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Abstract Purpose The COVID-19 pandemic was associated with a decrease in emergency department (ED) visits. However, contradictory, and sparse data regarding children could not yet answer the question, how pediatric ED utilization evolved throughout the pandemic. Our objectives were to investigate the impact of the pandemic in three language regions of Switzerland by analyzing trends over time, describe regional differences, and address implications for future healthcare. Methods We conducted a retrospective, longitudinal cohort study at three Swiss tertiary pediatric EDs (March 1st, 2018—February 28th, 2022), analyzing the numbers of ED visits (including patients` age, triage categories, and urgent vs. non-urgent cases). The impact of COVID-19 related non-pharmaceutical interventions (NPIs) on pediatric ED utilization was assessed by interrupted time series (ITS) modelling. Results Based on 304′438 ED visits, we found a drop of nearly 50% at the onset of NPIs, followed by a gradual recovery. This primarily affected children 0–4 years, and both non-urgent and urgent cases. However, the decline in urgent visits appeared to be more pronounced in two centers compared to a third, where also hospitalization rates did not decrease significantly during the pandemic. A subgroup analysis showed a significant decrease in respiratory and gastrointestinal diseases, and an increase in the proportion of trauma patients during the pandemic. Conclusions The COVID-19 pandemic had substantial effects on number and reasons for pediatric ED visits, particularly among children 0–4 years. Despite equal regulatory conditions, the utilization dynamics varied markedly between the three regions, highlighting the multifactorial modification of pediatric ED utilization during the pandemic. Furthermore, future policy decisions should take regional differences into account.

Abstract Background Cigarette smoking during adolescence is a major public health concern with far-reaching health implications. Adolescents who smoke are at an increased risk of developing long-term health problems and are more likely to continue smoking into adulthood. Therefore, it is vital to identify and understand the risk factors that contribute to adolescent smoking – which in turn facilitate the development of targeted prevention and intervention programs. Methods Data was drawn from a cross-sectional survey conducted between October and December 2021, encompassing adolescents of adolescents aged 14 to 19 residing in Switzerland (n = 2,683). Multiple logistic regression analysis was employed to explore which demographic, household, behavioural and psychographic factors are associated with current smoking status. Results The regression results showed higher odds of smoking for female respondents (OR 1.39; p-value 0.007); older adolescents (OR 1.30; p-value

ObjectivesTo assess the association between socioeconomic status (SES) and self-reported adherence to preventive measures in Switzerland during the COVID-19 pandemic.Methods4,299 participants from a digital cohort were followed between September 2020 and November 2021. Baseline equivalised disposable income and education were used as SES proxies. Adherence was assessed over time. We investigated the association between SES and adherence using multivariable mixed logistic regression, stratifying by age (below/above 65 years) and two periods (before/after June 2021, to account for changes in vaccine coverage and epidemiological situation).ResultsAdherence was high across all SES strata before June 2021. After, participants with higher equivalised disposable income were less likely to adhere to preventive measures compared to participants in the first (low) quartile [second (Adj.OR, 95% CI) (0.56, 0.37–0.85), third (0.38, 0.23–0.64), fourth (0.60, 0.36–0.98)]. We observed similar results for education.ConclusionNo differences by SES were found during the period with high SARS-CoV-2 incidence rates and stringent measures. Following the broad availability of vaccines, lower incidence, and eased measures, differences by SES started to emerge. Our study highlights the need for contextual interpretation when assessing SES impact on adherence to preventive measures.

Background The need to maintain physical and social distance between people and the stay-at-home recommendation/order to contain the spread of COVID-19 have raised concerns about the possible increase in loneliness. However, few studies have analyzed trends or changes in loneliness in samples of young adults. The present study aimed to explore the prevalence of loneliness and its change during the COVID-19 pandemic. Participants and procedure This is a repeated cross-sectional study analyzing data collected through six online surveys between April 2020 and March 2021 from 5,669 university students in Switzerland. Logistic regression models were used to examine trends in loneliness and associations between loneliness, well-being, life at home, COVID-19 symptoms and tests. Results Loneliness decreased between April 2020 and May-June 2020. In contrast, loneliness was higher in December 2020, January and March 2021 compared to April 2020. Loneliness was associated with younger age, studying architecture, design and civil engineering or engineering, enjoying time spent with family/partner, experiencing tensions and conflicts at home, boredom, feeling locked up and subjective well-being and current health. Conclusions Our findings highlight an increase in loneliness during the second wave of the COVID-19 pandemic, although a seasonality effect cannot be excluded. Public health systems and educational institutions need to monitor the effects of social distancing measures and reduced social contact on students’ loneliness and well-being.

IntroductionMental health literacy is receiving increasing research attention due to growing concerns for mental health globally. Among children, teachers have recently been recognized as playing a vital role in the recognition and reporting of potential mental health issues.MethodsA nationally sampled cross-section of teachers was surveyed to examine the discriminant validity of the mental health literacy measure across levels of teaching. A survey collected a total of n = 369 teacher responses in Switzerland (Kindergarten = 76, Primary = 210, Secondary = 83). Item response theory (IRT) analyses were conducted.ResultsInspection of psychometric properties indicated removal of two weak performing items. The 15-item measure exhibited a significant mean difference, such that class-responsibility function scored higher (M = 2.86, SD = .45) than non-responsible function (M = 2.68, SD = .45) teachers [t(309) = −2.20, p = .01]. It also exhibited a significant mean difference, such that more subjective experienced scored higher (M = 2.86, SD = .45) than less subjective experienced (M = 2.68, SD = .45) teachers [t(210) = −8.66, p

Abstract Background During the 2020/2021 winter, the labour market was under the impact of the COVID-19 pandemic. Changes in socioeconomic resources during this period could have influenced individual mental health. This association may have been mitigated or exacerbated by subjective risk perceptions, such as perceived risk of getting infected with SARS-CoV-2 or perception of the national economic situation. Therefore, we aimed to determine if changes in financial resources and employment situation during and after the second COVID-19 wave were prospectively associated with depression, anxiety and stress, and whether perceptions of the national economic situation and of the risk of getting infected modified this association. Methods One thousand seven hundred fifty nine participants from a nation-wide population-based eCohort in Switzerland were followed between November 2020 and September 2021. Financial resources and employment status were assessed twice (Nov2020–Mar2021, May–Jul 2021). Mental health was assessed after the second measurement of financial resources and employment status, using the Depression, Anxiety and Stress Scale (DASS-21). We modelled DASS-21 scores with linear regression, adjusting for demographics, health status, social relationships and changes in workload, and tested interactions with subjective risk perceptions. Results We observed scores above thresholds for normal levels for 16% (95%CI = 15–18) of participants for depression, 8% (95%CI = 7–10) for anxiety, and 10% (95%CI = 9–12) for stress. Compared to continuously comfortable or sufficient financial resources, continuously precarious or insufficient resources were associated with worse scores for all outcomes. Increased financial resources were associated with higher anxiety. In the working-age group, shifting from full to part-time employment was associated with higher stress and anxiety. Perceiving the Swiss economic situation as worrisome was associated with higher anxiety in participants who lost financial resources or had continuously precarious or insufficient resources. Conclusion This study confirms the association of economic stressors and mental health during the COVID-19 pandemic and highlights the exacerbating role of subjective risk perception on this association.

Abstract. Introduction:. Chronic pain is a prevalent, yet underrecognized, condition in children and adolescents. A biopsychosocial framework has been widely adopted over the past decades and resulted in a new pain classification in the International Classification of Diseases, 11th revision (ICD-11). Nevertheless, little is known about pediatricians' pain concepts. Objectives:. We explored pain concepts of Swiss pediatricians by means of a qualitative analysis. Method:. A cross-sectional online survey was sent to clinically active Swiss pediatricians registered with the Swiss Society for Pediatrics. A case vignette of a girl with chronic musculoskeletal pain was presented and pediatricians were asked (1) what they think caused the pain, and (2) how they would explain the pain to the patient and their family. Structuring content analysis was applied to describe major themes within the answers. Results:. The following main categories emerged: psychological factors, biological factors, unclear etiology, social context, disorder specific, and multifactorial. Most pediatricians reported the belief that psychological factors explained the pain. However, when explaining the pain to the patient, biological factors were reported most often. Conclusion:. There is a discrepancy between pediatricians' conviction that chronic pain is mostly explained by psychological factors and their exploratory model towards patients that focuses on biological factors. Promoting the biopsychosocial framework of chronic pain is key to ensure timely and effective treatment. The new pain classification in the ICD-11 has the potential to increase the use of the biopsychosocial model.

BACKGROUND: Chronic pain is a frequent complaint in children and adolescents, with great international variation in prevalence. Paediatricians are usually the first-line contact for pain problems in children and might refer patients to other specialists or pain clinics where available. Prevalence estimates of paediatric chronic pain and paediatricians’ care experiences in Switzerland are currently lacking. OBJECTIVES: The aim of this study was to assess the prevalence of paediatric chronic pain in Swiss paediatrician practices and paediatricians’ professional experience and confidence with, and care provision for patients with paediatric chronic pain. METHODS: Data were collected in 2019 using a cross-sectional online questionnaire among Swiss paediatricians. Ordinary least square regression analyses and Monte Carlo simulations were applied to estimate the prevalence rate of paediatric chronic pain. Explorative multivariate logistic regression analyses investigated whether sociodemographic and professional factors were associated with paediatricians’ confidence in treating and experience with paediatric chronic pain. RESULTS: We included 337 paediatricians in our anonymised analyses. The prevalence rate of paediatric chronic pain in our sample was estimated to be between 2.54% and 3.89%. Twenty percent of paediatricians reported feeling confident in treating paediatric chronic pain, 77.2% had referred patients with paediatric chronic pain to another specialist and more than half had at least some experience with paediatric chronic pain. Experience and confidence with treating paediatric chronic pain were associated with male gender. CONCLUSION: Our study is the first to estimate the prevalence of paediatric chronic pain by means of a sample of Swiss paediatricians. The prevalence rate was considerably lower than other estimates. Given the lack of training and confidence with treating paediatric chronic pain reported by paediatricians, absence of awareness and resulting under-diagnosis is possible.

ObjectivesYoung adults have been overly affected by the containment measures against COVID-19 and, consequently, worsening in mental health and change in health behavior have been reported. Because the life phase of emerging adulthood is crucial for developing health behaviors, this study aims to examine increase in alcohol consumption, single and multiple binge drinking, and associated factors in students during lockdown and post-lockdown periods.MethodsA prospective open cohort study design with nine survey time points between April 2020 and June 2021 was conducted. The present study uses pooled data from the first survey T0 (3 April to 14 April) and follow-ups at T1 (30 April to 11 May 2020) and T2 (28 May to 8 June 2020). Students from all faculties of the Zurich University of Applied Sciences (ZHAW) (N = 12'431) were invited. Of the 1,300 students who participated at baseline and in at least one follow-up, 1,278 (98.3%) completed the questionnaires, final net sample size was 947. Generalized Estimating Equations (GEE) models were used to investigate the factors associated with increases in alcohol consumption based on number of occasions/last 30 days; drinks/week, and binge drinking at T0, and respective changes at T1 and T2 (increases, decreases, no change).ResultsOverall, 20% of Swiss university students reported an increased alcohol consumption and 26% engaged in binge drinking. Number of drinks at baseline was associated with a higher probability of increased alcohol consumption, as well as engaging in single and multiple binge drinking events. Higher anxiety scores were associated with a higher probability to increase the alcohol consumption and engaging at least once in binge drinking. Additional factors associated with any binge drinking were male gender, younger age and not living with parents. Higher perceived social support was only associated with engaging in heavy binge drinking.ConclusionsA substantial number of students developed a more risky health behavior regarding alcohol consumption. It is important to identify at risk students and design target prevention including factors such as age, gender and social norms. Further, health behavior and determinants of health behaviors of students should be carefully monitored during the further course of the pandemic.

Abstract Background Digital media are increasingly abundant providing a wide scope of health information. To date, very little is known about parental health information seeking behaviour for child health outside of English-speaking and Nordic countries. Our study “Digital parental counsellors” examines how parents search for health information in digital media, print media and among “personal contacts”, distinguishing between the search for information about general child health and development and child’s acute illness, and comparing information seeking behaviour by disability status of the child. Methods The population-based sample consisted of 769 parents with children aged 0–2 in the German-speaking region of Switzerland returning the study questionnaire (30% response rate). We developed a frequency score of use of different information sources and conducted bivariate and multivariate linear regression analyses to describe parental search behaviour and the association with child’s disability status. Results The sample consists of 88% mothers (mean age: 35.7 years SD 4.33). Children’s mean age is 16 months (SD 7.1), 49% of the children are female and 6% have a disability. Parents use digital media significantly more frequently to search for information about general health and development questions than about an acute child’s illness (p

AIMS OF THE STUDY: In Switzerland, COVID-19 vaccines have been approved for children aged 5–11 years only recently, whereas vaccination of adolescents aged 12 years and older was approved in early summer 2021. Although the disease burden in children and adolescents has been reasonably mild, they can transmit COVID-19 to others, thus vaccinating this age group may help to curb the COVID-19 pandemic. The main objective was to investigate the association between five psychological antecedents of vaccination hesitancy in COVID-19 immunised parents and their intention to have their child vaccinated against COVID-19. Further, we examined if parental vaccination history and conviction of the benefits of Swiss paediatric vaccination recommendations are associated with child vaccination intention, and where parents would like the vaccination performed. METHODS: A cross-sectional anonymous online survey in the COVID-19 vaccination centre Winterthur was conducted between 16 May and 30 September 2021. Individuals receiving COVID-19 vaccines in the vaccination centre were invited to participate. All individuals who participated in the survey after their first dose with children under 16 years were included in the analysis (n = 1318). Using multivariable logistic regression, the association between our main predictor variables, psychological antecedents (confidence, constraints, complacency, calculation, collective responsibility) measured by the validated 5C scale, and parents’ intention to have their child vaccinated against COVID-19 was analysed, adjusted for parental vaccination history, conviction of benefits of vaccination recommendations for children and adults, children’s age group, sociodemographic factors, and time-point of vaccine authorisation for 12–16-year-olds. RESULTS: 58.7% of the parents intended to vaccinate their child against COVID-19. Their preferred vaccination location for their child was the paediatrician or family doctor. Three psychological antecedents were associated with vaccination intention: confidence (adjusted odds ratio [AOR] 1.33, 95% confidence interval [CI] 1.00–1.76; borderline significant), calculation (AOR 0.68, 95% CI 0.58–0.81), and collective responsibility (AOR 1.93, 95% CI 1.47–2.52). Influenza vaccination (AOR 1.53, 95% CI 1.15–2.03) and conviction of the benefits of the Swiss vaccination recommendations for children and adolescents were independently associated with parental vaccination intention. CONCLUSIONS: Campaigns on COVID-19 vaccination for children may increase the intention of parents to have a child vaccinated when they address collective responsibility and calculation (weighing risks and benefits), independent of the conviction of the benefits of the vaccination recommendations, which was also a significant factor. The findings further show that parents of younger children favour their paediatrician or family doctor over vaccination centres as the vaccination setting for their child, an important finding for paediatric COVID-19 vaccination strategies.

Abstract Background Non-specific neck pain and headache are major economic and individual burden in office-workers. The aim of this study is to investigate the effect of a multi-component intervention combining workstation ergonomics, health promotion information group workshops, neck exercises, and an app to enhance intervention adherence to assess possible reductions in the economic and individual burden of prevalent and incident neck pain and headache in office workers. Methods/design This study is a stepped wedge cluster-randomized controlled trial. Eligible participants will be any office-worker aged 18–65 years from two Swiss organisations in the Cantons of Zurich and Aargau, working more than 25 h a week in predominantly sedentary office work and without serious health conditions of the neck. One hundred twenty voluntary participants will be assigned to 15 clusters which, at randomly selected time steps, switch from the control to the intervention group. The intervention will last 12 weeks and comprises workstation ergonomics, health promotion information group workshops, neck exercises and an adherence app. The primary outcome will be health-related productivity losses (presenteeism, absenteeism) using the Work Productivity and Activity Impairment Questionnaire. Secondary outcomes are neck disability and pain (measured by the Neck Disability Index, and muscle strength and endurance measures), headache (measured by the short-form headache impact test), psychosocial outcomes (e.g. job-stress index, Fear-Avoidance Beliefs Questionnaire), workplace outcomes (e.g. workstation ergonomics), adherence to intervention, and additional measures (e.g. care-seeking). Measurements will take place at baseline, 4 months, 8 months, and 12 months after commencement. Data will be analysed on an intention to treat basis and per protocol. Primary and secondary outcomes will be examined using linear mixed-effects models. Discussion To the authors’ knowledge, this study is the first that investigates the impact of a multi-component intervention combining current evidence of effective interventions with an adherence app to assess the potential benefits on productivity, prevalent and incident neck pain, and headache. The outcomes will impact the individual, their workplace, as well as private and public policy by offering evidence for treatment and prevention of neck pain and headache in office-workers. Trial registration ClinicalTrials.gov, NCT04169646 . Registered 15 November 2019 - Retrospectively registered.

Abstract Background There has been an overall decreasing trend in the inflow into disability pension in Switzerland since 2003 with the exception of young adults. Disablement in young adulthood reflects a particularly critical phenomenon given the potentially far-reaching long-term social, economic and health consequences. The aim of this study was therefore to identify factors for disability pension in young adults aged 18–39, living in Switzerland. Methods We used the 2010–2015 cross-sections of the Social protection and labour market; a unique dataset linking microdata from the Swiss Labour Force Survey, the Swiss Central Compensation Office Register, and the Unemployment Insurance Register. Multiple logistic regression was employed to explore the association between demographic, socioeconomic, and health factors and disability pension in young adults living in Switzerland with long-term activity limitation (N = 5306). Alternative specifications of the benchmark model were estimated as robustness checks; and subsample analyses were conducted excluding (i) those aged 18–24 and (ii) those with partial disability pension. Results Our regression results showed that those living without a working partner (OR 2.11; 95% CI 1.51–2.94) and without a child aged 0–14 (OR 2.15; 95% CI 1.48–3.12), born in Switzerland (OR 2.68; 95% CI 1.87–3.84), of higher age (OR 1.16; 95% CI 1.12–1.19), having completed at most lower secondary school (OR 3.26; 95% CI 2.24–4.76), lacking income throughout the four-year period prior to interview (OR 3.94; 95% CI 2.70–5.75), suffering from chronic illness (OR 4.52; 95% CI 2.83–7.19), and severe long-term activity limitation (OR 4.52; 95% CI 2.83–7.19) had higher odds of DP. Our findings were robust to alternative specifications and subsamples; and the alternative specifications revealed differences by learnt occupation, with highest odds for those without an occupational qualification (OR 5.93; 95% CI 3.72–9.46; p-value 0.000) and for those in ‘Manufacturing’ (OR 3.59; 95% CI 1.91–6.71) relative to ‘Health, education, culture, and science’. Conclusions Most importantly, our results showed that educational and employment factors are of high relevance, as well as chronic morbidity and severe long-term activity limitation. From a policy perspective, early intervention should thus focus on the attainment of vocational and academic qualifications beyond the lower secondary level, facilitating school-to-work transition and labour market integration.

Abstract Background Digital media are increasingly abundant and used to seek health information, however, to date very little is known on parents’ seeking behavior in the context of child’s health and development outside English-speaking and Scandinavian countries. By investigating the prevalence of, and reasons for use, we studied parents’ perception of the Internet as a resource for improving their health-related knowledge. Methods The survey was conducted in a random sample of 2573 Swiss-German parents with at least one child aged less-than 2 years old. Parents received a mailed invitation to fill in an online questionnaire. Two reminders were sent, the later with a paper questionnaire attached. The questionnaire included questions on use of print, digital, and personal information sources, as well as different information situations: general health and development or illness. We ran descriptive analyses on information seeking behavior, type of digital media used, reasons of use. We also conducted regression analyses to explore factors associated with parental perceptions with regard to the Internet’s utility as a source for health information. Results A total of 769 questionnaires were returned (response rate 30%). Nearly all parents (91%) used digital media for seeking information on their child’s health and development, and the main reason for use was indicated as being the 24/7 availability of information. Search engines (55%) and webpages for parents (47%) were by far the most frequently used digital media. Generally, the internet is perceived as a good resource, especially by fathers (OR = 1.80, 95% CI: 1.03–3.16). However, a large percentage of parents are skeptical about the correctness of online info (91%), are unsure about their interpretive understanding, and ask for guidance from their pediatrician (67%). Conclusions The Internet has become a highly frequented source of information for Swiss-German parents on children’s health with largely valuable perceptions of its utility. Digital media are used in addition to and not in replacement of print media and personal contacts. Increasing parental guidance by health and public health professionals could improve parental digital health utilization and empower parents in the new role they adopt.

ObjectiveThe COVID-19 pandemic and government measures implemented to counter the spread of the infection may be a major stressor affecting the psychological health of university students. This study aimed to explore how anxiety symptoms changed during the pandemic.Methods676 students (76% females) at Zurich University of Applied Sciences participated in the first (T0) and second (T1) survey waves. Anxiety symptoms were assessed using the Generalized Anxiety Disorder-Scale-7 (GAD-7). Risk and protective factors (e.g., COVID-19-related variables) were examined.ResultsGAD-7 scores decreased significantly from T0 to T1 (mean change: −0.446, SE = 0.132, 95% CI: −0.706, −0.186, t = −3.371, df = 659, p = 0.001). Participants with moderate-to-severe anxiety score were 20.2 and 15.6% at T0 and T1, respectively. The following positively predicted anxiety: older age, female gender, non-Swiss nationality, loneliness, participants’ concern about their own health, and interaction between time and participants’ concern about their own health. Resilience and social support negatively predicted anxiety.ConclusionsOur findings provide information for public health measures and psychological interventions supporting the mental health of university students during the COVID-19 emergency.

PurposeThe COVID-19 lockdown interrupted normal daily activities, which may have led to an increase in sedentary behavior (Castelnuovo et al., 2020). The aim of this study was to investigate the effect of the COVID-19 pandemic on the level of physical activity among Swiss office workers.MethodsOffice workers from two Swiss organizations, aged 18–65 years, were included. Baseline data from January 2020 before the COVID-19 pandemic became effective in Switzerland were compared with follow-up data during the lockdown phase in April 2020. Levels of physical activity were assessed using the International Physical Activity Questionnaire. Paired sample t-tests or Wilcoxon signed-rank test were performed for statistical analysis.ResultsData from 76 participants were analyzed. Fifty-four participants were female (71.1%). The mean age was 42.7 years (range from 21.8 to 62.7) at baseline. About 75% of the participants met the recommendations on minimal physical activity, both before the COVID-19 pandemic and during the lockdown. Weak statistical evidence for a decline in total physical activity in metabolic equivalent of task minutes per week (MET min/week) was found (estimate = −292, 95% CI from – ∞ to 74, p-value = 0.09), with no evidence for a decrease in the three types of activity: walking (estimate = −189, 95% CI from – ∞ to 100, p-value = 0.28), moderate-intensity activity (estimate = −200, 95% CI from – ∞ to 30, p-value = 0.22) and vigorous-intensity activity (estimate = 80, 95% CI from – ∞ to 460, p-value = 0.74). Across the three categories “high,” “moderate,” and “low” physical activity, 17% of the participants became less active during the lockdown while 29% became more active.ConclusionThe COVID-19 pandemic did not result in a reduction in total physical activity levels among a sample of Swiss office workers during the first weeks of lockdown. Improved work-life balance and working times may have contributed to this finding.Clinical Trial Registrationwww.ClinicalTrials.gov, NCT04169646. Registered 15 November 2019 – Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT04169646.

BackgroundDespite an increasing importance of home care, quality assurance in this healthcare sector in Switzerland is hardly established. In 2010, Swiss home care quality indicators (QIs) based on the Resident Assessment Instrument-Home Care (RAI-HC) were developed. However, these QIs have not been revised since, although internationally new RAI-HC QIs have emerged. The objective of this study was to assess the appropriateness of RAI-HC QIs to measure quality of home care in Switzerland from a public health and healthcare providers' perspective.MethodsFirst, the appropriateness of RAI-HC QIs, identified in a recent systematic review, was assessed by a multidisciplinary expert panel based on the RAND/UCLA Appropriateness Method taking into account indicators' public health relevance, potential of influence, and comprehensibility. Second, the QIs selected by the experts were afterwards rated regarding their relevance, potential of influence, and practicability from a healthcare providers' perspective in focus groups with home care nurses based on the Nominal-Group-Technique. Data were analyzed using median scores and the Disagreement Index.Results18 of 43 RAI-HC QIs were rated appropriate by the experts from a public health perspective. The 18 QIs cover clinical, psychosocial, functional and service use aspects. Seven of the 18 QIs were subsequently rated appropriate by home care nurses from a healthcare providers' perspective. The focus of these QIs is narrow, because three of seven QIs are pain-related. From both perspectives, the majority of RAI-HC QIs were rated inappropriate because of insufficient potential of influence, with healthcare providers rating them more critically.ConclusionsThe study shows that the appropriateness of RAI-HC QIs differs according to the stakeholder perspective and the intended use of QIs. The findings of this study can guide policy-makers and home care organizations on selecting QIs and to critically reflect on their appropriate use.

BackgroundChronic systemic inflammation accelerates early vascular ageing. Atopic sensitization and allergic diseases may involve increased inflammatory activity. This study aimed to assess whether atopic sensitization and allergic diseases were associated with altered vascular biomarkers in Norwegian adolescents.MethodsDistensibility coefficient of the common carotid arteries, carotid intima-media thickness and atopic sensitization (serum total and specific IgEs) were assessed in 95 Norwegian adolescents, who participated in the RHINESSA generation study. Symptoms of allergic disease were assessed by an interviewer-led questionnaire.ResultsAtopic sensitization was found in 33 (34.7%) of the adolescents. Symptomatic allergic disease was found in 11 (33.3%) of those with atopic sensitization. Distensibility coefficient of the common carotid arteries appeared to be lower in participants with atopic sensitization than in those without (46.99±8.07*10-3/kPa versus 51.50±11.46*10-3/kPa; p>0.05), while carotid intima-media thickness did not differ between these groups (0.50±0.04mm versus 0.50±0.04mm; p>0.05). Crude, as well as age- and sex-adjusted multiple regression, revealed no significant association, neither of atopic sensitization nor of allergic disease, with distensibility coefficient of the common carotid arteries and carotid intima-media thickness.ConclusionsOur results do not support the assumption of an adverse impact of atopic sensitization and/or allergic disease on distensibility coefficient of the common carotid arteries and carotid intima-media thickness in Norwegian adolescents. Further research is necessary to study whether the clinical severity of allergic diseases might be more important than the status of allergic disease or atopic sensitization.

An amendment to this paper has been published and can be accessed via the original article.

Life course data on obesity may enrich the quality of epidemiologic studies analysing health consequences of obesity. However, achieving such data may require substantial resources. We investigated the use of body silhouettes in adults as a tool to reflect obesity in the past. We used large population-based samples to analyse to what extent self-reported body silhouettes correlated with the previously measured (9-23 years) body mass index (BMI) from both measured (European Community Respiratory Health Survey, N = 3 041) and self-reported (Respiratory Health In Northern Europe study, N = 3 410) height and weight. We calculated Spearman correlation between BMI and body silhouettes and ROC-curve analyses for identifying obesity (BMI ≥30) at ages 30 and 45 years. Spearman correlations between measured BMI age 30 (±2y) or 45 (±2y) and body silhouettes in women and men were between 0.62-0.66 and correlations for self-reported BMI were between 0.58-0.70. The area under the curve for identification of obesity at age 30 using body silhouettes vs previously measured BMI at age 30 (±2y) was 0.92 (95% CI 0.87, 0.97) and 0.85 (95% CI 0.75, 0.95) in women and men, respectively; for previously self-reported BMI, 0.92 (95% CI 0.88, 0.95) and 0.90 (95% CI 0.85, 0.96). Our study suggests that body silhouettes are a useful epidemiological tool, enabling retrospective differentiation of obesity and non-obesity in adult women and men.

QUESTIONS UNDER STUDY: High blood pressure, the single leading health risk factor worldwide, contributes greatly to morbidity and mortality. This study aimed to add to the understanding of diagnosed and undiagnosed high blood pressure in Switzerland and to evaluate adherence to hypertension guidelines. METHODS: Included were 3962 participants from the first (2001–2003) and second (2010–2011) follow-ups of the population-based Swiss Cohort Study on Air Pollution and Lung and Heart Disease in Adults. High blood pressure was defined as blood pressure ≥140/90 mm Hg and the prevalence of doctor-diagnosed hypertension was based on questionnaire information. RESULTS: High blood pressure was found in 34.9% of subjects, 49.1% of whom were unaware of this condition; 30.0% had doctor-diagnosed hypertension and, although 82.1% of these received drug treatments, in only 40.8% was blood pressure controlled (

BACKGROUND AND OBJECTIVES:There is a lack of evidence concerning associations between novel parameters of arterial stiffness as cardiovascular risk markers and traditional structural and functional vascular biomarkers in a population-based Caucasian cohort. We examined these associations in the second follow-up of the Swiss Cohort Study on Air Pollution and Lung and Heart Diseases in Adults (SAPALDIA 3). METHODS:Arterial stiffness was measured oscillometrically by pulse wave analysis to derive the cardio-ankle vascular index (CAVI), brachial-ankle (baPWV) and aortic pulse wave velocity (aPWV), and amplitude of the forward and backward wave. Carotid ultrasonography was used to measure carotid intima-media thickness (cIMT) and carotid lumen diameter (LD), and to derive a distensibility coefficient (DC). We used multivariable linear regression models adjusted for several potential confounders for 2,733 people aged 50-81 years. RESULTS:CAVI, aPWV and the amplitude of the forward and backward wave were significant predictors of cIMT (p < 0.001). All parameters were significantly associated with LD (p < 0.001), with aPWV and the amplitude of the forward wave explaining the highest proportion of variance (2%). Only CAVI and baPWV were significant predictors of DC (p < 0.001), explaining more than 0.3% of the DC variance. CONCLUSION:We demonstrated that novel non-invasive oscillometric arterial stiffness parameters are differentially associated with specific established structural and functional local stiffness parameters. Longitudinal studies are needed to follow-up on these cross-sectional findings and to evaluate their relevance for clinical phenotypes.

OBJECTIVES:Early life environment is essential for lung growth and maximally attained lung function. Whether early life exposures impact on lung function decline in adulthood, an indicator of lung ageing, has scarcely been studied. METHODS:Spirometry data from two time points (follow-up time 9-11 years) and information on early life exposures, health and life-style were available from 12862 persons aged 28-73 years participating in the European population-based cohorts SAPALDIA (n = 5705) and ECRHS (n = 7157). The associations of early life exposures with lung function (FEV1) decline were analysed using mixed-effects linear regression. RESULTS:Early life exposures were significantly associated with FEV1 decline, with estimates almost as large as personal smoking. FEV1 declined more rapidly among subjects born during the winter season (adjusted difference in FEV1/year of follow-up [95%CI] -2.04ml [-3.29;-0.80]), of older mothers, (-1.82 ml [-3.14;-0.49]) of smoking mothers (-1.82ml [-3.30;-0.34] or with younger siblings (-2.61ml [-3.85;-1.38]). Less rapid FEV1-decline was found in subjects who had attended daycare (3.98ml [2.78;5.18]), and indicated in subjects with pets in childhood (0.97ml [-0.16;2.09]). High maternal age and maternal smoking appeared to potentiate effects of personal smoking. The effects were independent of asthma at any age. CONCLUSION:Early life factors predicted lung function decline decades later, suggesting that some mechanisms related lung ageing may be established early in life. Early life programming of susceptibility to adult insults could be a possible pathway that should be explored further.

We examined cross-sectional associations of self-reported PA intensities with arterial stiffness in elderly Caucasians of the Swiss Cohort Study on Air Pollution and Lung and Heart Diseases in Adults (SAPALDIA). Mixed central and peripheral arterial stiffness was measured oscillometrically by the cardio-ankle vascular index (CAVI) and brachial-ankle pulse wave velocity (baPWV). The self-reported International Physical Activity Questionnaire (IPAQ) long version was administered to classify each subject’s PA level. We used univariable and multivariable mixed linear and logistic regression models for analyses in 1908 persons aged 50 years and older. After adjustment for several confounders moderate, vigorous and total PA were inversely associated with CAVI (p=0.02–0.03). BaPWV showed negative and marginally significant associations with vigorous and moderate PA (each p=0.06), but not with total PA (p=0.28). Increased arterial stiffness (CAVI≥9, upper tertile) was inversely and significantly associated with vigorous PA (Odds Ratio (OR)=0.65, 95% Confidence Interval (CI): 0.48–0.88), and marginally significantly with total PA (OR=0.76, 95% CI: 0.57–1.02) and moderate PA (OR=0.75, 95% CI: 0.56–1.01). The odds ratio for baPWV≥14.4 was 0.67 (95% CI: 0.48–0.93) across the vigorous PA levels, and was non-significant across the total (OR=0.91, 95% CI: 0.66–1.23) and moderate PA levels (OR=0.94, 95% CI: 0.69–1.28). In this general Caucasian population of older adults higher levels especially of vigorous PA were associated with lower arterial stiffness. These data support the importance of PA for improving cardiovascular health in elderly people.

There is some evidence that maternal smoking increases susceptibility to personal smoking's detrimental effects. One might question whether early life disadvantage might influence susceptibility to occupational exposure.In this cross-sectional study we investigated respiratory symptoms, asthma and self-reported chronic obstructive pulmonary disease (COPD) as related to working as a cleaner in Northern European populations, and whether early life factors influenced susceptibility to occupational cleaning's unhealthy effects.The RHINE III questionnaire study assessed occupational cleaning in 13,499 participants. Associations with respiratory symptoms, asthma and self-reported COPD were analysed with multiple logistic regressions, adjusting for sex, age, smoking, educational level, parent´s educational level, BMI and participating centre. Interaction of occupational cleaning with early life disadvantage (maternal smoking, severe respiratory infection 35 years) was investigated.Among 2138 ever-cleaners the risks of wheeze (OR 1.4, 95% CI 1.3-1.6), adult-onset asthma (1.5 [1.2-1.8]) and self-reported COPD (1.7 [1.3-2.2]) were increased. The risk increased with years in occupational cleaning (adult-onset asthma: ≤1 year 0.9 [0.7-1.3]; 1-4 years 1.5 [1.1-2.0]; ≥4 years 1.6 [1.2-2.1]). The association of wheeze with cleaning activity ≥4 years was significantly stronger for those with early life disadvantage than in those without (1.8 [1.5-2.3] vs. 1.3 [0.96-1.8]; pinteraction 0.035).Occupational cleaners had increased risk of asthma and self-reported COPD. Respiratory symptom risk was particularly increased in persons with factors suggestive of early life disadvantage. We hypothesize that early life disadvantage may increase airway vulnerability to harmful exposure from cleaning agents later in life.

Regular physical activity has been shown to reduce cardiovascular disease risk in the general population. While smaller studies in specified groups (highly trained versus untrained individuals) indicate a certain dose-dependent effect of physical activity on the reduction of carotid stiffness (an indicator of subclinical vascular disease), it is unclear whether this association is present in a representative sample. Thus, we investigated this question cross-sectionally in participants from the population-based Swiss Cohort Study on Air Pollution And Lung and Heart Diseases In Adults (SAPALDIA).Self-reported total, moderate and vigorous physical activity and distensibility as a measure of local arterial stiffness among 1636 participants aged 50 to 81 years without clinically manifest diseases were evaluated. Mixed regression models were used to examine associations of physical activity intensity with distensibility.Vigorous physical activity, but not total nor moderate physical activity, was significantly associated with increased distensibility (= reduced carotid stiffness) in univariate analyses (percent change in the geometric mean and 95% confidence interval per 1 standard deviation increment in vigorous physical activity = 2.54 (0.69; 4.43), p < 0.01; in total physical activity = 1.62 (-0.22; 3.50), p = 0.08; in moderate physical activity = 0.70 (-1.12; 2.56), p = 0.45). These associations disappeared when we additionally adjusted for age.After adjustment for the most important confounders and risk factors, we found no evidence for an association of physical activity with carotid stiffness in the general middle aged to elderly population.

QUESTIONS UNDER STUDY: As the burden of cardiovascular disease (CVD) increases globally, its prevention and risk assessment becomes ever more important. We thus investigated the longitudinal association of the cardiovascular risk scores in the population-based cohort SAPALDIA with carotid intima media thickening (CIMT), an indicator of sub-clinical disease, and CVD incidence. METHODS: In 2,832 SAPALDIA participants, the Swiss and ESC heart risk score (AGLA, SCORE) were calculated based on 2001 data and CIMT was measured in 2010/11. We ran multi-level linear regression analyses between scores and CIMT, stratified for CVD status and gender, and logistic analyses for doctor-diagnosed CVD incidence. Path analyses investigated direct and indirect effects on CIMT. RESULTS: AGLA and SCORE were positively associated with increasing CIMT in both healthy and CVD diagnosed subjects and men and women. Participants in highest risk categories showed a significant CIMT difference of >0.20 mm compared to the reference risk category (10% OR 2.1, >20% OR 3.7). Path analyses yield risk factors’ direct and indirect effects through blood pressure. CONCLUSION: The positive longitudinal association between risk estimations and CIMT confirms the use of risk scores in assessing individuals and populations at risk. Systolic blood pressure appears to be a main pathological mechanism, underscoring the importance of optimal blood pressure control and the importance of prevention strategies of risk factors, indirectly affecting CIMT through the haemodynamic pathway.