Negative Outcomes Research Articles

The impact of telework on mental health: a secondary analysis of the 2023 BelHealth

Abstract Background Teleworking gained ground in most workplaces, but questions remain about its impact on mental health. This research used data from the BELHEALTH cohort, a Belgian longitudinal wellbeing study, to investigate the relationship between the extent of telework and three mental health outcomes: anxiety, depression, and burnout. Methods In June 2023, the quarterly online survey assessed telework frequency (never, monthly, weekly, daily) as well as state of anxiety (GAD-7), depression (PHQ-9) and burnout (BAT-12). A complete case analysis (n = 2,303) of these cross-sectional data was performed with employed participants aged 18-65 years. Logit generalized linear mixed models were constructed, with the mental health outcomes as binary outcomes, telework as ordinal covariates, and occupation, type of job, as random effects. The anxiety, and depression models were controlled for geographical location, sex, age, and education confounders, whereas the burnout model was controlled only for sex, and education due to lack of observations. Results In this secondary analysis, we found that daily telework increased the odds of anxiety by 2.33 (95% CI [1.71; 3.17], p < 0.01), the odds of depression by 2.98 (95% CI [2.16; 4.12], p < 0.001), and the odds of burnout by 1.17 (95% CI [0.87; 1.58], p > 0.05) as compared with not teleworking while controlling for confounders. The category of monthly telework was associated with lower odds of anxiety (0.85; 95% CI [0.67; 1.07], p > 0.05), depression (0.91; 95% CI [0.74; 1.28], p > 0.05), and burnout (0.95; 95% CI [0.79; 1.15], p > 0.05) as compared to not teleworking. Conclusions Full-time teleworkers seem to have a higher odds for negative mental health outcomes. Future studies should focus on the long-term causal mechanisms that explain how telework intensity influences mental health to tailor and optimize current wellbeing initiatives at the workplace. Key messages • Our survey points out that full-time teleworkers seem to be at risk of mental health problems. • The frequency of telework has a mixed influence on mental health, indicating that different employees need tailored wellbeing initiatives.

Comorbid mental illness and intellectual disability: impact on employment

Objectives In the general population, studies have revealed that mental health concerns negatively impact employment. Research has also begun to reveal similar negative employment outcomes among individuals with an intellectual disability and co-occurring mental health disorder. This study sought to expand upon these findings and examine whether specific diagnoses relate to inclusive employment. Methods We conducted Chi-square tests to examine if reported diagnoses and challenging behaviors related to paid community employment among 378 individuals with an intellectual disability in Pennsylvania who participated in the Independent Monitoring for Quality program. We selected participants from a statewide database compiled via stratified random sampling and structured interview. Results We found statistically significant differences in community-based employment rates between those with and without a mood disorder (χ 2 (2) = 6.07; p = 0.01) and behavior challenges (χ 2 (2) = 5.04; p = 0.03). Anxiety disorders approached statistical significance (χ 2 (2) = 3.73; p = 0.05). Conclusions The significant relationships between employment and mental health is consistent with studies in the general population. We discuss diagnostic challenges and limitations of this study, proposing future research explore a transdiagnostic approach to targeting mental health concerns for those with an intellectual disability.

Health disparities among in multicultural and non-multicultural families in South Korea

Abstract South Korea has experienced significant immigrant growth, with international marriages playing a key role in this demographic change. In 2019, international marriages accounted for 10.3% of all marriages, increasing the number of multicultural households. Multicultural families in Korea faced controversies over accepting new members in a society traditionally considered racially and ethnically homogenous. In rural areas, where patriarchal and conservative values prevail, there is greater discrimination and negative perception towards foreigners compared to urban areas, impacting access to healthcare. This potentially adversely affects the health of married immigrants. However, research on this issue is limited. This study aims to examine the differences in health behaviors, access to care, and health status between multicultural and non-multicultural families in rural and urban areas. Using a cross-sectional study design based on the 2023 Community Health Survey, the sample included 228,216 adults from non-multicultural families and 3,373 adults from multicultural families. Adjusted differences in outcome were estimated using regression models, including linear probability and logistic models. Overall, there were minimal or no differences in health behaviors and health status between adults from multicultural and non-multicultural families. However, significant differences were observed in access to care, such as annual health check-ups (0.72 [0.64, 0.81]) and vaccinations (0.84 [0.76, 0.94]). Non-multicultural families showed regional differences in all outcomes, whereas multicultural families exhibited minimal or no regional differences. These findings suggest that multicultural families may face barriers beyond regional environments, limiting their access to care and potentially leading to long-term negative health outcomes. Targeted policy development for multicultural families in Korea is necessary to address this issue. Key messages • Access to health care may vary for individual and local factors, especially for people with different ethnicities or cultures. • Multicultural families may encounter greater barriers than individual and regional characteristics, requiring the development of tailored policies for immigrants and multicultural families.

The impact of diabetes pay-for-performance program on hyperglycemic hyperosmolar state (HHS)

Abstract Background To examine the effects of a diabetes pay-for-performance (P4P) program on the negative metabolic outcome: hyperglycemic hyperosmolar state (HHS) of patients in Taiwan. Methods Four years (2008∼2011) of data from the National Health Insurance Administration (NHIA) databases were examined. P4P patients included those who were newly enrolled in the P4P group in 2010, and consecutively included in 2011. Patients were never enrolled are defined as non-P4P group in these two years. The caliper matching method and a generalized estimating equation were used to estimate difference-in-differences models (baseline year 2009) and examine the effects of the P4P program on the count of the adverse outcome. Results The P4P program was associated with decreases in the incident of HHS (IRR 0.53, P = 0.02). Conclusions The disease management component of the diabetes P4P program can be beneficial for reducing the incidences of HHS. Key messages • The disease management component of the diabetes P4P program can be beneficial for reducing the incidences of HHS. • The disease management component of the diabetes P4P program is important.

The impact of maternal serum biomarkers on maternal and neonatal outcomes in twin pregnancies: a retrospective cohort study conducted at a tertiary hospital.

Prior prediction models used for screening preeclampsia (PE) in twin pregnancies were found to be inadequate. In singleton pregnancies, various maternal biomarkers have been shown to be correlated with negative pregnancy outcomes. However, the impact of these biomarkers in twin pregnancies remained uncertain. A retrospective cohort study was carried out on 736 twin pregnancies at a tertiary hospital in Hangzhou, China. Multivariable logistic models were employed to examine the association between levels of serological markers and the likelihood of adverse pregnancy outcomes. The final logistic model was formulated as a user-friendly nomogram. The primary outcome assessed was the occurrence of PE. Results were presented as odds ratios (ORs) with corresponding 95% confidence intervals (CIs). The prevalence of PE in the study was 10.3%. When comparing women diagnosed with PE to those without, it was evident that the former group experienced a significantly higher risk of unfavorable maternal and neonatal outcomes. A multivariable logistic regression analysis revealed notable associations between various factors including maternal age, parity, gestational weight gain, a family history of hypertension, as well as levels of cholesterol, albumin, and creatinine and the risk of developing PE, with a significance level of P < 0.05. The concordance index for the constructed nomogram was determined to be 0.792 (95% CI: [0.739-0.844]). Furthermore, an increment of 1 * 1012/L in red blood cell (RBC) count was associated with more than a two-fold increase in the odds of experiencing adverse maternal outcomes (OR 2.247, 95% CI: [1.229-4.107]). However, no significant correlations were identified between any of the examined variables and neonatal outcomes. In this study, we developed a user-friendly predictive model that achieves notable detection rates by incorporating maternal serum biomarker levels alongside maternal characteristics and medical history. Our findings indicate that the probability of adverse maternal outcomes increases with elevated levels of RBCs. Obstetricians should consider intensifying surveillance for these women in clinical practice.

School and family partnership can reduce chronic absenteeism

Families are critical partners in addressing chronic absenteeism. Drawing from research, authors Thomas J. Capretta, Jingyang (Max) Zhang, and Barbara J. Boone present four throughlines and six strategies for schools to improve attendance by building trust and partnering with families. In view of chronic absenteeism’s association with negative academic and life outcomes and disproportionate impact on underserved student populations, addressing absenteeism with families as partners is essential in building shared expectations and identifying unique solutions to unique barriers. The authors outline practical, accessible, and research-informed guidance for schools to tackle the persistent challenge of student attendance in education through high-quality partnerships with parents and community members.

Dose-response associations between physical activity and mental health among USA adolescents

Abstract Background Adolescent mental health is a critical public health concern. Physical activity has been shown to reduce risk of negative mental health outcomes. However, in adolescents little is known about the dose-response nature of this relationship. This study aims to fill this gap by examining the association between varying levels of self-reported physical activity and the odds of reporting depressive symptoms and poor mental health, among US high school students. Methods This is a cross-sectional study using data from the 2021 Youth Risk Behavior Survey. Physical activity exposure was assessed as students’ self-reported weekly frequency of ≥ 60min moderate-to-vigorous physical activity (MVPA), as well as frequency of participation in muscle-strengthening activities, sports teams, and physical education (PE) classes. For the dose-response analysis three categories were created for each item. Depressive symptoms and poor mental health were measured using established survey items. Multivariate logistic regression risk models were used. Results A total of 8,015 high-school students were included. Depressive symptoms were reported by 43% of students, and 28% reported poor mental health. Moderate doses (1-4 days) of muscle-strengthening activities reduced the odds of depressive symptoms by 23% and the odds of poor mental health by 38% compared to low doses (0 days). Higher reductions were observed for higher doses (5-7 days). Similar results were observed for sports teams (1 vs 0 teams). Moderate doses (1-4 days) of MVPA ≥60min showed a significant reduction in the odds for poor mental health (38%) but not depressive symptoms compared to low doses (0 days). No effect was observed for any dose of PE attendance. Conclusions The findings suggest a dose-response pattern in the association between physical activity and mental health in adolescents. Any increase in physical activity levels among young adults would be valuable in preventing poor mental health. Key messages • A dose-response pattern was observed between self-reported mental health and physical activity exposure in adolescents. • Moderate levels of physical activity significantly reduced the risk of self-reported poor mental health among adolescents.

Is being a physically active parent related to having a physically active son/daughter?

Abstract Background Engaging in physical activity (PA) during childhood and adolescence can promote lifelong healthy habits and improve overall health. Physically active parents could play a key role in influencing the sons’ and daughters’ PA. The study aimed to evaluate the levels of PA among children and adolescents and to investigate the possible relationship with PA levels of parents. Methods This cross-sectional study involved a random sample of parents of a son/daughter aged 5 to 17 years in the Southern part of Italy. Data were collected through an anonymous self-administered questionnaire designed to retrieve i) sociodemographic characteristics and anthropometric data, ii) parent’s knowledge about the World Health Organization’s (WHO) guidelines (GL) about PA, iii) levels of PA of son/daughter and parent. Results Preliminary findings refer to a sample of 230 parents, of whom, 52.2% were women with a mean age of 38.6 (SD ± 6.8) years. The vast majority of the sample was employed (79.6%) and married (89.1%). Less than half (48.7%) were knowledgeable about WHO’s GLs for PA both in adults (52.6%) and children/adolescents (74.8%). Almost two-thirds (63%) of parents practised PA according to WHO’s GLs. Among sons/daughters, 44.4% practised PA according to WHO’s GLs. The results of the multivariate analysis showed that sons/daughters of physically active parents had higher odds of practising PA according to WHO’s GLs (OR:6.48, 95%CI:3.29-12.79). Similarly, those with parents knowledgeable about WHO’s GLs for PA (OR:3.19, 95%CI:1.75-5.83) were more likely to practise PA according to WHO’s GLs. Conclusions Preliminary results reveal a lack of compliance with WHO’s GL on PA, especially among children and adolescents. This is of concern since it is linked to negative health outcomes in the future. The figure that sons/daughters of active parents had a higher likelihood of being active highlights that public health organizations should prioritise family-based interventions for PA. Key messages • Almost one-third of adults and more than half of the children and adolescents in the sample did not comply with WHO’s recommendations for physical activity. • Sons and daughters of physically active parents are more likely to be active, prompting the need for family-based public health intervention to promote physical activity.

Antibiotic use in the first 1000 days and maternal-infant outcomes: results from the MAMI-MED cohort

Abstract Introduction Antibiotic use within the initial thousand days of life could potentially lead to a range of negative health outcomes for both mothers and infants. This study seeks to identify the primary factors influencing antibiotic use and examine the associations with adverse neonatal outcomes, specifically focusing on neonatal intensive care unit (NICU) admissions. Methods Data were gathered from pregnant women and their offspring enrolled in the ‘MAMI-MED’ study at ARNAS Garibaldi Nesima in Catania (Italy), from December 2020 to January 2024. Information regarding antibiotic exposure and maternal-infant health outcomes was collected through follow-up questionnaires administered at birth, one year, and two years postpartum. Results Among 1492 women (average age: 31 years) included in the study, 20.4% reported using antibiotics during pregnancy. The mean age of antibiotic users during pregnancy was significantly higher compared to non-users (p = 0.008). Among the 304 women who used antibiotics during pregnancy, 45.5% did so during the third trimester, 41.4% during the second trimester, and 13.1% during the first trimester. Furthermore, 47.1% of women reported antibiotic use at delivery or postpartum. Of the 904 children studied, 63% were administered at least one antibiotic between birth and the first year of age. A greater proportion of newborns admitted to the NICU were born to mothers who used antibiotics during the second trimester of pregnancy compared to those who used antibiotics during other trimesters (p = 0.013). Conclusions Comprehensive research is needed to delve deeper into the intricate factors influencing maternal antibiotic use. This should thoroughly explore socio-demographic variables, such as income level, education, and access to healthcare. Understanding these multifaceted influences can provide valuable insights into designing tailored public health interventions aimed at promoting prudent antibiotic use during pregnancy. Key messages • Different factors influence maternal antibiotic use. • Tailored public health interventions aimed at promoting prudent antibiotic use during pregnancy are needed.

The role of weight stigma and food literacy in eating behaviour

Abstract Background Overweight/obesity is associated with negative health outcomes that may be caused by experience and internalization of weight stigma. Weight stigma seems to diminish weight control efforts and may be associated with unhealthy eating behaviours. Moreover, lack is known about the protective factors against stigmatization. We aimed to assess the role of weight stigma and food literacy in eating behaviour in people with overweight and obesity controlling for sociodemographic and clinical variables. Methods A total of 189 participants with overweight/obesity (52.9% female; mean age 48.8±14.5 years; body-mass index (BMI) 32.6±6.5 kg/m2; waist-to-height ratio (WHtR) 0.6±0.1) completed the Experienced Weight Stigma Questionnaire and the Weight Self-Stigma Questionnaire. To examine eating behaviours including cognitive restraint, uncontrolled eating, and emotional eating we used the Three Factor Eating Questionnaire. Multiple linear regression analyses were performed. Results Higher WHtR and BMI were associated with emotional eating and uncontrolled eating. Experienced weight stigma was associated with emotional eating but was no longer significant when self-stigmatization was added to the regression model. Self-stigmatization was associated with emotional eating and uncontrolled eating. This association attenuated when food literacy was added to the final models. Low food literacy was significantly associated with emotional and uncontrolled eating. No role of weight-related measures, stigma or food literacy in the cognitive restrain was found. The explained variance in the final regression models for emotional eating and uncontrolled eating was 41%, and 32.7%, respectively. Conclusions Emotional eating and uncontrolled eating may represent crucial components to address in health and weight management. Nutrition literacy may have a positive effect on diminishing associations between weight stigma and unhealthy eating patterns. [Funding: VEGA: 1/0748/22]. Key messages • Eating disorder symptoms and their association with obesity should be considered when designing public health interventions. • Interventions targeting weight stigmatization and food literacy may mitigate the negative impact of weight stigma on eating behaviours.

Acute kidney injury stage 2/3 during acute heart failure admission - clinical contributors and outcomes

Abstract Introduction Acute Heart failure (AHF) may be complicated by acute kidney injury (AKI) as a result of cardiorenal syndrome.(1) However other factors may contribute to AKI. AKI stage 2 or 3 predicts negative inpatient outcomes in the general population.(2) We have reported data in a contemporary cohort on AKI in AHF. This study looks at a larger cohort in 5 previous years to test whether those findings were consistent. Better understanding of this clinical scenario may lead to improvements in care. Aim To assess the clinical factors associated with AKI 2/3 in AHF inpatients. Methods This study used retrospective data from a single teaching hospital collected for inclusion in the UK National Heart Failure National Audit. All AHF admissions over a 5-year period, from April 2017 – April 2022 inclusive, were analysed. Renal function on admission and discharge/death were assessed. AKI stage was defined according to KDIGO guidelines based on serum creatinine levels. Electronic patient records were reviewed and the clinical course leading up to and following AKI 2/3 was reviewed. Reported mode of death was also collected. Results 3219 AHF admissions (2360 unique patients) were assessed. 257 patients died during admission (8% admission mortality, 10.9% patients). 157 (4.9%) admissions had AKI 2/3 on admission/discharge. 85 (54.1%) AKI 2/3 died during their hospital admission vs 6.1% mortality in admissions without AKI 2/3. Baseline population characteristics are summarised in Table 1. Admissions with AKI 2/3 who died were older (77.6±11.5 vs 71.5 ±15.8) and had higher rates of atrial fibrillation (48.2% vs 39.9%), diabetes (40% vs 36%), ischaemic cardiomyopathy (56.5% vs 41.7%) and LVEF &amp;lt;35% (38.8% vs 27.7%). The most frequent contributors to AKI 2/3 were sepsis (55, 64.7%) and congestive cardiac failure/cardiorenal syndrome (48, 56.6%). Hypotension (25, 29.4%), over-diuresis (17, 20%), radioiodine contrast (10, 11.8%) and aminoglycosides (8, 9.4%) were less common factors in development of AKI 2/3. ≥2 contributors were present in 49, 57.6%. The dominant contributor for AKI 2/3 was adjudicated to be sepsis in 33 (38.8%) of admissions, followed by cardiorenal syndrome (congestive heart failure with AKI) in 29 (34.1%), and cardiogenic shock in 7 (8.2%). AKI 2/3 contributors are summarised in Table 2. In AKI 2/3 cases who died, 35 (41.2%) involved renal specialist input; 60 (70%) involved heart failure specialist review. Conclusion AKI in AHF is associated with high inpatient mortality. Despite this, specialist renal input was uncommon. AKI 2/3 was usually multifactorial. Cardiorenal syndrome accounted for one third of cases and may not be preventable. In keeping with our findings from a smaller contemporary cohort, sepsis was the most common dominant cause of severe AKI. Prevention, early identification, and treatment of infection could reduce this risk. Awareness of the high mortality of AKI in AHF and specialist review may improve outcomes in AHF.

Participation With Compensation: Ethical Considerations for Research Payment Practices With People Who Are Incarcerated.

The participation of incarcerated individuals in research is necessary to appropriately address the health disparities that affect them and to adapt and implement health services for the carceral setting. Incarceration significantly impacts health, leading to negative outcomes including accelerated aging and increased mortality, with these effects disproportionately impacting communities of color. The U.S. Department of Health and Human Services' Office for Human Research Protections outlines ethical approaches to compensating individuals who participate in research activities, yet lacks specific guidance for payment within carceral settings. Historical abuses in carceral research underscore the persistent need for robust protections for incarcerated research participants. Existing regulations offer some protection but inadequately address ethical payment practices. Substantial variability in payment policies across carceral systems and vague national guidelines pose ethical challenges in ensuring equitable treatment for incarcerated research participants. We outline the ethical concerns related to compensating incarcerated individuals for participating in research and present a framework of approaches to payment. We argue for payment parity between incarcerated and community research participants. More community-engaged research is needed to understand the perspectives of incarcerated individuals on ethical payment.

The association between screen use, psychological distress and sleep among adolescents in Norway

Abstract Background Today’s adolescents dedicate a significant portion of their time to screens. Concerns have arisen regarding the lasting impact of screen use on adolescent health, making it a crucial public health topic. Previous studies have presented both positive and negative outcomes associated with screen use. Further insight is required into various forms of screen use and the influence on adolescent health. The objective of this study is to examine the relationship between gaming, social media use, psychological distress, and sleep among adolescents. Methods This study is based on cross-sectional data from the Ung-HUNT4-study, a health study conducted among adolescents 13-19 years old in Trøndelag municipality in Norway from 2017-2019 (n = 8066). Binomial logistic regression was used to analyse the association between gaming, social media, psychological distress and sleep. Analysis was controlled for gender, age, family economy and having friends. Results Preliminary results showed that the odds for having psychological distress were higher for those who spent more than 3 hours on social media after school (OR: 1.31, 95% CI: 1.10-1.57), and on weekends (OR: 1.45, 95% Cl: 1.22 - 1.73), and on gaming in weekends (OR:1.30 Cl: 1.08-1.55) compared to those who spent 3 hours and less. The odds for sleeping &amp;lt; 8 hours per day on weekdays were higher for those who spent more than 3 hours on gaming after school (OR: 1.27 Cl:1.07-1.52), and more than 3 hours on social media after school, (OR:1.41 Cl:1.20-1.67) or on weekends (OR:1.39 Cl: 1.19-1.62), compared to those who spent 3 hours or less. Conclusions More than 3 hours spent on social media after school and on weekends was associated with significantly higher odds for psychological distress and less sleep on weekdays. More knowledge about the impact of different types of screen use on adolescents’ health is needed, and new public health strategies to secure safe screen use should be developed. Key messages • Screen use is associated with psychological distress and less sleep. • Awareness on various types of screen use and its influence on health in adolescence, is important in public health policy and practice.

Harming the innocent: estimating the number of children affected by parental problem gambling

Abstract Background The impact of parental problem gambling on children and adolescents encompasses negative outcomes in psychological, financial, behavioral, physical health, and family relationship domains. For Germany, estimates on the number of co-affected minors are lacking. Methods Within the population-representative Germany-wide “Glücksspielsurvey 2023” (i.e., “Gambling Survey 2023”), we assessed parenthood in survey participants with gambling disorder (GD; according to DSM-5) as well as the number of minors (age &amp;lt;18 years) living a) together with a person with gambling disorder (shared household) or b) apart from a parent with gambling disorder (separate household). Using a “minimum maximum approach,” we performed a weighted extrapolation to estimate the number of co-affected minors in the German resident population (range 18 to 70 years of age) and the prevalence of parental GD among Germany-residing minors. Results 46.8% (n = 132) of survey participants with GD report shared households with minors and 16.3% (n = 46) separate households. The average number of minors concerned was 1.55 (SD = 0.07) in shared and 1.51 (SD = 0.13) in separate households. This translates into 480,294 to 701,766 co-affected children in shared households (3.4% to 4.9% of Germany-residing minors) and 91,742 to 124,618 co-affected children in separate households (0.6% to 0.9% of Germany-residing minors). Discussion and conclusions Taking shared and separate households into account, one in 20 Germany-residing minors is co-affected by parental GD. Acknowledging that impaired psychosocial wellbeing in the context of parental GD could persist into adulthood of co-affected minors, this issue ought to be recognized as a major public health concern. To reduce related harm, children of people with GD should be best possibly integrated into the care process by offering additional help and support strategies explicitly addressed at this vulnerable population. Key messages • Parental problem gambling significantly impacts a substantial portion of German minors, with approximately one in 20 being affected, highlighting the urgent need for attention to this issue. • Recognizing parental gambling’s long-term impact on minors, it’s crucial to implement support strategies in care to address their needs effectively.

Call for Action for a Disaster Literacy Course for Disaster Risk Management Process.

There is a need to utilise formal education to ensure and support the effective participation of communities in the disaster risk management process. The negative outcomes of disasters occurring as a result of various disasters in Turkiye show that the society is inadequately prepared. Therefore, the best fight against disasters can be carried out within the scope of formal education activities. In this study, the content and infrastructure of a curriculum for the management of disaster risks at the university level is presented at the conceptual level. Disaster literacy curriculum can contribute to the management of current and future disaster risks. However, there is a need to expand the implementation and measurement of the effectiveness and feasibility of the curriculum as a public health intervention tool. Finally, the support of the national education system needs to be ensured.

Demographic, socioeconomic and lifecourse risk-factors for internalized weight stigma

Abstract Background Obesity is highly stigmatized, with negative obesity-related stereotypes widespread across society. Internalized weight stigma (IWS) is linked to negative outcomes including poor mental health and disordered eating. Previous evidence examining population groups at higher risk of experiencing IWS comes from small, nonrepresentative samples. Here, we re-assess previously reported associations of IWS with social factors in a large general population birth cohort study for the first time. Methods In the Avon Longitudinal Study of Parents and Children (ALSPAC), we explored differences in IWS at age 31 years by sex, ethnicity, socioeconomic factors, and sexual orientation using multivariable regression. Using data collected over a 32-year period, we explore the impact of family, peer, and wider social influences in adolescence, and bullying from mid-childhood to adulthood, whilst minimising risk of recall bias. Results In models adjusted for potential confounders and BMI in childhood, adolescence, and adulthood (N = 4060), IWS was higher for females (0.56 S.D. higher, CI:0.50-0.61), sexual minorities (0.17 S.D. higher, CI:0.09-0.24), and less socioeconomically advantaged individuals (0.16 S.D. higher (CI:0.08-0.24) for those whose mothers had minimum or no qualifications, compared to a university degree). The social environment during adolescence and young adulthood was important: IWS was higher for people who at age 13 years felt pressure to lose weight from family (0.13 S.D., CI:0.03-0.23), and the media (S.D. 0.17, CI:0.10-0.25), or had experienced bullying (0.25 S.D., CI:0.17-0.33 for bullying at age 23 years). Conclusions Internalized weight stigma differs substantially between demographic groups, and this is not explained by differences in BMI. The family environment during adolescence, bullying, and pressure to lose weight from the media may have long-lasting impacts on adult IWS. These may be fruitful avenues for intervention to reduce IWS and its consequences. Key messages • Females, sexual minorities, and socioeconomically disadvantaged adults are at greater risk of IWS irrespective of BMI. • To reduce IWS, interventions should improve the family and social environment.

Deafness and Inclusion: Perceived Communicative Barriers in the Area of Rehabilitation in Italy

Abstract Introduction Deafness can create a communication deficit/barrier between the Deaf or Hard of Hearing patient and the Healthcare Workers (HWs), with negative outcomes for diagnostic and therapeutic success. As underlined by the COVID-19 pandemic, there is a need to train HWs in effective communication strategies in order to avoid marginalising or excluding the Deaf Community by denying them access to healthcare services. This study highlights the urgent need and desire of Healthcare staff for training in effective communication strategies, such as sign language, to help the Deaf community gain equal access to Healthcare. Materials and methods A cross-sectional survey was carried out between May and July 2022 using the Google Forms platform. An anonymous questionnaire was given to Rehabilitation HWs (RHWs) at a national level to collect information from the HWs of the various areas of rehabilitation, identifying their knowledge, training, and experience with regard to deafness. Data analysis was then carried out using the Google Forms program, SPSS program Windows7 Excel Spreadsheet. Results 252 RHWs belonging to 8 different profiles answered this survey. 89% were women. 46% were younger than 30. 57% of these 252 had deaf patients, but 54.6% of these had no prior training. 33% of the RHWs had followed courses or seminars on deafness at least once. When asked, 94% were interested in courses or training in communication with deaf people. Conclusions HWs recognize the gap in communication and are willing to learn more in the matter for effective communication with their patients to gain a better therapeutic success. They also consider a program that imparts such knowledge and training to be highly important. Key messages • Therapeutic success is increased if there are effective communication strategies, such as sign language, between the Deaf and Healthcare provider. • This study shows the importance of training all health workers in effective communication strategies with deaf people to allow an all-inclusive healthcare.

Protocol for the creation of a core outcome set for clinical trials of interventions to improve sleep in people with cognitive impairment: The Sleep in Cognitive Impairment Core Outcome Set (SCICOS) study.

Background While sleep disturbance is common in dementia, leading to negative outcomes, there is growing evidence that sleep disturbance begins early in prodromal dementia and may contribute to cognitive decline. Sleep is therefore an important treatment target throughout the natural history of dementia and there is increasing interest in sleep as a modifiable risk factor. Clinical trials of interventions to improve sleep in people with cognitive impairment are beset by wide heterogeneity in the outcome measures reported. A core outcome set (COS) is urgently required to improve the coherence and comparability of data. Aim To produce a COS for clinical trials of interventions to improve sleep in people with cognitive impairment: the Sleep in Cognitive Impairment Core Outcome Set (SCICOS). Methods The Core Outcome Set-STAndards for Development: the COS-STAD recommendations will be followed. A systematic review (Registration: CRD42024556750) will identify outcome measures used in relevant clinical trials. Qualitative interviews involving people living with cognitive impairment and their caregivers will ascertain the outcome measures important to them. Finally, a modified Delphi process, involving people living with cognitive impairment and their caregivers as well as expert clinicians and researchers, will be conducted to reach consensus regarding the final composition of the SCICOS. Conclusion Interventions to improve sleep in people with cognitive impairment may reduce distress associated with sleep disturbance and, potentially, slow progression of cognitive decline. Creating the SCICOS will facilitate development of more meaningful and coherent data to drive progress in this emerging field.

A realist change model for community-based perinatal mental health peer support from peer volunteers

ABSTRACT Aims To investigate what it is about community-based perinatal mental health peer support from trained volunteers that works, for whom, in what circumstances, in what respects, and why; and build a change model that includes positive and negative mechanisms and outcomes. Methods Realist evaluation methods based on semi-structured interviews were used to create a change model for a third sector programme in England. Results Mothers who received peer support (n = 20), peer support volunteers (n = 27), and programme staff (n = 9) were interviewed. Positive impact on mothers was primarily based on feeling understood and accepted, social comparison (including normalisation, hope, and gaining perspective) and sharing non-directive information from experiential knowledge. Negative impact on mothers was based on negative social comparison, or absence of key peer support mechanisms. Mothers were affected in different ways, depending on individual contexts: their backgrounds, personalities, social situations, resources, experiences, beliefs, and needs. Some different mechanisms were present in one-to-one and group situations. All participants considered the benefits of peer support to greatly outweigh the risks. Conclusion Individual contextual factors affect the multiple mechanisms through which mental health peer support can improve mothers’ emotional wellbeing and social participation. Peer support has potential risks as well as benefits, which can be mitigated. Programmes could use this understanding of how contexts and mechanisms interact to produce peer support outcomes to improve training for peer support volunteers and to design future evaluations that take into account diversity of peer support experience.

The Effectiveness of Trauma-Informed Parenting Programs for Traumatized Parents and Their Components: A Meta-Analytic Study.

Parents who have been exposed to trauma face distinct challenges in parenting that can lead to negative child developmental outcomes and intergenerational transmission of trauma. Parenting programs for traumatized parents seem promising, but the existing evidence on their effectiveness has not yet been synthesized. This study aimed to examine the overall effect of trauma-informed parenting programs on (a) parenting and (b) parental mental health outcomes by conducting two three-level meta-analyses. Moderator analyses were performed to identify whether program components, delivery techniques, and other study and program characteristics were associated with effectiveness. A literature search conducted up to August 2024 yielded 15 studies reporting on 110 effect sizes. Significant overall effects were found of trauma-informed parenting programs on both parenting outcomes (d = 0.75, 95% CIs = [0.09, 1.15], p = .027) and parental mental health outcomes (d = 0.21, 95% CIs = [0.09, 0.32], p < .001). The first meta-analysis on parenting found no significant moderators, while the second meta-analysis on parental mental health indicated that programs emphasizing child disciplining skills yielded smaller effects (d = 0.04) compared to programs without this component (d = 0.31). Programs using modeling techniques yielded larger effects (d = 0.32) compared to programs without (d = 0.14). Larger program effects on parental mental health were also found for programs with longer durations and when individual sessions were used. Thus, evidence supports the effectiveness of trauma-informed parenting programs in improving parenting and reducing parental mental health problems.