Public health care staff during the COVID-19 pandemic: a comparison of job demands and work functioning between temporary and permanent staff.

BACKGROUND: The COVID-19 pandemic posed an enormous challenge on the public health workforce, leading to the hiring of much temporary staff. Temporary staff may experience poorer working conditions compared to permanent staff. From a public health perspective, we need to know how working conditions are experienced when there is an acute pressure on recruiting sufficient public health care staff. This study aimed to investigate differences in job demands and work functioning between temporary and permanent public health care staff, during the fourth wave of the COVID-19 pandemic in the Netherlands and compare it with available pre-pandemic data from the general working population. METHODS: This cross-sectional study included temporary (n = 193) and permanent (n = 98) public health care staff from a municipal health care service in the north of the Netherlands. The participants completed a questionnaire with items about quantitative, cognitive, emotional demands (Copenhagen PsychoSOcial Questionnaire, COPSOQ, range 1-100) and work functioning (Work Role Functioning Questionnaire, WRFQ, range 1-100). The participants' scores were compared to the general working population and differences between temporary and permanent staff were investigated using linear regression analysis. In addition, explorative analyses were conducted with temporary staff stratified by task and permanent staff by department. RESULTS: Permanent staff had relatively high scores on job demands compared to the general working population, whereas temporary staff had relatively low scores. On work functioning, permanent staff had similar scores as the general working population and temporary staff had better scores. Compared to permanent staff, temporary staff had lower, i.e. better, scores on quantitative (regression coefficient (B)=-26.7; 95% Confidence Interval (CI) -30.8 to -22.5), cognitive (B=-24.4; 95% CI -29.0 to -19.9), and emotional demands (B=-11.8; 95% CI -16.0 to -7.7), and better scores on work functioning (B = 7.8; 95% CI 4.5 to 11.3). CONCLUSIONS: Temporary staff experienced lower job demands and reported better work functioning than permanent staff. The acute expansion of the public health workforce did not seem to negatively impact the job demands and work functioning of temporary public health care staff.

Mediation by parent health literacy and behaviour of socioeconomic inequality in child overweight.

BACKGROUND: Socioeconomic inequalities contribute to childhood overweight. Identifying mediators could help reduce these inequalities. OBJECTIVE: We assessed to what extent and how parental health literacy and health behaviours mediate the relationship between parental socioeconomic status and childhood overweight. METHODS: Data were taken from the multigenerational prospective Dutch Lifelines Cohort Study. We included 6683 children, baseline age 9.8 years (SD = 2.6), with an average follow-up of 36.2 months (SD = 9.3). Overweight was defined using age- and sex-specific cut-offs. Three indicators of socioeconomic status were included: education, income and occupation. We assessed the mediating role of parental health literacy and health behaviours (smoking, diet, physical activity and alcohol) using causal mediation. RESULTS: Four additional years of education and an SD-increase in both income and occupation decreased the odds of childhood overweight by 42%, 12% and 20%, respectively. Only parental smoking independently mediated the relationship of both education (6.6%) and occupation (5.7%) with overweight. Parental health behaviours jointly explained 8.4% (education), 19.4% (income) and 9.8% (occupation) per relationship. Lastly, adding parental health literacy explained 10.8% (education), 27.4% (income) and 13.3% (occupation) of these relationships. CONCLUSIONS: We found large socioeconomic inequalities in childhood overweight. Remarkably, parental smoking was a key mediator. Therefore, prevention targeting smoking may reduce socioeconomic inequalities in childhood overweight.

Adolescents' academic performance: what helps them and what hinders them from achievement and success?

Introduction: Research on adolescents' academic performance has mostly focused on the contribution of objective factors, such as socioeconomic situation of the family or individual cognitive skills and school results. Evidence with a focus on adolescents' subjective experiences is scarce. The aim of this qualitative study was to explore factors related to adolescents' academic performance from their perspectives. Methods: We used data from 11 group semi-structured interviews conducted in 2020/2021 with 45 adolescents in the first year of high school in Slovakia (mean age = 14.98; 22.2% boys). Participants were selected from three types of high school with regards to the graduation system. We analysed the data using consensual qualitative research and thematic analysis. Results: Based on the statements of the adolescents, we identified five main themes of factors that affect their academic performance. Adolescents reported that the following contribute to their academic performance: the contents and methods of teaching; how teachers behave and do their jobs; the way in which adolescents study and what motivates them; support within and outside the school, and the environment and appearance of the school. Adolescents reported that improving the curricula and using teaching methods that balance theoretical information with practical skills training would help their academic performance immensely. Conclusion: We identified several factors related to adolescents' academic performance using their own perspectives and experiences. Strengthening the capacities of teachers may largely benefit adolescents' educational process and further academic performance.

Psychometric properties of the Knowledge and Attitudes to Mental Health Scales in a Dutch sample (KAMHS-NL): A comprehensive mental health literacy measure in adolescents.

BACKGROUND: Mental health literacy (MHL) is crucial for early recognition of and coping with mental health problems, and for the use and acceptance of mental health services, leading to better health outcomes, especially in adolescence. The prevalence of mental health problems among adolescents is seen as a major public health concern and MHL is an important factor in facilitating positive mental health outcomes. However, the availability of valid measurement instruments for assessing the multifaceted nature of MHL is limited, hindering the ability to make meaningful comparisons across studies. The Knowledge and Attitudes to Mental Health Scales (KAMHS) is a promising comprehensive instrument for measuring adolescents' mental health literacy but its psychometric properties have not been explored in any other contexts than the Welsh. The aim of this study was to translate the KAMHS into Dutch, adapt it in this context, and evaluate its psychometric properties. METHODS: We performed a cross-sectional study with Dutch adolescents between the ages 11-16. We translated the KAHMS and assessed its content validity using cognitive interviewing with n = 16 adolescents. Next, n = 406 adolescents were asked to fill in the translated KAMHS-NL and reference scales, on mental health (SDQ and WHO-5), resilience (BRS), and mental health help-seeking behaviors. We assessed construct validity based on a priori hypotheses regarding convergent and divergent correlations between subscales of KAMHS-NL and the reference scales. Finally, we assessed structural validity via confirmatory factor analysis and exploratory structural equation modeling. RESULTS: The KAMHS-NL showed good content validity and satisfactory construct validity. In total, 28 of the 48 hypotheses regarding convergent and divergent correlations between the KAMHS and reference scales were confirmed. Contrary to our expectations, weak, but significant associations were found between MHL and resilience. The KAMHS showed an acceptable to good internal consistency (McDonald's omega ranging from 0.62 to 0.84). Finally, we could generally confirm the postulated structure of the KAMHS-NL in the Dutch sample with a 5-factor solution (RMSEA = 0.033; CFI = 0.96). CONCLUSIONS: The Dutch version of the KAMHS is a valid measure for detecting differences in MHL levels in adolescents. The KAMHS is a promising instrument for assessing MHL in adolescents in a multifaceted manner in other countries which may facilitate rigorous global MHL research. The instrument therefore deserves further validation research in other settings and comparisons across various cultural contexts.

Mothers in stress: Hair cortisol of mothers living in marginalised Roma communities and the role of socioeconomic disadvantage.

Roma living in marginalised communities are among the most disadvantaged groups in Slovakia. Socioeconomic disadvantage is associated with higher hair cortisol concentrations (HCC), including in parents. The aim of this study is therefore to assess differences in HCC, reflecting the levels of stress, between mothers living in MRCs and from the majority population, to assess the association of socioeconomic disadvantage with HCC, and whether disadvantage mediates the MRC/majority differences in HCC. Participants were mothers of children aged 15-18 months old living in MRCs (N=61) and from the Slovak majority population (N=90). During preventive paediatric visits, visits at community centres and home visits, hair samples and data by questionnaire were collected. HCC differed significantly between mothers living in MRCs and mothers from the majority population, with the mean HCC value being twice as high in mothers living in MRCs (22.98 (95% confidence interval, CI, 15.70-30.30) vs. 11.76 (8.34-15.20), p<0.05). HCC was significantly associated with education, household equipment and household overcrowding, but not with billing, socioeconomic stress and social support. The difference in HCC between mothers living in MRCs and mothers from the majority population was partially mediated by poor house equipment, such as no access to running water, no flushing toilet or no bathroom (the indirect effect of B=7.63 (95% CI: 2.12-13.92)). Practitioners and policymakers should be aware of high stress levels among mothers living in MRCs and aim at enhancing their living and housing conditions.

Educational inequalities in major depressive disorder prevalence, timing and duration among adults over the life course: a microsimulation analysis based on the Lifelines Cohort Study.

BACKGROUND: Educational inequalities in major depressive disorder (MDD) pose a major challenge. Tackling this issue requires evidence on the long-term impact of intervening on modifiable factors, for example lifestyle and psychosocial factors. For this reason, we aimed to simulate the development of educational inequalities in MDD across the life course, and to estimate the potential impact of intervening on modifiable factors. METHODS: We used data from the prospective Dutch Lifelines Cohort Study to estimate the required input for a continuous-time microsimulation. The microsimulation allowed us to project the development of educational inequalities in MDD between ages 18 and 65, and to assess the potential benefit of intervening on quality of social contacts, health literacy and smoking. RESULTS: On average, an additional 19.1% of individuals with low education will ever experience MDD between ages 18 and 65 compared with those with high education. Additionally, individuals with low education generally will develop MDD 0.9 years earlier and spend 1.2 years more with MDD, than individuals with high education. Improving the quality of social contacts in individuals with low education produced the largest effect; it would reduce the inequalities in the prevalence, onset and duration of MDD by an average of 18.4%, 18.3% and 28.6%, respectively. CONCLUSIONS: Intervening on modifiable factors, particularly quality of social contacts, in individuals with low education could help reduce the estimated educational inequalities in MDD over the life course.

Early stress during NICU stay and parent-reported health-related quality of life after extremely preterm birth: an exploratory study with possible targets for early intervention.

Introduction: The association between neonatal intensive care unit (NICU) related stress in preterm infants and their health-related quality of life (HRQoL) in the first year following preterm birth remains unexplored. Understanding this association is crucial for enhancing preventive and supportive measures for infants and parents within and beyond the NICU. Methods: From a single center observational cohort study, we included infants with gestational ages below 30 weeks and/or birth weights under 1,000 grams. HRQoL was quantified using the Infant Quality of Life Instrument (IQI) at 3-, 6-, 9- and 12-months corrected age, covering seven domains. NICU stress was quantified using the Neonatal Infant Stressor Scale (NISS) for the first week of life. We performed Spearman's correlation analyses to test this association. Results: Of the 45 included infants, the IQI was completed for 27 (60%) at 3, 15 (33%) at 6, 14 (31%) at 9 and 15 (33%) at 12 months. The HRQoL sum scores were related to neonatal stress at 9 and 12 months (ρ = 0.643 and 0.591, p = 0.013 and p = 0.019, respectively) but not at 3 and 6 months (ρ = -0.001 and -0.077 respectively, p > 0.05). Higher NICU stress tended to be associated with more respiratory and mood problems throughout the first year. Discussion: From a parental perspective on infant HRQoL, extremely preterm infants with higher stress exposure show more problems in the second half-year of life, mainly breathing and possibly mood-related problems. This knowledge may help improve our neonatal care, both during NICU stay and in follow-up clinics, by implementing targeted interventions.

Impact of the COVID-19 lockdown on the oral health behaviour of young children.

AIM: Children up to the age of 10 are dependant primarily on their caregivers for oral care; COVID-19 lockdowns may have disrupted this care. We therefore assessed whether the COVID-19 lockdown affected routine parental oral care for their children. METHODS: A short online survey regarding oral health behaviour and changes in the home setting during the COVID-19 lockdown was emailed to parents (n = 782, response 15%) participating in an existing study 'Healthy Teeth All Aboard (HTAA)'. RESULTS: During the lockdown, 29% of parents reported that they skipped their children's toothbrushing more often than before the lockdown, and 49% of the children were allowed to consume sugary snacks or drinks more often. These behaviours were not significantly associated with socio-economic status, country of birth of the mother, work situation of the parents, school attendance patterns or HTAA participation status. CONCLUSION: The COVID-19 lockdown affected the daily oral hygiene routines of children, potentially increasing caries risk. CLINICAL RELEVANCE: Dental professionals should be aware of the potential impacts on oral health in children in the circumstance of a new lockdown. Parents should be made aware of the oral health consequences of a lockdown.

Parenting by mothers from marginalized communities and the role of socioeconomic disadvantage: insights from marginalized Roma communities in Slovakia.

Background: Roma living in marginalized communities often face poor living conditions and material deprivation, which may negatively impact parenting. Our aim is to compare the parenting behavior (support, harsh discipline, and stimulation) of mothers from marginalized Roma communities and the majority population in Slovakia. We also examine the role of socioeconomic disadvantage and related worries in the differences in parenting behavior between these groups. Methods: We obtained cross-sectional data from mothers of children aged 14-18 months using the first wave of the longitudinal RomaREACH study dataset. Two groups were included in the sample: 93 mothers from MRCs and 102 mothers from the majority. We performed multiple regression and mediation analyses to assess whether the educational level of mothers, the degree of poverty, and poverty-related feelings of stress and worries explain parenting behavior differences between the groups of mothers. Results: We found significant differences in parenting, especially in harsh disciplining and stimulation. These two domains were significantly associated with maternal education, degree of poverty, and poverty-related stress and worries. The degree of poverty partially mediated stimulation differences between the two groups of mothers. Conclusion: Parenting in MRCs seems harsher and less stimulative than parenting in the Slovak majority. These differences are associated with the socioeconomic disadvantage of mothers. The degree of poverty partially explains why parenting in MRCs is less stimulative. These results may inform intervention efforts aimed at disadvantaged families.

Stability of neurodevelopmental trajectories in moderately late and early preterm children born 15 years apart.

BACKGROUND: Neurodevelopmental trajectories of preterm children may have changed due to changes in care and in society. We aimed to compare neurodevelopmental trajectories in early and moderately late preterm children, measured using the Developmental (D)-score, in two cohorts born 15 years apart. METHODS: We included early preterm and moderately late preterm children from two Dutch cohorts (LOLLIPOP, 2002-2003 and ePREM, 2016-2017). ePREM counterparts were matched to LOLLIPOP participants by gestational age and sex. D-score trajectories were summarized by a multilevel model with random intercepts and random slopes, and multigroup analyses were used to test if the intercepts and slopes differed across cohorts. RESULTS: We included 1686 preterm children (1071 moderately late preterm, 615 early preterm) from LOLLIPOP, and matched these with 1686 ePREM counterparts. The neurodevelopmental trajectories of the two cohorts were mostly similar. For early preterm children, we found no statistically significant differences. For moderately late preterm children, both the intercept (43.0 vs. 42.3, p < 0.001) and slope (23.5 vs. 23.9, p = 0.002) showed some, but only clinically minor, differences. CONCLUSION: Developmental trajectories, measured using the D-score, in the first four years of life are comparable and stable across a period of 15 years for both early and moderately late preterm children. IMPACT: Neurodevelopmental trajectories are similar for early and moderately late preterm children born 15 years apart and thus seem quite stable in time. The validated Developmental score visualizes these trajectories based on developmental milestone attainment Because of its stability over time, the Developmental score trajectory may aid clinicians in neurodevelopmental assessment of preterm children as this simplifies monitoring and interpretation, similar to a growth chart.

Diverging death risks: Mortality as a corollary of economic, social, cultural and person capital.

Introduction: Diverging death risks are associated with a wide range of social factors, including not only education and income but also other economic and non-economic resources. The aim of this study was to assess the association of mortality risks with four types of resources: economic, social, cultural and person capital. Methods: We used data of 2,952 participants from the Disparities in the Netherlands survey and annual mortality data from Statistics Netherlands for the period 2014 to 2021. Economic capital was measured through education, income, occupation, home equity, and liquid assets. Social capital was measured by the strength of social ties, the size of the core discussion network, and access to people in resourceful positions; cultural capital by lifestyle, digital skills, and mastery of English, and person capital by self-rated health, impediments to climbing stairs, self-confidence, self-image, people's appearance, and body mass index. To accommodate the fact that each capital was derived from several indicators, we used Partial Least Squares (PLS) Cox Regression. Results: In multiple regression, higher economic, cultural, and person capital were associated with lower mortality (hazard ratio, 0.77; 95% confidence interval [CI, 0.65 to 0.90], 0.77 [0.64-0.93] and 0.80; [0.70-0.92]), adjusted for all capital measures and sex. Conclusion: The finding that more economic, cultural and person capital is associated with lower mortality provides empirical support for an approach that uses a broad spectrum of capital measures - hitherto rarely included simultaneously in epidemiological research - in order to understand diverging death risks. By integrating sociological concepts, cohort data, and epidemiological research methods, our study highlights the need for further research on the interplay between different forms of resources in shaping health inequalities. In designing public health interventions, we advocate the adoption of a multidimensional capital-based framework for tackling social disparities in mortality.

Adolescents with emotional and behavioural problems are at higher risk to become excessive or addicted Internet users: is this association moderated by gender?

BACKGROUND: The Internet offers many opportunities for adolescents to facilitate their lives. However, its everyday use may lead to excessive behaviour, including addiction. Our aim was to assess the association between emotional and behavioural problems (EBP) and level of internet use, and whether gender moderates this association. METHODS: We used data from a representative sample of 5,433 Slovak adolescents (mean age: 13.51, 48.8% boys) from the Health Behaviour in School-aged Children-study conducted in 2018, collected through online self-report questionnaires. EBP was measured by the Strengths and Difficulties Questionnaire and excessive internet use (EIU) and internet addiction (IA) by the Excessive internet use scale. We analysed using multinomial logistic regression. RESULTS: More than 25% of the adolescents reported EIU; almost 4% reported being addicted to Internet. EIU was more prevalent in girls, but IA was more prevalent in boys. Adolescents with borderline or increased levels of EBP were more likely to report EIU (odds ratio, OR/95% confidence interval, CI: 1.85/1.60-2.14; 3.16/2.67-3.75, respectively) and IA (OR/95% CI: 2.23/1.57-3.18; 4.89/3.41-7.03, respectively). Adjustment for gender, age or perceived family wealth hardly changed the findings. Moreover, gender did not modify the associations between EBP with EIU. CONCLUSION: Adolescents with higher levels of EBP are more likely to become excessive Internet users or Internet addicts. This shows a need of early identification of adolescents with EBP as they seem to be relatively vulnerable to develop EIU or IA.

Culturally adapted training for community volunteers to improve their knowledge, attitude and practice regarding non-communicable diseases in Vietnam.

BACKGROUND: The burden of non-communicable diseases is becoming unmanageable by primary healthcare facilities in low- and middle-income countries. Community-based approaches are promising for supporting healthcare facilities. In Vietnam, community health volunteers are trained in providing health promotion and screening in a culturally adapted training. This study aims to assess the change in knowledge, attitude and practice regarding NCD prevention and management after a culturally adapted training, and the potential mechanisms leading to this change. METHODS: The Knowledge Attitude and Practice survey was assessed before and after an initial training, and before and after a refresher training (n = 37). We used a focus group discussion with community health volunteers (n = 8) to map potential mechanisms of the training and applying learned knowledge in practice. Data were collected in the districts Le Chan and An Duong of Hai Phong, Vietnam, in November 2021 and May 2022. RESULTS: We found that knowledge increased after training (mean = 5.54, 95%-confidence interval = 4.35 to 6.74), whereas attitude and practice did not improve. Next, knowledge decreased over time (m=-12.27;-14.40 to -10.11) and did not fully recover after a refresher training (m=-1.78;-3.22 to -0.35). As potential mechanisms for change, we identified the use of varying learning methods, enough breaks, efficient coordination of time located for theory and practice, handout materials, large group size and difficulty in applying a digital application for screening results. CONCLUSION: Culturally adapted trainings can improve knowledge among community health volunteers which is important for the support of primary healthcare in low- and middle-income countries. Using a digital screening application can be a barrier for the improvement of knowledge, attitude and practice and we suggest using an intergenerational or age-friendly approach, with the supervision of primary healthcare professionals. Future research on behavioral change should include additional components such as self-efficacy and interrelationships between individuals.

A study on the applicability of the Strengths and Difficulties Questionnaire among low- and higher-educated adolescents.

Aim: The Strengths and Difficulties Questionnaire self-report (SDQ-SR) is a valid instrument for detection of emotional and behavioral problems. The aim of this study was to compare the psychometric properties of the SDQ-SR for low and higher educated adolescents, and to explore its suitability. Methods: We included 426 adolescents. We compared internal consistency for low-educated, i.e., at maximum pre-vocational secondary education, and higher educated adolescents and assessed whether the five-factor structure of the SDQ holds across educational levels. We also interviewed 24 low-educated adolescents, and 17 professionals. Results: On most SDQ subscales the low-educated adolescents had more problematic mean scores than the higher educated adolescents. Findings on the invariance factor analyses were inconsistent, with some measures showing a bad fit of the five factor model, and this occurring relatively more for the low-educated adolescents. Professionals and adolescents reported that the SDQ included difficult wordings. Discussion: Our findings imply that the scale structure of the SDQ-SR is slightly poorer for low educated adolescents. Given this caveat, psychometric properties of the SDQ-SR are generally sufficient for use, regardless of educational level.

Barriers and enablers for sufficient moderate-to-vigorous physical activity: The perspective of adolescents.

BACKGROUND: Interventions to improve physical activity (PA) among adolescents continue to be a public health priority. To promote PA more effectively, we need to identify the main factors contributing to (not) engagement in PA in the perspective of adolescents themselves. Thus, we explored the barriers and enablers for sufficient moderate-to-vigorous physical activity (MVPA) in adolescents from their point of view. METHODS: We used qualitative data collected as part of the international Health Behaviour in School-Aged Children study. We obtained data from 14-17 years old adolescents from the first year of Slovak high school. We conducted 11 online, semi-structured individual and group interviews with 24 participants in total (7 boys; mean age = 15.17, SD = 0.87) in Slovakia. We analysed the data using consensual qualitative research and thematic analysis. RESULTS: In the statements of adolescents, four main themes were identified regarding factors contributing to (not) engagement in PA among adolescents. 'Myself as a source' represents the importance of adolescents' own efforts, knowledge, physical predispositions and PA experience. 'How PA can be done' represents school as an opportunity for PA, and PA teachers and sports coaches as specialists who can create an enabling environment for sports. 'Others as a source' represents the social circle that can set a positive sports example and can encourage adolescent's efforts in PA. 'Factors outside' represents other factors that can inspire adolescents, e.g. by giving them a comfortable space and time to exercise, or can be a barrier to PA. CONCLUSION: The potential factors that include adolescents' perspectives can be more leveraged in designing supportive, inclusive, enjoyable, and skills-appropriate PA programmes.

Computerized adaptive testing to screen pre-school children for emotional and behavioral problems.

Questionnaires to detect emotional and behavioral (EB) problems in preventive child healthcare (PCH) should be short; this potentially affects their validity and reliability. Computerized adaptive testing (CAT) could overcome this weakness. The aim of this study was to (1) develop a CAT to measure EB problems among pre-school children and (2) assess the efficiency and validity of this CAT. We used a Dutch national dataset obtained from parents of pre-school children undergoing a well-child care assessment by PCH (n = 2192, response 70%). Data regarded 197 items on EB problems, based on four questionnaires, the Strengths and Difficulties Questionnaire (SDQ), the Child Behavior Checklist (CBCL), the Ages and Stages Questionnaire: Social Emotional (ASQ:SE), and the Brief Infant-Toddler Social and Emotional Assessment (BITSEA). Using 80% of the sample, we calculated item parameters necessary for a CAT and defined a cutoff for EB problems. With the remaining part of the sample, we used simulation techniques to determine the validity and efficiency of this CAT, using as criterion a total clinical score on the CBCL. Item criteria were met by 193 items. This CAT needed, on average, 16 items to identify children with EB problems. Sensitivity and specificity compared to a clinical score on the CBCL were 0.89 and 0.91, respectively, for total problems; 0.80 and 0.93 for emotional problems; and 0.94 and 0.91 for behavioral problems.    Conclusion: A CAT is very promising for the identification of EB problems in pre-school children, as it seems to yield an efficient, yet high-quality identification. This conclusion should be confirmed by real-life administration of this CAT. What is Known: • Studies indicate the validity of using computerized adaptive test (CAT) applications to identify emotional and behavioral problems in school-aged children. • Evidence is as yet limited on whether CAT applications can also be used with pre-school children. What is New: • The results of this study show that a computerized adaptive test is very promising for the identification of emotional and behavior problems in pre-school children, as it appears to yield an efficient and high-quality identification.

Associations between the built environment and physical activity in children, adults and older people: A narrative review of reviews.

BACKGROUND: Physical activity is essential for promoting public health, and it is affected by the built environment at population level. Extensive evidence exists on the associations between the built environment and physical activity, but results are inconclusive for different age groups. Therefore, we conducted a narrative review summarizing existing reviews on the associations between the built environment and physical activity for children, adults and older people and synthesized their findings. METHODS: We followed the PRISMA 2020 review procedure and searched for systematic reviews published between January 2010 and April 2022 in seven databases (Scopus, Web of Science, Medline, PsycINFO, EMBASE, SocIndex and Cochrane Library) using keywords related to the built environment, urban interventions, physical activity and health. RESULTS: The selection process yielded 29 reviews with moderate to high quality. From these reviews, we identified 21 built environment characteristics, several of which were positively related to physical activity. For example, children and older people's physical activity was positively associated with pedestrian-friendly features and general safety. Furthermore, adults and older people's physical activity was positively related to the availability and accessibility of shops/commercial services and parks/open spaces. Lastly, the walkability index was positively associated with physical activity in every age group. CONCLUSION: Our findings provide valuable information on creating health-promoting urban environments for practitioners. Further research is needed to understand which characteristics make urban environments age friendly for physical activity. Special attention should be paid to less explored promising characteristics such as street lighting and the quality of green spaces.

Referral from well-child care clinics to dental clinics leads to earlier initiation of preventive dental visits: A quasi-experimental study.

BACKGROUND: An ealy first preventive dental visit for children is recommended no later than twelve months. However, still many children have their first dental visit relatively late. AIM: To evaluate whether active or passive referral by a well-child care (WCC) physician of babies for a first preventive dental visit leads to earlier initiation of dental care. DESIGN: From WCC clinics in two Dutch regions, 629 parents of babies participated. Parents received an active referral from a WCC physician for a dental visit for their babies (n = 204) or received care as usual (CAU) (n = 136) in one region and a passive referral (n = 143) or CAU (n = 146) in the other region. Active referral involved parents receiving a scheduled appointment at the dental practice, and passive referral involved parents making an appointment themselves. During the WCC visit, parents completed a baseline questionnaire. At age 2.5 years, parents received a follow-up questionnaire about dental attendance. RESULTS: Of the active referral intervention group, 59.3% had their first preventive dental visit in their first year compared with 3.7% in the CAU group (p < .001); for the passive referral group, 46.9% compared with 9.6% (p < .001). CONCLUSION: Referral of babies by WCC for their first preventive dental visit leads to earlier initiation of dental care. An active referral had a larger effect than passive referral.

Perceptions of healthcare providers on benefits, risks and barriers regarding intradialytic exercise among haemodialysis patients.

PURPOSE: Clinical guidelines call for the inclusion of exercise interventions in every patient's dialysis session, but these recommendations are rarely adopted. Healthcare providers play a key role in this. Therefore, the aim of this study was to explore how healthcare providers perceive the benefits, risks and barriers of intradialytic exercise (IDE). METHODS: We conducted 21 individual, semi-structured interviews with 11 nurses, 5 nephrologists, 3 training assistants and 2 managers from two dialysis centres in Slovakia. Verbatim transcripts of digitally recorded interviews were thematically analysed using MAXQDA®. RESULTS: Participants reported the benefits of IDE as improvements in patients' physical and psychosocial functioning, independence and self-efficacy, clinical profile and quality of therapy. As risks of IDE, they most frequently reported exercise-related damage to vascular access, insufficient individualization of training and musculoskeletal injuries. The presence of psychological problems among patients was reported as a major barrier for initiating and maintaining patients' exercise. Other reported barriers included limitations in financial and personnel resources of haemodialysis care. CONCLUSIONS: Safe and sustainable implementation of IDE, which might improve a patient's well-being, need to be prescribed in alignment with the patient's clinical profile, be delivered individually according to the patient's characteristics and requires adjustments in the available resources.

Long-term effects of a community-based oral health intervention for young children in the Netherlands: A 5-year follow-up.

OBJECTIVES: The aim of this study was to assess whether referral of parents of 6 months old children by a well-child care (WCC) clinic medical practitioner for an early first dental visit combined with the Non Operative Caries Treatment and Prevention (NOCTP) approach in dental practices was effective to maintain oral health in children. METHODS: The study was conducted as a quasi-experimental comparative pre-post trial with a baseline measurement before the intervention. In total 1347 children were allocated at the age of 6 months and 306 children (intervention group: n = 166; care as usual (CAU) group: n = 140) underwent an oral examination at 5 years of age and their parents completed a questionnaire. Nonparametric tests and Hurdle models were used to determine differences in caries experience between the intervention and CAU groups. RESULTS: Children in the intervention group had significantly lower caries experience (d1,2,3 mfs) than children in the CAU group (Median = 2 vs. 5, r = .15, p < .01). Children in the intervention group had significantly fewer inactive caries lesions compared with children in the CAU group (Median = 2 vs. 3, r = .18, p < .001). No differences were found for dentin caries experience and also no differences for active caries lesions. CONCLUSIONS: Referral of parents of newborns for a preventive first dental visit by a WCC medical practitioner combined with NOCTP in dental practices may offer a new opportunity to reduce enamel caries lesions in young children.