. We collected data on sociodemographic characteristics, heterosexual relationship experiences and personal determinants posited to be associated with condom use and VCT service use. We included 819 participants, who were selected using a clustered and random sampling design. We used Pearson's chi-square test to compare proportion and estimate the crude odd ratio as the effect size measure at 95% confidence interval, and Confidence Interval-Based Estimation of Relevance to determine correlation coefficients of means and the behaviours of interest at 95% confidence interval. RESULTS: Condoms were used by 96.1% of male participants and 95.0% of female participants. Additionally, 55.1% of male participants and 57.5% of female participants had previously used VCT services. Condom use was associated with discussing sexuality with mother, and self-efficacy for condom use negotiation, and negatively associated with attitudes that condoms reduce pleasure. VCT service use was associated with discussing sexuality with mother, sexual debut, having a sexual partner, and being in what they consider an important heterosexual relationship. Knowledge, attitude, self-efficacy and subjective norms were weakly associated with VCT service use. CONCLUSION: In first year university students in Mozambique, reported condom use was high but VCT services were only used by about half of the participants. Interventions aiming to increase VCT service use should focus on improving communication between parents and their adolescent or young adult children, providing personalized risk information, demonstrating that VCT service use is pleasant and non-judgmental, improving users' confidence to schedule a visit, and preparing users for possible positive testing results.

INTRODUçãO: Compreender os determinantes de comportamentos sexuais preventivos é importante para guiar o desenvolvimento de intervenções que reforçam e apoiam estes comportamentos e, assim, reduzir a carga das infecções transmitida sexualmente (ITSs) e do Vírus de Imunodeficiência Humana (HIV). Em geral, informação sobre os determinantes de comportamentos preventivos entre os estudantes universitários é limitada em Moçambique. Portanto, este estudo teve como objetivo avaliar a prevalência e os determinantes do uso de preservativos e uso dos serviços de aconselhamento e testagem em saúde (ATS) em estudantes universitários do primeiro ano. MéTODOS: Realizamos um estudo transversal em Maio­Setembro de 2021, na Universidade Católica de Moçambique e na Universidade Licungo, na Beira centro de Moçambique. Coletamos dados sobre características sociodemográficas, experiências de relacionamento heterossexual e determinantes pessoais considerados associados ao uso de preservativo e ao uso dos serviços de ATS. Foram incluídos 819 participantes, estes foram selecionados usando o desenho amostral de conglomerado e aleatório. Utilizamos o teste qui-quadrado para comparar as proporções, usamos odd ratio para estimativa de tamanho do efeito a 95% de intervalo de confiança. e para identificar os determinantes relevantes usamos a abordagem da estimativa de relevância baseada no intervalos de confiança (CIBER). RESULTADOS: O uso do preservativo foi declarado por cerca de 96,1% dos participantes homens e 95,0% de participantes mulheres. Mas apenas 55,1% dos participantes homens e 57,5% das participantes mulheres referiram terem usado o serviço de ATS. O uso do preservativo foi associado à discussão da sexualidade com a mãe e positivamente associado à autoconfiança para negociação do uso do preservativo, e negativamente associado à atitude de que, o preservativo reduz o prazer. O uso dos serviços de ATS foi associado à discussão da sexualidade com a mãe, início da vida sexual, ter um parceiro sexual e estar num relacionamento heterossexual que consideram importante. Conhecimento, atitude, autoconfiança e normas subjetivas mostraram-se fracamente associados ao uso de serviços de ATS. CONCLUSãO: Em estudantes universitários do primeiro ano em Moçambique, o relatado de uso do preservativo foi elevado, mas os serviços de ATS foram usados por apenas cerca de metade dos participantes. Intervenções que visam aumentar a visita e utilização dos serviços ATS devem centrar-se na melhoria da comunicação entre os pais e os seus filhos adolescentes ou jovens adultos, fornecendo informações personalizadas sobre riscos, demonstrando que a utilização dos serviços de ATS é agradável e sem julgamentos, incentivar a autoconfiança dos utentes para agendar uma visita à ATS e preparar usuários para possíveis resultados de testes positivos.

Associations of an individual's need for cognition with structural brain damage and cognitive functioning/impairment: cross-sectional population-based study.

BACKGROUND: High cognitive activity possibly reduces the risk of cognitive decline and dementia. AIMS: To investigate associations between an individual's need to engage in cognitively stimulating activities (need for cognition, NFC) and structural brain damage and cognitive functioning in the Dutch general population with and without existing cognitive impairment. METHOD: Cross-sectional data were used from the population-based cohort of the Maastricht Study. NFC was measured using the Need For Cognition Scale. Cognitive functioning was tested in three domains: verbal memory, information processing speed, and executive functioning and attention. Values 1.5 s.d. below the mean were defined as cognitive impairment. Standardised volumes of white matter hyperintensities (WMH), cerebrospinal fluid (CSF) and presence of cerebral small vessel disease (CSVD) were derived from 3T magnetic resonance imaging. Multiple linear and binary logistic regression analyses were used adjusted for demographic, somatic and lifestyle factors. RESULTS: Participants (n = 4209; mean age 59.06 years, s.d. = 8.58; 50.1% women) with higher NFC scores had higher overall cognition scores (B = 0.21, 95% CI 0.17-0.26, P < 0.001) and lower odds for CSVD (OR = 0.74, 95% CI 0.60-0.91, P = 0.005) and cognitive impairment (OR = 0.60, 95% CI 0.48-0.76, P < 0.001) after adjustment for demographic, somatic and lifestyle factors. The association between NFC score and cognitive functioning was similar for individuals with and without prevalent cognitive impairment. We found no significant association between NFC and WMH or CSF volumes. CONCLUSIONS: A high need to engage in cognitively stimulating activities is associated with better cognitive functioning and less presence of CSVD and cognitive impairment. This suggests that, in middle-aged individuals, motivation to engage in cognitively stimulating activities may be an opportunity to improve brain health.

How to use machine learning and fuzzy cognitive maps to test hypothetical scenarios in health behavior change interventions: a case study on fruit intake.

BACKGROUND: Intervention planners use logic models to design evidence-based health behavior interventions. Logic models that capture the complexity of health behavior necessitate additional computational techniques to inform decisions with respect to the design of interventions. OBJECTIVE: Using empirical data from a real intervention, the present paper demonstrates how machine learning can be used together with fuzzy cognitive maps to assist in designing health behavior change interventions. METHODS: A modified Real Coded Genetic algorithm was applied on longitudinal data from a real intervention study. The dataset contained information about 15 determinants of fruit intake among 257 adults in the Netherlands. Fuzzy cognitive maps were used to analyze the effect of two hypothetical intervention scenarios designed by domain experts. RESULTS: Simulations showed that the specified hypothetical interventions would have small impact on fruit intake. The results are consistent with the empirical evidence used in this paper. CONCLUSIONS: Machine learning together with fuzzy cognitive maps can assist in building health behavior interventions with complex logic models. The testing of hypothetical scenarios may help interventionists finetune the intervention components thus increasing their potential effectiveness.

Maternal Health Care Service Utilization in the Post-Conflict Democratic Republic of Congo: An Analysis of Health Inequalities over Time.

This study assessed inequality in maternal healthcare service utilization in the Democratic Republic of the Congo, using the Demographic and Health Surveys of 2007 and 2013-2014. We assessed the magnitude of inequality using logistical regressions, analyzed the distribution of inequality using the Gini coefficient and the Lorenz curve, and used the Wagstaff method to assess inequality trends. Women were less likely to have their first antenatal care visit within the first trimester and to attend more antenatal care visits when living in eastern Congo. Women in rural areas were less likely to deliver by cesarean section and to receive postnatal care. Women with middle, richer, and richest wealth indexes were more likely to complete more antenatal care visits, to deliver by cesarean section, and to receive postnatal care. Over time, inequality in utilization decreased for antenatal and postnatal care but increased for delivery by cesarean sections, suggesting that innovative strategies are needed to improve utilization among poorer, rural, and underserved women.

Basic Health Service Delivery to Vulnerable Populations in Post-Conflict Eastern Congo: Asset Mapping.

Populations in post-conflict settings often have increased healthcare needs, residing in settings where basic services needed to maintain good health may be non-existent or hard to access. Therefore, there is a need for better identification and reallocation of resources as part of the post-conflict health rehabilitation effort. Assets can be described as the collective resources that individuals and communities have at their disposal, which protect against adverse health outcomes and promote health status. This study applies an asset-based approach to explore the most optimal design of health services and to identify the resource constraints for basic health service delivery to the most vulnerable communities in eastern Congo. We implemented the asset mapping in two phases. Firstly, we combined a qualitative survey with community walks to identify the assets already present in the communities. Secondly, we conducted group discussions to map out assets that are the core of asset-based community development (ABCD) practice. We finally documented all assets in a Community Asset Spreadsheet. Overall, 210 assets were identified as available and potentially valuable resources for the communities in eastern Congo. Among them, 57 were related to local associations, 23 to land and physical environments, 43 to local institutions, 46 to individuals, 35 to economy and exchange, and only 6 to culture, history, and stories. Drawing upon the findings of the qualitative survey, community walks, and group discussions, we concluded that an important number of resources are in place for basic health service delivery. By activating existing and potential resources, the most vulnerable populations in eastern Congo might have the required resources for basic health service delivery. Our findings support the use of an asset-mapping research method as appropriate for identifying existing and potential resources for basic health services in a post-conflict setting.

Patterns and Determinants of Weight Gain among People Who Use Drugs Undergoing Treatment for Recovery in Lebanon.

Substance use disorder compromises the nutritional status and the eating habits of drug users, often leading to malnutrition. Once referred for treatment, hyperphagia and poor lifestyle practices leading to weight gain are observed. This study aimed to examine the patterns and extent of weight change as well as the determinants of weight gain in a sample of drug users who were receiving treatment in Lebanon. A total of 172 male participants undergoing either rehabilitation or opioid substitution treatment (OST) were included. Multivariate regression analysis was applied to assess the effect of different variables on weight gain while adjusting for potentially confounding variables. Approximately two-thirds (65.1%) of the participants gained weight (OST: 54.3%, rehabilitation: 78.2%; p < 0.05). The mean weight gain was 5.9 kg and was mainly reported among participants in the underweight, normal, and overweight pre-treatment categories and accentuated in the rehabilitation group (OST: 2 kg, Rehabilitation: 10.6 kg). Around half of the participants moved from the normal weight category to the overweight and obese categories during treatment. Weight gain was negatively associated with the number of previous treatment attempts (Odds Ratio = 0.86; Confidence Interval: 0.74-0.99), duration of current treatment (Odds Ratio = 0.98; Confidence Interval: 0.96-0.99), and pre-treatment body mass index (BMI) (Odds Ratio = 0.88; Confidence Interval: 0.80-0.96). Investigating other nutrition and lifestyle practices, neither nutrition knowledge, food addiction, physical activity level, nor sleep quality were associated with weight gain. Treatment through drug use was associated with meaningful weight gain that might lead to health risk factors. Developing health promotion programs is crucial to enhance treatment and decrease the risk of relapse.

Prevalence and risk factors of postpartum depression among women living in the United Arab Emirates.

PURPOSE: Postpartum depression received almost no attention in the United Arab Emirates (UAE). The aim was to examine the prevalence of depressive symptomatology and the associated risk factors among women in the UAE. METHODS: A prospective cohort study recruited women from postpartum wards in hospitals across four emirates in the UAE. Women completed questionnaires immediately after childbirth and at 3 and 6 months postpartum. Depressive symptomatology was measured using the Edinburgh Postnatal Depression Scale (EPDS > 12). Risk factors were identified using the generalized estimating equation. A stratified analysis of the postpartum period was performed. RESULTS: Among the 457 women recruited, 35% exhibited depressive symptomatology within the first 6 months postpartum. Younger women (< 25 years), part-time employment, the receipt of financial support from the family, and difficulty in managing monthly income were associated with a higher risk of postpartum depression. Husband's employment, husband's support, and living in own house were associated with a lower risk of postpartum depression. Maternity leave of more than 3 months increased the risk of depression during the first 3 months postpartum. From 3 to 6 months postpartum, Muslim women had a higher risk of depression whereas women who breastfed other children and in the past 7 days, and perceived their infant as healthy had a lower risk of depression. CONCLUSIONS: The prevalence of maternal depressive symptomatology is considerable in the UAE. Risk factors change over the 6-month postpartum period suggesting the need for an innovative multidisciplinary approach to the management of postpartum depression, including follow-up screening.

FCMpy: a python module for constructing and analyzing fuzzy cognitive maps.

FCMpy is an open-source Python module for building and analyzing Fuzzy Cognitive Maps (FCMs). The module provides tools for end-to-end projects involving FCMs. It is able to derive fuzzy causal weights from qualitative data or simulating the system behavior. Additionally, it includes machine learning algorithms (e.g., Nonlinear Hebbian Learning, Active Hebbian Learning, Genetic Algorithms, and Deterministic Learning) to adjust the FCM causal weight matrix and to solve classification problems. Finally, users can easily implement scenario analysis by simulating hypothetical interventions (i.e., analyzing what-if scenarios). FCMpy is the first open-source module that contains all the functionalities necessary for FCM oriented projects. This work aims to enable researchers from different areas, such as psychology, cognitive science, or engineering, to easily and efficiently develop and test their FCM models without the need for extensive programming knowledge.

Neck Circumference as a Screening Tool for Metabolic Syndrome among Lebanese College Students.

Metabolic syndrome (MetS) is a cluster of symptoms that, when present, increase the risk for cardiovascular disease. There is a need for reliable screening tools that are ethnically sensitive. Two hundred and sixty-six college students were assessed anthropometrically. They had a fasting blood sample drawn, and blood pressure measured. They then completed a demographic questionnaire and The International Physical Activity Questionnaire (IPAQ). The prevalence of MetS was found to be 10.1% in males and 4.5% in females. Neck circumference (NC) was positively associated with BMI in males (r = 0.55, p < 0.001) and females (r = 0.53, p < 0.001) and was positively associated with hip circumference in both males (r = 0.47, p < 0.001) and females (r = 0.50, p < 0.001) and with waist circumference in males (r = 0.46, p < 0.001) and females (r = 0.49, p < 0.001.) An area under the curve (AUC) was calculated using receiver operating characteristics (ROC), and NC > 38 cm in males and NC> 36 cm in females were found to be appropriate cut-offs for diagnosing MetS. NC is a reliable and non-invasive screening tool that can be used to screen for MetS in males. NC could also serve as an anthropometric instrument to assess abdominal obesity and could be valuable for college students.

Health inequalities in post-conflict settings: A systematic review.

Conflict can be a primary driver of health inequalities, but its impact on the distribution of social determinants of health is not very well documented. Also, there is limited evidence on the most suitable approaches aiming at addressing health inequalities in post-conflict settings. Thus, we undertook a systematic review of the literature concerning the current knowledge and knowledge gaps about structural determinants of health inequalities and assessed the effects of approaches aimed at addressing health inequalities in post-conflict settings. We performed a systematic search in bibliographic databases such as Web of Science, PubMed, and PsycINFO for relevant publications, as well as institutional websites that are relevant to this topic. The search was initiated in March 2018 and ultimately updated in December 2020. No time or geographical restrictions were applied. The quality of each study included in this review was independently assessed using criteria developed by CASP to assess all study types. Sixty-two articles were deemed eligible for analysis. The key findings were captured by the most vulnerable population groups, including the civilian population, women, children, internally displaced persons (IDPs), and people with symptoms of mental illness. A considerable range of approaches has been used to address health inequalities in post-conflict settings. These approaches include those used to address structural determinants of health inequalities which are accountable for the association between poverty, education, and health inequalities, the association between human rights and health inequalities, and the association between health inequalities and healthcare utilization patterns. However, these approaches may not be the most applicable in this environment. Given the multifactorial characteristics of health inequalities, it is important to work with the beneficiaries in developing a multi-sector approach and a strategy targeting long-term impacts by decision-makers at various levels. When addressing health inequalities in post-conflict settings, it may be best to combine approaches at different stages of the recovery process.

Tunneling a crosstown highway: a natural experiment testing the longitudinal effect on physical activity and active transport.

BACKGROUND: In the city of Maastricht in the Netherlands, a highway crossing several deprived neighborhoods was tunneled in 2016. The vacant space on top of this tunnel was redesigned and prioritized for pedestrians and cyclists. The aim of this study was to evaluate the effect of this major infrastructural change, named the Green Carpet, on total and transport-based physical activity (PA) levels. METHODS: Participants (≥18 years) were part of one of three area-based exposure groups. The maximal exposure group lived in neighborhoods directly bordering the Green Carpet. The minimal exposure group consisted of individuals living at the other side of the city, and the no exposure group consisted of individuals living in a nearby city. Actual use of the new infrastructure was incorporated as a second measure of exposure. Data were collected before and 3-15 months after the opening of the Green Carpet. Device-based measurements were conducted to obtain PA levels and collect location data. Changes in PA over time and intervention effects were determined using linear mixed models. RESULTS: PA levels in the Green Carpet area increased for the maximal and minimal exposure groups, but did not lead to an increase in total or transport-based PA. For the no exposure group, transport-based MVPA decreased and transport-based SB increased. The significant interaction (time x exposure) for transport-based SB, indicated differences in trends between the no exposure and maximal exposure group (B=-3.59, 95% CI - 7.15; -0.02) and minimal exposure group (B= -4.02, 95% CI -7.85, -0.19). Trends in the results based on analyses focusing on actual use and non-use of the new infrastructure were similar to those of the area-based analyses. CONCLUSIONS: Results suggest that the Green Carpet led to more PA in this specific area, but did not increase the total volume of PA. The area-based differences might reflect the differences between users and non-users, but we should be careful when interpreting these results, due to possible interference of selective mobility bias. This paper reflects that the relationship between infrastructure and PA is not unambiguous. TRIAL REGISTRATION: This research was retrospectively registered at the Netherlands Trial Register ( NL8108 ).

Nutritional parameters and lifestyle practices of people who use drugs undergoing treatment for recovery in Lebanon: a descriptive study.

Drug use disorder is a major public health problem. Once people who use drugs (PWUD) are referred to treatment, addressing their lifestyle practices and improving their quality of life improves treatment outcomes. The present study assessed the nutritional status and lifestyle practices among PWUD undergoing treatment for recovery in Lebanon. Furthermore, it explored significant differences in these parameters depending on the offered treatment modality, namely opioid substitution treatment (OST) and rehabilitation. In total, 187 PWUD undergoing treatment for recovery participated in this cross-sectional study. Nutritional status and anthropometrics, dietary intake, nutrition knowledge, food addiction, biochemical parameters, sleep and physical activity were measured using validated tools. Of the participants, 88⋅8 % were well nourished based on the Subjective Global Assessment. In total, 67 % gained weight during treatment placing them in the overweight category. This increase in weight was significantly higher in the rehabilitation group. It came in parallel with higher protein and energy intakes, higher rate of food addiction, and poor nutrition knowledge. Biochemical parameters, including fasting blood sugar, total protein, lipid profile and white blood cell count, were in the normal ranges. Moreover, the majority of participants exhibited poor quality sleep that was accentuated among the participants undergoing rehabilitation, in addition to activity levels that were mainly low in the OST group. PWUD undergoing treatment for recovery in Lebanon are subject to various vulnerability factors creating challenges to treatment. Longitudinal assessments to better understand health problems arising during treatment and to identify the components of a comprehensive health promotion intervention during treatment for recovery are needed.

People who use drugs in rehabilitation, from chaos to discipline: Advantages and pitfalls: A qualitative study.

Evidence-based models emphasizing on lifestyle behaviours for the treatment of drug use is still in its infancy. The development of multicomponent effective drug use intervention programs as part of health promotion is crucial to decrease risk of relapse. This study aims at exploring the lifestyle practices including dietary intake, physical activity and sleep of people who use drugs undergoing residential rehabilitation treatment in Lebanon with its perceived benefits and pitfalls. A purposive sample of 18 males and 9 females at different stages of recovery from drug use in rehabilitation centers participated in the qualitative discussions. The six phases thematic analysis revealed three themes: chaotic lifestyle, structuredlifestyle, benefits and pitfalls, and suggestions for making rehabilitation a better experience. Participants discussed their chaotic lifestyle during addiction with poor food intake, disrupted sleep and low physical activity moving to a more disciplined routine enforcing normality in lifestyle practices with social and professionlprofessional support. The early phases of treatment were marked with increased food intake and weight gain perceived as a health indicator and the sole divergent from drugs, moving towards more structured meals and efforts to lose weight in later stages. Lack of variety of Physical activity programs taking into consideration the motivational differences among the participants was also highlighted. Measures for improving rehabilitation services in terms of promoting healthy eating behaviours and environmental control were thoroughly addressed. These findings shed the light on the challenges faced in maintaining a healthy lifestyle in rehabilitation centers and the necessities of addressing them to improve the overall rehabilitation experience, prevent relapse and inform the development of future targeted intervention programs tackling all aspects of behavioural changes.

Evaluation of a Sexual Transmitted Infection Prevention Program Among University Students in Beira City Central Mozambique: A Study Protocol.

Background: Unhealthy sexual behaviors, such as unprotected sexual intercourse and lack of using screening services increase cyclical transmission of sexually transmitted infections including Human Immunodeficiency Virus (HIV), especially among young adults. Hence health promotion programs can contribute to reduce the consequences, by changing (determinants of) these behaviors. Such interventions need to embrace a comprehensive approach and apply theory-and evidence-based methods. This article describes the protocol for a process and effect evaluation study of a sexually transmitted infection prevention program among university students in Beira city, central Mozambique. Methods: The on-going program at Universidade Católica de Moçambique is described following the six steps of Intervention Mapping (IM), with a focus on the evaluation plan (i.e., the final step in IM). The details regarding previous steps in the protocol are briefly described as well, as they lay the foundation for the final step. The overall study will apply a hybrid type 1 approach by assessing the effectiveness of the intervention while gettering implementation. The process evaluation will apply qualitative and quantitative methods to gain insight in the context, reach, dose delivered, dose received and recruitment. Interviews with closed and open-ended questions will be conducted with program implementers and users. A quasi-experimental non-equivalent control group design is used to evaluate the effectiveness. A cohort of university students will be followed for 6 months. Self-administrated questionnaires will be used to collect data every 3 months. Discussion: A combination of process and effect evaluation is proposed. This is a useful and fruitful procedure, since concurrent process evaluation can allow researchers to better interpret findings from the effect evaluation and understand how the intervention might replicate in similar contexts. We decided to follow the IM approach since, it is a theory-and evidence-based, systematic and detailed guide regarding what to do at every steps. A quasi-experimental non-equivalent control group design was chosen to fit the context of the study and generate outcomes with high external validity. Study Registration: 004/CIBS/2020.

Beyond the ticked box: organ donation decision-making under different registration systems.

OBJECTIVE: To explore how people experience organ donation decision-making under the conditions of an opt-in, opt-out or no-objection registration system. DESIGN: A between-subjects experimental 3 × 2 design (registration system x preselection). Participants (N = 1312) were presented with a description of one of the three registration systems and went through a mock donor registration process. In half of the conditions, the default option of the system was visualized by a ticked box. After, participants answered questions about their perceived autonomy and perceived effective decision-making. MAIN OUTCOME MEASUREMENTS: Perceived autonomy, perceived decision effectiveness and registration choice. RESULTS: The preselected box did not impact any of the outcomes. Participants had higher perceived autonomy under the conditions of an opt-in system. There were no differences in effective decision-making across conditions. Registration choices did differ across conditions and educational levels. In the opt-in system, participants more often made an active decision. Lower-educated participants were more likely to choose to do nothing, while higher-educated people more often made an active decision, especially in the no-objection system. CONCLUSION: Where the opt-out system potentially leads to the highest number of donors, the opt-in system seems better in terms of preserving people's autonomy and motivating people to make an active decision.

The effectiveness of telemedicine interventions, delivered exclusively during the postnatal period, on postpartum depression in mothers without history or existing mental disorders: A systematic review and meta-analysis.

BACKGROUND: Postpartum depression, one of the most common forms of depression, is highly prevalent worldwide among women during childbirth. Despite available treatments for postpartum depression, numerous barriers hinder women to access care including time, financial constraints, and childcare concerns. Telemedicine interventions are suggested to be feasible to prevent and improve postpartum depression. OBJECTIVE: To examine the effectiveness of telemedicine interventions - delivered exclusively during the postnatal period, on postpartum depression symptomatology in women with no history of mental disorders. DESIGN: A systematic review and meta-analysis of randomized controlled trials. METHODS: PubMed, Web of Science, Cochrane Library, and ProQuest Dissertations & Theses databases were used to identify relevant randomized controlled trials, until 7 January 2020. Studies were quality assessed using the Cochrane Library Risk of Bias Tool. The results of postpartum depression scores were pooled using a random-effects model. Intervention completion rate and participants' satisfaction were reported in a narrative form, as secondary outcomes. RESULTS: Ten trials including a total of 2366 participants, contributed data to the review. Seven studies were included in the quantitative synthesis. Women who received technology-based interventions, regardless of the type (web-based versus telephone-based), had a statistically significant improvement in postpartum depression (mean difference: -1.81, 95% CI: -2.68 to -0.93; P<.0001). The completion rate was 80% in the intervention groups compared to 76% in the control groups. Three studies reporting participants' satisfaction revealed that the participants were highly satisfied with the technology-based interventions. CONCLUSION: Overall, telemedicine interventions appear to be promising in preventing and improving postpartum depression. Further larger-scale high-quality research is required to establish an evidence-based telemedicine approach, in terms of structure, content, and providers. Future economic evaluation is also vital to evaluate the long-term use of telemedicine in improving postpartum depression.

Nutritional status and eating habits of people who use drugs and/or are undergoing treatment for recovery: a narrative review.

A comprehensive overview is presented of the nutritional issues faced by people who use drugs or are undergoing treatment for recovery. Chronic substance use affects a person's nutritional status and body composition through decreased intake, nutrient absorption, and dysregulation of hormones that alter the mechanisms of satiety and food intake. Anthropometrics alone is not the best indicator of nutritional status, because this population has hidden deficiencies and disturbed metabolic parameters. Socioeconomic factors (eg, higher education, higher income, presence of a partner, living at home) positively affect nutritional status. Scarce available data on users undergoing treatment indicate improvement in anthropometric and metabolic parameters but with micronutrient intake remaining suboptimal. Weight gain is noted especially among women who use drugs and potentially increases their risk of relapse. Finally, specific amino acids and omega-3 fatty acids are promising in decreasing relapse and improving mental health during treatment; however, additional high-quality studies are needed. Nutrition intervention for people who use drugs or are undergoing treatment for recovery is underused; comprehensive programs addressing this population's unique needs are necessary. Future research will identify which components are needed.

The role of knowledge, risk perceptions, and cues to action among Iranian women concerning cervical cancer and screening: a qualitative exploration.

BACKGROUND: Iran has a low incidence but higher rate of death from cervical cancer (CC). The country is in the process of implementing an organized screening program including HPV testing and cytology. Studies show high dropout in continued testing among eligible women. This qualitative study aimed to explore women's awareness regarding CC and CC testing and the role of knowledge, perceived risk, and cues to action in this process. METHOD: Through a qualitative study based on the Framework Method, we recruited 81 women aged 25-65 who participated in 15 focus group discussions (FGDs) and two in-depth interviews in Tehran. The interviewees were selected purposefully during January to May 2015 from households belonging to different socioeconomic classes until data saturation. The data were acquired through 11 open-ended questions and 32 related probe questions. All interviews were transcribed and independently analyzed by two researchers (Kappa and agreement testing respectively: 0.77, 97.11%). RESULTS: The coded texts were categorized under three themes and 13 subthemes. The three thematic areas referred to knowledge, cues to action, and perceived risks regarding CC and screening. The results showed that women had limited and unspecified knowledge about CC and screening, compounded by misconceptions regarding infection and cancer prevention measures. Social and cultural barriers hindered proper communication between health system/providers and clients and within communities on subjects related to CC and screening. The perceived risk of getting CC was low because of overestimating the role of hereditary factors for CC, difficulty in differentiating between cancer and sexually transmitted infections (STI), and the absence of visible symptoms. CONCLUSION: The results indicate a strong need to invest more efforts to improve health education and communication in the current national health program to promote awareness of the need to screen for CC through, for example, establishing correct knowledge and risk perceptions among women. In addition, this intervention should address women's social environment in order to prevent misconceptions being communicated to women.