Population Health Perspective Research Articles

Physical Activity and Cognitive Decline Among Older Adults

Physical activity is associated with the risk for cognitive decline, but much of the evidence in this domain comes from studies with short follow-ups, which is prone to reverse causation bias. To examine how length of follow-up, baseline age, physical activity amount, and study quality modify the longitudinal associations of physical activity with cognition. Observational studies of adults with a prospective follow-up of at least 1 year, a valid baseline cognitive measure or midlife cohort, and an estimate of the association of baseline physical activity and follow-up cognition were sought from PsycInfo, Scopus, CINAHL, Web of Science, SPORTDiscus, and PubMed, with the final search conducted on November 2, 2022. Two independent researchers screened titles with abstracts and full-text reports. Two reviewers independently assessed study quality and extracted data. Pooled estimates of association were calculated with random-effects meta-analyses. An extensive set of moderators, funnel plots, and scatter plots of physical activity amount were examined. This study is reported following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. Pooled estimates of the associations between physical activity and global cognition, as well as specific cognitive domains, were examined. A total of 104 studies with 341 471 participants were assessed. Analysis of binary outcomes included 45 studies with 102 452 individuals, analysis of follow-up global cognition included 14 studies with 41 045 individuals, and analysis of change in global cognition included 25 studies with 67 463 individuals. Physical activity was associated with a decreased incidence of cognitive impairment or decline after correction for funnel plot asymmetry (pooled risk ratio, 0.97; 95% CI, 0.97-0.99), but there was no significant association in follow-ups longer than 10 years. Physical activity was associated with follow-up global cognition (standardized regression coefficient, 0.03; 95% CI, 0.02-0.03) and change in global cognition (standardized regression coefficient, 0.01; 95% CI, 0.01 to 0.02) from trim-and-fill analyses, with no clear dose-response or moderation by follow-up length, baseline age, study quality or adjustment for baseline cognition. The specific cognitive domains associated with physical activity were episodic memory (standardized regression coefficient, 0.03; 95% CI, 0.02-0.04) and verbal fluency (standardized regression coefficient, 0.05; 95% CI, 0.03-0.08). In this meta-analysis of the association of physical activity with cognitive decline, physical activity was associated with better late-life cognition, but the association was weak. However, even a weak association is important from a population health perspective.

Implementation and evaluation of Exercise is Medicine in primary care clinics within a large academic health system

ObjectiveExercise is Medicine (EIM) is a global initiative encouraging healthcare providers to routinely assess and promote physical activity (PA) among patients. The objective of this study was to evaluate the...

Determinants of workload-related clinician stress levels in general hospital consultation liaison psychiatry services during the COVID-19 pandemic in England and Ireland. Short report

ObjectiveTo explore workload-related stress levels experienced by consultation liaison psychiatry (CLP) staff in England and Ireland, and factors relevant to such a burden, during the COVID-19 pandemic. MethodsData were obtained for England and Ireland from a European survey among CLP services in general hospitals spread via CLP networks (11th June - 3rd October 2021). The heads of respective CLP services in general hospitals responded on behalf of each service, on 100 CLP hospital staff in total. Dependent variable: workload-related stress levels in CLP services due to COVID-19 (0–10 point scale). Independent variables: hospital size, CLP service size, degree of hospital involvement in COVID-19-related care, and the number of support options available to hospital staff. Spearman's rho correlation analyses were performed. ResultsThere was a significant association between the hospital's involvement in COVID-19-related care and workload-related stress levels as reported by CLP staff: r(22) = 0.41, p = 0.045, R2 = 0.17. There were no significant associations between workload-related stress levels and other variables including staff support (p = 0.74). ConclusionOur findings suggest that perceived workload-related stress levels of CLP staff during the COVID-19 pandemic can be an indicator of COVID-19 involvement of the hospitals. Staff support seemed not to alleviate work stress in the context of the pandemic. Healthcare policies should improve working conditions for CLP hospital staff that play an essential role from a population health perspective. Rigorous measures may be needed to ensure mental healthcare provision remains tenable and sustainable in the long term.

Education for public health 2030: transformation to meet health needs in a changing world.

Education for public health is at a critical inflection point, and either transforms for success or fails to remain relevant. In 2020, the Association for Schools and Programs of Public Health launched an initiative, Framing the Future 2030: Education for Public Health (FTF 2030) to develop a resilient educational system for public health that promotes scientific inquiry, connects research, education, and practice, eliminates inequities, incorporates anti-racism principles, creates and sustains diverse and inclusive teaching and learning communities, and optimizes systems and resources to prepare graduates who are clearly recognizable for their population health perspectives, knowledge, skills, attitudes, and practices. Three expert panels: (1) Inclusive excellence through an anti-racism lens; (2) Transformative approaches to teaching and learning; and (3) Expanding the reach, visibility, and impact of the field of academic public health are engaged in ongoing deliberations to generate recommendations to implement the necessary change. The article describes the panels' work completed thus far, a "Creating an Inclusive Workspace" guide, and work planned, including questions for self-evaluation, deliberation, and reflection toward actions that support academe in developing a resilient education system for public health, whether beginning or advancing through a process of change. The FTF 2030 steering committee asserts its strong commitment to structural and substantial change that strengthens academic public health as an essential component of a complex socio-political system. Lastly, all are called to join the effort as collaboration is essential to co-develop an educational system for public health that ensures health equity for all people, everywhere.

The Missing Piece: A Population Health Perspective to Address the U.S. Mental Health Crisis

Abstract The COVID-19 pandemic has enhanced our focus on mental health. Concerns about the high levels of mental disorders in the United States are not new, with rising trends-particularly among youth-observed prior to the pandemic. However, the pandemic may have exacerbated and accelerated these trends. The silver lining is that we can leverage this moment to reevaluate and reimagine not only how we treat mental health problems, but also how we promote emotional well-being throughout the life course. We argue that scholars, policymakers, and practitioners should broaden their view of mental health, and consider it as a full spectrum ranging from serious mental illness to robust emotional well-being. This perspective recognizes the importance of treatment access and quality, but also elevates the value of prevention, particularly at the population level. Greater attention to preventing problems before they occur will not only reduce manifest disorders but also encourage higher rates of psychological resilience and, ultimately, better physical health.

Insights from the PHIRI Network: How different Countries deal with Long-COVID related issues and developments

Abstract Long COVID research shows that on average, 10-20% of COVID-19 patients experience a variety of mid- to long-term effects after recovery from initial illness. This represents a serious issue for the healthcare sector and decision-makers and experts in the field. Against this backdrop the Population Health Information Research Infrastructure collaboration (PHIRI) established a Rapid Exchange Forum (REF). REF is a series of bi-weekly meetings addressing urgent questions in population health during the COVID-19 pandemic and beyond. Participants are national representatives from over 30EU countries, ranging from European public health institutes, Ministries of Health to research institutions, universities, and EU-level stakeholders. In preparation, questions on a given topic are sent in a systematic manner, allowing rapid exchange of information across countries and provides comparative learnings on different challenges, best practices, and tools used to overcome population health issues (e.g., communication strategies, mortality indicators, long-term pandemic monitoring and surveillance, and pandemic impacts). REF on Long-COVID focused on 5 key aspects of Management of long-COVID Patients. Across 19 different EU/EEA countries information shows, for example, that by March 2023. 1) none of the 19 countries have stated to have a specific working registry for Long-COVID patients 2) few countries so far have developed specialised clinics or medical institutions for the treatment of Long-COVID but at least 3) most countries have adopted a wide range of different tools, strategies, and activities to create national guidelines and models for better management of Long-COVID Patients. This discusses these findings and will take stock of the Long-COVID-19 situation from a population health perspective. It will offer unique insights on the development of different tools, strategies and structures in national healthcare systems and their fight against long-COVID.

1.D. Workshop: Long COVID: A Myth or a reality?

Abstract COVID-19 has been a pandemic since 2020 and to date has resulted in a substantial global burden through both morbidity and mortality. Long term symptoms impacting the mental, social, and physical well-being among COVID-19 survivors started to be noted from early pandemic. This phenomenon was reported as Long COVID, and the World Health Organization (WHO) has now defined it as “a condition that occurs in those with probable or confirmed COVID-19 infection where symptoms last for at least two months from the onset of the infection”. Yet, the paucity of longitudinal cohort studies and clinical trials on Long COVID presents the scientific, clinical, and public health ecosystems with limited understanding pertaining to this new condition as well as presents uncertainty on whether “Long COVID is a myth or a reality?” Additionally, on a country level, the level of preparedness to deal with Long COVID at a population level and through healthcare services are not established. With over 60% of Europeans reported to suffer from Long COVID, this timely workshop is set to bring forward a pan-European expert consensus on the existence and the deterrent effects attributed to Long COVID, with recommendations for the way forward. The workshop will start off by presenting the overall impact of COVID on the well-being of middle-aged and older adults residing in 27 European countries as well as explores whether having Long COVID further deteriorate their well-being. The symptoms of Long COVID will be explored along with their effect on the health-related quality of life (HRQoL), fatigue, mental well-being, while investigating the determinants that diminish HRQoL. This will provide an all-rounded approach to the direct effects of Long COVID. It is known that Long COVID individuals will seek their first medical care contact at primary healthcare. Therefore, the workshop will explore the general practitioner's knowledge, perceptions, and experience on Long COVID's diagnosis and management across two European countries. This will provide an insight whether primary healthcare practitioners are equipped with dealing with this emerging syndrome. The workshop then focuses on Italy's perspective, at a country level, in managing Long COVID through Good Clinical Practice and access to national services. Finally, a European overview of the Long-COVID-19 situation from a population health perspective will be provided and it will offer unique insights on the development of different tools, strategies and structures in national healthcare systems and their fight against long-COVID. Key messages • Long COVID is causing deterrent effects and impact the physical, mental, social and economic status of the populations. • We need better tools (e.g., registries or targeted Health Examination Surveys) to assess the situation and to customise health care provision for the current patients and avoid the further spread.

Looking Back, Moving Forward in Pain Medicine.

Pain is an ancient medical complaint and a clinical riddle that has never been entirely solved. Looking back into history was the springboard to a look into the future of pain medicine. This article was based on a series of presentations given in a recent congress (May 2023)and represents the research, views, and opinions of the authors. Opium has been used for millennia to treat pain, but when it gained broad use in the United States in the 1980s and 1990s, it was so vastly overprescribed and mis-prescribed that it led to a public health crisis. This, in turn, led to the reaction where opioids at times were under-prescribed, leaving out many patients who may have benefited from opioids while leaving many legacy pain patients to manage withdrawal on their own and with few analgesic options. Cannabinoids (CB) were likewise widely used for various conditions, including pain, but were outlawed in the 20th century, only to be brought back as a potential analgesic agent. Interventional pain medicine is a developing discipline and has reinforced the concept of the interdisciplinary pain clinic. It plays an increasingly important part in modern medicine overall, especially with the support of ultrasound, for both diagnosis and therapy. Today, the views about pain have changed. Anyone has accepted that pain is not purely a physical phenomenonbut a biopsychosocial phenomenon that occurs within a cultural context. Pain management remains a small but vitally important medical subspecialty that is critical from a functional enablement and population health perspective, which is helping to navigate new therapeutic targets, new drugsand routes of administration, greater understanding of pain psychology, and new technologies. Pain control today means early intervention, functional enablement through pain alleviation, educating patients about pain management, and minimizing the transition from acute to chronic pain.

The 2020 US cancer screening deficit and the timing of adults’ most recent screen: a population-based cross-sectional study

ObjectiveIn 2020, cancer screenings declined, resulting in a cancer screening deficit. The significance of this deficit, however, has yet to be quantified from a population health perspective. Our study addresses...

Does ambient air pollution influence biochemical markers of liver injury? Findings of a cross-sectional population-based survey

BackgroundThere is limited evidence supporting an adverse effect of ambient air pollution on the liver. ObjectivesTo test the association between exposure to residential air pollution and serum biochemical indicators of liver injury. MethodsWe used a nationally representative sample of 32,989 participants aged 3–79 years old who participated in the Canadian Health Measures Survey between 2007 and 2019. Cross-sectional associations were assessed by generalized linear mixed models incorporating survey-specific sampling weights. ResultsThe joint effect of an interquartile range (IQR) increase in nitrogen dioxide (NO2), ozone (O3) and fine particulate matter (PM2.5) was positively and significantly associated with all measures of liver injury adjusting for age, sex, education, income, smoking, alcohol consumption, body mass index (BMI), total cholesterol, diabetes, hypertension, and physical activity. The ranking of effect sizes from largest to smallest percent increases were 8.72% (95% confidence interval [CI] 7.56, 9.88) for alanine aminotransferase (ALT), 5.54% (95%CI 3.31, 7.77) for gamma-glutamyl transferase (GGT), 4.81% (95%CI 3.87, 5.74) for aspartate aminotransferase (AST), 2.46% (95%CI 0.26, 4.65) for total bilirubin (TBIL) and 1.18% (95%CI 0.62, 1.75) for alkaline phosphatase (ALP). Findings were not significantly different when stratified by age (≤16, >16 yr), sex, smoking (current, other), cholesterol (≤6.18, >6.18 mmol/l) and BMI (<30, ≥30 kg/m2). DiscussionThese findings suggest that ambient air pollution may have a relatively small impact on the liver, but these changes may have significant impact from a population health perspective, considering the ubiquitous nature of air pollution, or for individuals exposed to very high levels of air pollution.

An Insurance Value Modeling Approach That Captures the Wider Value of a Novel Antimicrobial to Health Systems, Patients, and the Population.

Background: Traditional health economic evaluations of antimicrobials currently underestimate their value to wider society. They can be supplemented by additional value elements including insurance value, which captures the value of an antimicrobial in preventing or mitigating impacts of adverse risk events. Despite being commonplace in other sectors, constituents of the impacts and approaches for estimating insurance value have not been investigated. Objectives: This study assessed the insurance value of a novel gram-negative antimicrobial from operational healthcare, wider population health, productivity, and informal care perspectives. Methods: A novel mixed-methods approach was used to model insurance value in the United Kingdom: (1) literature review and multidisciplinary expert workshops to identify risk events for 4 relevant scenarios: ward closures, unavoidable shortage of conventional antimicrobials, viral respiratory pandemics, and catastrophic antimicrobial resistance (AMR); (2) parameterizing mitigable costs and frequencies of risk events across perspectives and scenarios; (3) estimating insurance value through a Monte Carlo simulation model for extreme events and a dynamic disease transmission model. Results: The mean insurance value across all scenarios and perspectives over 10 years in the UK was £718 million, should AMR remain unchanged, where only £134 million related to operational healthcare costs. It would be 50%-70% higher if AMR steadily increased or if a more risk-averse view (1-in-10 year downside) of future events is taken. Discussion: The overall insurance value if AMR remains at current levels (a conservative projection), is over 5 times greater than insurance value from just the operational healthcare costs perspective, traditionally the sole perspective used in health budgeting. Insurance value was generally larger for nationwide or universal (catastrophic AMR, pandemic, and conventional antimicrobial shortages) rather than localized (ward closure) scenarios, across perspectives. Components of this insurance value match previously published estimates of operational costs and mortality impacts. Conclusions: Insurance value of novel antimicrobials can be systematically modeled and substantially augments their traditional health economic value in normal circumstances. These approaches are generalizable to similar health interventions and form a framework for health systems and governments to capture broader value in health technology assessments, improve healthcare access, and increase resilience by planning for adverse scenarios.

An Insurance Value Modeling Approach That Captures the Wider Value of a Novel Antimicrobial to Health Systems, Patients, and the Population

Background: Traditional health economic evaluations of antimicrobials currently underestimate their value to wider society. They can be supplemented by additional value elements including insurance value, which captures the value of an antimicrobial in preventing or mitigating impacts of adverse risk events. Despite being commonplace in other sectors, constituents of the impacts and approaches for estimating insurance value have not been investigated. Objectives: This study assessed the insurance value of a novel gram-negative antimicrobial from operational healthcare, wider population health, productivity, and informal care perspectives. Methods: A novel mixed-methods approach was used to model insurance value in the United Kingdom: (1) literature review and multidisciplinary expert workshops to identify risk events for 4 relevant scenarios: ward closures, unavoidable shortage of conventional antimicrobials, viral respiratory pandemics, and catastrophic antimicrobial resistance (AMR); (2) parameterizing mitigable costs and frequencies of risk events across perspectives and scenarios; (3) estimating insurance value through a Monte Carlo simulation model for extreme events and a dynamic disease transmission model. Results: The mean insurance value across all scenarios and perspectives over 10 years in the UK was £718 million, should AMR remain unchanged, where only £134 million related to operational healthcare costs. It would be 50%-70% higher if AMR steadily increased or if a more risk-averse view (1-in-10 year downside) of future events is taken. Discussion: The overall insurance value if AMR remains at current levels (a conservative projection), is over 5 times greater than insurance value from just the operational healthcare costs perspective, traditionally the sole perspective used in health budgeting. Insurance value was generally larger for nationwide or universal (catastrophic AMR, pandemic, and conventional antimicrobial shortages) rather than localized (ward closure) scenarios, across perspectives. Components of this insurance value match previously published estimates of operational costs and mortality impacts. Conclusions: Insurance value of novel antimicrobials can be systematically modeled and substantially augments their traditional health economic value in normal circumstances. These approaches are generalizable to similar health interventions and form a framework for health systems and governments to capture broader value in health technology assessments, improve healthcare access, and increase resilience by planning for adverse scenarios.

Poster 199: Rate of arthroscopic rotator cuff repair performed at ambulatory surgery centers remains low despite significant cost savings for the healthcare system

Objectives: The objectives of this study are to 1) understand the differences in costs between rotator cuff repair (RCR) performed in ambulatory surgery center (ASC) versus outpatient hospital (OH) settings; 2) determine the patient’s out-of-pocket expenditure and surgeon reimbursement; and 3) characterize trends in expenditure for RCR over time. Methods: We identified patients who had undergone outpatient arthroscopic RCR in the United States (U.S.) using the IBM MarketScan Commercial Claims and Encounters Database. The database was chosen for its large, national sample of privately insured patients. Patients who had Current Procedural Terminology (CPT) code 29827 between April 1, 2013 and June 30, 2018 were included. Revision RCR procedures and procedures with a concomitant arthroscopic or open biceps tenodesis, Bankart repair, superior labrum anterior and posterior (SLAP) repair, lysis of adhesions (CPT: 29828, 23430, 29806, 29807, 29825) were excluded. Day-of-surgery expenditure was identified by summing all claims billed with an “immediate-procedure-related code” in a 3-day window surrounding the date of the procedure (Procedure Date ± 1 Day). The day-of-surgery expenditure was broken down into anesthesia services, nerve block, operating room facility, surgical team, patient out-of-pocket expenditure, and other expenditures. Median and interquartile range were calculated for each variable. The breakdown of day- of-surgery expenditure and patient out-of-pocket expenditure between the OH and ASC settings were compared using two-tailed Mann Whitney U Tests. Spearman Rank Order Correlation was done for all variables to test for association between expenditure and year to determine trends over time. All values were inflation adjusted to 2018 dollars using the consumer price index for medical care. Results: A total of 43,020 patients were identified; 24,850 in the OH setting and 18,170 in the ASC setting. This converts to an ASC utilization of 42 percent over the study period. In 2018, ASC utilization was at 45%. We found that RCR performed in the OH setting resulted in 55% greater day-of-surgery expenditure (p&lt;0.001) than in the ASC setting. In the OH setting, operating room facility cost was 35% greater (p &lt;0.001), anesthesia services was 7.4% greater (p&lt;0.001), but nerve block was 2.4% lower (p&lt;0.001) (Figure 1). Additionally, for RCRs performed in the OH setting, Spearman coefficients demonstrated that immediate procedure cost (rho = 0.209, p &lt; 0.001) increased along with expenditure for anesthesia services (rho = 0.085, p &lt; 0.001), nerve block (rho = 0.135, p &lt; 0.001), and operating room facility cost (rho = 0.108, p &lt; 0.001) over our study period. For RCRs performed in the ASC setting, immediate procedure cost (rho = 0.309, p &lt; 0.001) increased along with expenditure for anesthesia services (rho = 0.116, p &lt; 0.001), nerve block (rho = 0.086, p &lt; 0.001), and operating room facility cost (rho = 0.148, p &lt; 0.001). Surgical team reimbursement was 6.3% greater in the ASC setting (p &lt; 0.001), but decreased over time in both the ASC (rho = -0.069, p &lt; 0.001) and OH (rho = -0.046, p &lt; 0.001) settings. Lastly, there was no difference in patient out-of-pocket expenditure for RCRs performed in the OH setting vs. ASC setting (Table 1). However, patient out-of-pocket expenditure for RCRs is increasing in both settings (OH: rho = 0.147, p &lt; 0.001; ASC: rho = 0.203, p &lt; 0.001). Conclusions: RCR performed in an ASC setting results in significant cost savings for payers with a slight change in surgeon reimbursement and no change in patient-out-of-pocket expenditure. Most of the cost savings came from operating room facility expenditure. For the surgeon, surgical team reimbursements are higher in the ASC setting. However, the overall trend in surgical team reimbursement is downwards in both the ASC and OH settings whereas the cost per RCR to the healthcare system is increasing. Thus, surgeon reimbursement is becoming a smaller percentage of the immediate procedure cost and should not be further cut when policy makers evaluate strategies to decrease the economic burden of RCRs on the healthcare system, especially when the cost savings from performing a RCR far outweigh both the amount the surgeon is reimbursed as well as the difference in surgeon reimbursement between an ASC and OH. For a healthcare system, especially under a population health perspective, the incentive to perform RCRs at an ASC is significant. The cost savings come from almost every breakdown category. The cost savings achieved per RCR in an ASC vs. an OH equals about $4,000. With nearly 400,000 RCRs performed per year, the U.S. healthcare system could save a projected $1.6 billion per year on RCRs alone when the surgery is performed in an ASC. Thus, our study shows that there is a clear financial advantage to the healthcare system for RCRs being done at ASCs, although the patient does not realize these cost savings. [Table: see text]

Comparative effectiveness of the sars-CoV-2 vaccines during delta dominance

BackgroundSeveral vaccines with demonstrated efficacy for coronavirus disease 2019 (Covid-19) are available. The purpose of this study was to evaluate the COVID mRNA based and adenovector based vaccines’ differential effectiveness during the time of circulation of the Delta variant and determine what impact this would have on population health and cost effectiveness. MethodsWe used de-identified claims in a research database that included vaccination status and Covid-positivity status. Individuals ≥18 years, fully vaccinated with Ad26.COV2·S/J&J/Janssen, mRNA-1273/Moderna, or BNT162b2/Pfizer-BioNTech by September 30, 2021, were included. Outcomes were SARS-CoV-2-infection, emergency department visits, outpatient visits, inpatient hospitalizations, intensive care unit (ICU) transfers, death, and hospice transfers through September 30, 2021. ResultsAmong ∼6.5 million fully vaccinated individuals in the UHC Medicare Advantage and our commercially insured research database, mRNA-1273 performed better than BNT162b2 for infection, composite-hospitalization (hospitalization/ICU transfer/hospice transfer/death), and composite-ICU transfer (ICU transfer/hospice transfer/death) caused by B.1.612.7 (delta) variant infection. 26 CE.COV2.S performed worse than BNT162b2 for infection, composite-hospitalization, and composite-ICU transfers. The number needed to vaccinate (NNV) with mRNA1273 to prevent one hospitalization at 90 days was 3130 compared to 26 CE.COV2·S and 15,472 compared to BNT162b2. The NNV with mRNA1273 to prevent one ICU transfer at 90 days was 6358 compared to 26 CE.COV2·S and 34,279 compared to BNT162b2. For every one million individuals vaccinated with BNT162b compared to mRNA-1273, the approximate incremental inpatient cost would be $405,000 and the approximate incremental ICU cost would be $662,000. ConclusionsThe two-dose mRNA vaccines' effectiveness significantly exceeded the single-dose Ad26.COV2·S vaccine's effectiveness from population health and cost-effectiveness perspectives. The mRNA1273 vaccine showed slightly more effectiveness than the BNT162b vaccine.

Changes in the residents’ step counts before and after a railway improvement project

IntroductionIn many Japanese cities, local governments have been planning compact city policies to reduce environmental impact and financial costs. The resulting walkable urban form, where people live near railway stations, could potentially contribute to residents' health as a secondary effect. In this longitudinal study, we investigated changes in residents’ walking behavior in an area subject to a railway improvement project, using large-scale data on step counts. MethodsWe compared the changes in daily step counts of middle-aged and older adults in Yokohama City before and after a railway improvement project. The project aimed to improve traveling convenience to central Tokyo by developing a railway line that directly connects the existing suburban stations to central Tokyo with no transfers to shorten travel time and by opening a new station in an inconvenient area. Comparing residents’ step counts in the project intervention area (N = 733 on average) and other areas (N = 2,914 on average) before and after the project, the effect of the project intervention was examined through difference-in-differences analysis using generalized linear mixed models. ResultsAfter the project, older residents aged 75–84 years living close to the new station walked approximately 400 steps more than their counterparts with the same level of step counts before the project. Moreover, older residents aged 75–84 years living around the existing stations, which benefitted from the direct connecting service, walked approximately 200 steps more than their counterparts. However, women aged 45–64 years living around the existing stations walked approximately 200 steps less than their counterparts. ConclusionThe railway improvement project promoted older adults’ walking behavior, supporting the worldwide trend toward transit-oriented development from the population health perspective. However, the project had an adverse effect on middle-aged women. Planners should consider that the impact of projects varies according to age and gender.

Socially responsible human resources management and stakeholders’ Health Promotion: A conceptual paper

The prime objective of this paper is to propose a new conceptual framework for how integrating corporate social responsibility (CSR) and human resources management (HRM) can impact on stakeholders’ health and wellbeing. The proposed framework argues that integrative socially responsible HRM (SR-HRM) policies coupled with public health literacy and integrative responsible leadership can play a significant role in shaping health behaviour change of internal stakeholders, which in turn can spill over to external stakeholders (family and proximate communities).&#x0D; From a health promotion and population health perspective, we see human resources (HR) as a leading partner in educating employees on the value of CSR and public health literacy programmes, and also as providing action plans on how to strategically and successfully implement these types of programmes. By helping to develop action plans to analyse CRS and public health literacy activities, HR professionals will be promoting both corporate citizenship and health behaviour change. Both of these are vital for developing a culture of social responsibility (and achieving the triple bottom line (TBL)) and sustainable population health promotion. Henceforth, SR-HRM policies and practices could help business organizations to contribute to the achievement of the United Nations’ Sustainable Development Goals (SDGs) and specifically Goals 3 and 8. This novel framework, which is especially pertinent to public health, has not yet been tested empirically. Hence, future studies are warranted to empirically test the theoretical framework using field data collection.

Early school-age family meal characteristics matter for the later development of boys and girls.

Sharing a meal together offers an innovative approach to study the family environment. How often families eat together may not capture the distinct experience for sons and daughters. Instead, studying family meal characteristics might be more enlightening. This study aims to examine the prospective associations between family meal environment quality at age 6 years and later well-being at age 12 years in 734 boys and 758 girls. Participants are from the Quebec Longitudinal Study of Child Development birth cohort. When children were aged 6 years, parents reported on their family meal environment experience. At age 12 years, child outcomes included parent-reported healthy lifestyle habits, teacher-reported academic achievement, and self-reported social adjustment. The relationship between early family meal environment quality and later child outcomes were analyzed using multivariate linear regressions. For girls, better family meal environment quality at age 6 years predicted an earlier bedtime, a lower consumption of soft drinks and sweet snacks, more classroom engagement, and fewer behavior problems at age 12 years. For boys, better family meal environment quality at age 6 years predicted an earlier bedtime and less anxiety and more prosocial behaviour at age 12 years. These significant relationships were adjusted for a multitude of child/family characteristics. From a population-health perspective, our findings suggest that family meals represent a cost-efficient, effective protective factor that likely has long-term influences on bio-psycho-social development. Information campaigns that promote family meals as a health intervention could optimize the well-being of boys and girls.

Multi-Jurisdictional Evaluation of Sentinel City Virtual Simulation for Community Health Nursing Clinical Education

Although positive learning outcomes have been documented for nursing students who participate in virtual simulation for community health nursing clinical education (Chircop & Cobbett, 2020), it is unknown whether learning outcomes of students using the same virtual simulation program are comparable across jurisdictions. Nine schools of nursing across Canada (Nova Scotia, Ontario, British Columbia) implemented and evaluated Sentinel City a virtual simulation program to complement the traditional community clinical, or as an alternative learning experience. A descriptive survey was used to carry out an evaluation of the use of Sentinel City and student learning outcomes. Quantitative data provided demographic statistics to describe the sample, compare student learning outcomes and perceptions of their learning experience and the qualitative data from open-ended questions provided detailed responses on the use of Sentinel City and its future recommendation. Data were analyzed using ANOVA (Welch statistic) to identify any significant differences among students from each jurisdiction in relation to their perception of the use of Sentinel City in meeting their course learning outcomes. Qualitative data from open-ended responses were analyzed using the six-step process outlined by Braun and Clarke (2006). The use of Sentinel City for community clinical learning in various Canadian jurisdictions positively contributed to achieving desired student learning outcomes. There are, however, significant differences among jurisdictions. Most of the students “agreed” that Sentinel City helped them achieve course learning outcomes. In all jurisdictions, most of the students indicated that they were “confident” and “very confident” in their knowledge about the community health nursing process, understanding of a population/community health assessment, understanding how to plan a population health intervention, and in their ability to integrate the five principles of primary health care into practice. Regarding their ability to apply a population health perspective (upstream thinking), most of the students were “confident” and “very confident”. Almost all students (93.62%) were confident and “very confident” in their ability to recognize health inequities indicating the highest level of confidence (Mean 4.38, SD 0.71). As educators, we found several advantages with the use of SC, including the ability to create controlled and standardized clinical learning experiences which contributes to fairness and quality of community clinical education. We recommend a robust orientation and professional development program for clinical instructors in community health nursing that is consistent with the new International Nursing Association for Clinical Simulation and Learning (2021) standards. The required expertise in community health nursing together with solid

Housing as a determinant of Inuit mental health: associations between improved housing measures and decline in psychological distress after rehousing in Nunavut and Nunavik.

In 2014-2015, more than 400 public housing units were constructed in Nunavut and Nunavik, two of the four Inuit regions in Canada. This provided the opportunity to assess the impact of improved housing conditions from a population health perspective in 12 Inuit communities where housing needs were the most severe. The aim of theresearch is to examine the associations between changes in housing conditions and changes in psychological distress pre-post rehousing. A pre-post uncontrolled study was conducted in collaboration with Nunavut- and Nunavik-based organizations. Applicants at the top of public housing waitlists were recruited by local housing officers; participants completed questionnaires 1-6 months before rehousing, and 15-18 months after. Change in psychological distress was measured with the Kessler 6-item scale. Changes in three housing measures were examined: number of adults per household, number of children per household, and sense of home score. For each housing measure, a categorical variable stratified participants into three categories. The reference category included participants reporting significant change in the concerned housing measure; the two other categories included participants reporting little or no change. Associations were tested with linear multilevel regression models for change. A total of 102 Inuit adults completed the study. A reduction in the number of adults per household (living with 2 adults or less after rehousing) and an increase in sense of home were associated with significant decline in psychological distress pre-post rehousing (p < 0.001). Increased investments leading to such improvements in housing circumstances are promising ways to promote mental health in Inuit regions.

From Personalized Medicine to Population Health: A Survey of mHealth Sensing Techniques

Mobile Sensing Apps have been widely used as a practical approach to collect behavioral and health-related information from individuals and provide timely intervention to promote health and well-beings, such as mental health and chronic cares. As the objectives of mobile sensing could be either \emph{(a) personalized medicine for individuals} or \emph{(b) public health for populations}, in this work we review the design of these mobile sensing apps, and propose to categorize the design of these apps/systems in two paradigms -- \emph{(i) Personal Sensing} and \emph{(ii) Crowd Sensing} paradigms. While both sensing paradigms might incorporate with common ubiquitous sensing technologies, such as wearable sensors, mobility monitoring, mobile data offloading, and/or cloud-based data analytics to collect and process sensing data from individuals, we present a novel taxonomy system with two major components that can specify and classify apps/systems from aspects of the life-cycle of mHealth Sensing: \emph{(1) Sensing Task Creation \& Participation}, \emph{(2) Health Surveillance \& Data Collection}, and \emph{(3) Data Analysis \& Knowledge Discovery}. With respect to different goals of the two paradigms, this work systematically reviews this field, and summarizes the design of typical apps/systems in the view of the configurations and interactions between these two components. In addition to summarization, the proposed taxonomy system also helps figure out the potential directions of mobile sensing for health from both personalized medicines and population health perspectives.