bluuebunny/crossref_metadata_2025 huggingface dataset:
Strengthening public health professionals in policymaking in the Eastern WHO European region
Authors: Hein J , Verschuuren M , Aragon De Leon E
Published: October 2024

Background

The collaborative research between EUPHA and WHO aimed to explore factors impacting public health professionals’ (PHP) involvement in health policy processes in the Eastern WHO European Region, addressing barriers, enablers, and capacity-building needs.

Methods

Utilizing a mixed methodology, the study employed document analysis, scoping review, and interviews to triangulate data, with the document analysis focusing on 4 published Essential Public Health Operations Self-Assessment Reports, the scoping review analysing 15 key articles, and 5 semi-structured interviews providing additional insight from key country stakeholders.

Results

Core findings revealed significant barriers impeding PHPs' participation in policy processes. Among others, these included limited intersectoral collaboration, shortage of skilled public health (PH) personnel, financial resource constraints and inadequate governance structures. Conversely, several enablers were identified, such as a positive trend in increased intersectoral collaboration and innovative governance structures during Covid-19, the development of more trained PHPs and the utilization of International Health Organisations. The two main capacity building needs reported were the importance of modernizing PH education and promoting intersectoral collaboration.

Conclusions

This study offers a preliminary overview of how PHPs' involvement in health policy processes in these countries can be enhanced: More intersectoral collaboration, updated PH education curricula and trainings, and governance re-design building on positive trends seen during the pandemic. Following actions are recommended: Creation of an international platform for cross-sectoral PH communication & exchange, direct support for universities and PH researchers, development of comprehensive PH trainings, assistance in forming or strengthening national public health associations and identification & sharing of effective local governance practices.

Key messages

• This research identifies barriers to PHPs’ participation in Eastern WHO European Region's health policy processes, while highlighting enablers like increased collaboration during Covid-19 to build on.

• Recommendations to harness the enablers include clear actions such as creating an international public health platform for interaction and exchange or build-up of national public health associations.
Knowledge, attitudes and practices of Italian general practitioners on food supplements
Authors: Driutti M , Cozzarin F , Celotto S , Arnoldo L , Brunelli L , Menis D
Published: October 2024

Background

Food supplements are widely used, but they can be dangerous if used inappropriately, as they often interaction with patients’ treatment. Their misuse has public health and patient out-of-pocket expenditure implications; general practitioners (GPs) play a central role in managing patient safety. This study aims to investigate the knowledge, attitudes and practices (KAP) of Italian GPs’ toward the use of food supplements.

Methods

From March to April 2024, an online survey was conducted via the EU-Survey platform among Italian GPs invited through their professional organization. The 62-question survey, adapted from a tool used among pharmacists, comprises two sections: A) KAP questions (28 true/false, 34 on a 5-point Likert scale) and B) socio-demographic questions (i.e. age, sex, years of experience, urban/extra-urban environment). Survey reliability was evaluated using Cronbach alfa and responses were analysed to look for differences between sub groups using Kruskal Wallis Test.

Results

202 GPs participated in the survey, 46.0% were male, 53.5% female and 0.5% non-binary, with a mean age of 47±2 years. The majority (70.3%) came from an urban environment and 54.9% worked in group medicine. Only 53.5% of GPs showed an adequate knowledge of the topic (more than 60% of correct answers), with a mean of 18 correct answers. The overall reliability of the test was evaluated as acceptable (alfa>0.7). The 99.5% of GPs interview agreed (score 4 or more on the Likert scale) that they have an important role in food supplements prescription and 98% are involved in life styles counselling activities, but only 66.3% felt they have adequate formation on the topic. No statistically significant differences between population groups were found (p < 0.05).

Conclusions

Although GPs have recognized their key role in prescribing food supplements, there seem to be a general lack of knowledge on the subject that requires targeted educational interventions to ensure patient safety.

Key messages

• Food supplements are often taken by patients because they are under the impression that these products are always and completely safe.

• Clinical recommendations for the use of food supplements are much more limited than their actual use.
Interaction between alcohol intake and employment status changes on mortality among young workers
Authors: Park H , Yun B , Oh J , Sim J , Lee J , Yoon J
Published: October 2024

Background

To investigate the impact of changes in employment status and their interaction with alcohol consumption on health outcomes among young workers. This study aims to explore how employment fluctuations, periodic unemployment, and economic activity levels influence the health of economically active individuals, focusing particularly on the synergistic effects that these employment changes may have when combined with alcohol consumption.

Methods

We conducted a retrospective cohort study using data from the Korean National Health Insurance Service database. The study included individuals aged 25-44 years who underwent health check-ups between 2009 and 2010. We categorized changes in employment status into three groups: continuously employed, economically active with employment fluctuations, and periodically unemployed. We estimated adjusted hazard ratios and 95% confidence intervals using multivariable Cox proportional hazard models to assess the impact of changes in employment status on the risk of all-cause mortality. The relative excess risk due to interaction, a widely accepted indicator of additive interaction, was used to assess the interaction between alcohol consumption and changes in employment status.

Results

Changes in employment status significantly increased the risk of all-cause mortality in both men and women in the economically active with employment fluctuations and periodically unemployed groups compared with the continuously employed group. The synergistic effect of alcohol consumption and changes in employment status on the risk of all-cause mortality was significant only among men.

Conclusions

The findings of this study indicate that changes in employment status, particularly when combined with alcohol consumption, significantly affect all-cause mortality among young workers.

Key messages

• Employment status fluctuations combined with alcohol consumption significantly increase all-cause mortality risks among young workers, especially men.

• This study emphasizes the urgent need for targeted interventions that address the combined impact of employment and lifestyle factors on public health.
Let’s Get Walking: Establishing Workplace Walking Groups in a regional Public Health Department
Authors: Kelly C , O’Kane G , Edwards D , Lee J , McCrossan D , Smith L , Farmer W , Conlan C , Fallon U , Cooney F
Published: October 2024

Maintaining staff health and wellbeing (HWB) is an ongoing priority for the Department of Public Health HSE Dublin and Midlands (PHD). This is particularly important in the context of an ongoing programme of reform for Public Health in Ireland. To support this priority, in November 2023 a pilot Workplace Walking Groups initiative was established to increase workplace physical activity and build team relationships. The initiative was designed following staff feedback on team HWB initiatives in September 2023. The Model for Improvement (which includes the Plan-Do-Study-Act cycle) was used to take a structured quality improvement approach to the development and evaluation of the 4-week pilot, led by the PHD HWB Committee. Staff joined across 3 sites. Lunchtime walks were arranged for 1-2 days per week. WhatsApp groups and email supported group communication. Quantitative data on registration and attendance were collected via Microsoft Excel. A virtual focus group was arranged to gather participant feedback, which was analysed into themes. Group registration (n = 10, n = 9, n = 5) and weekly attendance varied by site (n = 10, n = 9, n = 5). Key benefits noted by participants included physical activity, building relationships with colleagues, and getting fresh air. The main barrier was the impact of work schedules on attendance. There was broad support for re-establishment of Workplace Walking Groups for 2024. This pilot Workplace Walking Groups initiative achieved its dual aim of increasing physical activity and social connection among staff. Learning from this pilot informed the launch of a 3-month Walking Groups term for Spring 2024. The initiative is now established practice and is a component of the Department’s blended working policy, being a feature of on-site working days.

Key messages

• Our successful pilot Workplace Walking Groups project has translated into a sustainable health and well-being initiative for staff, during a time of ongoing reform across Public Health in Ireland.

• A structured approach to designing and implementing staff health promotion initiatives is crucial to support the cycle of learning and improvement, and to sustain change over time.
The Effect of Multidisciplinary Care on Polypharmacy in Advanced Cancer Patients near the End of Life
Authors: Kao Y C , Chen Y Y , Lin K C , Chang H C
Published: October 2024

Objectives

Multidisciplinary Team (MDT) aims to integrate cancer patient care plans and provide holistic care to improve clinical outcomes and quality of life. However, there is a lack of empirical evidence regarding the effect of MDT on polypharmacy in advanced cancer patients near the end of life, which warrants further investigation.

Methods

This retrospective cohort study utilizes the National Health Insurance Research Database (NHIRD), Taiwan Cancer Registry, and Cause of Death Statistics, provided by the Health and Welfare Data Science Center (HWDC), Ministry of Health and Welfare (MOHW). The study subjects were patients who were diagnosed with stage III or IV cancer, aged 65 or above, experienced recurrence or metastasis, and who died between 2014 and 2020. Propensity score matching (PSM) was employed, followed by analysis using the Generalized Estimating Equation (GEE) to examine the differences in the risk of polypharmacy in the last 30 days before death. In addition, to confirm the robustness of the results, we conducted two different sensitivity tests: the first way is to use different ages as sample selection criteria and only include people who died over 75 years old as study subjects; the second way is to use conditional logistic regression models as a multivariate statistical method.

Results

There were 35537 samples before matching, including 4942 who received MDT care and 30595 who did not. After 1:1 matching, 9884 patients were finally included in the analysis. The prevalence of polypharmacy significantly decreased during the study period from 59.90% to 58.80% (p = 0.03; trend test). When examined through different PIM criteria, patients who received care from MDT exhibited a lower risk of polypharmacy (OR = 0.91, 95% CI = 0.84-0.98).

Conclusions

Advanced cancer patients who received care from MDT during the end-of-life period had a significantly lower risk of polypharmacy.

Key messages

• The prevalence of polypharmacy significantly decreased during the study period from 2014 to 2020 among advanced cancer patients.

• Advanced cancer patients who received care from MDT during the end-of-life period had a significantly lower risk of polypharmacy.
Scoping the EU’s health impact in the Southern Neighbourhood: Building resilience and trust
Authors: Perehudoff K
Published: October 2024

Background

The European Neighborhood Policy (ENP) focuses on security, migration, and economic stability. Strengthening health systems can contribute to these aims by building local resilience and institutions; however, little is known about the EU’s health policy and impacts in the Southern Neighborhood (Syria, Lebanon, Jordan, Palestine, Egypt, Libya, Tunisia, Algeria, Morocco). This paper examines the role of health in the ENP and what is known about the health-related impacts of EU actions in this region.

Methods

This is a qualitative case study of the EU’s ENP commitments, outcomes, and impacts (2004-2024) in nine middle-income Southern Neighborhood countries. A scoping review of empirical evidence included 5 scholarly databases and grey literature published. Retrieved publications and the ENP documents were thematically analysed with WHO’s health systems building blocks and the alignment between the ENP and practice was assessed.

Results

ENP health actions have evolved from public health and selected communicable diseases (2004), to health service delivery, vaccine supply, and occupational health (2021). The review included 19 publications (2004-2024). Publications most often addressed the financing (n = 14 papers) and service delivery (n = 9) aspects of health systems (not mutually exclusive), and only once addressed workforce and health information. Publications addressed mostly intentional EU health actions in the region; 4 papers reported unintentional effects.

Conclusions

The limited scope of health actions in the ENPs suggests health may be instrumentalised to pursue the EU’s security and stability goals. The type of EU health actions reported most often in the literature were consistent with the ENP health priorities. There is no systematic evaluation of the impacts of the EU’s health-related commitments in the ENPs. To build resilience and trust in the region, future EU action should support a range of WHO building blocks and mitigate potential negative effects.

Key messages

• The EU’s health commitments in the European Neighborhood Policy evolved from public health & communicable diseases (2004), to health service delivery, vaccine supply, & occupational health (2021).

• There is no systematic empirical evaluation of the impacts of the EU’s health-related commitments in the European Neighborhood Policy.
The effect of team-model on healthcare usage and treatment levels among people with type 2 diabetes
Authors: Lamidi M , Wikström K , Tirkkonen H , Rautiainen P , Laaninen M , Laatikainen T
Published: October 2024

Background

In North Karelia Finland, a team-based service model was implemented in some municipalities’ primary healthcare (PHC) centers during 2020. In this team-model, a healthcare customer contacts a nurse who initiates the service process immediately. Nurses can also consult or direct customers to other healthcare professionals and arrange physical appointments if needed. The aims of the model are improved customer and personnel experience and satisfaction, and improved quality and effectiveness of care. We assess the effect of this team-model on treatment levels, measurement activity, and health care usage among patients with type 2 diabetes (T2D).

Methods

Patients with T2D were identified using the ICD-10 code E11 from the regional electronic health records. The data include all patients diagnosed by 2016 who were alive and residing in North Karelia in 2023 (N = 6312). Diabetes-related contacts with nurses or doctors in outpatient PHC and specialized healthcare (SHC) were considered, along with measurement activity and levels of glycated hemoglobin (HbA1c) and low-density lipoproteins (LDL) between the years 2017 and 2022. Annual differences between areas were analyzed using logistic and linear mixed models.

Results

In 2017, patients’ mean age was 66 and age range 20-93. The proportion of men was 55% and 45% resided in team-model areas in 2023. The team-model increased T2D-related outpatient PHC remote contact with nurses for a couple of years. But eventually they decreased to a lower level than before. Additionally, the team-model reduced the number of other contacts. An increased difference between areas in measurement activity on HbA1c and LDL levels was also observed. But the difference between areas in proportion of those who achieved treatment targets stayed unchanged.

Conclusions

In the long-term, the team-model reduced the number of T2D-related contacts and increased the measurement activity of HbA1c and LDL, but it had no effect on treatment levels.

Key messages

• Team-based service models might potentially reduce service use in the long term.

• More research and evidence are needed on the effectiveness and cost-effectiveness of team-based service models.
Public trust in national electronic health record systems: A scoping review of qualitative studies
Authors: Papadopoulos K , von Wyl V , Gille F
Published: October 2024

Background

Having public trust in national electronic health record systems (EHRs) is essential for the successful implementation of electronic health records within a country’s healthcare system. Without trust, people are less likely to consent to sharing their health data through an EHR and government stakeholders will have difficulties promoting uptake and facilitation of EHRs. Research investigating public trust in EHRs is limited, however. In response, we conducted a scoping review in order to gain clarity on the influences and themes behind public trust in EHRs, which can support the implementation of EHRs.

Methods

We reviewed 27 qualitative studies focusing on public trust in EHRs. Studies were identified between January 2022 and June 2022 and were ascertained using an inclusive search method and guided by the PRISMA-ScR checklist. In an iterative process, conceptual themes were derived, and detail the promoters and outcomes of public trust in EHRs.

Results

Three major themes that describe the promoters of public trust in EHRs and two major themes that detail the outcomes once public trust in EHRs exists were ascertained from the literature. Additional findings bring forth the consequential role of healthcare actors in the public trust building process.

Conclusions

Results show comprehension, autonomy, and data protection are key concepts that help build and consolidate public trust in EHRs, while the public and the healthcare system benefit from public trust in EHRs. Furthermore, health system actors can be supportive or detrimental to the implementation of EHRs. Their effect is dependent on their activities within the health care system and how the public perceives those activities. Based on: Papadopoulos K, von Wyl V, Gille F. What is public trust in national electronic health record systems? A scoping review of qualitative research studies from 1995 to 2021. DIGITAL HEALTH. 2024;10. doi:10.1177/20552076241228024

Key messages

• This research clarifies the conceptualizations that make up the trust relationship between the public and EHRs.

• The findings can assist researchers, policymakers, and other health system actors in attaining a better understanding of the intricacies of public trust in EHRs.
A Review of Lifestyle Interventions in Weight Loss Programs for Community-Based Psychiatric Patients
Authors: Picardo G , Donnoli C , Liotta G
Published: October 2024

Background

Psychiatric patients face aggravated physical health issues and reduced life expectancy, primarily due to premature cardiovascular diseases. The intricate relationship between lifestyle factors, illness, and psychotropic medications contributes to this phenomenon. The focus of this research is to evaluate weight management interventions for individuals with Severe Mental Disorders through a comprehensive scoping review, focusing on diverse study designs, outcomes, and their clinical implications.

Methods

20 studies were analyzed to understand the effectiveness of interventions and characteristics, such as duration, delivery, and professional involvement. Assessment criteria included weight modifications, BMI changes, and metabolic measures like blood pressure and lipid profiles.

Results

The total number of participants included in the 20 studies evaluated was 3886. All trials included individuals of all genders. The studies included patients with a weighted mean age of 44.37 (SD = 4.72) and a mean BMI of 34.7 kg/m2 (SD = 3.56). Varied interventions, mostly conducted in the US, showed promising weight reduction and cardiovascular risk management results among psychiatric patients. However, disparate methods used in the studies hindered the evaluation of outcomes. The studies which yielded more interesting results included Gaughran F. et al, 2017 who showed improvements in HDL cholesterol and metabolic indicators, (HR 0.085; 95% CI:0.007-0.16), and Bartels S. et al, 2015 who reported that 51% of participants achieved clinically significant reduction in overall cardiovascular risk.

Conclusions

Although interventions displayed potential benefits for beneficiaries, the lack of standardized protocols and non-uniform endpoints poses challenges in effectively addressing weight-related concerns in psychiatric patients. Clear guidelines and standardized assessments are necessary to implement psychiatric patients’ weight management interventions.

Key messages

• The health issues and reduced life expectancy of psychiatric patients is a major health burden. The mean BMI of 34.7 kg/m2, indicating a prevalence of Obese individuals needs to be addressed.

• Psychotropic medications are associated with increase in weight. More effort in increasing awareness and including mandatory nutritional educational classes when prescribing these drugs is needed.
Socio-economic gradients in urban green space access and respiratory health
Authors: Szabó D , Pikhart H , Bobák M , Kšiňan A
Published: October 2024

Background

This study investigates social disparities as one of the drivers influencing the access to green spaces and exposure to natural environments, potentially exacerbating disparities in respiratory health in children.

Methods

Longitudinal ELSPAC birth cohort study data included 4384 complete case participants born in cities of Brno and Znojmo, examined throughout the years 1990-2010. Estimates on socio-economic status (SES) scores of children’s parents and their education were used as socio-economical predictors. Tree cover density (TCD) calculated as mean canopy closure percentage in the individual walking distance neighbourhoods and the ownership and accessibility of a garden were used as indicators of green space accessibility. Multiple logistic regression models were employed to estimate odds ratios for predictors of respiratory health outcomes, controlling for several confounders.

Results

Parents’ SES was found to be positively associated with neighbourhood TCD, and this effect was even more pronounced for garden owners. Higher tree cover was then significantly negatively associated with development of acute bronchitis (OR 0.88, CI 95 % 0.84-0.94 for 1 SD of tree cover), while not having a garden (OR 1.81, CI 95 % 1.42-2.33) and living in area with lower tree cover (OR continuously decreasing from 1.88 to 1.68 for lowest and highest quartile respectively) was significantly associated with progression of acute bronchitis into chronic bronchitis in a fully adjusted model. Vice versa, higher tree cover was statistically significantly positively associated with development of allergic rhinitis (OR 1.09, CI 95 % 1.03-1.15), suggesting viability of the novel method of estimation of individual neighbourhood greenness.

Conclusions

The results suggest protective effect of access to urban green spaces against adverse respiratory outcomes in children. The socially uneven distribution of access emphasizes the importance of urban policies in promoting urban health. #NGEU

Key messages

• There is a significant protective effect of access to green spaces against respiratory diseases and their progression.

• There’s an unequal, but varied distribution of access to green spaces, and social gradient in health, highlighting the importance of urban green space distributive politics.
Outdoor living environment and cardiovascular disease risk: results from a Swedish cohort
Authors: Rebouillat P , Mattisson K , Gefenaite G , Nilsson P , Björk J
Published: October 2024

Cardiovascular disease (CVD) is the leading cause of mortality and morbidity worldwide. While sociodemographic, dietary and lifestyle factors have been well documented in relation to CVD, environmental factors have been less studied. However, considering the ongoing biodiversity, climate, and health crises, it is imperative to better understand the interplay between the environment and health. This study aimed to examine the associations between green qualities of the residential environment and CVD. The Malmö Diet and Cancer study is a prospective cohort initiated in the 1990s in the city of Malmö (southern Sweden). At baseline, participants were invited to a health screening, including extensive questionnaires about socioeconomic conditions, lifestyle and diet, clinical examination and blood sampling. The residential coordinates of the participants at baseline were linked to the Scania Outdoor Environment Database comprising scores for a range of perceived qualities of the neighbourhood outdoor environment. Three greenness-related dimensions (serene, natural, diverse) were selected for this substudy. Information on incidence of CVD until 2019 was retrieved from Swedish registers. Adjusted Cox proportional hazards models were used to estimate associations between green-related qualities and cardiovascular diseases (major adverse coronary events). Approximately 27000 participants were included, of which 60% were women. The average age at baseline was 58 years old (±8). Mean follow-up was 20 years (±7) and 4318 cases of major adverse coronary events were identified. Preliminary results suggest that several sociodemographic and lifestyle factors, as well as some aspects of neighbourhood greenness, were associated to increased cardiovascular incidence. Neighbourhood greenness might play a role in major adverse coronary events incidence. Further investigation on underlying mechanisms is required.

Key messages

• Identifying environmental risk factors for cardiovascular disease is of importance for public health.

• Neighbourhood greenness might play a role in cardiovascular disease incidence, and underlying mechanisms need to be investigated further.
Changes in anxiety among youth with and without disabilities before, during and after the pandemic
Authors: Lehtola SMH , Holm M E , Kiviruusu O , Sainio P , Lundqvist A
Published: October 2024

Background

Disabled youth are a vulnerable group that have faced challenges during the pandemic. Research about mental health and its changes of disabled youth during and after the pandemic is limited. Thus, this study examined changes in anxiety symptoms among youth with disabilities compared to those without disabilities before, during, and after the pandemic.

Methods

We analyzed population-based cross-sectional data from the Finnish School Health Promotion study (SHP) of youths with an age range of 12-29 years obtained in before (2019; n = 155,166), during (2021; n = 160,796), and after (2023; n = 151,224) the pandemic. Disabled youth were identified based on the Child Functioning Module (CFM). Anxiety symptoms were measured using the Generalized Anxiety Disorder-7 (GAD-7). Logistic regression models were applied to investigate population-level changes in anxiety.

Results

Over the years, the prevalence of anxiety symptoms was higher among youth with disabilities (10.2%, CI95% 10.1-10.4) compared to youth without disabilities (40.1%, 39.9-40.4), females having more symptoms than males. Prevalence of anxiety increased significantly during the pandemic (Before: 31.7% 95%CI 31.2-32.3 & During: 41.8%, 41.4-42.3) and continued to increase slightly after (44.4%, 43.9-44.9) among disabled youth. The same trend was seen in non-disabled youth (Before: 7.5%, 7.4-7.7, During: 11.4%, 11.2-11.6 & After: 12.0%, 11.8-12.2).

Conclusions

The prevalence of anxiety among disabled youth increased during the pandemic and has continued to increase even afterward, highlighting the inequality among youth with disabilities. The results indicate that it is important for educators and stakeholders to target measures and resources to support the mental health of youth with disabilities during and after a crisis, improving their equality in schools and society.

Key messages

• Youth with disabilities experienced anxiety symptoms four times more often than non-disabled youth, and this difference has remained quite stable during the pandemic and afterwards.

• Decision-makers should be aware of this weaker mental health condition of youth with disabilities while planning preventive actions and interventions.
Intersectional inequalities in child social-emotional health: a case for proportionate universalism
Authors: Rosenberg A , Ivarsson A , Pulkki-Brännström A M , Lindkvist M , Silfverdal S A , Vaezghasemi M
Published: October 2024

Background

Social-emotional difficulties in early childhood are associated with a range of outcomes across the life course and are related to socioeconomic factors. The aim of this study was to examine intersectional inequalities in social-emotional problems in preschool children relating to their parents’ income, education and country of birth in addition to investigating the public health implications.

Methods

This population-based study with a repeated cross-sectional design in the Västerbotten County of Sweden used the Ages and Stages Questionnaires: Social-Emotional (ASQ:SE) for children aged 3 in child health care services over the years of 2014-2018 and socio-economic information from national population registers. The effective sample of 8,823 individuals was analyzed using additive binomial regression in combination with an analysis of individual heterogeneity and discriminatory accuracy (AIHDA) approach to estimate risk differences for social-emotional problems across 27 intersectional groups and discriminatory accuracy.

Results

Average risk differences generally increased in the groups where multiple dimensions of social inequality intersected, with risk differences as high as 18% (95% CI 8 to 28%) and 25% (95% CI 14 to 37%) compared to the most advantaged category. The discriminatory accuracy of all three included regression models was estimated as moderate, but improved in a slight but statistically significant way with the addition of social inequalities.

Conclusions

This study increases our understanding of intersectional and social inequalities in social-emotional problems in preschool children. It supports the need for universal public health policies in addition to policies targeting more vulnerable groups when addressing this issue, consistent with the concept of proportionate universalism. An intersectional research perspective including discriminatory accuracy could increase our knowledge of health inequities and improve public health effectiveness.

Key messages

• Intersecting dimensions of social inequalities are associated with an increased risk of social-emotional problems in children aged 3.

• Universal public health policies are needed in addition to policies targeting vulnerable population groups with regards to social-emotional problems in young children.
Depressiveness in German higher education students – a systematic review and meta-analysis
Authors: Heumann E , Palacio Siebe A V , Stock C , Heinrichs K
Published: October 2024

Introduction

Evidence shows that German higher education students are vulnerable to depressive symptoms. However, there is no recent review compiling these findings. Thus, our study aims at describing the extent to which higher education students in Germany are affected by depressive symptoms.

Methods

We searched three databases for suitable publications using three core concepts (‘depressive symptoms’, ‘students’, and ‘Germany’). The inclusion criteria were: (a) the population studied consisted of students from higher education institutions, (b) data was assessed at higher education institutions in Germany, (c) information on depressive symptoms were pro-vided as outcome of instruments assessing depressive symptoms, (d) articles were published in peer-reviewed journals, in (e) English or German and (f) between 2002 and 2023. Random effects models were used to calculate both general and subgroup-specific pooled prevalence rates. Subgroups were formed based on the included literature (e.g. gender, before or during the COVID-19 pandemic, study phase and programme).

Results

The literature search resulted in 992 articles. After the removal of duplicates and the two-stage screening process, prevalence data was extracted from 60 articles. The overall pooled prevalence rate was 21.1% (95% CI: 17.6% - 24.6%). Medical students (13.2%; 95% CI: 9.9% - 16.4%) and first-year students (11.0%; 95% CI: 7.7% - 14.3%) were less likely to be affected than students in general. Women (29.0%; 95% CI: 21.4% - 36.5%) were more prone to depressive symptoms than men (23.1%; 95% CI: 16.5% - 29.6%). In samples collected during the COVID-19 pandemic, the pooled prevalence rates were higher than in pre-pandemic times (30.6%; 95% CI: 22.1% - 39.1% vs. 18.0%; 95% CI: 14.7% - 21.2%).

Conclusions

This analysis emphasizes the pressing need to address the mental health of higher education students both at the policy level and within universities.

Key messages

• German higher education students show alarming levels of depressive symptoms, demanding immediate action.

• During the pandemic mental health was even poorer than before, highlighting the need for tailored interventions and support in challenging times.
Exploring anxiety and depression trends: insights from the BELHEALTH cohort 2022-2024 in Belgium
Authors: Duveau C , Hermans L , Bruggeman H , Nélis G , Charafeddine R , Dispas M , Demarest S , Gisle L
Published: October 2024

Background

The swift impact of the COVID-19 pandemic and ensuing restrictions on the mental health of the Belgian population prompted the need for a sustainable system to monitor its evolution. Repeated COVID-19 surveys were conducted between 2020 and 2022 to address this issue, followed by the launch of the BELHEALTH cohort project. Our study aims to analyze the trajectory of anxiety and depression at the post-pandemic period, using data from five waves of the BELHEALTH longitudinal surveys from October 2022 to March 2024. High-risk groups and the potential of social support and resilience to mitigate anxiety and depression were explored.

Methods

The BELHEALTH follow-up cohort of around 7,300 Belgian residents uses online surveys to assess anxiety (with the GAD-7), and depression (with the PHQ-9). The analyses were performed using linear mixed models on the 3,676 individuals who participated in all five waves.

Results

Preliminary results indicated that more people were affected by anxiety in October 2022 (16%) compared to June 2023 (14%), while depression rates were lower in October 2022 (13%) compared to February 2023 (14%) and March 2024 (15%). However, the trajectory of mental health varied across demographic subgroups, with worse outcomes observed among unemployed and younger individuals, as well as those living alone, in the Walloon Region (South of Belgium). Overall, people with a low level of resilience or a low level of social support exhibited higher odds of experiencing depression.

Conclusions

Reducing these social inequities in mental health necessitates the development of structural prevention measures and interventions at the regional level. These measures should target factors such as unemployment, which is particularly prevalent among younger individuals and those living in Wallonia. Additionally, fostering protective factors such as social support and resilience is crucial for mitigating mental health inequalities over time.

Key messages

• Monitoring mental health and its determinants remains crucial to identify and address social inequities, tailor interventions, and support vulnerable populations.

• Unemployed, younger people, and those residing in the Walloon region are at particular risk.
Mental health promotion research in co-creation: Lessons from a multisite study in six countries
Authors: De Freitas C , Teixeira R , Sanna L , Tol W A
Published: October 2024

Background

Mounting public health threats associated with climate change, epidemiological and economic crises, digitalisation, rising migration, and population aging have uncovered at-risk groups’ increased vulnerability to mental ill health. Developing mental health promotion interventions tailored to their specific needs and expectations is essential to protect their wellbeing. However, researchers may find it challenging to identify and implement needed adaptations without engaging with end-users, and other stakeholders, to co-create tailor-made interventions. This study aimed to explore co-creators’ views about opportunities and constraints in participatory mental health promotion research.

Methods

Between September 2023 and July 2024, a qualitative study drawing on participant observation of bimonthly meetings and semi-structured interviews with six co-creation facilitators was conducted in the scope of Horizon Europe’s project ADVANCE. The multi-methods research approach to co-creation entailed desk reviews and online Delphi surveys co-developed with locally-established Society Advisory Groups, and scenario-based workshops held with stakeholders in the six partner countries: Denmark, Germany, Italy, Lithuania, Netherlands, Switzerland. Thematic analysis of the data was carried out.

Results

Research teams’ epistemic stances impact research planning, resource allocation, partnership nourishing and the unravelling of co-option risks during participatory research implementation. Research co-creation adds pressure onto research teams’ agenda, skillset and performance, but it also encourages power sharing, mutual learning and greater alignment of research design and implementation with end-users’ priorities and aspirations.

Conclusions

Research co-creation is a partnership-based and resource-intensive endeavour that can provide a valuable pathway to improve the relevance, acceptability and sustainability of public mental health promotion research.

Key messages

• Research co-creation demands planning, adequate resource allocation, flexibility and continuous investment to sustain academy-society partnerships.

• Engaging stakeholders in knowledge co-creation can increase the relevance, acceptability and sustainability of public mental health promotion research.
Disability during the last ten years of life: Evidence from a register-based study in Austria
Authors: Stolz E , Schultz A , Zuschnegg J , Großschädl F , Dorner T E , Roller-Wirnsberger R , Freidl W
Published: October 2024

Background

Many older adults experience disability in activities of daily living during the last years of life, but survey-based analyses suffer from non-representative samples due to selective participation and attrition. Here, we use individual-level register data on the receipt of the Austrian long-term care allowance (ALTCA) as a proxy for late-life disability.

Methods

In this retrospective mortality follow-back study, we analyse receipt of ALTCA, a cash benefit based on physician assessed disability during the last 10 years of life, among all decedents aged 65 years and over from 2020 in Austria (n = 76,781). The impact of sex, age of death, and cause of death on the duration and probability of receipt of ALTCA was assessed with regression models.

Results

10 years before death 10% of older men and 25% of older women received ALTCA, which increased to 27% and 51% at 5 years, 56% and 77% at 1 year, and finally to 70% and 87% at 1 month before death. On average, ALTCA was received for 3.2 years in men and 4.5 years in women. The probability to receive ALTCA and its duration increased sharply with age at death and varied by underlying causes of death: those who died from cancer, myocardial infarction, and external causes of death were less likely to receive ALTCA and experienced shorter durations of it, while those who died from dementia, Parkinson’s disease, chronic heart disease, or chronic obstructive lung disease were more likely to receive ALTCA and longer so.

Conclusions

Most older adults received ALTCA for multiple years before death, and this increased strongly with age at death and varied across causes of death. Our register-based estimates of late-life disability were twice as high as survey-based estimates, which points to an underestimation in previous studies. Policy-makers should be aware that costs of long-term care will likely increase as life expectancy rises and deaths from dementia and organ failure increase in ageing European societies.

Key messages

• A large majority of older adults in Austria experience late-life disability. On average, older men were disabled for 3.2 and older women for 4.5 years.

• Probability and duration of late-life disability increased steeply with age at death and was higher for those who died from dementia, Parkinson’s disease, or chronic heart or lung disease.
Childhood-to-adulthood body size trajectory and cancer risk: a prospective cohort study
Authors: Mandic M , Safizadeh F , Schöttker B , Hoffmeister M , Brenner H
Published: October 2024

Background

While excess weight in adulthood and childhood has been associated with increased cancer risk, the link between childhood-to-adulthood body size trajectories and cancer risk requires further investigation.

Methods

We used data from the UK Biobank, a prospective population-based cohort study. The main exposure was childhood-to-adulthood body size trajectory, constructed from self-reported body at age 10 (categories: thinner, average, and plumper than average) and measured body mass index (BMI) at recruitment (normal weight, overweight, and obese). Primary outcome was obesity-related cancer (13 different cancer types).

Results

During a median follow-up of 11.7 years, 21,289 participants developed obesity-related cancers. Having a larger body size at age 10 was strongly associated with being overweight or obese in adulthood. Compared to participants with average childhood to normal adulthood body size trajectory, all trajectories ending in overweight or obesity in adulthood were strongly associated with an increased risk of obesity-related cancers. The strength of the association was mostly determined by adulthood BMI, and similar patterns were observed for colorectal, endometrial, kidney, pancreatic and esophageal cancer. However, a larger body size in childhood was associated with a lower risk of postmenopausal breast cancer.

Conclusions

Although a larger body size in childhood predisposes to overweight and obesity in adulthood, it does not necessarily predispose to an increased obesity-related cancer risk if measures to maintain a healthy weight are taken in adulthood.

Key messages

• While larger body size in childhood predisposes individuals to overweight and obesity in adulthood, maintaining a healthy weight in adulthood may help mitigate the risk of obesity-related cancers.

• Our findings highlight the importance of preventing and reducing overweight and obesity in adulthood for primary cancer prevention.
Serum homocysteine levels and mortality: a cohort study
Authors: Shin S , Kim M
Published: October 2024

Background

Homocysteine, an intermediate metabolite derived from dietary methionine, plays a pivotal role in deoxyribonucleic acid expression and contribute to its antioxidant capabilities. Elevated homocysteine levels can increase the risk of cardiovascular disease (CVD), cancer, and neurological disorder; however, low levels of homocysteine are generally not considered harmful. This study evaluates the association between all levels of homocysteine-both low and high-and the risk of all-cause and cause-specific mortality in Korean adult men.

Methods

A study involving 221,356 Korean adult men categorized them into quintiles based on their homocysteine levels. The main outcomes examined were mortality from all causes, cardiovascular disease (CVD), cancer, and dementia. Hazard ratios (HRs) were determined using Cox proportional hazards models, and the dose-response relationship between homocysteine levels and mortality risk was further analyzed using a restricted cubic splines model.

Results

Compared to the reference category (Q2, 8.8-9.9 µmol/L), there was a significant increase in all-cause mortality associated with both low and high homocysteine levels after adjusting for multiple variables (Pinteraction=0.002). Furthermore, spline regression revealed a U-shaped relationship between homocysteine levels and both all-cause and CVD mortality, with an inflection point at 9.1 µmol/L. This U-shaped association was not observed in the subgroup that received vitamin supplements.

Conclusions

Among young and middle-aged Korean adult men, both low and high homocysteine levels were found to increase the risk of all-cause and CVD mortality, demonstrating a U-shaped relationship. However, this association lost statistical significance with vitamin supplementation. These findings underscore the importance of monitoring both low and high homocysteine levels as potential mortality risk factors in men and suggest a possible protective role of vitamins.

Key messages

• Both low and high levels of homocysteine in young and middle-aged Korean men are associated with increased risks of all-cause and cardiovascular mortality, demonstrating a U-shaped relationship.

• Vitamin supplementation appears to nullify this association, suggesting a potential protective effect against mortality.
Frailty and related factors among community-dwelling older adults in Türkiye
Authors: Sert S , Aydilek O H , Kavlu E , Er O , Metintas S , Onsuz M F
Published: October 2024

Background

Frailty in elderly can lead to complex challenges in the follow-up and management of health services. Ensuring comprehensive primary care services and social support can avert, reverse, or mitigate frailty in old age. We aimed to evaluate frailty and its associated factors in individuals aged ≥65 years.

Methods

We conducted a cross-sectional study in patients applying to primary care centres in 2024, in a city where 10% of the population is elderly. The centres were divided into clusters based on the socioeconomic status of the regions they serve, and nine were randomly selected by weight. A total of 1154 elderly who consecutively presented were included. A questionnaire including sociodemographic characteristics, Edmonton Frailty Scale, Loneliness Scale for the Elderly (LSE), Charlson Comorbidity Index (CCI), International Falls Effectiveness Scale (FES-I) was applied to the elderly.

Results

The mean age was 71.3±5.3 years, and 50.8% were male. In the study, 20.1% were frail, and 19.6% were apparently vulnerable. It was found that those aged 70-79 and ≥80 years, women, deceased/separated from their spouses, those with low education, those whose occupation was housewife, those earning below minimum wage, those who lived alone, non-exercisers, those taking >8 medications/day, and those who had ≥2 falls/last year were more frail. In multivariate logistic regression analysis, illiteracy (Odds ratio-OR:15.2, 95%CI:1.7-135.5), taking >8 medications/day (OR:4.1, 1.7-9.9), falling ≥2 times/last year (OR:3.4, 1.8-6.4) and ≥4 points on the CCI (OR:1.9, 1.0-3.4) were found to be predictors of frailty. Each score on the FES-I and LSE increased the risk of frailty by 1.08 (1.05-1.11) and 1.13 (1.08-1.17) times, respectively.

Conclusions

One in five people was found to be frail. Low education level, >8 medications/day, ≥2 falls in the last year, severity of comorbidity, fear of falling, and high levels of loneliness were found to be predictive factors for frailty.

Key messages

• Encouraging a healthy lifestyle to prevent comorbid diseases and early interventions to avoid falls can reduce frailty.

• Providing social activities in primary care and promoting the elderly to participate in these activities can help prevent loneliness, which is a risk factor of frailty.