Intersectoral actions in decreasing social inequities faced by children and adolescents

Comprehensive health care for adolescents and young people from the perspective of primary care professionals, San Pablo, Brazil

Comprehensiveness is a globally recommended principle for effective health care, particularly for adolescents and young people, whose needs combine biomedical aspects with sociocultural processes of subjectivity construction and citizenship exercise. However, significant challenges hinder its effective implementation. This study aims to identify the aspects of work carried out in primary health care units in the state of São Paulo, Brazil, that professionals perceive as facilitators or obstacles to providing comprehensive health care for adolescents and young people. This qualitative study, conducted between January and November 2023, involved workplace observations and semi-structured interviews with 73 health professionals. The findings highlight the predominance of decontextualized, fragmented, and prescriptive actions within a context of resource shortages and weak intersectoral coordination. The study underscores the need for adolescents and young people to participate as rights-bearing subjects in the development of intersectoral health actions and policies.

Social vulnerability among Brazilian children in early childhood: a scoping review

OBJECTIVE

To identify, map, and describe studies involving Brazilian children in early childhood in situations of social vulnerability.

SOURCE OF DATA

A scoping review including full articles published in Portuguese and English up to March 2023, with no temporal restrictions. Searches were conducted in the MEDLINE/PubMed, Scielo, EMBASE, Cochrane, Scopus, CINAHL, Web of Science, PEDro, and LILACS databases. Journal metrics, sample characteristics, study area, characterization of the situation of social vulnerability, and study outcomes were extracted.

SUMMARY OF THE FINDINGS

Seventy-six articles involving a total of 107.740 children in early childhood were included in this study. These studies presented relevant findings, including the temporal publication trend, the variability of social vulnerability indicators, the scarcity of intervention studies, and the fact that 100% of eligible studies were from the health area. Negative outcomes were associated with the condition of social vulnerability in almost the entire sample, reinforcing the need for government policies capable of protecting early childhood from the effects of social vulnerability.

CONCLUSION

This scoping review mapped important findings involving Brazilian children in social vulnerability. It also identified literature gaps such as the need for intervention and multisectoral studies among health, education, and social protection.

Understanding prenatal household exposures to per- and polyfluorylalkyl substances using paired Biological and dust measurements with sociodemographic and housing variables

Per- and poly-fluoroalkyl substances (PFAS) are chemicals of concern-they are ubiquitous, persistent, with known and suspected health impacts. Well studied, primary sources of exposure to PFAS are drinking water and food. The presence of PFAS in human tissue of general populations suggests other important exposure sources/pathways. House dust measurements suggest widespread presence of PFAS in residences. Limited studies report paired analyses of PFAS occurrence in indoor media and PFAS concentrations in serum. While paired samples of house dust and blood serum are currently rare, the National Children's Study (NCS) contains paired samples, as well as sociodemographic information, from pregnant people that participated in the study. These archived NCS data and specimens for 104 participants collected between 2009 and 2014 were leveraged and analyzed for 16 commonly measured PFAS. We evaluated PFAS levels in the home, and the relationships between PFAS in dust and serum, and sociodemographic or housing variables. In addition, mechanistic exposure models, and then steady-state serum level models with simple parameters were used to estimate dust contributions of PFAS to serum. The geometric means for the most commonly found PFAS (full names in table 1) in serum were: 4.1 ng/mL for PFOS, 1.1 ng/mL for PFOA, 0.87 ng/mL for PFHxS, 0.16 ng/mL for PFDA. The geometric means of PFAS in dust were: 17 µg/kg for PFOS, 16 µg/kg for PFOA, 9.6 µg/kg for PFDS, 4.5 µg/kg for PFHpA, 4.4 µg/kg for PFNA, 3.9 µg/kg for PFHxS, 3.5 µg/kg for PFDA, 2.3 µg/kg for PFDoA, 2.1 µg/kg for PFUdA. PFOA was significantly correlated in serum and dust as was the sum of all PFAS detected in > 50 % of serum and dust. PFAS in serum was significantly associated with: Higher income, recent renovations, years lived in the home, and educational attainment. PFAS in dust was significantly associated with: Higher participant age, type of home, amount of carpet, educational attainment, higher income, recent renovation, and membership in the military. For some PFAS, 25 % of the overall exposure, on average, is from dust, but for others, 3-4 % is attributed to dust. We were able to identify important associations in PFAS exposure in the homes of pregnant people based on paired serum and dust samples. This built a clearer picture of which PFAS and at what quantities they exist in these homes, how they relate to each other, and how they are tied to sociodemographic and housing factors. Our results demonstrate that exposure to PFAS via house dust may contribute up to 25% of total exposure for adults, highlighting the importance of understanding what drives residential exposures.

Quality of life, health perception, learning motivation and behavior of adolescents in an educational institution

OBJECTIVE

to analyze sociodemographic variables, quality of life, self-perceived health, learning motivation and behavior of adolescents in 2018 and 2021.

METHOD

observational cross-sectional study with 124 adolescents in 2018, and 68 in 2021. A Form for sociodemographic variables, Pediatric Quality of Life Inventory, Self-Perceived Health instrument, Learning Motivation Scale and Strengths and Difficulties Questionnaire were used to collect data. Data collection was carried out using forms on Google Forms. For the analysis, descriptive statistics and logistic regression were used.

RESULTS

the majority of participants belonged to class A. In the comparison between 2018 and 2021, there was a worsening in the assessment of self-perceived health. In the assessment of QoL by parents, there was a statistically significant difference between the scores of the social and psychosocial dimensions. Among adolescents, there were differences between QoL scores in the physical and psychosocial dimensions.

CONCLUSION

the adolescent with a better mental health assessment had a greater chance of having a better quality of life in the periods investigated (OR=5.35 and OR=5.51). Younger students showed greater motivation to learn, increasing the chance of improving their quality of life by up to 9.75 and 5.02 times in the two periods, respectively.

BACKGROUND

(1) The school environment is a space favorable to promoting physical, mental and social health.

BACKGROUND

(2) Awareness about healthy lifestyle habits should be carried out during adolescence.

BACKGROUND

(3) Aspects related to health can influence behavior and learning.

BACKGROUND

(4) Quality of life (QoL) and its dimensions are related to the motivation to learn.

BACKGROUND

(5) Adolescent mental health is related to self-perception of QoL.

Mental health among adolescents exposed to social inequality in Latin America and the Caribbean: a scoping review

Background and objective

Adolescents from Latin America and the Caribbean grow up in a context of social inequality, which diminishes their well-being and leads to impaired emotional-cognitive development. To understand the problem, it is important to synthesize the available research about it. This study aims to explore the knowledge about adolescents' mental health in Latin America and the Caribbean exposed to social inequality.

Methods

A systematic scoping review was conducted encompassing a search in five databases (Medline, CINAHL, PsycINFO, Scopus, and LILACS) in June 2022. Articles of various typologies were included without time limit. After two rounds of screening, relevant data were manually extracted and synthesized into self-constructed themes using thematic analysis.

Results

Out of 8,825 retrieved records, 42 papers were included in the final review, with a predominance of quantitative approaches. The synthesis revealed two main analytical themes: (a) defining social inequality, wherein intersecting inequalities produce discrimination and determine conditions for social vulnerability; (b) social inequality and mental health, which highlights the association between socio-structural difficulties and emotional problems, amplifying vulnerability to mental ill health and poor mental health care.

Conclusion

The scientific evidence reveals that social inequality is related to impaired well-being and mental ill health on the one hand and a lack of access to mental health care on the other hand.

Process evaluation of an integrated community-based intervention for promoting health equity in children in a new residential development area

BACKGROUND

Reducing health inequities for children from a disadvantaged background is an important task in public health. While intersectoral partnerships are a promising way to achieve this, few studies have examined the factors influencing the success of these interventions. In this study, we conducted a process evaluation of the integrated community-based intervention Präventionskette Freiham that the city of Munich, Germany, has implemented in a new residential development area. The aim was to investigate the implementation process as well as barriers and facilitators.

METHODS

Following a mixed methods approach, we collected data from different core groups making up Präventionskette Freiham from April 2020 to August 2022, exploring their perspective on the implementation process. We conducted repeated qualitative interviews with the network coordinators and eleven local professionals from institutions engaged with or relevant for the intervention. We also undertook a focus group with four members of the advisory group representing the three municipal departments guiding the intervention. Ego-centered network maps were drawn by the network coordinators to chart the development of the network. Subsequently, we also conducted an online survey with local network members.

RESULTS

At the early stage of the implementation process, the intervention was able to integrate actors from different sectors, serving as a platform for mutual exchange. However, the network produced limited output. According to the interviews, this may be mainly attributable to the early development status of the area. We identified seven topics that may act as facilitators or barriers to implementation of Präventionskette Freiham: (1) availability of resources, (2) political and administrative support, (3) the network coordinators, (4) network-internal processes, (5) trans-institutional cooperation, (6) perceived benefits of engagement, and (7) the output of the network.

CONCLUSIONS

The early development status of the area was a challenge for the intervention. This emphasizes the need to carefully consider context when planning and implementing integrated community-based public health interventions in new residential development areas.

Multisectoral actions in primary health care: A realist synthesis of scoping review

BACKGROUND

Multisectoral actions (MSAs) on health are key to implementation of primary health care (PHC) and achieving the targets of the Sustainable Development Goal 3. However, there is limited understanding and interpretation of how MSAs on health articulate and mediate health outcomes. This realist review explored how MSAs influence on implementing PHC towards universal health coverage (UHC) in the context of multilevel health systems.

METHODS

We reviewed published evidence that reported the MSAs, PHC and UHC. The keywords used in the search strategy were built on these three key concepts. We employed Pawson and Tilley's realist review approach to synthesize data following Realist and Meta-narrative Evidence Syntheses: Evolving Standards publication standards for realist synthesis. We explained findings using a multilevel lens: MSAs at the strategic level (macro-level), coordination and partnerships at the operational level (meso-level) and MSAs employing to modify behaviours and provide services at the local level (micro-level).

RESULTS

A total of 40 studies were included in the final review. The analysis identified six themes of MSAs contributing to the implementation of PHC towards UHC. At the macro-level, themes included influence on the policy rules and regulations for governance, and health in all policies for collaborative decision makings. The meso-level themes were spillover effects of the non-health sector, and the role of community health organizations on health. Finally, the micro-level themes were community engagement for health services/activities of health promotion and addressing individuals' social determinants of health.

CONCLUSION

Multisectoral actions enable policy and actions of other sectors in health involving multiple stakeholders and processes. Multisectoral actions at the macro-level provide strategic policy directions; and operationalise non-health sector policies to mitigate their spillover effects on health at the meso-level. At micro-level, MSAs support service provision and utilisation, and lifestyle and behaviour modification of people leading to equity and universality of health outcomes. Proper functional institutional mechanisms are warranted at all levels of health systems to implement MSAs on health.

Impacts of pregnancy among quilombola adolescents

OBJECTIVE

understand the impacts of pregnancy on the lives of quilombola adolescents.

METHOD

this is a qualitative study using an exploratory descriptive design. Ten quilombola mothers who experienced pregnancy during adolescence participated in this study. Data were collected through semi-structured interviews and then submitted to content analysis.

RESULTS

three categories were identified, showing the knowledge of the participants about being a quilombola and about the impacts on their lives after discovering they were pregnant and how they handled the fact of being a mother-adolescent according to the adaptations and expectations of their new phase.

CONCLUSION

pregnancy in adolescence had impacts on several aspects of the lives of adolescents, with psychological, educational, socioeconomic, and family implications, as well as new responsibilities. Also, this study highlights the role of pregnant adolescent reception of nursing professionals to meet the individual needs of adolescents and develop prevention strategies to help reduce pregnancy among quilombola adolescents.

HIGHLIGHTS

(1) Impacts of pregnancy on the daily routine of quilombola adolescents.(2) Psychological, educational, socioeconomic, and family implications.(3) Discovering motherhood and assuming new responsibilities.(4) Developing strategies to prevent pregnancy in quilombola adolescents.(5) Nursing assumes the role of reception of these pregnant quilombola adolescents.

Repercusiones del embarazo en adolescentes quilombolas

Resumen Objetivo: comprender las repercusiones de la gravidez en la vida de las adolescentes quilombolas. Método: estudio cualitativo con enfoque exploratorio y descriptivo. Participaron diez madres quilombolas que vivieron un embarazo en la adolescencia. La recolección de datos se llevó a cabo a través de entrevistas semiestructuradas. Los datos fueron sometidos a los procedimientos de análisis de contenido. Resultados: se elaboraron tres categorías que evidenciaron el conocimiento de las participantes sobre ser quilombola, así como los impactos en su rutina tras el descubrimiento de la gravidez y cómo se adecuaron para ser madres y adolescentes según las adaptaciones y expectativas de la nueva etapa. Conclusión: la existencia del embarazo adolescente repercutió en varios aspectos de sus vidas, con implicaciones relacionadas con los aspectos psicológicos, educativos, socioeconómicos y familiares; además de nuevas responsabilidades. Asimismo, se destaca el papel del proceso de atención de enfermería en la acogida de estas adolescentes, con el fin de atender sus necesidades individuales y desarrollar estrategias de prevención que puedan contribuir a la reducción del embarazo en este colectivo en las comunidades quilombolas.

Rupturas biográficas por la pandemia del COVID-19 en adolescentes y jóvenes hombres trans y transmasculinos: demandas para la enfermería

Resumen Objetivo: comprender las rupturas biográficas provocadas por la pandemia del COVID-19 en adolescentes y jóvenes hombres trans y personas transmasculinas en el contexto de Brasil. Método: estudio cualitativo - encuesta en línea - multicéntrico. Participaron 97 hombres trans y 22 personas transmasculinas autoidentificadas, que respondieron un formulario semiestructurado en dos etapas. Los datos se sometieron al Análisis de Contenido Temático Reflexivo. La interpretación se realizó sobre una base sociológica a partir del concepto de ruptura biográfica. Resultados: surgieron cinco categorías: interrupción de la terapia hormonal, cirugías y seguimiento especializado; malestares precipitados por la interrupción de las características masculinas, autoimagen, autopercepción e identidad; vulnerabilidad por la pérdida de familiares y seres queridos, empleo y debilitamiento de las redes de apoyo; aparición de problemas psicoemocionales, como la pérdida del sentido de la vida; demandas de atención de enfermería y valoración de la vida de adolescentes y jóvenes transexuales en el pospandemia. Conclusión: las rupturas biográficas provocadas por la pandemia amenazaron las identidades de los hombres trans y personas transmasculinas adolescentes y jóvenes, produjeron degradación y discontinuidad de las biografías, llevándolas a perder el sentido de la vida. Los profesionales de enfermería pueden ser estratégicos e imprescindibles en la superación de estas amenazas al promover una intervención anticipada.

Biographical ruptures by the COVID-19 pandemic on adolescent and young trans men and transmasculine people: demands for nursing

Abstract Objective: to understand the biographical ruptures caused by the COVID-19 pandemic on adolescent and young trans men and transmasculine people in the Brazilian context. Method: qualitative study - multicenter, online survey. A total of 97 self-identified trans men and 22 transmasculine people participated and completed a semi-structured form in two stages. The data was subjected to Reflective Thematic Content Analysis. The interpretation was made on a sociological basis, based on the concept of biographical rupture. Results: five categories were derived: interruption of hormonization, surgeries and specialized follow-up; discomforts caused by the rupture of masculine characteristics, self-image, self-perception, and identity; vulnerability from the losses of family members and significant people, employment, and weakening of support networks; emergence of psycho-emotional problems, such as loss of meaning in life; demands for nursing care and valuing the life of transmasculine adolescents and young men in post-pandemic times. Conclusion: the biographical ruptures caused by the pandemic threatened the identities of trans and transmasculine people of adolescents and youth, degraded and interrupted biographies, leading them to the loss of meaning in life. Nursing professionals can be strategic and essential in overcoming threats by intervening early.

Rupturas biográficas pela pandemia da COVID-19 sobre adolescentes e jovens homens trans e transmasculinos: demandas para a enfermagem

Resumo Objetivo: compreender as rupturas biográficas causadas pela pandemia da COVID-19 sobre adolescentes e jovens homens trans e pessoas transmasculinas no contexto do Brasil. Método: estudo qualitativo - survey on-line, multicêntrico. Participaram 97 homens trans e 22 pessoas transmasculinas, autoidentificados, que responderam formulário semiestruturado em duas etapas. Os dados foram submetidos à Análise de Conteúdo Temática Reflexiva. Realizou-se a interpretação com base sociológica, a partir do conceito de ruptura biográfica. Resultados: derivadas cinco categorias: interrupção da hormonização, cirurgias e acompanhamento especializado; desconfortos precipitados pela ruptura das características masculinas, autoimagem, autopercepção e identidade; vulnerabilidade a partir das perdas de familiares e pessoas significativas, emprego e fragilização das redes de apoio; emergência de problemas psicoemocionais, como perda do sentido da vida; demandas para o cuidado de enfermagem e valorização da vida de adolescentes e jovens transmasculinos no pós-pandemia. Conclusão: as rupturas biográficas provocadas pela pandemia ameaçaram as identidades de homens trans e pessoas transmasculinas de adolescentes e jovens, produziram degradação e descontinuidade das biografias, conduzindo-os à perda de sentido da vida. Profissionais de enfermagem podem ser estratégicos e essenciais na superação das ameaças, intervindo antecipadamente.

Repercussões da gravidez entre adolescentes quilombolas

Resumo Objetivo: compreender as repercussões da gravidez para a vida de adolescentes quilombolas. Método: estudo qualitativo de abordagem exploratória e descritiva. Participaram dez mães quilombolas que vivenciaram a gravidez durante a adolescência. A coleta de dados foi realizada por meio de entrevista semiestruturada. Os dados foram submetidos aos procedimentos para análise de conteúdo. Resultados: foram elaboradas três categorias que evidenciaram o conhecimento das participantes acerca do ser quilombola, bem como as repercussões nos seus cotidianos após descoberta da gravidez e como configuravam o ser mãe-adolescente de acordo com as adaptações e expectativas da nova fase. Conclusão: a ocorrência da gravidez na adolescência repercutiu em vários aspectos da vida das adolescentes, com implicações relacionadas a aspectos psicológicos, educacionais, socioeconômicos e familiares; além das novas responsabilidades. Ainda, destaca-se o papel da enfermagem para acolher as adolescentes grávidas, a fim de atender às suas necessidades individuais e desenvolver estratégias de prevenção que possam contribuir para a redução da gravidez na adolescência em comunidades quilombolas.