World Health Organization Well-Being Index Research Articles

Post-traumatic growth and value-directed living after acquired brain injury

ABSTRACT Traumatic events can be associated with positive change, termed “post-traumatic growth.” Existing resesarch suggests some overlap between post-traumatic growth and value-directed living. This study sought to explore the relationship between post-traumatic growth and value-directed living after acquired brain injury. Self-report questionnaires including the Posttraumatic Growth Inventory, Valued Living Questionnaire, Engaged Living Scale, Valuing Questionnaire, Hospital Anxiety and Depression Scale, World Health Organization Well-Being Index, Brief Resilience Scale, Trauma Screening Questionnaire and Glasgow Outcome Scale were posted to 317 individuals who had experienced a head injury, stroke or subarachnoid haemorrhage in the previous 3–13 years, with a hospital admission of minimum 7 days. Questionnaires were completed by 81 participants. Post-traumatic growth was significantly positively associated with two measures of value-directed living (VLQ, r = .269; VQ, r = .215). Higher levels of value-directed living were significantly associated with increased positive outcomes (wellbeing) and reduced negative outcomes (distress, post-traumatic stress symptoms). There was no significant association between post-traumatic growth and any of these outcomes. The association between post-traumatic growth and value-directed living indicates possible common underlying processes. Value-directed living appears to be a more useful concept, as it was associated with clinically relevant outcomes. It is recommended that value-directed living interventions are considered in brain injury rehabilitation.

Mental Well-being Among Workers: A Cross-national Analysis of Job Insecurity Impact on the Workforce

Drawing on 2011 and 2016 European Quality of Life Survey data from eight European countries, this paper considers the importance of subjective indicators of employment conditions in impacting mental well-being. Among employment conditions, job insecurity has been discussed as having a negative impact on mental well-being by enhancing the worker’s sense of unpredictability. The idea of losing one’s job brings with it the fear of an uncertain or unclear future and the sense of lack of agency—i.e. feeling powerless with respect to the risk of becoming unemployed. Thus, we investigate two dimensions of job insecurity, namely ‘cognitive job insecurity’ and ‘labour market insecurity’. Our dependent variable is mental health well-being, measured using the 5-item World Health Organization Well-Being Index (WHO-5), which is a self-reported health scale validated by several studies and internationally adopted for measuring psychological well-being. We apply a fixed-effects model and use a set of individual control variables to obtain parameter estimates. Moreover, to control for country-level heterogeneity, two macro-level variables are considered: the type of welfare regime and employment protection. The novelty of this research lies in disentangling the concept of precariousness from the dichotomy of open-ended/non-open-ended contract and in including in the analysis subjective categories such as self-perceived job insecurity. The findings of our study suggest that self-perceived job insecurity is negatively related to mental well-being for both permanent and temporary workers, making this stressor an important feature in predicting the emergence of psychological distress (i.e. feelings of anxiety or depression) among the workforce.

The mental health of health care workers in Oman during the COVID-19 pandemic.

Background:COVID-19 disease is one of the most destructive events that humanity has witnessed in the 21st century. It has impacted all aspects of life and all segments of populations, including already vulnerable health care providers.Aims:This study sought to detect the prevalence of mental health issues in sample of physicians and nurses working in several health facilities in Oman.Method:We gauged the mental health conditions of 509 physicians (38.1%) and nurses (61.9 %) using the Perceived Stress Scale, Generalized Anxiety Disorder Scale and World Health Organization Well-Being Index.Results:The study revealed a high prevalence of stress, anxiety and poor psychological well-being, especially among females, young health care workers and those who interacted with known or suspected COVID-19 patients.Conclusion:The outcomes of this study support the handful of studies published during this global health crisis that have found that the mental health of health care workers has been harshly affected and predicted that it will continue, to various degrees, to be affected in the foreseeable future. The results of this study highlight the urgency of providing administrative and psychological support as well as current and accurate information on COVID-19 to health care workers.

Patient-reported well-being: psychometric properties of the world health organization well-being index in specialised community mental health settings

The Five-item World Health Organization Well-being Index (WHO-5) is an increasingly used measure of generic well-being, but there is no evidence to support whether outpatients consider the questionnaire valuable. As the WHO-5 has not yet been psychometrically evaluated in specialised community mental health settings, an evaluation of its validity seems warranted. The aim of this cross-sectional study was to examine the psychometric properties of the WHO-5 in this type of setting. Data was collected from an outpatient center (N = 191 adults). Results indicate that the questionnaire was feasible to administer (n = 57 patients), it reported low mean Burden-scores and high Positive-Value scores, and had excellent internal consistency. No evidence of floor or ceiling effects was found. Results supported the unidimensional structure of the questionnaire. Significant differences were found concerning patients’ diagnoses, with patients with schizophrenia diagnoses reporting higher scores and patients with depression and personality disorders reporting lower ones. When comparing the WHO-5 total score and patients’ attitudes toward medication, negative correlations were observed with psychological reactance, as well as positive aspects of psychiatric medication. The present study demonstrates that the WHO-5 is feasible to administer and has robust psychometric properties in specialised community mental health centres.

Psychometric properties of the Five-item World Health Organization Well-being Index used in mental health services: Protocol for a systematic review.

To synthesize evidence of the psychometric properties of the Five-item World Health Organization Well-being Index in mental health settings and critically appraise the methodologies of the included studies. Protocol for a systematic psychometric review. The review protocol has been registered in the International Prospective Register for Systematic Reviews. The bibliographic databases MEDLINE, Embase, PsycINFO, CINAHL, Cochrane Library, and Web of Science will be searched for relevant studies. The psychometric properties of each study will be evaluated according to the Consensus-based Standards for the Selection of Health Measurements Instruments. The results of our psychometric review will synthesize the psychometric properties of the Five-item World Health Organization Well-being Index in mental health settings and identify possible gaps in the literature regarding methodological quality and its reliability, validity, and responsiveness to change. The evaluation of patient well-being is important, and the Five-item World Health Organization Well-being Index is an increasingly used patient-reported outcome measure. It is simple to collect, free to use, and consists of five questions using positive health statements. Although the number of studies assessing the validity, reliability, and responsiveness of the questionnaire is increasing worldwide, there is a need to summarize the existing evidence of the psychometric properties of this questionnaire. The proposed study's findings will contribute to future research recommendations and help midwives and nurses in different settings pick an effective, appropriate questionnaire to evaluate patient well-being.

Impact of the talent development environment on the wellbeing and burnout of Caribbean youth track and field athletes

This study examined the perceived talent development environment (TDE) of youth track and field athletes within the Caribbean region and explores the relationship with their subjective wellbeing and burnout levels. A sample of 400 Caribbean youth track and field athletes (male = 198, and female = 202; age 13–20 years) participated in this cross-sectional study. Athletes responded to a survey which included the Talent Development Environment Questionnaire (TDEQ-5), the World Health Organization Wellbeing Index (WHO-5) and the Athlete Burnout Questionnaire (ABQ). Structural equation modelling showed that a positive and supportive TDE was associated with better athlete wellbeing and lower athlete burnout. Moreover, gender and hours of training moderated relationships of athletes’ perceptions of their development environment with wellbeing and burnout levels respectively. Furthermore, there was a positive association between the support network and athlete wellbeing, while holistic quality preparation was negatively associated with athlete burnout. Development environments perceived as supportive and geared towards a holistic athlete-centred approach were associated with better athlete wellbeing and lower burnout.

Pilot study on subjectively and objectively measurable stress reduction in the daily routine of auniversity anesthesia department by an intervention program according to mindfulness-based stress reduction

Chronic stress and high workload in physicians can lead to loss of interest, emotional exhaustion and finally in burnout syndrome. This can cause serious consequences not only for the physicians personally and their own health by developing extensive health impairments, e.g. depression, suicide, substance abuse and poor self-care but also for patient care, reflected in an increase of medical errors, longer recovery times, lower care quality and consequently lower patient satisfaction. Additionally, it can also have negative effects on the healthcare system by reduced productivity, increased physician turnover and thereby higher costs. This pilot study investigated brief interventions inspired by mindfulness-based stress reduction (MBSR) combined with short daily meditation exercises in the everyday work of anesthetists at auniversity hospital. Secondly, whether this program increases the development of coping mechanisms for stress and improves participants' resilience and health status. The pilot study was designed as amonocenter prospective interventional study with four different points of measurement. Subjective and objective stress parameters were measured directly before (t0) and after (t1) the intervention as well as 3 (t2) and 6 (t3) months after end of the intervention. Measurements took place during work time and at the workplace. The intervention was based on the classical MBSR including short daily exercises and lasted for 6 weeks with sessions lasting 1- 1.5 h and an additional 20 min of daily mediation exercises. The subjective parameters were based on validated questionnaires, such as the World Health Organization (WHO) well-being index (WHO-5), resilience scale (RS-11), Maslach burnout inventory (MBI-22) and perceived stress scale (PSS-10). For objective parameters heart rate variability (HRV) was evaluated during rest and after exposure to physical exercise and hair cortisol concentrations (HCC) in a 1.5 cm length of a hair, which represents the equivalent of a6-week period. Data from 27subjects could be analyzed. Between t3 and t0 asignificant improvement of resilience was detected as apositive personality trait measured by RS-11 with alarge effect size (p = 0.013; r = 0.59) as well as asignificant reduction of burnout symptoms (MBI-22) also with alarge effect size (p = 0.019; r = 0.57). Furthermore, asignificant decrease was found in well-being (WHO-5) between t2 and t0 (p = 0.003, r = 0.67) and between t1 and t0 (p = 0.001, r = 0.71). The objective parameters did not show any significant differences between the examinations. An MBSR-based intervention in combination with short exercises during and after work can be implemented in daily work of anesthetists at auniversity hospital. Furthermore, there was clear evidence that the intervention program increased resilience and reduced burnout symptoms for up to 6 months. These findings are in line with the literature that MBSR reduces risk of burnout symptoms. The decrease in well-being might be biased by ahigh amount of socially accepted answers at the beginning of the study (t0).

Sleep quality among health care workers during the COVID-19 pandemic.

Citation:Badahdah AM, Khamis F, Al Mahyijari N. Sleep quality among health care workers during the COVID-19 pandemic. J Clin Sleep Med. 2020;16(9):1635.

Association Between Presenteeism/Absenteeism and Well-being Among Korean Workers

Absenteeism and presenteeism refer to loss in productivity related to sick leave and illness, respectively, which affect physical and mental health. We examined the association between presenteeism/absenteeism and level of well-being among Korean workers. We analyzed data from 44,019 participants who completed the 2017 Korean Working Conditions Survey. The World Health Organization Well-Being Index (WHO-5) was used to screen the well-being level. We examined the association between presenteeism/absenteeism and level of well-being using multiple linear regression. WHO-5 scores were lower among workers who experienced presenteeism or absenteeism than those who experienced neither (presenteeism: β = -1.011, P < 0.0001, absenteeism: β = -0.403, P < 0.0001). Presenteeism and absenteeism were associated with lower level of well-being. We suggest that their management is important for maintaining the health of Koreans.

Determinants of childbirth self-efficacy among multi-ethnic pregnant women in Singapore: A structural equation modelling approach

ObjectiveThis study aims to examine the relationships among sociodemographic and obstetric factors, fear of childbirth, psychosocial well-being and childbirth self-efficacy using a structural equation modelling approach. DesignIt adopted an exploratory cross-sectional study among 205 multi-ethnic pregnant women in Singapore. We used structural equation modelling to examine our hypothetical model, which integrates the concepts of Bandura's self-efficacy theory and previous literature reviews. The Childbirth Self-Efficacy Inventory, the Childbirth Attitudes Questionnaire and the World Health Organisation (Five) Well-Being Index were employed to measure childbirth self-efficacy, fear of childbirth and psychological well-being, respectively. FindingsThe structural equation model showed that multiparous women (β = 0. 24, P < 0.01), with better psychological well-being (β = 0.26, P < 0.001) were more likely to have higher childbirth self-efficacy; whereas Chinese women (β = -0.32, P < 0.01) with previous caesarean section (β = -0.17, P < 0.05) and higher fear of childbirth (β = -0.30, P < 0.001) were more likely to have lower childbirth self-efficacy. The structural equation model had good fit with the data (incremental fit index = 0.925, Tucker-Lewis index = 0.911, comparative fit index = 0.923, and root means square error of approximation = 0.048). ConclusionFindings of this study highlight that ethnic Chinese, multiparous women, previous caesarean section, psychological well-being and fear of childbirth were determinants of childbirth self-efficacy among pregnant women in Singapore. Enhancement of self-efficacy can increase coping ability and reduce fear of childbirth and thus promote normal childbirth. Future self-efficacy enhancing interventions among pregnant women should be tailored by age, ethnicity, parity and prior modes of birth.

The Validity of the Danish Version of the Canadian Occupational Performance Measure.

Purpose To establish the construct validity of the Danish version of the Canadian Occupational Performance Measure (COPM). Methods A cross-sectional study was performed in two settings, a regional hospital and a rehabilitation centre in a community. Including adult clients with a variety of diagnoses, we assessed construct validity by correlating the COPM to the Occupational Self-Assessment (OSA), the five-item World Health Organization Well-Being Index (WHO-5), and the EuroQol-five domain-five level questionnaire (EQ-5D-5L). Further examination of the comparability of the OSA and the COPM was performed in two ways. First, an interrater agreement of the theoretical correlation of the 21 OSA items and the three areas of the COPM was conducted. Secondly, we examined the compliance between the prioritized occupational performance issues (OPIs) and items of the OSA prioritized for change. Results The study included a total sample of 112 participants with more than half of the participants (56%) recruited from the hospital. 109 participants had measurements for both COPM and OSA (44% males) with a mean age of 64.7 years (range 16-96 years). All correlations, between the COPM and the OSA, the WHO-5, and the EQ-5D-5L, were low or negligible (r < 0.50). Manual examination confirmed a difference in the constructs of the OSA and the COPM. This was demonstrated by a negligible interrater agreement between the items of the OSA and the areas of the COPM, and differences in the prioritized OPIs and OSA items, even if there were some resemblances, were found. Conclusions This study suggests that the construct of the COPM provides data different to those obtained with the standardized measurements included for comparison. The present study supports the assumption that the COPM can detect unique OPIs that clients want to do, need to do, must do, or are not satisfied with the way they do.

The Language of Positive Mental Health: Findings From a Sample of Russian Facebook Users

Positive mental health is considered to be a significant predictor of health and longevity; however, our understanding of the ways in which this important characteristic is represented in users’ behavior on social networking sites is limited. The goal of this study was to explore associations between positive mental health and language used in online communication in a large sample of Russian Facebook users. The five-item World Health Organization Well-Being Index (WHO-5) was used as a self-report measure of well-being. Morphological, sentiment, and semantic analyses were performed for linguistic data. The total of 6,724 participants completed the questionnaire and linguistic data were available for 1,972. Participants’ mean age was 45.7 years ( SD = 11.6 years); 73.4% were female. The dataset included 15,281 posts, with an average of 7.67 ( SD = 5.69) posts per participant. Mean WHO-5 score was 60.0 ( SD = 19.1), with female participants exhibiting lower scores. Use of negative sentiment words and impersonal predicates (“should statements”) demonstrated an inverse association with the WHO-5 scores. No significant correlation was found between the use of positive sentiment words and the WHO-5 scores. This study expands current understanding of the association between positive mental health and language use in online communication by employing data from a non-Western sample.

Traumatic experiences, ICD‐11 PTSD, ICD‐11 complex PTSD, and the overlap with ICD‐10 diagnoses

ObjectivesThis study investigated the frequency of traumatic experiences, prevalence rates of ICD‐11 post‐traumatic stress disorder (PTSD) and complex PTSD (CPTSD), and overlap with ICD‐10 classified disorders in outpatient psychiatry.MethodOverall, 165 Danish psychiatric outpatients answered the International Trauma Questionnaire, the Life Event Checklist, and the World Health Organization Well‐being Index. ICD‐10 diagnoses were extracted from the hospital record. Chi‐square analysis, t‐tests, and conditional probability analysis were used for statistical analysis.ResultsNearly, all patients (94%) had experienced at least one traumatic event. CPTSD (36%) was more common than PTSD (8%) and had considerable overlap with ICD‐10 affective, anxiety, PTSD, personality, adjustment and stress‐reaction disorders, and behavioural and emotional disorders with onset usually occurring in childhood and adolescence. ICD‐11 PTSD overlapped with ICD‐10 anxiety, PTSD, adjustment and stress‐reaction disorders, and behavioural and emotional disorders with onset usually occurring in childhood and adolescence. A subgroup of patients with ICD‐10 PTSD (23%) did not meet criteria for ICD‐11 PTSD or CPTSD.ConclusionTraumatic experiences are common. ICD‐11 CPTSD is a highly prevalent disorder in psychiatric outpatients. One quarter with ICD‐10 PTSD did not meet criteria for either ICD‐11 PTSD or CPTSD. PTSD and CPTSD had considerable overlap with ICD‐10 disorders.

Mental wellbeing among Hispanic female domestic cleaners

BackgroundThe purpose of this study was to examine the mental wellbeing of self-employed, Hispanic female domestic cleaners in San Antonio, Texas.MethodsWe conducted a cross-sectional pilot study and administered a short questionnaire to 56 participants. Mental wellbeing was assessed using The World Health Organization Well-Being Index (WHO-5). We calculated the age-adjusted prevalence of poor mental wellbeing, both overall and stratified by socioeconomic, neighborhood, and health characteristics.ResultsAlmost half of the participants screened positive for poor mental wellbeing (47.3%) with a mean WHO-5 score of 68.9 [standard error (SE) = 3.1]. We observed a high prevalence of poor mental wellbeing among participants with less than a high school education (56.0%), who worked less than 30 h per week (57.0%) and who sometimes or always felt unsafe at her cleaning job (69.1%).ConclusionsFemale domestic cleaners, particularly those who work in the informal sector, are an overburdened and understudied population. This is particularly true regarding their mental wellbeing, which has largely been considered as an afterthought in epidemiologic studies of cleaning workers in general. Our results suggest that this group of domestic cleaners faces several psychosocial stressors, both in and outside of the workplace, and may have a high risk of poor mental health outcomes.

Experiences of participation in supervised group exercise among pregnant women with depression or low psychological well-being: A qualitative descriptive study

ObjectiveTo explore experiences with supervised group exercise during pregnancy in women with depression or low psychological well-being. DesignA qualitative descriptive study based on semi-structured, individual, in-depth interviews analyzed by means of thematic analysis. SettingThe Department of Obstetrics, Rigshospitalet, Copenhagen University Hospital, Denmark. ParticipantsThrough a purposeful, criterion-based sampling strategy, women with a current diagnosis of depression with prescribed antidepressant and/or a score ≤50 on the five-item World Health Organization Well-being Index were included. The women were recruited from a randomized controlled trial on the effects of supervised group exercise (the EWE study) and participated in the exercise program during the period 26 January 2017–8 March 2018. A total of 282 pregnant women participated in the RCT, of which 143 women were allocated to the intervention group. Of these, 27 women were eligible and were invited; 19 accepted the invitation and were included in the current qualitative descriptive study. Diversity of age, parity, level of education and employment status was seen in the sample. The average time from completing the exercise program to conducting the interview was 6.5 months, ranging from 1 week to 13 months. InterventionThe participants were offered an in-hospital supervised group exercise program twice weekly for 12 weeks from 17–22 weeks gestation in addition to standard antenatal care. Measurements and findingsQualitative thematic analysis of the interviews resulted in the identification of the overarching theme: Vulnerable yet strong. This theme was comprised from three main themes (1) From judging the body to feeling it, (2) A “we” is created, and (3) Taking responsibility and succeeding, together with nine sub-themes. Key conclusionsThe supervised group exercise intervention provided experiences of peer support and increased body awareness, which contributed to an experience of improved psychological equilibrium and preparedness for the coming birth and motherhood. The findings suggest that participation in group-based supervised exercise during pregnancy in women with depression or low psychological well-being contributes to psychological resilience, which may persist as a positive influence postpartum and beyond. Implications for practiceIn-hospital supervised group-based exercise can be a safe means to health promotion in a secure environment that supports pregnant women's physical and mental well-being while also preparing them for birth and the transition to motherhood.

Disease Burden of Patients With Osteoarthritis: Results of a Cross-Sectional Survey Linked to Claims Data.

Osteoarthritis (OA) is a major reason for chronic pain, stiffness, and functional limitation. This study was undertaken to analyze factors associated with the burden of OA, taking the pattern of joint involvement into account. From a random sample of 8,995 patients with OA (International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, German Modification codes M15 [polyarticular], M16 [hip], or M17 [knee]) from a German statutory health insurance database, 3,564 patients completed a survey including the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Patients with knee, hip, concomitant hip and knee, or polyarticular manifestation were compared concerning pain, stiffness, function, and impact on work and personal life. Data were linked to dispensation records. The association of age, sex, body mass index (BMI), symptom duration, and the World Health Organization-5 Well-Being Index (WHO-5) with WOMAC results was assessed in multiple linear regression models. Patients with knee (n = 1,448), hip (n = 959), hip and knee (n = 399), or polyarthritic (n = 758) OA were included. Concomitant hip and knee OA was accompanied by the highest WOMAC values (mean 44), frequent impairment of personal life (75%), and the highest use of analgesics (52% nonsteroidal antiinflammatory drugs, 22% opioids, and 37% others). In the regression analyses, BMI per 5 units and WHO-5 per 10% worsening were associated with an increase in WOMAC values of 4-5 points, irrespective of the joint manifestations. Disease burden is high in patients with concomitant hip and knee OA and is connected with frequent prescription of analgesics. Involvement of several joints, BMI, and depressive symptoms need to be considered when using the WOMAC as an outcome instrument.

Performance Measures for Short-Term Cardiac Rehabilitation in Patients of Working Age: Results of the Prospective Observational Multicenter Registry OutCaRe

ObjectiveTo determine immediate performance measures for short-term, multicomponent cardiac rehabilitation (CR) in clinical routine in patients of working age, taking into account cardiovascular risk factors, physical performance, social medicine, and subjective health parameters and to explore the underlying dimensionality. DesignProspective observational multicenter register study in 12 rehabilitation centers throughout Germany. SettingComprehensive 3-week CR. ParticipantsPatients (N=1586) ≤65 years of age (mean 53.8±7.3y, 77.1% men) in CR (May 2017-May 2018). InterventionsNot applicable. Main Outcome MeasuresFeasibility, defined by data availability for ≥85% of patients (CR admission and discharge), and modifiability based on pre-post comparison (statistical significance, with P value<.01; standardized effect size≥.35; change by ≥5% points in categorical variables). In addition, latent factors were identified using an exploratory factor analysis (EFA). ResultsBased on feasibility and modifiability criteria, smoking behavior, lifestyle change behavior, blood pressure, endurance training load, depression in Patient Health Questionnaire-9 (PHQ-9), the 5-item World Health Organization Well-Being Index (WHO-5), physical and mental health and pain scale of the indicators of rehabilitation status-24 (IRES-24), and self-assessed health prognosis proved to be suitable performance measures. As a result of the EFA, 2 solid factors were identified: (1) subjective mental health including PHQ-9, WHO-5, mental health (IRES-24), mental quality of life, and anxiety and (2) physical health including physical quality of life, physical health and pain scale of IRES-24, and self-assessed occupational prognosis. A third factor represents the blood pressure. ConclusionsWe provide a small set of performance measures, that are essentially based on 3 latent factors (subjective mental health, physical health, blood pressure). These performance measures can represent immediate success of comprehensive CR and be applied easily in clinical practice.

Study protocol of the Healthy High School study: a school-based intervention to improve well-being among high school students in Denmark

BackgroundThe prevalence of low well-being, perceived stress and unhealthy behaviours is high among high school students, but few interventions have addressed these problems. The aim of this paper is to present a study protocol of a cluster randomised controlled trial evaluating the Healthy High School (HHS) intervention programme. The intervention programme is designed to improve well-being (primary outcome) by preventing 1) stress and promoting 2) sleep, 3) sense of community, 4) physical activity (PA) and 5) regular and healthy meals among high school students in Denmark.MethodsThe development of the HHS study was guided by the Intervention Mapping protocol. The intervention comprises four components: 1) a teaching material, 2) a smartphone app, 3) a catalogue focusing on environmental changes, and 4) a peer-led innovation workshop aiming at inspiring students to initiate and participate in various movement activities. The HHS study employs a cluster-randomised controlled trial design. Thirty-one high schools across Denmark were randomly allocated to intervention (16 schools) or control (15 schools) groups. The study included all first-year students (~ 16 years of age) (n = 5976 students). Timeline: Intervention: August 2016 – June 2017. Collection of questionnaire data: Baseline (August 2016), 1st follow-up (May 2017) and 2nd follow-up (April 2018). All students were invited to participate in a monthly sub-study about perceived stress using text messages for data collection (September 2016 – June 2017). PA was objectively assessed among a sub-sample of students using accelerometers (Axivity, AX3) in August 2016 and May 2017. Primary outcome measures: Student well-being measured by the Cantril Ladder and the five item World Health Organisation Well-being Index (individual level outcomes). Secondary outcome measures: Stress (10-item Perceived Stress Scale), sleep (quantity and quality), PA (hours of moderate-to-vigorous PA per week, hours of daily sedentary time and average daily PA), meal habits (daily intake of breakfast, lunch, snacks and water), and strong sense of community in class and at school, respectively (individual level outcomes). The study encompasses process and effect evaluation as well as health economic analyses.Trial registrationISRCTN ISRCTN43284296, 28 April 2017, retrospectively registered.

Clinical and psychological characteristics of liraglutide treatment among patients with type 2 diabetes.

Aim:This study aimed to evaluate the glycemic control, quality of life (QOL), and sleep quality in type 2 diabetes mellitus (T2DM) patients who are treated with liraglutide and to investigate whether the QOL and sleep quality were correlated with the glycemic control of this population.Methods:A cross-sectional study was carried out on T2DM patients who were treated with liraglutide. Data on body weight and glycemic control were recorded while the QOL and sleep quality were assessed using the Short-Form Health Survey (SF-36), the 5-item World Health Organization Well-Being Index (WHO-5), and the Pittsburgh Sleep Quality Index (PSQI) questionnaires.Results:Eighty-four T2DM patients who initiated liraglutide with a mean age of 46.7 years were included in the study. The mean hemoglobin A1c (HbA1c) was 7.76% (standard deviation [SD] =0.62), and about 88.1% of patients had HbA1c > 7%. The PSQI score showed not too bad sleep quality (mean 4.3 ± 1.9). The mean WHO-5 score of the study population showed a “moderate” QOL (12.4 ± 3). Patients had lowest SF-36 score (mean = 52.3) in the subscale of “energy and fatigue.” There was a significant positive correlation between HbA1C and the “energy and fatigue” (r = 0.232, P = 0.034) but not with the other subscales.Conclusion:Patients with T2DM taking liraglutide have moderate sleep difficulty and QOL score. Nonetheless, none of these outcomes was significantly correlated with glycemic control. Further well-designed studies with long-term follow-up and larger population sizes are needed to confirm our findings.

Residential greenness, air pollution and psychological well-being among urban residents in Guangzhou, China

China’s rapid urbanization has led to an increasing level of exposure to air pollution and a decreasing level of exposure to vegetation among urban populations. Both trends may pose threats to psychological well-being. Previous studies on the interrelationships among greenness, air pollution and psychological well-being rely on exposure measures from remote sensing data, which may fail to accurately capture how people perceive vegetation on the ground. To address this research gap, this study aimed to explore relationships among neighbourhood greenness, air pollution exposure and psychological well-being, using survey data on 1029 adults residing in 35 neighbourhoods in Guangzhou, China. We used the Normalized Difference Vegetation Index (NDVI) and streetscape greenery (SVG) to assess greenery exposure at the neighbourhood level, and we distinguished between trees (SVG-tree) and grasses (SVG-grass) when generating streetscape greenery exposure metrics. We used two objective (PM2.5 and NO2 concentrations) measures and one subjective (perceived air pollution) measure to quantify air pollution exposure. We quantified psychological well-being using the World Health Organization Well-Being Index (WHO-5). Results from multilevel structural equation models (SEM) showed that, for parallel mediation models, while the association between SVG-grass and psychological well-being was completely mediated by perceived air pollution and NO2, the relationship between SVG-tree and psychological well-being was completely mediated by ambient PM2.5, NO2 and perceived air pollution. None of three air pollution indicators mediated the association between psychological well-being and NDVI. For serial mediation models, measures of air pollution did not mediate the relationship between NDVI and psychological well-being. While the linkage between SVG-grass and psychological well-being scores was partially mediated by NO2-perceived air pollution, SVG-tree was partially mediated by both ambient PM2.5-perceived air pollution and NO2-perceived air pollution. Our results suggest that street trees may be more related to lower air pollution levels and better mental health than grasses are.