Positive Health Research Articles

1.Y.2. Children’s mental health problems explode. Can exposome research offer a solution?

Abstract Background A week-long, multidisciplinary workshop at the Lorentz Institute explored the expectations of exposome research on child health. Exposome research investigates how combined exposures affect health. Currently we see an increase in adolescent mental health problems in Europe. We explore at the workshop if and how exposome research can be part of the solution to tackle this health issue. Findings The workshop aims were to analyze how monitoring data from exposome research can be best used for improving health policy in relation to improving (environmental) health policy in relation to children’s health. By taking a deep dive into solution-finding, we explored creative solutions to better utilize existing exposome data from digital data platforms, such as cohort data. And to facilitate working across disciplines using innovative tools of working transdisciplinary across research, policymakers and other professionals. Furthermore, we study how to enhance, harmonize and interpretation of data on child health. Furthermore, we look how child health depends not only on the quality of a healthcare system, but also on the magnitude of negative or positive influencing factors, such as social and environmental factors. Identifying such stressors and reducing their impact through adequate policies can improve child health on local, national, or even global scales. One innovative way of identifying such stressors is the exposome approach. The exposome approach is the characterization of the non-genetic drivers of health and disease. The exposome comprises aspects of the Built environment (characteristics of where we live); the Social environment (with whom we interact, social networks and income); the Physio-Chemical environment (chemical and environmental factors exposure) and the Lifestyle/Food environment (what we eat, how much we exercise) over the entire life-course. Workshop aims: - Provide a background on the urgency of adolescent mental health problems in Europe. - Compare approaches of stakeholders and researchers: stakeholders’ input from the practical field can shape the approach of the research process. The second benefit is to derive implications for creating effective interventions and policies to prevent adverse effects of environmental exposures and to foster positive health in children and later in life. - Explore existing interventions on child health for issues, experiences and possible solutions to the governance and organization of health adaptation in urban and social planning. - How to act in the process of research to intervention to public policies. The workshop consists of three short presentations followed by interactive panel discussions. We end with the audience actively engaging in the debate, as well as entering their questions. The workshop will end by identifying the current and future necessary roles, responsibilities, capacities of the public health researchers, policymakers, and professionals for child health protection in complicated exposure settings. Key messages • Child mental health issues are increasing in an unexplainable way. • Engaging stakeholders into an exposome research process can help to form a child health strategy in Europe.

Influencers as a new source of health information: Insights from an Austrian youth survey

Abstract Background Social media influencers (SMIs) have become the dominant source of health information for youth. While some SMIs may share valuable content, critics raise concerns that they lack expertise, have commercial motives, or hold personal biases. Yet, little is known about the epidemiology of the health influencer phenomenon. This study offers first insights into the reach of SMIs among Austrian youth, informing public health strategies to promote positive health behaviors in young populations. Methods A cross-sectional study was conducted with a representative sample of 1003 Austrian adolescents and young adults aged 15-25. Key research questions focus on the epidemiology of health influencers, engagement with SMIs, prevalent health topics, advertising, and perceived impact of SMIs on health. Preliminary results Participants estimate that over 51% of social media posts they see are from SMIs, and 75.37% follow at least one SMI. Additionally, 37.19% follow SMIs who specifically share health content, and 30.91% have purchased health products recommended by them (e.g., foods, supplements, beauty products). Moreover, 40.27% trust their followed SMIs for health information, similar to trust in traditional media (43.47%). Finally, over a third find SMI content beneficial for health (32.34%), while 29.20% find it harmful, and 33.83% neither. Conclusions The study provides first insights into the epidemiology of health influencers, revealing their extensive reach and positive reception among young people. Despite concerns about conflicts of interest or expertise, SMIs are perceived as trusted sources for health information and product purchases. This research enhances our understanding of influencers’ impact and informs public health strategies aimed at promoting positive health behaviors among youth. The insights from Austrian youth can inform future studies across Europe, deepening our understanding of the health influencer phenomenon and its implications for public health. Key messages • This cross-sectional study shows the high reach of social media influencers among youth and their important role as emerging sources of health information. • The study breaks new ground by investigating adolescents’ engagement with health influencers, offering insights for public health to promote positive health outcomes among young populations.

Validity of the Multigroup Ethnic Identity Measure for Māori, Pacific, Asian & European adolescents

Abstract Background Ethnic identity is important for positive health and wellbeing outcomes, especially for Indigenous youth and adolescents from minoritised ethnic groups. The Multigroup Ethnic Identity Measure (MEIM) is widely used to examine ethnic identity as a general phenomenon across ethnic groups. However, evidence regarding its validity for adolescents from different ethnic backgrounds is mainly limited to the US context. This study investigated psychometric properties of the MEIM, for the first time, within a large ethnically diverse population-based sample in New Zealand. Methods We used data from the Growing Up in New Zealand study. Participants were 4500 12-year-olds and included 22.4% Māori (the Indigenous people of New Zealand), 16.7% Pacific, 14.8% Asian and 51.9% European young people. 45.7% were cisgender boy, 37.4% were cisgender girl, and 16.4% were non-binary, trans or unsure. We conducted factor analysis for the 12-item MEIM. Results Confirmatory factor analysis model fit tended to be best for a solution with two factors representing two ethnic identity subcomponents of Exploration and Affirmation/Belonging. A single ‘ethnic identity’ factor showed a slightly weaker model fit. Exploratory factor analysis revealed a 2-factor structure with a slightly different item composition as compared to the original MEIM subscales. The findings were largely comparable across ethnic groups. Conclusions The MEIM appears to be a valid measure for Māori, Pacific, Asian and European young people. However, nuances may exist due to unique contexts including structural factors, societal norms and challenges, opportunities and access to cultural engagement. Ethnic identity is strongly linked to health and wellbeing including quality of life, self-esteem and life satisfaction. Therefore, we recommend acknowledging nuances of ethnic identity during an important time of development within diverse cultural contexts, by applying subscales and subgroup analyses where possible. Key messages • The Multigroup Ethnic Identity Measure is valid and appropriate to use at age 12-years among diverse ethnic groups including Māori, Pacific, Asian and European. • Nuances of ethnic identity should be acknowledged as an important factor for health and wellbeing, especially during critical times of transition for adolescents within diverse cultural contexts.

Impact of digital health literacy on public health: an umbrella review

Abstract Background Digital health literacy (DHL) is increasingly important for public health initiatives in the digital era. However, its impact on public health outcomes remains unclear. This umbrella review synthesizes evidence on relationships between DHL and public health. Methods Electronic databases were searched from 2010 to January 2024 for reviews evaluating associations between DHL and public health outcomes. Two independent reviewers screened records and extracted data. Results were narratively synthesized and screened respect quality using Amstrar 2 check list. Results 12 reviews met the inclusion criteria. Higher population DHL was consistently linked to positive health behaviors like preventive screening uptake, medical adherence, chronic disease management, and vaccination. However, lower DHL correlated with health disparities and exacerbated risk of mis/disinformation. DHL interventions improved eHealth skills and health status. Conclusions Digital Health Ltieracy shapes engagement with digital public health tools and programs. Integrating DHL assessments into planning can help identify at-risk groups and optimize interventions. Developing population DHL through education represents an avenue to advance health equity and resilience against digital health threats. However, more evidence and more digital maturity of tools appear to be necessary. Key messages • Digital Health Literacy as milestone of next health generation. • Health outcomes are clearly linked to digital and digital health literacy.

Health selection in three cohorts of outmigrants, return migrants and non-migrants

Abstract Background The two main hypotheses behind the healthy migrant effect are selection of healthier migrants and the salmon bias. However, these hypotheses have not been thoroughly and simultaneously investigated in distinct cohorts due to data limitations. Methods Linking national and provincial immigration registers with health care utilization datasets at the Manitoba Centre for Health Policy, we assembled a cohort of 816,185 adults who resided in Manitoba, Canada and were followed up for at least one year between 1985 to 2023 to outmigration, return migration or death. We included three subcohorts of international immigrants (16.4%), interprovincial migrants (10.8%) and all other Manitobans (AOM) (72.8%). Within each subcohort, we matched ‘stayers’ who never migrated, outmigrants and returnees on sex, birth year and place of residence and compared their hospitalization rates and Charlson and Elixhauser comorbidity scores 1-year before outmigration and 1-year after return migration. Results Outmigrants had lower hospitalization rates than stayers among AOM [Adjusted Relative Rate (RR): 0.80; 95% confidence interval (CI): 0.78, 0.82] and in the other two subcohorts. Comorbidity scores were also consistently lower among outmigrants compared to stayers in all three subcohorts, even after restricting to hospitalized cases. Outmigrants whose destination was another country were healthier than those who migrated to other provinces. Returnees had better health status than stayers upon return in the AOM subcohort only but lower than those who did not return at the time of outmigration in all three subcohorts. Conclusions Contrary to common belief, health selection is not restricted to international immigrants but also among interprovincial migrants and the local population. Migration dynamics may bias comparisons between population subgroups. Key messages • Migration is not only associated with positive health selection among international immigrants but also among interprovincial migrants and the local population. • Selective migration may represent a source of bias in health-related population-based studies.

Stakeholder involvement in the development of a serious game for and with healthcare professionals

Abstract Increasing pressure on the quality, accessibility and affordability of Dutch health services underlines the need for integrated approaches to healthcare that include lifestyle as preventive measure. Integrated healthcare requires coordinated collaboration between healthcare providers, which is facilitated by the concept of Positive Health as a unifying language. To support primary care providers (PCP) in developing knowledge and skills related to lifestyle as prevention, interdisciplinary collaboration and the concept of Positive Health, we are developing education in the form of a serious game: Game2Connect. Co-creation by active involvement of a consortium of educational institutes, healthcare organisations, a game developer, and PCP as end-users of Game2Connect plays a key role in its development. Data from interviews with PCP (on barriers and facilitators for health-promoting and collaborative behaviours), healthcare recipients (on input for case studies) and consortium meetings were incorporated into an initial version of Game2Connect, which is currently being piloted to assess and improve its utility and usability. Pilot sessions included an observed playthrough, followed by a usability questionnaire and a semi-structured group discussion. So far, 2 pilot sessions were held with consortium members (n = 16), and 3 sessions were held with PCP (n = 22). Learning indicators (e.g. PCP clarifying fellow players’ misconceptions) were observed in all sessions. Usability scores indicate high levels of challenge, content relevance, and positive affect, ranging between 3.3-3.6 on a 4-point scale. Qualitative feedback from group discussions resulted in the development of new case studies to appeal to a broader range of PCP, and the adjustment of a goal-setting exercise as a game component to encourage its use. These results suggest that serious gaming may be a viable and engaging method to educate PCP, especially when developed in active collaboration with stakeholders.

Assessing the use of activity trackers in clinical practice: a survey of cardiac rehabilitation clinicians from Australia, Brazil, and Canada

Abstract Background The use of wearable activity trackers has been found to significantly improve health profile and cardiorespiratory fitness, as well as to reinforce positive health behaviours in patients participating in cardiac rehabilitation (CR) programs. However, clinicians’ perceptions of activity trackers and their use in clinical practice have not been widely explored. Purpose To describe perceptions, attitudes, and behaviours of CR clinicians towards the use and usefulness of activity trackers in CR programs, and identify barriers and enablers associated with their personal and clinical use. Methods Descriptive cross-sectional survey. Data were collected using Research Electronic Data Capture (REDCap) from April to December 2023. Clinicians working in CR programs were recruited in each country via social media, email and digital flyers, group chats and author networks. A purpose-built 44-item digital survey comprising four sections was constructed: (1) socio-demographic details, (2) personal and professional use of activity trackers, (3) perspectives on the use of activity trackers for CR, and (4) perceptions of factors affecting the use of activity trackers in CR. Results In total, 199 clinicians from Australia (n=44), Brazil (n=102) and Canada (n=53) responded to the survey. Most were women (74%), physiotherapists (37%), working at a metropolitan hospital (55%), with a median age of 35 years (range 22-71). The majority found activity trackers helpful for patients with goal setting and monitoring exercise (89%) and promoting patient engagement and autonomy beyond structured, supervised CR (75%). Activity trackers were also perceived to be useful in engaging patients in their own health (94%), improving patient-provider communication (73%), boosting patient adherence with directed exercise (87%), and improving patient’s understanding of their own health conditions (79%). Furthermore, activity trackers were perceived to enable a more personalised care (69%), increase accessibility to CR (45%) and be time- and cost-effective for CR programs (49%). Sixty percent were motivated to use activity trackers and 69% recommended the use of trackers to their patients. On the other hand, the use of activity trackers was reported to be related to dependence (44%) and excessive obsession of one’s own health (55%); 50% reported a lack of relevant policies on activity trackers for clinical use in their respective institutions and limited funding for purchasing activity trackers by health services (78%). Only 30% reported that there was support from leadership and/or peers for the use of activity trackers. Conclusion In general, clinicians held positive attitudes towards the use of activity trackers in CR. However, a lack of relevant policies, funding and support from leadership are important barriers to the adoption and use of activity trackers in CR programs. Development of guidelines for the use of activity trackers in clinical practice is warranted.

An Innovative Public Health Solution with European Features for an American Problem

Abstract Problem The Eastern Shore of Maryland is a beautiful region that boasts a multicultural community of 455,000 year-round residents. Despite its rural location, the coastal lifestyle attracts retirees, making it the state’s oldest population. Unfortunately, the region also has the highest socioeconomic disparities in the state, which creates difficulties in accessing healthcare. This is a significant public health issue that results in costly barriers to preventive care and timely, accounting for $320 billion in unnecessary healthcare spending. Description of the problem Maryland’s healthcare funding formulas favor larger health systems in urban areas, leading to health inequities. To address this, we propose an innovative scenario analysis model partially based on European public health approaches. This model will adjust funding formulas based on each region’s specific needs and challenges, promoting fairness and equity in healthcare funding. Results Adopting this population health management approach would have built-in efficiencies: In the United States, healthcare spending tends to be higher among underserved populations due to delayed care, access challenges, missed diagnoses, and limited access to the latest scientific advances as well as proper preventive services. Lessons The proposed scenario-based public health funding approach targeting the needs of the underserved population on the Eastern Shore of Maryland could yield significant positive health outcomes and health savings generating a ripple effect across the state, and perhaps even the country. The lessons learned in how other countries handle public health funding could lead to global collaboration. Key messages • Our approach aims to provide a practical solution to unnecessary healthcare spending. • We must adapt to the changing tides to stay on course.

Inequities in child health in Luxembourg

Abstract Background In Luxembourg, despite its economic prosperity, 28.6 % of children are estimated to be at the risk of poverty. Research has shown that growing up with socioeconomic disadvantage is associated with worse physical and mental health in childhood. We explore the association of socioeconomic status with health, health behaviours and access to healthcare in Luxembourg for children up to age twelve. Methods We used data from 2014 to 2022 for 11-12 year old children from the Health Behaviour in School-aged Children (HBSC) survey as well as social security data from Luxembourg for a similar time period and children 0 to 12 years old. To assess socioeconomic status, we used information on self-perceived household wealth for the HBSC results and stratified health and health behaviours by well-off, average, or less well-off households. For the social security data, we stratified access to care indicators by equivalized household income quintiles. Results We found that physical activity levels, nutritional quality and daily routines such as eating breakfast and brushing teeth are significantly lower in children from less affluent families. For example, 61% of 11-12-year-old children from well-off families reported eating breakfast every day, but only 41% of children from less well-off families. Only 23% of 11-12 year olds from less affluent families rated their health as excellent, compared to 52% of children from affluent families. There were similarly large differences for multiple health complaints, with 63% of children from less affluent families reporting this indicator for psychosomatic problems, compared to 34% of children from affluent families. We did not find differences in the use of pre- and postnatal care visits. Conclusions Socioeconomic differences in child health, mental health and health behaviours are large, with children from poorer households being in worse physical and mental health and less likely to report positive health behaviours. Key messages • Many children in Luxembourg face socioeconomic challenges that are adversely associated with health and health behaviours. The underlying reasons require further attention to improve child health. • Children from poorer backgrounds are in significantly worse mental health than children from better off families in Luxembourg.

Validation of the Warwick-Edinburgh Mental Well-Being Scale for the Mental Health Surveillance (MHS) of German adults

BackgroundMental health encompasses more than just the absence of mental disorders. Thus, a Mental Health Surveillance (MHS) and reporting system for Germany should monitor mental well-being in addition to psychopathology to capture a more complete picture of population mental health. The Warwick-Edinburgh Mental Well-Being Scale (WEMWBS) is an internationally established inventory for the integrated assessment of different aspects of mental well-being (i.e., hedonic and eudaimonic) in population samples that has not yet been validated for Germany.MethodsUsing data from a cross-sectional online survey of a convenience sample of N = 1.048 adults aged 18–79 years (51% female) living in Germany, the factorial structure, measurement invariance (age, sex) and psychometric properties of the WEMWBS in its long (14 items) and short (7 items) versions were analyzed. Additionally, correlations to relevant factors (e.g., health-related quality of life, psychological distress) were investigated as indicators of criterion validity.ResultsMeans of model fit indices did not confirm a unidimensional factor structure for either version. The three-factor-correlative models showed moderate to good fit while the bifactor model with one general mental well-being factor and three grouping factors fitted the data best. The full range of possible responses was used for all items, and the distribution of both scales was approximately normal. Moreover, the results revealed measurement invariance across sex and age groups. Initial evidence of criterion validity was obtained. Internal consistencies were α = 0.95 and α = 0.89, respectively. Average mental well-being was comparable to that of other European countries at 3.74 for the long version and 3.84 for the short version. While there were no differences by sex, comparisons between age groups revealed higher mental well-being among the older age groups.ConclusionsBoth versions of the WEMWBS showed sound psychometric characteristics in the present German sample. The findings indicate that the instrument is suitable for measuring mental well-being at the population level due to its distributional properties. These results are promising, suggesting that the scale is suitable for use in a national MHS that aims to capture positive mental health in the population as a foundation for prevention and promotion efforts within public mental health.

Understanding the influence of children’s mental health, cognitive development, and environmental factors on learning outcomes in Chile

Mental health, cognitive development, and social background are related to educational success. While growing evidence is available in cultural settings other than Western countries, more knowledge is needed, especially regarding interactions among these dimensions. Rather than studying isolated factors, we propose an integrated approach to consider the diverse interrelated dimensions influencing children’s learning. Life course theory supports this approach underlying the role of early events in subsequent life paths and the multidisciplinary nature of these events. The sample consisted of 610 children (49.1% male) attending first grade. The children completed reading, mathematics, and visuospatial working memory (VWM) assessments. Parents completed the Strengths and Difficulties Questionnaire (SDQ-P) and reported their demographic information. A multilevel path model was estimated, including direct relationships between (i) children’s socioemotional behavior (SEB) and learning, (ii) VWM and learning, and (iii) SEB and VWM. The effects of sex and maternal education were also controlled. School and student level variances were modeled. At the school level, VWM, reading, and mathematics have variance, whereas SEB does not. At the student level, VWM, SEB, and maternal education have significant and differential effects on learning. Hyperactivity and peer problems were negatively related to reading and mathematics, while emotional problems were not, and conduct problems exhibited mixed results. These results reinforce developmental life course approaches, that is, from the beginning of schooling, promoting positive mental health can improve children’s learning outcomes.

Interconnectedness of mindfulness facets and their impact on mental health outcomes in Asian American and European American college students: A network approach.

Despite extensive research supporting the effectiveness of mindfulness-based interventions, the understanding of the dynamic connections between various mindfulness facets, particularly across diverse cultures, remained limited. This study aimed to investigate the networks among mindfulness aspects across different cultural backgrounds and their individual associations with mental health and well-being. Using the data collected from 710 undergraduate students in Hawaii (445 Asian Americans, 265 European Americans), we constructed sparse networks for each group to investigate their centrality index. To compare the overall structures of these networks, we utilized permutation-based tests. In addition, we used relative weight analysis to evaluate the distinct contributions of each mindfulness facet to positive and negative mental health outcomes. The results indicated similar trends in both racial groups, emphasizing the importance of specific mindfulness aspects like describing and acting with awareness within the mindfulness construct. However, notable variations were observed, particularly in how observing and nonjudging facets related among Asian Americans. In addition, acting with awareness and nonjudging showed substantial inverse associations with negative mental health outcomes across groups, whereas the observing aspect displayed positive connections with anxiety and stress among Asian Americans. The findings suggest which aspects are fundamental to mindfulness, aiding in a nuanced understanding of the construct. They also emphasize the importance of acknowledging cultural diversity in both mindfulness research and its clinical applications. Practical implications and directions for future research were discussed. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Promoting Positive Adolescent Mental Health (PPAMH!) for School Climate: protocol for a feasibility randomised control trial in secondary schools

Promoting Positive Adolescent Mental Health (PPAMH!) for School Climate: protocol for a feasibility randomised control trial in secondary schools

Thriving minds, thriving workplaces: unleashing creativity through psychological wellbeing and psychological capital

PurposeThis study examines the complicated relationship between psychological wellbeing, joy at work, creative ability and the mediating influence of psychological capital, drawing insights from self-determination theory within the context of the banking sector.Design/methodology/approachThe study utilized random sampling to gather comprehensive data from 465 banking employees. Following data collection, structural equation modeling was employed to test the hypotheses formulated based on the collected data.FindingsFindings underscore a significant association between psychological wellbeing and both joy at work and creative ability within the banking sector. Moreover, the study elucidates that psychological capital acts as a crucial mediator, illuminating the pathway through which psychological wellbeing influences joy at work and subsequently enhances creative ability.Practical implicationsThis research offers valuable insights for organizational leaders and policymakers, emphasizing the imperative of prioritizing psychological wellbeing initiatives and nurturing positive work environments to enhance employee satisfaction, productivity and innovative contributions within the banking sector.Originality/valueThe application of self-determination theory as a theoretical framework provides a robust foundation for understanding the dynamics between psychological factors and workplace outcomes. The banking industry, often characterized by high stress levels and demanding work environments, stands to benefit substantially from interventions aimed at fostering psychological wellbeing. By cultivating positive mental health and capitalizing on joy at work, organizations can stimulate employee creativity ability, thereby fostering innovation and adaptive problem-solving capabilities crucial in the contemporary banking landscape.

Development of Positive Mental Health Measurement for Gender-Diverse Students in Thailand

Development of Positive Mental Health Measurement for Gender-Diverse Students in Thailand

Hoping to Adhere? Examining the Relationship Between Hope and Pre-exposure Prophylaxis Willingness, Adherence, and Persistence Among Young Women in South Africa and Zimbabwe (HPTN 082).

Hope is a powerful psychological construct which is linked to positive health. Greater hope is associated with improved antiretroviral therapy adherence; however, less is known about the impact of hope on oral pre-exposure prophylaxis (PrEP) outcomes. HIV Prevention Trials Network 082, was an open-label PrEP study among young women (ages 16-25) in South Africa and Zimbabwe. Hope was measured at baseline and follow-up using a subset of the Hope for the Future Scale (score range 6-24) and PrEP willingness was measured using a subscale of the HIV Prevention Readiness Measure (score range 6-30). Intracellular tenofovir-diphosphate (TFV-DP) concentrations were obtained from dried blood spot samples at weeks 13, 26, and 52; high PrEP adherence was defined as TFV-DP concentrations ≥ 700 fmol/punch. Persistence was defined as TFV-DP > 16 fmol/punch at weeks 26 and 52. Linear regression and generalized estimating equations were used to assess the relationship between hope and PrEP willingness, adherence, and persistence. The median age of participants (n = 432) was 21years (interquartile range [IQR]: 19-22). The mean hope score at baseline was 21.0 (SD = 3.4). Although hope was positively associated with PrEP willingness (β = 0.22, 95% CI 0.15, 0.37), it was not associated with high PrEP adherence (aRR = 1.00, 95% CI 0.96, 1.05), or persistence at follow-up (aRR = 1.02, 95% CI 0.99, 1.05). While cultivating hope may be an important strategy in building willingness to take oral PrEP, it may not be enough to sustain PrEP adherence or persistence.

Enhanced Labeling to Promote Consumption of Nutrient Dense Foods and Healthier Diets.

Background/Objectives: Efforts are underway worldwide to design and deploy food labeling systems that provide consumers with the information needed to shift dietary patterns toward nutrient dense, healthier foods. Despite a compelling need for progress, worrisome public health trends persist that are rooted in the popularity of unhealthy, heavily processed foods. Methods: The nutrition and health-related content on the packaging of nine common foods sold in the US and Europe is analyzed and compared. The current scope of nutrient-specific messaging is characterized, including messages highlighting health-related benefits stemming from the mix and levels of mostly macronutrients in food products. Results: An average of 6.9 unique nutrition-related messages appear on the packaging of nine US food products, while EU food products contain an average of 5.0. Messaging around the ingredients in food products accounts for the largest share, e.g., "100% whole grain", "Vegan", and "No artificial preservatives". The macronutrients of fat, fiber, cholesterol, salt, sugar, and protein are the focus of most messaging around health benefits. The degree of food processing and essential vitamin, mineral, and phytochemical micronutrients receive little or no attention, despite their importance in positive health outcomes. Conclusions: Current nutrition-related labeling fails to inform consumers of the enormous differences in the contribution of food products in meeting nutritional needs. Existing metrics and rating systems do not effectively account for the critical relationship between nutrient density and caloric content. Existing metrics and systems do not reflect the impacts of processing on food nutritional quality in ways that provide consumers meaningful information. New concepts, metrics, and label elements are described that could promote healthier dietary patterns. Clear and mandatory nutrition labeling could begin shifting market share toward healthier options, and this could trigger and guide changes in manufactured food recipes that make brand-name products healthier, benefiting all consumers.

Examining the Influence of Health-Related Quality of Life on Job Satisfaction Among Nurses in Kazakhstan.

This study evaluated health-related quality of life (HRQOL) and job satisfaction among Kazakh nurses and investigated the relationship between HRQOL and job satisfaction. Nurses' HRQOL may, directly and indirectly, affect their job satisfaction, which could subsequently result in poorer productivity and quality patient care. A cross-sectional research design utilizing a standardized questionnaire was employed among 615 nurses working at the University Medical Center in Astana, Kazakhstan. Nurses generally reported moderate HRQOL and low job satisfaction. Marital status and the number of children were significant predictors of high HRQOL. Married nurses had lower job satisfaction than single nurses. Nurses' number of children contributed to an increase in job satisfaction. Experiencing better environmental health may lead to greater general, intrinsic and extrinsic job satisfaction among nurses. Positive physical health is associated with higher levels of extrinsic and general job satisfaction. Better social health is linked to better intrinsic and general job satisfaction, whereas positive psychological health is related to better intrinsic job satisfaction. This investigation provided evidence of the influence of HRQOL on nurses' job satisfaction in Kazakhstan. Healthcare facilities can create organizational cultures and working environments that prioritize the well-being of healthcare workers.

Preconception and prenatal vitamin D associations with positive behavioral health in Black children.

Low levels of vitamin D during pregnancy are associated with offspring behavioral problems but little is known about pre-pregnancy influences. Additionally, Black American individuals are underrepresented in studies, limiting translational impact. We tested independent and interactive effects of preconception and prenatal vitamin D in Black women in relation to positive behavioral and emotional outcomes in early childhood. Black-identifying participants (N = 156) enrolled in the longitudinal Pittsburgh Girls Study (PGS) provided venous blood samples before and during pregnancy to measure 25-hydroxyvitamin D (25[OH]D) levels. Participants completed questionnaires assessing sociodemographic factors, depression severity and life stress, and later reported on child behavioral and emotional problems and prosocial behavior between 2 and 4 years. Mean serum 25(OH)D concentrations were 15.5 ng/ml (s.d. = 7.7) before pregnancy and 18.0 ng/ml (s.d. = 9.2) during pregnancy; below the sufficiency threshold according to commonly used dietary guidelines. After adjusting for covariates, prenatal 25(OH)D was negatively related to behavior problems and positively related to prosocial behavior in children, although the association attenuated for behavior problems after accounting for preconception 25(OH)D, which may reflect patterns of stability. Maternal 25(OH)D was unrelated to child emotional problems, and no synergistic effects of 25(OH)D timing were observed for any child outcome. Findings have relevance for Black women living in the northeast U.S. Results suggest specific associations between maternal vitamin D and positive behaviors in early childhood, regardless of sufficiency levels and suggest potential opportunities for early interventions to support healthy child development.

Expanding the primary care workforce by integrating genetic counselors in multidisciplinary care teams.

Collectively, rare diseases are common, affecting approximately 8% of the population in Canada and the USA. Therefore, the majority of primary care (PC) clinicians will care for patients who are affected or at risk for a genetic disease. Considering the increasing ways in which genetics is being implemented into all areas of healthcare, one way to address these needs and expand the capacity of the PC workforce is through the integration of genetic counselors (GCs) into PC multidisciplinary teams. GCs are Masters-educated allied health professionals with specialized training in molecular genetics, communication, and short-term psychotherapeutic counseling. The current models of GCs in PC mimic other multidisciplinary models. Complex tasks related to genetics, such as pre- and post-test counseling, genetic test selection, and results interpretation, are conducted by GCs, which, in turn, allows physicians, nurse practitioners, and other PC providers to work at the top of their scope of practice. Quality genetics services provided by GCs improve clinical outcomes for patients and their families; the simultaneous provision of genetic education and psychological support by a GC is associated with an increase in patient knowledge, perceived personal control, decrease in distress, and can lead to positive health behavior changes, all of which are aligned with the goals of primary healthcare. With their extensive training in clinical care, medical communication, and psychotherapeutic counseling, integrating GCs into PC care teams will improve the care patients receive and allow PC clinicians to ensure their patients are at the forefront of the personalized medicine revolution.