Representative Population Sample Research Articles

Predicting Obesity via Deep Learning: The Role of Chrononutrition

Abstract Background Obesity is a significant public health challenge, prompting the need for assessing effective tools for its monitoring and prevention. Chrononutrition investigates the role of timing, regularity and frequency of food intake on body metabolism and health. Here we aim to check if data on the distribution of calorie intake in the day may improve BMI prediction as compared to using only data on total day intake. Methods We apply deep learning on chrononutritional data on calorie intake over 6 daily timeslots from a nationally representative cross-sectional survey sample of the Italian population (INRAN-SCAI 2005/2006) comprising 2313 Italian adults 18-64 ys old with 3 day diet diaries. In particular, we implemented three deep neural network models, varying network configurations and feature selection. The 1st includes 18 (6 for each day diary) chrononutritional variables and the 3 day total intakes, beside age and sex; the 2nd includes age, sex and the 18 chrononutritional variables only; the 3rd uses age, sex and the 3 day totals only. We applied Early Stopping to limit overfitting. Optimization was conducted using the Adam algorithm, minimizing the mean squared error (RMSE), while mean absolute error (MAE) was the primary performance indicator. Results The results highlight that Model 3 outperformed the other models with MAE=2.514 and RMSE=3.476, indicating that for the purpose of predicting obesity, information on the time-of-day distribution of calorie intake is not increasing predictive ability of BMI on top of age, sex and total calorie intake in the day. Conclusions Additional use of day-time intake information worsened prediction of BMI via deep learning using this cross sectional Italian survey. However the error made is still sizeable and warrants the inclusion of other variables; our results don’t rule out the role of chrononutrition on metabolic health which may act through other biological mechanisms related to specific nutrients. Key messages • Chrononutrition data don’t improve BMI prediction over total calorie intake data in a cross-setional representative sample of the Italian population. • Deep learning approach to BMI prediction shows the importance of targeted selection of features in public health nutrition.

Evolution of online health-related information seeking in France from 2010 to 2023

Abstract Background Given the rapid ongoing progression of the internet and increase in health information available online since 2010, it is important to understand how these changes impact online health information-seeking behaviour of the population and the way of managing one’s health. This study aims to describe the evolution of the use of internet to seek health-related information as well as the characteristics of online health information seekers. Methods We used data from the French nationally representative surveys Health Barometers. It is a cross-sectional repeated survey of random representative samples of the French population conducted by the French national public health agency since 1992 using computer-assisted telephone interviewing. It serves to measure the evolution of key indicators regarding health-related behaviors, attitudes, and opinions in the general population and includes individuals aged 18-75 years old selected through randomly generated phone numbers. In the 2010, 2014, 2017 and 2023 editions, the same question was asked about the internet use as a source of health information. Evolutions over time were assessed using chi-square tests. Associations with sociodemographic characteristics and health status were evaluated using logistic regression models. Results Although internet access increased steadily during this period, from 72.8% in 2010 to 95.2% in 2023, the use of the internet as a source of health information rose between 2010 and 2014 (from 37.3% to 67.9%), decreased significantly in 2017 (60.3%) and rose again in 2023 at 65.3 %. The study describes the characteristics of the online health information-seekers trough time. Conclusions The past decade was marked by a breakthrough of the use of internet in the general population and the use of internet to seek health information. The analysis of the digital health information-seekers serves the public health authorities in their mission to provide accessible information on public health. Key messages • This study aims to describe the evolution of Online Health-Related Information Seeking in France from 2010 to 2023 and the characteristics of digital health information-seekers. • The analysis of the digital health information-seekers serves the public health authorities in their mission to provide accessible information on public health.

The M-POHL Health Literacy Population Survey 2024-2026 (HLS24)

Abstract Background Inspired by the first European Health Literacy Survey (HLS-EU) and its policy impact, the WHO Action Network on Measuring Population and Organizational Health Literacy (M-POHL) was established in 2018 under the auspices of WHO Europe to monitor and strengthen health literacy (HL) in Europe. The Health Literacy Survey 2019-2021 (HLS19) was the first project of M-POHL, focusing on both general and specific aspects of HL. The follow-up survey (HLS24) builds on this work and will provide even more comprehensive data on HL by including more countries and new aspects of HL. By also focusing on NCDs and prevention, HLS24 is a key partner in the European Joint Action PreventNCD. Methods The HLS24 is a cross-sectional study based on nationally representative samples of the adult population (18+) in more than 20 participating countries. The HLS24 core questionnaire includes items on general HL, sociodemographics, health behavior, health status, and health care utilization. Some countries also include questions on prevention and early detection of chronic diseases and health problems. Five optional packages (OPs) enable countries to focus on specific aspects of HL, namely digital, communicative, navigational, vaccination and mental HL. Results HLS24 uses a harmonized set of HL instruments that provide a solid database for health policy decisions to strengthen HL and health equity in Europe. In addition to the three OPs on digital, communicative and navigational HL discussed in the following presentations, an 11-item set on vaccination literacy and a 21-item set on mental HL are provided. Conclusions Covering NCDs, prevention, digital health, immunization, and mental health, the HLS24 provides important data on current health challenges and highlights the needs of the European population regarding health information and services upon which policy and action interventions can be based.

Measured obesity and overweight in adults: the Italian Health Examination Survey 2023-CUORE Project

Abstract Background The WHO recommends to halt the rise of obesity by 2025, considering 2010 as baseline. This analysis aims to assess if Italy can meet the WHO target in the general adult population using data measured in the periodic health examination surveys (HESs) conducted within the CUORE Project. Methods In the HES started in 2023, mean level of BMI and prevalence of obesity (BMI > =30 kg/m2) and overweight (25 < =BMI< 30 kg/m2) were assessed in representative random samples of resident population, aged 35-74 years, stratified by age and sex (727 men and 706 women), from 7 (of 20) Italian Regions, in Northern, Central and Southern Italy. Weight and height were measured using standardized methods. Insufficient physical activity was defined as less than 150 minutes of moderate-intensity activity per week, or equivalent. The survey is funded by the Italian Ministry of Health-CCM. Results Prevalence of obesity was 23% (95% C.I. 16-29%) in men and 25% (19-31%) in women; prevalence of overweight was 47% (39-54%) in men and 30% (24-37%) in women. Mean level of BMI was 27.5 kg/m2 (27.2-27.8 kg/m2) in men and 26.9 kg/m2 (26.4-27.3 kg/m2) in women. Obesity resulted tendencially higher in persons with insufficient physical activity (27%, with 95% C.I. 17-36% in men; 28%, 19-37% in women) than among those without (19%, 11-27% in men; 21%, 12-30% in women), and in persons with primary or secondary school education (29%, 17-40% in men; 32%, 20-44% in women) than in those with higher educational level (20%, 12-27% in men; 21%, 14-28% in women). Conclusions Going in the direction of WHO target, preliminary data collected within 2023 showed a prevalence of obesity not statistically different in comparison to HES data of 15 and 5 years ago, both in men and women, however, 70% of men and 55% of women are in the overweight/obesity condition. Preventive actions at national and community level should be still massively implemented. Key messages • Prevalence of obesity and overweight resulted still at epidemic level in the Italian adult general population. • In the Italian adult population stable obesity prevalence trend was observed in comparison to 15 and 5 years ago.

Difference in long COVID prevalence due to different definitions and long COVID related risk factors

Abstract Several definitions of long COVID are used in research and practice what challenges epidemiological investigations. Here we present differences in long COVID prevalence accounting for several definitions and concordance between the definitions, as well as the risk factors associated with long COVID. Definitions considered were WHO post-COVID19 condition (PCC) definition with several thresholds (at least low - standard definition, moderate or strong impact on daily activities), NICE1 and NICE2 definitions (reported at least one or at least two symptoms), United States National Centre for Health Statistics, and United Kingdom Office for National Statistics definitions and perceived long COVID. Prevalence of long COVID among French adult population (N = 10 615) in autumn 2022 ranged from 1.2% to 13.4%, conditional of the definition. The concordance between the definitions was at best moderate. Next, on a smaller representative sample of a French adult population (N = 1 813) eight potential risk factors groups for long COVID were assessed in a systematic epidemiological investigation, following a conceptual model. Fifteen factors from seven groups were associated with long COVID including early-defined sociodemographic characteristics, pre-existing chronic conditions, short-term work-related factors, current socioeconomic position, health behaviours, infection-related factors, and perception of COVID-19 severity and long COVID. The likelihood of long COVID was higher for individuals with higher number of diseases and for nineteen out of twenty-six most prevalent dyads and a triad. A more standardized definition would facilitate research and surveillance of long COVID. Furthermore, long COVID should be observed as an interplay of social, medical and contextual factors rather than a mere complication of SARS-COV-2 infection, while patients with multimorbidity may present some of the particularly vulnerable population groups.

Inequalities in access to healthcare for older adults during COVID-19 pandemics in Lithuania

Abstract Background During COVID-19 pandemic, healthcare systems experienced unprecedented shock. Older adults were the most vulnerable group of Lithuanian society, facing distinctive health challenges and highest mortality rates. The aim of the study was to examine perceived inequalities and challenges in access to healthcare of Lithuanian population over 65 years old during COVID-19 pandemic. Methods Representative sample of Lithuanian population over 65 years old (1503 individuals) was involved in the anonymous questionnaire survey, performed in January, 2024. Results 22 % of respondents reported not using healthcare services during COVID-19 pandemics. Among them, 76% did not have any need for healthcare services, while 13.6% did not approach healthcare due to fear of getting infected by Covid-19, and the other 10.4% had various accessibility challenges. 15.8% reported frequent problems in registering with family doctors, and 20.0% - with the specialist appointment. There was a clear social gradient observed among those underserved: it was associated with educational level and place of residence. Those with lower education and living in smaller towns and rural areas reported more common healthcare accessibility problems. Higher education, income and better self-perceived health correlated with higher satisfaction with travel time reaching health care services and registering for the appointment (p < 0.05). Conclusions Health system resilience reflects the ability to continue service delivery in the face of extraordinary shocks. Limited health care accessibility and clear social gradient could increase vulnerability of older adults, which resulted in exceptionally high mortality rates during COVID-19 pandemics. Results of the survey will be used for further development of transformative capabilities of healthcare system, responding to public health disasters and protection of the vulnerable groups of the society. Key messages • Limited health care accessibility and clear social gradient could increase vulnerability of older adults, which resulted in exceptionally high mortality rates during COVID-19 pandemics. • Results of the survey will be used for further development of transformative capabilities of healthcare system, responding to public health disasters.

Digital health literacy and associated socio-demographic characteristics in the French population

Abstract Background With the development of digital devices in the health field, digital health literacy has become an important issue in promoting and protecting people’s health. Digital health literacy was measured in a representative sample of the French adult population in order to assess its level and to identify the socio-demographic characteristics of individuals with the lowest literacy levels. Comparisons with works carried out in other European countries as well as implications for the implementation of digital interventions will be discussed. Methods Digital health literacy was assed using the HLS19-DIGI-HI Instrument. This 8-item scale measuring the skills related to dealing with digital health information was introduced in the 2023 Health Barometer survey, conducted by the French national public health agency. The survey included French-speaking individuals living in France, aged 18-85, selected through randomly generated phone numbers. 3007 persons were interviewed using a computer assisted telephone interview. A continuous score and categories were calculated to determine the level of Digital Health Literacy. Their associations with sociodemographic characteristics were studied using univariate and multivariate analysis. Results 1902 persons declared they used internet to search information or advice on health on internet in the last 12 months and completed the Digital health literacy questionnaire. 61 % of these individuals have a low level of digital health literacy (29 % “inadequate” and 32% “problematic”). Multiple sociodemographic characteristics were associated with lower levels of literacy in univariate and multivariate analysis. Conclusions These results are useful to better understand and assess the digital health literacy of the population according to their socio-demographic characteristics. They will provide a knowledge base to implement web-based interventions for promoting targeted digital health interventions, according to targeted audiences. Key messages • This study in large random sample of the French population showed frequent difficulties to deal with online health information. • Multiple sociodemographic characteristics were associated with digital health literacy and can help to support implementation of targeted digital health interventions.

Mistreatment, Abuse, and Gender-Based Violence During Childbirth: A Longitudinal Analysis of Obstetric Violence in México (2011-2021).

This longitudinal retrospective study of mistreatment, abuse, and gender-based violence during childbirth uses two population representative samples of Mexican women to analyze the incidence of obstetric violence in Mexico from 2011 to 2021. Our assessment is that there are more continuities than changes in the phenomenon and our study does not find evidence to support the claims of increases in obstetric violence during the 2020-2021 COVID-19 pandemic. Conceptually it differentiates between acts of violence, disrespect, and abuse, based on socially constructed gender differences (gender-based violence), and those more generally related to medical authoritarianism and the biomedical model that confers medical professionals a more powerful and higher status relative to that of their patients.

Tobacco- and Nicotine-Containing Product Use in Italy: Results From Two Cross-Sectional Studies

BACKGROUND: Heated tobacco products (HTPs) are alternatives to cigarettes that heat rather than burn tobacco. The first HTP sold in Italy was _IQOS®_ (I-HTP), and while it has been available for nearly a decade, limited data are available on the use of these products. OBJECTIVE: To characterize how Italian adults (users of legal age) use tobacco- and nicotine-containing products (TNPs), including smoke-free products (SFPs), we surveyed this population about their current and past use of TNPs from 2018 to 2020. METHODS: Two consecutive cross-sectional surveys were conducted in representative samples of the general adult population (6,095 subjects from 2018 to 2019 and 6,118 from 2019 to 2020) and among adult I-HTP users (1,371 subjects from 2018 to 2019 and 1,401 from 2019 to 2020) in Italy. We assessed the prevalence of current TNP use in the general population sample and use patterns in the I-HTP_ _users sample. RESULTS: In the first cross-sectional study (2018-2019), cigarettes were the most used TNP (24.3%), while only a small proportion of the surveyed general population sample used e-cigarettes or I-HTPs (1.4% and 0.7%, respectively). Nearly all current I-HTP users were current adult cigarette smokers when they started using I-HTPs (98.0%). Both surveys showed low initiation, re-initiation, and relapse with I-HTPs, with the majority of current I-HTP users belonging to the intended audience of adults who already used TNPs. Some participants used both I-HTPs and combustible TNPs (38.6%); however, most (59.2%) used I-HTPs exclusively. I-HTP_ _users perceived the health risk (score 0 = no risk; score 100 = very high risk) associated with cigarette smoking higher (63.7) than that for I-HTP_ _use (42.6). Exclusive I-HTP users reported improved respiratory symptoms (reduced cough and phlegm) and exercise capacity compared to a year before they started using I-HTPs. Most current I-HTP users also reported improved smell and taste, better breath smell, and reduced stains or yellowing teeth. Overall, these results were more pronounced among exclusive I-HTP users. The results of the second cross-sectional study (2019-2020) were similar, except for an increase in I-HTP_ _use_ _(1.1% vs. 0.7% in 2018 to 2019). CONCLUSIONS: These studies show that most TNP users in Italy smoke cigarettes. The uptake of I-HTPs suggests that they are a viable alternative to cigarettes. Nearly all I-HTP users switched from cigarettes to I-HTPs. Furthermore, most I-HTP_ _users exclusively use the product. I-HTP users considered the health risk associated with I-HTP_ _use to be lower compared to cigarette smoking, but they did not perceive I-HTPs_ _as risk free. Study participants reported improvements on some health, hygiene, and appearance aspects after switching from cigarettes to I-HTPs. Our results suggest that SFPs can play a role in a harm reduction approach. Further studies are needed to continually monitor the prevalence of SFP use to provide long-term evidence of their impact.

Health information, what do people search and where? a cross-sectional online survey study in the adult Swiss population.

Health promotion and disease prevention are crucial for improving public health and alleviating the burden of illness in the population. This study aimed to investigate, the sources of health information most used and trusted, and the health topics most searched, by means of a nationwide cross-sectional online survey of a representative sample of the adult Swiss general population. Overall, complete surveys of 2020 participants were analysed (mean age 47 years old, 51% male, and matching the Swiss population regarding age, sex, and language-speaking region). Sources' use were calculated with descriptive statistics per sex and age groups. The most frequently used sources were general practitioners (min: 46% to max: 73%), government websites (40% to 55%), family and friends (37% to 63%), pharmacy (33% to 46%), and television (21% to 57%). The most trusted sources were specialised physicians (94% to 98%) general practitioners (90% to 96%), and pharmacies (81% to 89%). Based on multivariable controlled regression, age (per five years increase) was associated with increased odds of using television (Odds Ratio (OR): 1.19, 95% Confidence Interval (CI): 1.12 to 1.21), print media (OR: 1.15, 95% CI: 1.10 to 1.19), radio (OR: 1.15, 95%CI: 1.10 to 1.20), and the general practitioner (OR: 1.11, 95% CI: 1.07 to 1.15), and decreased odds of using news websites (OR: 0.94, 95% CI:0.9 to 0.98), family and friends (OR: 0.93, 95% CI: 0.9 to 0.98), foreign authorities websites (OR: 0.91, 95%CI: 0.86 to 0.97), and social media (OR: 0.88, 95% CI: 0.84 to 0.92). Women were more likely to seek health information in the pharmacy (OR: 1.39, 95% CI: 1.15 to 1.68), specialised physicians (OR: 1.39, 95% CI:1.13 to 1.72), television (OR: 1.41, 95% CI: 1.16 to 1.72), and books (OR: 1.9, 95% CI: 1.44 to 2.5). The most searched health topics, based on the International Classification of Primary Care, 2nd edition (ICPC2), were general and unspecified symptoms (20.9%) and musculoskeletal issues (19.4%). The use of these findings by policymakers and health care providers could potentially enhance the effectiveness of health-related education strategies, by aligning communication efforts with the populations' preferences and content needs, and allocating resources where they are most commonly accessed and trusted, namely in the general practice.

Why You Gamble Matters: A Systematic Review and Meta-analysis of the Association Between Gambling Motivation and Problem Gambling.

The propensity for individuals to experience problem gambling (PG) varies depending on their motivation to gamble. The present meta-analysis assessed the effect sizes associated with various gambling motives identified in representative population samples. Studies were sourced through PsycINFO, PudMed, and databases maintained by the Alberta Gambling Research Institute and the Greo Evidence Insights. Quantitative studies and technical studies were included if they reported on gambling motivation as a correlate of PG; were published in English, French, or Spanish; used valid and reliable measures PG as an outcome variable; and targeted the general adult population. A random effects meta-analysis was conducted to estimate pooled odds ratios. A total of 26 studies were included from 17 jurisdictions, with most studies conducted in Canadian provinces (k = 17) or specific states of the United States (k = 7). Number of participants varied, depending on the gambling motivation analyzed, and ranged from 2,835 to 51,685. Fourteen unique motives were identified with odds ratios ranging from 0.53 (95% CI, 0.45, 0.63) for gambling for charity to 6.20 (95% CI, 3.83, 10.05) for the motive "to be alone", with high study heterogeneity being observed for many gambling motives, given variability in important study characteristics. The results generally indicate that coping motives were associated with large effect sizes, enhancement motives with medium effect sizes, and all other motives with small or nil effects. Coping motives are on par with other strong risk factors such as participation in online gambling or electronic gaming machines, and are therefore important elements to consider when screening for PG or designing public health messages.

Sleep quality and sleep duration are associated with charitable donations: Evidence from two population-based surveys

Study objectivesInsufficient sleep alters emotional processing, leading to mood disturbances, reduced gratitude, and potentially the withdrawal of compassionate helping. Using data from two national surveys, we investigated whether sleep quality and sleep duration were associated with willingness to donate to local charities and places of worship. MethodsWe conducted secondary analyses of two Gallup-administered studies that used random address-based sampling methodologies to approximate population-representative samples. BRS-5 included 1501 respondents and BRS-6 included 1336 respondents (independent samples). Each survey inquired about sleep quality and whether participants had donated in the last year to local organizations and places of worship. In addition, BRS-5 included questions about sleep duration. ResultsIn both studies, participants who had better sleep quality and better sleep durations were more likely to donate charitably to local organizations and places of worship (ORs of 1.07–1.45). Most associations remained significant when accounting for age, gender, and income. ConclusionBetter sleep was associated with a greater likelihood to donate charitably. Experimental work is needed to determine if the relationship between sleep health and prosocial behaviors is uni- or bi-directional.

Adherence to the EAT-Lancet sustainable diet and ultra-processed food consumption: findings from a nationwide population-based study in Brazil.

To evaluate the association between ultra-processed food consumption and adherence to the EAT-Lancet diet in a representative sample of the Brazilian population. The study used data from the Brazilian National Dietary Survey 2017-2018 and employed linear regression models to evaluate the association between ultra-processed food consumption and adherence to the EAT-Lancet diet, as measured by the Nova food system and Planetary Health Diet Index (PHDI), respectively. Nationally representative sample of the Brazilian population. The study included 46 164 Brazilians ≥ 10 years old. The average PHDI total score was 45·9 points (95 % CI 45·6, 46·1). The ultra-processed food consumption was, with dose-response, inversely associated with the adherence to the EAT-Lancet diet. The PHDI total score was 5·38 points lower (95 % CI -6·01, -4·75) in individuals in the highest quintile of consumption of ultra-processed foods, as compared to those in the first quintile. The PHDI score was also inversely associated with the share of processed culinary ingredients and processed foods and positively associated with the share of unprocessed or minimally processed foods. Our study showed an inverse relationship between the consumption of ultra-processed foods and the adherence to a healthy and sustainable diet.

Are There Missed Opportunities For Falls Prevention In Older People With Fractures? Data From TILDA

Abstract Background Fractures can represent a seminal event in later life associated with significantly higher rates of functional impairment, nursing home admission and mortality. The aim of this study therefore was to measure the cumulative incidence of hip and wrist fractures longitudinally in a population-representative sample of community-dwelling older people and examine opportunities to intervene prior to the fracture. Methods Participants aged ≥65 years from the Irish Longitudinal Study on Ageing were included and followed from Wave 1 to Wave 5 (8-year follow-up). Falls and Fractures (Hip and Wrist) and were elicited by self-report at each wave. Participants were also asked how steady they feel when standing / walking. Logistic regression models assessed the relationship between reported falls and unsteadiness, and subsequent fracture. Results 3,072 participants were included (Mean age 73 years, 53% female) and followed for a median of 6.3 years, with over 7% (228/3,072) reporting a fracture. Over one quarter (69/267) of fractures were preceded by an injurious fall requiring medical attention in the prior 24 months, 45% were preceded by a fall of any type (121/267). One third of participants who subsequently had a fracture (89/267), reported that they were unsteady on their feet when interviewed prior to the fracture. One fifth (19/89) of these participants accessed physiotherapy services prior to the fracture. The combination of either a fall or unsteadiness reported during the preceding 24 months significantly increased the likelihood of future fracture (Odds Ratio 2.62 (95% CI 2.05 – 3.35)). Conclusion Most fractures are predictable with almost two thirds heralded by falls or unsteadiness in the preceding 24 months. Falls prevention strategies, which can reduce further falls by 20-40%, targeted at those with unsteadiness and falls would likely prevent an important proportion of future fractures, and have a positive impact on health outcomes in this cohort.

Comparison of four approaches in eliciting health state utilities with SF-6Dv2.

To empirically compare four preference elicitation approaches, the discrete choice experiment with time (DCETTO), the Best-Worst Scaling with time (BWSTTO), DCETTO with BWSTTO (DCEBWS), and the Standard Gamble (SG) method, in valuing health states using the SF-6Dv2. A representative sample of the general population in Quebec, Canada, completed 6 SG tasks or 13 DCEBWS (i.e., 10 DCETTO followed by 3 BWSTTO). Choice tasks were designed with the SF-6Dv2. Several models were used to estimate SG data, and the conditional logit model was used for the DCE or BWS data. The performance of SG models was assessed using prediction accuracy (mean absolute error [MAE]), goodness of fit using Bayesian information criterion (BIC),t-test, Jarque-Bera (JB) test, Ljung-Box (LB) test, the logical consistency of the parameters, and significance levels. Comparison between approaches was conducted using acceptability (self-reported difficulty and quality levels in answering, and completion time), consistency (monotonicity of model coefficients), accuracy (standard errors), dimensions coefficient magnitude, correlation between the value sets estimated, and the range of estimated values. The variance scale factor was computed to assess individuals' consistency in their choices for DCE and BWS approaches. Out of 828 people who completed SG and 1208 for DCEBWS tasks, a total of 724 participants for SG and 1153 for DCE tasks were included for analysis. Although no significant difference was observed in self-reported difficulties and qualities in answers among approaches, the SG had the longest completion time and excluded participants in SG were more prone to report difficulties in answering. The range of standard errors of the SG was the narrowest (0.012 to 0.015), followed by BWSTTO (0.023 to 0.035), DCEBWS (0.028 to 0.050), and DCETTO (0.028 to 0.052). The highest number of insignificant and illogical parameters was for BWSTTO. Pain dimension was the most important across dimensions in all approaches. The correlation between SG and DCEBWS utility values was the strongest (0.928), followed by the SG and BWSTTO values (0.889), and the SG and DCETTO (0.849). The range of utility values generated by SG tended to be shorter (-0.143 to 1) than those generated by the other three methods, whereas BWSTTO (-0.505 to 1) range values were shorter than DCETTO (-1.063 to 1) and DCEBWS (-0.637 to 1). The variance scale factor suggests that respondents had almost similar level of certainty or confidence in both DCE and BWS responses. The SG had the narrowest value set, the lowest completion rates, the longest completion time, the best prediction accuracy, and produced an unexpected sign for one level. The BWSTTO had a narrower value set, lower completion time, higher parameter inconsistency, and higher insignificant levels compared to DCETTO and DCEBWS. The results of DCEBWS were more similar to SG in number of insignificant and illogical parameters, and correlation.

Age-adjusted Baseline NDI Values: An Analysis of Neck Pain Disability in the General American Population.

Survey-based, prospective study. Identify age-adjusted baseline NDI values in the American population. The Neck Disability Index (NDI) is the most widely used tool for assessing self-rated disability in patients with neck pain. Establishing baseline NDI values can aid in understanding the clinical impact of cervical spine pathologies and treatment interventions. An internet-based survey was distributed using the Connect (TM) platform powered by CloudResearch. Based on the latest US Census, this survey was designed to engage a demographically representative sample of the US adult population. We captured 699 individuals, aiming for 100 people per each 10-year age group between 18-89. Participants scored their disability using the NDI survey. Mean NDI scores stratified by age group and sex were calculated for each cohort. A total of 699 participants were included with 352 (50.4%) males and 347 (49.6%) females and an age distribution closely aligning with national demographics. The overall mean NDI for the combined age groups was 16.5 with a 95% confidence interval (CI) of 15.5-17.5. The 18-29 age group had the lowest mean NDI of 12.3 (95% CI [10.4, 14.2]). Mean NDI scores increased until the 60-69 age group with a mean of 20.1 (95% CI [17.3, 23.0]) with women having a mean NDI of 22.2 (95% CI [18.8, 25.7]) compared to men with 15.4 (95% CI [10.3, 20.4]). Mean NDI scores decreased in the 70-79 and 80-89 age groups. This is the first study to assess age-adjusted baseline values of NDI in the US population. Our findings demonstrate a disproportionate distribution of disability ratings across age groups. This data is important for healthcare professionals as it provides age- and sex-specific levels of disability. Level III.

Validation of the Generic Version of China Health Related Outcomes Measures (CHROME-G) among individuals with type 2 diabetes in China.

The Generic Version of China Health Related Outcomes Measures (CHROME-G) was a new preference-based health-related quality of life (HRQoL) instrument designed specifically for the Chinese population. This study aimed to validate and compare measurement properties of CHROME-G with EuroQol-5 Dimensions-5 Levels (EQ-5D-5L), Short Form-6 Dimensions version 2 (SF-6Dv2), and Diabetes-Specific Quality of Life (DSQL) scales among the elderly Chinese population with type 2 diabetes. A representative sample population was recruited across the country. Internal consistency was assessed using Cronbach's alpha. Hypotheses testing including convergent validity and known-groups validity were evaluated using Spearman's rank correlation and effect sizes, respectively. Sensitivity was examined using relative efficiency and receiver operating characteristic curve. A total of 131 individuals with type 2 diabetes (54.20% male; mean age 69.03 years) were enrolled. Cronbach's alpha was 0.94 for DSQL, 0.93 for CHROME-G, 0.87 for EQ-5D-5L, and 0.88 for SF-6Dv2. For the convergent validity of CHROME-G, 24/29 (82.76%) correlations met the predefined hypotheses, with Spearman's rank correlation coefficients ranging from 0.51 to 0.96. Among the different health subgroups, the effect sizes for CHROME-G, DSQL, EQ-5D-5L, and SF-6Dv2 were 0.19-1.26, 0.36-1.62, 0.22-1.06, and 0.49-0.87, respectively. CHROME-G, DSQL, and SF-6Dv2 had higher efficiency compared with EQ-5D-5L in detecting differences in self-reported health status, with relative efficiency of 3.18 and 1.76, 4.38 and 6.52, and 1.56 and 2.09, respectively. CHROME-G demonstrates relatively good measurement properties compared with EQ-5D-5L and SF-6Dv2 for measuring the HRQoL among the elderly Chinese population with type 2 diabetes. The sensitivity of DSQL appears to be better than that of the three generic instruments.

Climate change distress and impairment in Germany.

Climate change has been widely recognized as one of the most challenging problems facing humanity and it imposes serious mental health threats. It is important, however, to differentiate between the affective experience of distress over climate change and the functional impairments associated with climate change. Such a distinction is crucial because not all negative affective states are pathological, and they might even motivate pro-environmental behavior. Functional impairments, like not being able to work or maintaining social relationships, however, might require immediate treatment. This study assesses climate change distress and climate change impairment within the population of Germany using a population-representative sample. The results identify vulnerable subgroups and thereby can help to facilitate the development of target group specific intervention programs. Furthermore, this study explores whether climate change distress and climate change impairment are associated with general health, physical health, mental health, and diverse health behaviors. Study participants were drawn from a panel which is representative of the German-speaking population in Germany with Internet access. Participants answered a series of questionnaires regarding their climate change distress, climate change impairment, general health, physical health, mental health, and diverse health behaviors. To evaluate differences between subgroups, Bayesian independent samples t-tests were calculated. To evaluate associations between constructs, Bayesian correlations were calculated. Especially women, younger people, people from West Germany, and people with a high level of formal education seem to experience higher levels of climate change distress. Regarding climate change impairment, the results suggest that especially women, older people, people from West Germany, people with a low level of formal education, people with a low or middle social status, and people with an inadequate/problematic health literacy seem to experience higher levels of climate change impairment. Furthermore, climate change distress and climate change impairment were weakly and differently associated with general health, physical health, mental health, and diverse health behaviors. Climate change distress and impairment are not evenly distributed within German society. The results of this study provide a starting point for the development of target group specific intervention programs.

Reducing strain on primary healthcare systems through innovative models of care: the impact of direct access physiotherapy for musculoskeletal conditions—an interrupted time series analysis

ObjectivesTo evaluate the longitudinal impact of introducing a national, direct access physiotherapy model of care on the rates of primary and secondary care consultations for musculoskeletal (MSK) conditions.DesignInterrupted time series...

‘Trust the messenger’: Public trust in sources of information on COVID-19

Abstract A key lesson of the coronavirus pandemic was the importance for pro-social behaviour of popular trust in key information sources. Yet existing studies rarely consider the role of people’s trust in a range of different information sources, and the relationship between such trust and particular attitudes and behaviours among individuals. This study goes beyond the general mantra that ‘trust matters’ and explores more specific effects, relating to trust in particular actors and for particular outcomes. Based on a survey fielded on a representative sample of the British population conducted towards the end of the pandemic, we find evidence that people’s coronavirus attitudes and behaviours are particularly related to their trust in scientific experts and, in some cases, to their trust in local councils. However, trust in these actors is not uniformly associated with people’s coronavirus beliefs and actions. This suggests that the link between people’s trust and their pro-social attitudes and behaviours is often specific rather than general. The results hold important implications for the design of effective public communication strategies in the event of any future health emergency.