Dysmenorrhea in Tunisian high school adolescent girls: frequency, effects, and absence from school.

OBJECTIVES: Dysmenorrhea is a known phenomenon and not just recently, and investigations conducted recently have shown that female adolescents are very susceptible to this condition. Our goal is to determine the prevalence of dysmenorrhea in Tunisia, its risk factors, its impact on truancy rates, and the therapeutic attitudes of girls attending high school about this illness using an epidemiological survey. METHODS: This eight-month study, which spans from October 2022 to May 2023, focuses on 160 high school girls between the ages of 13 and 21. It is a transversal descriptive study. The required data is gathered through the distribution of a self-administered questionnaire. RESULTS: The mean age of female adolescent participants is 16.44 years and 68 % of them reported dysmenorrhea. The most common symptoms of the pain were headaches (40.0 %). There is a notable prevalence of absenteeism during the menstrual cycle. There seems to be a trend toward self-medication. CONCLUSIONS: In Tunisia, primary dysmenorrhea is a common cause of school absenteeism among female adolescents. Girls' attitudes toward dysmenorrhea indicate a lack of knowledge, which is why it is crucial for midwives and physicians to educate teenage girls about the condition.

Period Product Resources and Needs in Missouri Schools: Focus Group Discussions with School Nurses.

This study explored period product resources and needs in Missouri schools from the perspective of school nurses. We conducted eight focus groups with school nurses (n = 51) across Missouri using purposive sampling. Focus group data were analyzed in Dedoose via multiple coders and achieved strong inter-rater reliability (Cohen's Kappa = 0.92). Several interconnected themes with associated sub-themes were identified. First, school nurses do not have sufficient resources to help students manage menstruation and minimize menstruation-related absenteeism. Second, schools' heavy reliance on donations can lead to inconsistencies in supply and a mismatch between what is donated and what is most needed. Third, school nurses desire additional educational resources around menstruation management for students and caregivers. Nurse-identified themes can help inform recommendations for improving schools' response to students' menstrual hygiene needs by highlighting priorities for educational content, resources, and product acquisition with a goal of ensuring the suitability and sustainability of MHM in schools.

Exploring the Role of Sickness Absence Coordinators in Implementing Interventions to Reduce Sickness Absence in Public Sector Workplaces in Denmark.

PURPOSE: In 2019, an initiative to reduce sickness absence in public sector workplaces in Denmark was introduced. The initiative involved appointing a sickness absence coordinator (SA coordinator) to oversee the implementation of workplace-based sickness absence interventions. Since the role of the SA coordinator is a novel concept introduced as part of the initiative, this study investigates the responsibilities of SA coordinators and the challenges they experienced in fulfilling this role during the implementation process. METHODS: Semi-structured interviews with and observations of SA coordinators from four public sector workplaces were carried out. We collected the first four interviews and observations during the implementation process with follow-up interviews collected at the end of the process. The data were analyzed using thematic analysis. RESULTS: The SA coordinators all experienced challenges in terms of lack of commitment among the line managers to participate in the intervention. They experienced being seen as a burden rather than a helping hand, and felt that the line managers might have difficulty recognizing the value of the SA coordinators. Potential ways to improve the collaboration between the SA coordinators and the line managers include considering hiring the SA coordinator in-house and incorporation of intervention components into existing activities to accommodate the busyness of the line managers. CONCLUSIONS: To support the SA coordinators in carrying out their role and responsibilities, this study suggests that it is important to ensure commitment to the role, especially among the line managers in order to enhance good working relationships.

Work Disability and Musculoskeletal Disorders Among Teleworkers: A Scoping Review.

PURPOSE: This project aimed to examine the existing evidence on work disability or musculoskeletal disorders (MSDs) among teleworkers. METHOD: A scoping review was conducted in eight bibliographic databases (MEDLINE, CINAHL, Embase, PsycINFO, ABI/Inform Global, EBM Reviews, Web of Science, Dissertations & Theses Global) from inception to June 2022. RESULTS: Out of 9192 records identified, a total of 79 selected articles representing 77 studies were retained. Most studies were published after 2019, aligning with the COVID-19 pandemic's telework surge. Among the included papers, 51 addressed MSDs among teleworkers, 17 were on work disability, and 11 addressed both concepts. The studies were predominantly cross-sectional. Some trends are emerging, although study results are contradictory. Several papers reported increased musculoskeletal discomfort among teleworkers. Factors associated with MSDs among teleworkers include poor workstation setup, extended workdays, sedentary lifestyle, excessive devices use, and psychological factors. Regarding work disability, studies found that telework is associated with reduced absenteeism but increased presenteeism, with employees more likely to work while unwell from home than when on-site. Mixed results were found regarding teleworkers' work ability and functioning. CONCLUSION: This paper provides an overview of the literature on work disability and MSDs among teleworkers. It identifies literature gaps, underlining the need for ergonomic improvements, long-term impact studies, a better conceptualization of presenteeism in the context of telework, and tailored interventions to enhance the telework experience.

Evaluation of absenteeism and presenteeism status of factory employees.

BACKGROUND: While absenteeism refers to not attending work, presenteeism is defined as not being present at work. These two conditions, which negatively affect employee health, can be indicators of work efficiency, work peace, work safety and work engagement. OBJECTIVE: Several factors were evaluated in this study concerning absenteeism and presenteeism among factory workers. METHODS: This cross-sectional study was conducted among workers in a factory operating in a heavy industry in southern Turkey in 2021. A survey consisting of 57 questions was applied to 152 factory workers by face-to-face interview method. The participants' behaviour over the last month was evaluated regarding absenteeism and presenteeism. RESULTS: It was reported that 24 (15.8%) of all employees were absent from work in the last month (absenteeism), excluding holidays and sick leave, and that 20 (13.2%) employees engaged in presenteeism, working when they should not have been at the workplace. There was a high absenteeism rate among employees who had an acute illness and were dissatisfied with their jobs. Several factors have been associated with presenteeism, including poor economic conditions, family health problems, previous unemployment, working overtime, job dissatisfaction, poor relationships with colleagues and difficulty finding a replacement, acute illness, sleep problems and fatigue. CONCLUSIONS: To increase the productivity and commitment of employees, it may be useful to identify the reasons for absenteeism and present behaviours, to facilitate effective interpersonal communication skills by examining the organisational climate of employees, and to regulate workload based on a comprehensive assessment of the health status of employees.

Effectiveness of interventions to reduce COVID-19 transmission in schools.

School reopenings in 2021 and 2022 coincided with the rapid emergence of new SARS-CoV-2 variants in the United States. In-school mitigation efforts varied, depending on local COVID-19 mandates and resources. Using a stochastic age-stratified agent-based model of SARS-CoV-2 transmission, we estimate the impacts of multiple in-school strategies on both infection rates and absenteeism, relative to a baseline scenario in which only symptomatic cases are tested and positive tests trigger a 10-day isolation of the case and 10-day quarantine of their household and classroom. We find that monthly asymptomatic screening coupled with the 10-day isolation and quarantine period is expected to avert 55.4% of infections while increasing absenteeism by 104.3%. Replacing quarantine with test-to-stay would reduce absenteeism by 66.3% (while hardly impacting infection rates), but would require roughly 10-fold more testing resources. Alternatively, vaccination or mask wearing by 50% of the student body is expected to avert 54.1% or 43.1% of infections while decreasing absenteeism by 34.1% or 27.4%, respectively. Separating students into classrooms based on mask usage is expected to reduce infection risks among those who wear masks (by 23.1%), exacerbate risks among those who do not (by 27.8%), but have little impact on overall risk. A combined strategy of monthly screening, household and classroom quarantine, a 50% vaccination rate, and a 50% masking rate (in mixed classrooms) is expected to avert 81.7% of infections while increasing absenteeism by 90.6%. During future public health emergencies, such analyses can inform the rapid design of resource-constrained strategies that mitigate both public health and educational risks.

Stress as a mediator between abusive supervision and clinical nurses' work outcomes.

AIMS: This study aimed to test whether stress could mediate the association between abusive supervision and nurses' work engagement, absenteeism, and turnover intention. BACKGROUND: Abusive supervision has been attributed to suboptimal work performance and reduced productivity among employees in different sectors. While existing nursing literature links abusive supervision to a wide range of work-related outcomes in the nursing workforce, little is known regarding the mechanism underlying this relationship. DESIGN: Data for this descriptive study were collected from 770 direct-care nurses from seven acute care hospitals in the Philippines, utilizing five standardized scales. RESULTS: Abusive supervision had direct positive effects on absenteeism (ß = .189, p < .001) and intent to leave (ß = .138, p < .001) and a direct negative effect on job engagement (ß = -.131, p < .001). The relationships between abusive supervision and absenteeism (ß = .175, p < .001), intent to leave (ß = .131, p < .001), and work engagement (ß = -.122, p < .001) were partially mediated by stress. CONCLUSIONS: Stress mediated the relationship between abusive supervision and nurses' work outcomes, including turnover intention, absenteeism, and work disengagement. IMPLICATIONS FOR NURSING AND HEALTH POLICY: The evident connection between abusive supervision, stress, and work-related outcomes underscores the importance of focusing on enhancing managerial supervisory styles as a potential organizational strategy to enhance staff retention and well-being.

Diabetic Foot and Work Outcomes: A Review.

The aim of this review article was to discuss impact of diabetic foot ulcers (DFUs) on employment status and work productivity. We performed a literature search from 2000 to 2023 in PubMed, Scopus, Google Scholar and in national repositories. The major work outcomes studied were presenteeism and absenteeism. Many DFUs patients had a poor social and educational background. Overall, DFUs patients experienced increased loss of productivity in their workplaces: either they had to be absent more working hours than average or they faced increased difficulty in meeting their daily requirements. The total loss in productivity is estimated to exceed almost one-third of anticipated working time, while 15 to 34.3% of DFUs patients expressed concerns about severe changes in their working environment, attributed directly to their condition. More than 1 out of 5 DFUs patients (ranging from 20 to 31.7%) were even confronted with overall job loss and unemployment. Amputations had an even more marked negative effect. In conclusion, DFUs negatively affect employment status and work productivity. Therefore, we need more studies with large participant numbers to increase our experience and to explore potential measures to mitigate these adverse effects.

Effectiveness of COVID-19 vaccination against school absenteeism in children and adolescents hospitalized with COVID-19.

BACKGROUND: COVID-19 vaccination has been recommended for children to protect them and to enable in-person educational and social activities. METHODS: We estimated COVID-19 vaccination effectiveness (VE) against school absenteeism in children 5-17 years old hospitalized from September 1, 2021 through May 31, 2023. Full vaccination was defined as two vaccine doses. RESULTS: We studied 231 children admitted to hospital with COVID-19, including 206 (89.2 %) unvaccinated/partially vaccinated and 25 (10.8 %) fully vaccinated. Unvaccinated/partially vaccinated children were absent from school for longer periods compared to fully vaccinated children (median absence: 14 versus 10 days; p-value = 0.05). Multivariable regression showed that full COVID-19 vaccination was associated with fewer days of absence compared to no/partial vaccination on average (adjusted relative risk: 0.77; 95 % CI: 0.61 to 0.98). COVID-19 VE was 50.7 % (95 % CI: -11.3 % to 78.2 %) for school absenteeism above the median duration of absenteeism. CONCLUSIONS: Full COVID-19 vaccination conferred protection against school absenteeism in hospitalized school-aged children with COVID-19.

Impact of 1-year treatment with dupilumab on work productivity in Japanese patients with atopic dermatitis.

Atopic dermatitis (AD) places a burden on work productivity. Recently, dupilumab was approved for AD, but its impact on work productivity in Japanese patients has not been reported. Furthermore, data on the effect of long-term treatment with dupilumab on work productivity are limited. We investigated the work productivity and activity in Japanese patients with moderate-to-severe AD, utilizing the Japanese version of the Work Productivity and Activity Impairment (WPAI-AD-Japan) questionnaire. Furthermore, we examined the impact of dupilumab on work productivity. Adult moderate-to-severe AD patients treated with dupilumab for more than 12 months from March 2020 to June 2022 who filled out the WPAI-AD-Japan questionnaire were included. Twenty-eight adult AD patients were analysed. Absenteeism was low (mean: 5.3%), but presenteeism, work productivity loss and activity impairment were high (36.8%, 39.7%, 48.9%, respectively). Significant positive correlations were observed between work productivity loss and visual analogue scale (VAS) score of pruritus and between activity impairment and dermatology life quality index (DLQI). Dupilumab treatment significantly reduced presenteeism, work productivity loss and activity impairment at both 6 and 12 months. The extent of their amelioration was numerically higher at 12 months than at 6 months. The reduction rates in presenteeism, work productivity loss and activity impairment were positively correlated with the reduction rates in DLQI and VAS score of pruritus at 12 months. Dupilumab improved work productivity in Japanese AD patients. Long-term remission of pruritus and improved quality of life are important for comprehensive improvement of work productivity.

A scoping review of the economic impact of family oral health: Implications for public health, research, and policy.

OBJECTIVES: To summarize evidence on the impact of oral health on individual and family economic outcomes, describe trends in the literature, and identify areas for additional research to inform public health research and practice. METHODS: Searches were conducted within PubMed, CINAHL, EconLit, Cochrane Library, PsycInfo, and Web of Science databases. Article review, selection, abstraction, and reporting processes were guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. RESULTS: Of 2758 unduplicated records identified, 52 met inclusion criteria. Study outcomes included indicators of employment/employability (n = 9), earnings/earnings potential (n = 26), parent missed work and family financial impacts of child oral health (n = 19), and financial loss (n = 3). Dental caries-related variables were the most common predictors of poorer economic outcomes. Other oral health problems, such as poorer dental functioning or poorer self-reported oral health status, also were associated with adverse economic outcomes. Significant associations with employment were found among studies that assessed interventions designed to improve oral health. Only one study estimated the impact of oral health on earnings. One-third of studies conducted multivariable analyses, and 14% incorporated race and ethnicity variables. CONCLUSIONS: Although existing evidence suggests associations between oral health problems and poorer economic outcomes, there is a substantial need for more rigorous research to better understand the extent of economic impact of oral health problems and which populations are most affected. Additional high-quality research is needed to inform which interventions are most likely to improve oral health, reduce adverse economic impacts, and promote health and economic equity.

Reducing sickness absence among public-sector healthcare employees: the difference-making roles of managerial and employee participation.

PURPOSE: Evaluations of organizational-level interventions to prevent work-related illness have identified enabling factors, but knowledge of necessary and sufficient conditions for intervention success is needed. The aim was to identify difference-making factors that distinguish intervention groups with and without a positive intervention effect on sickness absence. METHODS: An organizational-level intervention designed to decrease sickness absence by providing support from process facilitators was implemented at eight healthcare workplaces in Sweden between 2017 and 2018. We applied coincidence analysis (CNA) to analyze 34 factors and determine which factors were necessary and sufficient for a successful implementation of tailored interventional measures on an organizational level (dichotomous) and reduced sickness absence (trichotomous). RESULTS: Two factors perfectly explained both the presence and absence of a successful implementation: "a high sense of urgency" and "good anchoring and participation from the strategic management". The presence of either of these factors alone was sufficient for successful implementation, whereas the joint absence of both conditions was necessary and sufficient for the absence of successful implementation and an intervention effect. In addition, high employee participation was both necessary and sufficient for a high intervention effect. For organizations without high employee participation, successful implementation led to a medium-effect size. CONCLUSIONS: This study identified participation as a difference-maker in the implementation process. Participation from different stakeholders turned out to be important in different phases. When implementing organizational-level interventions, high participation from both strategic management and employees appears to be crucial in terms of the intervention's effect on sickness absence.

Implications of absenteeism of health workers on achieving universal health coverage in Nigeria: exploring lived experiences in primary healthcare.

Primary healthcare facilities are the bedrock for achieving universal health coverage (UHC) because of their closeness to the grassroots and provision of healthcare at low cost. Unfortunately, in Nigeria, the access and quality of health services in public primary healthcare centres (PHCs) are suboptimal, linked with persistent occurrence of absenteeism of health workers. We used a UHC framework developed by the World Health Organization-African Region to examine the link between absenteeism and the possible achievement of UHC in Nigeria. We undertook a qualitative study to elicit lived experiences of healthcare providers, service users, chairpersons of committees of the health facilities, and policymakers across six PHCs from six local government areas in Enugu, southeast Nigeria. One hundred and fifty participants sourced from the four groups were either interviewed or participated in group discussions. The World Health Organization-African Region UHC framework and phenomenological approach were used to frame data analysis. Absenteeism was very prevalent in the PHCs, where it constrained the possible contribution of PHCs to the achievement of UHC. The four indicators toward achievement of UHC, which are demand, access, quality, and resilience of health services, were all grossly affected by absenteeism. Absenteeism also weakened public trust in PHCs, resulting in an increase in patronage of both informal and private health providers, with negative effects on quality and cost of care. It is important that great attention is paid to both availability and productivity of human resources for health at the PHC level. These factors would help in reversing the dangers of absenteeism in primary healthcare and strengthening Nigeria's aspirations of achieving UHC.

Missed Healthcare Visits During the COVID-19 Pandemic: A Longitudinal Study.

INTRODUCTION: Missed visits have been estimated to cost the U.S. healthcare system $50 billion annually and have been linked to healthcare inefficiency, higher rates of emergency department visits, and worse outcomes. COVID-19 disrupted existing outpatient healthcare utilization patterns. In our study, we sought to examine the frequency of missed outpatient visits over the course of the COVID-19 pandemic and to examine patient-level characteristics associated with non-attendance. METHODS: This study utilized data from a longitudinal cohort study (the Chicago COVID-19 Comorbidities (C3) study). C3 participants were enrollees in 1 of 4 active, "parent" studies; they were rapidly enrolled in C3 at the onset of the pandemic. Multiple waves of telephone-based interviews were conducted to collect experiences with the pandemic, as well as socio-demographic and health characteristics, health literacy, patient activation, and depressive and anxiety symptoms. For the current analysis, data from waves 3 to 8 (05/01/20-05/19/22) were analyzed. Participants included 845 English or Spanish-speaking adults with 1 or more chronic conditions. RESULTS: The percentage of participants reporting missed visits due to COVID-19 across study waves ranged from 3.1 to 22.4%. Overall, there was a decline in missed visits over time. No participant sociodemographic or health characteristic was consistently associated with missed visits across the study waves. In bivariate and multivariate analysis, only patient-reported anxiety was significantly associated with missed visits across all study waves. CONCLUSION: Findings reveal that anxiety was consistently associated with missed visits during the COVID-19 pandemic, but not sociodemographic or health characteristics. Results can inform future public health initiatives to reduce absenteeism by considering patients' emotional state during times of uncertainty.

Absenteeism, Presenteeism, and the Economic Costs of Alcohol Hangover in The Netherlands.

The alcohol hangover is defined as the combination of negative mental and physical symptoms that can be experienced after a single episode of alcohol consumption, starting when the blood alcohol concentration (BAC) approaches zero. Alcohol hangover symptoms such as fatigue, nausea, and headache can negatively affect daily activities, including work performance. The alcohol hangover can therefore be a cause of both absenteeism (not going to work) and presenteeism (going to work while hungover). An online survey among a convenience sample of n = 347 Dutch adults examined the number of days of absenteeism and presenteeism associated with having a hangover as well as the loss of productivity when going to work when hungover during the year 2019. In the Dutch sample, 8.1% of employees reported one or more days of absenteeism due to hangover in 2019, and 33.4% reported one or more days of presenteeism. The analyses revealed that alcohol hangover was associated with 0.2 days of absenteeism and 8.3 days of presenteeism and a productivity loss of 24.9% on days worked with a hangover. The estimated associated costs for the Dutch economy in 2019 of absenteeism (EUR 234,538,460) and presenteeism (EUR 2,423,603,184) total EUR 2,658,141,644. In conclusion, the alcohol hangover is associated with absenteeism, presenteeism, and reduced performance at work while hungover. As such, the annual costs of the alcohol hangover have a significant impact on the Dutch economy. However, these first findings on the economic costs of the alcohol hangover should be considered a rough estimate. They should be verified in a longitudinal study to minimize recall bias, including a nationally representative sample of sufficient sample size.

Assessing the effect of cardiovascular disease on work productivity and financial loss among school teachers in Peninsular Malaysia: a nested case-control study.

Background: School teachers may have an increased risk of cardiovascular disease (CVD), potentially affecting their work productivity. However, limited data exists on the impact of CVD on teachers' productivity in Malaysia. Our objectives were to assess work productivity loss (absenteeism and presenteeism) as well as to determine the associated annual monetary loss among school teachers who experienced incident CVD in Peninsular Malaysia. Methods: We adopted a nested case-control design within a cohort of school teachers. Working teachers from six states of Peninsular Malaysia, and had experienced incident CVD before a right-censored date (31st December 2021) were defined as cases. Incident CVD was operationally defined as the development of non-fatal acute coronary syndrome (ACS), stroke, congestive cardiac failure, deep vein thrombosis or peripheral arterial disease before the censored date. Controls were working teachers who did not acquire an incident CVD before the similar right-censored date. All controls were randomly selected, with a ratio of one case to four controls, from among the working teachers in one of the states in Peninsular Malaysia. We used a shortened version of the Malay-validated World Health Organization-Health and Work Performance Questionnaire (WHO-HPQ) to estimate the workplace productivity effect among teachers with incident CVD (cases). The same questionnaire was distributed to teachers in a single state of Peninsular Malaysia who did not experience incident CVD (controls). Absenteeism, presenteeism and annual monetary loss were computed based on the scoring rules in the WHO-HPQ. Analysis of covariance was performed with covariate adjustment using propensity scores. The bootstrapping method was applied to obtain better estimates of marginal mean differences, along with standard errors (SE) and appropriate effect sizes. Results: We recruited 48 cases (baseline mean age = 42.4 years old, 54.2% females) and 192 randomly selected controls (baseline mean age = 36.2 years old, 99.0% females). The majority of the cases had ACS (73.9%). No significant difference was observed in absenteeism between cases and controls. The mean self-rated job performance score was lower for cases (7.63, SE = 0.21) compared to controls (8.60, SE = 0.10). Marginal mean scores of absolute presenteeism among cases (76.30) were lower (p < 0.05, eta squared = 0.075) than controls (85.97). The marginal mean annual cost of presenteeism was higher in cases (MYR 21,237.52) compared to controls (MYR 12,089.74) (p < 0.05, eta squared = 0.082). Conclusion: Absolute presenteeism was lower among school teachers who experienced incident CVD and the annual cost of presenteeism was substantial. Implementing supportive work strategies in school settings is recommended to increase absolute presenteeism, which can lead to a reduction in the annual cost of presenteeism among teachers experiencing incident CVD.

Support Needs of Labor and Delivery Nurses After Traumatic Experiences.

OBJECTIVE: To examine the effect of psychological distress, overall distress, and institutional support following a traumatic workplace event on absenteeism, turnover intention, and resilience among labor and delivery nurses. DESIGN: A quantitative cross-sectional survey. SETTING: Online distribution from January 13, 2021, to February 2, 2021. PARTICIPANTS: A nationwide convenience sample of labor and delivery nurses recruited from the Association of Women's Health, Obstetric and Neonatal Nurses (N = 171). METHODS: Participants completed a survey that included the Second Victim Experience and Support Tool-Revised and the Second Victim Support Desirability survey. We compared available versus desired support options using descriptive analyses. We examined levels of psychological distress and lack of institutional support in relation to turnover intention, absenteeism, and resilience using multiple regression analyses. RESULTS: Participants identified and described various traumatic experiences in the workplace, including neonatal and maternal death, complicated births, and workplace violence. Participants indicated that the available support services did not meet their needs. Psychological distress, overall distress, and lack of institutional support were associated with absenteeism and turnover, whereas only institutional support was associated with resilience. CONCLUSION: Labor and delivery nurses encounter various traumatic events in the workplace, and the support services provided after an event do not meet their needs. Additional research is needed to understand the scope of the problem and investigate best practices to assist labor and delivery nurses following traumatic events.

Changes in the menstrual hygiene management facilities and usage among Bangladeshi school girls and its effect on school absenteeism from 2014 to 2018.

BACKGROUND: The lack of menstrual hygiene management (MHM) information and facilities in schools is a major contributor to adolescent girls' school absenteeism in low- and middle-income countries like Bangladesh. OBJECTIVES: This paper examines the changes over time in school MHM facilities, knowledge and perceptions among adolescent girls, in relation to school absenteeism between 2014 and 2018 in Bangladesh. METHODS: We examined changes in MHM and school absenteeism among schoolgirls using nationally representative data from the Bangladesh National Hygiene Baseline Survey 2014 and National Hygiene Survey 2018. Given the repetitive nature of our data and its clustering within participants, our method included performing descriptive analysis, bivariate analysis, and multivariate Generalised Estimating Equation (GEE) modelling to analyse these changes. RESULTS: Results showed that adolescent girls' menstruation-related absenteeism decreased between 2014 and 2018. Percentage of adolescents who missed school decreased from 25% to 14% (PD: -11; CI: -16 to -6.1), while the average number of missed days reduced from 2.8 to 2.5 (PD: -0.33; CI: -0.57 to -0.10). In the GEE model, we found that living in rural areas (coef: -5.6; CI: -10.06 to -1.14), parental restrictions on going outside (coef: 4.47; CI: 0.75 to 8.2), education levels of girls (coef: -9.48; CI: -14.17 to -4.79), girl's belief that menstruation affects school performance (coef: 23.32; CI: 19.71 to 26.93), and using old cloths (coef: -4.2; CI: -7.6 to -0.79) were significantly associated with higher absenteeism. However, participant's age, type of school, knowledge of menstruation before menarche, receiving information regarding MHM, separate place for changing absorbents, and separate latrine and urine facility were not significantly associated with the changes in absenteeism over time. CONCLUSION: This paper emphasised the associations between changes in school absenteeism, parental restrictions on students, students' education levels, and menstruation-related misperceptions. Ongoing research, policy reviews, and targeted interventions to improve MHM perceptions among girls are required to provide long-term benefits for adolescent girls in Bangladesh.

Effect of planned school breaks on student absenteeism due to influenza-like illness in school aged children-Oregon School District, Wisconsin September 2014-June 2019.

Background: School-aged children and school reopening dates have important roles in community influenza transmission. Although many studies evaluated the impact of reactive closures during seasonal and pandemic influenza outbreaks on medically attended influenza in surrounding communities, few assess the impact of planned breaks (i.e., school holidays) that coincide with influenza seasons, while accounting for differences in seasonal peak timing. Here, we analyze the effects of winter and spring breaks on influenza risk in school-aged children, measured by student absenteeism due to influenza-like illness (a-ILI). Methods: We compared a-ILI counts in the 2-week periods before and after each winter and spring break over five consecutive years in a single school district. We introduced a "pseudo-break" of 9 days' duration between winter and spring break each year when school was still in session to serve as a control. The same analysis was applied to each pseudo-break to support any findings of true impact. Results: We found strong associations between winter and spring breaks and a reduction in influenza risk, with a nearly 50% reduction in a-ILI counts post-break compared with the period before break, and the greatest impact when break coincided with increased local influenza activity while accounting for possible temporal and community risk confounders. Conclusions: These findings suggest that brief breaks of in-person schooling, such as planned breaks lasting 9-16 calendar days, can effectively reduce influenza in schools and community spread. Additional analyses investigating the impact of well-timed shorter breaks on a-ILI may determine an optimal duration for brief school closures to effectively suppress community transmission of influenza.