Public Health Perspective Research Articles

Explosive Behavior in COVID-19 and Policy Responses: Lessons Learned for Public Health Management

Since the first case of COVID-19 in Turkey, there has been a lingering question as elsewhere in the world: “When will or should the government impose severe restrictions to protect public health?” From a public health perspective, there is value in developing a model to support proactive implementation of social policies. This study aimed to show the benefits of using a novel econometric test (the Generalized Supremum Augmented Dickey-Fuller Test) to detect explosive behavior (bubbles) in Turkey’s daily COVID-19 cases and deaths. Results from the analysis demonstrated a link between identified explosive episodes and critical public health decisions, especially in the case of daily new deaths. They also showed a negative relationship between the formation of exuberant behavior during the pandemic and the vaccination rate. Public health policymakers can incorporate this method into their arsenal to evaluate the overall health situation in combating the pandemic and respond accordingly. Furthermore, among the lessons learned from the Turkish experience is the importance of having a coronavirus scientific advisory board in the decision-making process and the ability to promptly implement policy measures. JEL Codes: C22, C58, I10, I18

Unlocking the value of Shingrix: how vaccination empowers older adults

Shingles, and its often-debilitating complication post-herpetic neuralgia (PHN), is a common condition, particularly in older populations whose immune systems have declined with age. As the number of older people continues to rise globally, healthy aging becomes an ever-increasing priority from a public health perspective. The recombinant zoster vaccine Shingrix has been shown in clinical trials to have excellent efficacy and provides long-lasting protection even in those with weaker immunity such as the very old. Cost-effectiveness analyses are complex due to the many factors that need to be considered, but many conducted to date support Shingrix vaccination as a cost-effective means of preventing shingles and PHN in the elderly. These studies suggest that Shingrix is superior to the live Zostavax vaccine. Shingrix was approved by the US Food and Drug Administration in October 2017, and the European Medicines Agency and Australian Therapeutic Goods Association in 2018 for the prevention on shingles in adults ≥50 years of age. In 2023, the Pharmaceutical Benefits Advisory Committee (PBAC) recommended funding a Shingrix program in Australia, and it became available on the National Immunisation Program (NIP) that year, whereas the Zostavax vaccine was discontinued. Shingrix is recommended under the Australian NIP for people aged 65 years and over, Aboriginal and Torres Strait Islander people ≥50 years and those ≥18 years with severe immunocompromise. Multiple other countries have funded national Shingrix programs in recent years with similar recommendations. Since its introduction, demand for Shingrix has been high, and uptake is expected to supersede Zostavax uptake.

Role of Human Papillomavirus in Carcinogenesis

Since a decade ago, it has been observed that the incidence of cancers caused by human papillomavirus (HPV) has seen an uptick, making it a point of concern from the public health perspective. Numerous cancers, including oral and cervical cancers, have been linked to HPV. HPV is carcinogenic due to its ability to induce abnormal expression of several genes, including nuclear factor-kappa B, nuclear factor erythroid 2-related factor 2, p16, p53, RB1 and some microRNA genes. Early cancer treatment involves identifying the up- or downregulation of various factors using techniques including polymerase chain reaction (PCR), reverse transcriptase PCR, p16 immunostaining and in situ hybridisation. The virus achieves its breakthrough by taking advantage of various types of cellular enzymes, enzymatic activities and their association or disassociation with other factors in order to up/downregulate enzyme levels. The methods used for screening and detection still need to have high sensitivity and high accuracy because the amount of factors showing change is remarkably minute. Vaccines can remarkably reduce the risk of HPV infection when administered as directed and in the recommended number of doses.

Association between institutionalization by 4 months post-discharge walking capacity and lean body mass in elderly hip fracture patients: Evidence from a Swedish Registry Based Study.

Losing independence is a main concern for hip fracture patients, and particularly not being able to return home. Given the large impact on quality of life by loss of independence and the high risk for institutionalization after hip fracture, it is of importance to identify modifiable risk factors for such negative outcomes. This study aimed to investigate the association between two such factors, that is, lean body mass and 4 months post-discharge walking capacity, and the risk of institutionalization in previously independent living older people who suffer a hip fracture. A retrospective cohort study was conducted using Swedish national-based population registers. Patients ⩾60 years with a hip fracture during 2008-2017 were included from the Swedish National Registry for Hip Fractures. Risk of institutionalization over the 1-year period following a hip fracture was analyzed using logistic regression analyses adjusted for potential predictors and characteristics. In total, 11,265 patients were included. Over the first year, 8% (95% CI: 8-9) of the patients with a hip fracture had lost independence, increasing to 15% (95% CI: 14-16) after 5 years. Poor recovery of post-discharge walking ability was associated with a higher odds ratio of losing independence compared with good recovery (OR 12.0; 95% CI: 7.8-18.4; p < 0.001). Having higher estimated lean body mass than 45 kg at index was associated with lower odds of losing independence. Maintaining lean body mass and mobility after a hip fracture is likely important from an individual as well as public health perspective.

Expanding Global Surgery Education in Brazil: Perspectives after the 35th Brazilian Surgical Congress.

The 35th Brazilian Congress of Surgery marked a turning point for surgical education in the country. For the first time, the Brazilian College of Surgeons included Global Surgery on the main congressional agenda, providing a unique opportunity to rethink how surgical skills are taught from a public health perspective. This discussion prompts us to consider why and how Global Surgery education should be expanded in Brazil. Although Brazilian researchers and institutions have contributed to the fields expansion since 2015, Global Surgery education initiatives are still incipient in our country. Relying on successful strategies can be a starting point to promote the area among national surgical practitioners. In this editorial, we discuss potential strategies to expand Global Surgery education opportunities and propose a series of recommendations at the national level.

Exploring Children’s Food Environments in Macau from a Built Environment Management Perspective

For urban planning and management and public health have been intertwined for most of their histories, the impact of built environment on children’s well-being has become an important topic in both fields today. Many studies have shown that the clustering of fast food restaurants (FFRs) around schools can increase the rate of obesity in children by changing their eating environment, so studying the concentration of FFRs around schools can help us assess the risk of obesity in children. Macau as a high density city, the obesity of children has generally become a critical public health problem. Therefore, this research aims to explore the distribution of FFRs around schools in Macau. Results show that there was not only an obvious clustering distribution of FFRs in Macau, but also a positive correlation between the distribution of schools and FFRs’ clustering. The study supports the improvement of the built environment around Macau’s schools from a public health perspective and enhances the development of Macau as a healthy city in the future.

Barriers to care for musculoskeletal sarcoma patients: a public health perspective.

This study seeks to investigate the barriers to care that exist for patients presenting with sarcomas of musculoskeletal origin. Understanding the roots of delays in care for patients with musculoskeletal sarcoma is particularly important given the necessity of prompt treatment for oncologic diagnoses. Investigators reviewed relevant studies of publications reporting barriers to care in patients undergoing diagnosis and treatment of musculoskeletal tumors. A comprehensive literature search was conducted using Scopus, Embase, Web of Science, and PubMed-MEDLINE. Twenty publications were analyzed, including a total of 114,056 patients. Four barrier subtypes were identified: Socioeconomic Status, Geographic Location, Healthcare Quality, Sociocultural Factors. Socioeconomic status included access to health insurance and income level. Geographic location included distance traveled by patients, access to referral centers, type of hospital system and resource-challenged environments. Healthcare quality included substandard imaging, access to healthcare resources, and healthcare utilization prior to diagnosis. Sociocultural factors included psychological states, nutrition, education and social support. After identifying the most significant barriers in this study, we can target specific public health issues within our community that may reduce delays in care. The assessment of barriers to care is an important first step for improving the delivery of oncologic patient care to this patient population.

The impact of the closure of mining plants on the local environment in the perspective of demographic change and public health

Purpose: in the cognitive space of the article, an important and significant challenge arises, which is - in the perspective of the megatrends indicated in the article, demographic change and public health - the need to prepare a package of socio-economic activities dedicated primarily to the inhabitants of the areas where the process of closing down mining plants will take place. In this context, the issues of demographic change and health should be given priority in these areas in activities promoting social and economic activity in the transformation process. Methodology: the theses presented in the article were verified using the following methods: literature review, critical analysis of literature, analysis and comparison of documents and an example of good practices. Resultat: in the perspective of the next decades, numerous social and economic challenges and effects related to the transformation of mining plants in the space of local communities (commune, district) can be pointed out. While maintaining the hierarchy of objectives described in the European Green Deal Plan and clearly related to the plan for the transformation of mining plants, lasting cooperation of the three key stakeholders in this process, i.e., local communities (representation of local and territorial self-government), employers and representation of state policies, should be expected in their environment. Originality: the conclusions and recommendations from the article may be important for researchers and practitioners involved in the implementation of activities aimed at limiting the marginalization, differentiation and social and economic exclusion of residents of areas where the process of closing mining plants will take place. Keywords: mining, demographic change, public health.

Multimorbidity and mortality among older patients with coronary heart disease in Shenzhen, China.

The current understanding of the magnitude and consequences of multimorbidity in Chinese older adults with coronary heart disease (CHD) is insufficient. We aimed to assess the association and population-attributable fractions (PAFs) between multimorbidity and mortality among hospitalized older patients who were diagnosed with CHD in Shenzhen, China. We conducted a retrospective cohort study of older Chinese patients (aged ≥ 65 years) who were diagnosed with CHD. Cox proportional hazards models were used to estimate the associations between multimorbidity and all-cause and cardiovascular disease (CVD) mortality. We also calculated the PAFs. The study comprised 76,455 older hospitalized patients who were diagnosed with CHD between January 1, 2016, and August 31, 2022. Among them, 70,217 (91.9%) had multimorbidity, defined as the presence of at least one of the predefined 14 chronic conditions. Those with cancer, hemorrhagic stroke and chronic liver disease had the worst overall death risk, with adjusted HRs (95% CIs) of 4.05 (3.77, 4.38), 2.22 (1.94, 2.53), and 1.85 (1.63, 2.11), respectively. For CVD mortality, the highest risk was observed for hemorrhagic stroke, ischemic stroke, and chronic kidney disease; the corresponding adjusted HRs (95% CIs) were 3.24 (2.77, 3.79), 1.91 (1.79, 2.04), and 1.81 (1.64, 1.99), respectively. All-cause mortality was mostly attributable to cancer, heart failure and ischemic stroke, with PAFs of 11.8, 10.2, and 9.1, respectively. As for CVD mortality, the leading PAFs were heart failure, ischemic stroke and diabetes; the corresponding PAFs were 18.0, 15.7, and 6.1, respectively. Multimorbidity was common and had a significant impact on mortality among older patients with CHD in Shenzhen, China. Cancer, heart failure, ischemic stroke and diabetes are the primary contributors to PAFs. Therefore, prioritizing improved treatment and management of these comorbidities is essential for the survival prognosis of CHD patients from a holistic public health perspective.

First Glance into Academics Health Literacy – Socio-demographics

In the health area, there is an extra-attention worldwide, after the COVID-19 pandemic, we are all more aware of the importance of data and the potential of data to help predict disease evolution and the relevance of the population’s understanding of disease prevention versus health promotion. The health literacy of a population has an impact on healthcare costs and on the patient’s recovery. This happens because disease prevention and health promotion are better understood, and healthcare professionals’ guidelines are followed by patients. The European Health Literacy Survey Questionnaire (HLS-EU-Q) was developed to measure the population’s general health literacy, including 12 subdomains, and get a broad public health perspective. In 2014, this questionnaire was translated for Portugal (HLS-EU-PT) and a 16-question survey was validated HLS-EU-PT-Q16. In this study, a broader survey was applied, a quantitative, observational, and cross-sectional study, based on an online survey disseminated in Portuguese universities. Answers analyzed were those collected among 251 students, 109 professors, 15 researchers, and 55 staff, from the Polytechnic of Leiria, namely 430 answers to 75 questions. Only the group II section of this survey was analyzed.

Salutogenic Environmental Health Model-proposing an integrative and interdisciplinary lens on the genesis of health.

The maintenance of health is a central objective of public health initiatives. Within the salutogenic paradigm, health promotion is focused on understanding the mechanisms of health development. Models serve as indispensable tools. One of the leading paradigms in the health sciences is the Salutogenic Model developed by Aaron Antonovsky. However, it lacks sufficient specification to reflect the complexity of the environmental dimensions that have emerged from research in environmental health science. The interactions and impact pathways between these dimensions on health status are not adequately distinguished. The objective of this study is to address this gap by extending Antonovsky's model to encompass environmental dimensions, that is, the interactions between humans and their environment. Furthermore, the study will integrate examples of models and theories from various disciplines to illustrate how a more comprehensive and holistic explanation of health development can be provided from an interdisciplinary environmental public health perspective. As part of a three-step approach, a Basic Model was first developed that integrates the five environmental dimensions-Natural, Built-Material, Socio-Cultural, Psycho-Social, and Individual-into the Salutogenic Model. Subsequently, narrative non-exhaustive literature research was used to identify interdisciplinary example models. The models were used to identify gaps in the Basic Model through a critical lens and to synthesize them into a more holistic model. The synthesis of fifteen interdisciplinary models resulted in the development of an integrative Salutogenic Environmental Health Model (SEHM), which comprises twelve principal components of health development and their interactions and pathways. Links to the original models permit the user to refer back to them. This integrative approach offers a comprehensive understanding of the development of health by synthesizing disparate explanatory models and theories from various disciplines through theoretical analysis. The various environmental dimensions and the determinants of health contained therein, as well as their mental and physical processing and the associated components of health development and their interactions, are summarized in this new model. The SEHM thus enables a differentiated analysis of health determinants and serves as an operational framework for health promotion and pathways to well-being in contemporary research contexts.

Marmara 1999 Earthquake Assesment with Public Health Perspective Before 24 Years Kahramanmaraş- Hatay 2023 Earthquake

17 Ağustos 1999 Marmara Depremi sonrasında Bolu Gölyaka ilçesinde kurulan iki çadırkentte 30 günlük izlem; Düzce’de ise araştırma süresinde kurulu olan en büyük üç çadırkentte durum saptama araştırması yapılmıştır. Gölyaka ve Düzce'de kurulan çadırkentlerde yaşamın halk sağlığı yönünden incelenmesinin ilerde benzeri durumlarda yol gösterici olması amaçlanmıştır. Gölyaka’da 88 Düzce’de 83 olmak üzere toplam 171 çadır araştırma kapsamında yer almıştır. Araştırmada bazı sosyodemografik özellikler, deprem hasarına ve sağlık durumuna ilişkin bilgiler Hane Halkı Bilgi Formu ve Kişisel İzlem Bilgi Formu, çevresel özellikler Çevre Sağlığı Bilgi Formu ile toplanmıştır. Gölyaka'da araştırmaya alınanların %51,0'i erkek, %49,0'u kadın; Düzce’de %49,7'si erkek, %50,3 'ü kadındır. Gölyaka'da araştırmaya katılan kişilerin %47,8'i ilkokul, Düzce'de ise %12,1 'i ilkokul mezunudur. Gölyaka'da çalışmaya katılanların % 31,4'ü öğrenci, %30,8'i ev hanımıdır. Düzce'de %26,7'si öğrenci, %23,6'sı ev hanımıdır. Gölyaka’da binaların %50'si, Düzce’de %26,5'i hasarlı oturulamaz durumdadır. Gölyaka'da izlenen çadırkentlerde deprem sırasında oturulan evlerin %45,5'i dört katlı, %18,2'si 3 katlı; Düzce'de %27,7'si beş katlı, %43,4'ü dört katlı binalardır. Deprem sonrasında araştırmaya katılanların yarısında iş kaybı ve gelirde azalma görülmüştür. Aile Planlaması yönünden incelendiğinde korunmama artmış, yöntem kullanımı azalmıştır. Cinsel aktivite olumsuz etkilenmiştir. İzlem yapılan çadırkentlerde de en sık öksürük-balgam, soğuk algınlığı-nezle görülmüştür. Çevre sağlığı yönünden kamp yeri ve su özellikleri olumludur. Tuvaletler temizlikleri hariç genelde olumludur. Banyo, çamaşırhane ve mutfak özellikleri yetersizdir. Atıklar yeterli sayıda çöp bidonu bulunması ve günlük olarak toplanmaları sonucunda olumsuz çevre koşulu yaratmamıştır. Gölyaka’da ortak mutfaklarda sunulan yemekler önerilen enerji ve besin ögelerini sağlamamıştır. Ancak beslenmeye ilişkin herhangi bir sorun gözlenmemiştir. Afet planlamalarında çadırkent düzenlemeleri yer almalıdır..

Detection Methods of Counterfeit Drugs: A Systemic Review

Counterfeit medicines are one of the major challenges facing pharmaceutical supply chains and patient safety and are a serious problem in countries around the world. These drugs represent a major threat to the patient’s life, to the real drug manufacturers, and to the country’s image. The problem of substandard/ counterfeit/counterfeit/counterfeit medical products is more serious in countries with weak health regulatory systems and fragile health infrastructure. These characteristics increase the risk of manufacturing and/or distributing medicinal products that do not comply with national and regional health regulations, putting patients at risk. High and variable prices, insufficient access to affordable medications, and drug shortages are incentives for actions, activities, and behaviors that lead to SSFFC medical products. These problems must be addressed from a public health perspective. In this paper, the authors will provide a direct and simple comparison between the five most popular detection techniques used to analyze and characterize various genuine and generic pharmaceutical brands, as an approach to analyzing counterfeit pharmaceutical products, as many genuine and generic products are classified as counterfeit and vice versa. The combination of analytical results provides a comprehensive characterization of counterfeit medical products. This information is essential for patient safety and to assist authorities in their mission to combat counterfeit products. The findings could help police, regulatory, and health bodies reduce the burden of combating counterfeit medicines and the consequences that occur if they are not detected and used.

Public Health Perspective of Integrated Antimicrobial Stewardship Programs: A Reality Check on the Indian Scenario

Public Health Perspective of Integrated Antimicrobial Stewardship Programs: A Reality Check on the Indian Scenario

Student mental health: towards sustainable community of caring approach based on the public mental health perspective.

Attending university can be stressful and involve significant lifestyle changes: adjusting to the demands of a new learning environment, interacting with a diverse range of new people&#x0D; and environments, and (coping with) being away from trusted support networks. Although sixty per cent of students navigate higher education without emotional problems, forty per cent experience mental health issues, and approximately one in five struggles with mental disorders.&#x0D; Against this background, the Flemish Community (Belgium) has rolled out a sustainable student mental health strategy which takes a public mental health perspective as its starting point. Such an approach shifts the focus from high-risk students and mental disorders to the emotional health of the entire student population, and, accordingly, interventions that can improve the resilience of all students. &#x0D; The new policy has several strengths. Monitoring is undertaken through the WHO World Mental Health International College Student initiative. A wide range of low-threshold e-health interventions free of charge to students is available on the MoodSpace internet platform. Going beyond these, the Flemish policy helps universities to adopt a more proactive, preventive approach. Students are actively involved in the development and evaluation of interventions and policy implementation.&#x0D; Structure:&#x0D; - Introduction: 15’ (Ronny Bruffaerts)&#x0D; The introduction focuses on the key elements of the new mental health strategy policy&#x0D; - Key element 1: Mental Health Monitor: 20’ (Ronny Bruffaerts - Maarten Vansteenkiste)&#x0D; This contribution provides an overview of the Monitor which includes a set of process variables that are sensitive to monitoring student mental health, study motivation and detecting policy effects. The 2022 results and specific action points translated to the macro, meso and micro levels will be presented.&#x0D; Q&amp;A 10’&#x0D; - Key element 2: MoodSpace: 20’ (Valérie Van Hees)&#x0D; This contribution provides an overview of MoodSpace. This contribution will bring an overview of the results of students’ engagement with the e-interventions.&#x0D; - Q&amp;A 10’ &#x0D; - Key element 3: Community of Caring: 15’: (Valérie Van Hees, Ronny Bruffaerts)&#x0D; This contribution provides a presentation of the gatekeeping training ‘We-care’. The training, designed for students and staff respectively, has been developed at Flemish level with the aim to detect emotional problems early and refer students to the help they need. Preliminary results are presented.&#x0D; - Q&amp;;A 10’&#x0D; - Closing: Take home messages 15’ (Valérie Van Hees)&#x0D; This contribution summarises the next steps and initiates a group discussion on the take home messages.&#x0D; How to engage with the audience:&#x0D; - Rooms will be organised in roundtables or a fish bowl setup&#x0D; - Interactive tools will be used during presentations (eg., dynamic dashboard mental health monitor, video testimonials, demonstrations MoodSpace and We-care).&#x0D; - Polling via mentimeter:&#x0D; - Each speaker shares different angles of the new policy. After each contribution, a moderator will ask the audience questions through mentimeter about their&#x0D; thoughts about each key element.&#x0D; How to summarise the take home messages:&#x0D; - The session will end with a last question asked by the moderator to the audience through the mentimeter app, on the take away that participants will bring home.

Towards local integrated care through the convention for a psychological offer in primary care

At the beginning of 2022, the additional offer of primary psychological care was implemented nationwide in Belgium. The main aim of this new convention is to strengthen local integrated care. In line with the public mental health perspective, an offer is set up based on regional needs around prevention and early intervention to prevent mild mental health problems from escalating. To ensure that this care is easily accessible, outreaching and location/community-oriented work is carried out. Special attention is paid to vulnerable target groups ('equity'). Within the implementation of this innovative approach, change management appears to be an important player. This presentation contains - based on the policy experiences since January 2022 - a preliminary evaluation of the opportunities and barriers in the implementation of this project.&#x0D; &#x0D;

Understanding the Basics of Nutrition for People with Disabilities

A certain percentage of individuals in any society have disabilities, which can be further complicated by the presence of disease. This can create additional burdens in their lives, making it essential to provide them with adequate attention and satisfactory care to alleviate their difficulties. Good nutrition, both in terms of quantity and quality, is an important factor in human life. This article serves as a reminder of the basics of healthy nutrition for all individuals while also highlighting the challenges related to nutrition for those with disabilities and disease conditions. Research has shown that people with disabilities and chronic diseases are often malnourished. For patients who have difficulty with swallowing and/or have gastrointestinal disorders, nutrition support therapy in the form of enteral or parenteral nutrition must be employed. This article includes a brief description of the tubes that are used in artificial feeding. Decisions on tube feeding should be made carefully, taking into consideration the quality of life on a case-by-case basis. Oral nutritional supplements can be used to provide all essential nutrients based on the type of disability and medical condition. There is a need for more research concerning the area of nutrition for individuals with disabilities, and specialized training of involved healthcare professionals is a necessity. From a public health perspective, raising awareness about all types of disabilities among families, educators, healthcare providers, and the public should be a priority.

Abnormal Comparison Analysis of Return and Trading Volume Activity Before and After The Announcement of The Covid 19 Pandemic

The Covid-19 pandemic has been a significant turning point in global history, not only from a public health perspective but also in the context of its impact on economic stability, including capital markets. This research aims to analyze the reaction of the Indonesian capital market to the first case of Covid-19 by focusing on two indicators, namely Abnormal Return (AR) and Trading Volume Activity (TVA). Observations were carried out seven days before and seven days after the first announcement of Covid-19 in Indonesia. The research population includes Financial sector companies listed in February and March 2020 on the Indonesia Stock Exchange (BEI). The purposive sampling method was used to select 30 financial companies that met certain criteria. A quantitative approach and comparative method were used in this research, tested using the Wilcoxon Signes Rank Test. The research results show significant differences in AR before and after the announcement of the Covid-19 pandemic. The increase in Abnormal Returns after the announcement indicates that investors tend to trust companies that already have a record of returns or profits before the event, rather than having to rely on predictions of future profits. The Wilcoxon Signed Rank Test results also revealed significant differences in Trading Volume Activity before and after the Covid announcement, indicating changes in trading activity in the capital market. This research provides insight into how the Indonesian capital market responds to health crisis events such as Covid-19, and can serve as a basis for further understanding of economic and financial dynamics in facing similar challenges.

Do Food and Meal Organization Systems in Polish Primary Schools Reflect Students' Preferences and Healthy and Sustainable Dietary Guidelines? The Results of Qualitative Research for the Junior-Edu-Żywienie (JEŻ) Project.

The school environment, together with that of the family, shapes students' eating behaviors, and is an important element of formal and informal nutrition education. The informal and practical dimensions can be realized through the food and meals offered/sold in school canteens, shops, and vending machines. As children and adolescents spend 6-10 h/day in schools and consume at least two meals there, the school food environment is important from a public health perspective. The aim of this study is to assess food and meal organization in primary schools in Poland. The study was conducted using individual in-depth interviews (IDIs) involving 24 school headmasters and 24 representatives of people employed in school canteens or catering companies involved in meal organization in schools. The nutritional food on offer at schools is important for shaping students' food preferences and choices, consequently influencing the development, functioning, and health of this subpopulation. The school environment can be an ideal place for hands-on nutrition education. In addition to the knowledge provided, there must be a consistent message concerning the provision of nutrition information to students between the teachings of parents, teachers, and, indirectly, the food and meals available at school. Our qualitative study is confirmed by the results of quantitative research to better understand the organization of nutrition and the problems and needs of primary schools in this area.

Fetal Alcohol Spectrum Disorders and Inadequacy of Care: Importance of Raising Awareness in Clinical Practice.

Prenatal alcohol exposure is one of the major avoidable causes of developmental disruption and health abnormalities in children. Fetal alcohol spectrum disorders (FASDs), a significant consequence of prenatal alcohol exposure, have gained more attention recently. This review aims to provide a narrative approach to the scientific literature on the history, clinical presentation, diagnosis, and management of FASDs. A literature search in PubMed, ScienceDirect, and Google Scholar online databases was conducted. The dates of publications ranged from 2000 to 2023. FASD presentations tend to persist into adulthood, which, combined with environmental factors, potentially lead to secondary psychosocial problems and disabilities. This review covers different aspects of FASDs regarding the concept of the umbrella term and public health, somatic, and psychiatric perspectives. FASD management remains an obstacle to health professionals, and mental health problems are underestimated. Its management involves a multi-disciplinary team, which varies according to the patient's individual needs. FASD diagnosis and management have not been sufficiently established and tailored. Stigma, cultural contexts, knowledge gaps, and the heterogeneity of clinical manifestations are significant barriers to an accurate diagnostic process. Further development of early interventions and the elaboration of complex treatment approaches are needed.