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Maaß L, Zeeb H, Rothgang H. International perspectives on measuring national digital public health system maturity through a multidisciplinary Delphi study. NPJ Digit Med 2024; 7:92. [PMID: 38609458 PMCID: PMC11014962 DOI: 10.1038/s41746-024-01078-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 03/14/2024] [Indexed: 04/14/2024] Open
Abstract
Unlocking the full potential of digital public health (DiPH) systems requires a comprehensive tool to assess their maturity. While the World Health Organization and the International Telecommunication Union released a toolkit in 2012 covering various aspects of digitalizing national healthcare systems, a holistic maturity assessment tool has been lacking ever since. To bridge this gap, we conducted a pioneering Delphi study, to which 54 experts from diverse continents and academic fields actively contributed to at least one of three rounds. 54 experts participated in developing and rating multidisciplinary quality indicators to measure the maturity of national digital public health systems. Participants established consensus on these indicators with a threshold of 70% agreement on indicator importance. Eventually, 96 indicators were identified and agreed upon by experts. Notably, 48% of these indicators were found to align with existing validated tools, highlighting their relevance and reliability. However, further investigation is required to assess the suitability and applicability of all the suggestions put forward by our participants. Nevertheless, this Delphi study is an essential initial stride toward a comprehensive measurement tool for DiPH system maturity. By working towards a standardized assessment of DiPH system maturity, we aim to empower decision-makers to make informed choices, optimize resource allocation, and drive innovation in healthcare delivery. The results of this study mark a significant milestone in advancing DiPH on a global scale.
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Affiliation(s)
- Laura Maaß
- University of Bremen, SOCIUM Research Center on Inequality and Social Policy, Department Health, Long-Term Care and Pensions, Bremen, Germany.
- Leibniz ScienceCampus Digital Public Health Bremen, Bremen, Germany.
| | - Hajo Zeeb
- Leibniz ScienceCampus Digital Public Health Bremen, Bremen, Germany
- Leibniz Institute for Prevention Research and Epidemiology-BIPS, Department Prevention and Evaluation, Bremen, Germany
| | - Heinz Rothgang
- University of Bremen, SOCIUM Research Center on Inequality and Social Policy, Department Health, Long-Term Care and Pensions, Bremen, Germany
- Leibniz ScienceCampus Digital Public Health Bremen, Bremen, Germany
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Adjei NK, Samkange-Zeeb F, Boakye D, Saleem M, Christianson L, Kebede MM, Heise TL, Brand T, Esan OB, Taylor-Robinson DC, Agyemang C, Zeeb H. Ethnic differences in metabolic syndrome in high-income countries: A systematic review and meta-analysis. Rev Endocr Metab Disord 2024:10.1007/s11154-024-09879-9. [PMID: 38598068 DOI: 10.1007/s11154-024-09879-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/23/2024] [Indexed: 04/11/2024]
Abstract
This review aimed to systematically quantify the differences in Metabolic Syndrome (MetS) prevalence across various ethnic groups in high-income countries by sex, and to evaluate the overall prevalence trends from 1996 to 2022. We conducted a systematic literature review using MEDLINE, Web of Science Core Collection, CINAHL, and the Cochrane Library, focusing on studies about MetS prevalence among ethnic groups in high-income countries. We pooled 23 studies that used NCEP-ATP III criteria and included 147,756 healthy participants aged 18 and above. We calculated pooled prevalence estimates and 95% confidence intervals (CI) using both fixed-effect and random-effect intercept logistic regression models. Data were analysed for 3 periods: 1996-2005, 2006-2009, and 2010-2021. The pooled prevalence of MetS in high-income countries, based on the NCEP-ATP III criteria, was 27.4% over the studied period, showing an increase from 24.2% in 1996-2005 to 31.9% in 2010-2021, with men and women having similar rates. When stratified by ethnicity and sex, ethnic minority women experienced the highest prevalence at 31.7%, while ethnic majority women had the lowest at 22.7%. Notably, MetS was more prevalent in ethnic minority women than men. Among ethnic minorities, women had a higher prevalence of MetS than men, and the difference was highest in Asians (about 15 percentage points). Among women, the prevalence of MetS was highest in Asians (41.2%) and lowest in Blacks/Africans (26.7%). Among men, it was highest in indigenous minority groups (34.3%) and lowest among in Blacks/Africans (19.8%). MetS is increasing at an alarming rate in high-income countries, particularly among ethnic minority women. The burden of MetS could be effectively reduced by tailoring interventions according to ethnic variations and risk profiles.
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Affiliation(s)
- Nicholas Kofi Adjei
- Department of Public Health, Policy and Systems, University of Liverpool, Waterhouse Building 2nd Floor Block F, Liverpool, L69 3GL, UK.
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany.
- Health Sciences Bremen, University of Bremen, Bremen, Germany.
| | | | - Daniel Boakye
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Maham Saleem
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Lara Christianson
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | | | - Thomas L Heise
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Tilman Brand
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Oluwaseun B Esan
- Department of Public Health, Policy and Systems, University of Liverpool, Waterhouse Building 2nd Floor Block F, Liverpool, L69 3GL, UK
| | - David C Taylor-Robinson
- Department of Public Health, Policy and Systems, University of Liverpool, Waterhouse Building 2nd Floor Block F, Liverpool, L69 3GL, UK
| | - Charles Agyemang
- Department of Public Health, Amsterdam Public Health Research Institute, Academic Medical Center, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Hajo Zeeb
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
- Health Sciences Bremen, University of Bremen, Bremen, Germany
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Beckert J, Zeeb H, De Santis KK. Disaster Preparedness Evaluation Tool (DPET): Adaptation and psychometric evaluation for nurses in Germany. Pflege 2024; 37:79-87. [PMID: 37905419 DOI: 10.1024/1012-5302/a000964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
Background: The Disaster Preparedness Evaluation Tool (DPET) with 47 items was developed to assess the disaster preparedness level among nurses in the USA. Aim: This study aimed (1) to adapt and validate the DPET for the nursing context in Germany and (2) to perform its psychometric evaluation. Methods: The DPET items were translated to German (DPET-GER). Adaptation was performed to identify irrelevant items and content validity was estimated using the scale-level content validity index (S-CVI) based on expert ratings. Psychometric evaluation was performed based on data from an online survey of 317 nurses. Internal consistency (Cronbach's alpha) and factor structure were assessed with an exploratory factor analysis. Results: Ten items were unanimously rated as irrelevant by four experts and removed. Based on ratings by further seven experts, the content validity of DPET-GER was low for all 37 items (S-CVI of 0.53) or moderate for 19 items rated as relevant (S-CVI of 0.74). The internal consistency of DPET-GER was high (Cronbach's alpha of 0.94) and 37 items were reduced to five factors that explain 55% of variance in all items. Conclusions: The DPET-GER has acceptable psychometric properties (internal consistency and factor structure). However, low content validity indicates that further adaptation of the DPET-GER is required before it could be used to assess disaster preparedness among nurses in Germany. More research is also needed to contextualize the construct of disaster preparedness.
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Affiliation(s)
- Joachim Beckert
- Institute of Health and Nursing Science, Charité - Universitätsmedizin Berlin, Germany
| | - Hajo Zeeb
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology (BIPS), Bremen, Germany
| | - Karina Karolina De Santis
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology (BIPS), Bremen, Germany
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Wiessner C, Licaj S, Klein J, Bohn B, Brand T, Castell S, Führer A, Harth V, Heier M, Heise JK, Holleczek B, Jaskulski S, Jochem C, Koch-Gallenkamp L, Krist L, Leitzmann M, Lieb W, Meinke-Franze C, Mikolajczyk R, Moreno Velásquez I, Obi N, Pischon T, Schipf S, Thierry S, Willich SN, Zeeb H, Becher H. Health Service Use Among Migrants in the German National Cohort-The Role of Birth Region and Language Skills. Int J Public Health 2024; 69:1606377. [PMID: 38510525 PMCID: PMC10952844 DOI: 10.3389/ijph.2024.1606377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 02/14/2024] [Indexed: 03/22/2024] Open
Abstract
Objective: To compare health service use (HSU) between migrants and non-migrants in Germany. Methods: Using data from the population-based German National Cohort (NAKO), we compared the HSU of general practitioners, medical specialists, and psychologists/psychiatrists between six migrant groups of different origins with the utilization of non-migrants. A latent profile analysis (LPA) with a subsequent multinomial regression analysis was conducted to characterize the HSU of different groups. Additionally, separate regression models were calculated. Both analyses aimed to estimate the direct effect of migration background on HSU. Results: In the LPA, the migrant groups showed no relevant differences compared to non-migrants regarding HSU. In separate analyses, general practitioners and medical specialists were used comparably to slightly more often by first-generation migrants from Eastern Europe, Turkey, and resettlers. In contrast, the use of psychologists/psychiatrists was substantially lower among those groups. Second-generation migrants and migrants from Western countries showed no differences in their HSU compared to non-migrants. Conclusion: We observed a low mental HSU among specific migrant groups in Germany. This indicates the existence of barriers among those groups that need to be addressed.
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Affiliation(s)
- Christian Wiessner
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sara Licaj
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jens Klein
- Institute of Medical Sociology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Tilman Brand
- Leibniz Institute for Prevention Research and Epidemiology—BIPS, Bremen, Germany
| | - Stefanie Castell
- Department of Epidemiology, Helmholtz Center for Infection Research, Brunswick, Germany
| | - Amand Führer
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Interdisciplinary Center for Health Sciences, Medical School of the Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Volker Harth
- Institute for Occupational and Maritime Medicine Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Margit Heier
- Institute of Epidemiology, Helmholtz Zentrum München—German Research Center for Environmental Health (GmbH), Neuherberg, Germany
- KORA Study Centre, University Hospital Augsburg, Augsburg, Germany
| | - Jana-Kristin Heise
- Department of Epidemiology, Helmholtz Center for Infection Research, Brunswick, Germany
| | | | - Stefanie Jaskulski
- Institute for Prevention and Cancer Epidemiology, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Carmen Jochem
- Department of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany
| | - Lena Koch-Gallenkamp
- Department of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Lilian Krist
- Institute of Social Medicine, Epidemiology and Health Economics, Charité University Medicine Berlin, Berlin, Germany
| | - Michael Leitzmann
- Department of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany
| | - Wolfgang Lieb
- Institute of Epidemiology, Faculty of Medicine, University of Kiel, Kiel, Germany
| | - Claudia Meinke-Franze
- Institute for Community Medicine, University Medical Center Greifswald, Greifswald, Germany
| | - Rafael Mikolajczyk
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Interdisciplinary Center for Health Sciences, Medical School of the Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Ilais Moreno Velásquez
- Max-Delbrueck-Center for Molecular Medicine in the Helmholtz Association (MDC), Molecular Epidemiology Research Group, Berlin, Germany
| | - Nadia Obi
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Institute for Occupational and Maritime Medicine Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tobias Pischon
- Max-Delbrueck-Center for Molecular Medicine in the Helmholtz Association (MDC), Molecular Epidemiology Research Group, Berlin, Germany
- Max-Delbrueck-Center for Molecular Medicine in the Helmholtz Association (MDC), Biobank Technology Platform, Berlin, Germany
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Sabine Schipf
- Institute for Community Medicine, University Medical Center Greifswald, Greifswald, Germany
| | - Sigrid Thierry
- Institute of Epidemiology, Helmholtz Zentrum München—German Research Center for Environmental Health (GmbH), Neuherberg, Germany
- Augsburg University Hospital, Augsburg, Germany
| | - Stefan N. Willich
- Institute of Social Medicine, Epidemiology and Health Economics, Charité University Medicine Berlin, Berlin, Germany
| | - Hajo Zeeb
- Leibniz Institute for Prevention Research and Epidemiology—BIPS, Bremen, Germany
| | - Heiko Becher
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany
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Zeeb H, Schüz B, Schultz T, Pigeot I. [Developments in the digitalization of public health since 2020 : Examples from the Leibniz ScienceCampus Digital Public Health Bremen]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2024; 67:260-267. [PMID: 38197925 DOI: 10.1007/s00103-023-03827-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 12/13/2023] [Indexed: 01/11/2024]
Abstract
Digital public health has received a significant boost in recent years, especially due to the demands associated with the COVID-19 pandemic. In this report, we provide an overview of the developments in digitalization in the field of public health in Germany since 2020 and illustrate these with examples from the Leibniz ScienceCampus Digital Public Health Bremen (LSC DiPH).The following topics are central: How do digital survey methods as well as digital biomarkers and artificial intelligence methods shape modern epidemiology and prevention research? What is the status of digitalization in public health offices? Which approaches to health economics evaluation of digital public health interventions have been utilized so far? What is the status of training and further education in digital public health?The first years of the Leibniz ScienceCampus Digital Public Health Bremen (LSC DiPH) were also strongly influenced by the COVID-19 pandemic. Repeated population-based digital surveys of the LSC indicated an increase in use of health apps in the population, for example, in applications to support physical activity. The COVID-19-pandemic has also shown that the digitalization of public health enhances the risk of misinformation and disinformation.
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Affiliation(s)
- Hajo Zeeb
- Leibniz-Institut für Präventionsforschung und Epidemiologie-BIPS, Achterstr. 30, 28359, Bremen, Deutschland.
- Leibniz-WissenschaftsCampus Digital Public Health Bremen, Bremen, Deutschland.
| | - Benjamin Schüz
- Leibniz-WissenschaftsCampus Digital Public Health Bremen, Bremen, Deutschland
- Institut für Public Health und Pflegewissenschaften, Universität Bremen, Bremen, Deutschland
| | - Tanja Schultz
- Leibniz-WissenschaftsCampus Digital Public Health Bremen, Bremen, Deutschland
- Cognitive Systems Lab, Universität Bremen, Bremen, Deutschland
| | - Iris Pigeot
- Leibniz-Institut für Präventionsforschung und Epidemiologie-BIPS, Achterstr. 30, 28359, Bremen, Deutschland
- Leibniz-WissenschaftsCampus Digital Public Health Bremen, Bremen, Deutschland
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Dratva J, Schaeffer D, Zeeb H. [Digital health literacy in Germany: current status, concepts, and challenges]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2024; 67:277-284. [PMID: 38315221 DOI: 10.1007/s00103-024-03841-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 01/25/2024] [Indexed: 02/07/2024]
Abstract
A key prerequisite for the successful digital transformation of the healthcare system is a well-developed level of digital health literacy (DHL) among the population. DHL is the ability to deal with health-relevant digital information and information options with the aim of promoting and maintaining health and well-being for oneself and one's environment. This article examines the discussions about digital health literacy, the existing studies and measurement tools used in them, the data situation in Germany, and current challenges.DHL consists of various sub-competencies that reflect current digital information behavior, opportunities, and risks. The data situation is very heterogeneous due to different study designs and instruments, which limits the informative value. Two representative studies, HLS-Ger‑2 by Bielefeld University and the study by AOK Rheinland/Hamburg and the Leibniz-WissenschaftsCampus, both indicate a high proportion of people with low DHL despite different methods. Both nationally and internationally, DHL is subject to a social gradient and is associated with educational level, social status, financial deprivation, and age.According to the current empirical data, the acquisition of DHL in Germany is still insufficient, so there is a great need for action. The necessary legal framework conditions have been established, but there is still a lack of reliable and financial resources, as well as a solid data basis on DHL at population level. This is essential to identify vulnerability factors and to prepare and evaluate the implementation of measures. In addition, there is a need for an in-depth conceptual discussion on DHL that builds on the established health literacy concept and addresses the emerging health-related infodemic and its consequences for DHL.
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Affiliation(s)
- Julia Dratva
- Institut für Public Health, ZHAW Zürcher Hochschule für Angewandte Wissenschaften, Katharina-Sulzer-Platz 9, 8400, Winterthur, Schweiz.
- Fakultät Medizin, Universität Basel, Basel, Schweiz.
| | - Doris Schaeffer
- Fakultät für Gesundheitswissenschaften, Universität Bielefeld, Bielefeld, Deutschland
| | - Hajo Zeeb
- Leibniz ScienceCampus Digital Public Health, Leibniz-Institut für Präventionsforschung und Epidemiologie - BIPS, Bremen, Deutschland
- Health Sciences Bremen, Universität Bremen, Bremen, Deutschland
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Fuhr DC, Wolf-Ostermann K, Hoel V, Zeeb H. [Digital technologies to improve mental health]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2024; 67:332-338. [PMID: 38294700 DOI: 10.1007/s00103-024-03842-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 01/26/2024] [Indexed: 02/01/2024]
Abstract
The burden of mental diseases is enormous and constantly growing worldwide. The resulting increase in demand for psychosocial help is also having a negative impact on waiting times for psychotherapy in Germany. Digital interventions for mental health, such as interventions delivered through or with the help of a website (e.g. "telehealth"), smartphone, or tablet app-based interventions and interventions that use text messages or virtual reality, can help. This article begins with an overview of the functions and range of applications of digital technologies for mental health. The evidence for individual digital forms of interventions is addressed. Overall, it is shown that digital interventions for mental health are likely to be cost-effective compared to no therapy or a non-therapeutic control group. Newer approaches such as "digital phenotyping" are explained in the article. Finally, individual papers from the "Leibniz ScienceCampus Digital Public Health" are presented, and limitations and challenges of technologies for mental health are discussed.
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Affiliation(s)
- Daniela C Fuhr
- Abteilung für Evaluation und Prävention, Leibniz Institut für Präventionsforschung und Epidemiologie, Achterstr. 30, 28359, Bremen, Deutschland.
- Gesundheitswissenschaften, Universität Bremen, Bremen, Deutschland.
| | - Karin Wolf-Ostermann
- Institut für Public Health und Pflegeforschung, Universität Bremen, Bremen, Deutschland
| | - Viktoria Hoel
- Institut für Public Health und Pflegeforschung, Universität Bremen, Bremen, Deutschland
| | - Hajo Zeeb
- Abteilung für Evaluation und Prävention, Leibniz Institut für Präventionsforschung und Epidemiologie, Achterstr. 30, 28359, Bremen, Deutschland
- Gesundheitswissenschaften, Universität Bremen, Bremen, Deutschland
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Zeeb H, Pigeot I, Schüz B. [Digital public health-what are the necessary preconditions so that promises and potentials are redeemed?]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2024; 67:257-259. [PMID: 38466438 DOI: 10.1007/s00103-024-03839-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2024] [Indexed: 03/13/2024]
Affiliation(s)
- Hajo Zeeb
- Leibniz-Institut für Präventionsforschung und Epidemiologie, Bremen - BIPS, Achterstr. 30, 28359, Bremen, Deutschland.
- Health Sciences Bremen, Universität Bremen, 28359, Bremen, Deutschland.
| | - Iris Pigeot
- Leibniz-Institut für Präventionsforschung und Epidemiologie, Bremen - BIPS, Achterstr. 30, 28359, Bremen, Deutschland.
- Fachbereich Mathematik und Informatik, Universität Bremen, 28359, Bremen, Deutschland.
| | - Benjamin Schüz
- Fachbereich Human- und Gesundheitswissenschaften, Institut für Public Health und Pflegeforschung, Universität Bremen, Grazer Straße 4, 28359, Bremen, Deutschland.
- Health Sciences Bremen, Universität Bremen, 28359, Bremen, Deutschland.
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Singh H, Samkange-Zeeb F, Kolschen J, Herrmann R, Hübner W, Barnils NP, Brand T, Zeeb H, Schüz B. Interventions to promote health literacy among working-age populations experiencing socioeconomic disadvantage: systematic review. Front Public Health 2024; 12:1332720. [PMID: 38439762 PMCID: PMC10909862 DOI: 10.3389/fpubh.2024.1332720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 02/05/2024] [Indexed: 03/06/2024] Open
Abstract
Background Experiencing financial insecurity and being underserved is often associated with low health literacy, i.e., the ability to identify, obtain, interpret and act upon health information, which may result in poor health outcomes. Little is known about effective interventions for promoting health literacy among underserved populations. The objective of this systematic review is to summarize the literature on such interventions and identify characteristics that differentiate more effective interventions. Methods Following PRISMA guidelines we searched the databases SCOPUS, Pubmed, Web of Science core collection and CINAHL. We included primary studies with a quantitative study design and control groups testing interventions to increase health literacy or health knowledge in underserved populations between 18 and 65 years. Where possible, we converted effect sizes into Cohen's d and compared mean differences of intervention and control groups. Albatross plots were created to summarize the results according to different health literacy and health knowledge outcomes. Results We screened 3,696 titles and abstracts and 206 full texts. In total, 86 articles were analyzed, of which 55 were summarized in seven albatross plots. The majority of the studies (n = 55) were conducted in the United States and had a randomized controlled study design (n = 44). More effective intervention approaches assessed needs of participants through focus group discussions prior to conducting the intervention, used bilingual educational materials, and included professionals fluent in the first languages of the study population as intervention deliverers. Additionally, the use of educational materials in video and text form, fotonovelas and interactive group education sessions with role playing exercises were observed to be effective. Discussion Although the outcomes addressed in the included studies were heterogeneous, effective intervention approaches were often culturally sensitive and developed tailored educational materials. Interventions aiming to promote health literacy in underserved populations should hence consider applying similar approaches.Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=323801, PROSPERO registration ID: CRD42022323801.
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Affiliation(s)
- Himal Singh
- Institute of Public Health and Nursing Research, University of Bremen, Bremen, Germany
| | - Florence Samkange-Zeeb
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany
| | - Jonathan Kolschen
- Institute of Public Health and Nursing Research, University of Bremen, Bremen, Germany
| | - Ruben Herrmann
- Institute of Public Health and Nursing Research, University of Bremen, Bremen, Germany
| | - Wiebke Hübner
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany
| | - Núria Pedrós Barnils
- Institute of Public Health and Nursing Research, University of Bremen, Bremen, Germany
| | - Tilman Brand
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany
| | - Hajo Zeeb
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany
- Health Sciences Bremen, University of Bremen, Bremen, Germany
| | - Benjamin Schüz
- Institute of Public Health and Nursing Research, University of Bremen, Bremen, Germany
- Health Sciences Bremen, University of Bremen, Bremen, Germany
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Sell L, Brandes B, Brandes M, Zeeb H, Busse H. Determinants promoting and hindering physical activity in primary school children in Germany: a qualitative study with students, teachers and parents. Front Public Health 2024; 12:1280893. [PMID: 38371239 PMCID: PMC10869510 DOI: 10.3389/fpubh.2024.1280893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 01/19/2024] [Indexed: 02/20/2024] Open
Abstract
Background Determinants affecting children's physical activity (PA) at an early age are of particular interest to develop and strengthen strategies for increasing the levels of children's PA. A qualitative study was conducted to investigate the views of primary school-aged children, their teachers and parents regarding barriers and facilitators to engage in PA. Methods Focus groups were conducted separately with primary school children, parents and teachers in a city in Northern Germany between October 2021 and January 2022. The semi- structured focus groups with children and teachers took part in person within school, whereas the focus groups with parents took place online. Data were transcribed verbatim and analysed using thematic analysis. During analysis, the socio-ecological model was identified as useful to map the determinants mentioned and was consequently applied to organize the data. Results Teachers (n = 10), parents (n = 18) and children (n = 46) of five primary schools in Germany participated in the focus groups. Participants of the three groups identified similar barriers and facilitators of PA in primary school-aged children, ranging across all four layers of the socio-ecological model. The barriers encountered were the preferences of children for sedentary activities (individual characteristics), the preference of parents to control their child's actions (microsystem), a lack of financial resources from parents and long sitting times in class (mesosystem), and barriers related to rainy weather and Covid-19 restrictions (exosystem). Facilitators mentioned were the childrens' natural tendency to be active (individual characteristics), involvement and co-participation of parents or peers in engaging in PA, support provided by teachers and the school (microsystem), living in rural areas, having sufficient facilities and favorable weather conditions (exosystem). Conclusion A range of determinants promoting and hindering PA, ranging across all layers of the socio-ecological model were identified by children, parents and teachers in this study. These determinants need to be kept in mind when developing effective PA intervention programs for primary school-aged children. Future interventions should go beyond individual characteristics to also acknowledge the influence of childrens' social surrounding, including parents, peers and teachers, and the wider (school) environment.
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Affiliation(s)
- Louisa Sell
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology, BIPS GmbH, Bremen, Germany
- Institute for Public Health and Nursing- IPP, Bremen University, Bremen, Germany
| | - Berit Brandes
- Department of Epidemiological Methods and Etiological Research, Leibniz Institute for Prevention Research and Epidemiology, BIPS GmbH, Bremen, Germany
| | - Mirko Brandes
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology, BIPS GmbH, Bremen, Germany
| | - Hajo Zeeb
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology, BIPS GmbH, Bremen, Germany
- Health Sciences Bremen, University of Bremen, Bremen, Germany
| | - Heide Busse
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology, BIPS GmbH, Bremen, Germany
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11
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Mudiyanselage KWW, De Santis KK, Jörg F, Saleem M, Stewart R, Zeeb H, Busse H. The effectiveness of mental health interventions involving non-specialists and digital technology in low-and middle-income countries - a systematic review. BMC Public Health 2024; 24:77. [PMID: 38172713 PMCID: PMC10763181 DOI: 10.1186/s12889-023-17417-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 12/05/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Combining non-specialists and digital technologies in mental health interventions could decrease the mental healthcare gap in resource scarce countries. This systematic review examined different combinations of non-specialists and digital technologies in mental health interventions and their effectiveness in reducing the mental healthcare gap in low-and middle-income countries. METHODS Literature searches were conducted in four databases (September 2023), three trial registries (January-February 2022), and using forward and backward citation searches (May-June 2022). The review included primary studies on mental health interventions combining non-specialists and digital technologies in low-and middle-income countries. The outcomes were: (1) the mental health of intervention receivers and (2) the competencies of non-specialists to deliver mental health interventions. Data were expressed as standardised effect sizes (Cohen's d) and narratively synthesised. Risk of bias assessment was conducted using the Cochrane risk-of-bias tools for individual and cluster randomised and non-randomised controlled trials. RESULTS Of the 28 included studies (n = 32 interventions), digital technology was mainly used in non-specialist primary-delivery treatment models for common mental disorders or subthreshold symptoms. The competencies of non-specialists were improved with digital training (d ≤ 0.8 in 4/7 outcomes, n = 4 studies, 398 participants). The mental health of receivers improved through non-specialist-delivered interventions, in which digital technologies were used to support the delivery of the intervention (d > 0.8 in 24/40 outcomes, n = 11, 2469) or to supervise the non-specialists' work (d = 0.2-0.8 in 10/17 outcomes, n = 3, 3096). Additionally, the mental health of service receivers improved through digitally delivered mental health services with non-specialist involvement (d = 0.2-0.8 in 12/27 outcomes, n = 8, 2335). However, the overall certainty of the evidence was poor. CONCLUSION Incorporating digital technologies into non-specialist mental health interventions tended to enhance non-specialists' competencies and knowledge in intervention delivery, and had a positive influence on the severity of mental health problems, mental healthcare utilization, and psychosocial functioning outcomes of service recipients, primarily within primary-deliverer care models. More robust evidence is needed to compare the magnitude of effectiveness and identify the clinical relevance of specific digital functions. Future studies should also explore long-term and potential adverse effects and interventions targeting men and marginalised communities.
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Affiliation(s)
- Kalpani Wijekoon Wijekoon Mudiyanselage
- Faculty 11 Human and Health Sciences, University of Bremen, Bremen, Germany.
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology- BIPS, Bremen, Germany.
| | - Karina Karolina De Santis
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology- BIPS, Bremen, Germany
| | - Frederike Jörg
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Department of Education and Research, Friesland Mental Health Care Services, Leeuwarden, the Netherlands
| | - Maham Saleem
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology- BIPS, Bremen, Germany
| | - Roy Stewart
- Department of Health Sciences, Community & Occupational Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Hajo Zeeb
- Faculty 11 Human and Health Sciences, University of Bremen, Bremen, Germany
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology- BIPS, Bremen, Germany
- Leibniz ScienceCampus Digital Public Health Bremen, Bremen, Germany
| | - Heide Busse
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology- BIPS, Bremen, Germany
- Leibniz ScienceCampus Digital Public Health Bremen, Bremen, Germany
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12
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Schwedhelm C, Nimptsch K, Ahrens W, Hasselhorn HM, Jöckel KH, Katzke V, Kluttig A, Linkohr B, Mikolajczyk R, Nöthlings U, Perrar I, Peters A, Schmidt CO, Schmidt B, Schulze MB, Stang A, Zeeb H, Pischon T. Chronic disease outcome metadata from German observational studies - public availability and FAIR principles. Sci Data 2023; 10:868. [PMID: 38052810 PMCID: PMC10698176 DOI: 10.1038/s41597-023-02726-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 11/07/2023] [Indexed: 12/07/2023] Open
Abstract
Metadata from epidemiological studies, including chronic disease outcome metadata (CDOM), are important to be findable to allow interpretability and reusability. We propose a comprehensive metadata schema and used it to assess public availability and findability of CDOM from German population-based observational studies participating in the consortium National Research Data Infrastructure for Personal Health Data (NFDI4Health). Additionally, principal investigators from the included studies completed a checklist evaluating consistency with FAIR principles (Findability, Accessibility, Interoperability, Reusability) within their studies. Overall, six of sixteen studies had complete publicly available CDOM. The most frequent CDOM source was scientific publications and the most frequently missing metadata were availability of codes of the International Classification of Diseases, Tenth Revision (ICD-10). Principal investigators' main perceived barriers for consistency with FAIR principles were limited human and financial resources. Our results reveal that CDOM from German population-based studies have incomplete availability and limited findability. There is a need to make CDOM publicly available in searchable platforms or metadata catalogues to improve their FAIRness, which requires human and financial resources.
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Affiliation(s)
- Carolina Schwedhelm
- Molecular Epidemiology Research Group, Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, 13125, Germany.
| | - Katharina Nimptsch
- Molecular Epidemiology Research Group, Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, 13125, Germany
| | - Wolfgang Ahrens
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, 28359, Germany
- Institute of Statistics, Faculty of Mathematics and Computer Science, University of Bremen, Bremen, 28334, Germany
| | - Hans Martin Hasselhorn
- Department of Occupational Health Science, University of Wuppertal, Wuppertal, 42119, Germany
| | - Karl-Heinz Jöckel
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital of Essen, Essen, 45122, Germany
| | - Verena Katzke
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, 69120, Germany
| | - Alexander Kluttig
- Institute of Medical Epidemiology, Biometrics, and Informatics, Interdisciplinary Center for Health Sciences, Medical Faculty of the Martin-Luther-University Halle-Wittenberg, Halle (Saale), 06112, Germany
| | - Birgit Linkohr
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, 85764, Germany
| | - Rafael Mikolajczyk
- Institute of Medical Epidemiology, Biometrics, and Informatics, Interdisciplinary Center for Health Sciences, Medical Faculty of the Martin-Luther-University Halle-Wittenberg, Halle (Saale), 06112, Germany
- DZPG (German Center for Mental Health), partner site Halle-Jena-Magdeburg, 07743, Jena, Germany
| | - Ute Nöthlings
- Institute of Nutrition and Food Sciences, Nutritional Epidemiology, University of Bonn, Bonn, 53115, Germany
| | - Ines Perrar
- Institute of Nutrition and Food Sciences, Nutritional Epidemiology, University of Bonn, Bonn, 53115, Germany
| | - Annette Peters
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, 85764, Germany
- Institute for Medical Information Processing, Biometry and Epidemiology, Department of Epidemiology, Medical Faculty of the Ludwig-Maximilians-Universität München, Munich, 81377, Germany
| | - Carsten O Schmidt
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, 17489, Germany
| | - Börge Schmidt
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital of Essen, Essen, 45122, Germany
| | - Matthias B Schulze
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam Rehbruecke, Nuthetal, 14558, Germany
- Institute of Nutritional Science, University of Potsdam, Nuthetal, 14558, Germany
| | - Andreas Stang
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital of Essen, Essen, 45122, Germany
- Department of Epidemiology, School of Public Health, Boston University, Boston, MA, 02118, USA
| | - Hajo Zeeb
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, 28359, Germany
- Faculty 11 - Human and Health Sciences, University of Bremen, Bremen, 28359, Germany
| | - Tobias Pischon
- Molecular Epidemiology Research Group, Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, 13125, Germany
- Biobank Technology Platform, Max-Delbrueck-Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, 13125, Germany
- Core Facility Biobank, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, 13125, Germany
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, 10117, Germany
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Muellmann S, Gansefort D, Zeeb H, Brand T. Addressing community readiness to promote physical activity in older adults in Germany. Health Promot Int 2023; 38:daad158. [PMID: 38011398 DOI: 10.1093/heapro/daad158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023] Open
Abstract
Community-based approaches are promising to promote physical activity in old age. The community readiness (CR) model offers a structured approach to assess community capacities to address a certain health topic before and after implementing an intervention. The objective of this study is to assess whether community-based capacity building for physical activity among the elderly has a lasting effect on CR. Four communities (two sub-urban and two urban) in Northwestern Germany were randomly assigned to either intervention or control group. CR was assessed at three time points (2015, 2018 and 2020) by interviewing local key informants (n = 129). Community capacity building was carried out in the two intervention communities after baseline assessment and included the development and implementation of a local physical activity action plan for elderly. Overall CR scores were calculated and random effects regression analysis was performed to analyze group-by-time interaction. At baseline, the overall CR score was 4.62 (standard deviation (SD) = 0.51) indicating that communities were in the preplanning stage of CR. CR scores in the intervention communities did not significantly increase at follow-up assessments compared to control communities [2018: 4.82, coefficient -0.03, 95% confidence interval (CI) (-0.80; 0.73); 2020: 4.54, coefficient 0.19, 95% CI: (-0.59; 0.97)]. The process evaluation indicated several factors facilitating a successful cooperation with community stakeholders. These included building on existing networks, using a structured approach for developing and implementing a local physical activity action plan for older adults, providing financial support for implementing activities and linking activities to existing community events.
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Affiliation(s)
- Saskia Muellmann
- Leibniz-Institute for Prevention Research and Epidemiology - BIPS, Achterstr. 30, 28359 Bremen, Germany
| | - Dirk Gansefort
- Leibniz-Institute for Prevention Research and Epidemiology - BIPS, Achterstr. 30, 28359 Bremen, Germany
- Association for Health Promotion and Academy for Social Medicine Lower Saxony Bremen, Fenskenweg 2, 30165 Hannover, Germany
| | - Hajo Zeeb
- Leibniz-Institute for Prevention Research and Epidemiology - BIPS, Achterstr. 30, 28359 Bremen, Germany
- Health Sciences Bremen, University of Bremen, Grazer Str. 4, 28359 Bremen, Germany
| | - Tilman Brand
- Leibniz-Institute for Prevention Research and Epidemiology - BIPS, Achterstr. 30, 28359 Bremen, Germany
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14
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Rach S, Kühne L, Zeeb H, Ahrens W, Haug U, Pohlabeln H. Mild COVID-19 infection associated with post-COVID-19 condition after 3 months - a questionnaire survey. Ann Med 2023; 55:2226907. [PMID: 37337723 DOI: 10.1080/07853890.2023.2226907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2023] Open
Abstract
INTRODUCTION The coronavirus disease 2019 (COVID-19), caused by infection with SARS-CoV-2, can lead to post-COVID-19 condition, a secondary syndrome of persistent and new post-acute symptoms, but evidence on this syndrome is still scarce. METHODS In a questionnaire survey, residents of the city of Bremen (Germany) with verified SARS-CoV-2 infection were invited to answer questions (online questionnaire or interview) concerning symptoms experienced at the time of infection and at the time of questionnaire completion at least three months later. Main outcome of the analysis was the presence of a post-COVID-19 condition at the time of the interview, defined as the presence of at least two of three leading symptoms: fatigue, breathing difficulties, or cognitive problems. RESULTS A post-COVID-19 condition was more likely to be reported if respondents had, at the time of infection, suffered from fatigue (OR 1.75; 95% CI: 1.00, 3.06), breathing difficulties (OR 4.02; 95% CI: 2.80, 5.77), cognitive symptoms (OR 2.98; 95% CI: 1.48, 6.02), or head- & bone aches (OR 2.06; 95% CI: 1.25, 3.42). The odds of developing a post-COVID-19 condition increased with the number of symptoms at infection. Females were more likely to report a post-COVID-19 condition (OR 1.54; 95% CI: 1.05, 2.24). Analyzing only non-hospitalized respondents changed results only slightly. CONCLUSION Our study adds to growing evidence that even a mild course of COVID-19 poses a risk for developing a post-COVID-19 condition. Females and those with initial symptoms including fatigue, breathing difficulties, and cognitive symptoms seem more likely to also experience post COVID-19 symptoms several months after infection.KEY MESSAGESEven a mild course of COVID-19 poses a risk for developing a post-COVID-19 condition.Females seem more likely to develop a post-COVID-19 condition.Those with initial symptoms including fatigue, breathing difficulties, and cognitive symptoms seem more likely to develop a post-COVID-19 condition.
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Affiliation(s)
- Stefan Rach
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Lisa Kühne
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Hajo Zeeb
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
- Faculty of Human and Health Sciences, University of Bremen, Bremen, Germany
| | - Wolfgang Ahrens
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Ulrike Haug
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
- Faculty of Human and Health Sciences, University of Bremen, Bremen, Germany
| | - Hermann Pohlabeln
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
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15
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De Santis KK, Helmer S, Barnes B, Kraywinkel K, Imhoff M, Müller-Eberstein R, Kirstein M, Quatmann A, Simke J, Stiens L, Christianson L, Zeeb H. Impact of the COVID-19 pandemic on oncological care in Germany: rapid review. J Cancer Res Clin Oncol 2023; 149:14329-14340. [PMID: 37507594 PMCID: PMC10590309 DOI: 10.1007/s00432-023-05063-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 06/29/2023] [Indexed: 07/30/2023]
Abstract
OBJECTIVES The COVID-19 pandemic affected medical care for chronic diseases. This study aimed to systematically assess the pandemic impact on oncological care in Germany using a rapid review. METHODS MEDLINE, Embase, study and preprint registries and study bibliographies were searched for studies published between 2020 and 2 November 2022. Inclusion was based on the PCC framework: population (cancer), concept (oncological care) and context (COVID-19 pandemic in Germany). Studies were selected after title/abstract and full-text screening by two authors. Extracted data were synthesized using descriptive statistics or narratively. Risk of bias was assessed and summarized using descriptive statistics. RESULTS Overall, 77 records (59 peer-reviewed studies and 18 reports) with administrative, cancer registry and survey data were included. Disruptions in oncological care were reported and varied according to pandemic-related factors (e.g., pandemic stage) and other (non-pandemic) factors (e.g., care details). During higher restriction periods fewer consultations and non-urgent surgeries, and delayed diagnosis and screening were consistently reported. Heterogeneous results were reported for treatment types other than surgery (e.g., psychosocial care) and aftercare, while ongoing care remained mostly unchanged. The risk of bias was on average moderate. CONCLUSIONS Disruptions in oncological care were reported during the COVID-19 pandemic in Germany. Such disruptions probably depended on factors that were insufficiently controlled for in statistical analyses and evidence quality was on average only moderate. Research focus on patient outcomes (e.g., longer term consequences of disruptions) and pandemic management by healthcare systems is potentially relevant for future pandemics or health emergencies.
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Affiliation(s)
- Karina Karolina De Santis
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology- BIPS, Bremen, Germany.
| | - Stefanie Helmer
- Faculty 11 Human and Health Sciences, University of Bremen, Bremen, Germany
| | - Benjamin Barnes
- German Center for Cancer Registry Data, Robert Koch Institute (RKI), Berlin, Germany
| | - Klaus Kraywinkel
- German Center for Cancer Registry Data, Robert Koch Institute (RKI), Berlin, Germany
| | - Maren Imhoff
- German Center for Cancer Registry Data, Robert Koch Institute (RKI), Berlin, Germany
| | | | - Mathia Kirstein
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology- BIPS, Bremen, Germany
| | - Anna Quatmann
- Faculty 11 Human and Health Sciences, University of Bremen, Bremen, Germany
| | - Julia Simke
- Faculty 11 Human and Health Sciences, University of Bremen, Bremen, Germany
| | - Lisa Stiens
- Faculty 11 Human and Health Sciences, University of Bremen, Bremen, Germany
| | - Lara Christianson
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology- BIPS, Bremen, Germany
| | - Hajo Zeeb
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology- BIPS, Bremen, Germany
- Faculty 11 Human and Health Sciences, University of Bremen, Bremen, Germany
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16
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Brand T, Gerstmann M, Samkange-Zeeb F, Zeeb H. Involving trained community health mediators in COVID-19 prevention measures. A process evaluation from Bremen, Germany. Front Digit Health 2023; 5:1266684. [PMID: 37886670 PMCID: PMC10598750 DOI: 10.3389/fdgth.2023.1266684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 09/29/2023] [Indexed: 10/28/2023] Open
Abstract
Objective The objective was to assess the feasibility of incorporating trained community health mediators in COVID-19 prevention in a multicultural and disadvantaged setting in Bremen, Germany. Specifically, we aimed to develop and implement measures corresponding to the needs of the residents and to analyse the role of digital communication tools and sustainability factors of the health mediator approach. Methods A comprehensive process evaluation using 41 qualitative interviews with residents, mediator short surveys and group discussions, work documentation sheets, and a stakeholder workshop was carried out. Results Uncertainties due to changing regulations, a lack of trust and fear of potential side effects were major themes identified in the needs assessment. The eight mediators documented more than 1,600 contacts. Digital communication via Facebook was a useful tool, but personal contacts remained crucial for communicating with residents. The participatory approach, multilingualism and the flexibility to react to dynamic situations were identified as relevant factors for the success and sustainability of the health mediator approach. Conclusion Multilingual health mediators can facilitate contact with and dissemination of health information to different communities and also can play an important role in pandemic preparedness.
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Affiliation(s)
- Tilman Brand
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology (LG), Bremen, Germany
| | - Marieke Gerstmann
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology (LG), Bremen, Germany
| | - Florence Samkange-Zeeb
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology (LG), Bremen, Germany
| | - Hajo Zeeb
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology (LG), Bremen, Germany
- Department of Prevention and Evaluation, University of Bremen, Bremen, Germany
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17
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Rahu K, Rahu M, Auvinen A, Zeeb H, Boice JD. Cancer incidence among Chernobyl cleanup workers from Estonia: A 34-year follow-up. Int J Cancer 2023; 153:1347-1355. [PMID: 37334866 DOI: 10.1002/ijc.34633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 05/15/2023] [Accepted: 05/31/2023] [Indexed: 06/21/2023]
Abstract
From 1986 to 1991, 4831 men from Estonia were sent to clean up radioactively contaminated areas near Chernobyl (Chornobyl). Their cancer incidence during 1986 to 2019 was compared to that of the male population of Estonia. The cohort of cleanup workers was linked to national population and cancer registers based on unique personal identification numbers. Nineteen (0.4%) workers could not be traced. A total of 4812 men contributing 120 770 person-years of follow-up were eligible for the analyses. Standardized incidence ratios (SIR) and adjusted relative risks (ARR, expressed as ratios of SIRs) with 95% confidence intervals (CI) were calculated. A total of 687 incident cancer cases were registered in the cohort (SIR 1.11, 95% CI 1.03-1.19). Presumptive radiation-related cancers combined were in excess, but not when smoking- and alcohol-related cancers were excluded (SIR 0.92, 95% CI 0.71-1.18). For smoking-related cancers, the SIR was 1.24 (95% CI 1.13-1.36) and for alcohol-related cancer the SIR was 1.53 (95% CI 1.31-1.75). Less educated workers had a higher risk of all cancers (ARR = 1.21, 95% CI 1.02-1.44) and smoking-related cancers (ARR = 1.42, 95% CI 1.14-1.76). An elevated risk of alcohol-related cancers was evident 15 to 24 years (vs <15 years) after return from the Chernobyl area. This updated register-based follow-up of Chernobyl cleanup workers from Estonia revealed an excess of radiation-related cancer sites combined, but the excess was not apparent after excluding cancers associated with smoking and alcohol.
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Affiliation(s)
- Kaja Rahu
- Department of Registries, National Institute for Health Development, Tallinn, Estonia
| | - Mati Rahu
- Formerly: Department of Epidemiology and Biostatistics, National Institute for Health Development, Tallinn, Estonia
| | - Anssi Auvinen
- Faculty of Social Sciences, Tampere University, Tampere, Finland
- Environmental Radiation Surveillance, Radiation and Nuclear Safety Authority-STUK, Vantaa, Finland
| | - Hajo Zeeb
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
- Faculty of Health Sciences, University of Bremen, Bremen, Germany
| | - John D Boice
- National Council on Radiation Protection and Measurements, Bethesda, Maryland, USA
- Division of Epidemiology, School of Medicine, Vanderbilt University, Nashville, Tennessee, USA
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18
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Spallek J, Zeeb H, Razum O. [Life course epidemiology in migrant health research]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2023; 66:1092-1098. [PMID: 37712986 PMCID: PMC10539437 DOI: 10.1007/s00103-023-03761-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 08/15/2023] [Indexed: 09/16/2023]
Abstract
From free choice to forced flight, there are many reasons for migration. Accordingly, the backgrounds and living conditions of migrating people are also diverse. The different associated exposures affect the health of migrants and their children. To capture such a complex phenomenon, an approach is required that takes specific living conditions during the life course of migrants into account.An established methodological approach that can accomplish this is life course epidemiology. When applied to migrating populations, it examines exposures before, during, and after migration. In epidemiological research on the health of migrant populations, it is desirable to consider all three phases. This is countered by the fact that reliable data on the entire life course is not always available.A valid, timely collection and data protection-compliant linkage of longitudinal data from different sources can improve life course-related research on the health of migrants in Germany. In the future, corresponding data should also be included from the countries of origin of migrants.
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Affiliation(s)
- Jacob Spallek
- Fachgebiet Gesundheitswissenschaften, Institut für Gesundheit, Brandenburgische TU Cottbus-Senftenberg, Senftenberg, Deutschland.
- Lausitzer Zentrum für Digital Public Health, Brandenburgische TU Cottbus-Senftenberg, Senftenberg, Deutschland.
- Brandenburgische TU Cottbus-Senftenberg, Universitätsplatz 1, 01968, Senftenberg, Deutschland.
| | - Hajo Zeeb
- Leibniz-Institut für Präventionsforschung und Epidemiologie-BIPS, Bremen, Deutschland
- Health Sciences Bremen, Universität Bremen, Bremen, Deutschland
| | - Oliver Razum
- AG3 Epidemiologie & International Public Health, Fak. für Gesundheitswissenschaften, Universität Bielefeld, Bielefeld, Deutschland
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19
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Peters A, Herr C, Bolte G, Heutelbeck A, Hornberg C, Kraus T, Lakes T, Matzarakis A, Novak D, Reifegerste D, Traidl-Hoffmann C, Zeeb H, Schneider A, Hoffmann B. [Health protection and climate change require ambitious limit values for air pollutants in Europe : Opinion on the revision of the Directive on Air Quality and Clean Air for Europe of the Environmental Public Health commission of the Robert Koch Institute and the Federal Environment Agency]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2023; 66:1030-1034. [PMID: 37603135 PMCID: PMC10465619 DOI: 10.1007/s00103-023-03755-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2023] [Indexed: 08/22/2023]
Abstract
Based on scientific findings, the World Health Organization (WHO) has recommended stricter guideline values for air quality in 2021. Significant reductions in the annual mean values of particulate matter (particle size 2.5 µm or smaller, PM2.5) and long-term exposure to nitrogen dioxide (NO2) and ozone (O3) were put forward. The risk of mortality already increases above the WHO guideline values, as shown in studies investigating low concentrations of air pollutants. In Germany, the 2021 WHO guideline values for PM2.5 and NO2 were clearly exceeded in 2022.In this position paper we give the following recommendations for the European Air Quality Directive: (1) set binding limit values according to WHO 2021, (2) apply the limit values to the whole of Europe, (3) continue and expand the established country-based monitoring networks, (4) expand air quality measurements for ultrafine particles and soot particles, and (5) link air pollution control and climate protection measures.Stricter limits for air pollutants require societal and political changes in areas such as mobility, energy use and generation, and urban and spatial planning. Implementation according to WHO 2021 would lead to a net economic benefit of 38 billion euros per year.Ambitious limit values for air pollutants also have an impact on climate change mitigation and its health impacts. The Environmental Public Health commission concludes that more ambitious limit values are crucial to enable effective health protection in Germany and calls for air pollutant limit values in line with the 2021 WHO recommendations to become binding in Europe.
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Affiliation(s)
- Annette Peters
- Institut für Epidemiologie, Helmholtz Zentrum München - Deutsches Forschungszentrum für Gesundheit und Umwelt (GmbH), Ingolstädter Landstr. 1, 85764, Neuherberg, Deutschland.
- Lehrstuhl für Epidemiologie, Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie, Medizinische Fakultät, Ludwig-Maximilians-Universität München, München, Deutschland.
| | - Caroline Herr
- Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit, München, Deutschland
| | - Gabriele Bolte
- Institut für Public Health und Pflegeforschung, Abteilung Sozialepidemiologie, Universität Bremen, Bremen, Deutschland
| | - Astrid Heutelbeck
- Institut für Arbeits‑, Sozial- und Umweltmedizin, Universitätsklinikum Jena, Jena, Deutschland
| | - Claudia Hornberg
- Medizinische Fakultät OWL, Universität Bielefeld, Bielefeld, Deutschland
| | - Thomas Kraus
- Institut für Arbeits‑, Sozial- und Umweltmedizin, Uniklinik RWTH Aachen, Aachen, Deutschland
| | - Tobia Lakes
- Geographisches Institut, Angewandte Geoinformationsverarbeitung, Humboldt-Universität zu Berlin, Berlin, Deutschland
| | - Andreas Matzarakis
- Zentrum für Medizin-Meteorologische Forschung, Deutscher Wetterdienst, Freiburg, Deutschland
| | - Dennis Novak
- Instituts- und Poliklinik für Arbeits‑, Sozial- und Umweltmedizin, Ludwig-Maximilians-Universität Klinikum, München, Deutschland
| | - Doreen Reifegerste
- Fakultät für Gesundheitswissenschaften, Universität Bielefeld, Bielefeld, Deutschland
| | - Claudia Traidl-Hoffmann
- Medizinische Fakultät - Lehrstuhl für Umweltmedizin, Universitätsklinikum Augsburg, Augsburg, Deutschland
| | - Hajo Zeeb
- Leibniz-Institut für Präventionsforschung und Epidemiologie - BIPS und Universität Bremen, Bremen, Deutschland
| | - Alexandra Schneider
- Institut für Epidemiologie, Helmholtz Zentrum München - Deutsches Forschungszentrum für Gesundheit und Umwelt (GmbH), Ingolstädter Landstr. 1, 85764, Neuherberg, Deutschland
| | - Barbara Hoffmann
- Institut für Arbeits‑, Sozial- und Umweltmedizin, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
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20
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Heinig M, Schäfer W, Langner I, Zeeb H, Haug U. German mammography screening program: adherence, characteristics of (non-)participants and utilization of non-screening mammography-a longitudinal analysis. BMC Public Health 2023; 23:1678. [PMID: 37653487 PMCID: PMC10469853 DOI: 10.1186/s12889-023-16589-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 08/22/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND In Germany, all women aged 50-69 have been invited to biennial mammography screening since 2009. We aimed to assess longitudinal adherence over ten years in women aged 50 in 2009 and characterize the different adherence groups. METHODS Using the German Pharmacoepidemiological Research Database (GePaRD, ~ 20% of the German population), we included women aged 50 in 2009 (baseline) with continuous health insurance coverage and without breast cancer or in-situ-carcinoma. We followed them until age 59 and categorized them according to mammography screening participation into the following groups: never, 1-2, 3-4, 5-6 times. We characterized these groups, inter alia, regarding the use of other preventive measures, non-screening mammography (i.e., mammography outside the organized screening program) and menopausal hormone therapy. RESULTS Overall, 82,666 women were included. Of these, 27.6% never participated in the screening program, 15.1% participated 1-2 times, 31.7% participated 3-4 times and 25.6% participated regularly (5-6 times). Among regular participants, 91% utilized other preventive measures (e.g., cervical cancer screening, general health checkup) before baseline as compared to 66% among non-participants. Menopausal hormone therapy was least common among non-participants (11% vs. 18% among regular participants). Among non-participants, the proportions using ≥ 1, ≥ 2, and ≥ 3 non-screening mammographies between age 50-59 were 25%, 18%, and 15%, respectively. CONCLUSIONS Using a large cohort based on claims data, this study provides novel insights into longitudinal adherence to the mammography screening program and the use of mammography outside of the program in Germany. Between age 50-59, 57% of eligible women participated at least three times in the German mammography screening program and 28% (~ 3 in 10 women) never participated. Among non-participants, 15% had at least three non-screening mammographies during this period, indicating potential gray screening. Participants more often utilized other preventive measures as compared to non-participants.
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Affiliation(s)
- Miriam Heinig
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstraße 30, 28359, Bremen, Germany.
| | - Wiebke Schäfer
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstraße 30, 28359, Bremen, Germany
| | - Ingo Langner
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstraße 30, 28359, Bremen, Germany
| | - Hajo Zeeb
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
- Faculty of Human and Health Sciences, University of Bremen, Bremen, Germany
| | - Ulrike Haug
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstraße 30, 28359, Bremen, Germany
- Faculty of Human and Health Sciences, University of Bremen, Bremen, Germany
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21
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Brandes B, Sell L, Buck C, Busse H, Zeeb H, Brandes M. Use of a toolbox of tailored evidence-based interventions to improve children's physical activity and cardiorespiratory fitness in primary schools: results of the ACTIPROS cluster-randomized feasibility trial. Int J Behav Nutr Phys Act 2023; 20:99. [PMID: 37596651 PMCID: PMC10439638 DOI: 10.1186/s12966-023-01497-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 07/23/2023] [Indexed: 08/20/2023] Open
Abstract
BACKGROUND School-based physical activity (PA) promotion is usually conducted by providing one specific intervention. In contrast, the ACTIvity PROmotion via Schools (ACTIPROS) toolbox provides a set of twelve evidence-based PA interventions serving different domains of the Health Promoting Schools framework that primary schools can select according to their requirements. In this study, we tested the feasibility of the toolbox approach in primary schools. METHODS A two-arm cluster-randomized feasibility trial at primary schools (n = 5 intervention schools [IS], n = 5 control schools) located in the Federal State of Bremen, Germany, was conducted. Children's habitual PA (GENEActiv, Activinsights Ltd.) and motor skills (Deutscher Motorik Test; DMT) were measured at the beginning (t0: Sept and Oct 2021) and at the end of the school year (t1: June and July 2022). Between Oct 2021 and July 2022, the ACTIPROS toolbox was implemented at IS. Teachers documented intervention choices and implementation within a short questionnaire (SIQ) at t1. RESULTS IS successfully implemented at least one intervention of the toolbox. In total, seven out of twelve possible interventions were selected. Two schools decided to replace an intervention with another during the trial. Results of the SIQ indicated that IS tended to choose similar interventions while implementation frequency was highly different. N = 429 students from two classes per school were recruited. The mean consent rate was 75.1% (n = 322). At t0 and t1, n = 304 (94.4%) and n = 256 (79.3%) of consented children took part in the DMT, respectively. The accelerometry sample included one class per participating school. At t0 and t1, n = 166 and n = 151 devices were handed out to students and n = 133 (80.1%) and n = 106 (70.2%) valid records could be retrieved, respectively. Linear mixed models showed an intervention effect of 15.5 min (95% CI: 4.5; 26.6) in children's daily MVPA at IS between t0 and t1 compared to controls. CONCLUSIONS All IS were able to implement at least one intervention from the toolbox, and unsuitable interventions were successfully replaced in a timely manner, highlighting the feasibility of implementing the ACTIPROS toolbox. Good consent rates for accelerometer and motor skills data were achieved. Results indicate a substantial increase in MVPA associated with the ACTIPROS toolbox and need to be tested in a larger sample. TRIAL REGISTRATION German Clinical Trials Register DRKS00025840.
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Affiliation(s)
- Berit Brandes
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstraße 30, 28359 Bremen, Germany
| | - Louisa Sell
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstraße 30, 28359 Bremen, Germany
- Faculty 11 – Human and Health Sciences, University of Bremen, Bremen, Germany
| | - Christoph Buck
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstraße 30, 28359 Bremen, Germany
| | - Heide Busse
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstraße 30, 28359 Bremen, Germany
| | - Hajo Zeeb
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstraße 30, 28359 Bremen, Germany
- Faculty 11 – Human and Health Sciences, University of Bremen, Bremen, Germany
| | - Mirko Brandes
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstraße 30, 28359 Bremen, Germany
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22
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Vonneilich N, Becher H, Bohn B, Brandes B, Castell S, Deckert A, Dragano N, Franzke CW, Führer A, Gastell S, Greiser H, Keil T, Klett-Tammen C, Koch-Gallenkamp L, Krist L, Leitzmann M, Meinke-Franze C, Mikolajczyk R, Moreno Velasquez I, Obi N, Peters A, Pischon T, Reuter M, Schikowski T, Schmidt B, Schulze M, Sergeev D, Stang A, Völzke H, Wiessner C, Zeeb H, Lüdecke D, von dem Knesebeck O. Associations of Migration, Socioeconomic Position and Social Relations With Depressive Symptoms - Analyses of the German National Cohort Baseline Data. Int J Public Health 2023; 68:1606097. [PMID: 37533684 PMCID: PMC10391163 DOI: 10.3389/ijph.2023.1606097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 07/05/2023] [Indexed: 08/04/2023] Open
Abstract
Objectives: We analyze whether the prevalence of depressive symptoms differs among various migrant and non-migrant populations in Germany and to what extent these differences can be attributed to socioeconomic position (SEP) and social relations. Methods: The German National Cohort health study (NAKO) is a prospective multicenter cohort study (N = 204,878). Migration background (assessed based on citizenship and country of birth of both participant and parents) was used as independent variable, age, sex, Social Network Index, the availability of emotional support, SEP (relative income position and educational status) and employment status were introduced as covariates and depressive symptoms (PHQ-9) as dependent variable in logistic regression models. Results: Increased odds ratios of depressive symptoms were found in all migrant subgroups compared to non-migrants and varied regarding regions of origins. Elevated odds ratios decreased when SEP and social relations were included. Attenuations varied across migrant subgroups. Conclusion: The gap in depressive symptoms can partly be attributed to SEP and social relations, with variations between migrant subgroups. The integration paradox is likely to contribute to the explanation of the results. Future studies need to consider heterogeneity among migrant subgroups whenever possible.
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Affiliation(s)
- Nico Vonneilich
- Institute of Medical Sociology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Heiko Becher
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Baden-Württemberg, Germany
| | - Barbara Bohn
- NAKO e.V., Heidelberg University, Heidelberg, Baden-Württemberg, Germany
| | - Berit Brandes
- Leibniz Institute for Prevention Research and Epidemiology (LG), Bremen, Germany
| | - Stefanie Castell
- Department of Epidemiology, Helmholtz Center for Infection Research, Helmholtz Association of German Research Centers (HZ), Braunschweig, Niedersachsen, Germany
| | - Andreas Deckert
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Baden-Württemberg, Germany
| | - Nico Dragano
- Institute for Medical Sociology, University Hospital of Düsseldorf, Düsseldorf, Germany
| | - Claus-Werner Franzke
- Institute for Prevention and Cancer Epidemiology, University of Freiburg Medical Center, Freiburg, Baden-Württemberg, Germany
| | - Amand Führer
- Institute for Medical Epidemiology, Biometrics and Informatics (IMEBI), University Hospital in Halle, Halle, Saxony-Anhalt, Germany
| | - Sylvia Gastell
- NAKO Study Center, German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE), Potsdam, Brandenburg, Germany
| | - Halina Greiser
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Baden-Württemberg, Germany
| | - Thomas Keil
- Institute of Social Medicine, Epidemiology and Health Economics, Charité University Medicine Berlin, Berlin, Germany
- Institute of Clinical Epidemiology and Biometry, Faculty of Medicine, University of Würzburg, Würzburg, Bavaria, Germany
- State Institute of Health I, Bavarian Health and Food Safety Authority, Erlangen, Germany
| | - Carolina Klett-Tammen
- Department of Epidemiology, Helmholtz Center for Infection Research, Helmholtz Association of German Research Centers (HZ), Braunschweig, Niedersachsen, Germany
| | - Lena Koch-Gallenkamp
- Department of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Baden-Württemberg, Germany
| | - Lilian Krist
- Institute of Social Medicine, Epidemiology and Health Economics, Charité University Medicine Berlin, Berlin, Germany
| | - Michael Leitzmann
- Deptartment of Epidemiology and Preventive Medicine, University Medical Center Regensburg, Regensburg, Bavaria, Germany
| | - Claudia Meinke-Franze
- Institute for Community Medicine, University Medical Center Greifswald, Greifswald, Mecklenburg-Vorpommern, Germany
| | - Rafael Mikolajczyk
- Institute for Medical Epidemiology, Biometrics and Informatics (IMEBI), University Hospital in Halle, Halle, Saxony-Anhalt, Germany
| | - Ilais Moreno Velasquez
- Molecular Epidemiology Research Group, Max Delbrück Center for Molecular Medicine, Helmholtz Association of German Research Centers (HZ), Berlin, Baden-Wurttemberg, Germany
| | - Nadia Obi
- Institute for Occupational and Maritime Medicine Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Hamburg, Germany
| | - Annette Peters
- Institute of Epidemiology, Helmholtz Center München, Helmholtz Association of German Research Centres (HZ), Neuherberg, Germany
| | - Tobias Pischon
- Molecular Epidemiology Research Group, Max Delbrück Center for Molecular Medicine, Helmholtz Association of German Research Centers (HZ), Berlin, Baden-Wurttemberg, Germany
- Berlin Institute of Health (BIH), Charité University Medicine Berlin, Berlin, Germany
| | - Marvin Reuter
- Subject Sociology, University of Bamberg, Bamberg, Bavaria, Germany
| | - Tamara Schikowski
- Leibniz-Institut für Umweltmedizinische Forschung (IUF), Dusseldorf, Germany
| | - Börge Schmidt
- Institute for Medical Informatics, Biometry and Epidemiology, Essen University Hospital, Essen, North Rhine-Westphalia, Germany
| | - Matthias Schulze
- German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE), Potsdam, Brandenburg, Germany
- Institute of Nutrition Science, Faculty of Mathematics and Natural Sciences, University of Potsdam, Potsdam, Brandenburg, Germany
| | - Dmitry Sergeev
- Department of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Baden-Württemberg, Germany
| | - Andreas Stang
- Institute for Medical Informatics, Biometry and Epidemiology, Essen University Hospital, Essen, North Rhine-Westphalia, Germany
| | - Henry Völzke
- Institute for Community Medicine, University Medical Center Greifswald, Greifswald, Mecklenburg-Vorpommern, Germany
| | - Christian Wiessner
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Hamburg, Germany
| | - Hajo Zeeb
- Leibniz Institute for Prevention Research and Epidemiology (LG), Bremen, Germany
| | - Daniel Lüdecke
- Institute of Medical Sociology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Olaf von dem Knesebeck
- Institute of Medical Sociology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Romero Starke K, Schubert M, Kaboth P, Gerlach J, Hegewald J, Reusche M, Friedemann D, Zülke A, Riedel-Heller SG, Zeeb H, Seidler A. Traffic noise annoyance in the LIFE-adult study in Germany: Exposure-response relationships and a comparison to the WHO curves. Environ Res 2023; 228:115815. [PMID: 37003550 DOI: 10.1016/j.envres.2023.115815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 03/15/2023] [Accepted: 03/30/2023] [Indexed: 05/16/2023]
Abstract
BACKGROUND Noise annoyance is the second-highest cause of lost disability-adjusted life-years due to environmental noise in Europe. Evidence on exposure-response relationships (ERRs) for traffic noise annoyance with more accurate exposure values is still needed. OBJECTIVES In an analysis of the population-based LIFE-Adult study in Leipzig, Germany, we aimed to investigate the effect of road, railway (train and tram), and aircraft noise on high annoyance (HA). METHODS Traffic exposure data was taken for 2012 and data on noise annoyance was evaluated between 2018 and 2021. HA was defined according to international standardized norms. We calculated risk estimates using logistic regression, controlling for age, sex, and socioeconomic status, and compared our ERRs with those from the last WHO review on this topic. RESULTS Aircraft noise had the highest relative risk for noise-related HA (OR = 12.7, 95% CI: 9.37-17.10 per 10 dB Lden increase). The road and railway traffic risk estimates were similar to each other (road: OR = 3.55, 95% CI: 2.78-4.54; railway: OR = 3.31, 95% CI: 2.77-3.97 per 10 dB Lden increase). Compared to the WHO curves, the proportion of highly annoyed individuals was somewhat lower for road and rail traffic noise, but higher for aircraft noise. DISCUSSION Aircraft noise is particularly annoying. There were differences between our study's ERRs and those in the WHO review, especially for aircraft noise. These differences may be partly explained by the improved accuracy of the exposure values, as we considered secondary road networks and tram noise, and by a lack of a nighttime flight ban at the Leipzig airport. Geographical, regional and climatic variations, inconsistency in HA cut-offs, as well as temporal developments in the annoyance experience may also explain the differences. Since ERRs serve as a basis for decision making in public policies, regular updates of the curves based on new evidence is recommended.
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Affiliation(s)
- Karla Romero Starke
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany.
| | - Melanie Schubert
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Pauline Kaboth
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Julia Gerlach
- Chair of Transport Ecology, Institute of Transport Planning and Road Traffic, Technische Universität Dresden, Dresden, Germany
| | - Janice Hegewald
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany; Federal Institute for Occupational Safety and Health, Unit 3.1 Prevention of Work-related Diseases, Berlin, Germany
| | - Matthias Reusche
- Institute for Medical Informatics, Statistics and Epidemiology, Leipzig University, Leipzig, Germany; Leipzig Research Centre for Civilization Diseases, Leipzig University, Leipzig, Germany
| | | | - Andrea Zülke
- Institute for Social Medicine, Occupational Medicine and Public Health, University of Leipzig, Leipzig, Germany
| | - Steffi G Riedel-Heller
- Institute for Social Medicine, Occupational Medicine and Public Health, University of Leipzig, Leipzig, Germany
| | - Hajo Zeeb
- Department of Prevention and Evaluation, Leibnitz-Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany; Health Sciences Bremen, University of Bremen, Bremen, Germany
| | - Andreas Seidler
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
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Wendt J, Scheller DA, Banik A, Luszczynska A, Forberger S, Zeeb H, Scheidmeir M, Kubiak T, Lien N, Meshkovska B, Lobczowska K, Romaniuk P, Neumann-Podczaska A, Wieczorowska-Tobis K, Steinacker JM, Mueller-Stierlin AS. Good practice recommendations on implementation evaluation for policies targeting diet, physical activity, and sedentary behaviour. BMC Public Health 2023; 23:1259. [PMID: 37380979 DOI: 10.1186/s12889-023-15775-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 04/27/2023] [Indexed: 06/30/2023] Open
Abstract
Health policies aim to achieve specific health goals through system-level changes, unlike common health interventions that focus on promoting specific health behaviors on individual level. However, reliable data on the feasibility and implementation of policy actions across Europe are lacking. Moreover, no practice-oriented guidance exists for policy makers and implementers on how to evaluate policy implementation.As part of the Policy Evaluation Network, we aimed to synthesise knowledge on how to evaluate the implementation of policies promoting healthy diets, physical activity, and reducing sedentary behaviours. The multidisciplinary working group comprised 16 researchers and conducted two scoping reviews, three systematic reviews, two meta-reviews, two qualitative case studies and one quantitative case study over three years. The target populations included the general population, those at risk for obesity, and school children. Based on these reviews and case studies, this article summarises and presents the findings and lessons learned regarding the implementation evaluation of policies in nine case reports.Drawing on these experiences, three critical requirements for policy implementation evaluation were set: 1) conduct a comprehensive policy implementation evaluation from a multi-level perspective, 2) use implementation frameworks to address processes, determinants, and outcomes, and 3) engage relevant stakeholders in policy implementation evaluation. Finally, the consensus process resulted in 10 steps for the implementation evaluation of policies to promote physical activity and a healthy diet and to reduce sedentary behaviours, which adhere to the requirements and resources of the targeted policy.The findings of an implementation evaluation can lead to a better understanding of why policies work or not and can serve as a basis for developing solutions. This practice-oriented guidance outlines factors that should be considered in policy implementation evaluation to address its complexity. In this way, involved researchers and practitioners are empowered to engage in the evaluation process to close the knowledge gap regarding policy implementation.
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Affiliation(s)
- Janine Wendt
- Department of Internal Medicine, Division of Sports and Rehabilitation Medicine, University Hospital Ulm, Ulm, Germany
| | - Daniel A Scheller
- Department of Internal Medicine, Division of Sports and Rehabilitation Medicine, University Hospital Ulm, Ulm, Germany
| | - Anna Banik
- Department of Psychology, SWPS University of Social Sciences and Humanities, Wroclaw, Poland
| | - Aleksandra Luszczynska
- Department of Psychology, SWPS University of Social Sciences and Humanities, Wroclaw, Poland
| | - Sarah Forberger
- Leibniz-Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
| | - Hajo Zeeb
- Leibniz-Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
| | - Marie Scheidmeir
- Health Psychology, Johannes Gutenberg University, Mainz, Germany
| | - Thomas Kubiak
- Health Psychology, Johannes Gutenberg University, Mainz, Germany
| | - Nanna Lien
- Department of Nutrition, University of Oslo, Oslo, Norway
| | | | - Karolina Lobczowska
- Department of Psychology, SWPS University of Social Sciences and Humanities, Wroclaw, Poland
| | - Piotr Romaniuk
- Department of Health Policy, Medical University of Silesia, Katowice, Poland
| | | | | | - Jürgen M Steinacker
- Department of Internal Medicine, Division of Sports and Rehabilitation Medicine, University Hospital Ulm, Ulm, Germany
| | - Annabel S Mueller-Stierlin
- Department of Internal Medicine, Division of Sports and Rehabilitation Medicine, University Hospital Ulm, Ulm, Germany.
- Department of Psychiatry & Psychotherapy II, Ulm University, Günzburg, Germany.
- Institute for Epidemiology & Medical Biometry, Ulm University, Ulm, Germany.
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Alpers R, Kühne L, Truong HP, Zeeb H, Westphal M, Jäckle S. Evaluation of the EsteR Toolkit for COVID-19 Decision Support: Sensitivity Analysis and Usability Study. JMIR Form Res 2023; 7:e44549. [PMID: 37368487 DOI: 10.2196/44549] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 05/14/2023] [Accepted: 05/15/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND During the COVID-19 pandemic, local health authorities were responsible for managing and reporting current cases in Germany. Since March 2020, employees had to contain the spread of COVID-19 by monitoring and contacting infected persons as well as tracing their contacts. In the EsteR project, we implemented existing and newly developed statistical models as decision support tools to assist in the work of the local health authorities. OBJECTIVE The main goal of this study was to validate the EsteR toolkit in two complementary ways: first, investigating the stability of the answers provided by our statistical tools regarding model parameters in the back end and, second, evaluating the usability and applicability of our web application in the front end by test users. METHODS For model stability assessment, a sensitivity analysis was carried out for all 5 developed statistical models. The default parameters of our models as well as the test ranges of the model parameters were based on a previous literature review on COVID-19 properties. The obtained answers resulting from different parameters were compared using dissimilarity metrics and visualized using contour plots. In addition, the parameter ranges of general model stability were identified. For the usability evaluation of the web application, cognitive walk-throughs and focus group interviews were conducted with 6 containment scouts located at 2 different local health authorities. They were first asked to complete small tasks with the tools and then express their general impressions of the web application. RESULTS The simulation results showed that some statistical models were more sensitive to changes in their parameters than others. For each of the single-person use cases, we determined an area where the respective model could be rated as stable. In contrast, the results of the group use cases highly depended on the user inputs, and thus, no area of parameters with general model stability could be identified. We have also provided a detailed simulation report of the sensitivity analysis. In the user evaluation, the cognitive walk-throughs and focus group interviews revealed that the user interface needed to be simplified and more information was necessary as guidance. In general, the testers rated the web application as helpful, especially for new employees. CONCLUSIONS This evaluation study allowed us to refine the EsteR toolkit. Using the sensitivity analysis, we identified suitable model parameters and analyzed how stable the statistical models were in terms of changes in their parameters. Furthermore, the front end of the web application was improved with the results of the conducted cognitive walk-throughs and focus group interviews regarding its user-friendliness.
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Affiliation(s)
- Rieke Alpers
- Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany
| | - Lisa Kühne
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Hong-Phuc Truong
- Fraunhofer Institute for Industrial Mathematics ITWM, Kaiserslautern, Germany
| | - Hajo Zeeb
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Max Westphal
- Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany
| | - Sonja Jäckle
- Fraunhofer Institute for Digital Medicine MEVIS, Lübeck, Germany
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Schwingshackl L, Stadelmaier J, Lay R, Griebler U, De Santis KK, Zeeb H, Kien C, Reimer M, Eble J, von Philipsborn P, Gerhardus A, von Elm E, Meerpohl JJ, Kiesswetter E. In Cochrane nutrition reviews assessment of dietary adherence varied considerably. J Clin Epidemiol 2023; 158:1-9. [PMID: 36965600 DOI: 10.1016/j.jclinepi.2023.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 03/06/2023] [Accepted: 03/21/2023] [Indexed: 03/27/2023]
Abstract
OBJECTIVES Our aim was to investigate if and how Cochrane nutrition reviews assess dietary adherence to a specific dietary regimen. STUDY DESIGN AND SETTING Cochrane nutrition reviews fulfilling the following criteria were included: systematic review of randomized controlled trials including adults and investigating the effect of caloric restriction, dietary pattern, foods, nutrients, supplements, or other nutrition-related-interventions. Extensive data extraction and descriptive statistics were conducted. RESULTS Overall, 226 Cochrane reviews were included. Most reviews mentioned dietary adherence in the main text (n = 174), predominantly in the Methods and Results. Dietary adherence was assessed in 76 reviews and defined in 19. It was included in the risk of bias (RoB) assessment in 20 reviews with nine using a newly created RoB domain for dietary adherence, and considered as outcome in 37 reviews. Seventy-five reviews addressed degree of adherence and five treatment effects considering the degree of adherence. CONCLUSION Dietary adherence was reported in a heterogeneous manner in Cochrane nutrition reviews. Due to its high importance, we suggest that systematic reviews report the assessment and degree of dietary adherence measured in primary studies. Dietary adherence can further be examined as outcome, evaluated within the RoB (deviations from intended interventions) and included in sensitivity analyses.
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Affiliation(s)
- Lukas Schwingshackl
- Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
| | - Julia Stadelmaier
- Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Roberta Lay
- Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Ursula Griebler
- Department for Evidence-Based Medicine and Evaluation, Danube University Krems, Krems an der Donau, Austria
| | - Karina Karolina De Santis
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
| | - Hajo Zeeb
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
| | - Christina Kien
- Department for Evidence-Based Medicine and Evaluation, Danube University Krems, Krems an der Donau, Austria
| | - Mia Reimer
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
| | - Julian Eble
- Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Peter von Philipsborn
- Institute for Medical Information Processing, Biometry and Epidemiology, LMU Munich, and Pettenkofer School of Public Health, Munich, Germany
| | - Ansgar Gerhardus
- Department for Health Services Research, Institute of Public Health and Nursing Research (IPP), University of Bremen, Bremen, Germany
| | - Erik von Elm
- Cochrane Switzerland, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Joerg J Meerpohl
- Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Cochrane Germany, Cochrane Germany Foundation, Freiburg, Germany
| | - Eva Kiesswetter
- Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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De Santis KK, Mergenthal L, Christianson L, Busskamp A, Vonstein C, Zeeb H. Digital Technologies for Health Promotion and Disease Prevention in Older People: Scoping Review. J Med Internet Res 2023; 25:e43542. [PMID: 36951896 PMCID: PMC10131689 DOI: 10.2196/43542] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 11/30/2022] [Accepted: 01/31/2023] [Indexed: 03/24/2023] Open
Abstract
BACKGROUND Digital technologies have the potential to contribute to health promotion and disease prevention in the aging world. OBJECTIVE This study aims to identify digital technologies for health promotion and disease prevention that could be used independently by older people in nonclinical settings using a scoping review. METHODS Through database (MEDLINE, PsycINFO, CINAHL, and SCOPUS; to March 3, 2022) and manual searches (to June 14, 2022), 90 primary studies and 8 systematic reviews were included in this scoping review. The eligibility was based on the PCC (Population, Concept, and Context) criteria: (1) people aged 50 years or older (population), (2) any digital (health) technology (eg, smartphone apps, websites, virtual reality; concept), and (3) health promotion and disease prevention in daily life in nonclinical and noninstitutional settings (context). Data items included study characteristics, PCC criteria, opportunities versus challenges, and evidence gaps. Data were synthesized using descriptive statistics or narratively described by identifying common themes. RESULTS The studies were published in 2005-2022 and originated predominantly from North America and Europe. Most primary studies were nonrandomized, reported quantitative data, and investigated effectiveness or feasibility (eg, acceptance or usability) of digital technologies in older people. The participants were aged 50 years to 99 years, predominantly female, affluent (ie, with high income, education, and digital competence), and intended to use or used digital technologies for a median of 3 months independently at home or in community settings. The digital technologies included mobile or nonmobile technologies or virtual reality. The studies used "modern devices" (eg, smartphones, wearables, or gaming consoles) or modern and "older devices" (eg, computers or mobile phones). The users interacted with digital technologies via websites, emails, text messages, apps, or virtual reality. Health targets of digital technologies were mobility, mental health, nutrition, or cognition. The opportunities versus challenges of digital technologies were (1) potential health benefits versus unclear or no benefits for some outcomes, (2) monitoring of health versus ethical issues with data collection and management, (3) implications for functioning in daily life (ie, potential to prolong independent living) versus unclear application for clinical management or care, (4) tailoring of technical properties and content toward older users versus general use, (5) importance of human support for feasibility versus other factors required to improve feasibility, (6) reduction of social isolation versus access to digital technologies, and (7) improvement in digital competence versus digital divide. CONCLUSIONS Various digital technologies were independently used by people aged 50 years or older for health promotion and disease prevention. Future studies should focus on (1) more diverse populations of older people, (2) new digital technologies, (3) other (clinical and care) settings, and (4) outcome evaluation to identify factors that could enhance any health benefits of digital technologies. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/37729.
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Affiliation(s)
- Karina Karolina De Santis
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology, Bremen, Germany
- Leibniz-Science Campus Digital Public Health Bremen, Bremen, Germany
| | - Lea Mergenthal
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology, Bremen, Germany
| | - Lara Christianson
- Department of Administration, Leibniz Institute for Prevention Research and Epidemiology, Bremen, Germany
| | - Annalena Busskamp
- Department Q6- Adults, Seniors, Women's and Men's Health, Health Equity, Federal Centre for Health Education, Cologne, Germany
| | - Claudia Vonstein
- Department Q6- Adults, Seniors, Women's and Men's Health, Health Equity, Federal Centre for Health Education, Cologne, Germany
| | - Hajo Zeeb
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology, Bremen, Germany
- Leibniz-Science Campus Digital Public Health Bremen, Bremen, Germany
- Faculty 11 Human and Health Sciences, University of Bremen, Bremen, Germany
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28
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Schubert M, Romero Starke K, Gerlach J, Reusche M, Kaboth P, Schmidt W, Friedemann D, Hegewald J, Zeeb H, Zülke A, Riedel-Heller SG, Seidler A. Traffic-Related High Sleep Disturbance in the LIFE-Adult Cohort Study: A Comparison to the WHO Exposure-Response-Curves. Int J Environ Res Public Health 2023; 20:4903. [PMID: 36981810 PMCID: PMC10049209 DOI: 10.3390/ijerph20064903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 02/23/2023] [Accepted: 03/08/2023] [Indexed: 06/18/2023]
Abstract
Sleep is negatively affected by environmental noise. In the present study, we investigated self-reported high sleep disturbances (being "highly sleep disturbed"-HSD) from road traffic (primary and secondary road networks), rail (train and tram) and air traffic noise in the LIFE-Adult cohort study in Leipzig, Germany. For this, we used exposure data from 2012 and outcome data of Wave 2 (collected during 2018-2021). HSD was determined and defined according to internationally standardized norms. The highest risk for transportation noise-related HSD was found for aircraft noise: the odds ratio (OR) was 19.66, 95% CI 11.47-33.71 per 10 dB increase in Lnight. For road and rail traffic, similar risk estimates were observed (road: OR = 2.86, 95% CI 1.92-4.28; rail: OR = 2.67, 95% CI 2.03-3.50 per 10 dB Lnight increase). Further, we compared our exposure-risk curves with the curves of the WHO environmental noise guidelines for the European region. The proportion of individuals with HSD for a given noise level was lower for rail traffic but higher for aircraft noise in the LIFE study than in the WHO curves. For road traffic, curves are not directly comparable because we also included the secondary road network. The results of our study add to the body of evidence for increased health risks by traffic noise. Moreover, the results indicate that aircraft noise is particularly harmful to health. We recommend reconsidering threshold values for nightly aircraft exposure.
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Affiliation(s)
- Melanie Schubert
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, 01307 Dresden, Germany
| | - Karla Romero Starke
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, 01307 Dresden, Germany
| | - Julia Gerlach
- Institute of Transport Planning and Road Traffic, Technische Universität Dresden, 01069 Dresden, Germany
| | - Matthias Reusche
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, 04107 Leipzig, Germany
| | - Pauline Kaboth
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, 01307 Dresden, Germany
| | - Wolfram Schmidt
- Institute of Transport Planning and Road Traffic, Technische Universität Dresden, 01069 Dresden, Germany
- Lohmeyer GmbH, 01067 Dresden, Germany
| | | | - Janice Hegewald
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, 01307 Dresden, Germany
| | - Hajo Zeeb
- Department of Prevention and Evaluation, Leibniz-Institute for Prevention Research and Epidemiology—BIPS, 28359 Bremen, Germany
- Health Sciences Bremen, University of Bremen, 28359 Bremen, Germany
| | - Andrea Zülke
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, 04103 Leipzig, Germany
| | - Steffi G. Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, 04103 Leipzig, Germany
| | - Andreas Seidler
- Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, 01307 Dresden, Germany
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Rahu K, Rahu M, Zeeb H, Auvinen A, Bromet E, Boice JD. Suicide and other causes of death among Chernobyl cleanup workers from Estonia, 1986 - 2020: an update. Eur J Epidemiol 2023; 38:225-232. [PMID: 36609895 PMCID: PMC9905157 DOI: 10.1007/s10654-022-00957-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 12/15/2022] [Indexed: 01/09/2023]
Abstract
Mortality was studied in a cohort of 4831 men from Estonia who participated in the environmental cleanup of the radioactively contaminated areas around Chernobyl in 1986-1991. Their mortality in 1986-2020 was compared with the mortality in the Estonian male population. A total of 1503 deaths were registered among the 4812 traced men. The all-cause standardized mortality ratio (SMR) was 1.04 (95% CI 0.99-1.09). All-cancer mortality was elevated (SMR 1.16, 95% CI 1.03-1.28). Radiation-related cancers were in excess (SMR 1.20, 95% CI 1.03-1.36); however, the excesses could be attributed to tobacco and alcohol consumption. For smoking-related cancers, the SMR was 1.20 (95% CI 1.06-1.35) and for alcohol-related cancers the SMR was 1.56 (95% CI 1.26-1.86). Adjusted relative risks (ARR) of all-cause mortality were increased among workers who stayed in the Chernobyl area ≥ 92 days (ARR 1.20, 95% CI 1.08-1.34), were of non-Estonian ethnicity (ARR 1.33, 95% CI 1.19-1.47) or had lower (basic or less) education (ARR 1.63, 95% CI 1.45-1.83). Suicide mortality was increased (SMR 1.31, 95% CI 1.05-1.56), most notably among men with lower education (ARR 2.24, 95% CI 1.42-3.53). Our findings provide additional evidence that unhealthy behaviors such as alcohol and smoking play an important role in shaping cancer mortality patterns among Estonian Chernobyl cleanup workers. The excess number of suicides suggests long-term psychiatric and substance use problems tied to Chernobyl-related stressors, i.e., the psychosocial impact was greater than any direct carcinogenic effect of low-dose radiation.
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Affiliation(s)
- Kaja Rahu
- Department of Registries, National Institute for Health Development, Hiiu 42, 11619, Tallinn, Estonia.
| | - Mati Rahu
- Formerly: Department of Epidemiology and Biostatistics, National Institute for Health Development, Tallinn, Estonia
| | - Hajo Zeeb
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
- Faculty of Health Sciences, University of Bremen, Bremen, Germany
| | - Anssi Auvinen
- Faculty of Social Sciences, Tampere University, Tampere, Finland
- Environmental Radiation Surveillance, Radiation and Nuclear Safety Authority-STUK, Tampere University, Vantaa, Finland
| | - Evelyn Bromet
- Department of Psychiatry, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, USA
| | - John D Boice
- National Council On Radiation Protection and Measurements, Bethesda, MD, USA
- Division of Epidemiology, School of Medicine, Vanderbilt University, Nashville, TN, USA
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Heise TL, Seidler A, Girbig M, Freiberg A, Alayli A, Fischer M, Haß W, Zeeb H. CAT HPPR: a critical appraisal tool to assess the quality of systematic, rapid, and scoping reviews investigating interventions in health promotion and prevention. BMC Med Res Methodol 2022; 22:334. [PMID: 36567381 PMCID: PMC9791771 DOI: 10.1186/s12874-022-01821-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 12/14/2022] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND For over three decades researchers have developed critical appraisal tools (CATs) for assessing the scientific quality of research overviews. Most established CATs for reviews in evidence-based medicine and evidence-based public health (EBPH) focus on systematic reviews (SRs) with studies on experimental interventions or exposure included. EBPH- and implementation-oriented organisations and decision-makers, however, often seek access to rapid reviews (RRs) or scoping reviews (ScRs) for rapid evidence synthesis and research field exploration. Until now, no CAT is available to assess the quality of SRs, RRs, and ScRs following a unified approach. We set out to develop such a CAT. METHODS The development process of the Critical Appraisal Tool for Health Promotion and Prevention Reviews (CAT HPPR) included six phases: (i) the definition of important review formats and complementary approaches, (ii) the identification of relevant CATs, (iii) prioritisation, selection and adaptation of quality criteria using a consensus approach, (iv) development of the rating system and bilingual guidance documents, (v) engaging with experts in the field for piloting/optimising the CAT, and (vi) approval of the final CAT. We used a pragmatic search approach to identify reporting guidelines/standards (n = 3; e.g. PRISMA, MECIR) as well as guidance documents (n = 17; e.g. for reviews with mixed-methods approach) to develop working definitions for SRs, RRs, ScRs, and other review types (esp. those defined by statistical methods or included data sources). RESULTS We successfully identified 14 relevant CATs, predominantly for SRs (e.g. AMSTAR 2), and extracted 46 items. Following consensual discussions 15 individual criteria were included in our CAT and tailored to the review types of interest. The CAT was piloted with 14 different reviews which were eligible to be included in a new German database looking at interventions in health promotion and prevention in different implementation settings. CONCLUSIONS The newly developed CAT HPPR follows a unique uniformed approach to assess a set of heterogeneous reviews (e.g. reviews from problem identification to policy evaluations) to assist end-users needs. Feedback of external experts showed general feasibility and satisfaction with the tool. Future studies should further formally test the validity of CAT HPPR using larger sets of reviews.
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Affiliation(s)
- Thomas L. Heise
- grid.418465.a0000 0000 9750 3253Leibniz Institute for Prevention Research and Epidemiology—BIPS, Bremen, Germany ,grid.7704.40000 0001 2297 4381Health Sciences Bremen, University of Bremen, Bremen, Germany
| | - Andreas Seidler
- grid.4488.00000 0001 2111 7257Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Maria Girbig
- grid.4488.00000 0001 2111 7257Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Alice Freiberg
- grid.4488.00000 0001 2111 7257Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Adrienne Alayli
- grid.14778.3d0000 0000 8922 7789Unit of Health Services Research, Clinic of General Pediatrics, Neonatology and Pediatric Cardiology, University Hospital Düsseldorf, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Maria Fischer
- grid.487225.e0000 0001 1945 4553Federal Centre for Health Education—BZgA, Cologne, Germany
| | - Wolfgang Haß
- grid.487225.e0000 0001 1945 4553Federal Centre for Health Education—BZgA, Cologne, Germany
| | - Hajo Zeeb
- grid.418465.a0000 0000 9750 3253Leibniz Institute for Prevention Research and Epidemiology—BIPS, Bremen, Germany ,grid.7704.40000 0001 2297 4381Health Sciences Bremen, University of Bremen, Bremen, Germany
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Ahmad F, Khan Z, Siddiqi K, Khan MN, Kibria Z, Forberger S, Bauld L, Kanaan M, Zeeb H. Awareness, perceptions of and compliance with tobacco control policies among naswar vendors in Khyber Pakhtunkhwa Pakistan. Tob Control 2022; 31:e111-e117. [PMID: 34226260 DOI: 10.1136/tobaccocontrol-2020-056377] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 05/03/2021] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Regulatory compliance in the retail environment is integral to the success of tobacco control. We assessed compliance among naswar (smokeless tobacco product widely used in South Asia) vendors with tobacco control laws. We also assessed their awareness of tobacco-related harms and policies and perceived effect of policies on their sales. METHODS We surveyed 286 naswar vendors in three districts of the Khyber Pakhtunkhwa province of Pakistan. We recruited general and specialty vendors from urban and rural areas through multistage cluster sampling. Compliance was measured for promotion, sale to/by minors and tax paid on naswar. We used logistic regression analyses for assessing the association between the outcome variables (awareness of tobacco harms and laws, perceptions about the effect of policies on business and compliance with laws) and their predictors. RESULTS Most vendors (70%) were aware of tobacco-related harms of naswar. Although educated vendors were more aware of tobacco control policies, the greatest awareness was for a ban on sales to/by minors (21% overall). The majority of vendors (76%) violated this policy (measured by self-report), and violations were more common among rural than urban vendors (OR 2.27, 95% CI 1.05 to 4.96). Most vendors (71%) violated a ban on promotion of naswar. Vendors perceived tax increases and sales ban to/by minors as most detrimental for business. CONCLUSIONS There was poor awareness and compliance among naswar vendors in Pakistan with tobacco control laws. This study finds potential areas for policy interventions that can reduce urban/rural disparities in implementation of and compliance with tobacco control laws.
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Affiliation(s)
- Fayaz Ahmad
- Institute of Public Health and Social Sciences, Khyber Medical University, Peshawar, Pakistan
- Office of Research, Innovation and Commercialization, Khyber Medical University, Peshawar, Pakistan
| | - Zohaib Khan
- Office of Research, Innovation and Commercialization, Khyber Medical University, Peshawar, Pakistan
| | - Kamran Siddiqi
- Institute of Health Sciences, University of York, UK, York, UK
| | - Muhammad Naseem Khan
- Institute of Public Health and Social Sciences, Khyber Medical University, Peshawar, Pakistan
| | - Zeeshan Kibria
- Institute of Public Health and Social Sciences, Khyber Medical University, Peshawar, Pakistan
- Office of Research, Innovation and Commercialization, Khyber Medical University, Peshawar, Pakistan
| | - Sarah Forberger
- Leibniz Institute for Prevention Research and Epidemiology, Bremen, Germany
| | - Linda Bauld
- Usher Institute and UK Centre for Tobacco and Alcohol Studies, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Mona Kanaan
- Health Sciences, University of York, York, UK
| | - Hajo Zeeb
- Prevention and Evaluation, Leibniz-Institute for Prevention Research and Epidemiology, Bremen, Germany
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Scheidmeir M, Kubiak T, Luszczynska A, Wendt J, Scheller DA, Meshkovska B, Müller-Stierlin AS, Forberger S, Łobczowska K, Neumann-Podczaska A, Wieczorowska-Tobis K, Zeeb H, Steinacker JM, Woods CB, Lakerveld J. Acceptability of policies targeting dietary behaviours and physical activity: a systematic review of tools and outcomes. Eur J Public Health 2022; 32:iv32-iv49. [PMID: 36444105 PMCID: PMC9897019 DOI: 10.1093/eurpub/ckac053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Successful implementation of health policies require acceptance from the public and policy-makers. This review aimed to identify tools used to assess the acceptability of policies targeting physical activity and dietary behaviour, and examine if acceptability differs depending on characteristics of the policy and of the respondents. METHODS A systematic review (PROSPERO: CRD42021232326) was conducted using three databases (Science Direct, PubMed and Web of Science). RESULTS Of the initial 7780 hits, we included 48 eligible studies (n = 32 on dietary behaviour, n = 11 on physical activity and n = 5 on both), using qualitative and quantitative designs (n = 25 cross-sectional, quantitative; n = 15 qualitative; n = 5 randomized controlled trials; n = 3 mixed-methods design). Acceptability was analysed through online surveys (n = 24), interviews (n = 10), focus groups (n = 10), retrospective textual analysis (n = 3) and a taste-test experiment (n = 1). Notably, only 3 (out of 48) studies applied a theoretical foundation for their assessment. Less intrusive policies such as food labels and policies in a later stage of the implementation process received higher levels of acceptability. Women, older participants and respondents who rated policies as appropriate and effective showed the highest levels of acceptability. CONCLUSION Highly intrusive policies such as taxations or restrictions are the least accepted when first implemented, but respondents' confidence in the relevance and effectiveness of the policy may boost acceptability over the course of implementation. Studies using validated tools and a theoretical foundation are needed to further examine opportunities to increase acceptability.
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Affiliation(s)
- Marie Scheidmeir
- Correspondence: Marie Scheidmeir, Department of Health Psychology, Johannes Gutenberg University, Binger Str. 14-16, 55122 Mainz, Germany, Tel: +49 6131 39 39 132, e-mail:
| | - Thomas Kubiak
- Department of Health Psychology, Johannes Gutenberg University, Mainz, Germany
| | - Aleksandra Luszczynska
- Department of Psychology, SWPS University of Social Sciences and Humanities, CARE-BEH Center for Applied Research on Health Behavior and Health, Wroclaw, Poland,Melbourne Centre for Behavior Change, Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Janine Wendt
- Department of Internal Medicine, Sports- and Rehabilitation Medicine, University of Ulm, Ulm, Germany
| | - Daniel A Scheller
- Department of Internal Medicine, Sports- and Rehabilitation Medicine, University of Ulm, Ulm, Germany
| | - Biljana Meshkovska
- Department of Nutrition, Institute of Basic Medical Sciences (UiO-PHN), University of Oslo, Oslo, Norway
| | | | - Sarah Forberger
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology—BIPS, Bremen, Germany
| | - Karolina Łobczowska
- Department of Psychology, SWPS University of Social Sciences and Humanities, CARE-BEH Center for Applied Research on Health Behavior and Health, Wroclaw, Poland
| | | | | | - Hajo Zeeb
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology—BIPS, Bremen, Germany
| | - Jürgen M Steinacker
- Department of Internal Medicine, Sports- and Rehabilitation Medicine, University of Ulm, Ulm, Germany
| | - Catherine B Woods
- Department of Physical Education and Sport Sciences, Physical Activity for Health, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Jeroen Lakerveld
- Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands,Upstream Team, www.upstreamteam.nl, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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Ahrens W, Brenner H, Flechtner-Mors M, Harrington JM, Hebestreit A, Kamphuis CBM, Kelly L, Laxy M, Luszczynska A, Mazzocchi M, Murrin C, Poelman MP, Steenhuis I, Roos G, Steinacker JM, van Lenthe F, Zeeb H, Zukowska J, Lakerveld J, Woods CB. Dietary behaviour and physical activity policies in Europe: learnings from the Policy Evaluation Network (PEN). Eur J Public Health 2022; 32:iv114-iv125. [PMID: 36444106 PMCID: PMC9706119 DOI: 10.1093/eurpub/ckac148] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The European Policy Evaluation Network (PEN), initiated in autumn 2018, aimed at advancing the evidence base for public policies impacting dietary behaviour, physical activity and sedentary behaviours in Europe. This is needed because non-communicable diseases-the leading cause of global mortality-are substantially caused by physical inactivity and unhealthy dietary behaviours, which in turn are driven by upstream factors that have not yet been addressed effectively by prevention approaches. Thus, successful policy interventions are required that target entire populations and tackle the 'causes of the causes'. To advance our knowledge on the effective implementation of policies and their impact in terms of improving health behaviours, PEN focused on five research tasks: (i) Adaptation and implementation of a Food Environment Policy Index (Food-EPI) and development of a Physical Activity Environment Policy Index (PA-EPI); (ii) Mapping of health-related indicators needed for policy evaluation and facilitating a harmonized pan-European approach for surveillance to assess the impact of policy interventions; (iii) Refining quantitative methods to evaluate the impact of public policies; (iv) Identifying key barriers and facilitators of implementation of policies; and (v) Advance understanding the equity impact of the development, implementation and evaluation of policies aimed at promoting physical activity and a healthy diet. Finally, and in order to provide concrete evidence for policymaking, existing exemplary policies, namely sugar-sweetened beverages taxation, active transport policies and school policies on nutrition and physical activity were assessed in consideration of these five tasks. At the end of the PEN project's formal runtime, considerable advancements have been made. Here, we present an overview of the most important learnings and outputs.
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Affiliation(s)
- Wolfgang Ahrens
- Correspondence: Wolfgang Ahrens, Department of Epidemiological Methods and Etiological Research, Leibniz Institute for Prevention Research and Epidemiology – BIPS, Achterstrasse 30, 28359 Bremen, Germany, Tel: +49 421 218 56822, e-mail:
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Marion Flechtner-Mors
- Division of Sports and Rehabilitation Medicine, Department of Medicine, University Hospital Ulm, Ulm, Germany
| | - Janas M Harrington
- HRB Centre for Health and Diet Research, School of Public Health, University College Cork, Cork, Ireland
| | - Antje Hebestreit
- Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany
| | - Carlijn B M Kamphuis
- Department of Interdisciplinary Social Science, Utrecht University, Utrecht, the Netherlands
| | - Liam Kelly
- Department of Physical Education and Sport Sciences, Faculty of Education and Health Sciences, Physical Activity for Health Research Cluster, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Michael Laxy
- Technical University of Munich, Professorship of Public Health and Prevention, Munich, Germany
| | | | - Mario Mazzocchi
- Department of Statistical Sciences, University of Bologna, Bologna, Italy
| | - Celine Murrin
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Belfield, Dublin, Ireland
| | - Maartje P Poelman
- Chair Group Consumption and Healthy Lifestyles, Wageningen University & Research, Wageningen, The Netherlands
| | - Ingrid Steenhuis
- Department of Health Sciences, Faculty of Science and Amsterdam Public Health Research Institute De Boelelaan 1085, VU University Amsterdam, Amsterdam, The Netherlands
| | - Gun Roos
- Consumption Research Norway, Oslo Metropolitan University, Oslo, Norway
| | - Jürgen M Steinacker
- Division of Sports and Rehabilitation Medicine, Department of Medicine, University Hospital Ulm, Ulm, Germany
| | - Frank van Lenthe
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands,Department of Human Geography and Public Health, Utrecht University, Utrecht, The Netherlands
| | - Hajo Zeeb
- Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany,Health Sciences Bremen, University of Bremen, Bremen, Germany
| | - Joanna Zukowska
- Faculty of Civil and Environmental Engineering, Gdansk University of Technology, Gdansk, Poland
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Forberger S, Reisch LA, Meshkovska B, Lobczowska K, Scheller DA, Wendt J, Christianson L, Frense J, Steinacker JM, Woods CB, Luszczynska A, Zeeb H. What we know about the actual implementation process of public physical activity policies: results from a scoping review. Eur J Public Health 2022; 32:iv59-iv65. [PMID: 36444100 PMCID: PMC9706118 DOI: 10.1093/eurpub/ckac089] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Physical inactivity rates have remained high worldwide since 2001. Public policies are an essential upstream lever to target individual physical activity (PA) behaviour. However, implementers have different strategies and face implementation challenges that are poorly understood. The present study analyzes the implementation processes of public policies to promote PA in terms of: (i) the policies covered and their legal quality, (ii) the actors and stakeholders involved in the implementation process and (iii) the used implementation strategies (vertical, horizontal or a mix). METHODS A scoping review was systematically conducted (registered Open Science Framework: osf.io/7w84q/), searching 10 databases and grey literature until March 2022. Of the 7741 titles and abstracts identified initially, 10 studies were included. RESULTS The current evidence includes high-income countries (USA, n = 7; UK, New Zealand and Oman, n = 1 each). Policy areas covered are education (school sector) and PA promotion in general (national PA plans or city-wide approaches). The legal classification ranges from laws (school sector) to coordination and budgeting to non-legally binding recommendations. The jurisdictions covered were federal (n = 4), state (n = 1), county (n = 1), school district (n = 1) and city (n = 3). Implementation strategies for city-wide approaches are characterized by a coordinated approach with vertical and horizontal integration; federal PA policies by a mix of implementation strategies; and the school sector by a strict horizontal top-down integration without the involvement of other actors. CONCLUSION Implementation strategies differ by policy field. Therefore, continuous evaluation of the implementation process is necessary to align policy implementation with policy goals to promote individual PA behaviour.
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Affiliation(s)
- Sarah Forberger
- Correspondence: Sarah Forberger, PhD, Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology—BIPS, Achterstrasse 30, 28359 Bremen, Germany. Tel: +49 421 218 56907, Fax: +49 421 218 56941, e-mail:
| | - Lucia A Reisch
- Leibniz Institute for Prevention Research and Epidemiology—BIPS, Bremen, Germany,Behavioural Economics and Policy, University of Cambridge, Cambridge, UK
| | - Biljana Meshkovska
- Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway,Domus Medica, Oslo, Norway
| | - Karolina Lobczowska
- Department of Psychology in Wroclaw, SWPS University of Social Sciences and Humanities, Wroclaw, Poland
| | - Daniel A Scheller
- Division of Sports and Rehabilitation Medicine, Department of Internal Medicine, Ulm University Medical Center, Ulm, Germany
| | - Janine Wendt
- Division of Sports and Rehabilitation Medicine, Department of Internal Medicine, Ulm University Medical Center, Ulm, Germany
| | - Lara Christianson
- Leibniz Institute for Prevention Research and Epidemiology—BIPS, Bremen, Germany
| | - Jennifer Frense
- Leibniz Institute for Prevention Research and Epidemiology—BIPS, Bremen, Germany
| | - Jürgen M Steinacker
- Division of Sports and Rehabilitation Medicine, Department of Internal Medicine, Ulm University Medical Center, Ulm, Germany
| | - Catherine B Woods
- School of Health and Human Performance, Dublin City University, Dublin, Ireland,Department of Physical Education and Sport Sciences, Physical Activity for Health Research Cluster, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Aleksandra Luszczynska
- Department of Psychology in Wroclaw, SWPS University of Social Sciences and Humanities, Wroclaw, Poland,Melbourne Centre for Behavior Change, Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Hajo Zeeb
- Leibniz Institute for Prevention Research and Epidemiology—BIPS, Bremen, Germany,Health Sciences Bremen, University of Bremen, Bremen, Germany
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Braitmaier M, Kollhorst B, Heinig M, Langner I, Czwikla J, Heinze F, Buschmann L, Minnerup H, García-Albéniz X, Hense HW, Karch A, Zeeb H, Haug U, Didelez V. Effectiveness of Mammography Screening on Breast Cancer Mortality – A Study Protocol for Emulation of Target Trials Using German Health Claims Data. Clin Epidemiol 2022; 14:1293-1303. [PMID: 36353307 PMCID: PMC9639456 DOI: 10.2147/clep.s376107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 10/12/2022] [Indexed: 11/06/2022] Open
Abstract
Background The efficacy of mammography screening in reducing breast cancer mortality has been demonstrated in randomized trials. However, treatment options - and hence prognosis – for advanced tumor stages as well as mammography techniques have considerably improved since completion of these trials. Consequently, the effectiveness of mammography screening under current conditions is unclear and controversial. The German mammography screening program (MSP), an organized population-based screening program, was gradually introduced between 2005 and 2008 and achieved nation-wide coverage in 2009. Objective We describe in detail a study protocol for investigating the effectiveness of the German MSP in reducing breast cancer mortality in women aged 50 to 69 years based on health claims data. Specifically, the proposed study aims at estimating per-protocol effects of several screening strategies on cumulative breast cancer mortality. The first analysis will be conducted once 10-year follow-up data are available. Methods and Analysis We will use claims data from five statutory health insurance providers in Germany, covering approximately 37.6 million individuals. To estimate the effectiveness of the MSP, hypothetical target trials will be emulated across time, an approach that has been demonstrated to minimize design-related biases. Specifically, the primary contrast will be in terms of the cumulative breast cancer mortality comparing the screening strategies of “never screen” versus “regular screening as intended by the MSP”. Ethics and Dissemination In Germany, the utilization of data from health insurances for scientific research is regulated by the Code of Social Law. All involved health insurance providers as well as the responsible authorities approved the use of the health claims data for this study. The Ethics Committee of the University of Bremen determined that studies based on claims data are exempt from institutional review. The findings of the proposed study will be published in peer-reviewed journals.
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Affiliation(s)
- Malte Braitmaier
- Department of Biometry and Data Management, Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany
| | - Bianca Kollhorst
- Department of Biometry and Data Management, Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany
| | - Miriam Heinig
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany
| | - Ingo Langner
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany
| | - Jonas Czwikla
- SOCIUM Research Center on Inequality and Social Policy, University of Bremen, Bremen, Germany
| | - Franziska Heinze
- SOCIUM Research Center on Inequality and Social Policy, University of Bremen, Bremen, Germany
| | - Laura Buschmann
- Institute for Epidemiology and Social Medicine, Faculty of Medicine, Westfälische Wilhelms University of Münster, Münster, Germany
| | - Heike Minnerup
- Institute for Epidemiology and Social Medicine, Faculty of Medicine, Westfälische Wilhelms University of Münster, Münster, Germany
| | - Xabiér García-Albéniz
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
- RTI Health Solutions, Barcelona, Spain
| | - Hans-Werner Hense
- Institute for Epidemiology and Social Medicine, Faculty of Medicine, Westfälische Wilhelms University of Münster, Münster, Germany
| | - André Karch
- Institute for Epidemiology and Social Medicine, Faculty of Medicine, Westfälische Wilhelms University of Münster, Münster, Germany
| | - Hajo Zeeb
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany
- Faculty of Human and Health Sciences, University of Bremen, Bremen, Germany
| | - Ulrike Haug
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany
- Faculty of Human and Health Sciences, University of Bremen, Bremen, Germany
| | - Vanessa Didelez
- Department of Biometry and Data Management, Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany
- Faculty of Mathematics and Computer Science, University of Bremen, Bremen, Germany
- Correspondence: Vanessa Didelez, Leibniz Institute for Prevention Research and Epidemiology – BIPS, Department of Biometry and Data Management, Achterstraße 30, Bremen, 28359, Germany, Tel +49-421-56939, Fax +49-421-56941, Email
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36
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De Santis KK, Mergenthal L, Christianson L, Zeeb H. Health promotion and disease prevention with digital technologies for older people: Scoping review. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac131.166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
In the aging world digital technologies are needed to target the health needs of older people. This study aimed to identify digital technologies for health promotion and disease prevention for older people by performing a scoping review.
Methods
A search of MEDLINE, PsycINFO, CINAHL and SCOPUS on 09.03.2022 identified 2150 studies. The inclusion criteria were: 1) Population: older people, 2) Concept: any digital health technology, 3) Context: health promotion and disease prevention in home or community settings. Preliminary study selection was performed automatically using the smart groups function in EndNote. Studies were clustered by digital technology type, health target, study design and study focus. Final study selection and data coding will be performed manually by two authors.
Results
Of the 2150 studies, 1874 studies were excluded, 159 studies met the inclusion criteria 1) and 2), but addressed different contexts (digital competence, digital technology development, disease management) or setting (care) and 117 studies were included. Digital technology types were: 1) any technologies (digital, virtual, video, eHealth or telehealth), 2) internet websites accessed via computer, 3) SMS or mobile phones, 4) exergaming or 5) smartphones or wearables. Health targets were: 1) physical activity, 2) mental health and wellness, 3) nutrition or 4) cognitive functioning. Study designs included primary studies (randomized-controlled trials) or reviews (systematic or scoping). Study focus was on effectiveness, feasibility or evaluation of digital technologies.
Conclusions
The health needs of older people are addressed by older technologies. Newer studies use heterogeneous terminology when referring to digital technologies. Future studies should focus on multiple aspects of healthy aging beyond mobility. More work is also needed to understand if and how a shift towards newer technologies occurs and if that is associated with health benefits in older people.
Key messages
• Older digital technologies (computers and mobile phones) address the health needs of older people.
• Mobility is the main health target of digital technologies for older people in the context of health promotion and disease prevention.
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Affiliation(s)
- KK De Santis
- Department of Prevention and Evaluation, Leibniz Institute BIPS , Bremen, Germany
- Leibniz-Science Campus Digital Public Health , Bremen, Germany
| | - L Mergenthal
- Department of Prevention and Evaluation, Leibniz Institute BIPS , Bremen, Germany
| | - L Christianson
- Department of Administration, Leibniz Institute BIPS , Bremen, Germany
| | - H Zeeb
- Department of Prevention and Evaluation, Leibniz Institute BIPS , Bremen, Germany
- Leibniz-Science Campus Digital Public Health , Bremen, Germany
- Faculty 11 Human and Health Sciences, University of Bremen , Bremen, Germany
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Zeeb H, Schüz B, Pigeot I. Highlighting the ‘public ‘in digital public health – a critical reflection. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac129.148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
What is the appropriate differentiation of digital public health versus digital health - or is there none? This is an essential question when pondering digitalisation and public health, especially with a view to the potential development of the field. Digital health seems to be a general term related to information and communication technology in health care. Putting a public health lens on this general descriptive term can be done by simply expanding it towards public health as a population science and practice field, rather than the narrow medical and health care arena. However, a more specific approach towards outlining similarities and differences will also focus on digital technologies and their challenges in the core areas of prevention and health promotion. Considering the leading public health functions, their relationship with digitalisation and their specific requirements towards digitalisation can be a valuable path to describe and discuss what digital public health is all about. We will also highlight where interfaces and interrelations with digital health need to be considered for research and practice. This contribution will aim to provide such a perspective.
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Affiliation(s)
- H Zeeb
- BIPS , Bremen, Germany
- Leibniz ScienceCampus Digital Public Health , Bremen, Germany
- EUPHA-DH
| | - B Schüz
- BIPS , Bremen, Germany
- Institute of Public Health and Nursing Research, University of Bremen , Bremen, Germany
| | - I Pigeot
- BIPS , Bremen, Germany
- Leibniz ScienceCampus Digital Public Health , Bremen, Germany
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Meyer J, Ratz T, Pauls A, Hellmers S, Boll S, Fudickar S, Hein A, Bauer JM, Koppelin F, Lippke S, Peters M, Pischke CR, Voelcker-Rehage C, Zeeb H, Forberger S. Designing and applying technology for prevention-Lessons learned in AEQUIPA and its implications for future research and practice. Front Public Health 2022; 10:832922. [PMID: 36339229 PMCID: PMC9627148 DOI: 10.3389/fpubh.2022.832922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 09/16/2022] [Indexed: 01/21/2023] Open
Abstract
Almost all Western societies are facing the challenge that their population structure is changing very dynamically. Already in 2019, ten countries had a population share of at least 20 percent in the age group of 64 years and older. Today's society aims to improve population health and help older people live active and independent lives by developing, establishing, and promoting safe and effective interventions. Modern technological approaches offer tremendous opportunities but pose challenges when preventing functional decline. As part of the AEQUIPA Prevention Research Network, the use of technology to promote physical activity in older people over 65 years of age was investigated in different settings and from various interdisciplinary perspectives, including technology development and evaluation for older adults. We present our findings in three main areas: (a) design processes for developing technology interventions, (b) older adults as a user group, and (c) implications for the use of technology in interventions. We find that cross-cutting issues such as time and project management, supervision of participants, ethics, and interdisciplinary collaboration are of vital importance to the success of the work. The lessons learned are discussed based on the experiences gained in the overall AEQUIPA network while building, particularly on the experiences from the AEQUIPA sub-projects TECHNOLOGY and PROMOTE. Our experiences can help researchers of all disciplines, industries, and practices design, study and implement novel technology-based interventions for older adults to avoid pitfalls and create compelling and meaningful solutions.
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Affiliation(s)
- Jochen Meyer
- OFFIS – Institute for Information Technology, Oldenburg, Germany,*Correspondence: Jochen Meyer
| | - Tiara Ratz
- Jacobs University Bremen, Bremen, Germany
| | - Alexander Pauls
- Section Technology and Health for Humans, Jade University of Applied Sciences Wilhelmshaven/Oldenburg/Elsfleth, Oldenburg, Germany
| | - Sandra Hellmers
- Department of Health Services Research, Assistance Systems and Medical Device Technology, Carl von Ossietzky University, Oldenburg, Germany
| | - Susanne Boll
- OFFIS – Institute for Information Technology, Oldenburg, Germany
| | - Sebastian Fudickar
- Department of Health Services Research, Assistance Systems and Medical Device Technology, Carl von Ossietzky University, Oldenburg, Germany
| | - Andreas Hein
- Department of Health Services Research, Assistance Systems and Medical Device Technology, Carl von Ossietzky University, Oldenburg, Germany
| | - Jürgen M. Bauer
- Center for Geriatric Medicine and Network Aging Research, Heidelberg University, Heidelberg, Germany
| | - Frauke Koppelin
- Section Technology and Health for Humans, Jade University of Applied Sciences Wilhelmshaven/Oldenburg/Elsfleth, Oldenburg, Germany
| | | | - Manuela Peters
- Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany
| | - Claudia R. Pischke
- Institute of Medical Sociology, Centre for Health and Society, Medical Faculty, Heinrich Heine University Duesseldorf, Duesseldorf, Germany
| | - Claudia Voelcker-Rehage
- Institute of Sport and Exercise Sciences, University of Muenster, Muenster, Germany,Institute of Human Movement Science and Health, Chemnitz University of Technology, Chemnitz, Germany
| | - Hajo Zeeb
- Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany
| | - Sarah Forberger
- Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany
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39
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Zeeb H, Brandes M, Bauer U, Forberger S, Gelius P, Muellmann S, Okan O, Pfeifer K, Renner B, Wright M. [Perspective Paper "Future Prevention Research" - Current and Future Coordinated Research on Prevention and Health Promotion]. Gesundheitswesen 2022; 85:388-394. [PMID: 36055281 PMCID: PMC10155309 DOI: 10.1055/a-1816-3398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
From 2014 to 2022, the BMBF has funded five research networks in prevention research and health promotion that are also jointly coordinated (Research Network Primary Prevention and Health Promotion, www.fp2g.net). The researchers have produced a large number of relevant research outputs with insights gained into essential aspects of prevention research and health promotion. The networks research focused on basic principles, application-relevant findings, and implementation conditions of long-term prevention and health promotion for non-communicable diseases (NCDs). The constraints imposed by the pandemic from 2020 onwards were partly addressed by integrating Corona-related research and transfer activities. The importance of resilience for dealing with multiple health and social challenges got increased attention and was analyzed and discussed during the pandemic. For prevention research, research questions such as how to better implement prevention measures through digital tools are gaining additional importance. Together, the research networks have presented achievements and desiderata for future research. This perspective paper with its nine theses formulated in conclusion is intended as a stimulus for discussion among funders as well as the communty of researchers on the subject of successful prevention and health promotion. It is explicitly part of the continuity of the memoranda on prevention research developed in 2012.
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Affiliation(s)
- Hajo Zeeb
- Abteilung Prävention und Evaluation, Leibniz-Institut für Präventionsforschung und Epidemiologie - BIPS, Bremen, Germany.,Health Sciences Bremen, Universität Bremen, Bremen, Germany
| | - Mirko Brandes
- Abteilung Prävention und Evaluation, Leibniz-Institut für Präventionsforschung und Epidemiologie - BIPS, Bremen, Germany
| | - Ullrich Bauer
- Fakultät für Erziehungswissenschaft, Interdisziplinäres Zentrum für Gesundheitskompetenzforschung (IZGK), Zentrum für Prävention und Intervention im Kindes- und Jugendalter (ZPI), Universität Bielefeld, Bielefeld, Germany
| | - Sarah Forberger
- Abteilung Prävention und Evaluation, Leibniz-Institut für Präventionsforschung und Epidemiologie - BIPS, Bremen, Germany
| | - Peter Gelius
- Institut für Sportwissenschaft und Sport, Lehrstuhl Bewegung und Gesundheit, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Saskia Muellmann
- Abteilung Prävention und Evaluation, Leibniz-Institut für Präventionsforschung und Epidemiologie - BIPS, Bremen, Germany
| | - Orkan Okan
- Fakultät für Sport- und Gesundheitswissenschaften, Technische Universität München, München, Germany
| | - Klaus Pfeifer
- Institut für Sportwissenschaft und Sport, Lehrstuhl Bewegung und Gesundheit, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Britta Renner
- Fachbereich Psychologie, AG Psychologische Diagnostik und Gesundheitspsychologie, Universität Konstanz, Konstanz, Germany
| | - Michael Wright
- Institut für Soziale Gesundheit, Katholische Hochschule fur Sozialwesen Berlin, Berlin, Germany
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Reuter M, Rigó M, Formazin M, Liebers F, Latza U, Castell S, Jöckel KH, Greiser KH, Michels KB, Krause G, Albrecht S, Öztürk I, Kuss O, Berger K, Lampl BMJ, Leitzmann M, Zeeb H, Starke KR, Schipf S, Meinke-Franze C, Ahrens W, Seidler A, Klee B, Pischon T, Andreas Deckert AD, Schmidt B, Mikolajczyk R, Karch A, Bohn B, Brenner H, Holleczek B, Dragano N. Authors' response: Occupation and SARS-CoV-2 infection risk among workers during the first pandemic wave in Germany: potential for bias. Scand J Work Environ Health 2022; 48:588-590. [PMID: 36153787 PMCID: PMC10539105 DOI: 10.5271/sjweh.4061] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
We thank van Tongeren et al for responding to our study on occupational disparities in SARS-CoV-2 infection risks during the first pandemic wave in Germany (1). The authors address the potential for bias resulting from differential testing between occupational groups and propose an alternative analytical strategy for dealing with selective testing. In the following, we want to discuss two aspects of this issue, namely (i) the extent and reasons of differential testing in our cohort and (ii) the advantages and disadvantages of different analytical approaches to study risk factors for SARS-CoV-2 infection. Our study relied on nationwide prospective cohort data including more than 100 000 workers in order to compare the incidence of infections between different occupations and occupational status positions. We found elevated infection risks in personal services and business administration, in essential occupations (including health care) and among people in higher occupational status positions (ie, managers and highly skilled workers) during the first pandemic wave in Germany (2). Van Tongeren's et al main concern is that the correlations found could be affected by a systematic bias because people in healthcare professions get tested more often than employees in other professions. A second argument is that better-off people could be more likely to use testing as they are less affected by direct costs (prices for testing) and the economic hardship associated with a positive test result (eg, loss of earnings in the event of sick leave). We share the authors' view that differential testing must be considered when analysing and interpreting the data. Thus, in our study, we examined the proportion of tests conducted in each occupational group as part of the sensitivity analyses (see supplementary figure S1, accessible at www.sjweh.fi/article/4037). As expected, testing proportions were exceptionally high in medical occupations (due to employer requirements). However, we did not observe systematic differences among non-medical occupations or when categorising by skill-level or managerial responsibility. This might be explained by several reasons. First, SARS-CoV-2 testing was free of charge during the first pandemic wave in Germany, but reporting a risk contact or having symptoms was a necessary condition for testing ( https://www.bundesgesundheitsministerium.de/coronavirus/chronik-coronavirus.html (accessed 5 September 2022). The newspaper article cited by van Tongeren et al is misleading as it refers to a calendar date after our study period. Second, different motivation for testing due to economic hardship in case of a positive test result is an unlikely explanation, because Germany has a universal healthcare system, including paid sick leave and sickness benefits for all workers (3). Self-employed people carry greater financial risks in case of sickness. We therefore included self-employment in the multivariable analyses to address this potential source of bias. While the observed inverse social gradient may be surprising, it actually matches with findings of ecological studies from Germany (4, 5), the United States (6, 7) as well as Spain, Portugal, Sweden, The Netherlands, Israel, and Hong Kong (8), all of which observed higher infection rates in wealthier neighbourhoods during the initial outbreak phase of the pandemic. One possible explanation is the higher mobility of managers and better educated workers, who are more likely to participate in meetings and engage in business travel and holiday trips like skiing. Given the increasing number of studies providing evidence for this hypothesis, we conclude that the inverse social gradient in our study likely reflects different exposure probabilities and is not a result of systematic bias. This also holds true for the elevated infection risks in essential workers, which is actually corroborated by a large body of research (9-11). Regarding differential likelihood of testing, van Tongeren et al state that "[i]t is relatively simple to address this problem by using a test-negative design" (1). As van Tongeren et al describe, this is a case-control approach only including individuals who were tested (without considering those who were not tested). However, the proposed analytical strategy can lead to another (more serious) selection bias if testing proportions and/or testing criteria differ between groups (12). This can be easily illustrated when comparing the results based on a time-incidence design with those obtained by a test-negative design as shown in table 1 (see PDF). Both approaches show similar results in terms of vertical occupational differences. Infection was more common if individuals had a high skill level or had a managerial position, but associations were stronger in the time-incidence design and did not reach statistical significance in the test-negative design (as indicated by the confidence intervals overlapping "1"). Unfortunately, the test-negative approach relies on a strongly reduced sample size and thus results in greater statistical uncertainty and loss of statistical power (13). In contrast, the test-negative design yields a different picture when estimating the association between essential occupation and infection risk: In this analysis, essential workers did not differ from non-essential workers in their chance of being infected with SARS-CoV-2 (the test-negative design even exhibits a lower chance for essential workers). This is rather counter-intuitive and is not in accordance with what we know about the occupational hazards of healthcare workers during the pandemic (14). The main problem is that proportions of positive tests are highly unreliable when testing proportions and/or testing criteria differ between groups. As essential workers were tested more often without being symptomatic (due to employer requirements), a lower proportion of positive tests in this group does not necessarily correspond to a lower risk of infection. Consequently, we are not convinced that the test-negative design should be the 'gold standard' for studying risk factors for SARS-CoV-2 infections (15). Especially problematic is the loss of statistical power (increasing the probability of a type II error) and the low validity of the test-positivity when test criteria and/or test proportions differ between groups. References 1. van Tongeren M, Rhodes S, Pearce N. Occupation and SARS-CoV-2 infection risk among workers during the first pandemic wave in Germany: potential for bias. Scand J Work Environ Health 2022;48(7):586-587. https://doi.org/10.5271/sjweh.4052. 2. Reuter M, Rigó M, Formazin M, Liebers F, Latza U, Castell S, et al. Occupation and SARS-CoV-2 infection risk among 108 960 workers during the first pandemic wave in Germany. Scand J Work Environ Health 2022;48:446-56. https://doi.org/10.5271/sjweh.4037. 3. Busse R, Blümel M, Knieps F, Bärnighausen T. Statutory health insurance in Germany: a health system shaped by 135 years of solidarity, self-governance, and competition. Lancet 2017;390:882-97. https://doi.org/10.1016/S0140-6736(17)31280-1. 4. Wachtler B, Michalski N, Nowossadeck E, Diercke M, Wahrendorf M, Santos-Hövener C, et al. Socioeconomic inequalities in the risk of SARS-CoV-2 infection - First results from an analysis of surveillance data from Germany. J Heal Monit 2020;5:18-29. https://doi.org/10.25646/7057. 5. Plümper T, Neumayer E. The pandemic predominantly hits poor neighbourhoods? SARS-CoV-2 infections and COVID-19 fatalities in German districts. Eur J Public Health 2020;30:1176-80. https://doi.org/10.1093/eurpub/ckaa168. 6. Abedi V, Olulana O, Avula V, Chaudhary D, Khan A, Shahjouei S, et al. Racial, Economic, and Health Inequality and COVID-19 Infection in the United States. J Racial Ethn Heal Disparities 2021;8:732-42. https://doi.org/10.1007/s40615-020-00833-4. 7. Mukherji N. The Social and Economic Factors Underlying the Incidence of COVID-19 Cases and Deaths in US Counties During the Initial Outbreak Phase. Rev Reg Stud 2022;52. https://doi.org/10.52324/001c.35255. 8. Beese F, Waldhauer J, Wollgast L, Pförtner T, Wahrendorf M, Haller S, et al. Temporal Dynamics of Socioeconomic Inequalities in COVID-19 Outcomes Over the Course of the Pandemic-A Scoping Review. Int J Public Health 2022;67:1-14. https://doi.org/10.3389/ijph.2022.1605128. 9. Nguyen LH, Drew DA, Graham MS, Joshi AD, Guo C-G, Ma W, et al. Risk of COVID-19 among front-line health-care workers and the general community: a prospective cohort study. Lancet Public Heal 2020;5:e475-83. https://doi.org/10.1016/S2468-2667(20)30164-X. 10. Chou R, Dana T, Buckley DI, Selph S, Fu R, Totten AM. Epidemiology of and Risk Factors for Coronavirus Infection in Health Care Workers. Ann Intern Med 2020;173:120-36. https://doi.org/10.7326/M20-1632. 11. Stringhini S, Zaballa M-E, Pullen N, de Mestral C, Perez-Saez J, Dumont R, et al. Large variation in anti-SARS-CoV-2 antibody prevalence among essential workers in Geneva, Switzerland. Nat Commun 2021;12:3455. https://doi.org/10.1038/s41467-021-23796-4. 12. Accorsi EK, Qiu X, Rumpler E, Kennedy-Shaffer L, Kahn R, Joshi K, et al. How to detect and reduce potential sources of biases in studies of SARS-CoV-2 and COVID-19. Eur J Epidemiol 2021;36:179-96. https://doi.org/10.1007/s10654-021-00727-7. 13. Cohen J. Statistical Power Analysis for the Behavioral Sciences. 2nd Editio. New York: Routledge; 2013. https://doi.org/10.4324/9780203771587. 14. The Lancet. The plight of essential workers during the COVID-19 pandemic. Lancet 2020;395:1587. https://doi.org/10.1016/S0140-6736(20)31200-9. 15. Vandenbroucke JP, Brickley EB, Pearce N, Vandenbroucke-Grauls CMJE. The Evolving Usefulness of the Test-negative Design in Studying Risk Factors for COVID-19. Epidemiology 2022;33:e7-8. https://doi.org/10.1097/EDE.0000000000001438.
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Affiliation(s)
- Marvin Reuter
- Dr. Marvin Reuter, Institute of Medical Sociology, Centre for Health and Society, Medical Faculty and University Hospital, Heinrich Heine University Duesseldorf Moorenstrasse 5, 40225 Düsseldorf,
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Reuter M, Rigó M, Formazin M, Liebers F, Latza U, Castell S, Jöckel KH, Greiser KH, Michels KB, Krause G, Albrecht S, Öztürk I, Kuss O, Berger K, Lampl BMJ, Leitzmann M, Zeeb H, Starke KR, Schipf S, Meinke-Franze C, Ahrens W, Seidler A, Klee B, Pischon T, Deckert A, Schmidt B, Mikolajczyk R, Karch A, Bohn B, Brenner H, Holleczek B, Dragano N. Occupation and SARS-CoV-2 infection risk among 108 960 workers during the first pandemic wave in Germany. Scand J Work Environ Health 2022; 48:446-456. [PMID: 35670286 PMCID: PMC9888438 DOI: 10.5271/sjweh.4037] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE The aim of this study was to identify the occupational risk for a SARS-CoV-2 infection in a nationwide sample of German workers during the first wave of the COVID-19 pandemic (1 February-31 August 2020). METHODS We used the data of 108 960 workers who participated in a COVID follow-up survey of the German National Cohort (NAKO). Occupational characteristics were derived from the German Classification of Occupations 2010 (Klassifikation der Berufe 2010). PCR-confirmed SARS-CoV-2 infections were assessed from self-reports. Incidence rates (IR) and incidence rate ratios (IRR) were estimated using robust Poisson regression, adjusted for person-time at risk, age, sex, migration background, study center, working hours, and employment relationship. RESULTS The IR was 3.7 infections per 1000 workers [95% confidence interval (CI) 3.3-4.1]. IR differed by occupational sector, with the highest rates observed in personal (IR 4.8, 95% CI 4.0-5.6) and business administration (IR 3.4, 95% CI 2.8-3.9) services and the lowest rates in occupations related to the production of goods (IR 2.0, 95% CI 1.5-2.6). Infections were more frequent among essential workers compared with workers in non-essential occupations (IRR 1.95, 95% CI 1.59-2.40) and among highly skilled compared with skilled professions (IRR 1.36, 95% CI 1.07-1.72). CONCLUSIONS The results emphasize higher infection risks in essential occupations and personal-related services, especially in the healthcare sector. Additionally, we found evidence that infections were more common in higher occupational status positions at the beginning of the pandemic.
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Affiliation(s)
- Marvin Reuter
- Institute of Medical Sociology, Centre for Health and Society, Medical Faculty and University Hospital, University of Düsseldorf, Dusseldorf, Germany,
Correspondence to: Dr. Marvin Reuter, Institute of Medical Sociology, Centre for Health and Society, Medical Faculty and University Hospital, Heinrich Heine University Duesseldorf Moorenstrasse 5, 40225 Düsseldorf, Germany. [E-Mail: ]
| | - Mariann Rigó
- Institute of Medical Sociology, Centre for Health and Society, Medical Faculty and University Hospital, University of Düsseldorf, Dusseldorf, Germany
| | - Maren Formazin
- Federal Institute for Occupational Safety and Health (BAuA), Berlin, Germany
| | - Falk Liebers
- Federal Institute for Occupational Safety and Health (BAuA), Berlin, Germany
| | - Ute Latza
- Federal Institute for Occupational Safety and Health (BAuA), Berlin, Germany
| | | | - Karl-Heinz Jöckel
- Institute for Medical Informatics, Biometry and Epidemiology (IMIBE), University Hospital Essen, Germany
| | - Karin Halina Greiser
- German Cancer Research Centre (DKFZ) Heidelberg, Div. of Cancer Epidemiology, Heidelberg, Germany
| | - Karin B. Michels
- Institute for Prevention and Cancer Epidemiology, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Gérard Krause
- Helmholtz Centre for Infection Research, Braunschweig, Germany,Institute for Infectious Disease Epidemiology, TWINCORE, Hannover, Germany,German Center for Infection Research (DZIF), Braunschweig, Germany
| | - Stefan Albrecht
- Robert Koch Institute, Department for Epidemiology and Health Monitoring, Germany
| | - Ilter Öztürk
- Robert Koch Institute, Department for Epidemiology and Health Monitoring, Germany
| | - Oliver Kuss
- Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Klaus Berger
- Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany
| | - Benedikt MJ Lampl
- Regensburg Department of Public Health, Germany,Department of Epidemiology and Preventive Medicine, University of Regensburg, Germany
| | - Michael Leitzmann
- Department of Epidemiology and Preventive Medicine, University of Regensburg, Germany
| | - Hajo Zeeb
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Karla Romero Starke
- Institute and Policlinic for Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Germany
| | - Sabine Schipf
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Claudia Meinke-Franze
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Wolfgang Ahrens
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Andreas Seidler
- Institute and Policlinic for Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Germany
| | - Bianca Klee
- Institute for Medical Epidemiology, Biometrics and Informatics, Interdisciplinary Center for Health Sciences, Medical Faculty of the Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Tobias Pischon
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Molecular Epidemiology Research Group, Germany
| | - Andreas Deckert
- Heidelberg Institute of Global Health, Heidelberg University,Heidelberg, Germany
| | - Börge Schmidt
- Institute for Medical Informatics, Biometry and Epidemiology (IMIBE), University Hospital Essen, Germany
| | - Rafael Mikolajczyk
- Institute for Medical Epidemiology, Biometrics and Informatics, Interdisciplinary Center for Health Sciences, Medical Faculty of the Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - André Karch
- Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany
| | | | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - Nico Dragano
- Institute of Medical Sociology, Centre for Health and Society, Medical Faculty and University Hospital, University of Düsseldorf, Dusseldorf, Germany
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Forberger S, Khan Z, Ahmad F, Ahmed F, Frense J, Kampfmann T, Ullah S, Dogar O, Siddiqi K, Zeeb H. Scoping Review of Existing Evaluations of Smokeless Tobacco Control Policies: What Is Known About Countries Covered, Level of Jurisdictions, Target Groups Studied, and Instruments Evaluated? Nicotine Tob Res 2022; 24:1344-1354. [PMID: 35428887 DOI: 10.1093/ntr/ntac102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 03/17/2022] [Accepted: 04/12/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The implementation of smokeless tobacco control policies lags behind those for smoking. This scoping review summarizes the studies that evaluated public policies on smokeless tobacco regulation (SLT) and provides an overview of the jurisdictional level, target groups, and policy instruments. METHODS Seven databases were systematically searched for studies reporting on public policies regulating SLT. Two reviewers independently screened all studies. Data extraction was performed using a predefined extraction form. Extraction was replicated for 10% of the identified studies for quality assurance. A narrative synthesis of the included studies was used to analyze and interpret the data. The protocol was published beforehand with the Open Science Foundation (OSF). RESULTS Fourty articles comprising 41 studies were included. Most of the studies reported in the articles were conducted in the United States (n = 17) or India (n = 14). Most studies reported outcomes for students (n = 8), retailers/sellers (n = 8), and users/former users (n = 5). The impact of public policies on smokeless tobacco use, in general, was most frequently assessed (n = 9), followed by the impact of taxes (n = 7), product bans (n = 6), sales/advertising bans near educational institutions (n = 4), and health warnings (n = 3) on consumer behavior. CONCLUSIONS There are significant gaps in the evaluation of smokeless tobacco regulation studies that need to be filled by further research to understand the observed outcomes. WHO reporting on Framework Convention on Tobacco Control (FCTC) implementation should be linked to studies evaluating smokeless tobacco control measures at all levels of jurisdictions and in countries not members of the WHO FCTC or do not provide data. IMPLICATION Large gaps in the evaluation of SLT control policies exist. For some countries, WHO FCTC evaluations are available for different levels of jurisdictions. In countries with a strong federal structure, there is a lack of data beyond the national level to provide a more detailed look at compliance, indirect effects, or implementation gaps. More research is needed at all levels of jurisdictions, which add to the work of the WHO to understand what works for which target group, how the different levels of jurisdiction interact, how the real-world context can be incorporated, and what indirect effects may occur.
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Affiliation(s)
- Sarah Forberger
- Department Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstrasse 30, 28359 Bremen, Germany
| | - Z Khan
- Office of Research, Innovation, and Commercialization (ORIC), Khyber Medical University, Phase 5 Hayatabad, Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - F Ahmad
- Faculty Institute of Public Health & Social Sciences, Khyber Medical University, F1 Phase-6 Rd, Phase 5 Hayatabad, Peshawar, Khyber Pakhtunkhwa 25100, Pakistan
| | - F Ahmed
- Department Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstrasse 30, 28359 Bremen, Germany
| | - J Frense
- Department Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstrasse 30, 28359 Bremen, Germany
| | - T Kampfmann
- Institute for Ethics and Transdisciplinary Sustainability Research, Leuphana University Universitätsallee 1, 21335 Lüneburg, Germany
| | - S Ullah
- Office of Research Innovation and Commercialization, Khyber Medical University Peshawar; Phase 5 Hayatabad, Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - O Dogar
- Department of Health Sciences, University of York, Heslington, York YO10 5DD, UK
- Usher Institute, The University of Edinburgh, Old College, South Bridge, Edinburgh EH8 9YLUK
| | - K Siddiqi
- Department of Health Sciences, University of York, Heslington, York YO10 5DD, UK
- Hull York Medical School, John Hughlings Jackson Building, University Rd, Heslington, York YO10 5DD, UK
| | - H Zeeb
- Department Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstrasse 30, 28359 Bremen, Germany
- Health Sciences Bremen, University of Bremen, 28359 Bremen, Germany
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Zeeb H. PRESENT – Koordination der Forschungsverbünde
für Primärprävention und
Gesundheitsförderung. Das Gesundheitswesen 2022. [DOI: 10.1055/s-0042-1753966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Schubert M, Romero Starke K, Kaboth P, Hegewald J, Reusche M, Gerlach J, Friedemann D, Zülke A, Riedel-Heller SG, Zeeb H, Seidler A. BELÄSTIGUNG UND SCHLAFGESTÖRTHEIT DURCH
VERKEHRSLÄRM: EIN VERGLEICH MIT DEN
WHO-EXPOSITIONS-WIRKUNGSFUNKTIONEN. Das Gesundheitswesen 2022. [DOI: 10.1055/s-0042-1753826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- M Schubert
- Technische Universität Dresden Medizinische Fakultät,
Institut und Poliklinik für Arbeits- und Sozialmedizin, Dresden,
Deutschland
| | - K Romero Starke
- Technische Universität Dresden Medizinische Fakultät,
Institut und Poliklinik für Arbeits- und Sozialmedizin, Dresden,
Deutschland
| | - P Kaboth
- Technische Universität Dresden Medizinische Fakultät,
Institut und Poliklinik für Arbeits- und Sozialmedizin, Dresden,
Deutschland
| | - J Hegewald
- Technische Universität Dresden Medizinische Fakultät,
Institut und Poliklinik für Arbeits- und Sozialmedizin, Dresden,
Deutschland
- Bundesanstalt für Arbeitsschutz und Arbeitsmedizin,
Prävention arbeitsbedingter Erkrankungen, Berlin,
Deutschland
| | - M Reusche
- Universität Leipzig, Medizinische Fakultät, Institut
für Medizininformatik, Biometrie und Epidemiologie, Leipzig,
Deutschland
| | - J Gerlach
- Technische Universität Dresden, Institut für
Verkehrsplanung und Straßenverkehr, Professur für
Verkehrsökologie, Dresden, Deutschland
| | | | - A Zülke
- Universität Leipzig, Medizinische Fakultät, Institut
für Arbeits-, Sozial- und Umweltmedizin, Leipzig,
Deutschland
| | - SG Riedel-Heller
- Universität Leipzig, Medizinische Fakultät, Institut
für Arbeits-, Sozial- und Umweltmedizin, Leipzig,
Deutschland
| | - H Zeeb
- Leibniz-Institut für Präventionsforschung und
Epidemiologie – BIPS GmbH, Abteilung Prävention und Evaluation,
Bremen, Deutschland
| | - A Seidler
- Technische Universität Dresden Medizinische Fakultät,
Institut und Poliklinik für Arbeits- und Sozialmedizin, Dresden,
Deutschland
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Kühne L, Brüssermann S, De Santis KK, Jäckle S, Grimm S, Ha TH, Zeeb H. EsteR – Decision support for German health departments by
risk modelling in order to contain the COVID-19 pandemic. A rapid living
review. Das Gesundheitswesen 2022. [DOI: 10.1055/s-0042-1753829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- L Kühne
- Leibniz Institute for Prevention Research and Epidemiology –
BIPS, Prevention and Evaluation, Bremen, Deutschland
- Leibniz Science Campus Digital Public Health Bremen, Bremen,
Deutschland
| | - S Brüssermann
- Leibniz Institute for Prevention Research and Epidemiology –
BIPS, Prevention and Evaluation, Bremen, Deutschland
| | - KK De Santis
- Leibniz Institute for Prevention Research and Epidemiology –
BIPS, Prevention and Evaluation, Bremen, Deutschland
- Leibniz Science Campus Digital Public Health Bremen, Bremen,
Deutschland
| | - S Jäckle
- Fraunhofer Institute for Digital Medicine MEVIS,
Bremen/Lübeck, Deutschland
| | - S Grimm
- Fraunhofer Institute for Industrial Mathematics ITWM, Kaiserslautern,
Deutschland
| | - T-H Ha
- Fraunhofer Institute for Digital Medicine MEVIS,
Bremen/Lübeck, Deutschland
| | - H Zeeb
- Leibniz Institute for Prevention Research and Epidemiology –
BIPS, Prevention and Evaluation, Bremen, Deutschland
- Leibniz Science Campus Digital Public Health Bremen, Bremen,
Deutschland
- University of Bremen, Faculty of Human and Health Sciences, Public
Health, Bremen, Deutschland
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46
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Potzauf M, Zeeb H. Association Between Childhood Verbal Abuse and Health Outcomes: A
Systematic Review. Das Gesundheitswesen 2022. [DOI: 10.1055/s-0042-1753778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- M Potzauf
- University of Bremen, Bremen, Deutschland
| | - H Zeeb
- Leibniz Institute for Prevention Research and Epidemiology –
BIPS, Prevention and Evaluation, Bremen, Deutschland
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47
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Hoenemann S, Altenhöner T, Zeeb H. Soziale Integration und gesundheitsbezogene Lebensqualität
– eine qualitative Analyse der Folgen von Diskriminierung bei in
Deutschland lebenden türkeistämmigen Frauen. Das Gesundheitswesen 2022. [DOI: 10.1055/s-0042-1753615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- S Hoenemann
- Fachhochschule Bielefeld, Fachbereich Sozialwesen, Bielefeld,
Deutschland
| | - T Altenhöner
- Fachhochschule Bielefeld, Fachbereich Sozialwesen, Bielefeld,
Deutschland
| | - H Zeeb
- Leibniz-Institut für Präventionsforschung und
Epidemiologie – BIPS, Bremen, Deutschland
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48
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Zeeb H, Brand T. Digitalisation and social inclusion in health care – lessons
learned from the Covid-19 pandemic. Das Gesundheitswesen 2022. [DOI: 10.1055/s-0042-1753877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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49
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De Santis KK, Zeeb H, Matthias K. Factors associated with the interest in smartphone apps for health
promotion and disease prevention: Results from a cross-sectional, nationwide
survey in Germany. Das Gesundheitswesen 2022. [DOI: 10.1055/s-0042-1753679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- KK De Santis
- Leibniz Institute for Prevention Research and Epidemiology- BIPS,
Department of Prevention and Evaluation, Bremen, Deutschland
- Leibniz Science Campus Digital Public Health Bremen, Bremen,
Deutschland
| | - H Zeeb
- Leibniz Institute for Prevention Research and Epidemiology- BIPS,
Department of Prevention and Evaluation, Bremen, Deutschland
- Leibniz Science Campus Digital Public Health Bremen, Bremen,
Deutschland
- University of Bremen, Faculty 11 Human and Health Sciences, Bremen,
Deutschland
| | - K Matthias
- University of Applied Science Stralsund, Faculty of Electrical
Engineering and Computer Science, Stralsund, Deutschland
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Brand T, Wiersing R, Zeeb H. Leibniz Living Lab – Gesundheitswerkstatt Osterholz –
Ein Reallabor zum Wissenstransfer zwischen Wissenschaft, Praxis und
Bevölkerung. Das Gesundheitswesen 2022. [DOI: 10.1055/s-0042-1753991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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