Teen Dating Violence and Mental Health: a Review.

This paper explores the intricate relationship between teen dating violence (TDV) and mental health disorders among adolescents, a demographic particularly susceptible to such issues due to their critical developmental stage. The study underscores how mental health disorders can serve as both risk factors and consequences of TDV, with depression, suicidality, post-traumatic stress disorder (PTSD), substance use, and eating disorders being prominently associated with TDV. The profound and long-lasting repercussions of these mental health issues necessitate a comprehensive strategy to address TDV and its associated mental health implications. This paper advocates for a multi-pronged approach that includes the implementation of prevention programs to educate teenagers about healthy relationships, regular screening for TDV among adolescents for early detection, and the establishment of robust referral systems to ensure victims receive necessary support and treatment. By integrating these strategies, we aim to foster healthier relationships among teenagers, mitigate the incidence of TDV, and safeguard the mental well-being of our adolescents.

Exploratory Factor Analysis of a French Adapted Version of the Substance Abuse Attitude Survey among Medical Students in Belgium.

To evaluate the impact of a new Substance Use Disorder (SUD) education program on medical students' attitudes, we selected the Substance Abuse Attitude Survey (SAAS) questionnaire, which we adapted to our curriculum and cultural context. To validate this adapted version, we conducted an exploratory factor analysis following the administration of our 29-item bSAAS questionnaire to 657 medical students in Belgium (response rate: 71.1%). Twenty-three items correlated to three factors; namely, "Stereotypes and moralism", "Treatment optimism" and "Specialized treatment" were retained (70% of total variance explained, Cronbach's alpha = 0.80) and constituted the new questionnaire called beSAAS. The factor "Specialized treatment" stood out from previous studies, which could be explained by our target population and the impact of the formal, informal and hidden curricula in medical education. This study was able to highlight certain factors influencing stereotypical representations such as age, gender, origin, personal or professional experience with substance use. Our study allowed us to retain the beSAAS as a good questionnaire to evaluate SUD stigma and highlighted interesting findings to improve SUD training in medicine. Further studies are needed to complete its validity and reliability.

Blended care to discontinue benzodiazepine receptor agonists use in patients with chronic insomnia disorder: a pragmatic cluster randomized controlled trial in primary care.

STUDY OBJECTIVES: International guidelines recommend using benzodiazepine receptor agonists (BZRA) for maximally four weeks. Nevertheless, long-term use for chronic insomnia disorder remains a common practice. This study aimed to test the effectiveness of blended care for discontinuing long-term BZRA use in general practice. METHODS: A pragmatic cluster randomized controlled superiority trial compared blended care to usual care through urine toxicology screening. In the intervention, care by the general practitioner (GP) was complemented by an interactive e-learning program, based on cognitive behavioral therapy for insomnia. Adults using BZRA daily for minimally 6 months were eligible. Participants were clustered at the level of the GP surgery for allocation (1:1). Effectiveness was measured as the proportion of patients who had discontinued at one-year follow-up. Data analysis followed intention-to-treat principles. RESULTS: In total, 916 patients in 86 clusters, represented by 99 GPs, were randomized. Primary outcome data was obtained from 727 patients (79%). At one-year follow-up, 82 patients (18%) in blended care, compared to 91 patients (20%) in usual care, had discontinued. There was no statistically significant effect for the intervention (OR: 0.924; 95% CI: 0.60; 1.43). No adverse events were reported to the research team. CONCLUSIONS: The findings did not support the superiority of blended care over usual care. Both strategies showed clinical effectiveness, with an average of 19% of patients having discontinued at one-year follow-up. Further research is important to study the effect of structurally implementing digital interventions in general practice. CLINICAL TRIAL: Big Bird trial; KCE-17016. This trial is registered at clinicaltrials.gov (NCT03937180).

Teen Dating Violence: A Mixed Methods Study in French-speaking Belgium.

BACKGROUND: "Teen dating violence" is a poorly studied issue in the literature. Several sociodemographic and psychiatric risk factors have been identified in the literature, and the consequences are numerous. The aim of this mixed study is to establish an initial inventory of the problem in French-speaking Belgium, to establish links with the socio-demographic and overall health characteristics of the population, and to issue recommendations for the future. SUBJECTS AND METHODS: A study by questionnaire was conducted among 103 young people aged between 14 and 18 living in French-speaking Belgium and speaking French in particular. Qualitative and quantitative (descriptive and inferential statistics) analyses were performed. RESULTS: 29.1% of respondents experienced violence. Significant links exist between the fact of having experienced violence and consumption as well as the presence of STDs. The combination of potential risk factors predicts a considerable part of the violence in the sample. A significant link exists between the fact of being subjected to violence and a high score on the scale of depression and violence suffered and committed. CONCLUSION: The prevalence of teen dating violence is relatively high in Belgium. A link between these and a large part of the potential consequences studied could be highlighted through the study.

Factors influencing medical students' attitudes towards substance use during pregnancy.

BACKGROUND: People with substance use disorder, and pregnant women especially, are subject to a lot of stigmas, which can prevent optimal accessibility and quality of care. In this survey, we investigated attitudes of final year medical students regarding substance use during pregnancy and identified the factors that influence these attitudes. METHOD: This cross-sectional study was conducted in 2019 and 2020 in Belgium using the short version of the "Substance Abuse Attitude Survey" questionnaire. We focused on two items regarding punishment of substance use during pregnancy. We analysed the concordance between these two, their correlation with other items (e.g. stereotyping, morality, forced withdrawal, low treatment optimism) and the association between respondents' opinion on punishment and their sociodemographic data. RESULTS: The response rate was 65.2% (370/567 online and face-to face questionnaires). 19.2% of respondents were in favour of punishment for alcohol use (n = 353) and 15.1% for drug use (n = 356) during pregnancy. The agreement analysis between the two items showed that 14.3% of students were in favour of punishing both pregnant women who use drugs and those using alcohol. Respondents tended to be more in favour of punishment if they were male students, older, their mothers' had a lower education level or had no personal or family history of substance use. Attitudes appeared to be more punitive among students with limited contact with people with substance use disorder (i.e. none or limited to hospital). Students intending to specialise in internal medicine were more in favour of punishment of women whereas none of those intending to specialise in psychiatry were in favour. CONCLUSION: Our study shows that about 20% of surveyed medical students favoured punishing substance-using pregnant women. Awareness and training work seems to be necessary to ensure adequate care and support for this already vulnerable population.

Effectiveness of a blended care programme for the discontinuation of benzodiazepine use for sleeping problems in primary care: study protocol of a cluster randomised trial, the Big Bird trial.

INTRODUCTION: Problematic benzodiazepine use is a global health issue. Although the adverse side effects of long-term use of benzodiazepines are well known, it remains difficult to implement interventions for discontinuation in primary care. Considering the success of blended care for the treatment of sleeping disorders and the support of substance use disorders, evidence suggests that a blended care approach, combining face-to-face consultations with the general practitioner with web-based self-learning by the patient, is beneficial for the discontinuation of chronic benzodiazepine use for primary insomnia in general practice. Therefore, the aim of this study is to evaluate the effectiveness of such an approach for the discontinuation of benzodiazepine and zolpidem, zopiclone and zaleplon drugs ((z-)BZD) use in the long term and evaluate the implementation process. METHODS AND ANALYSIS: This study is a multicentre, pragmatic, cluster randomised controlled trial with 1200 patients, included by 120 general practitioners. Allocation to usual or blended care happens at the level of the general practice in a 1:1 ratio using a block randomisation system stratified per language. The study population consists of adult primary care patients who have been using (z-)BZD for primary insomnia on a daily basis for at least 6 months. Primary outcome measure is the proportion of patients that discontinued (z-)BZD at 12 months assessed by toxicological screening for (z-)BZD in urine. Secondary outcomes include discontinuation of (z-)BZD at 6 months, quality of life and the number of defined daily doses of (z-)BZD prescribed. Data will be collected using a study-specific online platform and analysed using the intention-to-treat approach. The process of implementing blended care will be evaluated in a nested study. ETHICS AND DISSEMINATION: This trial was approved by the Ethics Committee for Research of UZ/KU Leuven (ref. S61194). Study results will be disseminated via open-access, peer-reviewed publications and conference presentations. TRIAL REGISTRATION NUMBER: NCT03937180.

Identification of food insecurity factors in French-speaking Belgium: a qualitative study.

BACKGROUND: Diet is an essential determinant of health. Among the health determinants, we find access problems that are summarized as food insecurity. While such food insecurity has been studied in other countries and correlated to several health problems, it has been scarcely assessed in Belgium. The purpose of this work was to determine the factors of food insecurity existing within the Belgian population. METHOD: From November 2016 to February 2017, a qualitative study using semi-structured interviews with 19 adults present attending the waiting rooms of six Public Social Action Centers in French-speaking Belgium, analyzed by grounded theory. RESULTS: In Belgium, for given food preferences and needs, food insecurity could be summarized as inadequacy between necessary and available resources within two dimensions: at the access level, for financial, temporal, informational, and freedom of action, and at the food use level, for temporal factors, material, knowledge, and skills. In these situations of inadequacy, participants reported finding either strategies to restore balance, or being forced to alter the quality or quantity of their diet. CONCLUSION: While several factors of food insecurity may exist in Belgium, it appears essential that the first line of care these factors into consideration, since they could interfere with care and health, and because the first line of care is ideally placed to inform and refer the patients in question. Several courses of action are proposed in this work, which must still be confirmed by other studies.

Parental separation and behaviours that influence the health of infants aged 28 to 32 months: a cross-sectional study.

BACKGROUND: In Western countries, many children are affected by the separation of their parents. The study's main objective was to analyse the parental behaviours potentially influential for preschool children's health by family structure (parents together or separated). METHODS: We conducted a cross-sectional study based on data collected from examinations as part of free preventive medical consultations in the French Community of Belgium. During the assessment of 30,769 infants aged 28 to 32 months, information was collected on the parents' use of tobacco, brushing of the infant's teeth, being monitored by a dentist, and receiving vision screening. The chi2 test was applied and the odds ratios were derived to compare the two groups of children (exposed/not exposed to parental separation). Multivariate logistic regression analyses were used to adjust the effect of exposure. RESULTS: Nearly one in ten (9.8%) did not live with both parents under the same roof. Taking into account the social and cultural environment and other potential confounders at our disposal, we found that in the event of parental separation, behaviours differ in comparison with situations where parents live together; the adjusted odds ratios (ORs) (95% confidence interval) for the infant's exposure to tobacco, absence of teeth brushing, lack of monitoring by a dentist and absence of visual screening, were respectively 1.7 (1.2-2.0), 1.1 (0.9-1.2), 1.3 (1.1-1.6), 1.2 (1.1-1.2), and 1.2 (1.1-1.4). CONCLUSIONS: This study confirms the suspicion that parental separation is an independent risk factor for parental behaviours that negatively influence the infant's health. If these results are confirmed, this it could affect the work of the family doctors and paediatricians, especially in terms of family support and information to parents.

Parental separation: a risk for the psychomotor development of children aged 28 to 32 months? A cross-sectional study.

BACKGROUND: In Western countries, about a quarter of children are affected by parental separation and a number of authors have previously investigated how familial structure impacts children's health. The purpose of the work: to analyze the psychomotor development of children aged 28 to 32 months based on family structure (parents together or separated), independently of the influence of socio-economic environment that is well documented. To analyse the psychomotor development of children younger than 3 years based on family structure (parents together or separated) independently of the influence of socio-economic environment that is well documented. METHODS: Cross-sectional study by examination of 28 871 children as part of a free preventive medicine consultation. The data came from an assessment conducted 28 to 32 months after birth during which information was collected about the psychomotor development: to perform a standing jump, dress themselves, draw a vertical line and circle, use the "I" pronoun, build a three-word sentence, and say their first name RESULTS: Ten percent of the children had separated parents. Compared to parents who were together, when adjusting for the socioeconomic environment, as well as all potential confounders, the adjusted odds ratios (ORs) (95 % confidence interval [CI]) for children with separated parents, in terms of their ability to perform a standing jump, dress themselves, and draw a vertical line and circle were respectively 0.9 (0.7-1.1), 1.1 (0.9-1.2), 1.3 (1.1-1.4) and 1.2 (1.1-1.4). The adjusted ORs (95 % CI) for children's inability to say the "I" pronoun, build a three-word sentence, and say their first name were respectively 1.2 (1.1-1.3), 1.3 (1.2-1.5), and 1.2 (0.9-1.5). CONCLUSIONS: After adjusting for sociocultural factors and other potential confounders, we observed that the children exhibited slower progression in psychomotor development, especially in language and graphic abilities when their parents were separated. While the implications of our study are somewhat limited, they do provide us with the necessary arguments enabling us to set up a prospective cohort study. Such a study should be able to better assess the impact of parental separation on the child's development, confirming our preliminary results.

Not living with both parents is associated with more health- and developmental problems in infants aged 7 to 11 months: a cross sectional study.

BACKGROUND: In Western countries, many children are affected by the separation of their parents. Our main objective was to assess the possible impact of parental separation family structure on certain aspects of somatic health in low-age children. METHODS: We conducted a cross-sectional study based on data collected in the framework of free preventive medicine consultations in the French Community of Belgium. The data was derived from assessments conducted, between 2006 and 2012, on children 7 to 11 months after birth during which information of 79701 infants was collected regarding the risk of sudden infant death, psychomotor development, and development in terms of height and weight. The main outcome measures were: episode of risk of sudden infant death, polysomnography, home monitoring, psychomotor development, and body mass index. RESULTS: The parents of 6.6% of the infants were separated. We established multivariable models, based on the presence or absence of confounders. The adjusted ORs (95% CI) of symptoms perceived as frightening, notably at night, of a prescription for a polysomnography, of an abnormal polysomnography result, and of follow-up by home monitoring were thus respectively 1.3 (1.1-1.6), 1.1 (0.9-1.3), 1.8 (1.3-2.4), and 1.3 (1.1-1.6). The adjusted ORs (95% CI) for psychomotor delay and for a body mass index above the 97(th) percentile were respectively 1.3 (1.0-1.6) and 1.2 (1.1-1.3) in the event of separation. CONCLUSIONS: This study confirms the possibility that not living with both parents is an independent risk factor for the somatic health and psychomotor development of infants. This observation should be verified because it would have a major impact on the actions of family doctors and other first-line healthcare providers, in particular with regard to information and targeted prevention.

Parental separation and behaviours that influence the health of infants aged 7-11†months: a cross-sectional study.

OBJECTIVE: Analyse the parental behaviours that are recognised as influencing the health of very young children based on family structure (parents separated or not). DESIGN: Cross-sectional study. SETTING: Free preventive medicine consultations in the French Community of Belgium. PARTICIPANTS: Examination of 79 701 infants aged 7-11 months as part of a free preventive medicine consultation. The data came from an assessment conducted 7-11 months after birth during which information was collected, namely about the parents' use of tobacco, the infant's type of nutrition and adherence to vaccination schedules. MAIN OUTCOME MEASURES: Parental behaviours: smoking, nutrition and compliance with vaccination schedule. RESULTS: The percentage of infants whose parents were separated was 6.6%. After adjusting for the cultural and socioeconomic environment as well as for other potential confounders, in the event of separation as compared with non-separated parents, the adjusted ORs (95% CI) were as follows: 1.5 (1.3 to 1.7) for the infant's exposure to tobacco; 1.3 (1.2 to 1.4) for total lack of exclusive breast feeding; 1.3 (1.1 to 1.4) and 1.2 (1.1 to 1.2) for breast feeding for a duration of less than 3 and 6 months, respectively; 1.2 (1.1 to 1.4) for non-compliance with the vaccination schedule against rotavirus. The duration of exclusive breast feeding was shorter when parents were separated (p<0.001; median 10 vs 13 weeks). CONCLUSIONS: This study reinforces the possibility that parental separation is independently associated with certain parental at-risk behaviours regarding the children's health. This observation should be verified because this could result in major consequences for the work of family doctors, in particular in terms of parent information and targeted prevention.