Search

Aim: The aim of the paper is to enhance understanding of how members of the public make sense of the Covid-19 vaccines and to understand the factors influencing their attitudes towards such artefacts of pandemic governance. Methods: The paper draws on 23 online in-depth interviews with members of the UK public and builds on relevant literature to examine participants' perceptions of the benefits and risks of Covid-19 vaccines, the sources that have shaped their attitudes, and the level of trust they have towards the government's handling of the pandemic through vaccines. Results: The findings indicate that participants generally felt that the benefits of having the vaccine outweigh the risks and that Covid-19 vaccines are a crucial mechanism for enabling society to return to normal. Vaccine acceptance was, for some, strongly linked to a sense of social responsibility and the duty to protect others. However, some participants expressed concerns with regard to the side-effects of Covid-19 vaccines and their perceived potential impact on fertility and DNA makeup. Participants used various sources of information to learn about Covid-19 vaccines and understand their function, benefits, and risks. The majority of participants criticised the government's response during the early stages of the pandemic yet felt positive about the vaccine rollout. Conclusion: Just as with any other vaccination programme, the success of the Covid-19 immunisation campaigns does not only depend on the efficacy of the vaccines themselves or the ability to secure access to them, but also on a myriad of other factors which include public compliance and trust in governments and health authorities. To support an effective immunisation campaign that is capable of bringing the pandemic to an end, governments need to understand public concerns, garner trust, and devise adequate strategies for engaging the public and building more resilient societies. [ABSTRACT FROM AUTHOR]

Background: In Germany there is a large wealth gap between East and West Germans as well as a gap in life satisfaction, with people in East Germany reporting to be less satisfied. This paper intends to shed light on the role of the different levels of wealth and their association with life satisfaction. On a wider scale, this paper examines psychological consequences of wealth inequality between large societal groups. Method: Longitudinal data from the years 2007, 2012, and 2017 of the German Socio-Economic Panel (GSOEP) with a sample size of N = 5066 (Nfemale = 2522, Nwest = 3756, mage2007 = 50.46) was used. To test our hypothesis, multiple linear regression models as well as a fixed-effects regression model were run. Furthermore, to examine the development of wealth distribution between different birth cohorts in East and West Germany a latent growth curve model was calculated. Results: Net-worth was found to be a highly significant predictor for life satisfaction. This holds true for variance between respondents as well as for individual change over time within respondents. Additionally, the results show that the wealth gap between East and West Germans in total as well as within most of the birth cohorts increased. Conclusion: Due to their socialistic history and the related obstacles in acquiring wealth as well as the unbalanced distribution of GDR-assets after the reunification, East Germans are significantly less wealthy than West Germans. This has consequences on the mental well-being and the life satisfaction of East Germans. [ABSTRACT FROM AUTHOR]

Main: Electronic health record (EHR) applications are digital versions of paper-based patient health information. Traditionally, medical records are made on paper. However, nowadays, advances in information and communication technology have made it possible to change medical records from paper to EHR. Therefore, preserving user data privacy is extremely important in healthcare environments. The main challenges are providing ways to make EHR systems increasingly capable of ensuring data privacy and at the same time not compromising the performance and interoperability of these systems. Subject and methods: This systematic mapping study intends to investigate the current research on security and privacy requirements in EHR systems and identify potential research gaps in the literature. The main challenges are providing ways to make EHR systems increasingly capable of ensuring data privacy, and at the same time, not compromising the performance and interoperability of these systems. Our research was carried out in the Scopus database, the largest database of abstracts and citations in the literature with peer review. Results: We have collected 848 articles related to the area. After disambiguation and filtering, we selected 30 articles for analysis. The result of such an analysis provides a comprehensive view of current research. Conclusions: We can highlight some relevant research possibilities. First, we noticed a growing interest in privacy in EHR research in the last 6 years. Second, blockchain has been used in many EHR systems as a solution to achieve data privacy. However, it is a challenge to maintain traceability by recording metadata that can be mapped to private data of the users applying a particular mapping function that can be hosted outside the blockchain. Finally, the lack of a systematic approach between EHR solutions and existing laws or policies leads to better strategies for developing a certification process for EHR systems. [ABSTRACT FROM AUTHOR]

Aim: We conducted a systematic review and meta-analysis to analyse gender differences in COVID-19 vaccination intentions. Subject and methods: PubMed, Web of Science and PsycInfo were searched (November 2020 to January 2021) for studies reporting absolute frequencies of COVID-19 vaccination intentions by gender. Averaged odds ratios comparing vaccination intentions among men and women were computed. Descriptive analyses of the studies were reported. Results: Sixty studies were included in the review and data from 46 studies (n = 141,550) were available for meta-analysis. A majority (58%) of papers reported men to have higher intentions to get vaccinated against COVID-19. Meta-analytic calculations showed that significantly fewer women stated that they would get vaccinated than men, OR 1.41 (95% CI 1.28 to 1.55). This effect was evident in several countries, and the difference was bigger in samples of health care workers than in unspecified general population samples. Conclusion: This systematic review and meta-analysis found lower vaccination intentions among women than men. This difference is discussed in the light of recent data on actual vaccination rates in different countries. [ABSTRACT FROM AUTHOR]

Purpose: High physical fitness and good health are not only essential for the civilian population but also for persons working in physically and psychologically demanding professions, such as armed forces personnel. To date there is no scientific summary of studies dealing with the physical activity of daily life in armed forces personnel, but this is necessary for a targeted intervention. Methods: A systematic review was performed in the PubMed database (target date: 24 May 2020), using the search terms "military personnel" and "exercise" or "(physical) activity of daily life" including the assigned MESH words. Results: Seven original papers have focused on the daily physical activity of military personal, and they were all conducted in different countries. The activity of daily life was on average 11,540 steps per day. Conclusions: It could be shown that soldiers performed more physical activity than the civilian population and that the recommended 10,000 steps per day were slightly exceeded on average. However, the number of steps performed was very low in fields of activity with limited physical activity options, such as on board a ship. Altogether, it thus seems that additional health-promoting physical activity programs are not required for most of the soldiers, but that, in contrast, corresponding offers for physical activity alternatives, e.g., in the form of fitness equipment, are urgently required in specific task areas (e.g., on board ships). [ABSTRACT FROM AUTHOR]

Background: Chile, like many other countries, has seen major health reforms. It is now moving towards universal access using social protection strategies. It is essential at this point to have a clear view of the barriers to and facilitators of healthcare that Chile's population faces. Methods: We used ontological meta-analysis to formalize, standardize, and assess healthcare access in Chile by mapping the 200 research papers written about it. This methodology can be adapted to any other country to analyze its current situation. Results: The results highlight the frequent, infrequent, and absent research themes. Among some of the findings are the importance of improving access to healthcare using physical, virtual, and combined access, based on the resource conditions, type of care, and the adequacy of personnel providing care. Conclusions: This ontology and the analysis set the foundation for future research and establishment of policies in relevant areas where we are currently not paying enough attention. [ABSTRACT FROM AUTHOR]

Aim: Designing financial incentives for health behaviour change requires choices across several domains, including value (the size of the incentive), frequency of incentives, and direction (gain or loss). However, the rationale underlying complex incentive design is infrequently reported. Transparent reporting is important if we want to understand and improve the incentive development process. This paper describes a mixed methods approach for designing financial incentives for health behaviour change which involves stakeholders throughout the design process. Subject and methods: The mixed methods approach focuses on incentives for weight loss for men with obesity living in areas with high levels of disadvantage. The approach involves: (a) using an existing framework to identify all domains of a financial incentive scheme for which choices need to be made, deciding what criteria are relevant (such as effectiveness, acceptability and uptake) and making choices on each domain on the basis of the criteria; (b) conducting a survey of target population preferences to inform choices for domains and to design the incentive scheme; and (c) making final decisions at a stakeholder consensus workshop. Results: The approach was implemented and an incentive scheme for weight loss for men living with obesity was developed. Qualitative interview data from men receiving the incentives in a feasibility trial endorses our approach. Conclusion: This paper demonstrates that a mixed methods approach with stakeholder involvement can be used to design financial incentives for health behaviour change such as weight loss. Trial registration number: NCT03040518. Date: 2 February 2017. [ABSTRACT FROM AUTHOR]

Aim: This paper aims to better understand the relationship between homicide and other public health outcomes, by studying their trends over time. Subject and methods: Research in both criminology and public health has long identified that crime and violence tend to cluster together with adverse phenomena in the social and health domains. However, such work has relied primarily on cross-sectional analyses. Here, we instead study trends over time. We take data from the Netherlands, between 2000 and 2020, and ask whether homicide shows similar trends over time as other public health phenomena – such as smoking behaviour, alcohol use, child mortality, adolescent pregnancies, and suicide. Results: We observe, first, that all of the phenomena – with the exception of suicide – declined over the period under study. We then employ a time series analysis to examine whether these trends arise independently, or whether they are the result of structural similarities between phenomena. Results showed that the decline in homicide rates is linked to a similar decline in adolescent pregnancies – the rates of these phenomena 'move together' during the period under study. Conclusion: This work shows that the phenomenon of homicide shares structural similarities with teenage pregnancies – a decline in one is linked to a similar decline in the other. More generally, the current work furthers our understanding of the place of homicide in the domain of (public) health. [ABSTRACT FROM AUTHOR]

Aim: Asians are the second largest and fastest growing non-European population in New Zealand but are under-researched in terms of their COVID-19 pandemic response. The paper aims to illustrates Asians' risk perceptions and knowledge of COVID-19, and self-protection practices to avoid infection and prevent community transmission. Subject and methods: An online survey was used to collect data and received 402 valid responses. Data analyses included: 1) a descriptive analysis by using Chi-square tests and a Kruskal-Wallis rank sum tests to explore associations between responses and the four demographic variables (i.e. age, gender, country of origin/ethnicity, and region); and 2) a correlation analysis between different survey objectives. Results: The descriptive analysis of the survey found that while ethnicity (within the Asian category) was the most influential variable that resulted in varying responses to many questions, gender and age were other two important variables in influencing the answering patterns. The correlation analysis found a positive correlation between the perceived 'dangerousness' of COVID-19 and respondents' overall compliance behaviour to New Zealand authorities' recommendations to prevent spread of COVID-19. Conclusion: The majority of the respondents provided correct answers to the questions about the vulnerable populations, symptoms, asymptomatic transmission and potential sequelae of COVID-19; however, their understanding of the availability of a cure for, and the incubation period of COVID-19 was not consistent with the official information. The research also found that the higher perceived dangerousness of COVID-19, the better compliance to self-protection practices among the surveyed population. [ABSTRACT FROM AUTHOR]

Objective: During the coronavirus pandemic lockdowns, general medical complications have received the most attention, and few studies have examined the association between the COVID-19 lockdown and eating disorders (ED). This study aimed to investigate the impact of the coronavirus lockdowns on ED symptoms severity and summarize factors associated with lockdowns that led to changes in eating disorders. Method: PubMed, Scopus, and Cochrane Library databases were searched for studies measuring the impact of coronavirus lockdowns on ED symptoms. Results: A total of 132 studies were retrieved, after abstract screening and removal of duplicates, 21 papers were full-text screened, and 11 eligible papers were identified. Factors associated with symptomatic deterioration in ED patients during COVID-19 lockdowns included disruption of lifestyle routine, social isolation, reduced access to usual support networks, limited or no access to healthcare and mental care services, and social anxiety. Discussion: Overall, the pandemic lockdowns were associated with worsening of eating disorders. This triggering environment can lead to increased anxiety and depression symptoms, change in dietary habits, and eventually result in worsening eating disorder symptoms. [ABSTRACT FROM AUTHOR]

Aim: With the COVID-19 pandemic, we witnessed an increase in purchases of certain products, such as toilet paper, disinfectants, or groceries. In the present study, we examined the individual and socio-psychological determinants of stockpiling behavior. For this purpose, we defined an explanatory model based on the Health Belief Model (HBM), which includes threat perceptions, barriers and benefits, and self-efficacy beliefs as main predictors of health-related behaviors, and extended the model to include social norms. Subject and methods: Participants were recruited via social media platforms and data collection was conducted via an online survey. The final sample included 861 German respondents (male = 199, female = 642, mean age = 36.76, SD = 12.38). Results: Perceived barriers of stockpiling, such as financial constraints or regulations in supermarkets, turned out to be the strongest predictors of stockpiling. Regarding the role of threat perception, the perceived severity of the disease in particular was positively related to stockpiling behavior. Finally, our results suggest a significant impact of social cues, showing that descriptive normative beliefs are associated with stockpiling behavior. Conclusion: Based on these findings, we propose targeted interventions to a) reduce perceived benefits of stockpiling and severity beliefs related to COVID-19, b) emphasize disadvantages of stockpiling, and c) reduce media exposure of stockpiling behavior to prevent panic buying. [ABSTRACT FROM AUTHOR]

Aim: The Health Gym Program is the main health promotion strategy in the Brazilian public health system. This paper aims to measure the impact of the Health Gym Program on hospital admission expenses for stroke in the state of Pernambuco, Brazil. Subject and methods: This public health impact evaluation used a panel of socioeconomic, demographic, and epidemiological data from 2007 to 2019 for all 185 municipalities in the state of Pernambuco. The empirical strategy used pre-tests, ordinary least-squares econometric modeling, and quantile regression as a robustness test. Results: The municipalities that implemented the Health Gym Program spent an average of 21.04% less on hospitalizations for stroke than the municipalities that did not, and this result was statistically significant at the 1% level. Further, the density of program coverage within the municipality also impacts the reduction of expenses. This saving is directly proportional to the number of hubs of the program in the municipalities. An increase of one program hub for every 10,000 inhabitants results in a 4.57% reduction in expenditure on stroke hospitalizations in the municipalities. Conclusion: The presence of the Health Gym Program led to a reduction in expenses related to hospital admissions for stroke, which may indicate that this program effectively expands the scope of health promotion actions in primary healthcare. The evidence generated from this study can be used to implement evidence-based policies aimed at preventing and controlling chronic diseases in Brazil. [ABSTRACT FROM AUTHOR]

Aim: To analyze the level of knowledge, attitudes, practices, and risk perception regarding COVID-19 among Chinese residents 1.5 years after the pandemic. Subject and methods: A cross-sectional study was carried out with both online and paper questionnaires. We included a variety of covariates that were characteristic-related factors such as age, gender, education level, and retirement status, as well as those closely associated with risk perception regarding COVID-19. Results: Participants (n = 3588), 53.49 ± 18.88 years old, from two provinces of China, of which 44.7% were male and 52.03% had a high school or greater level of education, answered the questions. More than 90% of participants had adequate background knowledge about COVID-19 and agreed or even strongly agreed with many attitude items related to the government's role in diagnosis, treatment, and dealing with COVID-19 infections. About three fifths of the participants reported fear of contracting COVID-19, but only a minority (18.63%) felt they were more susceptible than others. Respondents aged 45 years or younger were more likely to fear contracting the virus than those older than 45 years (adjusted OR = 1.464, 95% CI 1.196 to 1.794, P = 0.0002). High education level (adjusted OR = 1.503, 95% CI 1.187 to 1.904, P = 0.0007) and non-retired status (adjusted OR = 1.679, 95% CI 1.354 to 2.083, P < 0.0001) were associated with a higher perception of susceptibility to infection than others. Moreover, respondents who were not retired had a significantly reduced practice score (adjusted OR = 1.554, 95% CI 1.261 to 1.916, P < 0.0001). Age, retirement status, and education level were also associated with knowledge, attitude, and practice level. Conclusion: Our findings suggest that the public generally has trust in the COVID-19 vaccine and the government with regard to COVID-19 in China. We recommend that high-risk groups of communities, such as elders and patients with chronic diseases, be given greater consideration in the outbreaks. Health education campaigns combined with workplace preventive intervention should be aimed at improving COVID-19 knowledge and beliefs in order to encourage more optimistic attitudes and to maintain safe practices. [ABSTRACT FROM AUTHOR]

Background: According to the World Population Outlook (2019), people over 65, usually accompanied by various chronic diseases, will make up 16% of the population in 2050. Therefore, the health problems of middle-aged and elderly people are becoming the focus of current global attention. Some scholars have found that the health of middle-aged and elderly people is related to the childhood socio-economic environment. Methods: Using the China Health and Retirement Longitudinal Study (CHARLS) data, this paper innovatively constructed four measurement dimensions of health (namely, self-rated health, physical health, emotional health, and mental health). Moreover, logistic regression was used to explore the impact of childhood socio-economic environment (such as parent's education level, work experience, etc.) on the health status of middle-aged and elderly people. Results: Compared with a poor childhood social-economic environment, a good childhood socio-economic environment is more advantageous to the self-rated health of middle-aged and elderly people, especially a childhood socio-economic environment close to the medium level; the psychological health of middle-aged and elderly people who have experienced an adverse childhood socio-economic environment was better than those who did not; the childhood socio-economic environment has no apparent impact on the cognitive situation of middle-aged and elderly people. Conclusions: Some policy implications can be drawn. For example, the government should vigorously introduce policies to help migrant workers' children receive education in cities and provide special education guarantees for migrant workers' children. Societies and families should also pay more attention to the childhood socio-economic environment. [ABSTRACT FROM AUTHOR]

Background: Limited data regarding the effects of school-based obesity prevention programs focusing on the changes in obesity-related knowledge and behaviors in China are available. The objective of this paper was to evaluate the effects of a school-based comprehensive lifestyle intervention among Chinese kids against obesity (CLICK-Obesity) in primary schools in Nanjing. Methods: We designed a cluster randomized controlled trial in eight randomly selected urban primary schools among 4th graders between May 2011 to April 2012 in Jianye, an urban district of Nanjing. Each school was randomly assigned to either the intervention or control group (four schools in each group). Mixed regression models and generalized estimating equations (GEE) were used to adjust for individual-level covariates under cluster randomization. Results: In this study, 1178 students (96.2%; 665 boys and 513 girls, 544 in control and 634 in intervention) participated in the baseline survey with mean age 10.2 ± 0.5 years. At the end of one-year intervention, 1125 students (91.8%; 628 boys and 497 girls, 513 in control and 612 in intervention) were reassessed. Notably, we found that the intervention group improved the knowledge and awareness of obesity-related risk factors, presented a lower increase of consumption of red/white meat (with a mean difference of −180.9 g/week, 95% CI: −350.6 to −11.2, p = 0.040), a larger increase in the time spent playing ball (with a mean difference of 24.2 min/week, 95% CI: −5.3 to 53.7, p = 0.090), and a significant reduction in screen time (with a mean difference of −71.0 min/week, 95% CI: −125.3 to −16.6, p = 0.020) compared to the control group after cluster (school) adjustment. Conclusion: The school-based integrated intervention was successful to modify unhealthy lifestyle behaviors and had a potential effect on childhood obesity prevention in urban China. However, the long-term effects and cost-effectiveness need to be evaluated in through further study. [ABSTRACT FROM AUTHOR]

Aim: This study aimed at comparing health literacy measures, and their correlates, for the district of Favoriten to those of Vienna and Austria. The Viennese district of Favoriten was of particular interest, due to present characteristics, such as its high cultural and ethnic diversity as well as a relatively high unemployment rate. Subject and methods: This study was set up as a cross-sectional, paper-based self-completion random sample survey. For each sample representing Favoriten, Vienna, and Austria, 500 adults were randomly drawn from the population register. Results: Out of 1500 surveys sent out, 160 (10.7%) were included in the analysis. Regarding general health literacy, the sample of Favoriten scored highest (33.9; CI 95% 31.5, 36.3), followed by the samples of Austria (32.5; CI 95% 30.9, 34.2) and Vienna (31.5; CI 95% 29.6, 33.4). Higher household income (r = 0.46, p < 0.01), better education (r = 0.31, p = 0.09) and migration status outside the EU (d = −0.56, p = 0.12) showed moderately effect-sized associations to general health literacy in the sample of Favoriten, which was not the case for other characteristics such as age, gender, and employment status. Conclusion: In the light of previous studies, reporting on associations of health literacy measures with social determinants, such as migration and employment status, the sample of Favoriten might well have been expected to result in impaired health literacy measures. Our results do not support this assumption, though. Despite the limited external validity of this study, policymakers and practitioners may be advised to design health literacy measures in such a way that specifically reaches out to the socially disadvantaged target population and not focus merely on pertinent districts or regions. [ABSTRACT FROM AUTHOR]

Aim: In response to the SARS-CoV-2 emergency, the Competence Centre on digital health 'TrentinoSalute4.0' has developed TreC_Televisita, a tele visit solution that meets the needs of the Trentino healthcare system and maintains high-quality patient–doctor interactions while respecting social distancing. This paper highlights how 'TreC_Televisita' was integrated into the Trentino healthcare system and its potential to become a structural and durable solution for the future local healthcare service provisioning. Subject and methods: This paper presents the multifactorial context that TreC_Televisita has faced for its implementation and the strategies adopted for its structural integration into the healthcare system. The analysis focuses on the main issues faced for the integration of the tele visits (e.g. privacy, payments) and how the context of TrentinoSalute4.0 permitted responding quickly to its implementation during the pandemic. It also describes how TreC_Televisita fits into the healthcare continuum from the organisational and technological standpoint, the end-user perspective and the barriers that could hamper the solution scalability. Results: TreC_Televisita has demonstrated to be a technological solution that can be contextualised for different clinical domains beyond SARS-CoV-2. Moreover, it has shown its potential to scale up the solution beyond the COVID-19 emergency to the whole healthcare provisioning system in the long term. Conclusion: Being a positive experience in the first months of its implementation, the long-term goal is to transform TreC_Televisita into a structural pillar of the Trentino healthcare system, setting the bases for a sustainable, win–win situation for all the stakeholders involved in healthcare service provisioning. [ABSTRACT FROM AUTHOR]

Purpose: Patient engagement has traditionally been limited to involving patients in decision-making regarding their healthcare choices. The goal of this paper was to assess patients' perspectives on how they might be involved as a research partner in the design and implementation of pharmacoepidemiology research studies. Methods: Qualitative research methods were used to elicit patient perspectives on their involvement in pharmacoepidemiologic research. A total of 20 patients participated in five focus groups held from April to August 2016. Each focus group represented one of five chronic conditions, namely: human immunodeficiency virus/acquired immunodeficiency syndrome (HIV)/(AIDS), diabetes, mental health conditions, mild cognitive impairment/Alzheimer's disease (AD), and cardiovascular disease (CVD)/hypertension. A semi-structured field guide was used to elicit views on drug safety and effectiveness and to identify which aspects of the design and implementation of a research study individuals felt most comfortable contributing to. The discussions were audio-recorded, transcribed verbatim, and analyzed following a grounded theory approach to identify the key themes that consequently emerged. Results: For the most part, individuals equated safety with side-effects. There were several dimensions of effectiveness that corresponded with biological, clinical, and psychological aspects of well-being. Most individuals (84%) were comfortable deciding what information should be collected, and 74% felt they could help researchers select target outcomes to study. Fewer (58%) were confident they could advise on selecting comparator drugs. Conclusion: There is a need for training the patient community and for adapting existing patient engagement standards to expand patient involvement in pharmacoepidemiologic research. [ABSTRACT FROM AUTHOR]

Background: Undernutrition among children is a primary concern in sub-Saharan African countries such as Ethiopia. The objective of this paper is to measure the magnitude of undernutrition and associated factors among children under 2 years of age in the Jimma Zone of Southwest Ethiopia. Methods: A community-based cross-sectional study with stratified multistage sampling was conducted. Data were collected using a semi-structured questionnaire and anthropometric measurements. Bivariate and multivariable logistic regression models were fitted using SPSS 20.0 for Windows. Adjusted odds ratios (AOR) with 95% confidence intervals (CI) were used to measure the strength of the association between dependent and associated variables at a p value <0.05. Results: Among the study participants, 142 (25.4%) were stunted, 73 (13.1%) were underweight, and 54 (9.7%) were wasted. Older child age [AOR = 1.1, 95% CI (1.1, 1.2)], male sex [AOR = 2.601, 95% CI (1.681, 4.025)], and residing in an urban area [AOR = 0.526, 95% CI (0.323, 0.857)] were significantly associated with stunting. Independent predictors of wasting were younger child age [AOR = 0.894, 95% CI (0.833, 0.96)], living in a lowland area [AOR = 3.3, 95% CI (1.4, 8.1)], and living a in poor household [AOR = 6.2, 95% CI (2.2, 17.7)]. Underweight was significantly associated with male sex [AOR = 2.09, 95% CI (1.179, 3.703)], delayed initiation of breastfeeding [AOR = 2.1, 95% CI (1.0, 4.2)], and living in a poor household [AOR = 2.2, 95% CI (1.0, 4.6)]. Conclusions: Child malnutrition was found to be a moderate public health problem in the study area. Urban dwellers had higher levels of undernutrition than rural dwellers. Children living in lowlands had higher undernutrition than those living in highland areas. [ABSTRACT FROM AUTHOR]

Aim: International comparisons of public health measures relative to observed best practice are increasingly important for evaluating community health promotion strategies and policies such as meeting or not meeting public health guidelines. This study aimed to identify methods enabling robust evaluation with such binary effect measures at a population level. Subject and methods: Conventional efficiency comparisons of binary effect proportions are problematic due to a lack of consistency with alternate framing of resulting relative risks. In this paper, we illustrate such inconsistent efficiency measures comparing the proportion of school age children (9–11 years) meeting or not meeting integrated movement guidelines (IMGs) across the 12 countries from the International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE) study. IMGs jointly consider physical activity, sleep and sedentary behaviours. An odds method is developed to enable consistent efficiency comparison with alternative framing of binary effects. Results: A novel odds solution to relative risk problems arising with conventional efficiency comparison of binary effects with alternative framing is shown to provide consistent efficiency measures relative to best practice. Furthermore, this technical advancement is shown to extend to consistent indirect comparison and evidence translation. Conclusion: Robust methods for international cross-country comparison of binary effect measures such as meeting or not meeting guidelines are identified with a novel odds ratio method. This novel solution is particularly important for health promotion evaluation of IMGs given the need for consistent comparison in evaluating practice evidence of what works now and consistent evidence translation of treatment effects as and when they emerge. [ABSTRACT FROM AUTHOR]

Aims: Although ambient assisted living (AAL) environments and serious games for healthcare have been proposed as solutions to meet the changing demographics, the two approaches are rarely combined. We present the development and empirical evaluation of two serious games for healthcare in AAL. The first uses a cooking scenario for training of cognitive functioning. The latter uses a gardening scenario and motion capture for training agility and endurance. As the frequent lack of social acceptance is a major challenge in consumer health technology, we integrated methods of technology acceptance research by means of the UTAUT2-model and intention to use into the evaluation. Subject and methods: We developed both games utilizing user-centered and participatory design methods ranging from low-fidelity paper prototypes to usability and acceptance evaluations of functional prototypes. In the final evaluation, each game prototype was evaluated by 64 participants form different age groups. Results: The results show that although performance decreases with age, the performance attained in the games is not decisive for social acceptance measured as intention to use. However, user diversity factors shape the evaluation of the games, and older people and people with low technical competence are in danger of being excluded from using serious games for healthcare. Conclusion: Exercise games, if designed right, can mitigate the negative effects of demographic change. Nevertheless, user diversity needs must be considered to ensure that the games are usable and used by a broad audience. The article concludes with guidelines and open research questions for the design of serious games in AAL environments. [ABSTRACT FROM AUTHOR]

Aim: A comprehensive approach to health highlights its close relationship with the social and economic conditions, physical environment and individual lifestyles. However, this relationship is not exempt from methodological problems that may bias the establishment of direct effects between the variables studied. Thus, further research is necessary to investigate the role of socioeconomic variables, their composition and distribution according to health status, particularly on non-communicable diseases.Subjects and methods: To shed light on this field, here a systematic review is performed using PubMed, the Cochrane Library and Web of Science. A 7-year retrospective horizon was considered until 21 July 2017.Results: Twenty-six papers were obtained from the database search. Additionally, results from “hand searching” were also included, where a wider horizon was considered. Five of the 26 studies analyzed used aggregated data compared to 21 using individual data. Eleven considered income as a study variable, while 17 analyzed the effect of income inequality on health status (2 of the studies considered both the absolute level and distribution of income). The most used indicator of inequality in the literature was the Gini index.Conclusion: Although different types of analysis produce very different results concerning the role of health determinants, the general conclusion is that income distribution is related to health where it represents a measure of the differences in social class in the society. The effect of income inequality is to increase the gap between social classes or to widen differences in status. [ABSTRACT FROM AUTHOR]

Aim: Non-pharmaceutical interventions such as lockdowns have played a critical role in preventing the spread of the Covid-19 pandemic, but may increase psychological burden. This study sought to examine emotions reflected in social media discourse following the introduction of social contact restrictions in Central Europe. Subjects and methods: German-language Twitter posts containing '#corona' and '#covid-19' were collected between 2020/03/18 – 2020/04/24. A total of 79,760 tweets were included in the final analysis. Rates of expressions of positive emotion, anxiety, sadness and anger were compared over time. Bi-term topic models were applied to extract topics of discussion and examine association with emotions. Results: Rates of anxiety, sadness and positive emotion decreased in the period following the introduction of social contact restrictions. A total of 16 topics were associated with emotions, which related to four general themes: social contact restrictions, life during lockdown, infection-related issues, and impact of the pandemic on public and private life. Several unique patterns of association between topics and emotions emerged. Conclusion: Results suggest decreasing polarity of emotions among the public following the introduction of social contact restrictions. Monitoring of social media activity may prove beneficial for an adaptive understanding of changing public concerns during the Covid-19 pandemic. [ABSTRACT FROM AUTHOR]

Subject and aims: This paper reports on the development and evaluation of a stress prevention program for adolescents of grades 8 and 9. The program is based on the problem-solving approach and was developed on the basis of several evaluation studies. It consists of eight weekly training sessions with durations of 90 min each and is accompanied by an e-learning platform. Evaluation studies: The first section of the paper reports on a preceding demand analysis and the initial development and evaluation of the stress prevention program. The second section summarizes the results of providing an additional e-learning platform. Eight online-lessons were designed in correspondence to the training sessions of the face-to-face intervention. The last section of the paper focuses on the results of an evaluation of an optimized training version including the successful elements of the face-to-face and the e-learning platform. Results and conclusion: The results of the final evaluation study showed clear knowledge and self-efficacy improvement and reduction of stress symptoms. Moreover, the training led to positive assessments by most adolescents. Possible actions in contributing to an increase of the training effects beyond those already apparent in the current evaluation studies are additionally discussed. [ABSTRACT FROM AUTHOR]

Aim: Substantial progress has been made towards the 90–90–90 global targets; however, the pace at which new infections are declining remains undesirable to meet the UNAIDS 2020 global targets of below 500,000 new infections annually. We discussed the possibility of continued HIV incidence amidst remarkable scores in the 90–90–90 global targets. Subject and methods: A game theory simulation was used to explain micro-level sexual interactions in situations of imperfect information on each partner's HIV status. A non-cooperative sex game tree was constructed following the Harsanyi transformation in two scenarios; scenario one: a player assigns higher subjective probability that the partner is HIV negative; and in scenario two: a player assigns higher subjective probability that the partner is HIV positive. Subjective expected utilities were computed using hypothetical payoffs. Results: Accepting unprotected sex is a pure strategy for both players in scenario 1. Player2 is likely to acquire HIV/AIDS. Accepting protected sex is a mixed strategy equilibrium for both players in scenario 2. Player2 is likely to avoid HIV infection. Conclusion: Choice for safe or risky sex is a function of subjective probabilities individuals attach to their partners being infected or uninfected. More efforts towards addressing factors affecting individual probability distributions on riskiness of their sexual partners is required, especially for young women in Sub-Saharan Africa. [ABSTRACT FROM AUTHOR]

Background: Cigarette smoking is an established cause of preventable death and often initiated during adolescence. We estimated the short- and long-term costs of cigarette smoking among currently smoking adolescents in Nigeria. Methods: A cross-sectional survey among adolescents in Oyo state, Nigeria and a review of mortality records of patients managed for lung cancer in a tertiary facility in Ibadan, Nigeria were conducted. Short-term costs estimated were: (a) average weekly costs of purchasing cigarettes by currently smoking adolescents, and (b) costs of managing at least an episode of chronic cough occurring within 12 months of the survey. Long-term costs were limited to: (a) life-time expenditure on purchasing cigarettes, and (b) direct medical and non-medical (transportation) costs of managing lung cancer. Long-term costs were first projected to the approximate year when the adolescents (mean age:16.0 ± 1.8 years) might be diagnosed with lung cancer based on the average age at presentation with symptoms of lung cancer obtained from the records (59.8 years), and then discounted to 2020 prices. This was estimated as 44 years from the base year (2020). Costs were reported in 2020 prices in Nigerian Naira (NGN) and US dollar (USD) equivalent using the Central Bank of Nigeria, June 2020 exchange rate of USD 1: NGN 360.50. Results: Approximately 3.8% of the adolescents were current cigarette smokers. Average weekly expenditure on cigarettes was NGN 306.82 ± 5.74 (USD 0.85 ± 0.02). About 26% had experienced at least an episode of chronic cough which cost them an average of NGN 1226.81 ± 6.18 (USD 3.40 ± 0.02) to manage. Total future costs of cigarette smoking in 2020 prices for the 43 adolescents who were current smokers in the event that they develop lung cancer were approximately NGN 175.7 million (USD 487.3 thousand), NGN 871.8 million (USD 2.4 million) and NGN 4.6 trillion (USD 12.7 million) at assumed annual inflation rates of 10%, 15%, and 20% respectively and discount rate of 4.25%. Conclusion: The estimated economic costs of smoking were very high. Efforts to prevent smoking initiation among adolescents in our study area should be intensified. Interventions to subsidize the medical cost of health-related consequences of cigarette smoking are also required, especially as treatment costs are currently largely borne out-of-pocket. [ABSTRACT FROM AUTHOR]

Aim: Keeping shared toilets clean is a key public health challenge household users face in urban slum settlements of most developing countries. This paper provides insights on the cleanliness of households' shared toilets and the factors that influence their cleanliness, as well as influencing the inclination of the users to keep them clean. Subjects and methods: This analysis is part of a cross-sectional study conducted in 50 randomly selected slums in Kampala, Uganda between October and November 2010. A total of 1,500 respondents were interviewed, using a semi-structured questionnaire. Results: Out of 1,019 respondents using shared toilets, less than 12 % reported having very clean toilets. Some of the significant factors influencing the cleanliness of shared toilets are: the ease or difficulty in keeping shared toilets clean, the number of households sharing a toilet room, effortful cleaning behaviour and cleaning intention on the part of the users. Conclusion: The findings show that most slum dwellers use toilets that are not hygienic. [ABSTRACT FROM AUTHOR]

Aim: The objective of this study is to analyze the meaning of intergenerational educational transmission and intergenerational educational mobility on adolescents' obesity risk. In particular, the paper investigates if upward social mobility is a protective factor against obesity for children of lower educated parents. Subject and methods: Representative data was derived from a subsample (12-17 years, n = 5,111) of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS). Body height and weight were measured in a standardized way. Obesity (>97th percentile) was defined due to the national reference system that is based upon percentiles of the body mass index (BMI). Intergenerational educational mobility was defined as: stable high (parents and participant have high education), potentially upwardly mobile (participant's education is higher than parents' education), potentially downwardly mobile (participant's education is lower than parents' education), and stable low (parents and participant have low education). Results: The highest prevalence of obesity was found in adolescents with a stable low education, the lowest prevalence in adolescents with a stable high education. The educational gradient was steeper in girls than in boys. Compared to the 'stable high' reference category, potentially upwardly mobile adolescents had no significant increased risk of obesity, while the risk for potentially downwardly mobile adolescents was only significant in girls (OR 2.32; 95 % CI 1.23 -4.37). The obesity risk in boys and girls with a stable low education was significantly elevated (1.68; 1.04-2.73 and 3.06; 1.89-4.94). Conclusion: Parental education and adolescents' own educational status have cumulative effects on obesity risk. The fact that potentially upwardly mobile boys and girls are not more likely to be obese than adolescents with a stable high education and less often than adolescents with a stable low education can be interpreted as a protective effect of upward social mobility even though health selection might have played a role. [ABSTRACT FROM AUTHOR]

Aim: Knowledge about nurses' error perception is crucial for establishing a sustainable risk management. This paper presents categories and frequencies of errors as identified by nurses. The cross-sectional study results provide further knowledge for professional and organizational development. Subject and methods: Data from 1,100 German nurses working in 30 hospitals and 46 nursing homes were collected using a self-administered questionnaire. This paper firstly presents results from a content analysis of nurses' descriptions of errors and, secondly, results on frequencies of predefined nursing errors (closed-ended, ordinal frequency estimation). Thirdly, it compares the answers of hospital nurses with those of nurses employed in nursing homes and finally it compares answers of participant groups defined by sex or migration background. Results: In the open-ended section, errors described by 60.5 % of the participants concerned medical diagnosis/therapy. 20.7 % had experienced errors in hands-on care, while errors in communication with patients were noted by 3.7 %. In contrast, when offering predefined activities in the questionnaire's closed-ended part, indicated frequencies of errors stressed issues of hands-on care and documentation. Significant differences exist between participants from both settings regarding direct care and relationship building. Sex and migration background were related to frequency estimations. Conclusions: Findings point to shortened professional perspectives in the debates on risk and safety. This might lower nurses' compliance in risk management systems. The influence of health professionals' sex and migration background on their error perception needs further exploration. Field specific approaches for error prevention are needed. [ABSTRACT FROM AUTHOR]

Aim: In this paper, we explore the influence of alcohol consumption and sports participation on popularity of overweight adolescent males and females of different races and ethnicities. Subjects and methods: Using data collected in 1994 and 1996 from a large nationally representative survey of adolescent friendship networks, we estimate models accounting for school-level fixed effects, and a wide range of individual-level controls to ascertain the causal effect of these behaviors on change in popularity. Results: We find that sports participation leads to increase in the number of friends among overweight white males. Additionally, overweight white females and males experience a significant gain in popularity by engaging in alcohol consumption. Conclusion: These results underscore the importance of promoting sports and physical activity not only to objectively reverse the childhood obesity trend but also as a way to achieve popularity that is superior to alcohol consumption. [ABSTRACT FROM AUTHOR]

Aim: Nurses constitute an important group in identifying and preventing errors and risks in health care, but research on their perception of errors is scarce. This paper presents results of a representative study on health care errors, focusing on factors causing and influencing the occurrence of errors as perceived by nurses. Subject and methods: The cross-sectional research design comprised descriptive and correlational parts. The sample consisted of 1,100 nurses employed at 30 hospitals and 46 nursing homes in Germany. Data were collected in 2008/2009 using a questionnaire listing 21 factors that can potentially cause or influence errors. Participants could choose up to three factors they deem the most important. Differences between the two settings and variables which might have an influence on the perception of error-causing factors were analyzed using cluster-adjusted methods. Results: High workload, staff shortage and excessive labour topped the list. Hospital nurses more often chose 'workload' and 'interruptions' while nursing home nurses more often ranked 'lack of knowledge' and 'lack of motivation' as the most important. There are some significant variables such as years of professional experience and migration background that could affect nurses' perception. Conclusion: The findings support other studies, pointing to workload issues and below-optimum work processes producing errors. Inter-sectoral differences suggest the necessity of sector-specific support in education and on-going training as well as risk and quality management. [ABSTRACT FROM AUTHOR]

Aim: This paper examines the behavioural factors that are linked to the gender gap in mortality phenomenon and connects theoretical implications with the findings of a qualitative grounded theory research. Subject and methods: Differences in the life expectancy of men and women are a well-known fact. Though several theories take into account the wide range of factors underlying this phenomenon, they can only partly explain it. To get a deeper understanding of these issues, we use a qualitative approach to study this topic from another point of view. Expert interviews with professionals in the medical field were conducted to gain insights about the health lifestyles of men and women that may reveal hypotheses as to why the gender gap in mortality is narrowing. Results: The results bear in mind that apart from biological factors, behavioural factors are strongly connected to the gender gap in the mortality issue. Men and women tend to behave differently and their behaviour is linked to social norms and expectations. They have a different understanding of illness and also behave in different ways with regard to seeing doctors. However, because of changing gender roles due to changing norms and other influential factors, these health behaviour patterns have started to diminish. Conclusion: A generational change in the health behaviour of men and women is currently taking place. Traditional gender roles are diminishing due to versatile attributes and behavioural patterns of men and women. This development may partly explain the narrowing of the gender gap in life expectancy in Austria. [ABSTRACT FROM AUTHOR]

im: Parental depression is a strong risk factor for depression in children and is associated with offspring's behavioral problems. Therefore, prevention measures should aim to reduce the transmission of risk to children of depressed mothers. In this paper, description and evaluation results are reported for EFFEKT-E ( Entwicklungs förderung in Familien: Eltern- und Kinder- Training in emotional belasteten Familien), a prevention program to be used in the setting of mother-child rehabilitation clinics. EFFEKT-E is a family-oriented program including parent training and social skills training for pre-school children. Subjects and methods: The evaluation study contained 375 mothers and their children. The program was evaluated in a quasi-experimental pre-post-follow-up design using instruments on parenting behavior and children's emotional and behavioral problems. Results: Evaluation showed satisfying out reach and implementation of the program. Compared to a treatment-as-usual condition, EFFEKT-E children exhibited less emotional disruption and hyperactivity. Mother's sense of parental competence was promoted, problematic parenting behavior decreased. Conclusion: EFFEKT-E is an evidence-based selective program which has the potential to prevent intergenerational transmission of depression. [ABSTRACT FROM AUTHOR]

im: Disordered eating is a significant social and economic issue in Western societies. Weight and shape concerns are highly prevalent during adolescence and an alarming percentage of adolescents already show disturbed eating patterns. Sociocultural factors like the beauty ideal promoted by the media and social agents are among the main reasons for this trend. Prevention programmes which focus on established protective and risk factors are needed to counteract problematic developments as early as possible. Subject and methods: In this paper we describe the development and the contents of a structured school-based eating disorder prevention programme for adolescents. Results: The POPS programme (POtsdam Prevention at Schools) is an interactive multisession programme and encompasses nine lessons for pupils and one meeting with the parents. The programme is based on current research on risk and protective factors for eating disorders with an emphasis on sociocultural factors. It is designed to enhance resources based on the life skills approach. We included for instance lessons to enhance healthy eating and exercise habits and to reduce unhealthy dieting, to build up resistance through media literacy and strategies to react to social pressure. To further enhance life skills we integrated the impartation of problem-solving techniques and coping strategies which are potential protective factors not only in relation to eating disorders but also other diseases. In contrast to most existing programmes, psychoeducation on eating disorders is not part of the POPS programme for pupils but part of the information session for the parents. Conclusion: POPS is a theory-based, structured prevention programme that can be implemented by teachers as part of regular lessons. [ABSTRACT FROM AUTHOR]

im: Although working life issues are subject to European health monitoring schemes, not many routine data sources include information on occupations or working conditions. Additional in-depth analysis is therefore necessary for diseases with high public health impact. The aim of this paper is to introduce a multidimensional ranking procedure for priority setting of diseases based on European and national data. Subject and methods: Multidimensional ranking was carried out on ten disease-specific indicators. First, suitable data sources were identified and information on indicators was retrieved. Second, the diseases were sorted by their ranks according to each indicator. Third, all ranks were added to a rank sum. Finally, the diseases were sorted by their rank sum. Results: Diseases of the circulatory system account for the highest rank sum. The high public health impact is visible in regard to most criteria, particularly to mortality, hospital discharges, and costs. Diseases of the digestive system rank second mainly because of high ranks for hospital discharges and costs. The third place is assigned to diseases of the musculoskeletal system. Conclusion: A multidimensional ranking procedure has advantages when used for priority setting of diseases. The procedure leads to an overall rank as a summary measure for the public health impact but information for each indicator is still retrieved. Furthermore, the procedure uses ranks and is therefore scale invariant. However, ranking procedures do not lead to a selection of diseases but a rank order. So, there is still a decision rule required to determine which diseases are selected e.g. for in-depth health reporting. [ABSTRACT FROM AUTHOR]

im: Interest in the quality of economic analyses is increasing in the field of decision-making. Drummond's checklist is a useful tool. This study aimed to use a weighted version of Drummond's checklist together with a consensus of experts to derive a new scoring system to improve the evaluation of economic analyses of tetravalent human papillomavirus (HPV) vaccine as a case study. Methods: Drummond's checklist is composed of 35 items divided into 3 sections: study design, data collection and analysis and interpretation of results. To weight the items, a group of experts was asked to attribute a score according to their importance. A bibliographic search of economic evaluations of tetravalent HPV vaccine was performed. Two researchers assessed the quality of selected studies according to the original and weighted checklist. Results: The weighted scores assigned by the consensus to study design, data collection and analysis and interpretation of results were 26, 45 and 48, respectively. Thirteen papers were included in the review of economic evaluations of tetravalent HPV vaccine. According to the weighted Drummond's checklist, their median quality score was 74 with a maximum of 119. The highest score was reached in the study design section. Conclusion: According to the weighted Drummond's checklist, studies were judged to be of medium quality. The main pitfalls were found in issues assigned the highest scores by the consensus, underlying the utility of weighting available checklists to improve the estimate of the quality of economic analyses. The weighted checklist could be thus proposed as a scoring tool to assess the quality. [ABSTRACT FROM AUTHOR]

im: The present paper is an original research that explores housing satisfaction and residents' ability to cope with day-to-day demands, taking into account other dimensions of housing and sociodemographic factors. Subjects and methods: A cross-sectional survey ( n = 562) was randomly administered to residents in three neighbourhoods (Labone, Asylum Down and Nima) in Accra, Ghana. The association between the outcome variables and housing attributes were analysed using logistic regression. Results: The findings indicate that housing satisfaction was significantly predicted by age, with older people more likely to be dissatisfied with their housing arrangement. Respondents were dissatisfied with housing arrangements if they lived in Nima [odds ratio (OR) = 2.75, p < .001], Asylum Down (OR = 1.72, p < .01), crowded households (OR = 1.158, p < .05) or in compound houses (OR = 2.50, p < .001). In the context of housing attribute variables, respondent's ability to cope with day-to-day demands was significantly associated to their income level. Odour annoyance as an indicator of housing condition emerged as a strong predictor of respondent's inability to cope with daily demands with OR ranging from 1.68 to 2.33. Those who were dissatisfied with the location of their home as a place to live also reported poor coping abilities (OR = 1.86, p < .01). Discussion and conclusions: From the findings, government policy on housing should encourage the construction of more affordable housing units to ease the crowding situation in Accra. There is also a need for the Accra City Council to provide clearer guidelines for both tenants and landlords in response to increasing tenancy disputes in context. [ABSTRACT FROM AUTHOR]

Aim: Sometimes treatment is not necessarily according to guidelines, which is partly due to attitudes rather than lack of knowledge. In Germany, regional differences concerning prevalence rates of ADHD exist without valid explanation. We contribute with our data to the question of attitudes toward ADHD among pediatricians in Germany. Method: A specially designed questionnaire based on the Knowledge of Attention Deficit Disorders Scale and previous surveys was sent to pediatricians. In addition to descriptive statistics, we performed factor analysis and multiple linear regression analysis. Results: The vast majority (85.5%) of 581 respondents have a positive attitude toward ADHD, i.e., ADHD exists and should be treated appropriately. Physicians with positive attitudes were older and more often had a neuropediatric specialization. Conclusion: Most of the pediatricians surveyed in Germany assess ADHD and treatment in line with medical guidelines and treat as part of multimodal therapy. [ABSTRACT FROM AUTHOR]

Background: Active transport to school (ATS) is an effective health-promoting intervention to integrate physical activity into children's everyday lives. While previous studies have examined environmental and behavioural determinants on ATS in urban areas, evidence on rural areas is rare. Method: This study examined whether environmental and psychosocial characteristics are associated with ATS in two rural communities in Austria. Participants from four schools (two primary / two secondary schools) returned a self-reported questionnaire on individual and environmental determinants of ATS consisting of one section for parents and one for children, with 382 of the 467 total responses being included in the analysis. Results: Bivariate analyses showed a significant association of psychosocial characteristics of parents and children (intention, attitude, social norm, perceived behavioural control: p < 0.001), one environmental item (walking and cycling network: p ≤ 0.001) as well as distance and duration for walking to/from school between ATS. In a multiple regression model, the chances of participating in ATS were higher among children who have higher perceived behavioural control, walk between 5 to 10 minutes to school, and whose parents have a higher commitment to ATS. Conclusions: Future initiatives to enhance ATS in rural areas should focus on the control beliefs of parents and children, and should involve parents in order to increase parents' commitment to ATS. Additionally, measures should explore the effects of active transport promotion in the context of public transport and school buses. Above all, further opportunities for ATS should be considered in spatial and community planning. [ABSTRACT FROM AUTHOR]

Background: Understanding the effects of the COVID-19 pandemic on cause-specific mortality should be a priority, as this metric allows for a detailed analysis of the true burden of the pandemic. The aim of this systematic literature review is to estimate the impact of the pandemic on different causes of death, providing a quantitative and qualitative analysis of the phenomenon. Methods: We searched MEDLINE, Scopus, and ProQuest for studies that reported cause-specific mortality during the COVID-19 pandemic, extracting relevant data. Results: A total of 2413 articles were retrieved, and after screening 22 were selected for data extraction. Cause-specific mortality results were reported using different units of measurement. The most frequently analyzed cause of death was cardiovascular diseases (n = 16), followed by cancer (n = 14) and diabetes (n = 11). We reported heterogeneous patterns of cause-specific mortality, except for suicide and road accident. Conclusions: Evidence on non-COVID-19 cause-specific deaths is not exhaustive. Reliable scientific evidence is needed by policymakers to make the best decisions in an unprecedented and extremely uncertain historical period. We advocate for the urgent need to find an international consensus to define reliable methodological approaches to establish the true burden of the COVID-19 pandemic on non-COVID-19 mortality. [ABSTRACT FROM AUTHOR]

Aim: The incidence of inflammatory bowel disease (IBD) is increasing worldwide. The Saxon Pediatric IBD Registry was founded in 2000 to describe the epidemiology of pediatric IBD in Germany. The aim of this study was to determinate the completeness of this registry for children and adolescents younger than 15 years and to make this approach transparent. Results of this completeness update have broad implications for further scientific publications from the registry dataset. Method: The capture–recapture method with two data sources was used to ascertain completeness. A second data source was collected in 2019 for the observation period 2008–2014 from all pediatricians, gastroenterologists, and internists working in practices in a predefined region in Saxony, Germany. Results: A total of 23 patients with IBD were reported who fulfilled the inclusion criteria. One of them was not recorded in the registry. Therefore, the completeness of the registry was estimated at 95.7% (95% CI 90.2–100). Initial analysis of the Saxon Pediatric IBD Registry over the 15-year period 2000–2014 includes 532 patients, 312 (58.6%) male and 220 (41.4%) female. The distribution of single IBD diseases in the registry was as follows: Crohn's disease 338 patients (63.5%), ulcerative colitis 176 patients (33.1%), and unclassified IBD 18 patients (3.4%). Evaluations by sex and by disease in age groups and by age at onset were tabulated. Conclusion: This study demonstrates that the completeness level of the Saxon Pediatric IBD Registry is high (95.7%), and thus the epidemiological data of the registry are reliable. [ABSTRACT FROM AUTHOR]

Aim: Sedentary behavior is a severe and independent risk factor for health. According to current research, sitting time is at a dangerously high level. Especially young adults show a high prevalence compared to others. The study aimed to assess the effectiveness of a 6-week messenger-based intervention to reduce sedentary behavior in university students. Subject and methods: The 345 university students that enrolled were randomly assigned to the intervention group (n = 173) and control group (n = 172). Randomization and allocation to the trial group were computer assisted. The trial was conducted remotely, without any personal contact. A drop out of 276 participants led to a primary analysis of 71 (IG n = 41; CG n = 31) participants. Sedentary behavior was assessed online using the Heidelberg Questionnaire for the Assessment of Sitting Behavior, at 5 time points: baseline (T0), 2 weeks (Z1), 4 weeks (Z2) 6 weeks (end of the intervention, T1), and follow-up 4 weeks after intervention (T2). Results: Mixed ANOVA was carried out for T0 and T1 to reveal interaction effects between time and group. Mean differences show a highly practically and statistically relevant reduction in sitting time in the intervention group of 60 min between baseline and T1. No sustained effect of the intervention could be detected by analyzing sitting times at follow-up, 4 weeks after the end of the intervention. Conclusions: Reduction in sedentary behavior in the intervention group after 6 weeks shows that the intervention is practically and statistically relevant. Limitations concerning the assessment method (questionnaire) as well as the sample size should be considered. The trial serves as a pilot study. However, the positive outcome of sitting time reduction paves the way for further research in this field. [ABSTRACT FROM AUTHOR]

Aim: This study sought to investigate the effects of body-weight-based compared to health-based public health messages for encouraging fruit and vegetable consumption, dependent on gender and age, while also gauging adverse consequences. Subject and methods: Using an independent groups design, male and female participants, aged 18–65 years, were randomized to view either a weight-based (N = 245) or a health-based (N = 231) public health message for increasing fruit and vegetable consumption, and intentions to consume, immediate selection and subsequent consumption of fruit and vegetables and biscuit/cake-bars, adverse consequences and various confounders were assessed. Results: Weight-based messages resulted in greater immediate selection and subsequent fruit and vegetable consumption compared to health-based messages in females (smallest Beta = 0.375, p = 0.04), specifically younger females (least significant Beta = 0.683, p = 0.04). No effects were found in males. Intentions to consume fruit and vegetables, biscuit/cake-bars and subsequent biscuit/cake-bar consumption were predicted only by confounders. Adverse consequences of the messages were low (χ2(1) = 44.16, p < 0.05; smallest t(148) = 10.22, p < 0.01), and did not differ between weight-based and health-based messages (χ2(2) = 2.72, p > 0.05; largest t(278) = 0.75, p = 0.46). Conclusions: This work demonstrates a role for weight-based compared to health-based public health promotion messages for increasing fruit and vegetable selection and consumption in young females. Adverse consequences following the messages were low, but care may still be needed. [ABSTRACT FROM AUTHOR]

Aim: Even though students attending vocational school are very vulnerable to the development of mental health problems, few studies identify the correlation between suicidal ideations and vocational education. Therefore, this study aimed to identify the prevalence and associated risk factors for suicidal ideations among vocational students in Germany. Methods: We conducted a cross sectional survey with a total of 555 pupils. The pupils received a standardized questionnaire, assessing sociodemographic data, the use of protective factors, possible risk factors, traits for neuroticism and depressive symptoms. For our study, we excluded item 9 from the Beck depression index (BDI-II) to identify the prevalence of suicidal ideation. Results: Our results show that the prevalence of suicidal ideation among students attending vocational school is 23.2%. A combination of feeling lonely, male sex, low importance of religion, little time for hobbies and BMI scores outside the norm show the highest risk for suicidal ideation and can be identified as significant predictors. Conclusion: This cross-sectional study highlights the mental burden vocational students in Germany are confronted with and underlines the necessity of paying special attention to this group of young adults. Furthermore, it emphasizes the necessity of further studies on this topic, especially including larger student populations. The results should be used to decrease the significant loss of life caused by suicidal behavior in young adults. [ABSTRACT FROM AUTHOR]

Aim: Although caring relatives of people with dementia are a mainstay of many care systems, the availability of support services for them within the municipal community shows deficiencies. Adopting the Theoretical Domains Framework (TDF) this study aims to investigate 1) which of the TDF domains adapted to gerontology show up in public dialogue, and 2) the results that public dialogues produce in terms of support services for caring relatives. Subject and methods: The data consists of town hall meetings and focus groups from 14 municipal communities in Germany. Participants were caring relatives and stakeholders of the communities. A qualitative content analysis was conducted, focusing on the assessment of three TDF domains, namely knowledge, goals, and sociopolitical context as well as outcomes of care optimisation. Results: With regard to domain knowledge, it was evident that in every community there were actors aware of the situation and relevance of carers and their relatives. Only some actors mentioned goals for optimising the care of the target group. The sociopolitical context is often addressed through statements about incomplete requirements. Conclusion: Overall, a relation between the discussion about the domains in public dialogues and changes in supporting carers of people with dementia can be assumed. The results indicate that an increased discussion about the domains within town hall meetings influences the actors and their statements with regard to the improvement of support services for caring relatives of people with dementia. Since the domains were not developed exclusively for the outlined context, this approach can also be applied to other areas of care. [ABSTRACT FROM AUTHOR]

Aim: Long-term care considerations for persons with dementia are complex. Multi-criteria decision analysis (MCDA) methods are increasingly used to support healthcare decisions. The objective of this scoping review was to identify and analyze published MCDAs in which preferences for living and care concepts for persons with dementia are determined. Subject and methods: A literature search was conducted in PubMed, EMBASE, Web of Science, and Google Scholar in October 2021. Searches were limited to peer-reviewed articles published up to October 14, 2021. The included publications aimed at eliciting care preferences for persons with dementia from patients, relatives, healthcare practitioners or the broader public by means of MCDA. Results: Ten studies were included of whom seven were published in 2017 or afterwards. In nine studies, a discrete choice experiment (DCE) was conducted. The majority of studies surveyed the general population or caregivers of persons with dementia. Five studies assessed preferences for attributes of home care and two for long-term care facilities. Willingness to pay was addressed in eight studies. Choice task structure and experimental design varied widely. Despite different objectives, strong preferences for continuous care by the same person, organizational aspects, and caregiver expertise were found across studies. Conclusion: This review shows that MCDA methods have successfully been applied to analyze preferences for living and care arrangements for persons with dementia. The majority of publications report on DCEs, and a variety of different study objectives and methodological approaches have been observed. Further research is needed to inform the design of innovative concepts which are a valuable alternative to existing care options. [ABSTRACT FROM AUTHOR]

Aim: This study compares the pattern of physical activity and sleep between shift and non-shift workers using a novel physical activity–sleep index. By drawing from a diverse occupational population, this research aims to reduce any occupational specific biases which are prevalent in shift-work research. Subject and methods: Current data included 7607 workers (shift workers n = 832) from the Household Income and Labour Dynamics of Australia cohort study. The combined physical activity–sleep index comprised three physical activity components and three sleep health components: achieving moderate (1pt) or high (2pts) IPAQ classification; accruing ≥30% of physical activity as vigorous intensity (1pt); meeting sleep duration recommendations on a work night (1pt); and non-work night (1pt); and reporting no insomnia symptoms (1pt) (higher score = healthy behaviour, max. 6). Generalised linear modelling was used to compare behaviours of shift and non-shift workers. Results: Findings showed shift workers reported significantly lower activity–sleep scores (3.59 vs 3.73, p < 0.001), lower sleep behaviour sub-score (2.01 vs. 2.22, p < 0.001) and were more likely to report insomnia symptoms (p < 0.001) compared to non-shift workers. No difference was reported for overall physical activity (shift = 1.58 vs. non-shift = 1.51, p = 0.383). Conclusion: When viewed in conjunction using the combined activity–sleep index, shift workers displayed significantly poorer combined behaviours when compared to non-shift workers. [ABSTRACT FROM AUTHOR]

Aim: Sexual violence is global public health, human rights and gender equality issue. Sexual violence bystander programmes for nightlife workers are emerging across a few countries and further examination of such programmes is required. This exploratory study evaluates the potential effectiveness of the Good Night Out Campaign, a sexual violence bystander programme for nightlife workers. Subject and methods: Two hundred and seven trainees attending the 1.5 hour training programme across two cities in England were recruited opportunistically, immediately prior to training delivery. Sexual violence myth acceptance and readiness and confidence to intervene in sexual violence were measured at baseline and post-intervention. Analyses used paired-sample tests to examine differences in the three measurements pre to post-training and effect sizes were quantified using Cohen's d. Results: Compared to pre-training, post-training participants were significantly (p < 0.001) less likely to agree with sexual violence myths, and more likely to be confident and ready to intervene in sexual violence or incidents of vulnerability. Effect sizes were small–medium. Conclusions: The study adds to emergent evidence suggesting that sexual violence bystander programmes may be promising in decreasing sexual violence myths and barriers to bystander intervention, and increasing willingness to intervene amongst nightlife workers. Findings can support the emergence of sexual violence prevention activities implemented in nightlife spaces. Further programme implementation and evaluation using experimental designs is needed to explore outcomes in greater depth, considering the complexity of the nightlife environment. [ABSTRACT FROM AUTHOR]

Aim: We examined predictors of trust in the healthcare system during the COVID-19 pandemic in 27 European countries. Subjects and methods: We used population-based data drawn from the Living, working and COVID-19 survey (N = 21,884, 52% female, ages 18 to 92 years) covering 27 European countries dated June and July 2020. Multilevel linear regression, linear regression, and regression-tree analyses were conducted. Results: We found that most participants tended to trust the healthcare system, although a substantial part could still be classified as distrusting (approx. 21%). Multiple variables, including being middle-aged or of older age, being female, lower levels of education, unemployment, worse general health status, having income difficulties, having unmet needs for healthcare, no healthcare contact during the COVID-19 pandemic, higher mental distress, and loneliness, were significantly associated with lower levels of trust. Among these variables mental distress, income difficulties, and unmet needs for healthcare emerged as especially important and, across European regions and countries, consistent predictors for lower trust in the healthcare system during the COVID-19 pandemic. Conclusions: Medically vulnerable subgroups, such as individuals with unmet healthcare needs, higher levels of mental distress, and older age, as well as people living in socially and economically vulnerable situations, such as higher levels of loneliness and financial difficulties, were the least trusting of the healthcare system during the COVID-19 pandemic. As these vulnerable subgroups are also at highest risk for contracting COVID-19 and experiencing negative COVID-19-related outcomes, more targeted prevention and intervention efforts should be implemented in these groups. [ABSTRACT FROM AUTHOR]

Aim: The consumption of ultra-processed food (UPF) and its impact on diet quality has been extensively studied and reported in the literature, but only a few studies have focused on children and adolescents. The present study therefore aimed to describe UPF consumption in a representative sample of French children and adolescents and to evaluate its association with diet quality. Methods: The study included 1146 children and teenagers (3–17 years old) from the cross-sectional French Nutrition and Health Study 2006/2007 who completed three 24-hour food recalls over a period of 15 days. Food consumption was described using the NOVA classification. Regression models were used to estimate the association between UPF consumption and diet quality. Results: The UPF dietary share in children and adolescents represented 44.2% and 44.5% of total energy intake respectively. In both age groups, UPF consumption was positively associated with dietary energy density and total carbohydrate and free sugars content, but negatively associated with dietary contents of protein, fiber, and potassium. UPF consumption also showed a positive association with inadequate intakes of energy density, free sugars, fiber, and potassium among children, and inadequate consumption of fiber and free sugars among teenagers. Conclusion: Higher UPF consumption among French children and adolescents is associated with a lower quality diet. [ABSTRACT FROM AUTHOR]