Inflation and health: a global scoping review

High levels of economic inflation can adversely affect societies and individuals in many ways. Although numerous studies explore the health implications of macroeconomic factors, systematic investigation of the inflation-health nexus has been scarce. We conducted a comprehensive scoping review mapping the literature on inflation and health. From 8923 screened records, 69 empirical studies were analysed. These studies explored a wide range of health-related risk factors (eg, diet, substance use, stress, and violence) and outcomes (eg, life expectancy, mortality, suicidal behaviour, and mental health) linked to inflation, across diverse contexts and timeframes. The findings suggest a predominantly negative effect of inflation on health, with specific socioeconomic groups facing greater risks. Our Review uncovers notable gaps in the literature, particularly in geographical coverage, methodological approaches, and specific health outcomes. Among global socioeconomic and geopolitical shifts, understanding and mitigating the health effects of inflation is of contemporary relevance and merits thorough academic attention.

Measures implemented in the school setting to contain the COVID-19 pandemic

BACKGROUND

More than 767 million coronavirus 2019 (COVID-19) cases and 6.9 million deaths with COVID-19 have been recorded as of August 2023. Several public health and social measures were implemented in schools to contain the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and prevent onward transmission. We built upon methods from a previous Cochrane review to capture current empirical evidence relating to the effectiveness of school measures to limit SARS-CoV-2 transmission.

OBJECTIVES

To provide an updated assessment of the evidence on the effectiveness of measures implemented in the school setting to keep schools open safely during the COVID-19 pandemic.

SEARCH METHODS

We searched the Cochrane COVID-19 Study Register, Educational Resources Information Center, World Health Organization (WHO) COVID-19 Global literature on coronavirus disease database, and the US Department of Veterans Affairs Evidence Synthesis Program COVID-19 Evidence Reviews on 18 February 2022.

SELECTION CRITERIA

Eligible studies focused on measures implemented in the school setting to contain the COVID-19 pandemic, among students (aged 4 to 18 years) or individuals relating to the school, or both. We categorized studies that reported quantitative measures of intervention effectiveness, and studies that assessed the performance of surveillance measures as either 'main' or 'supporting' studies based on design and approach to handling key confounders. We were interested in transmission-related outcomes and intended or unintended consequences.

DATA COLLECTION AND ANALYSIS

Two review authors screened titles, abstracts and full texts. We extracted minimal data for supporting studies. For main studies, one review author extracted comprehensive data and assessed risk of bias, which a second author checked. We narratively synthesized findings for each intervention-comparator-outcome category (body of evidence). Two review authors assessed certainty of evidence.

MAIN RESULTS

The 15 main studies consisted of measures to reduce contacts (4 studies), make contacts safer (7 studies), surveillance and response measures (6 studies; 1 assessed transmission outcomes, 5 assessed performance of surveillance measures), and multicomponent measures (1 study). These main studies assessed outcomes in the school population (12), general population (2), and adults living with a school-attending child (1). Settings included K-12 (kindergarten to grade 12; 9 studies), secondary (3 studies), and K-8 (kindergarten to grade 8; 1 study) schools. Two studies did not clearly report settings. Studies measured transmission-related outcomes (10), performance of surveillance measures (5), and intended and unintended consequences (4). The 15 main studies were based in the WHO Regions of the Americas (12), and the WHO European Region (3). Comparators were more versus less intense measures, single versus multicomponent measures, and measures versus no measures. We organized results into relevant bodies of evidence, or groups of studies relating to the same 'intervention-comparator-outcome' categories. Across all bodies of evidence, certainty of evidence ratings limit our confidence in findings. Where we describe an effect as 'beneficial', the direction of the point estimate of the effect favours the intervention; a 'harmful' effect does not favour the intervention and 'null' shows no effect either way. Measures to reduce contact (4 studies) We grouped studies into 21 bodies of evidence: moderate- (10 bodies), low- (3 bodies), or very low-certainty evidence (8 bodies). The evidence was very low to moderate certainty for beneficial effects of remote versus in-person or hybrid teaching on transmission in the general population. For students and staff, mostly harmful effects were observed when more students participated in remote teaching. Moderate-certainty evidence showed that in the general population there was probably no effect on deaths and a beneficial effect on hospitalizations for remote versus in-person teaching, but no effect for remote versus hybrid teaching. The effects of hybrid teaching, a combination of in-person and remote teaching, were mixed. Very low-certainty evidence showed that there may have been a harmful effect on risk of infection among adults living with a school student for closing playgrounds and cafeterias, a null effect for keeping the same teacher, and a beneficial effect for cancelling extracurricular activities, keeping the same students together and restricting entry for parents and caregivers. Measures to make contact safer (7 studies) We grouped studies into eight bodies of evidence: moderate- (5 bodies), and low-certainty evidence (3 bodies). Low-certainty evidence showed that there may have been a beneficial effect of mask mandates on transmission-related outcomes. Moderate-certainty evidence showed full mandates were probably more beneficial than partial or no mandates. Evidence of a beneficial effect of physical distancing on risk of infection among staff and students was mixed. Moderate-certainty evidence showed that ventilation measures probably reduce cases among staff and students. One study (very low-certainty evidence) found that there may be a beneficial effect of not sharing supplies and increasing desk space on risk of infection for adults living with a school student, but showed there may be a harmful effect of desk shields. Surveillance and response measures (6 studies) We grouped studies into seven bodies of evidence: moderate- (3 bodies), low- (1 body), and very low-certainty evidence (3 bodies). Daily testing strategies to replace or reduce quarantine probably helped to reduce missed school days and decrease the proportion of asymptomatic school contacts testing positive (moderate-certainty evidence). For studies that assessed the performance of surveillance measures, the proportion of cases detected by rapid antigen detection testing ranged from 28.6% to 95.8%, positive predictive value ranged from 24.0% to 100.0% (very low-certainty evidence). There was probably no onward transmission from contacts of a positive case (moderate-certainty evidence) and replacing or shortening quarantine with testing may have reduced missed school days (low-certainty evidence). Multicomponent measures (1 study) Combining multiple measures may have led to a reduction in risk of infection among adults living with a student (very low-certainty evidence).

AUTHORS' CONCLUSIONS

A range of measures can have a beneficial effect on transmission-related outcomes, healthcare utilization and school attendance. We rated the current findings at a higher level of certainty than the original review. Further high-quality research into school measures to control SARS-CoV-2 in a wider variety of contexts is needed to develop a more evidence-based understanding of how to keep schools open safely during COVID-19 or a similar public health emergency.

[Participation in children's hospitals: approaches to participatory formats for paediatric patients]

Based on the UN Convention on the Rights of the Child, children and young people have the right to participate in all matters and decisions that affect them. This applies in particular when they are patients in a children's hospital. In the international context, established formats for the participation of young patients regarding health issues already exist, for example "Children's Councils" or "Young Person's Advisory Groups". In Germany, such approaches are still mostly lacking. It thus remains important to develop suitable formats that enable meaningful and effective participation of young patients in the health system. These formats must be chosen in such a way that they can realistically be implemented in clinical settings as well as in pediatric research, and that they can be sustained in the long term. In order to strengthen the consideration of children's rights in the health system, the advancement of such participatory formats as well as their sustainable implementation and evaluation are desirable.

Stress during pregnancy and fetal serum BDNF in cord blood at birth

INTRODUCTION

Adverse environments during pregnancy impact neurodevelopment including cognitive abilities of the developing children. The mediating biological alterations are not fully understood. Maternal stress may impact the neurotrophic regulation of the offspring as early as in utero and at birth. Brain-derived neurotrophic factor (BDNF) is essential for neurodevelopment. Short-term higher levels of BDNF in mice upon stressors associate with lower BDNF later in life, which itself associates with depression in animals and humans. Stress including glucocorticoids may impact BDNF, but there is a lack of data at birth. This study investigated if stress near term associates with fetal BDNF at birth in humans.

METHODS

Pregnant women near term who underwent primary cesarean sections (at 38.80±0.64 weeks), were included in this study (n=41). Stress at the end of pregnancy was assessed before the cesarean section by determining maternal depressive symptoms (EDPS), maternal state and trait anxiety (STAI-S and STAI-T), maternal prenatal distress (PDQ), stress over the past month (PSS), prenatal attachment to the offspring (PAI), maternal social support (F-Sozu), maternal early life stress (CTQ), socioeconomic status, and the glucocorticoids cortisol and cortisone (n=40) in amniotic fluid at birth. The association with fetal BDNF was analyzed. Cord blood serum of n=34 newborns at birth was analyzed for BDNF and newborn anthropometrics (weight, length and head circumference per gestational age at birth) were assessed. The association of fetal BDNF with anthropometrics at birth was analyzed.

RESULTS

After a BDNF-outlier (>3 SD) was removed, higher fetal BDNF associated significantly with maternal depressive symptoms (r=0.398, p=0.022), with lower socioeconomic status as assessed by the average number of people per room in the household (r=0.526, p=0.002) and with borderline significance with net income per person in the household (r=-0.313, p=0.087) in the bivariate analyses. In multivariable analysis, BDNF stayed positively associated with maternal depressive symptoms (β=0.404, 95% CI [7.057, 306.041], p=0.041) and lower net income per person in the household (β=-0.562, 95% CI [-914.511, -60.523], p=0.027) when controlling for maternal age, maternal pre-pregnancy BMI, fetal sex and gestational age. Fetal BDNF did not associate with newborn anthropometrics with the outlier removed in bivariate analyses or in multivariable analyses when controlling for maternal BMI and fetal sex.

CONCLUSION

Maternal depressive symptoms and lower socioeconomic status associated with higher fetal BDNF when controlling for confounders. Fetal BDNF did not associate with newborn anthropometrics with the outlier removed. Further studies should investigate how early altered BDNF associate with the development and possibly psychopathology of the offspring.

Process evaluation of an integrated community-based intervention for promoting health equity in children in a new residential development area

BACKGROUND

Reducing health inequities for children from a disadvantaged background is an important task in public health. While intersectoral partnerships are a promising way to achieve this, few studies have examined the factors influencing the success of these interventions. In this study, we conducted a process evaluation of the integrated community-based intervention Präventionskette Freiham that the city of Munich, Germany, has implemented in a new residential development area. The aim was to investigate the implementation process as well as barriers and facilitators.

METHODS

Following a mixed methods approach, we collected data from different core groups making up Präventionskette Freiham from April 2020 to August 2022, exploring their perspective on the implementation process. We conducted repeated qualitative interviews with the network coordinators and eleven local professionals from institutions engaged with or relevant for the intervention. We also undertook a focus group with four members of the advisory group representing the three municipal departments guiding the intervention. Ego-centered network maps were drawn by the network coordinators to chart the development of the network. Subsequently, we also conducted an online survey with local network members.

RESULTS

At the early stage of the implementation process, the intervention was able to integrate actors from different sectors, serving as a platform for mutual exchange. However, the network produced limited output. According to the interviews, this may be mainly attributable to the early development status of the area. We identified seven topics that may act as facilitators or barriers to implementation of Präventionskette Freiham: (1) availability of resources, (2) political and administrative support, (3) the network coordinators, (4) network-internal processes, (5) trans-institutional cooperation, (6) perceived benefits of engagement, and (7) the output of the network.

CONCLUSIONS

The early development status of the area was a challenge for the intervention. This emphasizes the need to carefully consider context when planning and implementing integrated community-based public health interventions in new residential development areas.

Consented indicators for the evaluation of integrated strategies of community health promotion targeting children and adolescents: results of an eDelphi

BACKGROUND

To date, there is no consensus on indicators for the evaluation of integrated community-based interventions for health promotion and prevention targeting children and adolescents. This study aims at consenting on a scoped set of indicators to evaluate integrated community-based interventions.

METHODS

Out of 738 indicators derived from a literature search, we preselected 94 indicators allotted to 20 domains based on an internal quality appraisal and consensus process and conducted an eDelphi procedure to assess their relevance in view of experts. Experts were recruited in the field of public health, health sciences and communal health promotion in practice and were invited as participants in this eDelphi. During the eDelphi, 47 experts rated the relevance of 94 indicators in two rounds. Consensus was defined as agreement of 75% (or above).

RESULTS

After round 1, 27 indicators among 11 consented subdomains reached a consensus on relevance. After round 2, a total of 36 indicators reached consensus on relevance in 9 subdomains (such as socioeconomic factors, health education, nutrition and physical activity, oral health, overall health status, specific health conditions, drug related behavior, exposure to drugs and violence, family factors).

CONCLUSIONS

These identified indicators may provide a basis for evaluation concepts of integrated community-based interventions for children and adolescents to inform stakeholders about intervention impacts.

[Newborn blood spot screening (NBS) in Germany : Status quo and presentation of a concept for further development]

Newborn screening from dried blood spots (NBS) is a highly effective secondary prevention measure that has been established for many years. Against the background of the inclusion of "new diseases" that meet the screening criteria, a concept for the further advancement of NBS was developed on behalf of the GKV-Spitzenverband. This was based on a systematic literature review and a survey of the status quo of NBS in Germany using quantitative and qualitative methods.It is essential for the success of NBS that all newborns affected by a target disease are diagnosed and treated at an early stage and that the harm to be expected with each screening (e.g., due to false positive findings) is kept as low as possible. This requires the organisation of screening in the sense of an integrated programme through central coordination with standardised structures, continuous quality management and digitalisation in line with data protection requirements.Although in general NBS is being implemented successfully in Germany, the research project presented here also reveals weaknesses and a need for action. Proposals and recommendations were compiled in a concept paper, which shows approaches for further development of NBS in line with the current state of research in consideration of changing demands on the infrastructure and processes in the health system. This review article summarises the challenges, current status and possible solutions for the central topics of the concept paper.

A Multimodal Prevention Program for Stress Reduction

BACKGROUND

Stress-reducing preventive measures and the elements of which they are made up have been inadequately studied to date. In this trial, we studied the stress experienced over the twelve months from the beginning of the intervention by subjects who underwent a two-week-long multimodal prevention program for stress reduction with a psycho-educative component, with a refresher at six months, compared to that experienced by subjects in two control groups (CG-B: prevention program without psychoeducation, CG-C: no intervention).

METHODS

Adults with an elevated stress exposure who were at risk of stressinduced health impairment were the subjects of a prospective, three-armed, randomized controlled trial. The subjects who participated in the two preventive programs (IG [intervention group], CG-B) traveled to a health resort. They were blinded with respect to their group assignment and the content of their intervention. The primary outcomes were subjectively experienced stress (Perceived Stress Questionnaire, PSQ) and chronic stress experience (Screening scale of the Trier Inventory for Chronic Stress, TICS-SSCS), assessed one, three, six, and twelve months after the start of the intervention. The groups were compared with univariate and multivariate analyses. Trial registry number: DRKS00011290.

RESULTS

Among 120 candidates who expressed interest in participation and were randomly allotted to one of the three groups, 87 persons (67.8% female) with a mean age of 50.5 years (SD 8.8 years) were included in the study. Subjects in the IG with psychoeducation had a lower degree of perceived stress at twelve months than those in either one of the control groups, with controlling for baseline values, as measured by both of the instruments used: PSQ (ANCOVA: F[2, 77] = 11.77; p < 0.001, strong effect: ηp² = 0.234) and TICS-SSCS (ANCOVA: F[2, 78] = 3.93; p = 0.024, moderate effect: ηp² = 0.091).

CONCLUSION

This exploratory trial reveals a lessening of subjectively experienced stress after participation in a two-part prevention program for stress reduction with a specific psychoeducative component.

[Quality of Life and Return to Work Following Rehabilitation - Results of the icfPROreha Study]

BACKGROUND

Not only the severity of an injury, but also bio-psycho-social factors affect health-related quality of life and participation in social life after severe musculoskeletal injuries.

METHODS

Multicentre prospective longitudinal study with follow-up up to 78 weeks after discharge from inpatient trauma rehabilitation. Data were collected using a comprehensive assessment tool. Quality of life was assessed using the EQ-5D-5L, return to work by patients' self-reports and routine data of health insurances. Analyses of the association between quality of life and return to work, change over time in quality of life compared to the general German population and multivariate analyses to predict quality of life were conducted.

RESULT

Of 612 study participants (444 men (72.5%); M=48.5 years; SD 12.0), 502 (82.0%) returned to work 78 weeks after discharge from inpatient rehabilitation. Quality of life improved during rehabilitation treatment from 50.18 to 64.50 (mean of visual analogue scale of EQ-5D-5L) and slightly to 69.38 78 weeks after discharge from inpatient trauma rehabilitation. EQ-5D index was below the values of the general population. In total, 18 factors were selected to predict quality of life 78 weeks after discharge from inpatient trauma rehabilitation. Among others, pain at rest and suspected anxiety disorder at admission had a very strong effect on quality of life. Contextual factors such as therapies after acute care and self-efficacy also had an effect on quality of life 78 weeks after discharge from inpatient rehabilitation.

CONCLUSION

Bio-psycho-social factors affect long-term quality of life of patients with musculoskeletal injuries. Already at the time of discharge from acute treatment and even more at the beginning of inpatient rehabilitation, decisions can be made in order to achieve the best possible quality of life for those affected.

Mental health in adolescents after experiencing a flood event in Bavaria, Germany-A qualitative interview study

Background

Children and adolescents are particularly vulnerable to the mental health impacts of extreme weather events (EWEs). This qualitative study aims to explore the stressful and protective factors after experiencing an EWE, such as flooding, how adolescents coped with these experiences and what mental health care they received.

Methods

Nine semi-structured interviews were conducted with young adults (18-24 years) living in Simbach am Inn, a German town affected by flooding in 2016. The interviews were analyzed using Kuckartz's qualitative content analysis.

Results

The days after the flood were described as the most stressful time. The main stressors were concern for their family, confrontation with the extent of the damage and uncertainty during the flood. In terms of protective factors, respondents cited talking about the flood, family support and helping with cleanup as the most important. Adolescents requested further mental health care in schools and not just in the immediate aftermath.

Conclusion

Future preventive and therapeutic care measures should be optimized according to protective and stressful factors. Mental health care should be offered after months and should be low-threshold. Additionally, the social environment of adolescents is essential for their mental wellbeing after an EWE and needs to be strengthened.

Interventions to build resilience and to ameliorate negative psychosocial effects of the COVID-19 pandemic on children and adolescents: a systematic review and meta-analysis

The psychosocial health of children and adolescents has been particularly affected by the COVID-19 pandemic. Containment measures have restricted social development, education and recreational activities, may have increased family conflicts and, in many cases, led to feelings of loneliness, sleep disturbances, symptoms of anxiety and depression. We conducted a systematic review to identify interventions that seek to ameliorate these detrimental effects of the COVID-19 pandemic and to build resilience in children and adolescents. Literature searches were conducted in the databases MEDLINE, EMBASE, PsycINFO, CENTRAL, WHO COVID-19 Global literature on coronavirus disease and Cochrane COVID-19 Study Register (up to 30 June 2022). The searches retrieved 9557 records of which we included 13 randomized-controlled trials (RCTs) for evidence synthesis. Included studies predominantly implemented online group sessions for school-aged children with either a psychological component, a physical activity component, or a combination of both. A meta-analysis of seven studies on anxiety and five on depressive symptoms provided evidence for a positive effect of interventions by reducing anxiety (Standardized Mean Difference (SMD) (95% CI): - 0.33 (- 0.59; - 0.06)) and depressive symptoms (SMD (95% CI): - 0.26 (- 0.36; - 0.16)) compared to the control interventions. Studies also showed improvements in positive mental health outcomes, such as resilience (n = 2) and mental and psychological wellbeing (n = 2). Exploratory subgroup analyses suggested a greater effectiveness of interventions that (i) are of higher frequency and duration, (ii) enable personal interaction (face-to-face or virtually), and (iii) include a physical activity component. Almost all studies were judged to be at high risk of bias and showed considerable heterogeneity. Further research may focus on the contribution of different intervention components or distinct subgroups and settings, and should examine children and adolescents over longer follow-up periods.

Strengthening the social resilience of people living at the intersection of precariousness and migration during pandemics: action recommendations developed in Munich, Germany

Introduction

An EU-funded project in five countries examined vulnerability mechanisms during the COVID-19 pandemic. The research team in Germany concentrated on people living at the intersection of migration and precariousness. The study aimed first to provide an understanding of how migrants living in precarious conditions in Munich had been affected by the pandemic, both from their own and from experts' perspectives. The second aim was to develop action recommendations to reduce structural vulnerabilities and increase resilience with a view towards improved pandemic preparedness.

Methods

The study followed a two-phase process. The first was a qualitative study based on interviews with 25 migrants and 13 experts. In the second, researchers developed action recommendations based on the vulnerability/ resilience factors that had been generated in the first phase. Three consecutive meetings with stakeholders (expert panel, focus group discussion with two migrant organization, meeting with the Munich Migration Council) were then held to further strengthen the draft recommendations.

Results

Content analysis revealed twelve vulnerability and eight resilience factors in three domains (COVID-19 prevention; human rights, living and housing environment; social support). Migrants had limited access to COVID-19 prevention measures; living conditions made outbreaks inevitable; uncertainty about legal status, employment, and housing, as well as stigma and discrimination, exacerbated their precariousness; social support had decreased; and resilience mechanisms had failed. The initial draft of recommendations contained 24 proposed actions. The meetings added recommendations such as enhancing psychosocial support, preventing ghettoization, improving social housing, preventing the interruption of language education in times of crisis, severe penalties for media stigmatisation and proactive truth-telling. The final list included 30 actions.

Conclusion

In Munich, the COVID-19 pandemic exacerbated vulnerability mechanisms commonly associated with being a migrant. The recommendations developed here speak to those vulnerabilities but need to be refined further to be more actionable and comprehensive. Nonetheless, the recommendations and the processes that led to them highlight the importance of migrant-inclusive approaches and empowerment in increasing migrants' resilience to future crises.

Health promotion networks in two districts in Bavaria, Germany: an exploratory case study mapping networks with respect to thematic agenda and location

Introduction

Building networks is an essential part of health promotion. However, network analysis remains relatively unexplored in this field. This study introduces a new technique that maps thematic agendas and geographical locations of health promotion actors.

Methods

This case study used elements of quantitative and qualitative methods to analyse network data. We used empirical data from two networks in Bavaria, a federal state of Germany.

Results

We identified a total of 55 actors in the first network and 64 actors in the second. We categorized the thematic agenda of actors according to their main field of work: "healthy childhood development," "healthy middle age phase," "healthy ageing," "health equity in all phases of life." One network showed a significant surplus of actors that focus on "healthy ageing." We combined and analysed data from both networks collectively. Two districts with no health promotion actors within their geographical borders were identified. To put geographical gaps into context, data about deprivation and age was included.

Discussion

Results identified geographical areas with high need for support from health promotion actors. Through comparison of our results with existing literature, we derived potential network strategies for further successful networking. This study adds a new perspective to characterize health promotion networks by mapping them thematically and geographically. The concept can be used to give health promotion organisations relevant insight into network structures. This can improve decision-making processes concerning partnership strategy and finally lead to a positive health impact. Hence, our findings encourage further development of this technique and other networking methods in the field of health equity and health promotion.

Implementing a psychosocial care approach in pediatric inpatient care: process evaluation of the pilot Child Life Specialist program at the University Hospital of Munich, Germany

Background

Child Life Specialists (CLSs) are psychosocial care professionals of child development and health who focus on the individual needs and rights of young patients. CLSs accompany sick children and focus on the children's perspective and their reality of life. CLS programs are already established in clinical settings in the United States and other Anglophone countries but have not yet been piloted in the German health care setting, neither has their implementation been evaluated in this context. This study aimed to explore the factors influencing the implementation of a pilot CLS program in pediatric inpatient care at the Dr. von Hauner Children's Hospital at the University Hospital of Munich, Germany.

Methods

Building on methods commonly employed in the evaluation of complex interventions, we developed a logic model to guide the process evaluation of our program. Semi-structured interviews with four groups of stakeholders were conducted in person or via videoconferencing between June 2021 and January 2022. Data was analyzed collectively using the method of qualitative content analysis by Mayring.

Results

Fifteen individual interviews were conducted with patients (children aged 5-17 years, n = 4), parents (n = 4), CLSs (n = 4) and other health professionals (n = 3). Factors influencing the implementation were identified on three levels: system, staff and intervention. On the system level, a clearer definition of CLSs' tasks and responsibilities was perceived as important and would likely lead to a delineation from other (psychosocial) professions and a reduction of potential resistances. On the staff level, lacking training opportunities and feelings of being insufficiently skilled were limiting the CLSs professional self-confidence. On the intervention level, the emergence of a unique characteristic of the CLSs' work (i.e., preparation for medical procedures) supported the acceptance of the new program.

Conclusions

The implementation of a CLS program into an established hospital system with existing psychosocial care services is challenging. Our results contribute to a better understanding of implementation processes of such an additional psychosocial care approach and provide recommendations for addressing upcoming challenges.

Evaluation of community-based health promotion interventions in children and adolescents in high-income countries: a scoping review on strategies and methods used

BACKGROUND

In recent decades, community-based interventions have been increasingly adopted in the field of health promotion and prevention. While their evaluation is relevant for health researchers, stakeholders and practitioners, conducting these evaluations is also challenging and there are no existing standards yet. The objective of this review is to scope peer-reviewed scientific publications on evaluation approaches used for community-based health promotion interventions. A special focus lies on children and adolescents' prevention.

METHODS

A scoping review of the scientific literature was conducted by searching three bibliographic databases (Medline, EMBASE, PsycINFO). The search strategy encompassed search terms based on the PCC (Population, Concept, Context) scheme. Out of 6,402 identified hits, 44 articles were included in this review.

RESULTS

Out of the 44 articles eligible for this scoping review, the majority reported on studies conducted in the USA (n = 28), the UK (n = 6), Canada (n = 4) and Australia (n = 2). One study each was reported from Belgium, Denmark, Germany and Scotland, respectively. The included studies described interventions that mostly focused on obesity prevention, healthy nutrition promotion or well-being of children and adolescents. Nineteen articles included more than one evaluation design (e.g., process or outcome evaluation). Therefore, in total we identified 65 study designs within the scope of this review. Outcome evaluations often included randomized controlled trials (RCTs; 34.2%) or specific forms of RCTs (cluster RCTs; 9.8%) or quasi-experimental designs (26.8%). Process evaluation was mainly used in cohort (54.2%) and cross-sectional studies (33.3%). Only few articles used established evaluation frameworks or research concepts as a basis for the evaluation.

CONCLUSION

Few studies presented comprehensive evaluation study protocols or approaches with different study designs in one paper. Therefore, holistic evaluation approaches were difficult to retrieve from the classical publication formats. However, these publications would be helpful to further guide public health evaluators, contribute to methodological discussions and to inform stakeholders in research and practice to make decisions based on evaluation results.

Changes in behavior and quality of life in German young children during the COVID-19 pandemic-results from the COVID kids bavaria study

Introduction

The COVID-19 pandemic with its containment measures such as closures of schools and daycare facilities led to numerous restrictions in daily life, putting developmental opportunities and health-related quality of life in children at risk. However, studies show that not every family was impacted equally by the pandemic and that this exceptional health and societal situation reinforced pre-existing health inequalities among the vulnerable. Our study aimed at analyzing changes in behavior and health-related quality of life of children attending elementary schools and daycare facilities in Bavaria, Germany in spring 2021. We also sought to identify associated factors contributing to inequalities in quality of life.

Methods

Data from a multi-center, open cohort study ("COVID Kids Bavaria") conducted in 101 childcare facilities and 69 elementary schools across all electoral districts of Bavaria were analyzed. Children attending these educational settings (aged 3-10 years) were eligible for participation in a survey on changes in behavior and health-related quality of life. The KINDL^R questionnaire (based on children's self-report and parental report) was administered about one year after the onset of the pandemic (spring 2021). Descriptive and logistic regression analyses and comparisons to pre-pandemic KiGGS (German Health Interview and Examination Survey for Children and Adolescents) data were undertaken.

Results

Among respondents, a high percentage of parents reported changes in their children's eating and sleeping behavior, sports and outdoor activities as well as altered screen time. Health-related quality of life in KINDL^R analyses compared to pre-pandemic population averages were lower in all age groups (for 3-6-year-old KINDL^R-total score: COVID Kids Bavaria MD 74.78 ± 10.57 vs KiGGS data 80.0 ± 8.1; 7-10 years-old KINDL^R-total score: COVID Kids Bavaria MD 73.88 ± 12.03 vs KiGGS data 79.30 ± 9.0). No significant differences were detected with regard to associated factors, namely type of institution, sex of the child, migration background, household size and parental education.

Conclusion

These findings suggest a relevant impact of the COVID-19 pandemic on children's behavior and health-related quality of life one year after the onset of the pandemic. Further analyses in large-scale longitudinal studies are needed to determine the effects of specific pandemic or crisis associated factors contributing to health inequalities.

Mental Health Impact of Early Stages of the COVID-19 Pandemic on Individuals with Pre-Existing Mental Disorders: A Systematic Review of Longitudinal Research

In view of disease-related threats, containment measures, and disrupted healthcare, individuals with pre-existing mental illness might be vulnerable to adverse effects of the COVID-19 pandemic. Previous reviews indicated increased mental distress, with limited information on peri-pandemic changes. In this systematic review, we aimed to identify longitudinal research investigating pre- to peri-pandemic and/or peri-pandemic changes of mental health in patients, focusing on the early phase and considering specific diagnoses. PsycINFO, Web of Science, the WHO Global literature on coronavirus disease database, and the Cochrane COVID-19 Study Register weresearched through 31 May 2021. Studies were synthesized using vote counting based on effect direction. We included 40 studies mostly from Western, high-income countries. Findings were heterogeneous, with improving and deteriorating mental health observed compared to pre-pandemic data, partly depending on underlying diagnoses. For peri-pandemic changes, evidence was limited, with some suggestion of recovery of mental distress. Study quality was heterogeneous; only few studies investigated potential moderators (e.g., chronicity of mental illness). Mental health effects on people with pre-existing conditions are heterogeneous within and across diagnoses for pre- to peri-pandemic and peri-pandemic comparisons. To improve mental health services amid future global crises, forthcoming research should understand medium- and long-term effects, controlling for containment measures.

["Child Life Specialist" Interventions in Clinical Pediatric Care: A Systematic Review of the Effects on Mental Health Outcomes of Children and Adolescents]

AIM OF THE STUDY

Hospital stays can lead to psychological stress in children, which is often not sufficiently addressed in standard care. A new approach is to involve specialized psychosocial professionals, designated as Child Life Specialists (CLS), in clinical care in order to strengthen the child's perspective, to cushion burdens through targeted interventions and to promote the well-being of the patients. The aim of this work is to analyze the effects of CLS interventions on fear, pain and stress of children in a clinical context.

METHODS

A systematic literature search was performed in the databases Medline, Embase and PsycINFO. The results are presented in tabular and graphical form.

RESULTS

Four randomized controlled trials (RCTs) were analyzed to investigate the effects of CLS interventions in 459 children aged 0-15 years. Significant improvement in each of the outcome criteria was reported in at least one study. All studies were expected to have a medium to high risk of bias.

CONCLUSION

The included RCTs report positive effects of CLS interventions on outcome variables of mental health of children in the clinical setting. Due to the small number of studies and their heterogeneity and quality, further research is needed.

Epidemiology of hand injuries that presented to a tertiary care facility in Germany: a study including 435 patients

BACKGROUND

Hand injuries compose up to 30% of all injuries in emergency care. However, there is a lack of epidemiological data reflecting patient or accident-related variables, injury types, injured anatomical structures or trauma localization.

OBJECTIVE

The objective of this study is (1) to provide epidemiological information on hand injuries and their patterns and (2) to visualise the frequencies of affected areas of the hand in relation to the most common trauma mechanisms using color-coded heatmaps.

METHODS

This prospective single-center observational trial conducted at a surgical emergency department in Germany collected data of hand trauma patients using a standardized documentation form. Demographic data, trauma-related data, diagnostic and therapeutic measures were analyzed. Color-coded heatmaps were generated marking anatomic danger zones.

RESULTS

435 patients with a mean age of 39.5 were included. Most patients admitted on their own initiative (79%). Leisure and sport injuries were most frequent (75%). Digiti II-V were injured most commonly (43%), followed by metacarpals (19%) and the thumb (14%). Blunt trauma and cuts accounted for most injuries (74%). Hand-graphics depicted color-coded frequencies of the affected areas of the palmar and dorsal aspect of the hand for the most common types of injury, as well as the most frequent circumstances of accident. Elective surgery was recommended in 25% of cases, and hand surgical follow-up was proposed in over 50% of cases.

CONCLUSIONS

The dorsal aspect of the hand including the 5th metacarpal, the radial wrist and thenar region, as well as the fingertips of Digiti II/III represent anatomic danger zones to injury of the hand. Due to the large variety of potentially injured structures, diagnosis and treatment is not trivial. Specific training is required for all surgical specialties in emergency care, to increase quality of diagnostic work-up and management of hand injuries.

Visualization of the location and level of pain in common wrist pathologies using color-coded heatmaps

BACKGROUND

Pain of the hand and wrist affects a large patient population. If the onset is unrelated to recent trauma, the first medical contact is rarely established with a specialized hand surgeon.

OBJECTIVE

The objective of this investigation was to (1) visualize the localization of hand pain using pain-related heatmaps in common wrist pathologies, (2) to test whether differences between these pathologies exist with regard to sociodemographic and pain-related aspects, and (3) to evaluate the major patient-reported complaints associated with the pathologies.

METHODS

This observational cross-sectional study included patients suffering from: thumb basal joint arthritis (CMC-1-OA), dorsal wrist ganglions, and TFCC tears. Patients marked the location of maximum pain projection on hand graphics depicting the outline of the palmar and dorsal hand. Color-graded frequency heat maps were generated for the wrist pathologies investigated. Daily life impairments were assessed and clustered into groups of functions/activities.

RESULTS

120 patients with a mean age of 44.3 years were investigated. The diagnostic groups showed significant differences regarding the level and location of pain, as well as daily life impairments. Patients with CMC-1-OA presented with increased pain levels compared to patients with dorsal wrist ganglions and TFCC tears. Daily life impairment was rated highest when household chores were adversely affected, and sport activities were symptomatic/painful. All groups showed significant skin surface pain projection, which was visualized in heatmaps. While general trends in pain localization were visible, pain levels were also reported distal/proximal and palmar/dorsal to the pathology.

CONCLUSIONS

Knowledge of main demographic parameters, pain projection, and degree of impairment in daily activities can help physicians to narrow differential diagnosis of wrist pain during first patient contact. Patients should then be referred to hand surgeons for specialist examination, to further differentiate the origin of the pain.

Einflussfaktoren beim Aufbau von Präventionsketten in Neubaugebieten am Beispiel des Münchner Stadtteils Freiham – eine qualitative Studie

Einleitung

Präventionsketten sind integrierte kommunale Strategien zur Förderung von Gesundheit und sozialer Teilhabe von Kindern, Jugendlichen und Familien sowie zur Vermeidung der Folgen von Kinderarmut. Sie sind als intersektorale Netzwerke in mehreren Kommunen in Deutschland etabliert. Der Aufbau von Präventionsketten in Neubaugebieten wurde bislang noch nicht systematisch erforscht. Im Rahmen der Prozessevaluation zur Präventionskette Freiham, die in dem sich derzeit im Bau befindlichen gleichnamigen Münchner Stadtteil implementiert wird, wurde eine qualitative Interview- und Fokusgruppenstudie durchgeführt. Das Ziel war, relevante Einflussfaktoren für den Aufbau von Präventionsketten in einem neu entstehenden Stadtteil zu identifizieren.

Methoden

Für die Studie wurden wiederholt Interviews mit dem Netzwerkwerkmanagement der Präventionskette Freiham durchgeführt sowie eine Fokusgruppe mit Vertreter*innen der beteiligten städtischen Referate. Zudem fanden Interviews mit 12 lokalen Fachkräften aus den Sektoren Bildung, Soziales und Gesundheit statt. Die Auswertung erfolgte mit der Methode der qualitativen Inhaltsanalyse in Anlehnung an Mayring.

Ergebnisse

Wichtige Einflussfaktoren für eine gelingende Implementierung stellten aus Sicht der Teilnehmer*innen die Ausstattung mit finanziellen und personellen Ressourcen sowie die Unterstützung durch die kommunale Politik und Verwaltungsspitzen dar. Für eine erfolgreiche Arbeit im Netzwerk waren die zentrale Netzwerkkoordination, eine transparente Kommunikation, die Integration der unterschiedlichen Interessen der Akteur*innen und die Vermittlung eines Mehrwerts des Engagements entscheidend. Eine spezifische Herausforderung für das Setting eines Neubaugebiets war der Aufbau von bedarfs- und zielgruppenorientierten Netzwerkstrukturen angesichts einer zunächst geringen Anzahl an Bewohner*innen und noch nicht etablierter Unterstützungsstrukturen.

Schlussfolgerung

Ausreichende Finanzierung und Rückhalt in Politik und Verwaltung sind zentrale Einflussfaktoren für die Implementierung einer Präventionskette in Kommunen. Insbesondere in Neubaugebieten ohne gewachsene Infrastruktur erfordert der Aufbauprozess eine langfristig angelegte Unterstützung.

Are We Prepared for the Next Pandemic? Management, Systematic Evaluation and Lessons Learned from an In-Hospital COVID-19 Vaccination Centre for Healthcare Workers

BACKGROUND

the organisation of a COVID-19 vaccination campaign for healthcare workers (HCWs) within a university hospital presents a challenge of a particularly large scale and urgency. Here, we evaluate the in-hospital vaccination process and centre for HCWs at LMU University Hospital in Munich, Germany.

METHODS

We executed a mixed-method process evaluation of the vaccination centre at LMU University Hospital during the first COVID-19 vaccination campaign. In a programme monitoring, we continuously assessed the implementation of the centre's operational management including personnel resources. In evaluating the outreach to and satisfaction of the target group with the centre and process, we executed two anonymous surveys aimed at the HCWs vaccinated at the in-hospital centre (1) as well as centre staff members (2).

RESULTS

staff numbers and process time per person were reduced several times during the first vaccination campaign. Lessons concerning appointment scheduling were learned. HCWs vaccinated at the in-hospital centre were satisfied with the process. A longer waiting time between admission and inoculation, perceived dissatisfying accessibility as well as an increased frequency of observed adverse events were linked to a reduced satisfaction. Comparatively subpar willingness to adhere to non-pharmaceutical measures was observed. Centre staff reported high satisfaction and a workload relatively equal to that of their regular jobs. Our outcomes provide references for the implementation of an in-hospital vaccination centre in similar settings.

CYP2C19 genotype-guided antithrombotic treatment versus conventional clopidogrel therapy in peripheral arterial disease: study design of a randomized controlled trial (GENPAD)

BACKGROUND

Clopidogrel is recommended in international guidelines to prevent arterial thrombotic events in patients with peripheral arterial disease (PAD). Clopidogrel itself is inactive and metabolism is dependent on the CYP2C19 enzyme. About 30% of Caucasian PAD patients receiving clopidogrel carry 1 or 2 CYP2C19 loss-of-function allele(s) and do not or to a limited extent convert the prodrug into its active metabolite. As a result, platelet inhibition may be inadequate which could lead to an increased risk of adverse clinical events related to arterial thrombosis. A CYP2C19 genotype-guided antithrombotic treatment might be beneficial for PAD patients.

METHODS

GENPAD is a multicenter randomized controlled trial involving 2,276 PAD patients with an indication for clopidogrel monotherapy. Patients with a separate indication for dual antiplatelet therapy or stronger antithrombotic therapy are not eligible for study participation. Patients randomized to the control group will receive clopidogrel 75 mg once daily without pharmacogenetic guidance. Patients randomized to the intervention group will be tested for carriage of CYP2C19 *2 and *3 loss-of-function alleles, followed by a genotype-guided antithrombotic treatment with either clopidogrel 75 mg once daily for normal metabolizers, clopidogrel 150 mg once daily for intermediate metabolizers, or acetylsalicylic acid 80 mg once daily plus rivaroxaban 2.5 mg twice daily for poor metabolizers. The primary outcome is a composite of myocardial infarction, ischemic stroke, cardiovascular death, acute or chronic limb ischemia, peripheral vascular interventions, or death. The secondary outcomes are the individual elements of the primary composite outcome and clinically relevant bleeding complications.

CONCLUSION

The aim of the GENPAD study is to evaluate the efficacy, safety, and cost-effectiveness of a genotype-guided antithrombotic treatment strategy compared to conventional clopidogrel treatment in PAD patients.

A cross-sectional study on the knowledge of and interest in Planetary Health in health-related study programmes in Germany

Planetary Health connects human health with the natural and anthropogenic systems on which it depends. Planetary Health education has been growing in a wide range of health-related disciplines, yet not been widely implemented in health-related university curricula. This cross-sectional study focused on students' knowledge of and interest in Planetary Health education in order to assess the relevance of Planetary Health and Planetary Health topics for university students and their fields of study. We surveyed 1,303 students enrolled in health-related programmes in Bavaria, Germany. Data was collected on students' previous knowledge of and interest in Planetary Health, as well as the relevance of different Planetary Health topics and students' willingness to select a Planetary Health elective within their study programmes. Descriptive statistics were calculated. The majority of participants (73.8%) had not yet heard of Planetary Health but were interested in learning more about this field (90.7%). Most participants considered Planetary Health as relevant to their field (81.6%) and would likely choose a Planetary Health elective (81.9%). Participants were most interested in topics about general associations between climate and health as well as its connections with mental health and (micro) plastics. There is an urgent need and high student interest to implement a Planetary Health module in health-related study programmes in order to move this topic more into focus for the next generation of students.

COVID-19 vaccination intent and associated factors in healthcare workers: cross-sectional study

Background

Considering the vaccine hesitancy recorded among healthcare workers (HCW) during the 2009/10 influenza pandemic, we aimed to examine the COVID-19 vaccination intent of HCW at one of the largest hospitals in Germany and to identify associated factors.

Methods

We conducted a cross-sectional anonymous survey at LMU University Hospital in Munich, Germany, between February 25 and March 20, 2021. Data was collected on COVID-19 vaccination intent as main outcome and on potential associated factors.

Results

In total, 2555 HCW completed the survey; 48,3% (n = 1325) of them had already received at least one COVID-19 vaccine dose. Of those not yet vaccinated 51,7% (n = 1320), 83,6% (n = 1104) reported intention to get vaccinated, while 10,2% (n = 134) were undecided and further 6,2% (n = 82) reported refusal. Disagreeing that everyone should receive the generally recommended vaccines was associated with refusal (RR = 529,500, p = 0,000) while being vaccinated against influenza in the 2020/21 season was linked with lower likelihood of refusal or indecisiveness (RR = 0,124, p = 0,000; RR = 0,182, p = 0,000). Low or partial conviction of the effectiveness and safety of COVID-19 vaccines were linked to refusal (effectiveness; RR = 485,471, p = 0,000; RR = 9,247, p = 0,000; safety: RR = 116,829, p = 0,000; RR = 5,423, p = 0,025). Feeling ill informed about COVID-19 vaccines was associated with refusal and indecisiveness (RR = 25,900, p = 0,000; RR = 21,104, p = 0,000).

Conclusions

At the beginning of the vaccination campaign in Germany, a small proportion of HCW at LMU University hospital was hesitant on receiving a COVID-19 vaccine. Factors associated with refusal or indecisiveness were a sceptical attitude towards vaccines in general as well as feeling ill informed about COVID-19 vaccines, especially regarding their effectiveness and safety. Having received an influenza vaccine was associated with COVID-19 vaccination intent.

Key messages

• The presented results provide insight into the reasons for hesitancy of HCW against COVID-19 vaccines, indicating a pattern-like behaviour in the acceptance of novel vaccines by HCW.

• The evidence from our analysis can help inform the communication aims and emphases of vaccination campaigns among HCW within similar organizational contexts or in future outbreak scenarios.

20 Years of ICF-International Classification of Functioning, Disability and Health: Uses and Applications around the World

The International Classification of Functioning Disability and Health (ICF) was approved in 2001 and, since then, several studies reported the increased interest about its use in different sectors. A recent overview that summarizes its applications is lacking. This study aims to provide an updated overview about 20 years of ICF application through an international online questionnaire, developed by the byline authors, and sent to each World Health Organization Collaborating Centers of the Family of International Classifications (WHO-FIC CCs). Data was collected during October 2020 and December 2021 and descriptive content analyses were used to report main results. Results show how, in most of the respondent countries represented by WHO-FIC CCs, ICF was mainly used in clinical practice, policy development and social policy, and in education areas. Despite its applications in different sectors, ICF use is not mandatory in most countries but, where used, it provides a biopsychosocial framework for policy development in health, functioning and disability. The study provides information about the needs related to ICF applications, that can be useful to organize targeted intervention plans. Furthermore, this survey methodology can be re-proposed periodically to monitor the use of the ICF in the future.

ICF-based prediction of return to work after trauma rehabilitation: Results of the icfPROreha study in patients with severe musculoskeletal injuries

Background

Physical aspects such as the type and severity of an injury are not the only factors contributing to whether or not a person can return to work (RTW) after a serious injury. A more comprehensive, biopsychosocial approach is needed to understand the complexity of RTW fully. The study aims to identify predictors of RTW 78 weeks after discharge from initial inpatient trauma rehabilitation in patients with severe musculoskeletal injuries using a biopsychosocial perspective.

Methods

This is a prospective multicenter longitudinal study with a follow-up of up to 78 weeks after discharge from trauma rehabilitation. Data on potential predictors were collected at admission to rehabilitation using a comprehensive assessment tool. The status of RTW (yes vs. no) was assessed 78 weeks after discharge from rehabilitation. The data were randomly divided into a training and a validation data set in a ratio of 9:1. On the training data, we performed bivariate and multiple logistic regression analyses on the association of RTW and potential predictors. The final logit model was selected via stepwise variable selection based on the Akaike information criterion. The final model was validated for the training and the validation data.

Results

Data from 761 patients (n = 561 male, 73.7%; mean age: 47.5 years, SD 12.3), primarily suffering from severe injuries to large joints and complex fractures of the large tubular bones, could be considered for analyses. At 78 weeks after discharge, 618 patients (81.2%) had returned to work. Eleven predictors remained in the final logit model: general health, current state of health, sensation of pain, limitations and restrictions in activities and participation (disability), professional sector, ongoing legal disputes, financial concerns (assets), personality traits, life satisfaction preaccident, attitude to life, and demand for pension claim. A predicted probability for RTW based on the multiple logistic regression model of 76.3% was revealed as the optimal cut-off score based on the ROC curve.

Conclusion

A holistic biopsychosocial approach is needed to address RTW and strengthen person-centered treatment and rehabilitation. Patients at risk for no RTW in the long term can already be identified at the onset of rehabilitation.

[Development of an Integrated Community-Based Prevention Strategy in Freiham (Munich) from the Perspective of the Steering Group: A Qualitative Interview Study with Social Network Analysis]

BACKGROUND

The City of Munich is planning and implementing a "Prevention Chain" as an integrated community-based prevention strategy in the new district of "Freiham" in Munich. This is taking place while the district is being built. The "Prevention Chain Freiham" aims to create an environment that enables a healthy upbringing of all children and adolescents right from the start. In order to guide this project, an interdepartmental working group was formed within the City of Munich's administration. This study analyses the working group's structures, processes and its collaboration with a variety of stakeholders.

METHODS

We conducted a multimethod study comprising qualitative interviews and social network analysis. Between March and April 2018, we conducted semi-structured interviews with members of the working group. The study participants also generated ego-centred social network maps. The transcripts were analysed using qualitative content analysis as described by Schreier. The network maps were also analysed using qualitative content analysis and the results were visualized. Our preliminary findings were interpreted, discussed and validated in a workshop in June 2018 with study participants.

RESULTS

Ten members of the working group participated in the study. The interdepartmental, multiprofessional collaboration in the working group was perceived as beneficial for the process of developing and implementing the Prevention Chain. The external coordination by MAGs and the scientific expertise provided by the LMU Munich were considered highly supportive. Barriers to the planning and implementation of the Prevention Chain were mainly located at administration level. Most facilitators were attributed to the collaborative processes within the working group. After having mapped all stakeholders currently involved in the Prevention Chain (mainly actors within the City of Munich's administration), additional relevant stakeholders were identified by the members of the working group.

CONCLUSION

The organizational form of the working group as a formalized association of representatives of various departments that are jointly responsible for the Prevention Chain is considered beneficial for the success of the Prevention Chain. This is further supported by the external coordination and academic support. Advancing the development and implementation of the Prevention Chain will require support from all relevant departments across sectors and hierarchies.

Public Mental Health Approaches for Building Resilience in Communities

Crises such as the corona pandemic, but also climate change associated events such as extreme weather events are major stressors for people on an individual, but also on a population level. Such crises often lead to highly burdened individuals with reduced quality of life, decreased well-being, mental health problems and an accumulation of psychiatric illnesses, especially in vulnerable population groups. These create a high demand and need for low intensive (psychosocial) support and primary and clinical care that can often no longer be adequately met by the existing infrastructure. However, good mental health and mental health care is a necessary prerequisite for people to lead fulfilling and productive lives and for communities and their settings (such as families, schools and workplaces, etc.) to function well. Therefore efficient supporting (public mental health) approaches are urgently needed. This presentation will introduce and discuss public mental health approaches and their effectiveness with a focus on mental health promotion and prevention. The implementation and dissemination of these approaches may help to further strengthen psychological resilience in communities to be better prepared for coping with acute crises and long-term stressors.

Public Mental Health Approaches for Building Resilience in Communities

Crises such as the corona pandemic, but also climate change associated events such as extreme weather events are major stressors for people on an individual, but also on a population level. Such crises often lead to highly burdened individuals with reduced quality of life, decreased well-being, mental health problems and an accumulation of psychiatric illnesses, especially in vulnerable population groups. These create a high demand and need for low intensive (psychosocial) support and primary and clinical care that can often no longer be adequately met by the existing infrastructure. However, good mental health and mental health care is a necessary prerequisite for people to lead fulfilling and productive lives and for communities and their settings (such as families, schools and workplaces, etc.) to function well. Therefore efficient supporting (public mental health) approaches are urgently needed. This presentation will introduce and discuss public mental health approaches and their effectiveness with a focus on mental health promotion and prevention. The implementation and dissemination of these approaches may help to further strengthen psychological resilience in communities to be better prepared for coping with acute crises and long-term stressors.

Alcohol Use of German Adults during Different Pandemic Phases: Repeated Cross-Sectional Analyses in the COVID-19 Snapshot Monitoring Study (COSMO)

There is little evidence on how different COVID-19 pandemic phases influence the alcohol use behaviour of adults. The objective of this study is to investigate alcohol use frequency over different COVID-19 pandemic phases and to identify vulnerable subgroups for risky use behaviour in the German adult population. Survey waves of 14/15 April 2020 (n = 1032), 23/24 June 2020 (n = 993), and 26/27 January 2021 (n = 1001) from the COVID-19 Snapshot Monitoring (COSMO) were analysed. The mean age was 46 ± 15.3 years in April, 46 ± 15.5 years in June, and 45 ± 15.5 years in January. The gender ratio was mostly equal in each survey wave. Descriptive analyses and univariate and multivariate logistic regression analyses for individuals with increased alcohol use frequency (AUF) were performed. 13.2% in April (lockdown), 11.3% in June (easement), and 8.6% in January (lockdown) of participants showed an increased AUF. Individuals with perceived burden, high frustration levels due to protective measures, and young to middle-aged adults were more likely to increase their AUF during different pandemic phases. In conclusion, unfavourable alcohol behaviour might occur as a potentially maladaptive coping strategy in pandemics. Because of potential negative long-term consequences of problematic alcohol use behaviour on health, public health strategies should consider mental health consequences and target addictive behaviour, while also guiding risk groups towards healthy coping strategies such as physical activities during pandemics/crises.

Mechanical and strain behaviour of human Achilles tendon during in vitro testing to failure

The Achilles tendon is the strongest tendon in the human body but its mechanical behaviour during failure has been little studied and the basis of its high tensile strength has not been elucidated in detail. In the present study, healthy, human, Achilles tendons were loaded to failure in an anatomically authentic fashion while the local deformation and strains were studied in real time, with very high precision, using digital image correlation (DIC). The values determined for the strength of the Achilles tendon were at the high end of those reported in the literature, consistent with the absence of a pre-existing tendinopathy in the samples, as determined by careful gross inspection and histology. Early in the loading cycle, the proximal region of the tendon accumulated high lateral strains while longitudinal strains remained low. However, immediately before rupture, the mid-substance of the Achilles tendon, its weakest part, started to show high longitudinal strains. These new insights advance the understanding of the mechanical behaviour of tendons as they are stretched to failure.

The Well-Being of the German Adult Population Measured with the WHO-5 over Different Phases of the COVID-19 Pandemic: An Analysis within the COVID-19 Snapshot Monitoring Study (COSMO)

The aim of this study is to evaluate factors associated with the subjective well-being (SWB) and suspected depression measured with WHO-5 among German adults during different phases of the COVID-19 pandemic. Survey data were analyzed from the COVID-19 Snapshot Monitoring (COSMO) study, which collected data from 972, 1013, and 973 participants in time point 1 (19–20 May 2020), time point 2 (15–16 September 2020), and time point 3 (21–22 December 2020), respectively. Descriptive analyses and logistic regression analyses to identify the factors associated with suspected depression (WHO-5 ≤ 50) were conducted. Data showed that the mean WHO-5 scores in three time points were 56.17, 57.27, and 53.93, respectively. The risk of suspected depression was increased by about 1.5 times for females, 2.5–3 times among 18–24 year-olds compared to ages above 65 years, 1.5 times for singles, 2 times for those with chronic illnesses, and 2–3 times for people living in poverty. The main study findings show that German adult SWB is lower than pre-pandemic reference values. Special focus should be placed on vulnerable groups, such as females, younger persons, and people living in poverty who are most prone to a reduction in SWB and therefore suspected depression.

Measures implemented in the school setting to contain the COVID-19 pandemic

BACKGROUND

In response to the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the impact of coronavirus disease 2019 (COVID-19), governments have implemented a variety of measures to control the spread of the virus and the associated disease. Among these, have been measures to control the pandemic in primary and secondary school settings.

OBJECTIVES

To assess the effectiveness of measures implemented in the school setting to safely reopen schools, or keep schools open, or both, during the COVID-19 pandemic, with particular focus on the different types of measures implemented in school settings and the outcomes used to measure their impacts on transmission-related outcomes, healthcare utilisation outcomes, other health outcomes as well as societal, economic, and ecological outcomes.  SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, and the Educational Resources Information Center, as well as COVID-19-specific databases, including the Cochrane COVID-19 Study Register and the WHO COVID-19 Global literature on coronavirus disease (indexing preprints) on 9 December 2020. We conducted backward-citation searches with existing reviews.

SELECTION CRITERIA

We considered experimental (i.e. randomised controlled trials; RCTs), quasi-experimental, observational and modelling studies assessing the effects of measures implemented in the school setting to safely reopen schools, or keep schools open, or both, during the COVID-19 pandemic. Outcome categories were (i) transmission-related outcomes (e.g. number or proportion of cases); (ii) healthcare utilisation outcomes (e.g. number or proportion of hospitalisations); (iii) other health outcomes (e.g. physical, social and mental health); and (iv) societal, economic and ecological outcomes (e.g. costs, human resources and education). We considered studies that included any population at risk of becoming infected with SARS-CoV-2 and/or developing COVID-19 disease including students, teachers, other school staff, or members of the wider community.  DATA COLLECTION AND ANALYSIS: Two review authors independently screened titles, abstracts and full texts. One review author extracted data and critically appraised each study. One additional review author validated the extracted data. To critically appraise included studies, we used the ROBINS-I tool for quasi-experimental and observational studies, the QUADAS-2 tool for observational screening studies, and a bespoke tool for modelling studies. We synthesised findings narratively. Three review authors made an initial assessment of the certainty of evidence with GRADE, and several review authors discussed and agreed on the ratings.

MAIN RESULTS

We included 38 unique studies in the analysis, comprising 33 modelling studies, three observational studies, one quasi-experimental and one experimental study with modelling components. Measures fell into four broad categories: (i) measures reducing the opportunity for contacts; (ii) measures making contacts safer; (iii) surveillance and response measures; and (iv) multicomponent measures. As comparators, we encountered the operation of schools with no measures in place, less intense measures in place, single versus multicomponent measures in place, or closure of schools. Across all intervention categories and all study designs, very low- to low-certainty evidence ratings limit our confidence in the findings. Concerns with the quality of modelling studies related to potentially inappropriate assumptions about the model structure and input parameters, and an inadequate assessment of model uncertainty. Concerns with risk of bias in observational studies related to deviations from intended interventions or missing data. Across all categories, few studies reported on implementation or described how measures were implemented. Where we describe effects as 'positive', the direction of the point estimate of the effect favours the intervention(s); 'negative' effects do not favour the intervention.  We found 23 modelling studies assessing measures reducing the opportunity for contacts (i.e. alternating attendance, reduced class size). Most of these studies assessed transmission and healthcare utilisation outcomes, and all of these studies showed a reduction in transmission (e.g. a reduction in the number or proportion of cases, reproduction number) and healthcare utilisation (i.e. fewer hospitalisations) and mixed or negative effects on societal, economic and ecological outcomes (i.e. fewer number of days spent in school). We identified 11 modelling studies and two observational studies assessing measures making contacts safer (i.e. mask wearing, cleaning, handwashing, ventilation). Five studies assessed the impact of combined measures to make contacts safer. They assessed transmission-related, healthcare utilisation, other health, and societal, economic and ecological outcomes. Most of these studies showed a reduction in transmission, and a reduction in hospitalisations; however, studies showed mixed or negative effects on societal, economic and ecological outcomes (i.e. fewer number of days spent in school). We identified 13 modelling studies and one observational study assessing surveillance and response measures, including testing and isolation, and symptomatic screening and isolation. Twelve studies focused on mass testing and isolation measures, while two looked specifically at symptom-based screening and isolation. Outcomes included transmission, healthcare utilisation, other health, and societal, economic and ecological outcomes. Most of these studies showed effects in favour of the intervention in terms of reductions in transmission and hospitalisations, however some showed mixed or negative effects on societal, economic and ecological outcomes (e.g. fewer number of days spent in school). We found three studies that reported outcomes relating to multicomponent measures, where it was not possible to disaggregate the effects of each individual intervention, including one modelling, one observational and one quasi-experimental study. These studies employed interventions, such as physical distancing, modification of school activities, testing, and exemption of high-risk students, using measures such as hand hygiene and mask wearing. Most of these studies showed a reduction in transmission, however some showed mixed or no effects.   As the majority of studies included in the review were modelling studies, there was a lack of empirical, real-world data, which meant that there were very little data on the actual implementation of interventions.

AUTHORS' CONCLUSIONS

Our review suggests that a broad range of measures implemented in the school setting can have positive impacts on the transmission of SARS-CoV-2, and on healthcare utilisation outcomes related to COVID-19. The certainty of the evidence for most intervention-outcome combinations is very low, and the true effects of these measures are likely to be substantially different from those reported here. Measures implemented in the school setting may limit the number or proportion of cases and deaths, and may delay the progression of the pandemic. However, they may also lead to negative unintended consequences, such as fewer days spent in school (beyond those intended by the intervention). Further, most studies assessed the effects of a combination of interventions, which could not be disentangled to estimate their specific effects. Studies assessing measures to reduce contacts and to make contacts safer consistently predicted positive effects on transmission and healthcare utilisation, but may reduce the number of days students spent at school. Studies assessing surveillance and response measures predicted reductions in hospitalisations and school days missed due to infection or quarantine, however, there was mixed evidence on resources needed for surveillance. Evidence on multicomponent measures was mixed, mostly due to comparators. The magnitude of effects depends on multiple factors. New studies published since the original search date might heavily influence the overall conclusions and interpretation of findings for this review.

Health indices for the evaluation and monitoring of health in children and adolescents in prevention and health promotion: a scoping review

BACKGROUND

Health indicators are used in different settings to monitor health outcomes. Child and adolescent health is arguably one of the most important areas for the application of indices and indicators in prevention and health promotion. Although single health indicators may be better suited to display the complexity of the health status and its determinants, a selected set of indicators will still offer a complex picture. Therefore, it is argued that a group of indicators combined into an index may offer a pragmatic tool that is easier to use in order to inform stakeholders.

METHODS

A scoping review was conducted to identify and describe health indices that monitor and evaluate health of children and adolescents and to appraise the quality and value of the identified indices that may guide the further applications of these indices in particular settings. The three bibliographic databases MEDLINE, EMBASE and PsycINFO were searched and a double screening of titles and abstracts as well as double screening of full texts was performed. Indices contained in these studies were analysed in terms of focus and composition and evaluated in terms of quality criteria.

RESULTS

The scoping review identified 36 eligible studies with 18 health indices in six thematic categories. Of the identified indices, seven indices focus on anthropometrical variables, three indices focus on special aspects of newborns and five indices focus on oral health. One index assesses "healthy lifestyle" and one "functional ability" whereas one index a combination of different aspects. Most indices are calculated by using primary health data.

CONCLUSIONS

Alone or in combination with single sets of indicators, indices in six major thematic domains may be used as pragmatic tools for monitoring children's and adolescents´ health and the evaluation of interventions in health promotion and prevention settings.

Digital Formats for Community Participation in Health Promotion and Prevention Activities: A Scoping Review

Objectives: Digital technologies in public health are primarily used in medical settings and mostly on an individual and passive way of use. There are research gaps on digital media facilitating participation, empowerment, community engagement, and participatory research in community settings. This scoping review aims to map existing literature on digital formats that enable participation in the field of health promotion and prevention in community settings.

Design: The databases Medline, EMBASE, and PsycINFO were used to identify studies published from 2010 up to date (date of literature search) onward that used digital formats in all or in the main sequences of the process to enable high levels of participation in health promotion and prevention activities in community settings.

Results: This review identified nine out of 11 included studies relevant to the research question. We found five studies that applied qualitative participatory research, two studies on peer support and one study each on empowerment and crowdsourcing. The digital technologies used varied widely and included social media platforms, bulletin boards, online forum webpages, and customized web providers and programs. Most studies mentioned anonymity, flexibility, and convenience as benefits of digital interventions. Some papers reported limitations such as difficulties by interpreting written-only data or the possibility of selection bias due to the digital divide.

Conclusion: This scoping review identified only few studies relevant to our objective, indicating an existing gap in research on this topic. Digital formats were found to be particularly suitable for purposes where anonymity and flexibility are beneficial, such as for online peer exchange and peer support programs.