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Few biomarker-based validation studies have examined error in online self-report dietary assessment instruments, and food records (FRs) have been considered less than food frequency questionnaires (FFQs) and 24-hour recalls (24HRs). We investigated measurement error in online and paper-based FFQs, online 24HRs, and paper-based FRs in 3 samples drawn primarily from 3 cohorts, comprising 1,393 women and 1,455 men aged 45–86 years. Data collection occurred from January 2011 to October 2013. Attenuation factors and correlation coefficients between reported and true usual intake for energy, protein, sodium, potassium, and respective densities were estimated using recovery biomarkers. Across studies, average attenuation factors for energy were 0.07, 0.07, and 0.19 for a single FFQ, 24HR, and FR, respectively. Correlation coefficients for energy were 0.24, 0.23, and 0.40, respectively. Excluding energy, the average attenuation factors across nutrients and studies were 0.22 for a single FFQ, 0.22 for a single 24HR, and 0.51 for a single FR. Corresponding correlation coefficients were 0.31, 0.34, and 0.53, respectively. For densities (nutrient expressed relative to energy), the average attenuation factors across studies were 0.37, 0.17, and 0.50, respectively. The findings support prior research suggesting different instruments have unique strengths that should be leveraged in epidemiologic research. [ABSTRACT FROM AUTHOR]

Objectives: A cost-efficient approach for assessing working postures could be to build statistical models for predicting results of direct measurements from cheaper data, and apply these models to samples in which only the latter data are available. The present study aimed to build and assess the performance of statistical models predicting inclinometer-assessed trunk and arm posture among paper mill workers. Separate models were built using administrative data, workers' ratings of their exposure, and observations of the work from video recordings as predictors. Methods: Trunk and upper arm postures were measured using inclinometry on 28 paper mill workers during three work shifts each. Simultaneously, the workers were video filmed, and their postures were assessed by observation of the videos afterwards. Workers' ratings of exposure, and administrative data on staff and production during the shifts were also collected. Linear mixed models were fitted for predicting inclinometer-assessed exposure variables (median trunk and upper arm angle, proportion of time with neutral trunk and upper arm posture, and frequency of periods in neutral trunk and upper arm inclination) from administrative data, workers' ratings, and observations, respectively. Performance was evaluated in terms of Akaike information criterion, proportion of variance explained (R²), and standard error (SE) of the model estimate. For models performing well, validity was assessed by bootstrap resampling. Results: Models based on administrative data performed poorly (R² ≤ 15%) and would not be useful for assessing posture in this population. Models using workers' ratings of exposure performed slightly better (8% < R² ≤ 27% for trunk posture; 14% < R² ≤ 36% for arm posture). The best model was obtained when using observational data for predicting frequency of periods with neutral arm inclination. It explained 56% of the variance in the postural exposure, and its SE was 5.6. Bootstrap validation of this model showed similar expected performance in other samples (5th-95th percentile: R² = 45-63%; SE = 5.1-6.2). Conclusions: Observational data had a better ability to predict inclinometer-assessed upper arm exposures than workers' ratings or administrative data. However, observational measurements are typically more expensive to obtain. The results encourage analyses of the cost-efficiency of modeling based on administrative data, workers' ratings, and observation, compared to the performance and cost of measuring exposure directly. [ABSTRACT FROM AUTHOR]

The authors assessed the utility and cost-effectiveness of using a World Wide Web-based questionnaire in a large prospective cohort study, the Black Women's Health Study (BWHS). In 1995, 59,000 African-American women were recruited into the BWHS through a paper questionnaire. Follow-up paper questionnaires have been mailed every 2 years since then. During the 2003, 2005, and 2007 questionnaire cycles, participants were given the option of completing a Web-based questionnaire. The cost of developing and processing a returned paper questionnaire was 4 times that of a returned Web questionnaire, primarily because of return postage costs and greater processing time for paper questionnaires. The proportion of respondents who completed a Web questionnaire doubled from 2003 to 2007, from 10.1% to 19.9%, but the characteristics of those completing the Web questionnaire remained the same. Web response was greatest at younger ages (20.9% of those aged <30 years) and declined with age to 3.6% among women aged 60 years or more. Web questionnaires were filled out more completely than paper questionnaires, regardless of the sensitivity of a question. The use of a Web questionnaire in the BWHS resulted in cost savings and more complete responses. Although there are advantages to using a Web questionnaire, the use of multiple means of soliciting questionnaire responses is still needed. [ABSTRACT FROM PUBLISHER]

Background Value-based healthcare (VBHC) is a conceptual framework to improve the value of healthcare by health, care-process and economic outcomes. Benchmarking should provide useful information to identify best practices and therefore a good instrument to improve quality across healthcare organizations. This paper aims to provide a proof-of-concept of the feasibility of an international VBHC benchmarking in breast cancer, with the ultimate aim of being used to share best practices with a data-driven approach among healthcare organizations from different health systems. Methods In the VOICE community—a European healthcare centre cluster intending to address VBHC from theory to practice—information on patient-reported, clinical-related, care-process-related and economic-related outcomes were collected. Patient archetypes were identified using clustering techniques and an indicator set following a modified Delphi was defined. Benchmarking was performed using regression models controlling for patient archetypes and socio-demographic characteristics. Results Six hundred and ninety patients from six healthcare centres were included. A set of 50 health, care-process and economic indicators was distilled for benchmarking. Statistically significant differences across sites have been found in most health outcomes, half of the care-process indicators, and all economic indicators, allowing for identifying the best and worst performers. Conclusions To the best of our knowledge, this is the first international experience providing evidence to be used with VBHC benchmarking intention. Differences in indicators across healthcare centres should be used to identify best practices and improve healthcare quality following further research. Applied methods might help to move forward with VBHC benchmarking in other medical conditions. [ABSTRACT FROM AUTHOR]

Aims The outbreak of COVID-19 was potentially stressful for everyone and possibly heightened in those having surgery. We sought to explore the impact of the pandemic on recovery from cardiac surgery. Methods and results A prospective observational study of 196 patients who were ≥18years old undergoing cardiac surgery between March 23 and July 4, 2020 (UK lockdown) was conducted. Those too unwell or unable to give consent/complete the questionnaires were excluded. Participants completed (on paper or electronically) the impact of event [Impact of Events Scale-revised (IES-R)] (distress related to COVID-19), depression [Centre for Epidemiological Studies Depression Scale (CES-D)], and EQ-5D-5L [(quality of life, health-related quality of life (HRQoL)] questionnaires at baseline, 1 week after hospital discharge, and 6 weeks, 6 months and 1 year post-surgery. Questionnaire completion was >75.0% at all timepoints, except at 1 week (67.3%). Most participants were male [147 (75.0%)], white British [156 (79.6%)] with an average age 63.4years. No patients had COVID-19. IES-R sand CES-D were above average at baseline (indicating higher levels of anxiety and depression) decreasing over time. HRQoL pre-surgery was high, reducing at 1 week but increasing to almost pre-operative levels at 6 weeks and exceeding pre-operative levels at 6 months and 1 year. IES-R and CES-D scores were consistently higher in women and younger patients with women also having poorer HRQoL up to 1-year after surgery. Conclusions High levels of distress were observed in patients undergoing cardiac surgery during the COVID-19 pandemic with women and younger participants particularly affected. Psychological support pre- and post-operatively in further crises or traumatic times should be considered to aid recovery. Registration Clinicaltrials.gov ID:NCT04366167. [ABSTRACT FROM AUTHOR]

Aims Psychological factors are among the most suspected indicators which may cause atherosclerosis. Coping strategies modifying psychological stress may be significantly associated with health outcomes. However, little is known about the influence of adaptive and maladaptive coping strategies on major adverse cardiovascular disease (CVD) events. The purpose of this study is to examine this idea among a sample of adults. Design: cohort study. Methods and results The Isfahan cohort study (ICS) is a longitudinal population-based, prospective study. Participants (⁠ N = 6323 individuals aged 35 years or greater at baseline) were selected by multistage random sampling with 6-year intervals (i.e. 2001: 6323 individuals, 2007: 3296 individuals, and 2013: 1706 individuals). Adaptive and maladaptive coping strategies were evaluated by a multicomponent self-administered stress management paper-based questionnaire. All CVD events were confirmed by a blinded panel of experts and a marginal cox regression model was used to model the survival data. Adaptive coping strategies could be protective against CVD events with hazard ratios (95% confidence interval) [0.97 (0.95–0.99)] and maladaptive coping strategies seem to be a risk factor, 1.02 (1.01–1.04) in the whole population. Individuals younger than 60 showed similar results, with 0.96 (0.93–0.98) and 1.04 (1.01–1.07) for adaptive and maladaptive coping strategies, respectively. However, these findings were not replicated among seniors older than age 60. Conclusion Based on our results, coping strategies have an important role in cardiovascular events, particularly among young adults. According to the results, informing patients about adaptive stress management may promote primary prevention of CVD events. [ABSTRACT FROM AUTHOR]

Medication use is often underreported in paper-based questionnaires or interviews.Web-based questionnaires may improve recall ofmedication use, but data on their validity are currently lacking. Participants in the Pregnancy and Infant Development (PRIDE) Study (2014-2016; n = 557) and the Pregnancy Drug Registry (pREGnant) (2015-2016; n = 169) completed a 6-week paper-based medication diary during gestational weeks 19-24 or 26-31. In week 34, they completed a Web-based questionnaire with questions on medication names, time period and frequency of use, and quantity taken. To assess the degree of underreporting, we calculated the questionnaire's sensitivity using the medication diary as the reference standard. Sensitivity was high formany medication groups, including antiepilepticmedication (sensitivity (Sn) = 0.96, 95% confidence interval (CI): 0.89, 1.00), antacids (Sn = 0.89, 95% CI: 0.86, 0.93), and iron preparations (Sn = 0.81, 95% CI: 0.64, 0.98). However, medications for short-term use were underreported more frequently, with sensitivities of 0.54 (95% CI: 0.35, 0.72) for antihistamines, 0.63 (95% CI: 0.57, 0.69) for analgesic and antipyretic agents, and 0.57 (95% CI: 0.51, 0.64) for acetaminophen. Shortening the period of time between exposure and questionnaire administration increased sensitivity substantially. In conclusion, underreporting in Web-based questionnaires is limited for many medication groups. In prospective studies, underreporting of medications for short-term usemay be reduced by decreasing the interval between consecutive questionnaires. medication use; pregnancy; Pregnancy Drug Registry (pREGnant); Pregnancy and Infant Development (PRIDE) [ABSTRACT FROM AUTHOR]

A key objective of health promotion capacity building and professional development programmes is to enhance competencies in the workforce or training participants. The goal of this study was to investigate and validate the psychometric properties of a recently developed self-assessment tool, based on 'The CompHP core competencies framework for health promotion', to establish whether it is suitable for evaluating training. The tool was employed in 2018 to evaluate two different programmes, with 584 participants submitting their assessment and evaluation of 77 different health promotion training courses in a paper and pencil questionnaire. Longitudinal data were available for 148 participants in the programme for workplace health promotion because they completed an online questionnaire beforehand. The reliability and validity of the assessment tool were tested in several confirmatory factor analyses and structural equation models. Structurally, there was a significant increase in health promotion competencies when comparing measurements before and after training. Furthermore, participants were shown to have different levels of competencies due to their prior knowledge, the format of the course or the professional development programme attended but not based on gender, age or sector. The results justify the creation of an overall scale to assess core health promotion competencies that are suitable for evaluating training courses. However, various methodological issues need to be considered in future applications including decisions about the design of the study (e.g. pre–post test, control groups), type of measurements (e.g. general and specific instrument, background information) and depth of analysis (e.g. confirmatory model and invariance testing). [ABSTRACT FROM AUTHOR]

Background The aim of this paper is to describe UK-trained doctors' early intentions about seeking careers in public health and their eventual speciality destinations. Methods Analysis of longitudinal studies of medical graduates from all UK medical schools in selected year-of-qualification cohorts from 1974 to 2008; data collected by postal questionnaires at various times after qualifying; and selection, for this paper, of doctors who expressed an early preference for a career in public health and/or who eventually practised in it. Results Of all doctors eventually practising in public health, for whom we had early choices, public health had been the unreserved first choice of 8% (10/125) in their first post-qualification year, 27% (33/122) in their third year and 59% (51/86) in their fifth year. Including first choices for public health ‘tied’ with an equal preference for a different speciality, and doctors' second and third choices for public health, 19% (24/125) of practising public health doctors had considered public health as a possible career in their first post-graduation year, 41% (50/122) in the third and 83% (71/86) in the fifth year. Conclusions Comparisons with other specialities show that doctors in public health chose their speciality relatively late after qualification. [ABSTRACT FROM PUBLISHER]

Higher education traditionally focuses on didactic, or passive, teaching and learning techniques as these are efficient ways of conveying information to the students. However, passive learning places the responsibility for students' learning on the instructor rather than the students themselves. Constructive learning techniques, such as case-based learning (CBL), give students opportunities to apply previous knowledge while constructing their own deep learning. The purpose of this article is to describe both the implementation and evaluation of a CBL unit in a junior-level undergraduate music therapy theories and methods course. The cohort study utilized student reflection papers, faculty observations, class materials, and a student survey to evaluate the impact of a behavioral health-focused CBL unit on information literacy, critical thinking skills, and student enjoyment of learning. Students answered both Likert-type and open-ended questions on these topics. Open-ended questions were analyzed using a directed qualitative content analysis. Students felt that the CBL unit was effective in increasing their information literacy and critical thinking skills, and they enjoyed the unit. According to survey results, the CBL developed several measured areas of student critical thinking skills, with the exception of the students' abilities to analyze their own biases. The CBL unit appeared to be an effective and efficient way of simultaneously covering multiple learning outcomes and music therapy competencies. However, students did not perceive any changes in their ability to analyze their own biases which, based on previous psychology and sociology research, takes more than one isolated learning unit to address. Implications for music therapy education are addressed. [ABSTRACT FROM AUTHOR]

Background Increasing numbers of hepatitis C virus (HCV) infections among men who have sex with men (MSM) are being observed in the Western world. The actual routes of HCV transmission during high-risk sex practices and associated drug use remain poorly understood. Methods Forty-seven patients with HCV were prospectively enrolled. Rectal and nasal swabs were collected to quantify HCV-RNA levels within rectal and nasal fluids. Contamination by occult rectal bleeding was excluded by guaiac paper test. Risk behavior was assessed by standardized questionnaires. Results Median age was 41.9 years, 89% were HIV positive (+) (42/47) and 85% (40/47) were male, 58% (23/40) of whom were MSM. Acute HCV infection was diagnosed in 32% (15/47) ,with all patients being HIV+MSM and 93% (14/15) having a documented history of sexually transmitted disease. Thirty-three (70%) patients had ≥1 HCV+ swab sample (HCV+SS; 48%, 22/46 rectal; 62%, 29/47 nasal), and contamination with blood was excluded in all patients. Individuals with HCV+SS had significantly higher serum HCV-RNA levels than patients with HCV-negative SS (6.28 [IQR, 0.85] log IU/mL vs 4.08 [2.45] log IU/mL; P <.001). Using ROC-curve analysis, serum HCV-RNA cutoffs for ruling in/out any HCV+SS were established at 6.02 log IU/mL and 4.02 log IU/mL, respectively. Conclusions HCV-RNA is commonly detectable in rectal and nasal fluids of both HIV+ and HIV-negative HCV patients with high serum HCV-RNA, independently of the suspected route of HCV transmission. Accordingly, high-risk sex practices and sharing of nasal drug-sniffing "tools" might be important HCV transmission routes, especially in patients with high serum HCV-RNA. [ABSTRACT FROM AUTHOR]

Background The emergence of new types of tobacco and tobacco-related products on the European Union (EU) market has precipitated the possibility for both poly-tobacco use and transitions between products. In the EU, the regulatory environment has shifted with the implementation of the European Tobacco Products Directive (TPD) in May 2016, which may influence consumer transitions between products. Methods The aim of this paper was to examine trends and transitions in tobacco products from 2016 to 2018 -before and after implementation of the TPD in the EU. Data come from Wave 1 (pre-TPD) and Wave 2 (post-TPD) of the EUREST-PLUS ITC Six European Country Survey, a cohort study of adults who at the time of recruitment were smokers from six EU countries- Germany, Greece, Hungary, Poland, Romania, and Spain. D (N = 3195). Bivariate and logistic regression analyses of weighted data was conducted using SAS-callable SUDAAN Results Overall, among those who smoked factory-made cigarettes (FM) only at Wave 1, 4.3% switched to roll-your-own tobacco (RYO) only. Among RYO only users at Wave 1, 17.0% switched to FM only, however compared to all other countries, respondents from Hungary had the highest percentage of FM only users at Wave 1 switch to RYO only at Wave 2 (18.0%). Conclusions The most prominent transition overall was from smoking RYO exclusively at Wave 1 to smoking FM tobacco exclusively at Wave 2, however this varied across countries. As the tobacco control regulatory environment of the EU develops, it is important to continue to monitor transitions between types of products, as well as trends in cessation. [ABSTRACT FROM AUTHOR]

Objective The aims of the study were to identify prognostic factors associated with health care outcomes in patients with musculoskeletal (MSK) conditions in primary care and to determine whether characteristics associated with choice of care modify treatment effects of a direct-access physical therapist–led pathway in addition to general practitioner (GP)–led care compared to GP-led care alone. Methods A secondary analysis of a 2-parallel-arm, cluster randomized controlled trial involving general practices in the United Kingdom was conducted. Practices were randomized to continue offering GP-led care or to also offer a direct-access physical therapist–led pathway. Data from adults with MSK conditions who completed the 6-month follow-up questionnaire were analyzed. Outcomes included physical health, opioid prescription, and self-reported health care utilization over 6 months. Treatment effect modifiers were selected a priori from associations in observational studies. Multivariable regression models identified potential prognostic factors, and interaction analysis tested for potential treatment effect modifiers. Results Analysis of 767 participants indicated that baseline pain self-efficacy, pain severity, and having low back pain statistically predicted outcomes at 6 months. Higher pain self-efficacy scores at baseline were associated with improved physical health scores, reduced opioid prescription, and less health care utilization. Higher bodily pain at baseline and having low back pain were associated with worse physical health scores and increased opioid prescription. Main interaction analyses did not reveal that patients' age, level of education, duration of symptoms, or MSK presentation influenced response to treatment, but visual trends suggested those in the older age group proceeded to fewer opioid prescriptions and utilized less health care when offered direct access to physical therapy. Conclusions Patients with MSK conditions with lower levels of pain self-efficacy, higher pain severity, and presenting with low back pain have less favorable clinical and health care outcomes in primary care. Prespecified characteristics did not modify the treatment effect of the offer of a direct-access physical therapist–led pathway compared to GP-led care. Impact Patients with MSK conditions receiving primary care in the form of direct-access physical therapist–led or GP-led care who have lower levels of self-efficacy, higher pain severity, and low back pain are likely to have a less favorable prognosis. Age and duration of symptoms should be explored as potential patient characteristics that modify the treatment response to a direct-access physical therapist–led model of care. [ABSTRACT FROM AUTHOR]

The paper explores the views of social work practitioners regarding their ability to explore the emotional content of their practice in formalandin formal forums. The responses from a questionnaire- and interview-based study of a Scottish local authority reveal that supervision is subject to issues of ‘safety', permissions, manageria list approaches and individual relationships. Informal support from peers was valued due to its unrecorded, on-demand and supportive nature. The findings have implications for seeking improvements in supervision as suggested by the Social Work Task Force,and for securing of the validity and place of emotions in practice. [ABSTRACT FROM AUTHOR]

Introduction: Postpartum depression (PPD) is a common perinatal complication. Risk factors previously found to correlate with PPD in civilians include prenatal depression, childcare stress, limited social support, difficult infant temperament, and maternity blues. Previously identified risk factors in military spouses include spouse deployment/redeployment cycles. It is unclear if these previously identified risk factors are also a risk factor for AD women or if the additional stressors associated with being on active duty (AD) are risk factors for PPD. The purpose of this review is to determine if civilian risk factors have been found to put AD women at risk for PPD and to identify unique risk factors for PPD in AD women.Materials and Methods: A scoping literature review was performed using PubMed, Defense Technical Information Center, and PsychINFO. The searches were conducted using relevant medical subject headings and keywords. The inclusion criteria included articles published since 1948 (the year women were legally allowed to join the military) that reference risk factors for postpartum/peripartum depression in AD women serving in the U.S. military. The following exclusion criteria were also applied: in a language other than English, opinion papers, and/or not published in a peer-reviewed journal. Articles meeting criteria were evaluated and mapped to stressors previously identified in the literature for civilian and military spouses with PPD with novel stressors identified as mapping outside this framework.Results: Only two articles met the inclusion criteria. The first study included 87 AD women. The second study, a cohort study between 2001 and 2008, included 1660 AD women. Unique risk factors identified in AD women include previous deployments, serving in the Army, smoking status, alcohol use, and low self-esteem.Conclusions: Few studies have investigated the risk factors for PPD in AD women. It appears that AD women share many risk factors, or variants of those risk factors, for PPD as their civilian and AD spouse counterparts, but there are also unique risks to consider. More work is needed to improve screening and prevention efforts. [ABSTRACT FROM AUTHOR]

While the availability of mental health promotion and prevention programs worldwide is growing, there is divergence in their level of effectiveness that has led to increasing interest in the development of 'effect management' strategies. Mental health promotion and prevention science and practice has a relatively young history in Croatia, but major investments towards its development have been made over the last decade. This paper reports on a research project that took place within the Istrian Region. The long-term goal of the initiative is to establish quality assurance indicators for mental health promotion and prevention interventions. The current study involved adapting the Dutch Preffi 2.0 instrument for use in Croatia. The content of the Preffi reflects the literature regarding research-based effect predictors. An instrument allows users to assess whether programs have been designed and implemented in ways that maximize their ability to be effective. The Preffi scores can be used for improving a program and the quality with which it is implemented. The first aim of the study is to determine if independent researchers can use the Preffi reliably as a quality assessment instrument. The second aim is to use the Preffi to describe the quality of one cohort of mental health promotion and prevention programs. The study represents the first steps toward developing a strategy for quality assurance that strengthens community capacity for effective service delivery and that could inform other countries whose mental health promotion and prevention efforts are in early stages of development. [ABSTRACT FROM AUTHOR]

This paper draws on an international comparative study of social work decision making in cases that are on the edge of care order proceedings, involving child protection workers from Finland, Norway, England and the USA (California). It focuses on workers' responses in an online questionnaire to questions about the use of independent experts to inform their decisions about whether or not to take a case to court. All the countries try to avoid taking cases to court if possible, but the ways they do this vary considerably. The findings show the different meanings and implications that the request for an independent assessment has in the different systems. Workers' views reflect the roles and tasks that independent experts have in the different countries; and these in turn reflect their distinctive child protection systems and wider child welfare approaches. The paper offers a starting point for reflection about one's own system, and suggests that the well-known distinction between family support and child protection models should not be seen as a simple binary categorisation, but rather as a complex, contingent and contested continuum. [ABSTRACT FROM AUTHOR]

This paper reports the findings from the first UK study to examine the use of mobile phones by looked after children. Contact with family and friends is important, but it has sometimes to be carefully managed to avoid unintended consequences such as placement instability. The study examined the ways in which mobile phone technology impacts on contact, drawing on the experiences of children and young people in foster-care and residential care, and of policy makers, social workers, foster parents and residential care staff. No guidance was available that addressed the issue of mobile phone contact arrangements for looked after children and young people. Three years on from the start of the study, this remains the case in the area where the study was conducted, resulting in variation in the way mobile phone use for contact is managed; the issue appears only to be specifically addressed when identified as a problem. The position of mobile phone facilitated contact as a recognised form of contact requires review. The evidence suggests it should routinely form part of children's care plans, and that residential staff and foster parents need to be adequately prepared and supported for the dynamics of mobile phone facilitated contact. [ABSTRACT FROM AUTHOR]

Previous research has consistently found that transgender women experience high levels of domestic violence and abuse (DVA). Yet, to date, no studies have explored the efficacy of training workshops aimed at increasing the capacity of service providers to meet the needs of transgender women. This paper reports on findings from one such workshop developed and run in South Australia. Workshop participants (n = 25) from three domestic violence services completed both pre- and post-workshop measures of attitudes towards working with transgender women, comfort in working with transgender women and confidence in providing services to transgender women. In addition, participants responded to open-ended questions regarding terminology, and awareness of referrals related to the link between DVA and animal abuse. Statistically significant changes were identified on all measures, with workshop attendees reporting more positive attitudes, greater comfort and greater confidence after completing the workshop. Analysis of open-ended responses found that attendees developed a better understanding of both appropriate terminology, and referrals for women who present to services with animal companions. We conclude with suggestions for how programmes and services may become more welcoming and inclusive of transgender women experiencing DVA. [ABSTRACT FROM AUTHOR]

Two frequently encountered but underrecognized challenges for causal inference in studying the long-term health effects of disasters among survivors include 1) time-varying effects of disasters on a time-to-event outcome and 2) selection bias due to selective attrition. In this paper, we review approaches for overcoming these challenges and demonstrate application of the approaches to a real-world longitudinal data set of older adults who were directly affected by the 2011 Great East Japan Earthquake and Tsunami (n  = 4,857). To illustrate the problem of time-varying effects of disasters, we examined the association between degree of damage due to the tsunami and all-cause mortality. We compared results from Cox regression analysis assuming proportional hazards with those derived using adjusted parametric survival curves allowing for time-varying hazard ratios. To illustrate the problem of selection bias, we examined the association between proximity to the coast (a proxy for housing damage from the tsunami) and depressive symptoms. We corrected for selection bias due to attrition in the 2 postdisaster follow-up surveys (conducted in 2013 and 2016) using multivariable adjustment, inverse probability of censoring weighting, and survivor average causal effect estimation. Our results demonstrate that analytical approaches which ignore time-varying effects on mortality and selection bias due to selective attrition may underestimate the long-term health effects of disasters. [ABSTRACT FROM AUTHOR]

Objective The objective of this study was to evaluate whether early postpartum exercise is associated with changes in pelvic symptom severity, pelvic floor muscle strength, and diastasis recti abdominis (DRA) from 3 to 12 months postpartum. Methods In this prospective cohort study, 504 participants with and without pelvic symptoms (pelvic girdle pain, stress urinary incontinence, vaginal heaviness) were followed. At 3, 6, 9, and 12 months postpartum, we assessed pelvic symptoms, exercise behavior (by questionnaires), pelvic floor muscle strength (by vaginal palpation), and DRA (by caliper measurement). Based on the 3-months questionnaire, participants were categorized as nonexercisers (n  = 105), minimal low-impact exercisers (n  = 249), regular low-impact exercisers (n  = 117), and high-impact exercisers (n  = 32). Between-group differences and within-group changes from 3 to 12 months were calculated using Chi-square tests, Kruskal–Wallis tests, and Friedman analysis of variance. Results At 3 months, no differences in symptom prevalence were seen between the groups. Nonexercisers reported higher pelvic girdle pain severity and had weaker pelvic floor muscles. The within-group analysis showed that pelvic girdle pain severity did not change in nonexercisers or high-impact exercisers, but decreased in minimal and regular low-impact exercisers. Stress urinary incontinence increased in nonexercisers from 3 to 12 months, while it remained unchanged in regular low-impact and high-impact exercisers, and decreased in minimal low-impact exercisers. Across all groups, vaginal heaviness and DRA decreased, and pelvic floor strength increased from 3 to 12 months. Conclusion The study indicates that early low-impact exercising is associated with reduced pelvic girdle pain severity during the first postpartum year. Minimal low-impact exercisers also showed a slight reduction in stress urinary incontinence. Conversely, nonexercisers reported an increase in stress urinary incontinence between 3 and 12 months postpartum. Impact Physical therapists should encourage women to start with low-impact exercise early after pregnancy. Lay Summary This study highlights the positive effects of starting gentle, low-impact exercise early after childbirth to reduce pelvic girdle pain and urinary incontinence. [ABSTRACT FROM AUTHOR]

Background: Gambling products differ in terms of their harm potential. Products are also constantly developing and changing. However, little research has addressed changes and trends in the types of gambling that are associated with harms. The current study explores trends in the gambling product categories identified as harmful in longitudinal helpline data from three Nordic countries. Methods: We use data collected by national helplines in Denmark (StopSpillet), Finland (Peluuri) and Sweden (Stödlinjen) in their daily operations (N = 46 646). The data consist of information collected on gamblers and concerned significant others who have contacted these helplines between January 2019 and December 2022. We analyse which gambling products are mentioned as harmful by clients. The analysis uses linear regression with the interaction term (country) times time regressed over the outcome variable (proportion per month). Results: The results show that an increased share of contacts concern online gambling. Online casino products have become the most harmful category across contexts. The share of reported harms from online betting and new emerging online forms is also increasing. The share of land-based products as a reported source of harms has decreased across 2019-22. Conclusions: The results suggest that online gamlbing environments, and particularly online casino products, are associated with increasing harms to help-seekers. The harmfulness of different gambling products may not be stable, but change over time. Further harm prevention efforts are needed to address the online gambling field, including emerging formats. [ABSTRACT FROM AUTHOR]

Background: In 2005, the UK Department of Health recommended that a new role, the arrhythmia care coordinator (ACC), be created to guide patients through the diagnosis and treatment for arrhythmia. The belief was that this would improve the efficiency of care and improve their quality of life. The British Heart Foundation provided funding for 32 such posts, all of which were filled by arrhythmia specialist nurses, and commissioned an evaluation of the new service to assess its impact on patients. Aims: This paper focuses on the impact of the ACCs on their patients’ levels of anxiety and depression, hospital readmissions and costs to the National Health Service (NHS). Methods: From 2008 to 2010, using questionnaires, we conducted a longitudinal audit of the psychological status of the patients referred to the ACCs; we also assessed the ACCs’ impact on readmissions and cost benefits to the NHS using UK Hospital Episode Statistics. Results: We found high levels of anxiety and depression amongst patients. Nearly one-third were at the ‘borderline’ or ‘clinically anxious’ and 18% were at the ‘borderline’ or ‘clinically depressed’ level at their first assessment with small changes at follow-up. In arrhythmia specialist nurse sites, readmission rates were reduced by half. After deducting the cost of the ACCs and their support, the estimated annual saving was £29,357 per ACC. Conclusion: This evaluation has shown that the NHS saves £29,357 per year over and above the costs of employing a British Heart Foundation ACC and that all arrhythmia centres should be encouraged to employ an appropriate number of such specialists. [ABSTRACT FROM AUTHOR]

In the disaster literature, psycho-social recovery is conceptualised typically as the alleviation of traumatic stress, with the alleviation of disaster-related grief as a less prominent part of this. Yet, incorporating grief understandings into recovery conceptualisations post disaster is important. This paper explores these conceptualisations by analysing participants' bereavement experiences following the Black Saturday bushfires. It draws on data from Beyond Bushfires, a mixed-methods study (n = 1,016) in which survey and interview data relating to individual loss and recovery experiences were examined. The loss through death of friends and community members was found to be predictive of poorer mental health outcomes, although prolonged grief outcomes were rare. The sense of relationships as being 'like family' was identified by interviewees as an important dimension of their particular communities, as was coping with multiple deaths and the hierarchy of grief that emerged, and the stress of notifying others of these deaths. The implications of these impacts are considered for social work research and practice. [ABSTRACT FROM AUTHOR]

Background Following hip fracture surgery, patients from residential care are frequently excluded from inpatient rehabilitation. We aimed to assess the impact of place of residence and other factors such as frailty on rehabilitation outcomes after hip fracture surgery. Methods Retrospective cohort study. Outcome measures included Functional Independence Measure efficiency, discharge destination and recovery of pre-fracture mobility. Univariable and multivariable linear or logistic regression analyses were performed. Setting One general rehabilitation and two geriatric evaluation and management wards in a large public tertiary teaching hospital. Participants A total of 844 patients who underwent inpatient rehabilitation after hip fracture surgery from 2010 to 2018. Results There were 139 (16%) patients from residential care. Being from residential care was not an independent predictor of poor outcomes. Premorbid frailty (Clinical Frailty Scale) was the strongest independent predictor of poorer Functional Independence Measure efficiency, inability to recover pre-fracture mobility and return to community dwelling. Dementia and delirium were also independently predictive of poor outcomes across all measures. Age > 90 years was independently predictive of inability to recover pre-fracture mobility and return to community dwelling. Conclusion Being from residential care is not independently associated with poor outcomes following inpatient rehabilitation after hip fracture surgery and should not be the basis for excluding these patients from rehabilitation. Major predictors of poorer outcomes include premorbid frailty, dementia, delirium and age > 90 years. If able and motivated, those with potentially reversible functional limitations should be given the opportunity to participate in inpatient rehabilitation as even small gains can have a significant impact on quality of life. [ABSTRACT FROM AUTHOR]

Online health behaviour interventions have great potential but their effectiveness may be hindered by a lack of formative and theoretical work. This paper describes the process of formative research to develop theoretically and empirically based health messages that are culturally relevant and can be used in an online intervention to promote healthy lifestyle behaviours among new university students. Drawing on the Theory of Planned Behaviour, a three-phase programme of formative research was conducted with prospective and current undergraduate students to identify (i) modal salient beliefs (the most commonly held beliefs) about fruit and vegetable intake, physical activity, binge drinking and smoking, (ii) which beliefs predicted intentions/behaviour and (iii) reasons underlying each of the beliefs that could be targeted in health messages. Phase 1, conducted with 96 pre-university college students, elicited 56 beliefs about the behaviours. Phase 2, conducted with 3026 incoming university students, identified 32 of these beliefs that predicted intentions/behaviour. Phase 3, conducted with 627 current university students, elicited 102 reasons underlying the 32 beliefs to be used to construct health messages to bolster or challenge these beliefs. The three-phase programme of formative research provides researchers with an example of how to develop health messages with a strong theoretical- and empirical base for use in health behaviour change interventions. [ABSTRACT FROM AUTHOR]

This paper investigates associations between hazardous jobs, mental health and wellbeing among Thai adults. In 2005, 87 134 distance-learning students from Sukhothai Thammathirat Open University completed a self-administered questionnaire; at the 2009 follow-up 60 569 again participated. Job characteristics were reported in 2005, psychological distress and life satisfaction were reported in both 2005 and 2009. We derived two composite variables grading psychologically and physically hazardous jobs and reported adjusted odds ratios (AOR) from multivariate logistic regressions. Analyses focused on cohort members in paid work: the total was 62 332 at 2005 baseline and 41 671 at 2009 follow-up. Crosssectional AORs linking psychologically hazardous jobs to psychological distress ranged from 1.52 (one hazard) to 4.48 (four hazards) for males and a corresponding 1.34-3.76 for females. Similarly AORs for physically hazardous jobs were 1.75 (one hazard) to 2.76 (four or more hazards) for males and 1.70-3.19 for females. A similar magnitude of associations was found between psychologically adverse jobs and low life satisfaction (AORs of 1.34-4.34 among males and 1.18-3.63 among females). Longitudinal analyses confirm these cross-sectional relationships. Thus, significant dose– response associations were found linking hazardous job exposures in 2005 to mental health and wellbeing in 2009. The health impacts of psychologically and physically hazardous jobs in developed, Western countries are equally evident in transitioning Southeast Asian countries such as Thailand. Regulation and monitoring of work conditions will become increasingly important to the health and wellbeing of the Thai workforce. [ABSTRACT FROM AUTHOR]

Social workers employed within statutory settings in countries such as the UK are subject to legal and policy requirements to communicate directly and effectively with children and young people. Qualifying social work education is expected to prepare students so that they can practice competently. However, in England at least, practice and education are both falling short. While active attention is now being given to ways of facilitating improvements in practice, almost nothing is known about how qualifying courses might best promote student learning. This paper reports some of the findings from a UK-based empirical study into factors and processes which support students in developing the self-efficacy and 'applied understanding' they need to undertake effective direct work with children. A superficial focus on the 'doing' of communication (techniques and skills) appears to be inadequate: courses must additionally provide a range of experiential, participatory, didactic and critically reflective learning opportunities which can enable deep learning of the underpinning knowledges, ethical commitments and personal qualities also needed. A model is presented of an integrated and coherent learning sequence which could be used by programmes to ensure students develop the necessary generic, child-centred and 'applied child-specialist' capabilities in communication with children. [ABSTRACT FROM AUTHOR]

Background Evidence regarding the potential effect of fruit and vegetable consumption on cardiovascular diseases (CVD) was limited and inconsistent among Asian people. Methods We prospectively examined associations of fruit and vegetable consumption with the risk of CVD among 9740 participants aged 65 years and older (mean baseline age: 88 years) in the Chinese Longitudinal Healthy Longevity Survey (CLHLS) (2008–2018). Dietary data were collected using a validated food frequency questionnaire. Results During 37 366 person-years of follow-up, a total of 3738 CVD cases were recorded. After adjusting for demographics, dietary, lifestyle and economical social factors, higher intakes of total fruits and vegetables were associated with lower risk of CVD [comparing with extreme quintiles, hazard ratio and 95% confidence interval: 0.84 (0.74, 0.95)]. The inverse association was mainly driven by vegetable consumption [0.86 (0.77, 0.95)]. Furthermore, the inverse association was stronger for the risk of hypertension [0.84 (0.72, 0.98)]. These associations were consistent across age, sex, body mass index, residence, exercise status, smoking, drinking, meat intake, modified hPDI and health status. Conclusions This study suggests higher intakes of total fruits and vegetables are associated with a lower risk of CVD among elderly Chinese people, supporting the current recommendations of increasing fruit and vegetable consumption as part of a healthy diet for the prevention of CVD. [ABSTRACT FROM AUTHOR]

This paper compares the key findings from the first piece of research in the UK to focus exclusively on ‘stress, support and well-being of social work students’ (n = 76), with findings from a cohort of Indian social work students studying in the Tamil Nadu region in Southern India (n = 235), using the same questionnaire. This comparative international study highlights a range of differences in the key outcome variables, namely British students reported significantly higher levels of demands and significantly lower levels of support than their Indian counterparts; however, despite the lower levels of demands and higher levels of support reported by Indian students, they had significantly poorer well-being than their British counterparts. In the Indian study, there were no significant correlations between the main outcome variables of demands, support and well-being; however, in the British study, support was negatively correlated with well-being (measured using the GHQ-12), indicating that those who reported higher levels of support also reported better well-being. This study draws particular attention to the potentially differing contexts of ‘support’ amongst both groups, and raises questions concerning the challenges of using questionnaires to capture culturally specific stressors and support mechanisms. [ABSTRACT FROM PUBLISHER]

The Westminster government in the UK remains keen to promote the use of personal budgets (PBs) in social care, as it believes these confer choice, empower the budget holder, and lead to greater levels of personalisation and better outcomes. This paper considers the costs and benefits of PBs—to local authority Social Services Departments, and to people using PBs, respectively—in a single English local authority setting. A comparative design was used to collect data from a large sample of ‘traditional’ social services users and a cohort of people who were using PBs as Direct Payments. Benefits relative to costs were compared using a statistical technique known as ‘bootstrapping’. The authors found that, compared to younger adults, older people did not greatly benefit from possessing a budget on the outcome measures used, but costs were higher for budget holders across all care groups. These findings support evidence from an earlier study (Glendinning et al., 2008) and raise important questions about the suitability of PBs as a means of achieving personalised services for older people and the implications for social work practice. [ABSTRACT FROM AUTHOR]

Relationships between some risk factors and breast cancer incidence are known to vary by tumor subtype. However, breast tumors can be classified according to a number of markers, which may be correlated, making it difficult to identify heterogeneity of risk factors with specific tumor markers when using standard competing-risk survival analysis. In this paper, we propose a constrained competing-risk survival model that allows for assessment of heterogeneity of risk factor associations according to specific tumor markers while controlling for other markers. These methods are applied to Nurses’ Health Study data from 1980–2006, during which 3,398 incident invasive breast cancers occurred over 1.4 million person-years of follow-up. Results suggested that when estrogen receptor (ER) and progesterone receptor (PR) status are mutually considered, some risk factors thought to be characteristic of “estrogen-positive tumors,” such as high body mass index during postmenopause and increased height, are actually significantly associated with PR-positive tumors but not ER-positive tumors, while other risk factors thought to be characteristic of “estrogen-negative tumors,” such as late age at first birth, are actually significantly associated with PR-negative rather than ER-negative breast cancer. This approach provides a strategy for evaluating heterogeneity of risk factor associations by tumor marker levels while controlling for additional tumor markers. [ABSTRACT FROM PUBLISHER]

Intervention programs aimed at preventing tobacco use among youth have been shown to be effective in curbing tobacco use onset and progression. However, the effects of even very successful tobacco prevention programs may not always impress policy-makers and lay audiences. Economic analysis potentially strengthens the case. In this paper, we evaluate the cost-effectiveness of a youth tobacco use prevention program which has been translated and implemented in India, a developing country. Although programs like these are inexpensive to implement in the USA, they are even less expensive in India due to low labor costs. Our results show that the costs per quality-adjusted life-year added, due to averted smoking, was $2057, even without including averted medical costs. If we ignore student time, cost-effectiveness improves by roughly 10%. To put the cost-effectiveness of this smoking prevention program into context, it is over 24 times more cost-effective than dialysis in the USA, which costs $50 000 for a life-year. [ABSTRACT FROM PUBLISHER]

Objective To describe adverse event reporting processes in long-term care facilities in the Czech Republic. Design Prospective cohort study involving a written questionnaire followed by in-person structured interviews with selected respondents. Setting Long-term care facilities located in the Czech Republic. Participants Staff of 111 long-term care facilities (87% of long-term care facilities in the Czech Republic). Intervention(s) None. Results Sixty-three percent of long-term health-care facilities in the Czech Republic have adverse event-reporting processes already established, but these were frequently very immature programs sometimes consisting only of paper recording of incidents. Compared to questionnaire responses, in-person interview responses only partially tended to confirm the results of the written survey. Twenty-one facilities (33%) had at most 1 unconfirmed response, 31 facilities (49%) had 2 or 3 unconfirmed responses and the remaining 11 facilities (17%) had 4 or more unconfirmed responses. Conclusions In-person interviews suggest that use of a written questionnaire to assess the adverse event-reporting process may have limited validity. Staff of the facilities we studied expressed an understanding of the importance of adverse event reporting and prevention, but interviews also suggested a lack of knowledge necessary for establishing a good institutional reporting system in long-term care. [ABSTRACT FROM PUBLISHER]

Our objective was to assess how exposure to secondhand tobacco smoke occurs in Hungarian homes, particularly among non-smokers, and to examine the effectiveness of home smoking bans in eliminating exposure to secondhand smoke at home. In 2009, 2286 non-smokers and smokers aged 16–70 years, who were selected randomly from a nationally representative sample of 48 Hungarian settlements, completed paper-and-pencil self-administered questionnaires addressing tobacco-related attitudes, opinions and behaviors. Chi-square tests, one-way analysis of variance and multivariate logistic regression models were used to assess the effect of demographics, socio-economic characteristics and home smoking policies on the risk of exposure to secondhand tobacco smoke at home. Significantly higher risk of exposure was found among younger, lower educated and poorer people and among those having no or partial home smoking restrictions. There was a significant interaction between education level and home smoking policies: the effect of a smoking ban on exposure to secondhand tobacco smoke was stronger for the lower educated group than the higher educated group. The results suggest that Hungarians are making good progress in implementing home smoking bans, and that in the majority of population these bans are working. More can be done to promote the uptake of home smoking bans among poorer and less educated subpopulations. [ABSTRACT FROM PUBLISHER]

Introduction. It has been noted that only 14% of all clinical trials are translated into practice. The objective of this paper is to promote translation of an efficacious rehabilitative exercise program for breast cancer survivors by clarifying for clinicians the safety profile of participants (e.g., rates of musculoskeletal injury and referral to medical professionals), and to use this evidence to make recommendations on the appropriate training of health and fitness staff who would be capable of safely, effectively, and sustainably delivering the program. Methods. Breast cancer survivors with and at risk for lymphedema were randomized to twice-weekly weightlifting or standard care for 1 year. An injury survey and health care evaluation were administered after 1 year and in 3-month intervals, respectively. Results. The cumulative incidence and rate of injury were higher in the weightlifting than in the control group. The injury rates were 2.3 and 0.3 per 1,000 bouts of weightlifting among breast cancer survivors with and at risk for lymphedema, respectively. Among breast cancer survivors with or at risk for lymphedema, 20.9% in the weightlifting group had an encounter with a health care provider that required cessation or dose modification of weightlifting. Conclusion. Despite the demonstrated efficacy of weightlifting, musculoskeletal injuries and other health problems did occur. Therefore, for the successful translation of this rehabilitative intervention into clinical practice, health and fitness professionals working with breast cancer survivors need the knowledge, skills, and abilities that clarify their scope of practice to address these health care needs. [ABSTRACT FROM AUTHOR]

Background. To date, there has been no attempt to describe or compare physical therapy as practiced globally, nor any evidence that an international data set exists to support this effort. It is known that research evidence can be used in strategic and tactical ways, especially within the highly politicized context of the policy arena. The International Private Practitioners Association recognized the potential value a global evidence base could have in influencing policy and supporting professional development in a number of countries, yet it lacked a mechanism to achieve these aims. Objectives. The purposes of this study were: (1) to identify and test an international data set, definitions, and means of data collection and (2) to establish views in relation to the value of international collaborations. Design. A mixed, prospective design was used in the study. Method. Phase 1 (2006-2007) involved the development of a data set, definitions, and Web-based and paper-based data collection options involving 98 physical therapists from 68 physical therapy practices in 7 countries. Phase 2 (2008-2009) involved testing of the data set in 34 practices involving 3,195 patient episodes and included physical therapist feedback of experience, local relevance of the data set, and value of international collaborations. Results. Testing confirmed the relevance and reliability of the data set and definitions and a preference for Web-based data collection (74.0%). Physical therapist feedback supported these findings. Most respondents (60.0%-100.0%) reported the value of further international collaborations for their profession nationally or internationally. Limitations. Although a true international collaboration, the limited sample size should be recognized. Conclusions. It is possible to develop an agreed-upon international data set and means of data collection. Testing appears to support its acceptability and relevance for use in practice. Participants highly valued the opportunity to undertake international collaborations that may benefit their profession nationally and internationally. Further testing and use of the data set are advocated before final validation is sought. [ABSTRACT FROM AUTHOR]

Objective. This paper examined whether or not closer proximity to local services and amenities was associated with maintenance of more frequent walking over time among urban-dwelling seniors over and above individual-level characteristics. Method. A sample of 521 adults who were part of the VoisiNuAge study and who resided in a large North American urban area reported on the frequency of walking outside the home over a 3-year period and on their health, sociodemographic characteristics, social support and resources, and perceptions of different features of their residential environment. Information about the distance between their home and 16 services and amenities was obtained from a geographic information system. Seniors were then classified into quartiles of proximity (Q1, Q2, Q3, Q4). Results. Unadjusted and adjusted ordinal growth curve models showed that closer proximity to services and amenities was associated with greater likelihood of frequent walking at all times throughout the 3-year period. Discussion. Findings are consistent with the notion that environments may act as buoys for the maintenance of important health behaviors. Future experimental and quasi-experimental research is required to explore whether or not the environment can play a causal role in influencing patterns of walking over time. [ABSTRACT FROM PUBLISHER]

To date, Web-based 24-hour recalls have not been validated using objective biomarkers. From 2006 to 2009, the validity of 6 Web-based DietDay 24-hour recalls was tested among 115 black and 118 white healthy adults from Los Angeles, California, by using the doubly labeled water method, and the results were compared with the results of the Diet History Questionnaire, a food frequency questionnaire developed by the National Cancer Institute. The authors performed repeated measurements in a subset of 53 subjects approximately 6 months later to estimate the stability of the doubly labeled water measurement. The attenuation factors for the DietDay recall were 0.30 for blacks and 0.26 for whites. For the Diet History Questionnaire, the attenuation factors were 0.15 and 0.17 for blacks and whites, respectively. Adjusted correlations between true energy intake and the recalls were 0.50 and 0.47 for blacks and whites, respectively, for the DietDay recall. For the Diet History Questionnaire, they were 0.34 and 0.36 for blacks and whites, respectively. The rate of underreporting of more than 30% of calories was lower with the recalls than with the questionnaire (25% and 41% vs. 34% and 52% for blacks and whites, respectively). These findings suggest that Web-based DietDay dietary recalls offer an inexpensive and widely accessible dietary assessment alternative, the validity of which is equally strong among black and white adults. The validity of the Web-administered recall was superior to that of the paper food frequency questionnaire. [ABSTRACT FROM PUBLISHER]

Background. We recently reported that cancer-related fatigue (CRF) after adjuvant breast cancer therapy was prevalent and disabling, but largely self-limiting within 12 months. The current paper describes sexual functioning (SF) and its relationship to CRF, mood disorder, and quality of life (QOL) over the first year after completion of adjuvant therapy. Methods. Women were recruited after surgery, but prior to commencing adjuvant treatment, for early-stage breast cancer. Self-reported validated questionnaires assessed SF, CRF, mood, menopausal symptoms, disability, and QOL at baseline, completion of therapy, and at 6 months and 12 months after treatment. Results. Of the 218 participants, 92 (42%) completed the SF measure (mean age, 50 years). They were significantly younger, more likely to be partnered, and less likely to be postmenopausal than non-responders. At baseline, 40% reported problems with sexual interest and 60% reported problems with physical sexual function. SF scores declined across all domains at the end of treatment, then improved but remained below baseline at 12 months, with a significant temporal effect in the physical SF subscale and a trend for overall satisfaction. There were significant correlations between the SF and QOL domains (physical and emotional health, social functioning, and general health) as well as overall QOL. The presence of mood disorder, but not fatigue, demographic, or treatment variables, independently predicted worse overall sexual satisfaction. Conclusions. Sexual dysfunction is common after breast cancer therapy and impacts QOL. Interventions should include identification and treatment of concomitant mood disorder. [ABSTRACT FROM AUTHOR]

Evaluating the effectiveness of social work education has become a topic of major interest in the UK in the wake of a succession of child-care tragedies that have undermined confidence in the profession. However, many key aspects of social work education remain under-researched and/or contested and our knowledge of how students acquire and develop professional expertise remains limited. This paper reports on the first part of a longitudinal study aimed at developing evidence-based knowledge in this area by considering student perceptions at different stages of their social work education at Queen's University Belfast. Focusing on the strengths and limitations of preparatory teaching, and their first experience of practice learning, this article considers the impact of demographic factors, including age, gender and experience, on how students experience the learning process. The findings indicate a significant level of disjunction between academic and practice learning and suggest that better integration between these two domains of learning is needed if social work students are to be more effectively prepared for the challenges they are likely to encounter in practice. [ABSTRACT FROM PUBLISHER]

Background The objective of this study was to examine the association between physical activity during childhood and adolescence and the risk of all-cause mortality in midlife. We analyzed data from a birth cohort (The 1958 National Child Development Survey), including births in England, Wales and Scotland. Methods Physical activity was assessed using questionnaires at ages 7, 11 and 16. Death certificates defined all-cause mortality. Cumulative exposure, sensitive and critical periods, and physical activity trajectory from childhood to adolescence were tested using multivariate Cox proportional hazard models. The sweep the death was confirmed was defined as the time event. Results From age 23 to 55, 8.9% of participants (n  = 9398) died. Physical activity in childhood and adolescence affected the risk of all-cause mortality in midlife. In men, physical activity at ages 11 [hazard ratio (HR): 0.77; 95% confidence interval (CI): 0.60–0.98] and 16 (HR: 0.60; 95% CI: 0.46–0.78) was associated with reduced risk of all-cause mortality. In women, physical activity at age 16 (HR: 0.68; 95% CI: 0.48–0.95) was associated with reduced risk of all-cause mortality. Physical activity in adolescence eliminated the risk of all-cause mortality associated with physical inactivity in adulthood in women. Conclusions Physical activity during childhood and adolescence was associated with reduced risk of all-cause mortality with different effects by sex. [ABSTRACT FROM AUTHOR]

The aim of this study was to update and validate the Pregnancy Physical Activity Questionnaire (PPAQ), using novel and innovative accelerometer and wearable camera measures in a free-living setting, to improve the measurement performance of this method for self-reporting physical activity. A prospective cohort of 50 eligible pregnant women were enrolled in early pregnancy (mean = 14.9 weeks' gestation). In early, middle, and late pregnancy, participants completed the updated PPAQ and, for 7 days, wore an accelerometer (GT3X-BT; ActiGraph, Pensacola, Florida) on the nondominant wrist and a wearable camera (Autographer; OMG Life (defunct)). At the end of the 7-day period, participants repeated the PPAQ. Spearman correlations between the PPAQ and accelerometer data ranged from 0.37 to 0.44 for total activity, 0.17 to 0.53 for moderate- to vigorous-intensity activity, 0.19 to 0.42 for light-intensity activity, and 0.23 to 0.45 for sedentary behavior. Spearman correlations between the PPAQ and wearable camera data ranged from 0.52 to 0.70 for sports/exercise and from 0.26 to 0.30 for transportation activity. Reproducibility scores ranged from 0.70 to 0.92 for moderate- to vigorous-intensity activity and from 0.79 to 0.91 for sports/exercise, and were comparable across other domains of physical activity. The PPAQ is a reliable instrument and a valid measure of a broad range of physical activities during pregnancy. [ABSTRACT FROM AUTHOR]

Multi-site research studies redefine cohort studies by simultaneously providing a cross-sectional snapshot of patients and monitoring them over time, to evaluate outcomes. However, careful design is crucial to minimize potential biases, such as seasonal variations, that may arise during the study period. Addressing snapshot study challenges requires strategic solutions: implementing multi-stage sampling for representativeness, providing rigorous data collection training, using translation techniques and content validation for cultural and linguistic appropriateness, streamlining ethical approval processes, and applying comprehensive data management for follow-up and missing data. These strategies can optimize the efficacy and ethicality of snapshot studies. [ABSTRACT FROM AUTHOR]

Mental health literacy (MHL) is a determinant of psychological well-being in young people. A randomized controlled design was used to evaluate the appreciation and effectiveness of an interactive video on French University students' MHL (knowledge about depression and suicidal behavior, mental health help-seeking behaviors, stigma and misconceptions about mental health). At the baseline, all participants (n = 101) completed a questionnaire including several scales on MHL. One month after, participants were randomly assigned to two homogeneous groups (intervention, n = 50 or control, n = 51) and again completed the questionnaire on MHL. Through a mixed-methods approach, semi-structured interviews were also conducted with the intervention group to collect information on the appreciation of the interactive video. Quantitative data indicated that MHL scores increased or remained stable in the intervention group. Comparison with the control group and multivariate logistic regression models did not show statistically significant differences, due to the small sample of the study. According to qualitative data, users appreciated the content and the format of the intervention. It was suggested that the video could be disseminated in other University campuses in France and internationally to promote MHL among students. [ABSTRACT FROM AUTHOR]

Background Even though dietary sugars are the most important nutrient for caries development, the disease process is dependent on other dietary practices. The intake of individual nutrient components cannot be evaluated separately from the overall diet which includes other nutrients, foods and habits. Therefore, the aim of this study was to investigate the association between adherence to dietary guidelines and dental caries. Methods This study was embedded in the Generation R Study, conducted in Rotterdam, the Netherlands. In total, 2911 children were included in the present analyses. Dietary intake at the age of 8 years was assessed using food-frequency questionnaires. Diet quality scores were estimated, reflecting adherence to Dutch dietary guidelines. Dental caries was assessed at the age of 13 years using intra-oral photographs. Associations were estimated using multinomial logistic regression analyses, adjusted for sociodemographic characteristics and oral hygiene practices. Results The prevalence of dental caries at the age of 13 years was 33% (n  = 969). Better diet quality was associated with a lower occurrence of severe dental caries after adjustments for sociodemographic factors [e.g. highest vs. lowest quartile of diet quality: odds ratio (OR) 0.62, 95% confidence interval (CI) 0.39–0.98]. After additional adjustments for oral hygiene practices, this association was not statistically significant (OR 0.65, 95% CI 0.41–1.03). Conclusion Adherence to dietary guidelines has the potential to reduce dental caries in children; however, with proper oral hygiene practices, this relationship might be attenuated. To understand the role of dietary patterns and dental caries, the contributing role of daily eating occasions needs to be studied further. [ABSTRACT FROM AUTHOR]

The Environmental Influences on Child Health Outcomes (ECHO)-Wide Cohort Study (EWC), a collaborative research design comprising 69 cohorts in 31 consortia, was funded by the National Institutes of Health (NIH) in 2016 to improve children's health in the United States. The EWC harmonizes extant data and collects new data using a standardized protocol, the ECHO-Wide Cohort Data Collection Protocol (EWCP). EWCP visits occur at least once per life stage, but the frequency and timing of the visits vary across cohorts. As of March 4, 2022, the EWC cohorts contributed data from 60,553 children and consented 29,622 children for new EWCP data and biospecimen collection. The median (interquartile range) age of EWCP-enrolled children was 7.5 years (3.7–11.1). Surveys, interviews, standardized examinations, laboratory analyses, and medical record abstraction are used to obtain information in 5 main outcome areas: pre-, peri-, and postnatal outcomes; neurodevelopment; obesity; airways; and positive health. Exposures include factors at the level of place (e.g. air pollution, neighborhood socioeconomic status), family (e.g. parental mental health), and individuals (e.g. diet, genomics). [ABSTRACT FROM AUTHOR]

Objective To describe factors associated with change in health-related quality of life (HRQOL) in people living with gout in primary care. Methods In a UK prospective cohort study, adults with a diagnosis of gout registered with 20 general practices completed the Gout Impact Scale (GIS; scale 0–100), 36-item Short Form Physical Function subscale (PF-10; 0–100) and HAQ Disability Index (HAQ-DI; 0–3) via postal questionnaires at baseline and 6, 12, 24 and 36 months. Linear mixed modelling was used to investigate factors associated with changes in HRQOL over 3 years. Results A total of 1184 participants responded at baseline (adjusted response 65.6%); 990 (83.6%) were male, with a mean age of 65.6 years (s. d. 12.5). A total of 818, 721, 696 and 605 responded at 6, 12, 24 and 36 months, respectively. Factors associated with worse disease-specific and generic HRQOL over 3 years were flare frequency (five or more flares; GIS subscales, PF-10), oligo/polyarticular flares (GIS subscales, PF-10, HAQ-DI), worse pain (GIS subscales, PF-10, HAQ-DI), body pain (GIS subscales, PF-10, HAQ-DI) and more severe depression (GIS subscales, PF-10, HAQ-DI) (P  ≤ 0.05). More severe anxiety was associated with worse disease-specific HRQOL only (GIS subscales). Older age (PF-10), being female (PF-10, HAQ-DI) and BMI (HAQ-DI) were associated with worse generic HRQOL (P  ≤ 0.05). Conclusion Gout-specific, comorbid and sociodemographic factors were associated with change in HRQOL over a 3-year period, highlighting people at risk of worse outcomes who could be targeted for interventions. [ABSTRACT FROM AUTHOR]

Objectives This study evaluated musculoskeletal ultrasound (MSUS) use by dermatologists previously trained on a novel handheld, chip-based ultrasound device (HHUD) to screen for early PsA. Methods Twelve dermatologists were recruited to screen psoriasis patients for PsA using the novel HHUD in one major hospital in Bonn (Germany) and six private practices in surrounding regions. Patient screening was based on medical history, clinical examination, and the GEPARD questionnaire paired with an MSUS examination of up to three painful joints. All screened patients were then referred to rheumatologists, who determined the final diagnosis. The screening effect of MSUS was assessed according to its sensitivity and specificity before and after its application. Results Between 1 October 2020 and 26 May 2021, a total of 140 psoriasis patients with arthralgia participated in this study. PsA was diagnosed in 19 (13.6%) cases. Before applying MSUS, dermatologists' screening sensitivity and specificity were recorded as 88.2% and 54.4%, respectively, while after applying MSUS the sensitivity and specificity changed to 70.6% and 90.4%, respectively. MSUS led to a change of PsA suspicion in 46 cases, with PsA no longer being suspected in 45 of them. Conclusion This study was able to demonstrate that PsA screening using MSUS by previously trained dermatologists can lead to more precise PsA detection and potentially decreased rheumatologist referral rates. [ABSTRACT FROM AUTHOR]

Aims Germany is experiencing a decline in alcohol consumption but not for every alcoholic beverage type. Given the differential health impacts of alcoholic beverage type, it is important to understand the drivers of these trends. We investigated: (a) temporal trends in beverage preference and (b) the effects of age, period and cohort on these trends. Methods Data came from nine waves (1995–2018; n total = 75,550) of the German Epidemiological Survey of Substance Abuse, a nationally representative household survey of individuals aged 18–59 years. The quantity of beer, wine, spirits and mixed drinks drank in the last 30 days was transformed into grammes of ethanol, and the beverage type preference was estimated as the proportion of total ethanol consumption. Fractional multinomial logit regression was applied to analyse the age, period and cohort effects on temporal trends of beverage preference by sex. Results The preference for spirits and mixed drinks decreased with increasing age, while the preference for wine increased with no age effect on beer. There was a general decrease in the preference for beer and an increase in the preference for wine among both sexes, with an additional increase in the preference for spirits in males. Conclusion Trends in beverage preference were more related to individual ageing and changes in the whole population than to cohorts. With the continued reduction in alcohol consumption, the decreasing preference for beer and the growing preference for wine suggest a positive development. Trends of an increasing preference for spirits in males are of concern. [ABSTRACT FROM AUTHOR]