Cancer prevention in people experiencing homelessness: ethical considerations and experiences from the CANCERLESS project

The incidence of cancer in Europe has been increasing in recent years. Despite this, cancer prevention has remained a low priority in health policies. Cancer is one of the main causes of mortality among people experiencing homelessness, who continue to have difficulties accessing prevention programs. A strategy that has been tested to favor cancer prevention is the health navigator figure. The objective of CANCERLESS project is to implement this model among populations experiencing homelessness in four European countries to foster the prevention and early detection of cancer. In this perspective, a presentation of CANCERLESS project is made, and its ethical aspects are discussed according to the ethics of public health, the ethics of care, solidarity, relational autonomy, and the social recognition of the virtue of just generosity. The ethical foundations of CANCERLESS project are rooted in social justice and in equity in access to health systems in general and cancer screening programs in particular. The ethics of public health guided by utilitarianism are insufficient in serving the interests of the most disadvantaged groups of the population. Hence, it is necessary to resort to relational bioethics that includes the ethics of care and solidarity and that recognizes the moral identity of socially excluded persons, reaffirming their position of equality in society. Relational autonomy therefore provides a broader conception by including the influence of living conditions in decisions. For this reason, the CANCERLESS project opts for a dialogue with those affected to incorporate their preferences and values into decisions about cancer prevention.

Cancer risk factors and access to cancer prevention services for people experiencing homelessness

Cancer is one of the most pressing global health issues, and populations with complex needs, such as people experiencing homelessness, have higher cancer incidence and mortality rates compared with the housed population. We mapped the evidence on cancer risk factors as well as barriers and facilitators to cancer prevention services among people experiencing homelessness, which is key to localising research gaps and identifying strategies for tailored interventions adapted to people experiencing homelessness. The results of 40 studies contribute to an understanding of the dynamic, interactive factors at different levels that determine access to cancer prevention services: socioeconomic, psychological, and physical factors (individual level); practical support and relational loops between health-care providers and people experiencing homelessness (interpersonal level); housing and regular medical care (system level); and interventions to facilitate access to cancer prevention (policy level). Furthermore, studies reported higher prevalence of various cancer-associated risk factors among people experiencing homelessness with the most common being tobacco use, ranging from 26% to 73%. The results show the importance of interventions to facilitate cancer prevention services through social support and low-threshold interventions (eg, navigation programmes), and training health-care staff in creating supportive and trusting environments that increase the likelihood of the continuity of care among people experiencing homelessness.

Changes in frequency of urology clinic visits and diagnosis of erectile dysfunction in Germany before and during COVID-19

OBJECTIVES

To explore and analyze [1] the differences in the total number of patients visiting urology practices in Germany, [2] explore and analyze any differences in the number of newly diagnosed erectile dysfunction (ED) patients as well as [3] the number of new drug prescription, before and during the COVID-19 pandemic in Germany (April 2019-March 2020 and April 2020-March 2021).

METHODS

This retrospective cross-sectional study used data from the Disease Analyzer database (IQVIA) and included all patients aged ≥18 years with at least one visit to one of 85 urology practices across Germany. Outcomes were the mean number of patients with [1] new diagnosis of ED and [2] new prescription of drugs for erectile dysfunction per practice, in pandemic (April 2020-March 2021) versus non-pandemic (April 2019-March 2020) time periods. Differences between the periods were assessed using Wilcoxon tests.

RESULTS

In the non-pandemic period, there were 195,895 men, and in the pandemic period, 192,659 men visiting urology practices in Germany. A total of 10,977 men were initially diagnosed with ED in non-pandemic and 12,213 (+11.26%) men in pandemic time periods. Although the differences of new ED diagnoses were not statistically significant, a non-significant increase of new ED diagnoses was observed across all age groups. Also, a non-significant increase in new ED prescription drugs was detected across all age groups.

CONCLUSIONS

Even though less urology practice-visits of men with ED were recorded during the COVID-19 pandemic, an increase of new ED diagnosis was observed across all age groups between April 2020 and March 2021.

Barriers and facilitators to health care access for people experiencing homelessness in four European countries: an exploratory qualitative study

BACKGROUND

People experiencing homelessness (PEH) are known to be at higher risk of adverse health outcomes and premature mortality when compared to the housed population and often face significant barriers when attempting to access health services. This study aimed to better understand the specific health care needs of PEH and the barriers and facilitators associated with their timely and equitable access to health services in the European context.

METHODS

We conducted an exploratory cross-national qualitative study involving people with lived experience of homelessness and health and social care professionals in Austria, Greece, Spain, and the UK. A total of 69 semi-structured interviews comprising 15 social care professionals, 19 health care professionals, and 35 PEH were completed, transcribed, and analysed thematically.

RESULTS

Findings were organised into three overarching themes relating to the research question: (a) Health care needs of PEH, (b) Barriers to health care access, and (c) Facilitators to health care access. Overall, the general health of PEH was depicted as extremely poor, and mainstream health services were portrayed as ill-equipped to respond to the needs of this population. Adopting tailored approaches to care, especially involving trusted professionals in the delivery of care, was identified as a key strategy for overcoming existing barriers.

CONCLUSIONS

The results of this study indicate there to be a high degree of consistency in the health care needs of PEH and the barriers and facilitators associated with their access to health care across the various European settings. Homelessness in itself is recognized to represent an essential social determinant of health, with PEH at risk of unequal access to health services. Changes are thus required to facilitate PEH's access to mainstream primary care. This can also be further complemented by investment in 'in-reach' services and other tailored and person-centred forms of health care.

TRIAL REGISTRATION

This study was registered retrospectively on June 6, 2022, in the registry of ClinicalTrials.gov under the number NCT05406687.

Unequally Unequal? Contextual-level status inequality and social cohesion moderating the association between individual-level socioeconomic position and systemic chronic inflammation

BACKGROUND

Status inequality is hypothesised to increase socioeconomic inequalities in health by creating an environment in which social cohesion erodes and social comparisons intensify. Such an environment may cause systemic chronic inflammation. Although these are often-used explanations in social epidemiology, empirical tests remain rare.

METHODS

We analysed data from the West of Scotland Twenty-07 Study. Our sample consisted of 1977 participants in 499 small residential areas. Systemic chronic inflammation was measured by high-sensitivity C-reactive protein (hs-CRP; <10 mg/L). An area-level measurement of status inequality was created using census data and contextual-level social cohesion was measured applying ecometrics. We estimated linear multilevel models with cross-level interactions between socioeconomic position (SEP), status inequality, and social cohesion adjusted for age and gender. Our main analysis on postcode sector-level was re-estimated on three smaller spatial levels.

RESULTS

The difference in hs-CRP between disadvantaged and advantaged SEPs (0.806 mg/L; p = 0.063; [95%CI: -0.044; 1.656]) was highest among participants living in areas where most residents were in advantaged SEPs. In these status distributions, high social cohesion was associated with a shallower socioeconomic gradient in hs-CRP and low social cohesion was associated with a steeper gradient. In areas with an equal mix of SEPs or most residents in disadvantaged SEPs, the estimated difference in hs-CRP between disadvantaged and advantaged SEPs was -0.039 mg/L (p = 0.898; [95%CI: 0.644; 0.566]) and -0.257 mg/L (p = 0.568; [95%CI: 1.139; 0.625]) respectively. In these status distributions, the gradient in hs-CRP appeared steeper when social cohesion was high and potentially reversed when social cohesion was low. Results were broadly consistent when using area-levels smaller than postcode sectors.

CONCLUSIONS

Inequalities in hs-CRP were greatest among participants living in areas wherein a majority of residents were in advantaged SEPs and social cohesion was low. In other combinations of these contextual characteristics, inequalities in systemic chronic inflammation were not detectable or potentially even reversed.

Cancer risk factors and access to cancer prevention services for people experiencing homelessness: a scoping review protocol

INTRODUCTION

Homelessness is a complex social issue that significantly impairs the health of those affected. People experiencing homelessness (PEH) have a higher prevalence of adverse health outcomes, including premature mortality, compared with the general population, with cancer being the second-leading cause of death. The objective of this scoping review is to map the evidence to assess the exposure of PEH to known cancer risk factors and identify barriers and facilitators PEH experience in accessing cancer prevention services.

METHODS AND ANALYSIS

This scoping review will be conducted in line with the Joanna Briggs Institute guidelines for scoping reviews. For a time window from the date of database establishment until 20 February 2023, the research team will create a detailed search strategy and apply it to the following databases: CINAHL, Embase, Global Index Medicus, PubMed, Scopus and Web of Science. In addition, we will search OpenGrey and Google for grey literature and contact non-governmental organisations to request relevant reports. In the first stage, eligibility criteria will be assessed through a blinded title/abstract assessment, and following this assessment, a full-text screening will be performed. Subsequently, the research team will perform the data extraction and synthesise all relevant information in relation to the scoping review question.

ETHICS AND DISSEMINATION

As this protocol does not involve gathering primary data, ethical approval is not necessary. The results of this review will be published in a peer-reviewed journal and on institutional websites.

Access to cancer preventive care and program considerations for people experiencing homelessness across four European countries: an exploratory qualitative study

Background

People experiencing homelessness (PEH) have a higher prevalence of adverse health outcomes and premature mortality compared to the non-homeless population. These include a higher burden of cancer and cancer-specific morbidity and mortality-outcomes that may be a consequence of significant barriers to accessing primary and secondary prevention and community health services. This study aimed to better comprehend the health needs and barriers to accessing preventive cancer care for PEH across four European countries as well as necessary considerations for developing interventions around cancer prevention for this population.

Methods

In this exploratory qualitative study, 69 semi-structured interviews were conducted across Austria, Greece, Spain, and the UK, with a sample comprising 15 professionals working in homelessness support services, 19 health professionals, and 35 PEH. Interviews took place between August 1 and October 31, 2021, and data were analysed inductively and iteratively following a thematic approach.

Findings

Findings were organised into two overarching themes: (1) Experiences and understanding of cancer prevention and treatment and (2) Considerations for program interventions. While cancer was a significant worry among PEH across all settings, they generally had minimal knowledge and understanding of cancer symptoms and prevention. Specific programs for cancer prevention for PEH were described as almost non-existent. Health professionals in some settings indicated that cancer in PEH was often missed in the early stages and instead diagnosed when the severity of symptoms intensified.

Interpretation

Overall, our findings indicate many commonalities in the health needs of PEH and the barriers they face when they seek access to cancer-specific healthcare services in the European context.

Funding

This study received funding from the European Union's Horizon 2020 Research and Innovation Programme under GA 965351.

Exchanging screen for non-screen sitting time or physical activity might attenuate depression and anxiety: A cross-sectional isotemporal analysis during early pandemics in South America

OBJECTIVES

To examine the theoretical substitutions of screen exposure, non-screen sitting time, moderate and vigorous physical activity with depressive and anxiety symptoms in South American adults during the COVID-19 pandemic.

DESIGN

A cross-sectional study during the first months of the COVID-19 pandemic with data from 1981 adults from Chile, Argentina, and Brazil.

METHODS

Depressive and anxiety symptoms were assessed using the Beck Depression and Anxiety Inventories. Participants also reported physical activity, sitting time, screen exposure, sociodemographic, and tobacco use data. Isotemporal substitution models were created using multivariable linear regression methods.

RESULTS

Vigorous physical activity, moderate physical activity, and screen exposure were independently associated with depression and anxiety symptoms. In adjusted isotemporal substitution models, replacing 10 min/day of either screen exposure or non-screen sitting time with any intensity of physical activity was associated with lower levels of depressive symptoms. Improvements in anxiety symptoms were found when reallocating either screen exposure or non-screen sitting time to moderate physical activity. Furthermore, replacing 10 min/day of screen exposure with non-screen sitting time was beneficially associated with anxiety (B = -0.033; 95 % CI = -0.059, -0.006) and depression (B = -0.026; 95 % CI = -0.050, -0.002).

CONCLUSIONS

Replacement of screen exposure with any intensity of physical activity or non-screen sitting time could improve mental health symptoms. Strategies aiming to reduce depressive and anxiety symptoms highlight physical activity promotion. However, future interventions should explore specific sedentary behaviors as some will relate positively while others negatively.

The impact of urinary incontinence on multiple health outcomes: an umbrella review of meta-analysis of observational studies

BACKGROUND AND AIM

We aimed to capture the breadth of health outcomes that have been associated with the presence of Urinary Incontinence (UI) and systematically assess the quality, strength, and credibility of these associations through an umbrella review and integrated meta-analyses.

METHODS

We assessed meta-analyses of observational studies based on random-effect summary effect sizes and their p-values, 95% prediction intervals, heterogeneity, small-study effects, and excess significance. We graded the evidence from convincing (Class I) to weak (Class IV).

RESULTS AND DISCUSSION

From 3172 articles returned in search of the literature, 9 systematic reviews were included with a total of 41 outcomes. Overall, 37 out of the 41 outcomes reported nominally significant summary results (p < 0.05), with 22 associations surviving the application of a more stringent p-value (p < 10^-6). UI was associated with worse scores than controls in female sexual function (Class II), while it was also associated with a higher prevalence of depression (odds ratio [OR] = 1.815; 95% confidence interval [CI]: 1.551-2.124), and anxiety (OR = 1.498; 95% CI: 1.273-1.762) (Class IV). UI was associated with poorer quality of life (QoL), higher rate of mortality (hazard ratio = 2.392; 95% CI: 2.053-2.787) an increase in falls, frailty, pressure ulcers, diabetes, arthritis, and fecal incontinence (Class IV).

CONCLUSIONS

UI is associated with female sexual dysfunction, with highly suggestive evidence. However, the evidence of other adverse outcomes including depression, anxiety, poorer QoL, higher mortality, falls, pressure ulcers, diabetes, arthritis, fecal incontinence, and frailty is only weak. A multidimensional approach should be taken in managing UI in the clinical setting.

Integrated Care as a Model for Interprofessional Disease Management and the Benefits for People Living with HIV/AIDS

INTRODUCTION

Today, antiretroviral therapy (ART) is effectively used as a lifelong therapy to treat people living with HIV (PLWH) to suppress viral replication. Moreover, PLWH need an adequate care strategy in an interprofessional, networked setting of health care professionals from different disciplines. HIV/AIDS poses challenges to both patients and health care professionals within the framework of care due to frequent visits to physicians, avoidable hospitalizations, comorbidities, complications, and the resulting polypharmacy. The concepts of integrated care (IC) represent sustainable approaches to solving the complex care situation of PLWH.

AIMS

This study aimed to describe the national and international models of integrated care and their benefits regarding PLWH as complex, chronically ill patients in the health care system.

METHODS

We conducted a narrative review of the current national and international innovative models and approaches to integrated care for people with HIV/AIDS. The literature search covered the period between March and November 2022 and was conducted in the databases Cinahl, Cochrane, and Pubmed. Quantitative and qualitative studies, meta-analyses, and reviews were included.

RESULTS

The main findings are the benefits of integrated care (IC) as an interconnected, guideline- and pathway-based multiprofessional, multidisciplinary, patient-centered treatment for PLWH with complex chronic HIV/AIDS. This includes the evidence-based continuity of care with decreased hospitalization, reductions in costly and burdensome duplicate testing, and the saving of overall health care costs. Furthermore, it includes motivation for adherence, the prevention of HIV transmission through unrestricted access to ART, the reduction and timely treatment of comorbidities, the reduction of multimorbidity and polypharmacy, palliative care, and the treatment of chronic pain. IC is initiated, implemented, and financed by health policy in the form of integrated health care, managed care, case and care management, primary care, and general practitioner-centered concepts for the care of PLWH. Integrated care was originally founded in the United States of America. The complexity of HIV/AIDS intensifies as the disease progresses.

CONCLUSIONS

Integrated care focuses on the holistic view of PLWH, considering medical, nursing, psychosocial, and psychiatric needs, as well as the various interactions among them. A comprehensive expansion of integrated care in primary health care settings will not only relieve the burden on hospitals but also significantly improve the patient situation and the outcome of treatment.

Characteristics and Effectiveness of Co-Designed Mental Health Interventions in Primary Care for People Experiencing Homelessness: A Systematic Review

People experiencing homelessness (PEH) face a disproportionately high prevalence of adverse mental health outcomes compared with the non-homeless population and are known to utilize primary healthcare services less frequently while seeking help in emergency care facilities. Given that primary health services are more efficient and cost-saving, services with a focus on mental health that are co-designed with the participation of users can tackle this problem. Hence, we aimed to synthesize the current evidence of such interventions to assess and summarize the characteristics and effectiveness of co-designed primary mental healthcare services geared towards adult PEH. Out of a total of 10,428 identified records, four articles were found to be eligible to be included in this review. Our findings show that co-designed interventions positively impacted PEH's mental health and housing situation or reduced hospital and emergency department admissions and increased primary care utilization. Therefore, co-designed mental health interventions appear a promising way of providing PEH with continued access to primary mental healthcare. However, as co-designed mental health interventions for PEH can improve overall mental health, quality of life, housing, and acute service utilization, more research is needed.

Barriers to access cancer prevention services for the homeless population in four European countries

Background

People experiencing homelessness (PEH) are known to have increased burden of cancer and higher cancer-related mortality when compared to the general population. These outcomes are linked to a variety of etiological factors, as well as the existence of significant barriers in accessing cancer prevention services. The aim of this study was to better understand current practices and knowledge relating to cancer prevention among PEH, health professionals and social care workers.

Methods

During autumn 2021, a cross-national qualitative study was conducted within the framework of the Horizon 2020 funded CANCERLESS project. Data were collected in Austria, Greece, Spain and the UK through semi-structured interviews. Interviews were transcribed verbatim and thematically analyzed in accordance with the approach set out by Saldaña (2021).

Results

In total, 69 interviews were conducted with a sample comprising 15 professionals working in homelessness support services, 19 health professionals, and 35 PEH. Two overarching themes relating to the research question were identified, namely (a) experiences and understanding of cancer prevention and treatment, and (b) considerations for program intervention. While cancer was a major source of concern, tailored cancer prevention programs for the homeless population were described as effectively non-existent, and very few homeless participants recalled being invited to a screening appointment. Health professionals also indicated that because of barriers to health care, opportunities for the early diagnosis of cancer among PEH were often being missed.

Conclusions

The results indicate that PEH have limited knowledge around the importance of cancer prevention programs, and that more focused input on the part of health and social care services is required in this area. Culturally sensitive and person-centered approaches should be adopted to facilitate access to cancer prevention for PEH.

Key messages

• Specialized cancer prevention and health care pathways that take account of the living conditions and support needs of PEH should be established to improve health and cancer-related outcomes.

• Cancer prevention programs should focus on improving health literacy by using accessible and tailored approaches, both for PEH and those that work directly with the homeless population.

Application of the patient navigation model with people experiencing homelessness: a scoping review

Background

Barriers in accessing healthcare services are a common issue that contributes to the disproportionately poor health outcomes in people who experience homelessness. A possible way to overcome these barriers and meaningfully engage with this under-served population is through the implementation of the so called patient navigation (PN) models. We conducted a systematic scoping review to gain a better understanding on how PN models are utilized with people experiencing homelessness and other comparable populations and to identify their features, barriers and facilitators to their implementation and their outcomes.

Methods

A systematic scoping review was done based on a predetermined protocol. We conducted a search of Web of Science, PubMed/Medline and Scopus databases on the 15th of June 2021. A narrative analysis of the included studies was conducted.

Results

Our search yielded 1203 hits, and after removing 475 duplicates, we were left with 728 publications of interest. Finally, 21 studies have been included in the review, comprising of nine review articles and 12 individual studies, with most studies stemming from the USA. Results show that PN models are consistently associated with improvements in a wide range of health related outcomes, mostly with timely access to healthcare services. Implementation strategies and measurements used in assessing PN models show heterogeneity between studies. However, a number of consistencies were found including; a longitudinal approach, using of non-clinical navigators who share similarities to the participant groups and who engage as facilitators. Additional considerations for gender and age may further improve the outcomes.

Conclusions

In order to improve on the success of the PN models and their application in removing barriers to healthcare access for people experiencing homelessness, more research is needed that focuses on the feasibility, acceptability and scalability of the approach outside the USA.

Key messages

• People experiencing homelessness experience considerable barriers in accessing healthcare service leading to disproportionately larger burden of disease as well as lower life expectancy.

• Patient navigation models have a great potential in removing barriers and facilitating timely access to healthcare services in people experiencing homelessness.

Barriers and facilitators to healthcare access for homeless people in four European countries

Background

People experiencing homelessness (PEH) have higher prevalence of adverse health outcomes and premature mortality compared to the general population, and often experience significant barriers in accessing healthcare services. This study aimed to better understand the health needs of PEH, as well as to identify the barriers and facilitators to their timely and equitable access to health services from the perspective of PEH and relevant health professionals and social care workers.

Methods

During autumn 2021, a cross-national qualitative study was conducted within the framework of the Horizon 2020 funded CANCERLESS project. Semi-structured interviews were conducted across four European settings (Austria, Greece, Spain and the UK). Interviews were audio-recorded, transcribed verbatim and analyzed according to the inductive thematic approach set out by Saldaña (2021).

Results

In total, 69 interviews were completed with a sample comprising 15 professionals working in homelessness support services, 19 health professionals, and 35 PEH. Three overarching themes relating to the research question were identified: (a) Health needs of people experiencing homelessness; (b) Barriers to access healthcare services and (c) Facilitators to access healthcare services. Overall, the general health of PEH was depicted as extremely poor and mainstream health services were portrayed as ill-equipped to respond to the needs of this population, with many organizational and system-level barriers noted. Tailored approaches to care, and in particular involving trusted professionals in the delivery of care, were identified as a key strategy for overcoming existing barriers.

Conclusions

While a number of context-specific findings were identified, results indicated there to be a high degree of overlap and consistency in the health needs of PEH, and in the barriers and facilitators that exist when accessing healthcare across four different healthcare systems.

Key messages

• Homelessness is a determinant of health that is linked to poor health outcomes. Tailored approaches that draw upon trusting relationships have the potential to overcome this problem.

• The array of identified barriers indicates that general healthcare services are not currently structured in a way that facilitates timely and equitable access and appropriate care for PEH.

Involvement, Perception, and Understanding as Determinants for Patient-Physician Relationship and Their Association with Adherence: A Questionnaire Survey among People Living with HIV and Antiretroviral Therapy in Austria

BACKGROUND

The relationship between patients and healthcare professionals (physicians) is the cornerstone of successful long-term antiretroviral therapy for people living with human immunodeficiency virus (HIV).

PURPOSE

This study aimed to investigate the connection between involvement, perception, and understanding as the basis for the patient-physician relationship and drug adherence, measured as the probability of non-adherence.

METHODS

In an online survey, people with HIV were asked about their relationship with their physicians and the extent to which they felt involved in treatment-related decisions. A statistical analysis was conducted to determine whether a better patient-physician relationship was associated with higher adherence to therapy. This was performed by univariate group comparison (Mann-Whitney-U, Fishers Exact Test) and logistic regression.

RESULTS

A total of 303 persons living with HIV participated in the survey, and 257 patients were included in the analysis. Overall, 27.6% were classified as non-adherent and self-reporting based on whether an antiretroviral therapy (ART) was taken in the past or how often the ART was interrupted. This proportion was significantly higher among patients aged 50-74 years (39.7%) and those with a longer therapy duration (9-15 years: 46.6%; from 15 years on: 55.8%). Therapy-non-adherent patients showed significantly lower scores in the relationship aspects understanding (2.68 vs. 3.03), participation (2.63 vs. 3.07), and perception (3.00 vs. 3.24) compared to adherent patients. Logistic regression analysis confirms that higher scores for understanding, involvement, and perception are strongly associated with a reduction in the risk of becoming non-adherent. This was true for all examined regression models, regardless of whether they were adjusted for the length of therapy and socio-demographic characteristics.

CONCLUSION

The results reinforce the need for awareness among health care professionals (HCP) regarding understanding, involvement, and perception as important aspects to improve the quality of the patient-physician relationship for high adherence levels with maximized non-adherence in ART management by PLWH.

Association of food insecurity with suicidal ideation and suicide attempts in adults aged ≥50 years from low- and middle-income countries

BACKGROUND

The aim of the present study was to investigate associations between food insecurity with suicidal ideation and suicide attempts in adults aged ≥50 years from six low- and middle-income countries (LMICs).

METHODS

Cross-sectional, community-based data from the World Health Organisation's Study on Global Aging and Adult Health were analyzed. Self-reported information on past 12-month suicidal ideation and suicide attempts was collected. Past 12-month food insecurity was assessed with two questions on frequency of eating less and hunger due to lack of food. Multivariable logistic regression analysis was conducted to assess the association between food insecurity and suicidal ideation or suicide attempts.

RESULTS

The final analytical sample included 34,129 individuals aged ≥50 years [mean (SD) age 62.4 (16.0) years; 52.1% females]. Compared to no food insecurity, severe food insecurity was associated with a significant 2.78 (95%CI = 1.73-4.45) times higher odds for suicidal ideation, while moderate and severe food insecurity were associated with 2.59 (95%CI = 1.35-4.97) and 5.15 (95%CI = 2.52-10.53) times higher odds for suicide attempts, respectively.

LIMITATIONS

The cross-sectional design, the use of self-reported wish to die as a measure of suicide ideation, and that suicidal ideation and suicide attempts were only assessed among those who had depressive symptoms, could be considered limitations of our study.

CONCLUSIONS

Food insecurity was positively associated with suicidal ideation and suicide attempts. Targeting food insecurity among older adults in LMICs may lead to reduction in suicidal ideation and suicide attempts, although future longitudinal studies are warranted to confirm this.

Associations of handgrip strength with all-cause and cancer mortality in older adults: a prospective cohort study in 28 countries

Background

mixed evidence exists on the association between muscle strength and mortality in older adults, in particular for cancer mortality.

Aim

to examine the dose–response association of objectively handgrip strength with all-cause and cancer mortality.

Study Design and Setting

data from consecutive waves from the Survey of Health, Ageing and Retirement in Europe comprising 27 European countries and Israel were retrieved. Overall, 54,807 men (45.2%; 128,753 observations) and 66,576 women (54.8%; 159,591 observations) aged 64.0 (SD 9.6) and 63.9 (SD 10.2) years, respectively, were included. Cox regression and Fine-Grey sub-distribution method were conducted.

Results

during the follow-up period (896,836 person-year), the fully adjusted model showed the lowest significant risk estimates for the highest third of handgrip strength when compared with the first third (reference) in men (hazard ratio [HR], 0.41; 95% confidence interval [CI], 0.34–0.50) and women (HR, 0.38; 95% CI, 0.30–0.49) for all-cause mortality. We identified a maximal threshold for reducing the risk of all-cause mortality for men (42 kg) and women (25 kg), as well as a linear dose–response association in participants aged 65 or over. No robust association for cancer mortality was observed.

Conclusion

these results indicate an inverse dose–response association between incremental levels of handgrip and all-cause mortality in older adults up to 42 kg for men and 25 kg for women, and a full linear association for participants aged 65 years or over. These findings warrant preventive strategies for older adults with low levels of handgrip strength.

Association between back and neck pain and workplace absenteeism in the USA: the role played by walking, standing, and sitting difficulties

PURPOSE

There is a paucity of literature identifying factors that influence the back and neck pain (BNP)-workplace absenteeism relationship. Therefore, this study aimed to investigate the association between BNP and workplace absenteeism and potential mediating variables in a large sample of the US population.

METHODS

Nationally representative data collected in 2019 from the RAND American Life Panel (ALP) were used for this retrospective study. Workplace absenteeism was defined as the number of days of absence in the past 12 months for health-related reasons (count variable), while BNP corresponded to the presence of back pain due to spinal stenosis, back pain due to other causes, or neck pain (dichotomous variable). Control variables included sex, age, ethnicity, marital status, education, occupation, annual family income, health insurance, obesity, and diabetes. There were eight influential variables (depression, anxiety, sleep disorder, alcohol dependence, opioid dependence, walking difficulty, standing difficulty, and sitting difficulty). The association between BNP and workplace absenteeism was analyzed using a negative binomial regression model.

RESULTS

There were 1,471 adults aged 22-83 years included in this study (52.9% of men; mean [standard deviation] age 44.5 [13.0] years). After adjusting for control variables, BNP was positively and significantly associated with workplace absenteeism (incidence rate ratio = 1.40, 95% confidence interval: 1.07-1.83). Walking, standing, and sitting difficulties individually explained between 24 and 43% of this association.

CONCLUSIONS

Workplace interventions focusing on the management of BNP and overcoming difficulties in walking, standing, and sitting, potentially utilizing exercise, therapy, and ergonomic interventions, may prevent absenteeism.

Changes in Health-Related Behaviours and Mental Health in a UK Public Sample during the First Set of COVID-19 Public Health Restrictions

Public health restrictions, in response to the COVID-19 pandemic, have had potentially wide-ranging, unintended effects on health-related behaviours such as diet and physical activity and also affected mental health due to reduced social interactions. This study explored how health-related behaviours and mental health were impacted in a sample of the UK public during the first set of COVID-19 public health restrictions. Two online surveys were administered in the UK, one within the first three months of the restrictions (Timepoints 1 (T1—involving pre-pandemic recall) and 2/T2) and another ten weeks later (Timepoint 3/T3). Moderate−vigorous physical activity (MVPA), outdoor time, sitting time, screen time and sexual activity were self-reported. Diet was assessed using the Dietary Instrument for Nutrition Education questionnaire. Mental health was measured using the short-form Warwick−Edinburgh Mental Wellbeing Scale and Becks’ Anxiety and Depression Inventories. Differences between timepoints were explored using the Friedman, Wilcoxon signed-rank, McNemar and McNemar−Bowker tests. Two hundred and ninety-six adults (74% under 65 years old; 65% female) provided data across all timepoints. Between T1 and T2, MVPA, time outdoors and sexual activity decreased while sitting, and screen time increased (p < 0.05). Between T2 and T3, saturated fat intake, MVPA, time outdoors, and mental wellbeing increased while sitting, screen time and anxiety symptoms decreased (p < 0.05). This study found that depending on the level of COVID-19 public health restrictions in place, there appeared to be a varying impact on different health-related behaviours and mental health. As countries emerge from restrictions, it is prudent to direct necessary resources to address these important public health issues.

The challenges of measuring social cohesion in public health research: A systematic review and ecometric meta-analysis

The relationship between social cohesion and health has been studied for decades. Yet, due to the contextual nature of this concept, measuring social cohesion remains challenging. Using a meta-analytical framework, this review's goal was to study the ecometric measurement properties of social cohesion in order to describe dissimilarities in its measurement as well as bring a new perspective on the empirical usefulness of the concept itself. To this end, we analysed if, and to what extent, contextual-level reliability and intersubjective agreement of 78 social cohesion measurements varied under different measurement conditions like measurement instrument, spatial unit, ecometric model specification, or region. We found consistent evidence for the contextual nature of social cohesion, however, most variation existed between individuals, not contexts. While contextual dependence in response behaviour was fairly insensitive to item choices, population size within chosen spatial units of social cohesion measurements mattered. Somewhat counterintuitively, using spatial units with, on average, fewer residents did not yield systematically superior ecometric properties. Instead, our results underline that precise theory about the relevant contextual units of causal relationships between social cohesion and health is vital and cannot be replaced by empirical analysis. Although adjustment for respondent's characteristics had only small effects on ecometric properties, potential pitfalls of this analytic strategy are discussed in this paper. Finally, acknowledging the sensitivity of measuring social cohesion, we derived recommendations for future studies investigating the effects of contextual-level social characteristics on health.

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Social cohesion aims to describe aspects of the social environment we live in but its measurement remains challenging.

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We meta-analysed the ecometric properties of 78 social cohesion measurements.

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There is modest but consistent evidence for the contextual nature of social cohesion.

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Contextual dependence in individual response behaviour is sensitive to the chosen spatial unit.

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Meta-ecometrics studies the empirical usefulness of theoretical concepts aiming to describe social environments.

Social environmental impact of COVID-19 and erectile dysfunction: an explorative review

BACKGROUND

To date, no attempt has been made to collate literature on the relationship between the social environmental impact of COVID-19 and erectile dysfunction. The aim of this explorative review was to assess and compare the prevalence of erectile dysfunction (ED) in male healthcare workers and males during the COVID-19 pandemic.

METHODS

A systematic review of major databases from inception to February 2021 was conducted. Prevalence data were extracted, and a random-effects meta-analysis was undertaken.

OUTCOMES

The pooled prevalence of ED amongst healthcare workers working in COVID-19 specific environments, and non-healthcare during the COVID-19 pandemic.

RESULTS

Of 52 initial studies, six were included for the final analysis. The pooled prevalence of ED in healthcare workers working in a COVID-19 environment was 63.6% (95% CI 20.3-92.3%), and in non-healthcare workers during the COVID-19 pandemic was 31.9% (95% CI 19.5-47.6%).

CONCLUSION

The prevalence of ED in healthcare workers working in COVID-19 environments was higher than representative samples and is of concern. Sexual health (and by extension, overall health), should be a priority when considering ways to care for this population. Considering the social environmental impact of COVID-19 on sexual health and in particular on ED, it is important to provide adequate psychological support systems and to promote quality of life with particular attention to sexual health.

A Multicountry Study of the Violence-Related Risk Factors for Early Sexual Debut and Risky Sexual Behavior in Adolescents

Globally, the prevalence of adolescent sexual intercourse and violence is high. However, to date, no study has investigated the association between violence and sexual behavior in a large representative sample of adolescents, while multicountry studies are also lacking. The objective was thus to examine the relationship between being physically attacked and physical fighting with sexual intercourse, multiple sexual partners, and non-condom use among adolescents aged 12 to 15 years from 43 low- and middle-income countries. Cross-sectional data from 127,513 adolescents participating in the Global School-based Student Health Survey 2003-2016 were analyzed. Data on being physically attacked and physical fighting were assessed through self-report. Data on sexual behavior were collected as follows: (a) ever having had intercourse; among those who reported having had intercourse, (b) multiple (≥2) lifetime sexual partners, and (c) condom use in last sexual intercourse. Data were analyzed using multivariable logistic regression analysis with violence as the exposure and sexual behavior as the outcome, with odds ratios being estimated. Physical attack was dose-dependently and significantly associated with all three sexual behavior outcomes with it being associated with 1.42 (95% confidence interval [CI] = [1.16, 1.74]), 2.13 (95% CI = [1.39, 3.27]), and 1.48 (95% CI = [1.10, 2.00]) times higher odds for sexual intercourse, condom non-use, and multiple sex partners, respectively, when the highest category was compared with the lowest (i.e., ≥4 times vs. 0 times). As for physical fights, compared with not being in a fight in the past 12 months, being in a fight ≥4 times was associated with 2.34 (95% CI = [2.03, 2.70]) and 1.98 (95% CI = [1.56, 2.52]) times higher odds for sexual intercourse and multiple sex partners, respectively. In conclusion, in a large global sample of adolescents, physical attack and physical fight were associated with greater risk of engaging in sexual behavior. Multidimensional government programs and policies addressing violence in young adolescents may lead to reduction in early sexual debut and other risky sexual behavior.

Association between Anxious and Depressive Symptomatology and Sexual Activity in Spain: A Cross-Sectional Study during the COVID-19 Quarantine

INTRODUCTION

Evidence on sexual behaviour and COVID-19 shows a change in sexual habits; however, there is no research on the association between mental health and sexual activity.

AIM

To examine the relationship between mental health and sexual activity during the quarantine in Spanish adults.

METHODS

A sample of 305 adults filled out an online questionnaire. Sexual activity was assessed with one question. Anxiety and depression symptoms were assessed using the Beck Anxiety Inventory (BAI) and the Beck Depression Inventory (BDI), respectively. To check associations between levels of both anxiety and depressive symptoms (exposure) and weekly prevalence of sexual activity (outcome), we conducted multiple logistic regression adjusted for control variables (marital status, employment, average household annual income, place of living, pre-COVID-19 sexual activity, current smoking, current alcohol consumption, chronic physical conditions, chronic psychiatric conditions, physical symptoms, and days of confinement).

RESULTS

Higher depression level was associated with lower weekly sexual activity in a dose-response fashion in the three implemented models. Participants with higher levels of depression were associated with significantly lower sexual activity in the fully adjusted model (OR: 0.09, 95% CI 0.01-0.61). Mild anxiety-level participants consistently presented significantly lower ORs for lower sexual activity than their minimal-anxiety category counterparts. Particularly, the fully adjusted model showed the lower values (OR: 0.40, 95% CI 0.19-0.84).

CONCLUSION

The results of this study support existing evidence stressing the association between mental health and sexual activity in quarantined adults.

Associations between oral health and cancer in a national representative sample of Spanish adults

BACKGROUND

The goal of this study was to investigate the association between several oral health outcomes and cancer in adults living in Spain.

METHODS

Data from the Spanish National Health Survey 2017 were analysed. Seven oral health outcomes (dental caries, dental extraction, dental filling, gingival bleeding, tooth movement, dental material and missing tooth) were assessed with questions with 'yes' and 'no' options. Cancer was assessed and defined with the following yes-no question: 'Have you ever been diagnosed with malignant tumours?'. The relationship of each oral health outcome and the number of poor oral health outcomes with cancer was studied in regression models adjusted for sex, age, marital status, education, smoking and alcohol consumption.

RESULTS

This study included 23 089 participants aged 15-103 years [45.9% of males; mean (standard deviation) age 53.4 (18.9) years]. The prevalence of cancer was 5.0% in the overall population. After adjusting for several potential confounding factors, all oral health outcomes except missing tooth were significantly and positively associated with cancer [odds ratios (ORs) ranging from 1.15 for dental filling to 1.48 for dental extraction]. In addition, there was a positive and significant association between the number of poor oral health outcomes and cancer (OR = 1.16, 95% confidence interval = 1.11-1.22).

CONCLUSIONS

On a nationally representative sample of 23 089 participants in Spain, poorer oral health outcomes were found in participants with history of cancer, with positive associations between several oral health outcomes as well as the number of poor oral health outcomes and cancer.

Experiences of Trans and Non-Binary Patients during Medical Transitioning and Associations with the Patient-Physician Relationship in Austria

Background

Trans and non-binary (TNB) patients confront various issues in the healthcare system and with healthcare workers (HCWs) tasked with navigating complex systems to achieve optimal outcomes. The most time intensive and intimate contact TNB patients have is typically with physicians making the physician-patient relationship instrumental. This study aimed to explore the experiences of patient-physician relationship in TNB patients in Austria in order to identify caveats for future interventions.

Methods

We conducted an exploratory cross-sectional study using an online questionnaire consisting of 86 items including the Patient-Doctor Relationship Questionnaire 9 (PDRQ-9) distributed between June and October 2020 through various organizations working with TNB people. Austrian residents older than 18 who self-identified as TNB and were undergoing or finished medical transitioning were included. Descriptive statistics and linear regression models were applied.

Results

From a total of 91 participants, 58.3% identified as trans, 70.3% were assigned female at birth, and 87.7% were on hormone replacement therapy. Most (58.1%) perceived physicians as the most problematic HCWs, and 60.5% reported having never or rarely been taken seriously in healthcare settings. Linear regression model showed that PDRQ-9 score was associated with a diagnosis of a mental illness (beta=3.88, 95%CI 0.24 - 7.51), quality of life (beta=0.66, 95%CI 0.43 - 0.90), never being taken seriously (beta=11.69, 95%CI 2.91 - 20.47) and being misgendered (beta=-7.64, 95%CI -14.88 - -0.41) by HCWs.

Conclusions

TNB patients in Austria reported negative experiences in the healthcare system, mostly with physicians that often did not take their gender identity seriously or used inappropriate language. Future interventions should focus on increasing transgender care competencies across various components of medical education.

Strategies to challenge discrimination and foster inclusivity for LGBT+Q+ youth in workplaces: a qualitative exploratory study in six European countries

Background

Lesbian, gay, bisexual, trans and queer (LGBT+Q+) youth are highly vulnerable to work-based discrimination, which correlates with poor social, physical and mental health. The European Union funded WE-Project aims to empower LGBT+Q+ youth in Europe through work-based educational interventions. The first leg focused on exploring barriers and facilitators to workplace equality in Austria, Croatia, Serbia, Slovakia, Spain and the United Kingdom, gathering experiences of LGBT+Q+ youth and stakeholders.

Methods

Self-identifying LGBT+Q+ 15-26 year-olds were recruited via social media and diverse organisations for semi-structured interviews, while stakeholders from various institutions were invited to participate in focus group discussions based on standardised interview and discussion guidelines. Transcriptions were coded, categorised and thematically analysed, revealing five themes: societal discrimination influencing work-life, experiences of workplace discrimination, barriers to resolve discrimination, facilitators to overcome discrimination and creation of inclusive strategies.

Results

Overall 56 LGBT+Q+ youth interviewees and 38 stakeholders from 6 European countries were recruited. Facilitators overcoming workplace discrimination and inclusive strategies towards work-based equality for LGBT+Q+ youth were varyingly emphasised and included: clear policies, open communication, staff involvement and inclusive infrastructure, LGBT+Q+ quotas as well as education on diversity in schools and increasing visibility, legal recognition of partnerships, implementing youth centres, and access to counselling.

Conclusions

Results indicate several strategies to consider when designing interventions challenging work-based discrimination of LGBT+Q+ youth. Participating countries differ in social acceptance and legal protections of LGBT+Q+ youth, but experiences and voiced issues are similar, necessitating relevant anti-discrimination interventions throughout Europe.

Alcohol use in self-isolation during the COVID-19 pandemic: a cross-sectional survey in Brazil

OBJECTIVES

To assess alcohol use and perceived change in alcohol consumption (before and during the pandemic) in Brazilians during the COVID-19 pandemic, their correlates, and their associations with depressive, anxiety and co-occurring depressive and anxiety symptoms (D&A).

METHODS

This is a cross-sectional study comprising 992 individuals in self-isolation. A self-report questionnaire was used to assess whether participants were drinking during self-isolation and whether they changed their drinking behavior (drinking less, more, or no change) from before to during the pandemic. D&A symptoms were assessed using the Beck Depression and Anxiety Inventories (BDI and BAI).

RESULTS

A total of 68.5% of participants reported alcohol consumption during the pandemic, and 22.7% of these reported increased alcohol use. Smoking was positively associated with alcohol consumption during the pandemic. Alcohol consumption was associated with anxiety (OR = 1.40, 95%CI 1.06-1.85, p < 0.01) and D&A (OR = 1.38, 95%CI 1.02-1.87, p = 0.033) symptoms.

CONCLUSIONS

Drinking during self-isolation was prevalent and was associated with risk factors for alcohol use disorders. The long-term effects of high drinking rates and increased consumption should be proactively monitored and assessed.

"I Don't Even Want to Come Out": the Suppressed Voices of Our Future and Opening the Lid on Sexual and Gender Minority Youth Workplace Discrimination in Europe: a Qualitative Study

INTRODUCTION

In Europe, young sexual and gender minority (SGM) people continue to face discrimination in the labour sector despite advances in legislation towards their acceptance and equal treatment. Non-discrimination policy strategies helping SGM individuals are not equally enforced in all contexts, making it difficult for many SGM individuals to disclose their identity, hence undermining their health and well-being.

METHODS

Qualitative semi-structured interviews were conducted between October 2020 and February 2021 with 55 SGM youth (18-27 years) having work experience from Austria, Croatia, Serbia, Slovakia, Spain and the UK.

RESULTS

From the analysis, three overarching themes were significant: (1) societal discrimination played a major role in sociocultural factors and policy considerations, (2) workplace discrimination had distinct factors and impacts on SGM individuals and (3) SGM inclusion should use strategies to ensure workplace diversity and equality.

CONCLUSIONS

SGM individuals from contexts of poor acceptance tended to hide their identity in the workplace, while transgender and non-binary individuals were prone to experience force-disclosure and discrimination in all aspects of employment. There is a lack of resolute reaction from policy makers in managing problems faced by SGM people in workplaces. New laws improving the status of SGM people need to be further adopted, staff training should be implemented, and managers are crucial in achieving an inclusive climate in the workplace.Policy ImplicationsIt is essential to implement policies on how to effectively handle problems faced by sexual and gender minority people in the workplace.

Workability, quality of life and cardiovascular risk markers in aging nightshift workers: a pilot study

Background

In aging healthcare professionals, multiple stressors such as night work may affect life and work satisfaction and risk for chronic diseases (e.g. cardiovascular disease [CVD]). In this pilot study we compared workability, quality of life (QoL), and CVD risk markers between night shift and day workers.

Methods

We included 70 hospital employees (mean age 52 ± 4 years, 91.4% female): 32 rotating night shift workers (> 3 nights/month) and 38 permanent day workers. In addition to sociodemographic, lifestyle, and sleep characteristics, we assessed i) workability index (WAI), ii) QoL (World Health Organization Quality of Life [WHOQOL-Bref]) and iii) CVD risk markers, i.e. carotid ultrasound measurements, and biomarkers (NTproBNP, CRP, IL‑6, LDL, ferritin, copper, zinc, and selenium). WAI, QoL, and CVD risk markers were compared between night and day workers. In a subgroup of participants (N = 38) with complete data, we used quantile regression analysis to estimate age and multivariate adjusted differences in biomarker levels.

Results

We found no differences in the domains of QoL (physical health, psychological, social relationships, and environment) and WAI scores between night and day workers. Night shift workers were less likely to report excellent workability than day workers, although differences were not statistically significant. Night shift workers reported more sleep problems (73.1% vs. 55.6%) and tended to have lower zinc levels and higher inflammatory markers (CRP, IL‑6, ferritin), but differences were not significant after adjusting for potential confounders.

Conclusions

Workability, QoL and CVD markers did not significantly differ between rotating night shift and day workers in this small pilot study. Sleep problems and inflammatory marker levels carry implications for occupational health.

Supplementary Information

The online version of this article (10.1007/s00508-021-01928-6) contains supplementary material, which is available to authorized users.

Partner loss and its effect on frailty trajectories: results from the 13-year follow-up Survey of Health, Ageing and Retirement in Europe (SHARE)

BACKGROUND

Frailty is a geriatric syndrome closely linked to a variety of adverse health outcomes. Thus, it is important to identify factors associated with the development of frailty. It was the aim of this study to examine, if, and to what extent partner loss, a highly stressful life event, affects frailty trajectories of community dwelling adults aged 50 or older.

METHODS

Using six waves of panel data from the Survey of Health, Ageing and Retirement in Europe (SHARE), we investigated the effect of partner loss on frailty trajectories estimating growth curve models. Our sample included 183 502 observations of 83 494 community-dwelling individuals aged 50 or older from 21 European countries collected between 2004 and 2017. Frailty was measured using the validated sex-specific SHARE-Frailty-Instrument including muscular weakness, unintended weight loss, decrease in walking capacity, low physical activity and exhaustion.

RESULTS

Our sample contained 79 874 participants who lived in a partnership during their entire observational period and 3620 participants who lost their partner during their observational period. Both men (β=0.184 (95% CI: -0.017 to 0.386), p=0.073) and women (β=0.237 (95% CI: 0.106 to 0.369), p<0.001) showed initial effects of partner loss on frailty, but while only women gradually recovered over time (β=-0.023 (95% CI: -0.039 to -0.008), p=0.002), among men, the effect of partner loss persisted (β<0.001 (95% CI: -0.029 to 0.029), p=0.998).

CONCLUSION

This study revealed that partner loss is followed by elevated frailty. However, while women's frailty tended to recover from partner loss over time, men's frailty remained elevated. Notable individual differences in the response of frailty trajectories to partner loss suggest the existence of effect modifiers.

Utilization of occupational therapy services and relation to survival in people taking dementia-specific medication in Austria-A retrospective population-based study with a 13-year observation period

OBJECTIVES

Evidence-based treatment of dementia includes pharmacological and non-pharmacological methods of which psycho-social interventions are an important component, commonly administered by occupational therapists. The aim of this study was to investigate the utilization of occupational therapy (OT) services and its association with survival in people taking dementia-specific medication in a population-based Austrian dataset compared to a two times as large control group without dementia-specific medication.

METHODS/DESIGN

A retrospective study with a 13-year observation period (2003-2016) was conducted on real-world data. Two stratifications were done and we used descriptive statistics, Chi-squared/Fisher's Exact Tests and survival analyses including three Cox models.

RESULTS

Data from 286,553 participants were analysed. Only 4.5% (n = 12,950) received OT services. In the dementia-medication group (n = 111,033), participants who received OT services (3.6%; n = 4032) had significantly more comorbidities (4.7%) compared to those without OT (3.5%; p < 0.001) and were also more likely to be male (4 vs. 3.5%; p < 0.001). While persons taking dementia-specific medication showed a slightly reduced survival with OT (p < 0.001) compared to those without, the result in the control group without dementia-specific medication showed a slightly better result of the participants who received OT (p < 0.001). The reduced survival in the dementia-medication group with OT is likely to be related to the higher number of comorbidities in this group.

CONCLUSION

People receiving dementia-specific medication were more likely to receive OT if they had additional comorbidities, however our analysis showed that utilization of OT services in Austria was very low indicating an overall insufficient accessibility of OT services for patients who needed it.

Anxiety symptoms and mild cognitive impairment among community-dwelling older adults from low- and middle-income countries

AIM

Anxiety may be a risk factor for mild cognitive impairment (MCI) but there is a scarcity of data on this association especially from low- and middle-income countries (LMICs). Thus, we investigated the association between anxiety and MCI among older adults residing in six LMICs (China, Ghana, India, Mexico, Russia, South Africa), and the mediational effect of sleep problems in this association.

METHODS

Cross-sectional, community-based, nationally representative data from the WHO Study on global AGEing and adult health (SAGE) were analyzed. The definition of MCI was based on the National Institute on Ageing-Alzheimer's Association criteria. Multivariable logistic regression analysis, meta-analysis, and mediation analysis were conducted to assess associations.

RESULTS

The final sample included 32,715 individuals aged ≥50 years with preservation in functional abilities [mean (standard deviation) age 62.1 (15.6) years; 48.3% males]. Country-wise analysis showed a positive association between anxiety and MCI in all countries (OR 1.35-14.33). The pooled estimate based on meta-analysis with random effects was OR=2.27 (95%CI=1.35-3.83). Sleep problems explained 41.1% of this association.

CONCLUSIONS

Older adults with anxiety had higher odds for MCI in LMICs. Future studies should examine whether preventing anxiety or addressing anxiety among individuals with MCI can lead to lower risk for dementia onset in LMICs, while the role of sleep problems in this association should be investigated in detail.

Experiences and Interactions with the Healthcare System in Transgender and Non-Binary Patients in Austria: An Exploratory Cross-Sectional Study

Medical care of transgender and non-binary (TNB) patients if often a complex interdisciplinary effort involving a variety of healthcare workers (HCWs) and services. Physicians not only act as gatekeepers to routine or transitioning therapies but are also HCWs with the most intimate and time-intensive patient interaction, which influences TNB patients' experiences and health behaviors and healthcare utilization. The aim of this study was to investigate the physician-patient relationship in a sample of TNB individuals within the Austrian healthcare system, and explore its associations with sociodemographic, health-, and identity-related characteristics. A cross-sectional study utilizing an 56-item online questionnaire, including the Patient-Doctor Relationship Questionnaire 9 (PDRQ-9), was carried out between June and October 2020. The study involved TNB individuals 18 or older, residing in Austria, and previously or currently undergoing medical transition. In total, 91 participants took part, of whom 33.0% and 25.3% self-identified as trans men and trans women, respectively, and 41.8% as non-binary. Among participants, 82.7% reported being in the process of medical transitioning, 58.1% perceived physicians as the most problematic HCWs, and 60.5% stated having never or rarely been taken seriously in medical settings. Non-binary participants showed significantly lower PDRQ-9 scores, reflecting a worse patient-physician relationship compared to trans male participants. TNB patients in Austria often report negative experiences based on their gender identity. Physicians should be aware of these interactions and reflect potentially harmful behavioral patterns in order to establish unbiased and trustful relations.

Impact of physical activity, protein intake and social network and their combination on the development of frailty

BACKGROUND

Frailty is a geriatric condition associated with adverse health outcomes. As physical inactivity, low protein intake and poor social network are known risk factors, we aimed to assess the influence of these parameters and their interaction in an 11-year follow-up study on a Europe-wide level.

METHODS

Data from the Study on Health, Ageing and Retirement in Europe were used, including 22 226 community-dwelling robust and prefrail persons aged ≥50 years, from 11 countries. Frailty was assessed with the 'Frailty Instrument for Primary care of the Survey of Health, Ageing and Retirement in Europe'. Additionally, self-reported physical activity (PA), protein intake and satisfaction with social network were assessed. The impact of these parameters on the development of frailty was calculated using multivariate cox regressions.

RESULTS

Performing no regular PA, was associated with higher hazards ratio (HRs) for frailty compared with performing regular PA [men: 1.90 (95%CI: 1.50-2.42); women: 1.65 (95%CI: 1.25-2.18)]; HRs for low protein intake were 1.16 (95%CI: 0.93-1.46) for men and 1.05 (95%CI: 0.80-1.37) for women. And HR for poor social network were 0.92 (95%CI: 0.74-1.15) for men and 1.72 (95%CI: 1.31-2.27)] for women. In general, persons with a combination of two of the assessed risk factors had a higher risk for frailty compared with those with no or only one of the risk factors. However, no significant synergy index could be found.

CONCLUSION

The results illustrate the importance of PA, but also of nutritional and social network to prevent frailty.

Moderate to vigorous physical activity and sedentary behavior changes in self-isolating adults during the COVID-19 pandemic in Brazil: a cross-sectional survey exploring correlates

Background

The COVID-19 pandemic imposed major changes on daily-life routine worldwide. To the best of our knowledge, no study quantified the changes on moderate to vigorous physical activity (MVPA) and sedentary behaviors (SB) and its correlates in Brazilians. This study aimed to (i) evaluate the changes (pre versus during pandemic) in time spent in MVPA and SB in self-isolating Brazilians during the COVID-19 pandemic, and (ii) to explore correlates.

Methods

A cross-sectional, retrospective, self-report online web survey, evaluating the time spent in MVPA and SB pre and during the COVID-19 pandemic in self-isolating people in Brazil. Sociodemographic, behavioral, and clinical measures, and time in self-isolation were also obtained. Changes in MVPA and SB and their correlates were explored using generalized estimating equations (GEE). Models were adjusted for covariates.

Results

A total of 877 participants (72.7% women, 53.7% young adults [18-34 years]) were included. Overall, participants reported a 59.7% reduction (95% CI 35.6-82.2) in time spent on MVPA during the pandemic, equivalent to 64.28 (95% CI 36.06-83.33) minutes per day. Time spent in SB increased 42.0% (95% CI 31.7-52.5), corresponding to an increase of 152.3 (95% CI 111.9-192.7) minutes per day. Greater reductions in MVPA and increases in SB were seen in younger adults, those not married, those employed, and those with a self-reported previous diagnosis of a mental disorder.

Conclusions

People in self-isolation significantly reduced MVPA levels and increased SB. Public health strategies are needed to mitigate the impact of self-isolation on MVPA and SB.

Supplementary Information

The online version contains supplementary material available at 10.1007/s11332-021-00788-x.

Laparoscopy in Low-Income Countries: 10-Year Experience and Systematic Literature Review

Laparoscopy is a procedure that ultimately reduces hospital stay time and speeds up post-operative recovery. It is mainly performed in high-income countries but its implementation in many low- and middle-income countries (LMICs) is increasing. However, no aggregate data exist regarding the outcomes of this procedure in resource-limited settings. We retrospectively reviewed all cases of laparoscopy recorded from January 2007 to March 2017 at the Department of Surgery of Beira to assess the related outcomes. Moreover, we performed a systematic review of the laparoscopic practices and outcomes in low-income countries. Data from the Department of Surgery of Beira identified 363 laparoscopic procedures, mainly relating to gynecological diseases, cholelithiasis, and appendicectomy with only a 1.6% complication rate (6 cases) and a 1.9% conversion rate (7 cases) to open surgery. The systematic review showed a pooled risk of overall complications significantly lower in laparoscopic vs. open appendicectomy (OR = 0.43; 95% CI 0.19-0.97; I² = 85.7%) and a significantly lower risk of infection (OR = 0.53; 95% CI 0.43-0.65; I² = 0.00%). The pooled SMD in operation duration in laparoscopic vs. open appendectomy was 0.58 (95% CI -0.00; 1.15; I² = 96.52), while the pooled SMD in hospitalization days was -1.35 (95% CI -1.87; -0.82; I² = 96.41). Laparoscopy is an expensive procedure to adopt as it requires new equipment and specialized trained health workers. However, it could reduce post-operative costs and complications, especially in terms of infections. It is crucial to increase its accessibility, acceptability, and quality particularly in LMICs, especially during this COVID-19 era when the reduction of patient hospitalization is essential.

Associations between workplace characteristics and 'outness' in LGBTI workers in Austria

OBJECTIVES

Lesbian, gay, bisexual, transgender and intersex (LGBTI) individuals are often subjected to negative attitudes in the workplace, which may lead to non-disclosure of their sexual orientation and/or gender identities. We aimed to determine the prevalence of workplace disclosure of sexual or gender identity (ie, 'outness'; being 'out') and to examine its associations with workplace characteristics in LGBTI workers in Austria.

METHODS

This cross-sectional study analysed sociodemographic, work-related and well-being-related data from self-identifying gender and/or sexual minority participants elicited by an online questionnaire between February and June 2017. From the initial 1268 respondents, 1177 (93%) provided complete data and were included in the subsequent analyses.

RESULTS

The largest proportion of the sample were 26-35 years old (39.1%), cisgender gay men (40.0%) in full-time employment (63.9%). Overall, 51.7% of the sample were 'out' at the workplace. Being bisexual (OR=0.46, 95% CI 0.27 to 0.81), the provision of antidiscrimination guidelines in the workplace (OR=0.53, 95% CI 0.32 to 0.90), living alone (OR=0.50, 95% CI 0.32 to 0.79) and in shared households (OR=0.49, 95% CI 0.25 to 0.96) were associated with a decreased likelihood of being 'out' at work.Factors associated with being 'out' at work were being middle aged (36-45 years old; OR=1.74, 95% CI 1.07 to 2.85), having been in employment for >10 years (OR=2.03, 95% CI 1.08 to 3.81), an LGBTI-friendly work environment (OR 1.61, 95% CI 1.36 to 1.91), labour-management antidiscrimination contract (OR=2.02, 95% CI 1.23 to 3.32) and work council protections (OR=1.56, 95% CI 1.04 to 2.36).

CONCLUSIONS

Instating antidiscrimination protections might facilitate 'outness' of LGBTI workers and lead to a better promotion of diversity in the workplace.

Association between food insecurity and fall-related injury among adults aged ≥65 years in low- and middle-income countries: The role of mental health conditions

PURPOSE

We investigated the association between food insecurity and fall-related injury among older adults from six low- and middle-income countries (LMICs), and the extent to which this association is mediated by mental health.

METHODS

Cross-sectional, community-based, nationally representative data from the WHO Study on global AGEing and adult health (SAGE) were analyzed. Past 12-month food insecurity was assessed with two questions on frequency of eating less and hunger due to lack of food. Fall-related injury referred to those that occurred in the past 12 months. Multivariable logistic regression analysis and mediation analysis were conducted to assess associations.

RESULTS

Data on 14,585 adults aged ≥65 years [mean (SD) age 72.5 (11.5) years; 54.9% females] were analyzed. After adjustment for potential confounders, severe food insecurity (versus no food insecurity) was associated with 1.95 (95%CI = 1.11-3.41) times higher odds for fall-related injury. Moderate food insecurity was not significantly associated with fall-related injury (OR = 1.34; 95%CI = 0.81-2.25). The mediation analysis showed that 37.3%, 21.8%, 17.7%, and 14.0% of the association between severe food insecurity and fall-related injury was explained by anxiety, sleep problems, depression, and cognition, respectively.

CONCLUSION

Severe food insecurity was associated with higher odds for injurious falls among older adults in LMICs, and a large proportion of this association may be explained by mental health complications. Interventions to improve mental health among those who are food insecure and a strong focus on societal and government efforts to reduce food insecurity may contribute to a decrease in injurious falls.

Changes in Sitting Time, Screen Exposure and Physical Activity during COVID-19 Lockdown in South American Adults: A Cross-Sectional Study

The worldwide prevalence of insufficient physical activity (PA) and prolonged sedentary behavior (SB) were high before the coronavirus (COVID-19) pandemic. Measures that were taken by governments (such as home confinement) to control the spread of COVID-19 may have affected levels of PA and SB. This cross-sectional study among South American adults during the first months of COVID-19 aims to (i) compare sitting time (ST), screen exposure, moderate PA (MPA), vigorous PA (VPA), and moderate-to-vigorous PA (MVPA) before and during lockdown to sociodemographic correlates and (ii) to assess the impact of lockdown on combinations of groups reporting meeting/not-meeting PA recommendations and engaging/not-engaging excessive ST (≥7 h/day). Bivariate associations, effect sizes, and multivariable linear regressions were used. Adults from Argentina (n = 575) and Chile (n = 730) completed an online survey with questions regarding demographics, lifestyle factors, and chronic diseases. Mean reductions of 42.7 and 22.0 min./day were shown in MPA and VPA, respectively; while increases of 212.4 and 164.3 min./day were observed in screen and ST, respectively. Those who met PA recommendations and spent <7 h/day of ST experienced greatest changes, reporting greater than 3 h/day higher ST and more than 1.5 h/day lower MVPA. Findings from the present study suggest that efforts to promote PA to South American adults during and after COVID-19 restrictions are needed.

Effectiveness of Electronic Cigarettes in Smoking Cessation: A Systematic Review and Meta-analysis

INTRODUCTION

Reports of the effectiveness of e-cigarettes (ECs) for smoking cessation vary across different studies making implementation recommendations hard to attain. We performed a systematic review and meta-analysis to assess the current evidence regarding effectiveness of ECs for smoking cessation.

METHODS

PubMed, PsycInfo, and Embase databases were searched for randomized controlled trials comparing nicotine ECs with non-nicotine ECs or with established smoking cessation interventions (nicotine replacement therapy [NRT] and or counseling) published between 1 January 2014 and 27 June 2020. Data from eligible studies were extracted and used for random-effects meta-analyses (PROSPERO registration number: CRD42019141414).

RESULTS

The search yielded 13 950 publications with 12 studies being identified as eligible for systematic review (N = 8362) and 9 studies for random-effects meta-analyses (range: 30-6006 participants). The proportion of smokers achieving abstinence was 1.71 (95 CI: 1.02-2.84) times higher in nicotine EC users compared with non-nicotine EC users. The proportion of abstinent smokers was 1.69 (95 CI: 1.25-2.27) times higher in EC users compared with participants receiving NRT. EC users showed a 2.04 (95 CI: 0.90-4.64) times higher proportion of abstinent smokers in comparison with participants solely receiving counseling.

CONCLUSIONS

Our results suggest that nicotine ECs may be more effective in smoking cessation when compared with placebo ECs or NRT. When compared with counseling alone, nicotine ECs are more effective short term, but its effectiveness appears to diminish with later follow-ups. Given the small number of studies, heterogeneous design, and the overall moderate to low quality of evidence, it is not possible to offer clear recommendations.

IMPLICATIONS

The results of this study do not allow for a conclusive argument. However, pooling current evidence points toward a potential for ECs as a smoking cessation tool. Though, given the overall quality of evidence, future studies should aim for more clarity in terms of interventions and larger study populations.

Differences in health status, health behaviour and healthcare utilisation between Immigrant and native homeless people in Spain: An exploratory study

Few studies have examined the differences between immigrant and native-born homeless populations. Our aim was to conduct an exploratory study to examine the differences in health status, health behaviour and healthcare utilisation in a sample of Spanish immigrant and native homeless people. Study was conducted in eight different temporary accommodations in the Valencia region in August 2018. Overall, 86 participants were included in the analysis who answered questionnaires concerning socio-demographic characteristics, immigration status, health status and behaviour, healthcare utilisation and experienced discrimination in healthcare and health literacy. In total, 76.7% were men with a mean age of 41.91 (14.17) years, with 60.4% having immigration background with an average of 4.8 (4.2) years since arrival in Spain. No differences were found in the subjective health status, however, native homeless participants reported significantly higher prevalence of heart disease (87.5% vs. 12.5%), hypertension (84.6% vs. 15.4%), psychological illness (63.6% vs. 36.4%) and were also more often smokers (73.5% vs. 28.8%), reported smoking more cigarettes per day (12.0 vs. 7.4) and were more often illegal drug users (17.6% vs. 2.0%). Immigrant participants were significantly more often not insured, reported more problems in healthcare access and had lower rates of visits to general practitioners and less hospital admissions. Differences were also observed in social status with the native homeless more often reporting receiving income, and living in less crowded accommodations. Our results show a variety of issues that the immigrant homeless population in Spain is confronted with that also prevents adequate social inclusion and achieving good health. However, the immigrant population engaged less often in risky health behaviour. More, and continuous, monitoring of social, mental and physical health of the homeless population is necessary. Public health interventions aiming at health promotion in the immigrant homeless populations need to focus on increasing overall social integration.

Prevalence and correlates of body dysmorphic disorder in health club users in the presence vs absence of eating disorder symptomology

PURPOSE

Body dysmorphic disorder (BDD) has been consistently linked with eating disorders, however studies that stratify associations between BDD in subjects with and without eating disorder symptomology are sparse. It was, therefore, the aim of this study to assess correlates of BDD (including social media use, motivations for exercise, exercise addiction, and sexuality) stratified by eating disorder symptomology.

METHODS

Cross-sectional study of 1665 health club users recruited online completed a battery of surveys. BDD prevalence rates were calculated and logistic regression models were created in two sub-samples: indicated or no-indicated eating disorder symptomology.

RESULTS

The key findings showed the prevalence of BDD in participants with indicated-eating disorder symptomology was significantly higher than in participants without indicated-eating disorder symptomology, yielding an odds ratio of 12.23. Furthermore, several correlates were associated with BDD only participants with an absence of eating disorder symptomology (gender, BMI, exercise addiction, exercising for mood improvement, attractiveness and tone), with others being significantly associated with BDD in participants in the presence of indicated eating disorders symptomology (exercising for health and enjoyment, relationship status, and ethnicity).

CONCLUSIONS

This study provides more evidence of the complex relationship that exists between BDD and eating disorders. Furthermore, it is recommended that practitioners working with BDD subjects should screen for eating disorders due to the high morbidity associated with eating disorders.

LEVEL OF EVIDENCE

Level III: case-control analytic study.

Adherence Is More Than Just Being Present: Example of a Lay-Led Home-Based Programme with Physical Exercise, Nutritional Improvement and Social Support, in Prefrail and Frail Community-Dwelling Older Adults

BACKGROUND

Little is known about the implementation of lifestyle interventions in frail, community-dwelling people. This study highlights different domains of adherence to explain an effectively delivered home-based intervention.

METHODS

Eighty prefrail and frail persons (≥65 years) participated in a physical training, nutritional, and social support intervention over 24 weeks. A detailed log book was kept for comprehensive documentation in order to assess adherence and further organizational, exercise, and nutritional parameters.

RESULTS

Participants reached an adherence rate (performed home visits/number of planned visits) of 84.0/80.5% from week 1-12/13-24. Out of those, 59% carried out ≥75% of the offered visits. Older age was associated with a higher adherence rate. A mean of 1.5 (0.6) visits/week (2 were planned) were realized lasting for a mean of 1.5 (0.9) hours (154% of the planned duration). Per visit, 1.2 (0.6) circuits of strength training were performed (60.5% of the planned value) and 0.5 (0.3) nutritional interventions (47%). After twelve months, 4.2% still carried out the home visits regularly and 25.0% occasionally.

CONCLUSION

Adherence is much more than "being there". Adherence rate and category are limited parameters to describe the implementation of a complex lifestyle intervention, therefore a comprehensive documentation is needed.

Association between food insecurity and depression among older adults from low- and middle-income countries

BACKGROUND

To examine the association between self-reported food insecurity and depression in 34,129 individuals aged ≥50 years from six low- and middle-income countries (LMICs) (China, Ghana, India, Mexico, Russia, and South Africa).

METHODS

Cross-sectional, community-based, nationally representative data from the WHO Study on global AGEing and adult health (SAGE) were analyzed. Self-reported past 12-month food insecurity was assessed with two questions on frequency of eating less and hunger due to lack of food. Questions based on the World Mental Health Survey version of the Composite International Diagnostic Interview were used for the endorsement of past 12-month DSM-IV depression. Multivariable logistic regression analysis and meta-analysis were conducted to assess associations.

RESULTS

In total, 34,129 individuals aged ≥50 years [mean (SD) age, 62.4 (16.0) years; 52.1% females] were included in the analysis. Overall, the prevalence of moderate and severe food insecurity was 6.7% and 5.1%, respectively, while the prevalence of depression was 6.0%. Meta-analyses based on countrywise estimates showed that overall, moderate food insecurity (vs. no food insecurity) is associated with a nonsignificant 1.69 (95% confidence interval [CI] = 0.82-3.48) times higher odds for depression, while severe food insecurity is significantly associated with 2.43 (95% CI = 1.65-3.57) times higher odds for depression.

CONCLUSIONS

In this large representative sample of older adults from six LMICs, those with severe food insecurity were over two times more likely to suffer from depression (compared with no food insecurity). Utilizing lay health counselors and psychological interventions may be effective mechanisms to reduce depression among food-insecure populations. Interventions to address food insecurity (e.g., supplemental nutrition programs) may reduce depression at the population level but future longitudinal studies are warranted.

Association between sexual orientation and subjective cognitive complaints in the general population in England

There is a scarcity of literature investigating the association between minority sexual orientations and subjective cognitive complaints (SCC). Therefore, the aim of this study was to investigate the association between identifying as a sexual minority and SCC in a large sample of adults from England. The study further aimed to identify the extent to which the association could be explained by several behavioral, psychological and clinical factors. Cross-sectional data from the 2007 Adult Psychiatric Morbidity Survey (APMS) were analyzed. Sexual orientation was dichotomized into heterosexual and sexual minority orientation. SCC referred to subjective concentration and memory complaints. Control variables included sex, age, ethnicity, marital status, education, employment, and income. Influential factors included smoking status, alcohol dependence, perceived stress, the number of stressful life events, depression, any anxiety disorder, sleep problems, and obesity. This study included 7,400 participants (51.4% women; mean [standard deviation] age 46.3 [18.6] years). After adjusting for control variables, sexual minority orientation was positively and significantly associated with subjective concentration (OR = 1.40, 95% CI = 1.12-1.76) but not memory complaints (OR = 1.19, 95% CI = 0.96-1.47). The number of stressful life events, sleep problems and any anxiety disorder explained 13.4%, 11.0% and 10.9% of the association between sexual orientation and subjective concentration complaints, respectively. In this large sample of English adults, identifying as a sexual minority was significantly associated with subjective concentration complaints, while stressful life events, sleep problems, and anxiety explained a large proportion of the association. Targeted interventions towards sexual minority groups to reduce SCC may be warranted.

COVID-19 Confinement and Sexual Activity in Spain: A Cross-Sectional Study

Restrictions of free movement have been proven effective in tackling the spread of COVID-19 disease. However, sensitive populations submitted to longer periods of restrictions may experience detrimental effects in significant areas of their lifestyle, such as sexual activity. This study examines sexual activity during the COVID-19 confinement in Spain. A survey distributed through an institutional social media profile served to collect data, whereas chi-squared tests, t-tests, analyses of variance, and multiple logistic regression analysis were used to assess differences among sample subgroups. A total of 71.3% adults (N = 536) (72.8% female) reported engaging in sexual activity with a weekly average of 2.39 times (SD = 1.80), with significant differences favoring males, middle age, married/in a domestic relationship (p < 0.001), employed (p < 0.005), medium–high annual household income, living outside the Iberian Peninsula, and smoking and alcohol consumption. Analyses adjusted for the complete set of control variables showed significant odds for a lower prevalence of weekly sexual activity in women (OR = 0.44, 95% CI 0.27–0.72). Interventions to promote sexual activity in confined Spanish adults may focus on groups with lower sexual activity.

Comparison of physical activity levels in Spanish adults with chronic conditions before and during COVID-19 quarantine

Background

This is the first study analysing levels of physical activity in a sample of quarantined adults with chronic conditions. The aim of this study was to compare moderate-intensity and vigorous-intensity physical activity levels in Spanish adults with chronic conditions before and during COVID-19 quarantine.

Methods

A cross-sectional online survey was administered during the COVID-19 quarantine in Spain. A total of 163 participants with chronic conditions (113 females and 47 males; age range 18-64 years) completed the survey. A total of 26 chronic conditions were included. Participants self-reported average minutes/day of moderate and vigorous physical activity before and during quarantine. Differences in moderate-intensity physical activity and vigorous-intensity physical activity levels before and during COVID-19 quarantine (overall, by gender, by age, by number of chronic conditions and by each chronic condition) were assessed by Wilcoxon signed-rank test.

Results

During COVID-19 quarantine, there was a significant decrease of moderate-intensity physical activity in Spanish people with chronic conditions (in both males and females, in those aged 18-24, 25-34, 35-44 and 55-64 years, in those with multimorbidity, in those with one/two chronic condition/s, and in those diagnosed with asthma/hypercholesterolemia/chronic skin disease/hemorrhoids). Also, there was a significant decrease of vigorous-intensity physical activity in Spanish males with chronic conditions and in those with multimorbidity.

Conclusions

These results should be considered to develop effective strategies of physical activity promotion targeting these specific groups when new quarantine or restriction measures are implemented, in order to avoid new significant decreases of physical activity in these vulnerable populations.

Tai Chi for Chronic Illness Management: Synthesizing Current Evidence from Meta-Analyses of Randomized Controlled Trials

An umbrella review of systematic reviews and meta-analyses of randomized controlled trials (RCTs) was conducted to evaluate the existing evidence of Tai Chi as a mind-body exercise for chronic illness management. MEDLINE/PubMed and Embase databases were searched from inception until March 31, 2019, for meta-analyses of at least two RCTs that investigated health outcomes associated with Tai Chi intervention. Evidence of significant outcomes (P value < 0.05) was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. This review identified 45 meta-analyses of RCTs and calculated 142 summary estimates among adults living with 16 types of chronic illnesses. Statistically significant results (P value < 0.05) were identified for 81 of the 142 outcomes (57.0%), of which 45 estimates presenting 30 unique outcomes across 14 chronic illnesses were supported by high (n = 1) or moderate (n = 44) evidence. Moderate evidence suggests that Tai Chi intervention improved physical functions and disease-specific outcomes compared with nonactive controls and improved cardiorespiratory fitness compared with active controls among adults with diverse chronic illnesses. Between-study heterogeneity and publication bias were observed in some meta-analyses.