Menstruation and social inequities in Spain: a cross-sectional online survey-based study.

BACKGROUND: Available research suggests that menstrual inequity has an impact on (menstrual) health outcomes and emotional wellbeing. It is also a significant barrier to achieve social and gender equity and compromises human rights and social justice. The aim of this study was to describe menstrual inequities and their associations with sociodemographic factors, among women and people who menstruate (PWM) aged 18-55 in Spain. METHODS: A cross-sectional survey-based study was conducted in Spain between March and July 2021. Descriptive statistical analyses and multivariate logistic regression models were performed. RESULTS: A total of 22,823 women and PWM were included in the analyses (Mean age = 33.2, SD = 8.7). Over half of the participants had accessed healthcare services for menstruation (61.9%). The odds for accessing menstrual-related services were significantly higher among participants with university education (aOR: 1.48, 95% CI, 1.13-1.95). Also, 57.8% reported having had partial or no menstrual education pre-menarche, with odds being higher among participants born in non-European or Latin American countries (aOR: 0.58, 95% CI, 0.36-0.93). Lifetime self-reported menstrual poverty was between 22.2-39.9%. Main risk factors for menstrual poverty were identifying as non-binary (aOR: 1.67, 95% CI, 1.32-2.11), being born in non-European or Latin American countries (aOR: 2.74, 95% CI, 1.77-4.24), and not having a permit to reside in Spain (aOR: 4.27, 95% CI, 1.94-9.38). Completed university education (aOR: 0.61, 95% CI, 0.44-0.84) and no financial hardship < 12 months (aOR: 0.06, 95% CI, 0.06-0.07) were protective factors for menstrual poverty. Besides, 75.2% reported having overused menstrual products due to lack of access to adequate menstrual management facilities. Menstrual-related discrimination was reported by 44.5% of the participants. Non-binary participants (aOR: 1.88, 95% CI, 1.52-2.33) and those who did not have a permit to reside in Spain (aOR: 2.11, 95% CI, 1.10-4.03) had higher odds of reporting menstrual-related discrimination. Work and education absenteeism were reported by 20.3% and 62.7% of the participants, respectively. CONCLUSIONS: Our study suggests that menstrual inequities affect a high number of women and PWM in Spain, especially those more socioeconomically deprived, vulnerabilised migrant populations and non-binary and trans menstruators. Findings from this study can be valuable to inform future research and menstrual inequity policies.

RESUMEN: INTRODUCCIóN: Investigación previa disponible indica que la inequidad menstrual tiene un impacto en los resultados de salud (menstrual) y en el bienestar emocional. Es también una barrera para la equidad social y de género. El objetivo de este estudio es evaluar la inequidad menstrual y las asociaciones con factores sociodemográficos, en mujeres y personas que menstrúan entre 18-55 años en España. MéTODOS: Este es un estudio transversal, basado en una encuesta, llevado a cabo en España entre marzo y julio de 2021. Se realizaron análisis descriptivos y modelos de regresión logística multivariados.  RESULTADOS: Los análisis se realizaron con los datos de 22,823 mujeres y personas que menstrúan. Más de la mitad de las participantes habían accedido a servicios sanitarios para la menstruación (60.5%). La probabilidad de acceder a servicios sanitarios para la menstruación fue significativamente más alta en participantes con educación universitaria (aOR: 1.48, 95% CI, 1.13-1.95). El 57.8% informó no haber tenido educación menstrual o que ésta fuera parcial, pre-menarquia; la probabilidad fue más alta en participantes que no habían nacido en países europeos o latinoamericanos (aOR: 0.58, 95% CI, 0.36-0.93). La pobreza menstrual durante el ciclo vital se reportó en el 22.2-39.9% de las participantes. Los principales factores de riesgo fueron identificarse como persona no binaria (aOR: 1.67, 95% CI, 1.32-2.11), nacer en países fuera de Europa o Latinoamérica (aOR: 2.74, 95% CI, 1.77-4.24), y no tener papeles para residir en España (aOR: 4.27, 95% CI, 1.94-9.38). Tener estudios universitarios (aOR: 0.61, 95% CI, 0.44-0.84) y no haber reportado problemas económicos en los últimos 12 meses (aOR: 0.06, 95% CI, 0.06-0.07) fueron factores protectores para la pobreza menstrual. Además, el 74.6% indicó haber sobreutilizado productos menstruales por no haber tenido acceso a espacios adecuados para el manejo menstrual. El 42.6% de las participantes comunicaron experiencias de discriminación menstrual. Participantes no binarios (aOR: 1.88, 95% CI, 1.52-2.33) y aquellas que no tenían papeles (aOR: 2.11, 95% CI, 1.10-4.03) presentaron una mayor probabilidad de indicar discriminación menstrual. El absentismo laboral y escolar fue indicado por el 18.3% y el 56.6% de las participantes respectivamente. CONCLUSIONES: Nuestro estudio sugiere que la inequidad menstrual afecta a un número significativo de mujeres y personas que menstrúan en España y, especialmente, a aquellas en situaciones de mayor deprivación socioeconómica, algunos colectivos vulnerabilizados de personas migradas, y a personas no binarias y trans que menstrúan. Los resultados de este estudio pueden ser útiles para investigación futura, así como para el desarrollo de políticas públicas de equidad menstrual.

Japanese Local Governments' Dissemination Activities for Advance Care Planning: A Descriptive Analysis of a Nationwide Survey during the COVID-19 Pandemic.

This study aims to compare the awareness-raising activities between municipalities with and without focused anti-infection measures during the 2019 coronavirus disease (COVID-19) pandemic. Descriptive analysis was conducted using a nationwide self-administered questionnaire survey on municipalities' activities for residents and for healthcare providers and care workers (HCPs) in October 2022 in Japan. This study included 433 municipalities that had conducted awareness-raising activities before 2019 Fiscal Year. Workshops for residents were conducted in 85.2% of the municipalities, and they were more likely to be conducted in areas with focused anti-infection measures than those without measures (86.8% vs. 75.4%). Additionally, 85.9% of the municipalities were impacted by the pandemic; 50.1% canceled workshops, while 26.0% switched to a web-based style. Activities for HCPs were conducted in 55.2-63.7% of the municipalities, and they were more likely to be conducted in areas with focused anti-infection measures. A total of 50.6-62.1% of the municipalities changed their workshops for HCPs to a web-based style. Comparisons between areas with and without focused anti-infection measures indicated that the percentages of those impacted for all activities were not significantly different. In conclusion, awareness-raising activities in municipalities were conducted with new methods during the COVID-19 pandemic. Using information technology is essential to further promote such activities for residents.

Heart health for South Asians: improved cardiovascular risk factors with a culturally tailored health education program.

BACKGROUND/AIM: The Kaiser Permanente (KP) Northern California Heart Health for South Asians (HHSA) Program is a two-hour educational class that provides culturally relevant lifestyle and dietary recommendations to South Asian (SA) patients, in an effort to reduce their known disproportionate burden of cardiovascular (CV) disease. We evaluated the impact of the HHSA Program on CV risk factors and major adverse CV events (MACE). METHODS: A retrospective cohort study identified 1517 participants of SA descent, ≥ 18 years old from 2006 to 2019. We evaluated the change in risk factors with program attendance (median follow up of 6.9 years) for systolic blood pressure (SBP), diastolic blood pressure (DBP), triglycerides (TG), LDL, HDL, BMI, and HbA1c. We also performed a propensity matched analysis to evaluate differences in MACE including stroke, myocardial infarction (MI), coronary revascularization, and all-cause mortality. RESULTS: There were significant improvements in DBP, TG, LDL-c, HDL-c, BMI, and HbA1c at one year follow up and sustained improvements in DBP (-1.01mmHg, p = 0.01), TG (-13.74 mg/dL, p = 0.0001), LDL-c (-8.43 mg/dL, p = < 0.0001), and HDL-c (3.16 mg/dL, p = < 0.0001) levels at the end of follow up. In the propensity matched analysis, there was a significant reduction in revascularization (OR 0.33, 95% CI 0.14-0.78, p = 0.011) and mortality (OR 0.41, 95% CI 0.22-0.79, p = 0.008), and a trend towards reduction in stroke. CONCLUSIONS: Our study demonstrates the efficacy of a culturally tailored SA health education program in improving CV risk factors and reducing MACE. The program highlights the importance and value of providing culturally tailored health education in primary CV disease prevention.

Parental reports of vaccine information statement usage in Utah.

BACKGROUND: Since the implementation in 1986, there is little research focused on vaccine information statements (VISs) use for vaccine education and parental perception. PURPOSE: To explore parental reports of dissemination and use of VISs. METHODS: Data for this pilot, cross-sectional, descriptive study were collected through an online survey in both English and Spanish. RESULTS: Responses from 130 parents in one school district were analyzed. Most participants (67.7%) reported getting vaccine information from a pediatric health care provider. A majority (71.5%) said that VISs were included in the vaccination process. Approximately one third of participants (37.7%) reported reading some or all the VIS before their child was vaccinated, and more than half (59.3%) read some or all the VIS after their child was vaccinated. CONCLUSIONS: While promising that many parents reported receiving a VIS, more than one quarter of parents reported they did not. Inadequate time to read and understand VIS information before an immunization may lead to limited parental understanding. Although some participants reported struggling to understand VISs, more than half said that VISs were helpful and would read another in the future. IMPLICATIONS: Without appropriate use of vaccine education material, providers miss the opportunity to educate parents on the risks and benefits of vaccinating their children. Providers must be aware of literacy levels and vaccine attitudes and create appropriate opportunities for parents to read and learn about vaccines. VISs are valuable educational tools for patients and parents. Improvements are needed to improve both VIS clarity and dissemination.

Evaluations of Continuing Health Provider Education Focused on Opioid Prescribing: A Scoping Review.

PURPOSE: Continuing health provider education (HPE) is an important intervention supported by health policy to counter the opioid epidemic; knowledge regarding appropriate program design and evaluation is lacking. The authors aim to provide a comprehensive understanding of evaluations of opioid-related continuing HPE programs and their appropriateness as interventions to improve population health. METHOD: In January 2020, the authors conducted a systematic search of 7 databases, seeking studies of HPE programs on opioid analgesic prescribing and overdose prevention. Reviewers independently screened the titles and abstracts of all studies and then assessed the full texts of all studies potentially eligible for inclusion. The authors extracted a range of data using categories for evaluating complex programs: the use of theory, program purpose, inputs, activities, outputs, outcomes, and industry involvement. Results were reported in a narrative synthesis. RESULTS: Thirty-nine reports on 32 distinct HPE programs met inclusion criteria. Of these 32, 31 (97%) were U.S./Canadian programs and 28 (88%) were reported after 2010. Measurements of changes in knowledge and confidence were common. Performance outcomes were less common and typically self-reported. Most studies (n = 27 [84%]) used concerns of opioid-related harms at the population health level to justify the educational intervention, but only 5 (16%) measured patient- or population-level outcomes directly related to the educational programs. Six programs (19%) had direct or indirect opioid manufacturer involvement. CONCLUSIONS: Continuing HPE has been promoted as an important means of addressing population-level opioid-related harms by policymakers and educators, yet published evaluations of HPE programs focusing on opioid analgesics inadequately evaluate patient- or population-level outcomes. Instead, they primarily focus on self-reported performance outcomes. Conceptual models are needed to guide the development and evaluation of continuing HPE programs intended to have population health benefits.

Processo de educação em saúde a pacientes e familiares na perspectiva do cuidado seguro / Health education process for patients and family members safe care setting

Introdução: Este artigo resulta de uma pesquisa de avaliação sobre o processo educativo de pacientes e familiares realizado por equipe multiprofissional de saúde do Hospital de Clínicas de Porto Alegre.Métodos: Pesquisa de avaliação desenvolvida em unidades de internação clínicas, cirúrgicas e pediátricas, tendo como amostra 149 sujeitos de pesquisa entre pacientes, ou familiares ou acompanhantes.A coleta de dados utilizou um questionário impresso semiestruturado, contendo nove questões sobre o processo educativo, a atuação multiprofissional e a compreensão da educação recebida.Resultados: Dentre os 149 participantes, 75 (50,3%) composto por pacientes e 74 (49,7%) por familiares/acompanhantes. Entre os respondentes, 94,6% recebeu orientações realizadas por médicos e enfermeiros; 91,2% referiu que compreendeu a orientação educativa. Um percentual de 90,6% dos participantes conhecia o seu problema de saúde ou o do seu familiar e 81,9% sentiam-se seguros para assumir o cuidado.Conclusão: A educação ocorre em diferentes cenários do hospital. Entretanto, há necessidade de incrementar a participação de diferentes profissionais na educação, potencializando o planejamento terapêutico multiprofissional na perspectiva da segurança no cuidado.

Introduction: This study resulted from an evaluation survey on the educational process of patients and their family members/caregivers conducted by a multidisciplinary health team at Hospital de Clínicas de Porto Alegre, Brazil.Methods: This was an evaluation study conducted at clinical, surgical, and pediatric inpatient units. The sample included 149 participants, consisting of patients and family members/caregivers. Data was collected using a semi-structured printed questionnaire with 9 questions about the educational process, multidisciplinary work, and whether participants understood the educational guidance.Results: Of 149 participants, 75 (50.3%) were patients and 74 (49.7%) were family members/caregivers. Among the respondents, 94.6% received guidance by a doctor or nurse and 91.2% reported that they understood the educational guidance. Most participants (90.6%) were aware of their health problem or that of their family member, and 81.9% felt confident to assume care. Conclusion: Education takes place in different hospital settings. However, the inclusion of different professionals in the educational process should be increased to promote multidisciplinary therapeutic planning in a safe care setting.

Concepções de jovens educandos sobre sistema e serviços de saúde públicos / Conceptualizaciones de jóvenes educandos sobre sistema y servicios de salud públicos / Conceptions of young students about public health system and services

RESUMO Objetivo: descrever as concepções de jovens educandos sobre o sistema e serviços de saúde públicos, a partir da pesquisa participante. Métodos: pesquisa participante realizada no período de outubro a dezembro de 2017, com 12 educandos de 12 a 16 anos, pertencentes a uma escola pública de Pelotas. A coleta e análise de dados ocorreu por meio do Círculo de Cultura e Photovoice. Resultados: os educandos associam serviços de saúde com doenças e questões biológicas, e sabem que os serviços prestados pelo Sistema Único de saúde são financiados com dinheiro público. A visão dos educandos sobre a Unidade Básica de Saúde foi preocupante pelo desconhecimento sobre o que é este serviço, apesar da proximidade física com a escola e, além disso, referem não frequentar a unidade. Considerações finais: o diálogo permitiu o reconhecimento de concepções dos educandos relativo ao sistema de saúde, porém evidenciou desconhecimento e falta de vivências em serviços públicos. Isto reforça a importância da promoção do diálogo no espaço da escola para que se tenha a formação de cidadãos críticos e atuantes na sociedade, podendo refletir na construção de outros significados e valores e com isso, outras concepções de sociedade, saúde e doença.

RESUMEN Objetivo: describir las conceptualizaciones de jóvenes educandos sobre el sistema y servicios de salud públicos, a partir de la investigación participante. Método: investigación participante realizada en el período de octubre a diciembre de 2017, con 12 educandos de 12 a 16 años, pertenecientes a una escuela pública de Pelotas-RS-Brasil. La recolección y el análisis de datos se llevó a cabo a través del Círculo de Cultura y Photovoice. Resultados: los educandos asocian los servicios de salud con enfermedades y problemas biológicos, y saben que los servicios prestados por el Sistema Único de Salud se financian con dinero público. La visión de los educandos sobre la Unidad Básica de Salud fue preocupante por el desconocimiento sobre qué es este servicio, a pesar de la proximidad física con la escuela y, además, relatan no frecuentar la unidad. Consideraciones finales: el diálogo permitió el reconocimiento de conceptualizaciones de los educandos relativo al sistema de salud, pero evidenció desconocimiento y falta de vivencias en servicios públicos. Esto refuerza la importancia de la promoción del diálogo en el espacio de la escuela para que se tenga la formación de ciudadanos críticos y actuantes en la sociedad, pudiendo reflejar en la construcción de otros significados y valores y con ello, otras conceptualizaciones de sociedad, salud y enfermedad.

ABSTRACT Objective: to describe the conceptions of young students about the public health system and services, based on the participant research. Methods: participant research conducted from October to December 2017, with 12 students aged 12 to 16 years, belonging to a public school in Pelotas. Data collection and analysis occurred through the Circle of Culture and Photovoice. Results: students associate health services with diseases and biological issues, and know that the services provided by the Unified Health System are financed with public money. The students' view of the Basic Health Unit was worrisome because of the lack of knowledge about what this service is, despite the physical proximity to the school and, moreover, they reported not attending the unit. Final considerations: the dialogue allowed the recognition of students' conceptions related to the health system, but showed ignorance and lack of experiences in public services. This reinforces the importance of promoting dialogue in the school space so that critical and active citizens in society are trained, and may reflect on the construction of other meanings and values and thus other conceptions of society, health and disease.

Knowledge, attitude and practice towards cervical cancer prevention among mothers of girls aged between 9 and 14 years: a cross sectional survey in Zimbabwe.

BACKGROUND: Cervical cancer (CC) morbidity and mortality is still high in developing countries like Zimbabwe. Treatment for CC is out of reach for many women, hence the need to maximise on prevention which mainly includes screening and administering human papillomavirus (HPV) vaccine. Knowledge about CC prevention is a prerequisite for utilisation of all the available options for CC prevention, yet little is known about its levels and the corresponding attitudes and practices on cancer prevention methods within the society. METHODS: A cross sectional survey was done to assess knowledge, attitude and practice (KAP) on CC prevention among mothers of girls aged between 9 and 14 years in Zimbabwe as well as factors explaining the KAP. Four hundred and six mothers participate. Descriptive and inferential statistics (binary logistic regression and Chi-Square test of association) were applied to determine participant characteristics with KAP using STATA version 16 software. FINDINGS: Overall KAP of cervical cancer prevention is in a poor state. The knowledge was poor with 24% being able to say CC is caused by HPV; the attitude is negative with 58% being of the opinion that CC is caused by witchcraft and it is a death sentence, while the bad practices of relying only on traditional means were being practiced. Factors associated with knowledge are: not having medical aid (odds: 0.17, 95%CI: 0.05-0.59, p = 0.005) and high levels of education (secondary level odds: 4.20; 95%CI: 2.25-7.84 p < 0.001 and tertiary odds: 7.75; 95%CI: 2.04-29.45, p-value: 0.003 compared to primary education). Attitude towards CC management was driven by levels of education (secondary level odds: 0.39, 95%CI: 0.20-0.78, p = 0.007 and tertiary odds: 0.12, 95%CI: 0.04-0.33, p < 0.001), the same factor increases odds of good practice (secondary odds: 3.78, 95%CI: 1.99-7.18, p < 0.001 and tertiary odds: 3.78, 95%CI: 1.99-7.18, p < 0.001). On the other hand, HPV vaccine knowledge was also very moderate (with majority of mothers not knowing the right age of vaccination; vaccine acceptability was high (90%), but uptake was very low (8% had their daughter vaccinated). CONCLUSION: KAP about CC prevention was poor with factors necessary for improvement of KAP identified as education, medical insurance coverage. Making health education easily accessible in schools, primary health facilities and various media platforms will help to address the myths on causes of CC and how it can be treated. Health education and availability of free screening services and free vaccine will improve CC prevention out outcomes.

Qualidade de vida de pessoas com diabetes seis meses após término de programa educativo / Quality of life of people with diabetes six months after the end of an educational program / Calidad de vida de las personas con diabetes seis meses después de la finalización de un programa educativo

Objetivo: Avaliar a qualidade de vida de pessoas com diabetes mellitus seis meses após o término da participação em programa educativo. Método: estudo descritivo de abordagem quantitativa desenvolvido com 32 pessoas com diabetes mellitus acompanhadas no ambulatório de um hospital universitário de Sergipe. Para a coleta de dados foram utilizados três instrumentos, um para a caracterização sociodemográfica e clínica e dois para avaliação da qualidade de vida, o Whoqol-bref e o B-PAID. Resultados: Houve declínio da qualidade de vida, sobretudo nos domínios Relações sociais e Ambiente e aumento do sofrimento em viver com o diabetes. Foi observada correlação positiva e estatisticamente significativa entre o sexo e a medida de qualidade de vida WhoqoL-bref, com os homens tendo apresentado melhor avaliação. Conclusão: O declínio da qualidade de vida e o aumento do sofrimento em viver com o diabetes podem estar associados ao término das atividades do programa de educação em saúde. (AU)

Objective: To evaluate the quality of life of people with diabetes mellitus six months after the end of their participation in an educational program. Methods: A descriptive study with a quantitative approach developed with 32 people with diabetes mellitus monitored at the outpatient clinic of a university hospital in Sergipe. For data collection, three instruments were used, one for the sociodemographic and clinical characterization and two for the assessment of quality of life. Results: There was a decline in the quality of life, especially in the Social Relationship and Environment domains and an increase in the suffering of living with diabetes. A positive and statistically significant correlation was observed between gender and the quality of life measure, with men having a better evaluation. Conclusion: The decline in quality of life and the increase in suffering in living with diabetes may be associated with the termination of activities in the health education program. (AU)

Objetivo: Evaluar la calidad de vida de personas con diabetes mellitus a los seis meses de finalizar su participación en un programa educativo. Métodos: Estudio descriptivo con abordaje cuantitativo desarrollado con 32 personas con diabetes mellitus monitorizadas en la consulta externa de un hospital universitario de Sergipe. Para la recolección de datos se utilizaron tres instrumentos, uno para la caracterización sociodemográfica y clínica y dos para la evaluación de la calidad de vida. Resultados: Hubo una disminución en la calidad de vida, especialmente en los dominios de Relaciones Sociales y Medio Ambiente y un aumento en el sufrimiento de vivir con diabetes. Se observó una correlación positiva y estadísticamente significativa entre el sexo y la medida de calidad de vida siendo los hombres quienes obtuvieron una mejor evaluación. Conclusión: El deterioro de la calidad de vida y el aumento del sufrimiento al vivir con diabetes pueden estar asociados con el final de las actividades del programa de educación para la salud. (AU)

The Impact of a Short-term Intervention on Adolescent Eating Habits and Nutritional Knowledge.

BACKGROUND: Adequate dietary habits and physical activity during childhood and adolescence may promote growth and cognitive development and contribute to the prevention of chronic disease in later life. School is considered an important social environment that can promote healthy eating habits and life-style changes. OBJECTIVES: To evaluate the effects of a school-based intervention on nutritional knowledge, eating habits, and physical activity of adolescents. METHODS: We conducted a prospective questionnaire-based study. Anonymous questionnaires were administered at the beginning of the academic year (September 2014) in one high school. During the following year, vending machines containing milk products were installed within the school facility, and students were given two informative nutrition lectures regarding proper nutrition for age, calcium requirement and importance, and physical activity. One active sports day was initiated. At the beginning of the following academic year (September 2015), the students completed the same questionnaires. RESULTS: The study was comprised of 330 teenagers, mean age 15.1 ± 1.39 years, 53% males. Response rate was 83.6% ± 0.4% to multiple choice questions, 60.7% ± 0.5% to multiple section tables, and 80.3% ± 0.9% to open questions. Post-intervention, respondents reported an increase in eating breakfast (57% vs. 47.5%, P = 0.02) and a decrease in purchasing food at school (61.6% vs. 54.3%, P = 0.03). No changes were observed in consumption of milk products, knowledge regarding calcium and vegetable consumption, or sports activities. CONCLUSIONS: Short-term high school-based interventions may lead to improvements in eating habits but are not sufficient for changing nutritional knowledge and physical activity.

Factors associated with nutritional status, knowledge and attitudes among tuberculosis patients receiving treatment in Ghana: A cross-sectional study in the Tema Metropolis.

BACKGROUND: Nutritional deficiencies are generally associated with increased risk and severity of tuberculosis. This study investigated the nutritional status, knowledge, and attitudes of tuberculosis (TB) patients receiving treatment in the Tema Metropolis. METHOD: A cross-sectional design was used to collect data on the nutritional knowledge, attitude, and status of TB patients. Nutritional status was analysed using World Health Organization's formula for body mass index. Pearson's chi-square and logistic regression models were used to assess associations between predictor and outcome variables. All statistical analyses were considered significant at p-values < 0.05. RESULT: The prevalence of malnutrition among TB patients was 39.7%, 14.4%, and 4.8% for underweight, overweight, and obesity respectively. There was a high (61.0%) knowledge of nutrition among the patients. Also, 65.8% had good attitude towards nutrition. There were significant associations between normal nutritional status and age of the TB patients (p = 0.041), highest educational level attained (p = 0.036), employment status (p = 0.019), status of alcohol intake (p = 0.031), number of months on TB treatment (p = 0.021), and attitude towards nutrition (p = 0.028). CONCLUSION: There was a reasonable nutrition-related knowledge and attitude towards nutrition among the TB patients. However, that did not reflect on their nutritional status. We recommend continuing education on smoking cessation, avoidance of harmful use of alcohol, and the establishment of food aid and other livelihood intervention programs for TB patients.

The needs and opportunities of older laypeople to acquire first aid skills.

We aimed to determine the needs and opportunities of older lay people to obtain first aid skills. We determined the level of theoretical knowledge of performing first aid with a structured questionnaire, performed on the sample of 842 adult inhabitants of Slovenia. The method of sampling was balanced by using a system of sampling weights in order to correct deviations in the structure of the sample to the level of the population structure. We also checked their attitude regarding the renewal of first aid knowledge. The level of self-assessment of first aid knowledge and actual theoretical knowledge of proper first aid measures typically decreased with age. The percentage of those who had attended first aid courses at any time was statistically significantly lower among respondents over the age of 60; 38% of elderly respondents thought they needed to renew their first aid knowledge, and 44% would attend a suitable first aid course. None of the 29 European Red Cross and Red Crescent Societies member states that responded have a developed a formally adopted first aid program to train the elderly. A tailored first aid training program for the elderly could be one of the many steps that should be taken to ensure adequate health care for the elderly population.

The impact of health education videos on general public's mental health and behavior during COVID-19.

BACKGROUND: COVID-19 has seriously affected people's mental health and changed their behaviors. Previous studies for mental state and behavior promotion only targeted limited people or were not suitable for daily activity restrictions. Therefore, we decided to explore the effect of health education videos on people's mental state and health-related behaviors. METHODS: Based on WeChat, QQ, and other social media, we conducted an online survey by snowball sampling. Spearman's non-parametric method was used to analyze the correlation related to mental health problems and health-related behaviors. Besides, we used binary logistic regression analyses to examine mental health problems and health-related behaviors' predictors. We performed SPSS macro PROCESS (model 4 and model 6) to analyze mediation relationships between exposure to health education videos and depression/anxiety/health-related behaviors. These models were regarded as exploratory. RESULTS: Binary logistic regression analyses indicated that people who watched the health education videos were more likely to wear masks (OR 1.15, p < 0.001), disinfect (OR 1.26, p < 0.001), and take temperature (OR 1.37, p < 0.001). With higher level of posttraumatic growth (PTG) or perceived social support (PSS), people had lower percentage of depression (For PSS, OR 0.98, p < 0.001; For PTG, OR 0.98, p < 0.01) and anxiety (For PSS, OR 0.98, p < 0.001; For PTG, OR 0.98, p = 0.01) and better health behaviors. The serial multiple-mediation model supported the positive indirect effects of exposure to health education videos on the depression and three health-related behaviors through PSS and PTG (Depression: B[SE] = - 0.0046 [0.0021], 95% CI - 0.0098, - 0.0012; Mask-wearing: B[SE] = 0.0051 [0.0023], 95% CI 0.0015, 0.0010; Disinfection: B[SE] = 0.0059 [0.0024], 95% CI 0.0024, 0.0012; Temperature-taking: B[SE] = 0.0067 [0.0026], 95% CI 0.0023, 0.0013). CONCLUSION: Exposure to health education videos can improve people's self-perceived social support and inner growth and help them cope with the adverse impact of public health emergencies with better mental health and health-related behaviors.

Intervention to Reduce Stigma and Improve Knowledge of HPV and Cervical Cancer in Nigeria: A Community-Based Assessment.

We compared the effectiveness of an educational intervention at reducing stigma and improving knowledge of human papillomavirus (HPV) and cervical cancer among Nigerian men and women. We used a pre-/posttest design to deliver 2 educational interventions to 266 adults. Low knowledge was observed at baseline, which improved significantly post-intervention with no difference between groups. No significant changes were observed between groups in 5 out the 6 stigma domains. Health education was effective in improving knowledge. However, the lack of positive change in stigma shows urgent need for HPV and cervical cancer stigma reduction interventions.

Prevention of re-establishment of malaria.

The current consensus on prevention of re-establishment of malaria is based on the following principles: (1) Fundamental role of general health services; (2) Surveillance; (3) Vector control; (4) Border actions; (5) Intersectoral collaboration. These principles are critically reviewed, and it is pointed out that alertness of the general health services to suspected malaria (vigilance) needs to be maintained everywhere, while health education is rational only if targeting high-risk sub-populations. It is argued that prevention of re-establishment of malaria transmission should be integrated with prevention of malaria mortality in cases of imported malaria, and that this requires collaboration with entities dealing with travellers' health and the availability of chemoprophylaxis and other measures for travellers to malaria endemic countries.

Kenyan school book knowledge for water, sanitation, hygiene and health education interventions: Disconnect, integration or opportunities?

BACKGROUND: Schools, depending on their access to and quality of water, sanitation and hygiene (WASH) and the implementation of healthy behaviours, can be critical for the control and spread of many infectious diseases, including COVID-19. Schools provide opportunities for pupils to learn about the importance of hygiene and WASH-related practice, and build healthy habits and skills, with beneficial medium- and long-term consequences particularly in low- and middle-income countries: reducing pupils' absenteeism due to diseases, promoting physical, mental and social health, and improving learning outcomes. WASH services alone are often not sufficient and need to be combined with educational programmes. As pupils disseminate their acquired health-promoting knowledge to their (extended) families, improved WASH provisions and education in schools have beneficial effects also on the community. International organisations frequently roll out interventions in schools to improve WASH services and, in some cases, train pupils and teachers on safe WASH behaviours. How such interventions relate to local school education on WASH, health promotion and disease prevention knowledge, whether and how such knowledge and school books are integrated into WASH education interventions in schools, are knowledge gaps we fill. METHODS: We analyzed how Kenyan primary school science text book content supports WASH and health education by a book review including books used from class 1 through class 8, covering the age range from 6 to 13 years. We then conducted a rapid literature review of combined WASH interventions that included a behaviour change or educational component, and a rapid review of international policy guidance documents to contextualise the results and understand the relevance of books and school education for WASH interventions implemented by international organisations. We conducted a content analysis based on five identified thematic categories, including drinking water, sanitation, hygiene, environmental hygiene & health promotion and disease risks, and mapped over time the knowledge about WASH and disease prevention. RESULTS: The books comprehensively address drinking water issues, including sources, quality, treatment, safe storage and water conservation; risks and transmission pathways of various waterborne (Cholera, Typhoid fever), water-based (Bilharzia), vector-related (Malaria) and other communicable diseases (Tuberculosis); and the importance of environmental hygiene and health promotion. The content is broadly in line with internationally recommended WASH topics and learning objectives. Gaps remain on personal hygiene and handwashing, including menstrual hygiene, sanitation education, and related health risks and disease exposures. The depth of content varies greatly over time and across the different classes. Such locally available education materials already used in schools were considered by none of the WASH education interventions in the considered intervention studies. CONCLUSIONS: The thematic gaps/under-representations in books that we identified, namely sanitation, hygiene and menstrual hygiene education, are all high on the international WASH agenda, and need to be filled especially now, in the context of the current COVID-19 pandemic. Disconnects exist between school book knowledge and WASH education interventions, between policy and implementation, and between theory and practice, revealing missed opportunities for effective and sustainable behaviour change, and underlining the need for better integration. Considering existing local educational materials and knowledge may facilitate the buy-in and involvement of teachers and school managers in strengthening education and implementing improvements. We suggest opportunities for future research, behaviour change interventions and decision-making to improve WASH in schools.

A Survey of Hospitalized Trauma Patients in Hemorrhage Control Education: Are Trauma Victims Willing to Stop the Bleed?

BACKGROUND: The Stop the Bleed (STB) campaign was developed in part to educate the lay public about hemorrhage control techniques aimed at reducing preventable trauma deaths. Studies have shown this training increases bystanders' confidence and willingness to provide aid. One high-risk group might be better solicited to take the course: individuals who have been a victim of previous trauma, as high rates of recidivism after trauma are well-established. Given this group's risk for recurrent injury, we evaluated their attitudes toward STB concepts. METHODS: We surveyed trauma patients admitted to 3 urban trauma centers in Baltimore from January 8, 2020 to March 14, 2020. The survey was terminated prematurely due to the COVID-19 pandemic. Trauma patients hospitalized on any inpatient unit were invited to complete the survey via an electronic tablet. The survey asked about demographics, prior exposure to life-threatening hemorrhage and first aid training, and willingness to help a person with major bleeding. The Johns Hopkins IRB approved waiver of consent for this study. RESULTS: Fifty-six patients completed the survey. The majority of respondents had been hospitalized before (92.9%) and had witnessed severe bleeding (60.7%). The majority had never taken a first aid course (60.7%) nor heard of STB (83.9%). Most respondents would be willing to help someone with severe bleeding form a car crash (98.2%) or gunshot wound (94.6%). CONCLUSIONS: Most patients admitted for trauma had not heard about Stop the Bleed, but stated willingness to respond to someone injured with major bleeding. Focusing STB education on individuals at high-risk for trauma recidivism may be particularly effective in spreading the message and skills of STB.