Prevention Research Research Articles

The Role of Vitamin E Isoforms and Metabolites in Cancer Prevention: Mechanistic Insights into Sphingolipid Metabolism Modulation.

Natural forms of vitamin E include four tocopherols and four tocotrienols (α, β, γ, and δ), which are essential as lipophilic antioxidants. Among these eight isoforms, α-tocopherol (αT), the predominant form of vitamin E found in tissues, has traditionally received the most attention in disease prevention research due to its robust antioxidant activity. However, recent studies suggest that other forms of vitamin E exhibit distinct and potentially more potent beneficial activities in disease prevention and treatment. These non-αT forms of vitamin E are metabolized in vivo, producing various metabolites, including 13'-carboxychromanol, though their biological roles remain largely unknown. Notably, sphingolipids, known for their significant roles in cancer biology, may be involved in the anticancer effects of vitamin E through the modulation of sphingolipid metabolism. This review focuses on the diverse biological activities of different vitamin E forms and their metabolites, particularly their anticancer effects, while highlighting the underlying mechanisms, including their novel impact on regulating sphingolipid pathways. By elucidating these interactions, we aim to provide a deeper understanding on the multifaceted roles of vitamin E in cancer prevention and therapy.

Analysis of Concussions with Persisting Symptoms Caused by Motor Vehicle Crashes in 136 Vehicle Occupants Shows that Females Are Vulnerable Road Users.

At the Canadian Concussion Centre, we treated 136 patients from 2000 to 2020 who sustained concussion plus persisting concussion symptoms (C+PCS) as motor vehicle occupants involved in motor vehicle crashes (MVCs). This center specializes in the treatment of patients with C+PCS. The objective of the present study was to identify strategies for preventing concussion among vehicle occupants involved in MVC. Indeed, this is the first study focused on C+PCS in MVC occupants, and our main purpose was to evaluate the effectiveness of onboard concussion prevention strategies. In this retrospective, consecutive cohort of 136 patients with C+PCS, we examined the patients' demographic and injury features in relation to the nature of the MVC including speed, direction of impact, and availability, deployment, and effectiveness of onboard occupant safety measures including seatbelts, head restraints, and airbags. The most frequent combination of factors was a belted female driver of an automobile struck from behind by another automobile. Surprisingly, the entire patient cohort comprised more females (69.1%) than males (30.9%), and rear-end collision was the most common type in females. Most injured occupants of both sexes were wearing seatbelts, but only a minority of the crashes caused airbag deployment. The seven most common symptoms were headache (84.6%), anxiety (72.8%), sensitivity to light (70.6%), memory problems (69.9%), sensitivity to noise (66.2%), irritability (56.6%), and depression (55.9%). Whiplash was a frequent associated injury in both sexes. Complete recovery from C+PCS was rare, and most patients with known follow-up continued to suffer from persisting symptoms for months to years. The median symptom duration for all 136 patients was 30.0 months (interquartile range: 16.8-56.0 months). Based on these findings, we conclude that females are indeed vulnerable road users with respect to C+PCS, and our literature search showed that there had been some previous evidence of increased injury risk of other injuries in female occupants. We recommend that additional prevention strategies are required to reduce the post-crash acceleration-deceleration "bobble-head" movement of the head on trunk causing both concussion and whiplash as has been accomplished in auto racing. Also, these prevention measures must be investigated in crash studies that include low-to-high speed rear-end collisions using anthropometrically appropriate models of male and female occupants reflecting the range of sizes of both sexes. There is a need for more concussion brain injury prevention research focusing on the vulnerability of female occupants, which has not been sufficiently addressed even though the deficiency was identified many years ago. The sex inequity of current onboard motor vehicle concussion brain injury prevention measures especially with respect to females should be addressed by governments and the automobile and insurance industries.

Improving daily precipitation estimation using a double triple collocation-based (DTC) merging framework

The availability of accurate precipitation data is crucial for water resources management, disaster prevention, and related research. While gridded products offer precipitation information at high spatial resolution, they still exhibit significant errors in precipitation estimation. The merging of multi-source gridded products has become a mainstream approach for improving precipitation estimation. However, many existing frameworks rely on gauge observations to estimate the merging weights, which limits their applicability in data-scarce regions. Moreover, these frameworks predominantly focus on enhancing precipitation estimation rather than on precipitation events. This study proposes a novel Double Triple Collocation-based (DTC) merging framework, which combines time–space TC (TC_2D)-based precipitation rate merging with categorical triple collocation (CTC)-based rain/no-rain merging. The objective is to minimize errors in precipitation estimation and enhance the detection capability for precipitation events without relying on rain gauge observations. Given that the TC_2D-based method is initially applied to precipitation merging, its effectiveness must be verified by comparing it with classic TC-based merging approaches (TC_Space and TC_Time). Taking the Jiulong River Basin (JRB) as a case study, the performance of the DTC and its comparative objects was evaluated with three triplets composed of independent precipitation products. The results indicated that all merged precipitation products outperform their parent products. Furthermore, the merged precipitation datasets, after being corrected using rain/no-rain time series generated by CTC-based merging, showed enhanced capability in detecting precipitation events. The performance of merged precipitation products was found to be highly dependent on the quality of the satellite precipitation products (SPPs) within the triplets. This study provides a promising approach for generating high-quality precipitation datasets, particularly in regions with limited observation data availability.

Hatha yoga, integrating the segmental stabilization exercise model, can improve trunk muscle endurance in healthy adults.

Low back pain is a very common symptom worldwide and an increasingly important public health problem. Exercises to stabilize the lumbar spine and pelvis have been shown to be effective in preventing or reducing the risk of low back pain. Hatha yoga practice is now increasingly appearing in prevention research and has the potential to improve trunk muscle endurance. The prevention research on endurance training of trunk muscle lacks evidence. The aim of this study was to investigate the effectiveness of a professional and scientifically based exercise program to improve and balance trunk muscle endurance in healthy adults. A non-randomized control study was conducted. Participants were healthy adults without low back pain or injury who had not performed exercises to improve trunk muscle endurance prior to participation in the study. An analysis of the proposed exercise program's effectiveness was conducted. The participants were divided into two groups: the exercise group (EG) performed a three-month hatha yoga exercise program (60 min twice a week) that included the spinal and pelvic segmental stabilization exercise model, or the control group (CG), in which participants were asked to maintain their previous lifestyle during the study period. Trunk muscle endurance was measured at baseline (PRE) and after completion of the exercise program (POST) in both groups. The changes in the measured variables were analyzed (PRE-POST analysis, EG-CG comparison). Seventy-two subjects (nEG = 36, age 32.2 ± 6.8 years; nCG = 36, age 29.9 ± 7.8 years) participated in the study. After the exercise program, the EG participants had significantly better results in endurance in three of the four trunk muscle groups (p < 0.05), but not in any of the endurance ratios. Hatha yoga when integrating the segmental stabilization exercise model can significantly improve the endurance of at least three of the four major trunk muscle groups. For clinical relevance, the long-term effects of the proposed exercise program should be investigated in individuals with low back pain.

Anti-Tetanus Vaccination Is Associated with Reduced Occurrence and Slower Progression of Parkinson's Disease-A Retrospective Study.

Background: Parkinson's disease (PD) is a neurodegenerative disorder that progressively damages the autonomic and central nervous systems, leading to hallmark symptoms such as resting tremor, bradykinesia, and rigidity. Despite extensive research, the underlying cause of PD remains unclear, and current treatments are unable to halt the progression of the disease. In this retrospective study, based on historical electronic health records (EHR) from a national health provider covering the period from 2003 to 2023, we investigated the impact of vaccination and medication purchases on PD occurrence and severity. Methods: Using a case-control design, we compared the vaccination histories of 1446 PD patients with 7230 matched controls to assess the association between vaccination and PD onset. Additionally, we explored statistical associations between vaccination, medication purchases, and PD severity over an average of 9 years of follow-up, utilizing a machine learning algorithm to quantify disease severity based on annual antiparkinsonian medication purchases. Results: Our analysis revealed a significant reduction in PD occurrence following tetanus-diphtheria (Td) vaccination, with an adjusted odds ratio of 0.17 (95% CI [0.04, 0.70]) for PD onset within 5 years post-vaccination. Furthermore, a time-dependent relationship was identified between the duration since vaccination and both the rate of PD onset and disease progression. Notably, we observed that antimicrobial treatments significantly influenced disease severity, consistent with the antibiotic sensitivity profile of Clostridium tetani. Conclusions: These findings support the hypothesis that tetanus vaccination and/or C. tetani eradication may reduce PD occurrence and slow its progression, suggesting promising directions for future research in PD prevention and treatment.

The Interaction of Second Trimester Prenatal Maternal Inflammation and Psychosocial Stress on Offspring Depressive Symptoms in Adolescence

BackgroundHigher second trimester (T2) prenatal maternal inflammation (PNMI) and prenatal maternal psychosocial stress have been shown to independently contribute to offspring depression risk. Similarly, interactions between sources of inflammation and maternal daily life stress in T2, previously have been associated with increased offspring adolescent depressive symptoms. We aimed to extend previous findings by examining the potential interaction between exposure to higher T2 PNMI and maternal daily life stress on offspring depressive symptoms in adolescence. Methods614 mother-offspring dyads from the Child Health and Development Studies (CHDS) had data available for T2 maternal serum interleukin (IL)-6, IL-8, IL-1 receptor antagonist (IL-1ra), and soluble TNF receptor-II (sTNF-RII), presence/absence of maternal reported daily life stress coded from interviews primarily conducted in T2, and adolescent offspring (ages 15-18 years) depressive symptoms assessed via self-report. Interactions were evaluated using hierarchical multiple regressions, controlling for maternal education. ResultsMaternal daily life stress interacted with higher serum levels of maternal T2 IL-6 and T2 IL-8 to predict adolescent offspring depressive symptoms. Higher IL-6 and higher IL-8 were only associated with offspring depression in the presence of daily life stress. Maternal T2 IL-1ra and sTNF-RII were not associated with offspring adolescent depressive symptoms. ConclusionThe interaction of the adverse impacts of maternal daily life stress and higher maternal IL-6 and/or IL-8 levels during the second trimester may contribute significantly to exacerbate depression risk in adolescent offspring. These results have potential implications for multiple targets of future early intervention and prevention research.

Answering the call for better science: an update on SAVIR’s efforts to advance antiracism in injury and violence research

In response to the call for better science that the Society for Advancement of Violence and Injury Research (SAVIR) put out 4 years ago, SAVIR established its Anti-racism Interest Group...

Potential for advances in data linkage and data science to support injury prevention research

The recent COVID-19 pandemic stimulated unprecedented linkage of datasets worldwide, and while injury is endemic rather than pandemic, there is much to be learned by the injury prevention community from...

Early preventive services in Germany-perspectives for future development

The future development of early preventive services and intervention depends on structural anchoring, the resources of the professionals working in the field, and utilization and acceptance by the target population. In order to understand the dynamics of the development, this discussion contribution first presents the contemporary historical origins of early intervention in Germany since the beginning of the 20thcentury. Further sections bring together the bodies of knowledge from various relevant sciences, in particular neuroscientific findings on the early childhood development of the brain, attachment theory, results of family and prevention research, trauma studies, and health economic models on the benefits of social interventions. From this, requirements for the further growth of the early intervention system are derived. These can be conceptually classified as a"Health in all Policies" strategy (with aparticular focus on combating child poverty) combined with interprofessional learning and collaboration, inclusive access for all children, and diversity-friendliness as characteristics of good process quality. To further develop and expand early interventions, proof of benefits must be carefully planned and implemented through long-term, interdisciplinary research programs in the aforementioned fields of knowledge through independent research funding. The complex methods for evaluating complex interventions at the individual level, subgroups, and the entire population, including health economic effects and participatory and qualitative empirical research, are partly available and should be further developed.

High shape and weight importance in adolescence relates to worse body image in the first perinatal period

Understanding whether shape and weight importance in adolescence relates to body image during the perinatal period is essential to inform eating disorder prevention and intervention research. We longitudinally examined the relationship between weight and shape importance during adolescence and body image during (1) pregnancy and (2) the first postpartum year. Participants included 554 women from the Life-course Experiences and Pregnancy (LEAP) study, a longitudinal cohort of women participating since adolescence in Project EAT (Eating and Activity in Teens and Young Adults). Participants reported shape and weight importance during adolescence (11–18 years old) for Project EAT and retrospectively recalled body image during and after their first pregnancy for the LEAP study 20 years later. Separate linear regression models estimated the longitudinal associations between adolescent shape and weight importance and pregnancy and postpartum body image. After covariate adjustment, results showed small, positive associations between adolescent shape and weight importance and pregnancy (B = 0.07 95 % CI: 0.02, 0.11) and postpartum (B = 0.10, 95 % CI: 0.06, 0.14) body image. These findings indicate that high shape and weight importance in adolescence relates to worse body image across the perinatal period. Results highlight the importance of (1) targeting the years prior to adolescence for eating disorder prevention interventions and (2) providing support and interventions for people in the perinatal period, specifically targeting body image.

The Generating Excellent Nutrition in UK Schools (GENIUS) network: working towards a more health-promoting food and nutrition system in UK schools.

School food has a major influence on children's diet quality and has the potential to reduce diet inequalities and non-communicable disease risk. Funded by the UK Prevention Research Partnership, we have established a UK school food system network. The overarching aim was to build a community to work towards a more health-promoting food and nutrition system in UK schools. The network has brought together a team from a range of disciplines, while the inclusion of non-academic users and other stakeholders, such as pupils and parents, has allowed the co-development of research priorities and questions. This network has used a combination of workshops, working groups and pump-priming projects to explore the school food system, as well as creating a systems map of the UK school food system and conducting network analysis of the newly established network. Through understanding the current food system and building network expertise, we hope to advance research and policy around food in schools. Further funding has been achieved based on these findings, working in partnership with policymakers and schools, while a Nutrition Society Special Interest Group has been established to ensure maximum engagement and future sustainability of the network. This review will describe the key findings and progress to date based on the work of the network, as well as a summary of the current literature, identification of knowledge gaps and areas of debate, according to key elements of the school food system.

Mental Health Risk and Protection Among First-Generation Latinx Immigrant Youth: A Latent Profile Analysis.

First-generation Latinx immigrant youth from the Northern Triangle (NT; El Salvador, Guatemala, and Honduras) face unique risks for experiencing stressors across the phases of migration, which could exacerbate their mental health. This study aimed to (a) identify and characterize unique latent profile groups based on response patterns to immigrant minority stress and psychosocial protective factor items and (b) examine the associations of latent profile membership with depression and anxiety symptoms among NT immigrant youth, controlling for study covariates (i.e., postmigration victimization and forced immigration-related family separation). Primary surveys assessing immigrant minority stress and psychosocial protective factors (i.e., ethnic identity importance, and family, peer, and school support) were administered (N = 172, age range = 14-21, 63% female). Latent profile analysis (Aim 1) and multiple linear regression (Aim 2) were conducted to examine the study aims. A three latent profile model was identified: (a) moderate immigrant minority stress and low psychosocial protection (weak resources), (b) moderate immigrant minority stress and moderate psychosocial protection (average resources), and (c) low immigrant minority stress and high psychosocial protection (strong resources) during postmigration. Multiple linear regression demonstrated that latent profile membership was significantly associated with mental health. Protective associations with mental health were consistently present among the strong resources group. Detrimental associations with mental health were consistently present among the weak resources group. The average resources group demonstrated both protective and detrimental associations with mental health. Postmigration victimization and forced immigration-related family separation covariates were significantly associated with mental health. Findings provide a foundation for further mental health prevention research with NT immigrant youth.

Bio-Politics and Cultural Rubric on the Prevention of Corruption of Village Funds in Wonogiri Regency

Corruption prevention in Indonesian villages is generally limited to the formal and informal dichotomy. To bridge this dichotomy, this research uses a bio-political approach and a cultural framework as a representation of the formal and informal. This research aims to explore bio-politics and cultural frameworks in preventing corruption in village funds in Sendang Village, Wonogiri. Using phenomenological qualitative research methods and triangulation, the results show that Sendang Village in Wonogiri has become a prime example of transparency and accountability prior to the recommendation from Transparency International Indonesia (TII) in 2023. Sendang Village also issued various regulations and utilized inherent and extrinsic village values to build massive corruption prevention practices. Despite the dynamics and issues arising from the simultaneous application of the bio-political and cultural frameworks, corruption prevention efforts in Sendang Village continue to be built consistently. The research has implications for bridging the dichotomy between formal and informal corruption prevention in the village. In addition, this research also provides an in-depth description and different perspectives in the research of corruption prevention at the village level.

Make the Right Call: formative evaluation for a water safety programme for adults in Western Australia.

Preventing drowning in adults is a complex, multifaceted injury prevention issue. The adult drowning rate in Australia is continuing to rise. In 2023, more than half of those who drowned were aged over 45 years. While there has been a call for robust, evidence-informed drowning prevention interventions across the life course, evidence of evaluated, drowning prevention programmes for adults is lacking. For more than a decade, drowning prevention researchers and practitioners in Western Australia (WA) have worked in partnership to design and evaluate evidence-informed programmes. This paper describes formative research to develop 'Make the Right Call' (MTRC), an adult water safety programme in WA. A staged, mixed-methods, formative evaluation was undertaken to inform the design of MTRC. The approach involved cluster analysis of coronial data 2008-2018 (n = 93), interviews with adults aged 45-64 years (n = 10) and 65 years and older (n = 15), theory mapping, survey design, content and face validity testing of a baseline questionnaire with content experts (n = 11) and a refined instrument to collect knowledge, and data on norms and water-based activity. The subsequent MTRC programme comprised a media campaign, community swimming and safety classes, lifejacket trade-in, subsidised first-aid training and community education. The results of each stage informed the design and evaluation of a new evidence-informed and theory-driven drowning prevention programme for adults aged 45 years and older, delivered by the peak drowning prevention agency in WA, Royal Life Saving Western Australia. An investment in mixed-methods research by the partnership added rigour and credibility to the programme and evaluation design. To the best of our knowledge, this is the first adult water safety programme to apply a theory-driven, evidence-informed approach to its development, implementation and evaluation. The partnership was vital in maximising and accelerating the acceptable transfer of results to enhance knowledge creation and, ultimately, the design of the MTRC drowning prevention programme.

A Cross Community Comparison of Muting in Conversations of Gendered Violence on Reddit

Gender-based violence (GBV) is an ongoing public health issue. Prevention practice and research on GBV contend with an incomplete understanding of its public health burden due to gender-exclusive definitions of GBV and inhibited survivor disclosure. Prior work in CSCW and HCI has explored sensitive disclosures and GBV conversations but excludes examination of conversation dynamics in surfacing knowledge of GBV. We used a mixed-methods approach to understand the phenomenon characterized by Muted Group Theory as a mechanism inhibiting disclosure in the context of GBV discussions on Reddit. Using an iterative process informed by literature of GBV research on cis-gender women, girls, trans, and non-binary populations, we developed comprehensive keywords to obtain, annotate, and analyze 298 posts and 10,369 comments about GBV across 7 subreddits. We found that muting faced by survivors offline, precluding reporting, is replicated on the Reddit platform. This study surfaced 5 categories of muting in discussions of GBV situated by variations in communication norms between dominant and non-dominant groups. These findings were supported by analysis of linguistic attributes that inform an Ensemble Classifier's detection of muting in conversations of GBV. The results offer that muting is a harmful occurrence in online disclosures of GBV that is mediated by existing moderation practices. This work contributes an expanded understanding of GBV conversations online, muting as a feature of those conversations, and an initial foray into detection to inform muting prevention.

The most optimal school recruitment strategies for school-based obesity prevention and health promotion research in the United States: A systematic review with Delphi study.

This systematic review with the Delphi study aimed to identify effective and resource-efficient (optimal) strategies for recruiting schools into health promotion interventions in the United States. A literature search was conducted in PubMed, Cochrane Library, and CINAHL (EBSCO). A total of 116 interventions reported in 160 articles were included. Most school-based interventions did not report data regarding school recruitment duration (81%), target school size (63%), and school recruitment strategies (78%). Further, no details were provided regarding the reasons for declining to participate despite being eligible. For the Delphi, responses from 23 researchers in school-based clinical trials were collected. A qualitative descriptive approach was used for coding responses and collapsed into higher-order categories based on school recruitment strategies. Delphi participants reported that (1) creating new or leveraging pre-existing partnerships, (2) intervention champion, (3) minimal school disruptions, (4) working with open mind/flexibility, and (5) transparent communication are the most optimal school recruitment strategies. Staff time and travel were the most frequently reported costs for implementing those strategies. The overall trend in school-based obesity prevention intervention studies illustrates the importance of a better understanding school recruitment. Improved reporting can allow researchers to budget their time and resources better and provide greater confidence in reaching their target school size.

Correlation between acute mountain sickness and body constitution of Tibetan medicine and other factors: A case–control study

ObjectiveThis study aimed to determine the correlation between the incidence of acute mountain sickness (AMS) and the body constitution of Tibetan medicine and other relevant factors to provide a reference for the prediction and prevention of AMS. MethodsA case–control study was conducted to recruit participants who experienced or did not experience AMS after entering a plateau. The data was collected through online questionnaires for convenient sampling. Demographic characteristics, body constitution, and related states or behaviors were investigated before and after entering the plateau. The participants were divided into case and control groups based on the incidence of AMS. The distributions of relevant factors were compared. Binary logistic regression analysis was used to screen for risk and protective factors. ResultsThere were 167 participants who completed the questionnaire. A total of 54 cases were excluded, and 113 participants were included, including 52 in the case group and 61 in the control group. In the case group, 37, 13, and 2 patients had mild, moderate, and severe AMS, respectively. In terms of the Tibetan medicine constitution, the case group had the highest proportion of Bad-rlung (25.0 %) and Rlung types (21.2 %), whereas the control group had the highest proportion of Bad-rlung (29.5 %) and Mkhris-bad types (24.6 %). There was no significant difference in the distribution of the constitutional types between the two groups. Insomnia or insufficient sleep within the week prior to entering the plateau and fatigue after arrival were risk factors for AMS, with odds ratios (OR) and 95 % confidence intervals (CI) of 5.012 (1.871–13.426) and 3.387 (1.393–8.236), respectively. A history of short-term plateau travel is a protective factor for AMS (OR: 0.32, 95 % CI: 0.129 to 0.792). ConclusionInsomnia or lack of sleep before ascending to a plateau and fatigue after arrival are risk factors for AMS. The Rlung constitution might be related to the incidence of AMS; however, this still needs to be verified in large-sample observational studies. The risk factors identified in this study can provide a reference for the prevention practice and research of AMS.

A qualitative study evaluating a health evidence intervention with local government for influencing healthier urban development

BackgroundUrban development impacts on population health and wellbeing through multiple mechanisms. Many issues are considered in urban development decision-making, including amount and type of housing, greenspaces, transport, neighbourhood amenity, safety and community infrastructure. Costs and financial viability are important and public health may not be prioritised. This study seeks to understand how sharing locally-relevant health evidence at key decision points can influence creation of healthier environments. MethodsThe local government of a UK city was developing a spatial regeneration framework for a 15 ha area, changing from predominantly industrial to residential use, alongside community and employment spaces and parks. An embedded researcher worked with the framework's practitioner team (October, 2020 to February, 2024) to iteratively provide locally-relevant health evidence in different formats. Sources included routine and local data, and a new health economic model developed by academics to quantify health impacts of possible development scenarios. The embedded researcher conducted semi-structured interviews with a purposive sample of practitioners involved in framework development (N=5, July, 2023 to September, 2023; average 46 min) to explore the evidence's influence on design decisions. Observational fieldnotes and meeting notes were also collected. Data were analysed using a framework approach and inductive thematic analysis. FindingsPractitioners used health evidence in three key ways: highlighting problems, e.g. noise and air pollution risks to future residents from busy roads; supporting good or aspirational designs, e.g. providing additional greenspaces; or considering competing issues, e.g. balancing housing, employment and climate resilience needs. The iterative and locally-relevant nature of the health evidence increased its value for practitioners, although health was not the main decision-making priority. InterpretationTailoring health evidence to fit local contexts, and working collaboratively to meet practitioners’ requirements for information at key decision points, can influence urban development plans to support health. This approach could be transferred to other local authorities. FundingThis work was funded as part of a multi-disciplinary research project called TRUUD (‘Tackling Root causes Upstream for Unhealthy Urban Development’). It was supported by the UK Prevention Research Partnership (award reference: MR/S037586/1), which is funded by the British Heart Foundation, Cancer Research UK, Chief Scientist Office of the Scottish Government Health and Social Care Directorates, Engineering and Physical Sciences Research Council, Economic and Social Research Council, Health and Social Care Research and Development Division (Welsh Government), Medical Research Council, National Institute for Health Research, Natural Environment Research Council, Public Health Agency (Northern Ireland), The Health Foundation and Wellcome.

Co-production of a stakeholder workshop to inform multimorbidity prevention research: working with public contributors to ask the right questions (the MELD-B experience)

BackgroundThe MELD-B project aims to identify childhood lifecourse targets for the prevention of early-onset, burdensome multimorbidity, and to characterise ‘burden’ for people living with multimorbidity. Drawing upon lived experiences and the expertise of policy and practice stakeholders can enrich the MELD-B project, inform data analysis, and contribute to meaningful and practical outputs. In pursuit of this collaborative approach, a stakeholder workshop, co-produced with PPIE members, was conducted to inform the MELD-B project. MethodsFive PPIE members with lived experience of multimorbidity co-produced the planning of the workshop, including the utilisation of a project-specific animation and the creation of imaginary persona illustrating the lifecourse concepts of multiple long term conditions. 25 stakeholders with lived experience and policy and practice expertise of the early life course, from backgrounds including integrated care boards, healthcare practitioners, academics, council employees and not-for-profit organisations attended the 2 h workshop, and contributed in an advisory capacity. The workshop aimed to identify critical time points and targets in the early lifecourse (from before pregnancy up until 18 years), for feasible and practical interventions to prevent or delay multimorbidity. The stakeholders were split into three groups each facilitated by two team members and Jamboard (an online interactive whiteboard) was used to collate ideas. Overarching themes were then identified from these Jamboards. A poll was administered at the end of the workshop giving choices to prioritise time points for interventions. FindingsA number of focus areas emerged from the workshop that will inform future research on utilising longitudinal data for the early life course prevention of multimorbidity. Overarching themes included: mental health, educational attainment and attendance, the early identification of conditions and neurodiversity, diet and nutrition, and wider family factors. Stakeholders suggested that family-targeted interventions maybe more important to prioritise in early childhood, however at secondary school age individual-focused interventions may become more significant. The poll that included four timepoints (birth, 5, 10, and 16 years) identified -by an equal split- the first three as the most important timepoints for interventions, with ages 5 and 10 years considered transitional ages at the start of primary and secondary school respectively. Later adolescence (age 16 years) was not voted as a priority compared to the other timepoints. InterpretationCo-production with PPIE experts and stakeholders needs to become an integral early part of shaping research questions around prevention of multimorbidity. Our workshop has led to the identification of multiple priority themes and important timepoints from the perspective on those engaging with families and young people in their everyday work. This informs our next step in modelling prevention interventions using routinely collected and national cohort data. FundingThis work is part of the multidisciplinary ecosystem to study lifecourse determinants and prevention of early-onset burdensome multimorbidity (MELD-B) project which is supported by the National Institute for Health Research (NIHR203988). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.

Environmental therapy: interface design strategies for color graphics to assist navigational tasks in patients with visuospatial disorders through an analytic hierarchy process based on CIE color perception.

Environmental therapy theory has been applied in the research of disease prevention, and the effectiveness of using color and graphic designs to assist patients with spatial orientation has been confirmed. Visual-spatial impairments are common symptoms associated with cognitive decline. However, the interaction and driving factors between these impairments and spatial color and graphic designs remain unclear. This paper first discusses the correlation between the characteristics of visual-spatial impairments and environmental factors and then investigates the color preferences of such patients based on the CIE 1976 color system and the Analytic Hierarchy Process (AHP). Subsequently, the paper explores spatial design strategies conducive to spatial orientation from the perspective of adaptability to pathological characteristics, utilizing case study analysis. (1) Pathological characteristics of visual-spatial impairments (such as difficulties in spatial orientation and spatial neglect) are related to environmental factors; (2) Emotional attachment factors play a key role in patients' perception of satisfaction with environmental colors; (3) Color associations have the potential to strengthen spatial memory. Additionally, interface designs with high luminance, low saturation, and clear color differentiation facilitate patients' recognition of space. This paper posits that spatial interface design is a feasible approach to assist with spatial orientation, and it achieves this through a mediating process that progresses from influencing visual stimuli to cognitive memory and then to behavioral orientation. The article provides insights into the operational feasibility of this method.