bluuebunny/crossref_metadata_2025 huggingface dataset:
Do family characteristics explain a social gradient in overweight in early childhood?
Authors: Hoffmann S , Rattay P , Blume M , Hövener C , Schneider S , Moor I , Pischke C , Schüttig W , de Bock F , Spallek J
Published: October 2022

Background

Children's overweight is associated with many factors, including their living situation, in particular their family's socioeconomic position (SEP) and family characteristics. Research on the extent to which family characteristics account for a social gradient in overweight in early life is scarce. This study evaluated whether family characteristics explain SEP differences in the risk of overweight in early childhood.

Methods

The study used baseline data of 3-6 year-old children (n = 1,116) from the intervention ‘Ene mene fit’ conducted at kindergartens in Baden-Württemberg, Germany. Data included overweight (body mass index > 90 percentile) and parents’ reports on their education and family characteristics associated with overweight (child consumes: sweets in front of TV, soft drinks; family joined time: outdoor, breakfast, sports; cooking; child sets table; role model). Model-based single mediation analyses decomposed the total effect of highest parental education on overweight into direct (unmediated) and indirect (mediated) effects (OR, 95% CI).

Results

Girls and boys with low parental education had higher odds for overweight than children with high/medium education. Among boys, low education influenced the risk of overweight via indirect effects of i. ‘sweets consumption in front of TV’ (OR = 1.31, 1.05-1.59) and ii. ‘no joined sports’ (OR = 1.14, 1.00-1.44). The direct effect of low education only remained significant when ‘no joined sports’ was considered (OR = 2.19, 1.11-5.19). Among girls, family characteristics measured here did not explain SEP differences in overweight.

Conclusions

The family characteristics ‘sweets consumption in front of TV’ and ‘no joined sports’ contribute to inequalities in overweight among boys, but not among girls. Therefore, more gender-sensitive research is needed to identify family risk and protective characteristics that explain health inequalities among both boys and girls.
Quality changes of workplace health promotion in Austrian companies over time
Authors: Lang G , Heigl C , Jiménez P
Published: October 2022

Background

Workplace health promotion (WHP) is effective when it is implemented in a high-quality and sustainable manner. Companies in the Austrian quality management system can apply for a WHP quality certificate every three years. More and more companies are integrating WHP into their regular operations. This work investigates the WHP quality system and how the companies develop over time.

Methods

WHP quality is measured using 15 holistic quality criteria, which are assessed by an external, independent institute. For the period 2014-2021, evaluations from n = 570 companies with two and from n = 278 companies over three measurement points in time are available (initial and renewal awards). The (potential) change of the WHP quality is examined with a longitudinal design by the means of confirmatory factor analyses and autoregressive models with latent variables.

Results

The measurement of WHP quality shows acceptable to good measurement accuracy (internal consistency-reliability: α = 0.85-0.89), validity (convergent and discriminant validity) and metric measurement invariance over time. At structural level, relative stability of WHP quality can be demonstrated for the measurement points (β = 0.40-0.52, p < 0.001). Both the quality of WHP and the temporal stability differentiate significantly according to the firm size and the experience of the company with WHP structures and processes.

Conclusions

The use of the criteria allows a reliable, valid and objective quality assessment of WHP quality due to the concept of the assessment process. WHP quality is a relatively stable characteristic of the company, which, however, varies according to temporal, structural and process-related aspects. Company size moderates to a lesser extent of quality changes over time. This is in line with expectations, but also indicates that small companies should be clearly motivated and supported for their WHP measures. The insights help to further develop quality assurance in WHP and public health.

Key messages

• The criteria used allow a reliable, valid and objective assessment of WHP quality.

• Because firm size moderates the change in WHP quality, small firms should be continuously encouraged and supported.
Are French local health contracts promising in addressing determinants of diet and physical activity?
Authors: Le Bodo Y , Diallo D , Hudebine H , Harpet C , Jabot F , Breton E
Published: October 2022

Background

There is a consensus on the need to transform the built, economic and socio-cultural environments to promote healthy eating (HE) and physical activity (PA). Yet, limited capacity and the biomedicalisation of public health are often blamed for steering investments towards individual risk factors. In France, local health contracts (LHCs) agreed between a regional health agency (RHA) and a local government could improve health promotion strategies. We examined how LHCs take into account the environmental determinants of HE and PA.

Methods

Using the CLoterreS national census, we analysed a stratified random sample of 53 LHCs with a view to identify if actions target individual (knowledge, skills, etc.) or environmental (interpersonal, organisational, community or political) determinants. To this end, we developed an instrument drawing from different typologies of action and consensus documents to assess the integration of the socioecological approach in programmes. We ran a series of interviews with RHA staff (n = 39) and local actors (n = 23) to put into context our results.

Results

Out of 53 LHCs, 42 included at least one action on HE or PA. For these topics, there was a higher proportion of actions targeting individuals (83% and 76% per contract, respectively) than environments (51% and 58%). For the latter, actions on interpersonal determinants (e.g. family) were the most common. However, we also found instances of actions on more distal ones (e.g. to improve nutrition standards in school canteens and walkability). Contextual factors such as local priorities, past experience with health promotion and the involvement of local actors in needs assessment and action planning may influence such orientations.

Conclusions

LHCs constitute a promising avenue to address the environmental determinants of health-related behaviours. A key feature of this instrument is its capacity to develop intersectoral strategies. Further research will show if LHCs deliver on their action plan.

Key messages

• Local health contracts facilitate the mobilisation of a broad diversity of NGOs and agencies.

• This makes it a promising device for addressing the environmental determinants of HE and PA, provided adequate resources are devoted to stakeholder engagement and local government capacity-building.
Prevalence of unnecessary antibiotic use in European hospitals – a systematic review
Authors: Tyllack L , Renz A , Runge Ranzinger S , Louis VR , Deckert A , Dambach P , Horstick O , Lowery Wilson M
Published: October 2022

Background

Antibiotics (AB) are essential to modern day medicine as prophylaxis and therapy. Yet, unnecessary use has various negative effects on individual and global health, such as antimicrobial resistance (AMR) and contribution to high greenhouse gas (GHG) emissions of the healthcare sector. This systematic review provides an overview of unnecessary AB use in European hospitals in order to present possible ways forward.

Methods

The systematic review followed PRISMA guidelines, included as databases were: Embase, ProQuest Environmental Science Collection, PubMed, ScienceDirect, Scopus and Web of Science. Studies conducted among adult in-patients in EU/EEA countries were included if they provided assessment methodology, included a clear standard of measurement and chart reviews were used as evaluation basis.

Results

Fifty-six included studies were categorised into the following three groups: (1) Studies using an established evaluation method; 20 studies belong to this group, 18 used the same, established approach. Eleven of these studies performed an observational audit, while the interventions in the remaining studies were of educational or advisory nature. Unnecessary AB use ranged from 1.5% to 51% of all observed prescriptions. Outcomes of interventions showed great variation of effects on unnecessary use (-34.7% - +11.6). (2) Studies using a newly developed, clearly stated evaluation method (4 studies); (3) Studies which conform with established evaluation methods but the processes were not specified (32 studies). Results are subject to further analysis.

Conclusions

The studies included reported a great range of unnecessary AB use in adult in-patients, for both prophylactic and therapeutic indications. Evaluation methods of unnecessary AB use vary greatly between studies. In future research, comprehensive application of established approaches is essential for better overview and identification of key areas for AMR and GHG emission reduction activities.

Key messages

• Unnecessary antibiotic use varies greatly among studies conducted in European adult in-patients.

• In future research, wider application of established evaluation methods will improve comparability and targeting of interventions.
Information technology systems to support antimicrobial stewardship programs
Authors: Gallinoro V , Grazzini M , Paolini D , Dannaoui B , Farese A , Mantengoli E , Ipponi A , Pieralli F , Bonaccorsi G , Niccolini F
Published: October 2022

Problem

Inappropriate antibiotic use contributes to the emergence and spread of multidrug-resistant organisms that are responsible for life-threatening infections. Furthermore, overprescription of antibiotics is associated with an increased risk of adverse effects and higher costs.

Description of the problem

Careggi is a tertiary care teaching hospital in Italy, with nearly 1,200-bed units, involved since 2015 in antimicrobial stewardship (AMS) programs. Despite implementation programs, carbapenems (CAR) consumption rates remained higher than the national average; for this reason, the AMS hospital team started a project aimed at improving the appropriateness of this type of drug.

Results

The project started in October 2021 and involved 10 hospital Units selected as the major prescribers of CAR. The strategies were planned by a multi-professional and multi-disciplinary team of experts in AMS and were set in place by a multimodal approach focused on information technology (IT) functions implemented in the electronic medical record such as:

• time-out alerts at 72 hours inviting physicians to evaluate if the prescribed antimicrobial is still warranted or effective against the identified organism(s);

• interactive and customizable prescribing algorithms to support physicians in empirical and targeted therapies;

• electronic dashboards viewable by physicians and the AMS team to daily monitor and review CAR prescriptions.

These functions were complemented by a series of training sessions for prescribing physicians aimed to promote a more rational and appropriate antimicrobials use. Six months after the project began, an overall reduction in the prescription of CAR was observed: from 6.2 DDD/100 patient-days to 4.9 DDD/100 patient-days.

Lessons

AMS programs use different interventions to influence the behavior of prescribers toward more appropriate use of antimicrobials. IT functions represent complementary and useful tools to promote antimicrobial stewardship programs.

Key messages

• Antimicrobial stewardship programs aim at optimizing antibiotic use and reducing inappropriate antibiotic prescriptions.

• Information technology systems represent useful tools within AMS programs.
Elevated stress during pregnancy in women of Turkish origin: Results from a prospective cohort study
Authors: Scholaske L , Entringer S , Razum O , Spallek J
Published: October 2022

Background

Ethnic health disparities exist in the context of pregnancy and childbirth, suggesting that women of Turkish origin (i.e., they or their parents born in Turkey) in Germany have higher risks for some adverse maternal health and child developmental outcomes. Stress is believed to be a relevant pathway by which migration may be associated with these risks. In this study, we tested associations of Turkish origin with stress biology and psychological stress experiences during pregnancy.

Methods

140 pregnant women (33 of Turkish/26 of other origin) participated in a prospective cohort study that was carried out in Bielefeld and Berlin (Spallek et al., 2020). Inflammatory markers CRP and IL-6 from venous blood samples and diurnal cortisol profiles from salivary cortisol samples were derived and participants completed the Perceived Stress Scale (PSS) and Center for Epidemiologic Studies Depression Scale (CESD) at two study visits during pregnancy (T1: 20-25 weeks of gestation, T2: 30-35 weeks of gestation). Multilevel models were conducted to account for the nested data structure due to repeated measurements.

Results

Compared to non-migrant women, women of Turkish origin had significantly higher inflammatory levels (b = 0.28, SE = 0.14, p=.052) (Spallek et al., 2021), a blunted cortisol awakening response (b=-0.21, CI=-0.38–0.03, p<.05), a flatter diurnal cortisol slope (b = 0.02, CI = 0.00-0.04, p<.05), and higher PSS (b = 0.46, SE = 0.13, p< .001) and CESD scores (b = 0.29, SE = 0.08, p<.001) during pregnancy after adjusting for socioeconomic factors.

Conclusions

The results of our study suggest higher stress at the biological and psychological level in pregnant women of Turkish origin. Stress is a risk factor for pregnancy complications and poor birth and child developmental outcomes. To reduce such unequally distributed risks, interventions for stress reduction are needed that are tailored to women of Turkish origin.

Key messages

• Women of Turkish origin in Germany have elevated psychological and biological stress levels during pregnancy compared to non-migrant women.

• This finding underscores the need for targeted interventions to reduce stress in this high-risk group.
Training peer researchers for CBPR on racism in health care in Germany
Authors: Gangarova T
Published: October 2022

For many affected by ongoing coloniality, research is not neutral or objective, but is part of the colonial violence inflicted through disciplines as diverse as medicine and ethnography. Against this background, choosing Community-based Participatory Research (CBPR) as research strategy for researching racism in health care can be seen as a way of challenging existing epistemologies of ignorance by embracing diversity of knowledge production. ‘Community Perspectives on Racism in Health Care’ is a participatory research project carried out in the frame of the National Discrimination and Racism Monitor which aims to improve the involvement of people affected by racial injustice in the research process, collect data on and generate theory about healthcare-related racism. It is conducted by DeZIM-Institut in collaboration with different racialized communities. Community members were trained as peer researchers and supported to conduct CBPR-projects. Two CBPR-projects were conducted: 1) digital focus groups with people marked as Muslims 2) digital focus groups with Black people. ‘Racial’ health disparities were identified on three levels: differential access to health care, differential care within the system and differences in exposures. The theory was built inductively, while drawing on existing theoretical concepts from the disciplines of public health, postcolonial and decolonial studies. Racialized people used the opportunity to be trained as peer researchers. They conducted CBPR projects tailored to the needs of their communities and conceptualized racism in the broader context of health care. Suggestions were made for improving health care services. Including those most impacted by racial injustice as peer researchers enables us to widen the “we” who constitute the researchers and to harvest the wisdom of situated knowledges. However ongoing challenges have been faced raising the question of the (im)possibilities of democratic knowledge production in German academia.

Key messages

• Including those most impacted by racial injustice as peer researchers enables us to harvest the wisdom of situated knowledges.

• Ongoing challenges have been faced by trying to establish democratic knowledge production in German academia.
Years of life lost for 137 causes of death in Belgium by age, sex, and region, 2004-2018
Authors: Scohy A , De Pauw R , Gorasso V , Van den Borre L , Devleesschauwer B
Published: October 2022

Information on years of life lost (YLLs) due to premature mortality is necessary to assess the fatal impact of disease, crucial for the calculation of Belgian disability-adjusted life years (DALYs). This study presents a novel method to redistribute cause of death data. Belgian cause of death data are obtained from Statistics Belgium (Statbel). After mapping the ICD-10 codes defining the underlying cause of death to the GBD cause list, we redistributed ill-defined deaths (IDDs) to specific causes using a four-step probabilistic redistribution process developed to fit the Belgian context: internal redistribution, redistribution using predefined ICD codes, redistribution using multiple causes of death data, and redistribution to all causes. Finally, we used the GBD 2019 standard life expectancy table to calculate the years of life lost at age of death. In Belgium, between 2004 and 2018, IDDs increased from 31% to 34% of all deaths, reflecting increases in the average age at death. The majority was redistributed using predefined ICD codes (13%), followed by the redistribution using multiple causes of death data (10-11%). The total number of YLLs decreased from 1.83 to 1.77 million. In 2018, the top causes of YLLs were ischemic heart disease and lung cancer with a share of 8.4% each, followed by dementia and cerebrovascular disease with a share of 5.5% each. All results are stratified by age, sex, region, and year, and can be explored via an online tool: https://burden.sciensano.be/shiny/mortality.
Report from public health decision-maker interviews
Authors: Landsman Keren
Published: October 2022

Report from NGO interviews on impact on vulnerable communities

Sylvia Agbih

Ethik der Medizin, University of Augsburg, Augsburg, Germany

Contact: sylvia.agbih@med.uni-augsburg.de

Report from school interviews

Quintus Sleumer

Ethik der Medizin, University of Augsburg, Augsburg, Germany

Contact: quintus.sleumer@uni-a.de

Report on selected key ethical issues arising from analysis

Verina Wild

Ethik der Medizin, University of Augsburg, Augsburg, Germany

Contact: verina.wild@uni-a.de

Building for the future: some thoughts on a comprehensive ethics assessment

Angus Dawson

Sydney Health Ethics, University of Sydney, Sydney, Australia

Contact: angus.dawson@sydney.edu.au
Life-work balance of school-principals during the COVID-19 pandemic in Poland
Authors: Leksy K , Borzucka-Sitkiewicz K , Muster R
Published: October 2022

Background

The health crisis caused by the COVID-19 pandemic has severely affected the education sector and its whole community. Due to their responsibility for organizing schoolwork, school managers were in an extremely challenging position. The main objective of the present study is to reveal the extent to which school principals in Poland put aside their own needs in favor of fulfilling their professional duties during the COVID-19 pandemic.

Methods

The results come from an online survey among school principals in Poland, which is part of the international COVID-19 Health Literacy School Principals Survey. The survey was conducted in 8 out of 16 provinces in Poland between June 2021 and December 2021. 1899 school principals participated in the survey, of which 928 completed the questionnaire.

Results

The study revealed that 68,3% of school principals often and very often worked longer than contractually agreed and 71,3% reported to be available for their colleagues, pupils, and parents in their free time. Most of them also had to give up leisure activities in favor of work (67,9%), work extra hours in their spare time (60%), waive breaks during working hours (57,3%), and did not get sufficient sleep in favor of work (50,5%). Devoting more time to work and high stress levels during the pandemic were associated with somatic complaints among respondents (e.g. muscle pain (neck, shoulder, or back) and headache).

Conclusions

The results suggest that Polish school principals worked at the expense of their free time and health during the COVID-19 pandemic. As such, findings emphasized a lack of life-work balance and the need to raise their awareness of the consequences of self-exploitation in work in challenging times. The ability to set healthy boundaries between work and private life among managers is one of the health promotion tasks in demanding times.
Future in Pediatrics: prevention in maternal child chronic diseases in the first 1000 days
Authors: Hugonin-Rao B
Published: October 2022

Introduction

The screening and management of obesity, metabolic chronic conditions conditions and genetic predisposition, before and during pregnancy, improve the effects of therapies and reduce the rate congenital diseases, metabolic fetal disorders and early chronic diseases during first 1000days. The maternal child health promotion program ‘Future in Pediatrics’ is dedicated to women in preconception and in early pregnancy, with three steps: 1) a specific survey, 2) a personalisated plan 3) the management of chronic conditions (diabetes, hypertension, overweight, metabolic disorders) and surveillance during the first maternal child 1000 days. Encouraged results

Methods

In 2019-2021, FUTURA project involved 460 women (before,during and after pregnancy) into 2 groups: group 1 of 280 women, with overweight/ obesity, metabolic conditions, malnutrition, and hypovitaminosis, group 2 of 180 women without chronic conditions, but physical inactivity, high level of homocysteine (60 to 100 μmol/L) and with predisposition for cardiovascular diseases. We have involved the patients in a survey of 100 questions about health, lifestyle, habits, sleep and in a daily diary. In the second time we have realized a personalised and educational program for diet, supplementations sleep, physical activities, health routine.

Results

The 2 groups of women improved the quality of their health and the management of weight, chronic and metabolic conditions, with impact on reproductive and perinatal health, reduction of inflammatory status and metabolic parameters.We have observed a great influence on cardiovascular health in both groups and decreased of homocysteine levels in the 2nd group. During first 1000 days 393 women, involved into the program, continued with the healthy and preventive routine with zero cases of weight and metabolic chronic disorder in their children.

Conclusions

This research that the prevention in perinatal health influences the children's health.

Key messages

• The origins of chronic and metabolic conditions are in uterine life before the conception. The unhealthy lifestyle influenced fertility, cardiovascular health and child health.

• The cardiovascular health and metabolic chronic conditions are influenced by first 1000 days health and habits.
Structural and school factors, affirmation and well-being among gender minority youth across Europe
Authors: Sevic S , Klasnic K , Doyle DM
Published: October 2022

Background

Previous research has shown that structural-level factors (discriminatory laws and policies) result in impaired health and well-being for transgender and gender diverse (TGD) adults. This study aims to assess if structural stigma is associated with school bullying/victimization and well-being among TGD youth and if more LGBTI supportive school environments, as well as social, physical, and legal gender identity affirmation ameliorate the effects of both structural stigma and experiencing violence.

Methods

The study was conducted online in 2019 in 27 EU Member States and in the UK. We analyzed data from TGD students, aged 15 to 24 years, who at most had completed lower secondary education (n = 2,714). Well-being indicators used in the analyses included one-item measures of life satisfaction, depression, and considering leaving or changing school.

Results

School environment, but not structural-level stigma, was associated with school bullying/victimization. Similarly, the effects of structural-level stigma, along with physical and legal gender identity affirmation were inconsistently related to students’ well-being across the multilevel models, whereas a more positive school environment and especially experiences of social identity affirmation were related to greater life satisfaction, better mental health, and lower odds of considering leaving or changing school; even though the negative effects of school bullying/victimization remained statistically significant across all models.

Conclusions

This study's results suggest that compared with distal factors, more proximal factors - better school environment and social identity affirmation - have a greater impact on TGD students’ well-being. Given the inconsistency of our findings, more research is needed to understand the role of structural stigma and legal and physical gender identity affirmation in TGD students’ well-being.
Psychotherapy and change in mental health-related work disability - A prospective population level register-based study in Finland
Authors: Kausto J , Gluschkoff K , Selinheimo S , Turunen J , Väänänen A
Published: October 2022

Introduction

Mental disorders are a major cause of work disability among working age population. Psychotherapy has been shown to be an effective treatment for mental disorders, but the evidence mainly comes from small scale randomised trials with a relatively short follow-up.

Objectives

We used population-based register data to examine the association between statutory rehabilitative psychotherapy and change in depression or anxiety related work disability using a quasi-experimental interrupted time series analysis.

Methods

All those who started rehabilitative psychotherapy in 2011-2014 comprised the study group. The study group included 10436 participants who were followed from three years prior to four years after the onset of rehabilitative psychotherapy, resulting in 83488 observations. Annual total number of mental health related work disability months was calculated based on total number of annual compensated sickness absence and disability pension days.

Results

The onset of rehabilitative psychotherapy marked a decline in depression or anxiety related work disability as compared to the counterfactual trend. Specifically, a 20% decrease in the level (incidence rate ratio, IRR 0.80; 95% CI 0.76-0.85) as well as a 48% decrease in the slope (IRR 0.52; 95% CI 0.50-0.54) of work disability was detected. The decline was steepest in the oldest age-group

Conclusions

Providing statutory psychotherapy may decrease work disability at the population level. Further evidence for causal inference and the potential heterogeneity of the association is required.
Preschool children’s temperament and its associations with energy intake
Authors: Pajulahti R , Ray C , Salmela-Aro K , Korkalo L , Lehto R , Vepsäläinen H , Nissinen K , Roos E , Erkkola M
Published: October 2022

Background and objectives

Child's temperament dimensions have been linked with different weight outcomes as well as dietary factors such as consumption of fruit and vegetables, sugar-rich foods and drinks and an overall dietary quality. Links between temperament dimensions and energy intake, however, remain under-examined. This study expands the literature by investigating associations between child's temperament dimensions and energy intake.

Methods

Altogether 505 Finnish children aged 3-6 years provided data for the analyses. The data is a part of the DAGIS (Increased Health and Wellbeing in Preschools) study conducted in 2015-2016. Child's energy intake was measured with 3-day food records. To be included, children had to 1) have food record for two preschool days and one weekend day and 2) to have consumed both lunch and an afternoon snack in the preschool on the two preschool days. The very short form of Children's Behavior Questionnaire was used to measure child's temperament dimensions. Concurrent associations between three temperament dimensions (surgency, negative affectivity, and effortful control) and energy intake were examined using linear regression models adjusted for child's age, sex, mother's highest education, and moderate-to-vigorous physical activity.

Results

Surgency, temperament dimension referring to characteristics such as impulsivity, high activity level and high approach, was positively associated with energy intake. Effortful control or negative affectivity were not associated with energy intake.

Conclusions

The findings imply that temperamental surgency may be one relevant determinant of energy intake among preschool children. The result is in line with previous studies linking child's surgency as well as its specific facets, such as impulsivity, with weight outcomes and food approach behaviors. Considering child's individual temperament dimensions when counselling families in eating issues could be beneficial.

Key messages

• Surgency, a temperament dimension referring to characteristics such as impulsivity, high activity level and high approach, was positively associated with energy intake.

• When promoting children’s balanced eating, tailored support for parents acknowledging child’s temperament could be beneficial.
The bidirectional relationship between growth and appetite regulation in the first year of life
Authors: Demetriou C , Singhal A , Lanigan J , Mahmood A , Vichas C , Hileti D
Published: October 2022

Childhood obesity is a public health crisis. Even though appetite traits in infancy were associated with childhood adiposity, whether early weight gain can influence later appetite has not been researched. Our aim was to prospectively examine the bidirectional association between growth and appetite traits during the first year of life. We followed up 450 healthy term infants for 12 months (m). Appetite traits at 4 weeks (wk), 6m and 12m were assessed using the Baby and Child Eating Behaviour Questionnaires. Infant feeding, anthropometric, socioeconomic and demographic data were also collected. Infant weight-for-age z-scores (WFAZ) were calculated using the WHO 2006 growth reference. Growth was assessed as conditional WFAZ change (cWFAZc) by saving the residuals from linear regression models of WFAZ at each successive time point versus WFAZ at the earlier time point. Multivariable linear regression was used to analyse bidirectional associations between cWFAZc (0-4wk, 4wk-6m, 6-12m) and appetite traits Enjoyment of Food (EF), Food Responsiveness (FR), Satiety Responsiveness (SR) and Slowness in Eating (SE) at 4wk, 6m and 12m. All models were adjusted for relevant confounders. At 4wk, SR score was associated with lower (β:-0.16; 95% CI:-0.28,-0.03), and FR score with higher (β:0.10; 95% CI:0.01,0.19) cWFAZc from 4wk to 12m. SR score at 6m was inversely associated with cWFAZc from 6-12m (β:-0.09; 95% CI:-0.16,-0.01). Conversely, higher cWFAZc between 4wk-6m was associated with higher EF (β:0.10; 95% CI:0.01,0.19) and FR (β:0.16; 95% CI:0.04,0.29) scores at 12m. cWFAZc between 6m-12m was inversely associated with SR at 12m (β:-0.18; 95% CI:-0.35,-0.01). Our results suggest that the growth acceleration hypothesis, where faster growth in infancy leads to later obesity, may be mediated by an up-regulation of appetite traits at 12m. This highlights the public health importance of avoiding growth acceleration in infancy as a way to curb the childhood obesity epidemic.

Key messages

• Weight gain in early infancy impacts appetite regulation in the first year of life and up-regulation of appetite traits at 12 months predisposes to childhood obesity.

• Avoiding growth acceleration in infancy can decrease the risk for childhood obesity.
Understanding eating-related health outcomes: connections between anxiety and eating behavior
Authors: Hussenoeder FS , Conrad I , Löbner M , Löffler M , Tönjes A , Sturmvoll M , Villringer A , Riedel-Heller S
Published: October 2022

Background

Research shows that anxiety is connected to a variety of mental health outcomes, and that it is widespread among the population. In the light of the great personal and societal costs of obesity and eating disorders, we want to understand the connection between anxiety and different dimensions of eating behaviors that have a strong empirical link with negative eating-related health outcomes.

Methods

We used data from the population- based LIFE-Adult-Study (n = 5019) to analyze the connection between anxiety (GAD-7) and the three dimensions of eating behaviors: Cognitive Restraint, Disinhibition, and Hunger (FEV, German version of the Three-Factor-Eating-Questionnaire). We controlled for sociodemographic variables, smoking, physical activity, personality, and social support.

Results

Multivariate regression analyses showed significant positive associations between anxiety and Disinhibition (β = 0.23, p ≤ 0.001), Hunger (β = 0.21, p ≤ 0.001) and Cognitive Restraint (β = 0.04, p ≤ 0.01). After adding control variables, analyses revealed significant positive associations between anxiety and Disinhibition (β = 0.15, p ≤ 0.001) as well as Hunger (β = 0.14, p ≤ 0.001), but not between anxiety and Cognitive Restraint (β = 0.03, p = 0.076).

Conclusions

There is an empirical connection between anxiety and two factors of eating behavior, i.e., Disinhibition and Hunger. If future research strengthens the assumption of a causal direction from anxiety to those factors, interventions that help individuals to better regulate and cope with anxiety, could be one potential pathway to reducing eating disorders and obesity in the population.

Key messages

• There is a significant connection between anxiety and eating behavior.

• Interventions that address anxiety could reduce problematic eating-related health outcomes like eating disorders and obesity.
11.D. Workshop: Depression comorbidity in prediabetes and diabetes: evaluating risk factors and outcomes
Authors:   Organised by: Tuebingen University (Germany),   Chair persons: Norbert Schmitz (Germany)
Published: October 2022

Depression is a common comorbidity in prediabetes and diabetes. Evidence for the interaction of depression and behavioural and biological risk factors for (pre-) diabetes and diabetes-related outcomes will be presented and discussed using longitudinal data from the Lifelines Cohort, the Canadian Longitudinal Study on Aging, and the Cartagene study. In addition, digital phenotyping will be discussed as an alternative approach for the assessment of mobility and behaviour in people with diabetes.

Key messages

• Behavioural, psychosocial and biological risk factors might increase the risk of poor diabetes outcomes in a synergistic way.

• Prevention program for diabetes and diabetes realted outcomes should focus on behavioural, psychosocial and biological risk factors simultaneously.
Systemic inflammation and the risk of depression in people with type 2 diabetes
Authors: Schmitz N , Graham E , Deschenes S
Published: October 2022

Background

Depression is a common co-morbidity in diabetes. The mechanisms underlying the association between depression and diabetes are poorly understood. Although risk factors, such as poor lifestyle behaviours, obesity, and stress have been identified, emerging evidence suggests that systemic inflammation may play an important role in the pathogenesis and recurrence of depression in people with diabetes. The aim of the present study was to evaluate if the inflammatory marker C-reactive protein (CRP) is associated with an increased risk of major depression episodes in people with type 2 diabetes.

Methods

A prospective, community-based study was conducted in Quebec, Canada. Individuals were recruited from the CARTaGENE (CaG) cohort, a population-based survey of Quebec residents aged 40 to 69 years. Our sample included 719 individuals with type 2 diabetes and 1423 individuals without diabetes. Individuals were assessed at baseline and 5 years after baseline. Major depression disorders were assessed using a clinical interview (CIDI). Inflammatory markers were assessed from blood samples. Elevated CRP levels were defined as ≥ 3 mg/L.

Results

Participants with both diabetes and elevated CRP levels had the highest risk of major depressive episodes (adjusted OR = 1.90, 95% CI 1.45, 2.50), compared to those without diabetes and without elevated CRP levels. The risk of major depressive episodes in individuals with diabetes without elevated CRP episodes was lower (adjusted OR = 1.21, 95% CI 0.85, 1.73) and similar to the risk of those without diabetes and elevated CRP levels (adjusted OR = 1.15, 95% CI 0.94, 1.39).

Discussion

The study highlights the interaction between diabetes, inflammatory makers, and depression in a community sample. Early identification, monitoring, and management of elevated inflammation levels might be an important depression prevention strategy in people with type 2 diabetes.
Primary mental health care in India for older people: stigmatization and community-orientation
Authors: Kafczyk T , Hämel K
Published: October 2022

Background

In India, older persons are among the fastest growing population groups that are particularly vulnerable to an impaired mental health. Strengthening public primary mental health care (PMHC) has been one of the political priorities in recent years, including efforts to provide more old age-inclusive care. Many factors play a role in shaping equitable access to PMHC. In this study, we focus on how social norms and perceptions of mental health in old age on the community-level facilitate or hamper access to inclusive PMHC.

Methods

Semi-structured interviews with key informants (n = 14) from the fields of mental health and old age policy and practice have been conducted and analyzed.

Results

The interviewees describe barriers and opportunities towards old-age inclusive and community-oriented PMHC that go beyond the availability of services. The stigmatization of mental health - especially in old age - is a major barrier that is deeply rooted within the family and community care system. While experts stress the relevance of relatives in fostering mental health of older people, a lack of awareness of facets of mental health and a fear of stigmatization within communities prevents older persons and their family caregivers to seek formal mental healthcare. Moreover, experts describe an increasing disintegration of family support systems in rural and urban areas. Therefore, a more prominent role for outreach-support provided by community health workers (CHWs) is suggested. However, according to experts, transforming the scope of practice of CHWs to include mental healthcare for older persons is still predicted to be a major challenge.

Conclusions

To improve equitable access to and participation of older persons and their families in PMHC, the perceptions and attitudes towards mental health and old age need to be considered.
Language barriers for primary care access in Europe: a systematic review
Authors: Evenden R , Singh N , Sornalingam S , Harrington S , Paudyal P
Published: October 2022

Background

A recent increase in migration both inside Europe and from non-European countries has expanded the language profile of many European countries. As a result, there has been a significant increase in barriers to healthcare access experienced by linguistic minority migrants. This systematic review aims to explore language barriers in primary care, focusing on the experiences of linguistic minority migrants living in Europe.

Methods

PubMed, Embase, Scopus and Global Health were searched to identify studies published in English until May 2021. Qualitative and mixed methods studies on either linguistic minority migrants or healthcare workers working with linguistic minority migrants, exploring the impacts of language barriers in a primary care setting published were eligible. The studies were analysed using a Braun and Clarke's thematic analysis approach. Quality of the studies were assessed using the Mixed Methods Appraisal Tool.

Results

16 studies from 14 different European countries were eligible. Participants in the studies included four groups: linguistic minority migrants (n = 11), healthcare workers (n = 10), interpreters (n = 1) and administrative staff (n = 1). Barriers identified included a lack of interpreters, limited cultural competence of practitioners, a lack of practitioner training and knowledge, a lack of accessible information for migrants, difficulties expressing emotions and building patient-practitioner relationships, and risks to women's bodily autonomy resulting from language barriers.

Conclusions

Linguistic minority migrants living in Europe face a number of barriers when accessing primary care. These barriers can risk patient safety, reduce the likelihood of seeking healthcare services, and impact patient experiences of healthcare services. There is a need for improved interpreter services, practitioner training, and information accessibility for both migrants and healthcare staff.

Key messages

• Linguistic minority migrants experience significant barriers to primary healthcare access across Europe.

• There is a need for improved interpreter services, practitioner training, and information accessibility for both migrants and healthcare staff.
Ethnicity and paediatric healthcare utilisation: Improving the quality of quantitative research
Authors: Zhang CX , Quigley MA , Bankhead C , Bentley T , Otasowie C , Carson C
Published: October 2022

Background

The COVID-19 pandemic highlighted the stark health inequities affecting minority ethnic populations in Europe. However, research on ethnic inequities and healthcare utilisation in children has seldom entered the policy discourse. A scoping review was conducted in the UK, summarising and appraising the quantitative evidence on ethnic differences (unequal) and inequities (unequal and unfair or disproportionate to healthcare needs) in paediatric healthcare utilisation.

Methods

Embase, Medline and grey literature sources were searched for studies published 2001-2021. Studies that found differences and inequities were mapped by ethnic group and healthcare utilisation outcome. They were appraised using the National Institute for Health and Care Excellence appraisal checklists. The distribution of studies was described across various methodological parameters.

Results

Of the 61 included studies, most found evidence of ethnic variations in healthcare utilisation (n = 54, 89%). Less than half attempted to distinguish between ethnic differences and inequities (n = 27, 44%). Studies were concentrated on primary and preventive care and hospitalisation, with minimal evidence on emergency and outpatient care. The quality of studies was often limited by a lack of theory underpinning analytical decisions, resulting in conflation of difference and inequity, and heterogeneity in ethnic classification. The majority of studies examined children's ethnicity but overlooked parent/caregiver ethnicity, and also didn't investigate patterns across age, year or location.

Conclusions

To improve the validity, generalisability and comparability of research on ethnicity and paediatric healthcare utilisation, findings from this scoping review were used to develop recommendations for future research. These lessons could be applied more broadly across the European context to improve evidence generation and evidence-based policy-making to reduce inequities in healthcare.

Key messages

• Quantitative studies of ethnicity and paediatric healthcare utilisation in the UK lack the use of sound theoretical frameworks, and often do not distinguish between ethnic differences and inequities.

• The quality of future studies can be improved with greater attention to how ethnicity is classified and analysed, alongside specific considerations for examining healthcare utilisation in children.
Health Service Experiences of Transgender Individuals from Foreign Backgrounds in Finland
Authors: Czimbalmos M , Rask S
Published: October 2022

Background

Internationally, an increasing body of scholarship has focused on the experiences of transgender individuals when accessing gender-affirming healthcare. However, the experiences of transgender individuals who belong to the foreign background population in Finland have rarely been studied. This study aims to fill the gap in research and contribute to the understanding of the experiences of acquiring gender-affirming healthcare among those, who fall into the intersections of transness and also identify of foreign origin in Finland.

Methods

Fourteen semi-structured qualitative interviews were conducted and analyzed with reflexive thematic analysis (RTA), through the framework of intersectionality. The interviews were part of a broader sample of qualitative data, collected about the experiences of sexual and gender minorities among the foreign origin populations in Finland.

Results

The analysis showed two main interconnected themes. Firstly, perceived barriers when accessing gender-affirming care. In this theme, the intersections of transgender identity, foreign background, class, and age affected the experiences of the individuals. Secondly, the necessity of “performing identities:” the intersections of class, transgender identity, and race affected those.

Conclusions

The findings of the current study suggest that the intersectional aspects of individual identities create structural inequalities in the Finnish gender-affirmation healthcare system. To tackle these inequalities, further research is needed on the healthcare experiences of gender minorities in Finland both within and outside the scope of transgender-specific healthcare.

Key messages

• Intersectional aspects of individual identities create structural inequalities in accessing gender-affirming healthcare.

• Further research is needed on the healthcare experiences of gender minorities that examines health and wellbeing using an intersectional lens.