Impact and cost-effectiveness analysis of the national school-based sexuality education programme in Estonia

Policy-makers making decisions on the implementation of school-based sexuality education (SE) programmes face two important questions: (1) what are the costs of implementing and scaling up SE programmes, and (2) what are the impacts? This paper responds to these questions by retrospectively assessing costs, impact and cost-effectiveness of the national school-based SE programme in Estonia 1997–2009. The three-year curriculum had been taught to 190,000 students at the end of 2009. The cost of reaching one student was USD 32.90 and the total costs were USD 5.6 million. There has been a remarkable improvement in sexual health indicators in the age groups 15–19 and 20–24 years in Estonia between 2001 and 2009. During this period, annual abortions, STIs and diagnosed HIV infections in the age groups were reduced by 37%, 55% and 89%, respectively. It is difficult to assess to what extent the improvements in these sexual health indicators are attributable to the SE programme. Nevertheless, our conservative threshold analysis indicates that the Estonian SE programme could be considered cost-saving if only 4% of the observed reductions in HIV infections are attributable to the programme. There is strong evidence, therefore, to support that the Estonian school-based sexuality programme has been cost-effective.     

Learning objectives for science practicals at traditional and distance universities

This study is designed to determine whether, and to what extent, the perceived importance of objectives of undergraduate practicals in the Natural Sciences is dependent upon the type of institute at which practicals are given. The two dimensions used in this research to discriminate between types of institutes are type of education offered (face‐to‐face versus correspondence) and type of programme offered (monodisciplinary versus interdisciplinary). For this reason, distance universities throughout the world (DUs) and more traditional, residential universities (RUs) in The Netherlands were compared. Special attention has been paid to the Open university of The Netherlands (OuN). The results show that RUs and DUs approach practicals in a very similar manner with both of them differing in a number of respects with the OuN. Implications of this research for the use of practicals in a curriculum in the Natural Sciences are presented.     

A cross‐cultural comparison of childhood developmental disorders between schoolchildren in the Netherlands and Greece

The scope of the present study was first to evaluate the cross‐cultural reliability and validity of the Social Emotional Questionnaire (SEQ) and second to estimate and compare the prevalence rates of childhood developmental and psychiatric disorders in the general population of young children in the Netherlands and Greece. To this end, the caregivers of 1748 Dutch and 384 Greek 4–12‐year‐old children from the general population completed the SEQ. The number of children displaying symptoms of childhood developmental disorders was estimated by applying the Diagnostic and Statistical Manual of Mental Disorders‐IV criteria of symptom occurrence. Results showed that the reliability and the construct validity of the SEQ were acceptable in both countries and for all the age‐groups of children. Concerning the prevalence, the Greek children were found to display overall significantly more symptoms of developmental disorders than the Dutch children. However, when the number of children suffering from psychiatric symptoms in the clinical range was estimated using the clinical criteria provided by categorical classification systems, no statistical significant differences emerged between the two countries. This finding suggests that when the criterion of clinical impairment is applied in diagnostic procedures, the number of children suffering from severe psychiatric disorders is about equal in the two countries. The implications of the study are discussed.     

The prevalence and risk indicators of symptoms of common mental disorders among current and former Dutch elite athletes

The aim of the study was to determine the prevalence and comorbidity of symptoms of common mental disorders (distress, anxiety/depression, sleep disturbance, eating disorders, adverse alcohol use) among current and former Dutch elite athletes, and to explore the inference between potential risk indicators (severe injury, surgery, life events, sport career dissatisfaction, social support) and the outcomes measures under investigation. Cross-sectional analyses were conducted on baseline questionnaires from an ongoing prospective cohort study among 203 current and 282 former elite Dutch athletes (response rate: 28% among current athletes and 95% among former athletes). Based on validated scales, an electronic questionnaire was set up and distributed. Prevalence (4-week) ranged from 6% for adverse alcohol use to 45% for anxiety/depression among current elite athletes, and from 18% for distress to 29% for anxiety/depression among former elite athletes. A higher number of past severe injuries, higher number of past surgeries, higher number of recent life events, higher level of career dissatisfaction and lower level of social support were related to the occurrence of symptoms of common mental disorders among both current and former elite athletes. On average, the 4-week prevalence of common mental disorders as shown in our study among current and former Dutch elite athletes were similar to the ones found among athletes from other sports disciplines and does compare with the lifetime prevalence estimates in the general population of the Netherlands.     

Advocacy for school-based sexuality education: lessons from India and Nigeria

Drawing on evidence from a wider study on the cost and cost-effectiveness of sexuality education programmes in six countries, and focusing on the examples of India and Nigeria, this paper argues that advocacy is a key, yet often neglected component of school-based sexuality education programmes, especially where sex and sexuality are politically or culturally sensitive issues. It also suggests that advocacy is not a one-off activity but needs to be carried out continuously and adapted as contexts and needs change. Overall, this piece recommends that advocacy should be a key component of sexuality education work, and needs to be planned and budgeted for. Without such investment, country-level sexuality education programmes are likely to fail.     

A systematic review of injuries in recreational field hockey: From injury problem to prevention

ABSTRACT

The purpose of this study was to gather information from scientific literature related to all steps of Van Mechelen’s “sequence of prevention” for injuries applied to youth and adult recreational field hockey players. A systematic review was conducted in Medline via Pubmed and in SPORTDiscus via EBSCOhost. Twenty-six original studies were included. Regarding injury incidence (step 1) results showed several overall injury incidence rates (youth: 1.47 per 1,000 Athlete Exposure (AE) time-loss (TL) injury up to 11.32 per 1,000 AE TL ánd non-time loss (NTL) injury, adults: 2.2 NTL injury per 1,000 AE, 15.2 injury per 1,000 hours of sports participation). Considering games and practices, most injuries were sustained in games (youth: 4.9, adults: 7.87 per 1,000 AE). Considering body parts, highest injury incidence rates were found in body parts in the lower extremities (youth: knee injuries in games (0.33 per 1,000 AE), adults: hamstring injuries in pre-season (0.75 per 1,000 AE)) and injuries in the head/face/eye (youth: 0.66 and adults: 0.94 head/face/eye, 0.71 head/face and 0.63 concussion per 1,000 AE). Regarding aetiology (step 2), no studies were found. Regarding the efficacy of available interventions (step 3 and 4), one study was found among youth players, describing a warm-up programme.     

Effects of a multifactorial injury prevention intervention in physical education teachers: A randomized controlled trial

Physical education (PE) teachers are at a high risk of musculoskeletal sports or work-related injuries because of the physical activity as inherent part of their profession. Such injuries have a negative impact on work and leisure time activities, and effective injury prevention interventions are needed. The present study aimed at testing the effectiveness of an injury prevention intervention that was developed and optimized according to PE teachers' wishes and values. Fifty-five PE teachers were randomly assigned to intervention or control group. Intervention group teachers engaged in two days of training during which they familiarized with eight injury prevention strategies (seven intrinsic and one extrinsic). A special feature of the intervention was that the way of delivery was based on the self-determination theory in order to stimulate participants' motivation to adhere to the proposed strategies. Prospective registrations during one school year were conducted concerning injuries and preventive behaviours. Results showed that the intervention group teachers had a lower number of injuries per 1000?h time of exposure (TOE) than the controls (INT: 0.49, CON: 1.14 injuries/1000?h TOE, OR: 2.32, 95% CI: 1.06–5.07), and applied a broader variety of strategies including dynamic and static stretching, core stability, balance and strength training, when compared to the controls who mainly engaged in warming-up. In conclusion, with the same amount of time, an injury reduction was found in PE teachers through a more balanced use of provided preventive strategies.     

A 12-month prospective cohort study of symptoms of common mental disorders among professional rugby players

The primary aims were to determine the 12-month incidence (and comorbidity) of symptoms of common mental disorders (CMD) among male professional rugby players and to explore their association with potential stressors. A secondary aim was to explore the view of male professional rugby players about the consequences of symptoms of CMD and related medical support/needs. An observational prospective cohort study with three measurements over a 12-month period was conducted among male professional rugby players from several countries. Symptoms of CMD (distress, anxiety/depression, sleep disturbance, eating disorders and adverse alcohol use) and stressors (adverse life events, rugby career dissatisfaction) were assessed through validated questionnaires. A total of 595 players (mean age of 26 years; mean career duration of 6 years) were enrolled, of which 333 completed the follow-up period. The incidence of symptoms of CMD were: 11% for distress, 28% for anxiety/depression, 12% for sleep disturbance, 11% for eating disorders and 22% for adverse alcohol use (13% for two simultaneous symptoms of CMD). Professional rugby players reporting recent adverse life events or career dissatisfaction were more likely to report symptoms of CMD but statistically significant associations were not found. Around 95% of the participants stated that symptoms of CMD can negatively influence rugby performances, while 46% mentioned that specific support measures for players were not available in professional rugby. Supportive and preventive measures directed towards symptoms of CMD should be developed to improve not only awareness and psychological resilience of rugby players but also their rugby performance and quality-of-life.     

Preventing injuries among recreational adult volleyball players: Results of a prospective randomised controlled trial

ABSTRACT

The objective was to evaluate the effectiveness of an exercise-based warm-up programme (“VolleyVeilig”) on the one-season occurrence of musculoskeletal injuries among recreational adult volleyball players. A prospective randomised controlled trial was conducted over the 2017–2018 volleyball season. Recreational adult volleyball players were allocated either to an intervention or control group. The Dutch version of the Oslo Sports Trauma Research Centre questionnaire was used to register and monitor acute and overuse injuries. A total of 672 volleyball players were enrolled: 348 in the intervention group (mean age: 30) and 324 in the control group (mean age: 27). The incidence rate of acute injury was 21% lower in the intervention group, namely 8.9 versus 11.3 per 1,000 h in the control group (Cox mixed effects crude model: hazard ratio = 0.82 [95%CI: 0.69–0.98]; Cox mixed effects adjusted model: 0.85 [95%CI: 0.71–1.02]). No significant difference in mean prevalence of overuse injury was found between the intervention (4.8%) and control (4.2%) groups. The severity of injuries was not significantly different between groups, while injury burden was slightly lower in the intervention group. The exercise-based warm-up programme led to a trend in less acute injuries among recreational adult volleyball players.