Lower Educated Participants Research Articles

Self-assessed threshold for cold temperatures and thermal insulation of clothing among poultry workers

The association between self-assessed cold threshold (CT) and thermal insulation of clothing (Icl) was analysed in 283 poultry workers in Thailand. The mean CT was 13.5 °C (range − 28–29) and the mean Icl was 1.23 clo (range 0.35–2.21). The adjusted CT remained unchanged at low Icls (0.35 through 1.25 clo) but was estimated to increase by 14.8 °C at high Icls (1.25 through 2.21 clo). Overall, CT was higher by 2.4 °C (95% confidence interval [CI] 0.3–3.8) at high (≥ 1.25 clo) than that at low (< 1.25 clo) Icl, but this difference was modified by personal and work-related factors. The difference was 2.6 °C (CI 0.5–4.6) for older (30–57 y) compared to younger (18–29 y) participants, with an excess of 7.3 °C (CI 5.6–9.0) for low vs high educated participants, 2.6 °C (CI 0.5–4.8) for those doing heavy vs light work, 7.4 °C (CI 3.7–11.0) for alcohol consumers vs others, and 3.4 °C (CI 0.6–6.3) for smokers vs non-smokers. The differences were independent of personal characteristics and worksite physical conditions and were interpreted as increased cold sensitivity among subgroups with lesser stamina and poorer health. Sensitive worker subgroups should be identified, and their need for cold protection should be reviewed.

Association of oral health with all-cause and cause-specific mortality in older Chinese adults: A 14-year follow-up of the Guangzhou Biobank Cohort study.

Poor oral hygiene is associated with overall wellness, but evidence regarding associations of oral health with all-cause mortality remain inconclusive. We aimed to examine the associations of oral health with all-cause and cause-specific mortality in middle-aged and older Chinese adults. 28 006 participants were recruited from 2003-2008 and followed up until 2021. Oral health was assessed by face-to-face interview and causes of death was identified via record linkage. Cox regression yielded hazard ratios (HRs) and 95% confidence intervals (CIs) with adjustment of multiple potential confounders. During an average of 14.3 years of follow-up, we found that a lower frequency of toothbrushing was associated with higher risks of all-cause mortality with a dose-response pattern (P for trend <0.001). Specially, the adjusted HR (95% CI) (vs. ≥ twice/d) was 1.16 (1.10, 1.22) (P < 0.001) for brushing once/d and 1.27 (1.00, 1.61) (P = 0.048) for < once/d. Similar associations were also found for cardiovascular disease (CVD), stroke, and respiratory disease mortality, but not for ischemic heart disease (IHD) and cancer mortality. A greater number of missing teeth was also associated with higher risks of all-cause, CVD, stroke, and respiratory disease mortality with a dose-response pattern (all P for trend <0.05). The association of missing teeth with all-cause mortality was stronger in lower-educated participants. Both less frequent toothbrushing and a greater number of missing teeth were associated with higher risks of all-cause, CVD, stroke, and respiratory disease mortality, showing dose-response patterns, but not with IHD and cancer mortality. Moreover, the dose-response association of missing teeth with all-cause mortality was stronger in lower-educated participants.

Health and social care leaders’ and employees’ perceptions of remote leadership and the associated factors

PurposeThe purpose of this study was to describe health and social care leaders’ and employees’ perceptions of remote leadership and the associated factors.Design/methodology/approachA total of 45 leaders and 177 employees from one Finnish health and social care organization completed an electronic questionnaire between October and November 2020. The questionnaire included questions related to background information, along with structured and open-ended questions addressing remote leadership and the associated factors. The collected quantitative data was analyzed with statistical methods, while inductive content analysis was used to analyze the qualitative data.FindingsRemote leadership emerged as a developing form of leadership that was part of everyday life at a regional health and social care organization. However, it was also considered by some as a distanced and authoritarian form of leadership that reduced communication to a one-way flow of information. Remote leadership and digitalization in health and social care were generally perceived positively, especially among higher educated participants and those working mainly in a remote context. However, digitalization was also perceived as a burden and remote leadership as a source of uncertainty at work, especially among lower educated participants and those who worked mainly in traditional contexts.Originality/valueThis study expands the little-researched area and provides insights that can be used to further develop remote leadership and the related education.

Bridging gaps, building futures: evaluating a multinational’s employment programme vs. work-first for youth with diverse education levels

ABSTRACT In the Netherlands, public work-first support tends to cause unemployed young people to exit into primarily non-standard jobs. A worldwide-renowned Dutch company, Royal Philips, has offered since the mid-1980s a two-year lasting work experience and vocational training programme to long-term unemployed youth as an alternative to public work-first support. This quasi-experimental study uses data from the company programme's participants and national longitudinal register data for the matched control group receiving public work-first support. The present study observes the employment impact of this private company's employment programme compared to the public programme for inadequately skilled youth (aged 16–35) by education level. Participants’ employment levels are compared with a carefully matched public work first-subjected control group up to a maximum of ten years later. Fixed-effects panel regression models show that, due to its upskilling and work experience features, the employment programme positively affects sustained wage-fitted employment over ten years compared with the control group subjected to public work-first support. The programme's employment effect associated with upskilling is achieved notably with low-educated participants who received vocational training. In contrast, participating high-educated young people seem to profit from human capital and signalling effects.

Estimating the income-related inequality aversion to energy limiting behavior in the United States

Distributive energy justice is measured by the degree to which, and whether, different members of society have equal share in the benefits and burdens of the energy system. One way to achieve distributional energy justice is to ensure all households, regardless of income, can use as much energy as they need to heat and cool their home to desired temperature. We define a household's cooling balance point (CBP) as the ideal set temperature at which the household desires to keep its living space in summer; the heating balance point (HBP) is defined as the ideal set temperature in winter. To quantify the extent to which balance points were disproportionately concentrated among certain income groups, we used the extended concentration index. This index has an inequality aversion parameter that reflects the value judgment of a society. If this parameter <1, the society is pro-rich; if this parameter >1, as it increases, the society becomes more pro-poor. We estimated the empirical value of the income-related inequality aversion in eight U.S. states and examined several effects of demographic characteristics on inequality aversion.In an online survey, 1066 (from four southern states) and 906 (from four Midwest states) participants made choices between energy policies leading to different distributions of CBP (southern) or HBP (Midwest) across five income groups in a hypothetical society. Participants showed a pro-poor propensity: the median inequality aversions were 1.37, 95% CI of [1.35, 1.39] (CBP) and 1.56, 95% CI of [1.56, 1.60] (HBP). For both CBP and HBP: younger participants were less averse to inequality. For CBP, blacks (vs. whites) and conservatives (vs. centrist) were less averse to inequality; for HBP, Hispanics (vs. whites), low (vs. high) education participants, and those whose homes were well insulated (vs. adequately and vs. poorly insulated) were less averse to inequality. Our findings provide insights into how the broader public values energy justice, which further provides important policymaking implications.

The impact of retirement on blood pressure: evidence from a nationwide survey in China

IntroductionThe health impact of retirement is controversial. Most previous studies have been based on self-reported health indicators or the endpoints of some chronic diseases (e.g., morbidity or mortality), but objective physiological indicators (e.g., blood pressure) have rarely been used. The objective of this study is to elucidate the health effects of retirement on blood pressure, thereby offering empirical evidence to facilitate the health of retirees and to optimize retirement policies.MethodsFrom 2012 to 2015, 84,696 participants of the Chinese Hypertension Survey (CHS) were included in this study. We applied the fuzzy regression discontinuity design (FRDD) to identify retirement’s causal effect on systolic blood pressure (SBP), diastolic blood pressure (DBP) and pulse pressure. We also explored the heterogeneity in the effects of retirement across different sex and education level groups.ResultsBased on the fully adjusted model, we estimated that retirement increased SBP by 5.047 mm Hg (95% CI: -2.628-12.723, P value: 0.197), DBP by 0.614 mm Hg (95% CI: -3.879-5.108, P value: 0.789) and pulse pressure by 4.433 mm Hg (95% CI: -0.985-9.851, P value: 0.109). We found that retirement led to a significant increase in male participants’ SBP and pulse pressure as well as a possible decrease in female participants’ blood pressure. Additionally, the blood pressure levels of low-educated participants were more vulnerable to the shock of retirement.ConclusionRetirement is associated with an increase in blood pressure level. There is a causal relationship between the increase in blood pressure levels of men and retirement. Policy-makers should pay extra attention to the health status of men and less educated people when adjusting retirement policies in the future.

Recruitment strategies for reaching adults aged 50 years and older with low socioeconomic status for participation in online physical activity interventions.

Generally, the health condition of those with higher socioeconomic status (SES) is better compared to those with lower SES. The application of appropriate strategies to reach low SES populations with electronic health (eHealth) interventions is thus of major importance to reduce health inequalities. eHealth-studies providing detailed information on recruitment strategies are scarce, despite the fact that this information is crucial for comparable research and implementation. To provide insight into the reach, sample characteristics and costs of three pre-planned strategies for recruiting adults aged 50 years and older with low SES for participation in an online physical activity intervention, as part of a field study. Recruitment took place via (1) invitation letters via a municipality, (2) gyms and (3) social media advertisements, aiming to include 400 participants. Additional procedures were followed to reach specifically the low SES group. Response rates, sociodemographic characteristics and costs per strategy were assessed. The highest response was shown for the municipality approach (N = 281), followed by social media (N = 71) and gyms (N = 45). Ten participants were recruited via family/friends. The most low-educated participants were reached via the municipality (N = 128) followed by social media (N = 9), gyms (N = 8) and family/friends (N = 5). Recruitment costs were with €2,142.37 the highest for the municipality compared to €96.81 for social media and no costs for gyms. Recruitment via invitation letters through a municipality has the highest potential for reaching low SES participants of the three applied strategies, although the higher recruitment costs need to be taken into account.

Depression and Anxiety Symptoms in Headache Disorders: An Observational, Cross-Sectional Study.

Headache disorders have been associated with anxiety and depressive disorders. The aim of this study was to assess symptoms of anxiety and depression in a large sample of individuals with different headache disorders (HDs) in order to determine whether their frequency differs by headache type. Consecutive individuals with headache attending a headache outpatient clinic were interviewed with the HAM-D and HAM-A, along with age, sex, and education matched non-headache individuals. Individuals numbering 2673 with headache (females 71.2%) and 464 non-headache individuals (females 70.9%) were interviewed (with participation rates of 98.3% and 91.0%, respectively). Migraine was diagnosed in 49.7%, tension-type headache in 38%, cluster headache 5.2%, and medication overuse (MO) in 21.8%. Participants with HD scored more in HAM-A (OR = 4.741, CI95%: 3.855-5.831, p < 0.001) and HAM-D scales (OR = 2.319, CI95%: 1.892-2.842, p < 0.001) than non-headache individuals. Participants with chronic HDs (≥15 days with headache for ≥3 consecutive months; 52.5%) scored higher for both HAM-A (OR = 1.944, CI95%: 1.640-2.303, p < 0.001) and HAM-D (OR = 1.625, CI95%: 1.359-1.944, p < 0.001) than those with episodic HDs (33.1%), as did participants with MO vs. participants without MO (OR = 3.418, CI95%: 2.655-4.399, p < 0.001 for HAM-A, OR = 3.043, CI95%: 2.322-3.986, p < 0.001 for HAM-D). Female and low-educated participants scored higher on both scales. Because symptoms of anxiety and depression are substantial in people with HD, the treating physicians should look out for such symptoms and manage them appropriately.

ENHANCE: a comparative prospective longitudinal study of cognitive outcomes after 3 years of hearing aid use in older adults.

With an aging population, the prevalence of hearing loss and dementia are increasing rapidly. Hearing loss is currently considered the largest potentially modifiable risk factor for dementia. The effect of hearing interventions on cognitive function should therefore be investigated, as if effective, these may be successfully implemented to modify cognitive outcomes for older adults with hearing loss. This prospective longitudinal observational cohort study compared outcomes of a convenience sample of prospectively recruited first-time hearing aid users without dementia from an audiology center with those of community-living older adults participating in a large prospective longitudinal cohort study with/without hearing loss and/or hearing aids. All participants were assessed at baseline, 18 months, and 36 months using the same measures. Participants were 160 audiology clinic patients (48.8% female patient; mean age 73.5 years) with mild-severe hearing loss, fitted with hearing aids at baseline, and 102 participants of the Australian Imaging, Biomarkers and Lifestyle Flagship Study of Aging (AIBL) (55.9% female patient; mean age 74.5 years). 18- and 36-month outcomes of subsets of the first participants to reach these points and complete the cognition assessment to date are compared. Primary comparative analysis showed cognitive stability for the hearing aid group while the AIBL group declined on working memory, visual attention, and psychomotor function. There was a non-significant trend for decline in visual learning for the AIBL group versus no decline for the hearing aid group. The hearing aid group showed significant decline on only 1 subtest and at a significantly slower rate than for the AIBL participants (p < 0.05). When education effects on cognitive trajectory were controlled, the HA group still performed significantly better on visual attention and psychomotor function (lower educated participants only) compared to the AIBL group but not on working memory or visual learning. Physical activity had no effect on cognitive performance trajectory. Hearing aid users demonstrated significantly better cognitive performance to 3 years post-fitting, suggesting that hearing intervention may delay cognitive decline/dementia onset in older adults. Further studies using appropriate measures of cognition, hearing, and device use, with longer follow-up, are required.

Adherence to the World Cancer Research Fund/American Institute for Cancer Research recommendations for cancer prevention in adolescent and young adult (AYA) cancer survivors: results from the SURVAYA study.

For adolescent and young adult (AYA) cancer survivors with a good prognosis, having a healthy lifestyle prevents morbidity and mortality after treatment. The aim of this study was to investigate the prevalence of (un)healthy lifestyle behaviors and related determinants in AYA cancer survivors. A population-based, cross-sectional study was performed among long-term (5-20years) AYA cancer survivors (18-39years old at diagnosis) registered within the Netherlands Cancer Registry. Self-reported questionnaires data about health behaviors were used to calculate the 2018 World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) adherence score. Associations between the score and clinical/sociodemographic determinants of (un)healthy behaviors were investigated using logistic regression models. The mean WCRF/AICR score was low to moderate, 3.8 ± 1.2 (0.5-7.0) (n = 3668). Sixty-one percent adhered to "limit the consumption of sugar sweetened drinks," 28% to "be a healthy weight," 25% to "fruit and vegetable consumption," and 31% to "limit alcohol consumption." Moderate and high adherence were associated with being a woman (ORmoderate = 1.46, 95% CI = 1.14-1.85, and ORhigh = 1.87, 95% CI = 1.46-2.4) and highly educated (ORmoderate = 1.54, 95% CI = 1.30-1.83, and ORhigh = 1.87, 95% CI = 1.46-2.4). Low adherence was associated with smoking (ORmoderate = 0.68, 95% CI = 0.50-0.92, and ORhigh = 0.30, 95% CI = 0.21-0.44) and diagnosis of germ cell tumor (ORmoderate = 0.58, 95% CI = 0.39-0.86, and ORhigh = 0.45, 95% CI = 0.30-0.69). Adherence to the 2018 WCRF/AICR lifestyle recommendations was low to moderate, especially regarding body weight, fruit, vegetables, and alcohol consumption. Men, current smokers, lower-educated participants, and/or those diagnosed with germ cell tumors were less likely to have a healthy lifestyle. Health-promotion programs (e.g., age-specific tools) are needed, focusing on high-risk groups.

Interest in genetic susceptibility testing and disclosure of AD dementia risk in cognitively normal adults: a survey study

BackgroundApolipoprotein-E (APOE) genetic testing for Alzheimer’s disease is becoming more important as clinical trials are increasingly targeting individuals carrying APOE-ε4 alleles. Little is known about the interest in finding out one’s genetic risk for Alzheimer’s disease in the general population. Our objective was to examine this in a sample of cognitively normal (CN) adults within a population-based online research registry with the goal to implement APOE-ε4 status for trial recruitment.MethodsAn online survey was completed by 442 CN participants between the age of 49 and 75 years (56% female) from the Dutch Brain Research Registry. The survey assessed interest in participation in research into, and disclosure of, genetic risk for dementia. The survey assessed interest in participation in research into, and disclosure of, genetic risk for dementia and knowing their genetic risk in different hypothetical risk scenarios (10%, 30%, and 50% genetic risk for dementia at age 85, corresponding to APOEε2/ε2 or ε2/ε3, APOEε3/ε4 or ε2ε4, and APOE-ε4/ε4 genotypes). Cochran’s Q and post hoc McNemar tests were used to analyse differences in frequencies across scenarios.ResultsMost participants were interested in participating in research into and disclosure of their genetic risk (81%). The most reported reason was to contribute to scientific research (94%). Interest was higher in males, whilst lower-educated participants were more often undecided. When provided with different risk scenarios, interest in knowing their risk was somewhat higher in the scenarios with higher risk, i.e. in the 50% (79%) compared to the 10% scenario (73%;χ2(2) = 7.98; p = .005). Most individuals expected they would share their genetic risk with close relatives (77–89%), would participate in medication trials (79–88%), and would make long-term arrangements, e.g. retirement, health care, will (69–82%), with larger proportions for scenarios with higher hypothetical genetic risk.ConclusionsOur findings indicate that the vast majority of CN adults participating in a research registry expresses interest in AD genetic risk research and disclosure. Interest in genetic risk disclosure is higher in scenarios corresponding to the APOE-ε4 genotype. This suggests APOE-ε4 screening within an online research registry is potentially a well-received method to accelerate inclusion for trials.

Determinants of Society's Rape Myths Acceptance

This study was planned to determine the acceptance status of rape myths in society and also the factors affecting this situation. The target population of this descriptive cross-sectional study consisted of individuals living in Turkey. Random sampling method was used in sample selection. It was determined that there were 268 individuals who met the research criteria. The research data were collected online via Google form between April 30, 2021 and January 30, 2022. "Personal Information Form" and "Illinois Rape Myths Acceptance Scale - Short form" were used as data collection tools. Descriptive statistical analyses, One-way ANOVA test, student t test and linear regression test were used to analyze the data. The mean age of the participants was 31.023+9.73 years. 42% of the participants were in the 28-37 age range and 59.9% of the participants were female. Gender, employment status, education level, place of residence and income status explained 28.7% of the acceptance of rape myths (p&amp;lt;0.001). It was determined that women accepted rape myths more than men, while the acceptance of rape myths was lower among low-educated participants. Within the scope of this study, it was determined that there are gender differences in the acceptance of rape myths and that the tendency to blame the victim is high. The results of this preliminary study are a reference for other researchers or institutions, and studies with a larger sample group are needed.

A global perspective on cardiovascular risk factor management in patients with CHD and different educational level: SURF CHD II

Abstract Background Clinical guidelines recommend that patients with established coronary heart disease (CHD) change health behaviors and use medication to control risk factors (RF), eventually reducing cardiovascular risk. Nevertheless, RF management in daily practice is challenging and RF control in secondary prevention remains suboptimal. Patients with low educational level tend to have higher cardiovascular risk. This association varies indifferent contexts, yet research on health inequalities in secondary prevention has focused mostly on high-income countries. Purpose To provide a global picture of health inequalities in RF management in secondary prevention of CHD, by assessing RF recording, target attainment, and treatment by educational level in patients from four world regions. Methods The Survey of Risk Factors in Coronary Heart Disease (SURF CHD) II is a clinical audit on RF management, undertaken in patients with CHD during routine outpatient visits. The survey is easy to perform, allowing its use in low-resource centers. We studied RF recording (data availability), attainment of targets defined by guidelines, and treatment (medication and cardiac rehabilitation). RF included smoking, physical activity, waist circumference, blood pressure, LDL, non-HDL cholesterol, triglycerides, and Hba1c (among diabetics). We reported the % of recording, target attainment and treatment in patients with primary/secondary schooling and in those with tertiary education. We assessed differences in RF management by educational level with logistic regression adjusted by age and sex, and stratified by region. Results 13884 patients were enrolled in 29 countries in Europe (N=10255), South-East Asia (SEA) (N=2290), the Americas (N=779) and North Africa and Eastern Mediterranean (N=560). 47.0% of participants had tertiary education, 34.5% had secondary schooling, and 18.6% primary schooling. RF recording ranged from 22.2% (waist circumference) to 93.0% (blood pressure); target attainment from 15.9% (waist circumference) to 76.9% (smoking). 50.5% participated in cardiac rehabilitation. RF information was collected more often in highly educated patients for most RF in the Americas, and for blood pressure and HBa1c in SEA. BMI and waist circumference were more frequently registered among lower-educated participants in Europe and SEA. Highly educated patients were more likely to meet RF targets for smoking in most regions, physical activity in Americas and Europe, LDL in SEA, and Non-HDL cholesterol and Hba1c in SEA and Americas regions. Patients with higher education participated more often in cardiac rehabilitation in all regions except SEA (Figure 1). Conclusions Health inequalities persist in secondary prevention of CHD: highly educated patients are generally more likely to have RF information recorded, have RF levels on target and attend cardiac rehabilitation. However, these associations present specific patterns by RF and region.

Exploring Inequalities in the Use, Quality, and Outcome of the Diabetes Management Program of Indonesian National Health Insurance.

Access to diabetes management programs is crucial to control the increasing contribution of diabetes to the global burden of disease. However, evidence regarding whether such services are equally accessible for all population groups is still lacking, particularly in the context of low-middle-income countries and under the National Health Insurance (NHI). This study aimed to assess the extent of socioeconomic and geographical inequalities in the use, quality, and outcome of a diabetes management program for beneficiaries of Indonesian NHI. A total of 628 participants in the NHI diabetes management program in Banyumas District, Indonesia, were included in 2021 in this cross-sectional study. The main variables measured were regular visits to primary care facilities, standard medication, and glycemic control. The rate difference and rate ratio of age-sex standardized prevalence rates, as well as multiple logistic regressions, were used to measure the extent of inequalities. Around 70% of participants regularly visited primary care facilities and received standard medication, but only 35% had good glycemic control. Highly educated participants were more likely to have regular visits compared to low-educated participants (odds ratio [OR] 1.92; 95% confidence interval [95% CI]: 1.04-3.56). Based on employment and type of NHI beneficiaries, a small extent and even reverse inequalities were found although these findings were insignificant statistically. Urban residents were also more likely to have regular visits (OR 6.61; 95% CI: 2.90-15.08), receive standard medication (OR 9.73; 95% CI: 3.66-25.90), and have good glycemic control (OR 3.85; 95% CI: 1.68-8.83) compared to rural residents. Evidence on the extent of socioeconomic inequalities is inconclusive but substantial geographical inequalities in the use, quality, and outcome of diabetes management programs exist among Indonesian NHI beneficiaries. Future implementation policies of the program should consider particularly the geographical characteristics of participants to avoid and reduce inequalities and, hence, the disease burden of diabetes.

Using mHealth for Primary Prevention of Dementia: A Proof-of-Concept Study on Usage Patterns, Appreciation, and Beliefs and Attitudes Regarding Prevention.

Health- and lifestyle factors account for a substantial part of all dementia cases, which opens the opportunity for primary prevention. However, the required behavioral change is complex and involves targeting multiple risk factors. mHealth interventions can potentially contribute to improving motivation in a low-cost and scalable way. To explore usage patterns, appreciation, and beliefs and attitudes regarding dementia risk reduction during the use of the MyBraincoach mobile app. Participants were community-dwelling middle-aged adults from the Netherlands and used either the standard (education) or extended (education+motivational triggers) app version for three months. Two panel studies were combined in this paper. Chi-square tests, t-tests and linear mixed models were used, adjusted for age, sex, and education. Of all participants (n = 299, 50.2% male), 167 (55.9%) had installed the app. The most reported reason for non-use was technical problems (47%). Those who used the app were at baseline already more positive about dementia risk reduction than those who did not use the app. Of all users who completed the evaluation (n = 102), 78.4% (n = 80) stated that the app provided a positive approach towards brain health and 80.4% (n = 82) felt better informed. Younger (<60y) and lower educated participants evaluated the app most positively. Usage of the app was low, but users showed more positive beliefs and attitudes regarding dementia risk reduction. Most users evaluated the app positively and stated to have gained knowledge on the topic. Improving the use of the app must keep high priority in future studies.

Cardiovascular disease patients’ views on using financial incentives for health behavior change: Are deposit contracts acceptable?

BackgroundThere is an urgent need to find new approaches that improve long-term adherence to a healthy lifestyle for people with cardiovascular disease (CVD). Deposit contracts (a financial incentive in which the participant deposits own money) are inexpensive and effective, but acceptability among CVD patients is unclear. This study investigated the acceptability of a deposit contract intervention for physical activity among CVD patients. MethodsWe approached CVD patients through the Harteraad patient panel of the Dutch CVD patient organization and asked them to fill in an online survey. In total (N = 659) CVD patients with a mean age of 66.2 years completed the survey. The survey assessed acceptability of deposit contracts, responses to a concrete example of a deposit contract for physical activity behavior change, and suitable moments for implementation. ResultsOverall, half of the participants (45.6%) confirmed needing extra commitment to maintain lifestyle change. Yet, a small part of the sample was convinced by the idea that losing money could be motivating (18.8%) and indicated that they would be willing to deposit money themselves (13.2%). Responding to a concrete example of a deposit contract for physical activity, a quarter of the sample (26.2%) reported there was a chance they would participate. Furthermore, 27.1% of the participants found the deposit contract effective and 27.4% found it acceptable. Exploratory analyses showed that a subgroup of younger and lower educated participants responded more favorably. Opinions on when to start with a deposit contract were mixed. ConclusionsBecause acceptability was generally found to be low, future research should also investigate strategies to leverage commitment principles for CVD patients without a cash deposit requirement. When deposit contracts are offered to CVD patients in practice, we recommend offering them as an optional, additional element to existing interventions that patients can opt-in to.

Drinking water quality and inflammatory bowel disease: a prospective cohort study.

Environmental factors, such as drinking water and diets, play an important role in the development of inflammatory bowel disease (IBD). This study aimed to investigate the associations of metal elements and disinfectants in drinking water with the risk of inflammatory bowel disease (IBD) and to assess whether diet influences these associations. We conducted a prospective cohort study including 22,824 participants free from IBD from the Yinzhou cohort study in the 2016-2022 period with an average follow-up of 5.24years. The metal and disinfectant concentrations were measured in local pipeline terminal tap water samples. Cox regression models adjusted for multi-level covariates were used to estimate adjusted hazard ratios (aHRs) and 95% confidence intervals (95% CIs). During an average follow-up period of 5.24years, 46 cases of IBD were identified. For every 1 standard deviation (SD) increase in the concentration of manganese, mercury, selenium, sulfur tetraoxide (SO4), chlorine, and nitrate nitrogen (NO3_N) were associated with a higher risk of IBD with the HRs of 1.45 (95% CI: 1.14 to 1.84), 1.51 (95% CI: 1.24-1.82), 1.29 (95% CI: 1.03-1.61), 1.52 (95% CI: 1.26-1.83), 1.26 (95% CI: 1.18-1.34), and 1.66 (95% CI: 1.32-2.09), whereas zinc and fluorine were inversely associated with IBD with the HRs of 0.42 (95% CI: 0.24 to 0.73) and 0.68 (95% CI: 0.54-0.84), respectively. Stronger associations were observed in females, higher income groups, low education groups, former drinkers, and participants who never drink tea. Diets have a moderating effect on the associations of metal and nonmetal elements with the risk of IBD. We found significant associations between exposure to metals and disinfectants and IBD. Diets regulated the associations to some extent.

Field Experiments Examining Trust in Law: Interviewer Effects on Participants with Lower Educational Backgrounds

An important prerequisite for democratic societies to function smoothly is that citizens put trust in the law and as such trust the judges in their country. Therefore, whether various participants actually trust the law is an important topic in many different studies. The current paper notes that insights into trust in law among lower educated participants is relatively lacking. We further note that there is a possibility that levels of trust in law may vary in important ways among participants with lower educational backgrounds as a function of who is conducting the research. Three field experiments tested this assumption. Results of all three experiments show that, when completing questionnaires given to participants by interviewers presenting themselves as coming from law schools, participants with lower educational backgrounds indicated that they hold higher levels of trust in their country&rsquo;s judges than when the same interviewers presented themselves as coming from regional community colleges. Taken together, these findings indicate a robust phenomenon overlooked thus far in the literature, namely that trust in the judiciary can vary systematically among citizens with lower educational backgrounds as a function of interviewer affiliation. Implications on how to understand this phenomenon are discussed.

The guided use of an e-health tool to strengthen health literacy. A pilot study in a multicultural diabetes population in a primary care clinic in Brussels.

We aimed to investigate whether the use of an e-health tool, guided by a healthcare provider, can improve health literacy (HL) in primary care. We set up a longitudinal prospective cohort study in a primary care clinic in Brussels. Diabetes patients were invited to participate in two study consultations with a trained healthcare provider, in which an e-health tool was introduced. The Health Literacy Questionnaire (HLQ) was used to evaluate HL before (n = 59) and after intervention (n = 41). The data were analysed within SPSS, Version 26. Additionally, impressions and experiences of both patients and healthcare providers were collected throughout the different phases of the study. Patients feel significantly stronger in finding good health information after intervention (p = 0.041), with relatively stronger progress for the subgroup with weaker digital skills (p = 0.029). Participants also declare understanding health information better after intervention (p = 0.050). Specifically, the lower educated participants feel reinforced to correctly evaluate and assess health information and come closer to the skill level of the higher educated patients after intervention. The relationship with the healthcare provider was also more markedly enhanced within the group of the lower educated (p = 0.008; difference between higher and lower educated), which could strengthen self-management in the long run. The guided use of an e-health tool in primary care strengthens various patient HL skills. Most particularly the skills "the ability to find good health information" and "understand health information well enough to know what to do" are reinforced. Moreover, patient populations with lower HL, such as the lower educated and lower digitally skilled, show a greater learning potential. Our results offer further proof for the learnable and flexible nature of HL, and show that even a small e-health intervention, in a very diverse patient population, can produce significant, positive effects on HL. These results need to be considered as promising, and a motivation for further investments in more widely accessible e-health tools to further improve HL at population level and to bridge health differences.

Mediating Role of Lifestyle Behaviors in the Association between Education and Cancer: Results from the European Prospective Investigation into Cancer and Nutrition.

Many studies have shown that socioeconomic position (SEP) is associated with the incidence of malignant tumors at different sites. This study aims to estimate the association between educational level (as proxy for SEP) and cancer incidence and to understand whether the observed associations might be partially explained by lifestyle behaviors. The analyses were performed on data from the European Prospective Investigation into Cancer and Nutrition (EPIC) study, globally and by sex. We used Cox proportional hazards models together with mediation analysis to disentangle the total effect (TE) of educational level [measured through the Relative Index of Inequality (RII)] on cancer incidence into pure direct (PDE) and total indirect (TIE) effect, unexplained and explained by mediators, respectively. PDE and TIE were then combined to compute the proportions mediated (PM). After an average of 14 years of follow-up, 52,422 malignant tumors were ascertained. Low educated participants showed higher risk of developing stomach, lung, kidney (in women), and bladder (in men) cancers, and, conversely, lower risk of melanoma and breast cancer (in post-menopausal women), when compared with more educated participants. Mediation analyses showed that portions of the TE of RII on cancer could be explained by site-specific related lifestyle behaviors for stomach, lung, and breast (in women). Cancer incidence in Europe is determined at least in part by a socioeconomically stratified distribution of risk factors. These observational findings support policies to reduce cancer occurrence by altering mediators, such as lifestyle behaviors, particularly focusing on underprivileged strata of the population.