Ongoing Health Research Articles

Trends in Cerebrovascular Disease-related mortality among Older Adults in the United States from 1999 to 2020: an analysis of gender, race/ethnicity, and geographical disparities

One of the most prevalent causes of morbidity and death is cerebrovascular disease in the US. The manifestations and pathophysiology of cerebrovascular disease are significantly impacted by aging and determine the quality of one's late life. However, contemporary mortality trends in cerebrovascular disease and comparison to older adults of different gender, race, and geographic disparities have not been fully examined. A thorough comprehension of these correlations and current cerebrovascular disease death patterns can impact medical treatment and strategies. We examined the mortality trends according to gender, race, and geographical disparities in cerebrovascular disease among older adults, using mortality data (1999 - 2020) from the Centers for Disease Control and Prevention WONDER database METHODS: This research study aims to analyze disparities in cerebrovascular disease among senior citizens in the United States. The analysis has considered factors such as gender, race, and geographical variations over 21 years from 1999 to 2020. Mortality data obtained from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research database has been utilized for this retrospective cohort analysis, focusing on individuals aged 75 and above. From 1999 to 2020, there were 3,813,729 deaths related to Cerebrovascular disease in older adults, demonstrating a declining trend (AAPC=). Males (880.6) had slightly higher AAMRs than females (866.7). Non-Hispanic (NH) Black (1050) had higher AAMRs than NH whites (880.8) followed by NH American Indians (699.7), Hispanic (673.2), and NH Asians (669.3). AAMRs also varied by region with the Midwest (922) having the highest AAMRs followed by the South (918.2), West (884.3), and Northeast (744). Among states, Tennessee had the highest AAMRs (1076.3), whereas New York had the lowest (609.7). These results indicate a significant decline in cerebrovascular disease-related mortality among older adults from 1999 to 2020, highlighting improvements in healthcare and preventive measures over the two decades. Despite the overall decrease, elderly females had more deaths, elderly males had a higher AAMR, non-Hispanic blacks had the highest AAMR, and the Midwest and non-metropolitan areas had higher mortality burdens. The recent uptick in mortality rates from 2018 to 2020 underscores the need for ongoing public health efforts to address cerebrovascular diseases, particularly targeting vulnerable populations and high-risk regions.

Nudging consumers’ choices for niche milk: A real purchase experiment

Changing behaviours causing poor health is an ongoing global health challenge that requires developing adequate food policies and strengthening their effectiveness. Policies based on nudging have become increasingly popular internationally, but the literature provides mixed evidence of their effectiveness, with an intense academic debate. This study contributes to the debate by investigating the effect of different nudging techniques (availability enhancement, visibility enhancement and healthy eating calls) via a framed field experiment involving purchases of milk types. Participants were split into different nudging treatment groups and were endowed with a cash amount to purchase any desired quantity of the different products. We modelled observed choices via the multiple discrete–continuous nested extreme value model, which has yet to receive attention for the analysis of nudging effects on food choices. Results show that only the healthy eating call nudge effectively drove participants towards healthier milk choices, while the effect of other nudges is statistically insignificant. We provide simulated demand curves conditional on nudging treatments, which measure the effect of the latter on consumers’ consumption levels of the different milk types available.

Impact of self-perceived oral health and socio-economic factors on oral health-related behavior in Estonian adults.

To identify which socioeconomic factors are affecting oral health-related behavior and to provide suggestions for improving the population's oral health. Materials and methods: The survey includes population groups from age 35 and older from all 15 Estonian counties and major cities (n = 2,376). The study is based on data from a nationwide Estonian Adult Oral Health Survey questionnaire. In addition to analyzing eight aspects of oral health-related behavior and self-perceived oral health variables, the survey also includes participants' socio-economic and demographic characteristics. The study utilizes frequency tables (including cumulative distributions), means, correlations, and regression analysis as its methods. The mean number of beneficial behaviors reported by the participant was 4.2 (SD 1.6). The value of the oral health-related behavior index (OHBI, the number of reported behaviors from the eight) is initially determined by the optimal timing between meals, abstinence from smoking, and the choice of drinking water or refraining from any intake between meals. Participants with higher OHBI tended to rate their self-perceived oral health better. Adherence to beneficial dental health-related behavior in Estonian adults is primarily influenced by gender, educational level, type of settlement, and household income level. In order to significantly improve oral health and related behaviors, it is imperative to integrate dental services into universal health coverage and deliver ongoing oral health education for adults.

Sex-specific Concordance of Striatal Transcriptional Signatures of Opioid Addiction in Human and Rodent Brains.

Opioid use disorder (OUD) has emerged as a severe, ongoing public health emergency. Current, frontline addiction treatment strategies fail to produce lasting abstinence in most users. This underscores the lasting effects of chronic opioid exposure and emphasizes the need to understand the molecular mechanisms of drug seeking and taking, but also how those alterations persist through acute and protracted withdrawal. Here, we used RNA sequencing in post-mortem human tissue from males (n=10) and females (n=10) with OUD and age and sex-matched comparison subjects. We compared molecular alterations in the nucleus accumbens (NAc) and dorsolateral prefrontal cortex (DLPFC) between humans with OUD and rodent models across distinct stages of opioid use and withdrawal (acute and prolonged) using differential gene expression and network-based approaches. We found that the molecular signature in the NAc of females with OUD mirrored effects seen in the NAc of female mice at all stages of exposure. Conversely, males with OUD showed strong overlap in expression profile with rats in acute withdrawal. Co-expression networks involved in post-transcriptional modification of RNA and epigenetic modification of chromatin state. This study provides fundamental insight into the converging molecular pathways altered by opioids across species. Further, this work helps to disentangle which alterations observed in humans with OUD are driven by acute drug exposure and which alterations are consequences of chronic exposure.

Secondary school randomized controlled interventions with a minimum dual approach to health and the links to BMI in pupils: A systematic review and meta-analysis within the project From Science 2 School

Introduction & Purpose Health behavior offers a pivotal domain of health for managing current global crises, including physical inactivity and overweight/obesity (Schroeder, 2007). However, adults have limited capacity for adopting healthy behavior into their lifestyle (Prochaska & Velicer, 1997). Schools offer an ideal setting for implementing health interventions considering the breadth of children that can be reached and the amount of time children spend in school (Tanous et al., 2022). The present study hypothesized that appropriately planned physical activity (PA) intervention for pupils and during compulsory secondary school time results in healthier body weight management. Methods A systematic review and meta-analysis was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines, a published protocol (Tanous et al., 2022), and a trial registration was completed on the International Register of Systematic Reviews (PROSPEO: CRD4202347770). The databases searched (12/2021) included PubMed, Education Source, and EMBASE. Only school-based randomized controlled trial interventions on PA and/or diet published in English or German were included. The study population included pupils (10-19 years of age) enrolled in secondary schools and without major nutritional deficit or unstable health condition. The study sample was refined using exclusion criteria: (i) no outcome on body weight, body mass index (BMI), or self-reported, (ii) intervention groups only targeting overweight and/or obese pupils, (iii) interventions outside of regular school hours or implemented beyond the school setting, (iv) total intervention duration less than eight weeks, (v) branches of schools specializing on physical exercise/sports in general, and (vi) no control group. Title/abstract and full-text screening, data appraisal, and summary data extraction were completed by two reviewers. Results A total of 5,945 articles were identified by the search process, including 23 studies and 9,441 pupils (of which 4,787 males and 4,654 females) eligible for the analysis. PA interventions ranged from eight weeks to eight months and included jumping (n = 2), strength exercises (n = 3), cardiovascular endurance (n = 4), or a combination (n = 2). For PA intervention implemented in the secondary level school setting for at least eight weeks duration, a random effect size of -0.12 units (95% CI [-0.26. 0.02]) of BMI (kg/m2) was found with low statistical heterogeneity (I2 = 0%; p = 0.60). Discussion Due to the behavioral constraints of the school setting, children are denied from achieving the minimum level of health protection, which adversely contributes to the poor global health status with a major impact. Previous meta-analyses identified a small PA intervention effect for improving BMI in pupils (-0.02 kg/m2 and -0.05 kg/m2; Guerra et al., 2013; Harris et al., 2009) with considerable heterogeneity (I2 = 77% and 54%, respectively). The findings of the present investigation revealed a more precise effect measure than previous meta-analyses (Guerra et al., 2013; Harris et al., 2009) regarding the exclusive power of the secondary school setting over PA levels and the BMI health improvement possibility for pupils (-0.12 kg/m2). Conclusion PA intervention in secondary schools contributes to limited, yet beneficial body weight management for pupils in the ongoing global health crisis (Schroeder, 2007; Tanous et al., 2022). Considering the lack of formal organization at homes, schools are urged to achieve 60 minutes of PA daily.

Impact of a collaborative model on community clinician confidence in child and adolescent mental health care, wellbeing, and access to child psychiatry expertise.

The COVID-19 pandemic was associated with an increase in child and adolescent mental health disorders, with subsequent worsening of patient access to specialist mental health care. Clinicians working in the community were faced with increased demands to diagnose and manage pediatric mental health disorders, without always having the confidence and knowledge to do so. We therefore developed COnnecting Mental-health PAediatric Specialists and community Services (COMPASS)-a collaborative model designed to upskill community clinicians in child and adolescent mental health care and provide them with better access to child and adolescent psychiatry expertise. COMPASS comprises (1) an online Community of Practice (CoP) with fortnightly one-hour sessions covering: anxiety; aggression and challenging behaviours; depression; self-harm and suicidality; eating disorders; and autism spectrum disorder/complex cases and (2) primary and secondary consultations for general practitioners and paediatricians with an experienced child psychiatrist. We aimed to assess the impact of COMPASS on community clinician self-reported confidence in: managing common child and adolescent mental health disorders (Objective 1, primary outcome); navigating the mental health care system (i.e. knowing how services are organised, accessed, and how to refer patients, Objective 2); diagnosing conditions (Objective 3); prescribing psychotropic medications (Objective 4) as well as the impact on, clinician practice and wellbeing (Objective 5) and outcomes of patients referred by COMPASS clinicians to the child psychiatrist (Objective 6). We evaluated COMPASS in its first year, with COMPASS running from March to July 2021. Participating clinicians completed pre-post surveys evaluating change in Objectives 1 to 4 above, using study-designed measures. A purposive sample of clinicians was then invited to a semi-structured interview to understand their experience of COMPASS and its impacts on practice and wellbeing (Objective 5). We adopted an inductive approach to the qualitative analysis using the Framework Method. This involved selecting five random transcripts which were double coded and categorized, to generate an initial framework against which all subsequent transcripts were analysed. Themes and subthemes were generated from the data set, by reviewing the matrix and making connections within and between clinicians, codes and categories One child psychiatrist completed a 2-week logbook of the nature and outcomes of primary and secondary consultations (Objective 6). 51 (86%) clinicians attended CoP sessions and completed pre-post surveys, with 92% recommending COMPASS to peers. Clinicians reported increased confidence in the pharmacological and non-pharmacological management of all conditions, most notably for management of self-harm. They also reported increased knowledge of how to navigate the mental health system and prescribe medications. Qualitative analysis (n = 27 interviews) found that COMPASS increased clinician wellbeing and reduced feelings of professional isolation and burnout. Over the 2-week snapshot, the child psychiatrist consulted on 22 patients and referred all back to the community clinician. COMPASS is associated with improved clinician confidence to manage child and adolescent mental health concerns, navigate the mental health system, improved clinician wellbeing, and reduced need for ongoing mental health care by specialists.

Biological transformation of herbal extracts through Lactic Acid Bacteria fermentation: A study on Milk thistle and liquorice root extract

Herbal extracts have recently gained attention in pharmaceuticals, supplements, and cosmetics. This study explored the impact of Lactic Acid Bacteria (LAB) fermentation on the functional properties of milk thistle and licorice root extracts to develop health-enhancing beverages. Biological transformation using microorganisms or enzymes was employed to improve the stability and efficacy of these extracts. After 36 h of fermentation, bacterial growth in both extracts surged approximately two-fold. The licorice root extract showed a particularly significant increase in total phenolic content and antioxidant activity, attributed to bacterial enzymes breaking down complex, high-molecular-weight phenolic compounds into simpler, more potent free phenols. Despite a reduction in total flavonoid content across all samples, this did not indicate a decline in biological activity. High-Performance Liquid Chromatography (HPLC) analysis revealed a notable increase in silymarin concentration in the milk thistle extract, rising from 0.59 mg mL−1 to 2.5 mg mL−1 after fermentation with Lactiplantibacillus plantarum. Glycyrrhizic acid in the licorice root extract slightly decreased following fermentation with L. plantarum, while no significant changes were observed in extracts fermented with L. acidophilus. Cell viability studies during cold storage showed that the bacterial count in the licorice root extract remained within acceptable limits (106 CFU mL−1) for four weeks, ensuring ongoing health benefits. However, in the milk thistle-fermented extract, no viable cells were detected by the third week. These findings demonstrate the potential of LAB-fermented extracts for developing functional beverages with enhanced health benefits and therapeutic properties.

A Qualitative Exploration of Refugee Experiences of Access to a Dedicated Multi-Disciplinary Refugee Health Team in an Australian Context: Implication for Future Care

Aims Refugees experience physical and mental health issues that need attention following settlement in a new community. However, access to and utilisation of healthcare services is challenging. We aimed to explore the experience of refugee access to a dedicated multi-disciplinary refugee health team. Methods An interpretative qualitative study. 17 qualitative interviews were conducted with Ezidi refugees who attended a newly established multi-disciplinary refugee health program in a regional town in NSW, Australia. Data were analysed using an inductive thematic approach. Results Participants ( n = 17) identified as Ezidi and were from Iraq. Parents were between 23 and 57 years of age and had 1–12 children per family. Most had been in Australia between 2 and 5 years. Four key themes were identified: (1) Identifying the extent of health needs following a long wait to migrate; (2) Health support across the life span: the benefit of access to a multi-disciplinary team; (3) Gaps in cultural competence – impacted by understanding and interpreter access; and (4) Ongoing health and lifestyle concerns – influenced by understanding and education. Conclusions We identified the benefit of access to allied health for prompt diagnosis, treatment and management of conditions including congenital and developmental conditions, mental health and chronic diseases. Access to a dedicated team ensured early intervention for a broad range of health and social issues including early referral to services, close coordination and help to complete supporting paperwork and applications. Ongoing investments are needed to maintain this comprehensive and coordinated approach to care that is underpinned by a family centric approach.

Primary care practitioner and patient perspectives on care following bariatric surgery: A meta-synthesis of qualitative research.

Primary care is central to ongoing health care following bariatric surgery and patients indicate a preference for receiving follow-up support by their primary care practitioner (PCP). This meta-synthesis investigates the perspectives of both PCPs and patients in post-bariatric surgery care provided by PCPs. The aim was to synthesize themes from qualitative research to recommend improvements in post-bariatric surgery clinical care in primary care settings. Systematic searches of Scopus, Medline, EMBASE, PsycINFO, the Cochrane Library, and Google Scholar resulted in the inclusion of eight papers in the meta-synthesis. Papers were critiqued using the Critical Appraisal Skills Program (CASP) and thematically coded in Quirkos Cloud. Seven themes were reached by author consensus including stigma and judgment; clinician barriers and facilitators; patient-related support needs; communication considerations; patient context or determinants; health care setting; and adapting to life after surgery. PCPs reported barriers including poor communication and guidance from bariatric surgery centers, limited knowledge and training in bariatric patient care, and patients who may have unrealistic outcomes and poor health literacy. Patients seek comprehensive care from their PCP, however, barriers hindering the provision of this care include adverse surgical outcomes, a poor relationship with their PCP, and limited and short-term follow-up care from the PCP. Insights from this meta-synthesis offer actionable recommendations for PCPs and bariatric surgery centers to enhance patient care immediately.

Strengthening rural healthcare outcomes through digital health: qualitative multi-site case study

BackgroundRural populations experience ongoing health inequities with disproportionately high morbidity and mortality rates, but digital health in rural settings is poorly studied. Our research question was: How does digital health influence healthcare outcomes in rural settings? The objective was to identify how digital health capability enables the delivery of outcomes in rural settings according to the quadruple aims of healthcare: population health, patient experience, healthcare costs and provider experience.MethodsA multi-site qualitative case study was conducted with interviews and focus groups performed with healthcare staff (n = 93) employed in rural healthcare systems (n = 10) in the state of Queensland, Australia. An evidence-based digital health capability framework and the quadruple aims of healthcare served as classification frameworks for deductive analysis. Theoretical analysis identified the interrelationships among the capability dimensions, and relationships between the capability dimensions and healthcare outcomes.ResultsSeven highly interrelated digital health capability dimensions were identified from the interviews: governance and management; information technology capability; people, skills, and behaviours; interoperability; strategy; data analytics; consumer centred care. Outcomes were directly influenced by all dimensions except strategy. The interrelationship analysis demonstrated the influence of strategy on all digital health capability dimensions apart from data analytics, where the outcomes of data analytics shaped ongoing strategic efforts.ConclusionsThe study indicates the need to coordinate improvement efforts targeted across the dimensions of digital capability, optimise data analytics in rural settings to further support strategic decision making, and consider how consumer-centred care could influence digital health capability in rural healthcare services. Digital transformation in rural healthcare settings is likely to contribute to the achievement of the quadruple aims of healthcare if transformation efforts are supported by a clear, resourced digital strategy that is fit-for-purpose to the nuances of rural healthcare delivery.

What Helps Children and Young People to Disclose their Experience of Sexual Abuse and What Gets in the Way? A Systematic Scoping Review

Abstract Background Global research has found that prevalence rates of child sexual abuse suggest that this is a significant ongoing public health concern. A recent Australian study, for example, revealed that more than three girls and almost one in five boys reported experiencing sexual abuse before the age of 18. Self-reported rates of abuse, however, far exceed official figures, suggesting that large numbers of children who experience sexual abuse do not come to the attention of relevant authorities. Whether and how those children have tried to tell their stories remains unclear. Objective The goal of the review was to explore scholarly literature to determine what was known about what enables or constrains children to disclose their experience of sexual abuse. Method A systematic scoping review was undertaken to better understand the current state of knowledge in the scholarly literature on child sexual abuse disclosure. Thirty-two scholarly publications were included for analysis following a rigorous process of sourcing articles from five databases and systematically screening them based on transparent inclusion and exclusion criteria. Ecological systems and trauma-informed theoretical paradigms underpinned an inductive thematic analysis of the included manuscripts. Results Three multi-dimensional themes were identified from the thirty-two publications. These themes were: factors enabling disclosure are multifaceted; barriers to disclosure include a complex interplay of individual, familial, contextual and cultural issues; and Indigenous victims and survivors, male survivors, and survivors with a minoritised cultural background may face additional barriers to disclosing their experiences of abuse. Conclusions The literature suggests that a greater understanding of the barriers to disclosures exists. Further research that supports a deeper understanding of the complex interplay of enablers and the barriers to disclosure across diverse populations is needed. In particular, future research should privilege the voices of victims and survivors of child sexual abuse, mobilising their lived experiences to co-create improved practice and policy.

How Much Information Is Too Much? An Experimental Examination of How Information Disclosures May Unintentionally Encourage the Withholding of Health Information.

Information disclosures are used in medicine to provide patients with relevant information. This research examines whether patients are less likely to discuss medical conditions with their physicians after seeing an insurance information disclosure. Three experimental studies with nonprobability online samples (ntotal = 875 US adult participants) examined the impact of information disclosures on patients' likelihood of disclosing symptoms to providers, using new symptoms and preexisting chronic conditions. The effects of insurance disclosures were also compared to those of pharmaceutical discount disclosures. These studies demonstrate that information disclosures can result in unintended consequences for patients and providers. Results showed that information disclosures about insurance claims significantly negatively affected willingness to discuss health information with providers. This effect was consistent for both new health concerns, b = -0.661, P < 0.001 (study 1, n = 250) and b = -0.893, P < 0.001 (study 3, n = 375), as well as chronic conditions, b = -1.175, P < .001 (study 2, n = 250); all studies were conducted in January 2023. Information provided to patients about pharmaceutical savings did not similarly affect willingness to discuss symptoms with providers. These were experimental studies with hypothetical scenarios. Future research is needed to understand how patients react to information disclosures in a physician's office. Future research is also needed to examine the role of specific wording and tone used in information disclosures. Prior research has shown that patients prefer more information and to be involved in their medical decisions; however, these studies demonstrate that some information disclosures can discourage full communication between patients and physicians. This research has important implications for the potential consequences of information disclosures in health care settings. Information disclosures should be presented in a way that will not discourage candid discussions of patient symptoms. This research found that information disclosures about insurance claims can negatively affect patient willingness to discuss health information with providers.Information disclosures may sometimes fall short of their intended purpose of aiding patient decisions with the goal of improved well-being.When information disclosures are focused on warning about potential new costs, patients may feel uncomfortable discussing new symptoms with their providers.Findings suggest patients may often be more concerned with costs than with addressing their ongoing health problems.

Rocky Mountain Spotted Fever in Mexico: A Call to Action.

Rocky Mountain spotted fever (RMSF) is an ongoing public health crisis in Mexico, particularly in states bordering the United States. The national highest incidence and mortality of RMSF occur in this region, resulting in a case-fatality rate that ranges annually between 10% and 50%, primarily affecting vulnerable groups such as children, elderly adults, and persons living in poverty. Multiple biological, environmental, and social determinants can explain its growing presence throughout the country and how it challenges the health system and society. It is necessary to integrate resources and capacities from health authorities, research centers, and society to succeed in dealing with this problem. Through a scientific symposium, a group of academicians, U.S. health officials, and Mexican health authorities met on November 8-10, 2023, in Hermosillo, Mexico, to discuss the current situation of RMSF across the country and the challenges associated with its occurrence. An urgent call for action to improve national capacity against RMSF in the aspects of epidemiological and acarological surveillance, diagnosis, medical care, case and outbreak prevention, health promotion, and research was urged by the experts. The One Health approach is a proven multidisciplinary strategy to integrate policies and interventions to mitigate and prevent the burden of cases, deaths, and suffering caused by RMSF in Mexico.

Bringing Trust Building to Life Within Health Policy-Making Comment on "Placing Trust at the Heart of Health Policy and Systems"

Public trust is crucial for health policy-making as it is closely linked to public participation and policy-makers’ legitimacy. While we have witnessed increasing interest in issues of public trust, especially since COVID-19, we argue that efforts should be made to deeply integrate the concept of public trust into health policy-making from the design to the implementation, assessment, and evaluation processes across the public health and medical domains. We propose four key aspects to consider for building public trust in the healthcare system, which have emerged from our past and ongoing health policy research on public trust: to understand trust before aiming to build trust; to provide tailored guidance on trust building in health policy; to develop trust performance indicators to assess trust interventions; and to implement targeted communication strategies.

A stress-coping analysis of ‘stranded’ Australians seeking repatriation during the COVID-19 pandemic

ABSTRACT Objective The COVID-19 pandemic declared in early 2020 led to the closure of Australia’s international borders and the stranding of thousands of Australians overseas. We surveyed “stranded” Australians pre- and post-repatriation to evaluate their stress-coping responses at the time and the longer-term impacts of their experience. Method Stranded Australians (n = 587; 18–70 years of age; M = 40.15, SD = 11.90) completed a survey measuring COVID-19 impact, stressor appraisal and coping strategy, and psychological adjustment, and 203 of them completed a follow-up survey of psychological adjustment and posttraumatic stress disorder (PTSD) symptoms post-repatriation. Results Path analysis showed that “primary” appraisals of the repatriation situation (i.e. as a threat or challenge) were positively associated with negative affect, use of avoidant coping, and poorer psychological adjustment. Although the follow-up survey revealed improvements in psychological adjustment, initial use of avoidant coping was associated with higher levels of PTSD post-repatriation. Conclusion Primary appraisals and avoidant coping were associated with poorer psychological adjustment and longer-term PTSD symptomatology. The results highlight the need for ongoing mental health support for repatriated Australians and call for higher prioritisation of practical and mental health support in the event of future border closures.

A longitudinal health promotion program for autistic children and their caregivers: Impact of an urban community-based program.

Autistic children, as well as their primary caregivers (e.g., parents), experience greater health disparities when compared with the general population. Despite this reality, there has been relatively little priority placed on promoting positive trajectories of health in either of these underserved populations. The primary purpose of this study was to examine the impact of participation in a 12-month, longitudinal health promotion program designed for both autistic children and their parent. A total of 27 families participated in the intervention, including 29 autistic children (83% male, M = 8.28 ± 3.60 years) and 27 parents (93% female, M = 40.04 ± 7.95). Families attended in-person health promotion programming for 90 min per week. Children and parents were evaluated at four time points across the program, including baseline (0-months), 4-months, 8-months, and 12-months. Children were measured on fundamental motor competence, physical fitness, body composition, and proxy-reported physical activity. Parents were measured on body composition, physical fitness, and self-reported physical activity. Significant improvements were observed for autistic children in motor competence (p < 0.001) and grip strength (p = 0.006), and for parents in body mass index (p = 0.004) and aerobic capacity (p = 0.003) across the 12-month intervention. Differing trajectories of improvement were noted between urban- and suburban-dwelling families on multiple outcomes. The knowledge acquired from this research may offer initial support for the need to bolster opportunities for accessible and ongoing health promotion programs for both autistic children and their parents.

Assessing the Utility of Prediction Scores PAINT, ISARIC4C, CHIS, and COVID-GRAM at Admission and Seven Days after Symptom Onset for COVID-19 Mortality.

The COVID-19 pandemic underscores the need for accurate prognostic tools to predict patient outcomes. This study evaluates the effectiveness of four prominent COVID-19 prediction scores-PAINT, ISARIC4C, CHIS, and COVID-GRAM-at two critical time points: at admission and seven days post-symptom onset, to assess their utility in predicting mortality among hospitalized patients. Conducted at the Clinical Emergency Hospital Pius Brînzeu in Timișoara, this retrospective analysis included adult patients hospitalized with confirmed SARS-CoV-2 infection. Eligible patients had complete data for the scores at both time points. Statistical analysis involved ROC curves and logistic regression to assess the scores' predictive accuracy for mortality. The study included 215 patients, split into 139 survivors and 76 non-survivors. At admission, the PAINT, ISARIC4C, CHIS, and COVID-GRAM scores significantly differentiated between the survival outcomes (p < 0.0001). The best cutoff values at admission were 6.26 for PAINT, 7.95 for ISARIC4C, 5.58 for CHIS, and 0.63 for COVID-GRAM, corresponding to sensitivities of 85.47%, 80.56%, 88.89%, and 83.33% and specificities of 77.34%, 82.12%, 75.01%, and 78.45%, respectively. By day seven, the cutoff values increased, indicating deteriorating conditions in patients who eventually succumbed to the virus. The hazard ratios at admission for exceeding these cutoffs were significant: PAINT (HR = 3.45), ISARIC4C (HR = 2.89), CHIS (HR = 4.02), and COVID-GRAM (HR = 3.15), highlighting the scores' abilities to predict severe outcomes. One week post symptom onset, these scores' predictive values and corresponding hazard ratios increased, further validating their prognostic significance over time. The evaluated COVID-19 prediction scores robustly predict mortality at admission and become more predictive by the seventh day of symptom onset. These findings support the use of these scores in clinical settings to facilitate early identification and intervention for high-risk patients, potentially improving patient outcomes during the ongoing global health crisis.

Functioning School Leadership During COVID-19

The current global pandemic has created an extraordinary and unprecedented opportunity for educational authorities to initiate significant reforms in the operating protocols of schools as a necessary response to the challenges posed by the COVID-19 crisis. The abrupt shift from traditional, in-person classroom instruction to remote and online learning environments has highlighted the need for swift action and thorough preparedness, requiring educational systems to adapt rapidly to new teaching methods and technologies. The long-lasting impact of the COVID-19 pandemic has introduced additional challenges for school leadership, emphasizing the urgent need for change and adaptation during this ongoing global health emergency. The critical role of academic leadership has become increasingly important, as leaders are now tasked with addressing complex issues and ensuring that education continues to be delivered effectively despite the disruptions caused by the pandemic. This study conducts a comprehensive analysis of the current literature on the effects of school leadership during the COVID-19 pandemic. It aims to identify significant trends, advancements, and insights regarding academic leadership practices and their impact on school communities during the pandemic. Practical guidelines and views are offered for immediate use and future research areas.

Establishing Australia’s national linked COVID Register

Objective and ApproachThe Australian Institute of Health and Welfare (AIHW) is an independent statutory Australian Government agency tasked with collating health data across federal and state/territory governments, and is accredited to provide complex integration, de-identification and secure access to linked data. To support research into the COVID pandemic, the AIHW has created a national-level COVID Register, which integrates COVID case data from infectious disease registers, and data from hospitals and intensive care, immunisation, deaths, health system usage data, aged care and disability support. ResultsData were probabilistically linked using the AIHW’s linkage spine, matching names, addresses, date of birth and sex. The AIHW data linkage protocols are based on the Five Safes framework which reinforce management of the privacy and confidentiality of data. Linkage rates for COVID cases across participating jurisdictions generally exceeded 95%. Ongoing work aims to increase the coverage of COVID cases, both in time and to include case data from one remaining jurisdiction. ConclusionsLinking disparate datasets from multiple sources has created a critical resource for exploring COVID and patient journeys in Australia. Currently, the Register supports projects to estimate expenditure associated with COVID, describe the impact of COVID for subgroups such as people living rural and remote areas, or those with dementia. ImplicationsUltimately, the Register will be integrated into the National Health Data Hub to enable ongoing health research and analysis through enduring national linked health data. The value of the Register extends beyond COVID and into other infectious diseases and chronic conditions.

Persisting social disadvantage and intercensal social mobility in Northern Ireland: an examination of morbidity and all-cause mortality using three waves of the Northern Ireland Longitudinal Study (NILS).

Objective and ApproachUsing census returns from three waves of NILS (1991, 2001, 2011) linked with mortality data, we examined morbidity/mortality outcomes by socio-economic disadvantage over time (using an individual-level deprivation index derived from educational attainment, social class, housing tenure and household car availability at each census). These were combined to generate two indicators of Intercensal social mobility: measuring no change, and upward/downward mobility between censuses. The relationship between mobility (2001-2011) and (separately) self-reported mental ill-health (MIH) at the 2011 Census and all-cause mortality (2011-2015) were examined using logistic regression and Cox PH modelling respectively. Results Population comprised 288,262 individuals aged 25-74 in 2011, recording 19,318 deaths (2011-2015) and 23,959 (8.3%) reporting MIH. MIH: those with no intercensal mobility followed the standard pathway associated with persisting disadvantage (comparing with the most advantaged the least advantaged recorded OR=16.13:95%CI=13.50,19.28); and while both the upwardly and downwardly mobile generally recorded higher ORs than those consistently most advantaged, the magnitude of ORs increased with social distance traversed; and ORs for downward mobility were consistently higher than with upward mobility. Patterns associated with all-cause mortality were similar. ConclusionsThis suggests: upward mobility retains something of the social patterning pertaining in social disadvantage levels left behind; downward mobility may be connected to ongoing health issues. Poor health outcomes remain strongly associated with socio-economic circumstance. Implications Research focusing on relationship between social mobility, disadvantage and health outcomes in NI is limited: access to more precise administrative data will enhance possibilities associated with evidence-based policy formation.