Institut für Epidemiologie u. Sozialmedizin
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The COVID-19 pandemic is one of the most serious health and economic crises of the 21st century. From a psychological point of view, the COVID-19 pandemic and its consequences can be conceptualized as a multidimensional and potentially toxic stressor for mental health in the general population. This selective literature review provides an overview of longitudinal studies published until June 2021 that have investigated the impact of the COVID-19 pandemic on mental health in the European population. Risk and protective factors identified in the studies are summarized. Forty-two studies that met inclusion and search criteria (COVID-19, mental health, longitudinal, and Europe) in PubMed, PsycInfo, and Web of Science databases indicate differential effects of the pandemic on mental distress, depression, and anxiety, depending on samples and methods used. Age-specific (e.g., young age), social (e.g., female, ethnical minority, loneliness), as well as physical and mental health-related factors (e.g., pre-pandemic illness) were identified as risk factors for poor mental health. The studies point to several protective factors such as social support, higher cognitive ability, resilience, and self-efficacy. Increasing evidence supports the assumption of the pandemic being a multidimensional stressor on mental health, with some populations appearing more vulnerable than others, although inconsistencies arise. Whether the pandemic will lead to an increase in the prevalence of mental disorders is an open question. Further high-quality longitudinal and multi-national studies and meta-analyses are needed to draw the complete picture of the consequences of the pandemic on mental health.
Abstract
Aims
To demonstrate the attitudes of general practitioners (GPs), nurses, persons with dementia, and caregiver towards suitable tasks and qualification needs for and the acceptance and impact of advanced nursing roles in German dementia primary care.
Design
Observational study using a questionnaire survey with 225 GPs, 232 nurses, 211 persons with dementia, and 197 caregivers, conducted between December 2017–August 2018.
Methods
A questionnaire was generated that includes specific assessment, prescription, and monitoring tasks of advanced nursing roles in dementia primary care as well as qualification requirements for and the acceptance and the impact of advanced nursing roles. Data were analysed using descriptive statistics. Group differences were assessed using the Fisher's exact test.
Results
Advanced nursing roles were highly appreciated across all groups. Assessment and monitoring tasks were rated as highly suitable, and prescription authorities as moderately suitable. Nurses felt less confident in assessment and monitoring, but more confident in prescribing as practitioners expected. Patients and caregivers would appreciate a takeover of tasks by nurses; nurses and practitioners preferred a delegation. A dementia‐specific qualification was rated as best suitable for advanced nursing roles, followed by ‘no specific qualification’ if medical tasks that only can be carried out by practitioners were delegated and an academic degree if tasks were substituted. Advanced nursing roles were rated as beneficial, strengthening the confidence in nursing care and improving the cooperation between professionals and the treatment. Practitioners assumed that advanced nursing roles would improve job satisfaction of nurses, which was not confirmed by nurses.
Conclusion
There is an extended consensus towards the enlargement of advanced nursing roles, represented by high endorsement, acceptance, and willingness to reorganize tasks.
Impact
Results debunk the common notion that German practitioners would be reluctant towards advanced nursing roles and a takeover of current practitioner tasks, supporting the implementation of advanced nursing roles in Germany.
Trade of cattle between farms forms a complex trade network. We investigate partitions of this network for cattle trade in Germany. These partitions are groups of farms with similar properties and they are inferred directly from the trade pattern between farms. We make use of a rather new method known as stochastic block modeling (SBM) in order to divide the network into smaller units. SBM turns out to outperform the more established community detection method in the context of disease control in terms of trade restriction. Moreover, SBM is also superior to geographical based trade restrictions and could be a promising approach for disease control.
Medical education research has focused almost entirely on the education of future physicians. In comparison, findings on other health-related occupations, such as medical assistants, are scarce. With the current study, we wanted to examine the knowledge-is-power hypothesis in a real life educational setting and add to the sparse literature on medical assistants. Acquisition of vocational knowledge in vocational education and training (VET) was examined for medical assistant students (n = 448). Differences in domain-specific vocational knowledge were predicted by crystallized and fluid intelligence in the course of VET. A multiple matrix design with 3 year-specific booklets was used for the vocational knowledge tests of the medical assistants. The unique and joint contributions of the predictors were investigated with structural equation modeling. Crystallized intelligence emerged as the strongest predictor of vocational knowledge at every stage of VET, while fluid intelligence only showed weak effects. The present results support the knowledge-is-power hypothesis, even in a broad and more naturalistic setting. This emphasizes the relevance of general knowledge for occupations, such as medical assistants, which are more focused on learning hands-on skills than the acquisition of academic knowledge.
This study aims to analyze psychometric properties and validity of the Compulsive Internet Use Scale (CIUS) and the Internet Addiction Test (IAT) and, second, to determine a threshold for the CIUS which matches the IAT cut-off for detecting problematic Internet use. A total of 292 subjects with problematic or pathological gambling (237 men, 55 women) aged 14-63 years and with private Internet use for at least 1 h per working or weekend day were recruited via different recruitment channels. Results include that both scales were internally consistent (Cronbach's α = 0.9) and had satisfactory convergent validity (r = 0.75; 95% CI 0.70-0.80). The correlation with duration of private Internet use per week was significantly higher for the CIUS (r = 0.54) compared to the IAT (r = 0.40). Among all participants, 25.3% were classified as problematic Internet users based on the IAT with a cut-off ≥40. The highest proportion of congruent classified cases results from a CIUS cut-off ≥18 (sensitivity 79.7%, specificity 79.4%). However, a higher cut-off (≥21) seems to be more appropriate for prevalence estimation of problematic Internet use.
Background/Aims: Only rather few data on the validity of screening questionnaires to detect problem drinking in adolescents exist. The aim of this study was to compare the performance of the Alcohol Use Disorders Identification Test (AUDIT), its short form AUDIT-C, the Substance Module of the Problem Oriented Screening Instrument for Teenagers (POSIT), and CRAFFT (acronym for car, relax, alone, forget, family, and friends). Methods: The questionnaires were filled in by 9th and 10th graders from two comprehensive schools. All students received an interview using the alcohol section of the Composite International Diagnostic Interview. Alcohol abuse and alcohol dependence according to DSM-IV as well as episodic heavy drinking served as criteria to validate the screening instruments. Results: All 9th and 10th graders (n = 225) of both schools participated. No significant differences were found for areas under the receiver operating characteristic curves ranging from 0.810 to 0.872. Cronbach’s alpha was satisfactory (0.77–0.80) but poor for CRAFFT (0.64). Different cut-offs are discussed. Conclusions: Considering validity as well as reliability, AUDIT, AUDIT-C and POSIT performed well; however, the POSIT is quite lengthy. AUDIT-C showed good psychometric properties and has clear advantages because of its brevity.
Background: Sedentary behavior (SB) is a modifiable behavior with increasing prevalence worldwide. There is emerging evidence that time spend in SB and the manner in which SB is accumulated over time is associated with cardiovascular and cardiometabolic health. The requirement for SB data to be accurately measured is minimization, or at least accurate quantification of human-related sources of measurement errors such as accelerometer measurement reactivity (AMR). The present thesis was to examine SB and their associations with cardiovascular and cardiometabolic health, and to focus on challenges related to the assessment of SB. The first aim of the thesis was to identify patterns of SB describing how individuals accumulate their time spend in SB day-by-day over one week, and to examine how these patterns are associated with cardiorespiratory fitness as a marker for cardiovascular health (paper 1). The second aim of the thesis was to examine the multiple types of SB, and how this is associated with a clustered cardiometabolic risk score (CMRS; paper 2). The third aim of the thesis was to examine AMR and the reproducibility in SB and physical activity (PA) in two measurement periods, and to quantify AMR as a confounder for the estimation of the reproducibility of SB and PA data (paper 3).
Methods: The three papers were based on data of two different studies. For study 1, 1165 individuals aged 40 to 75 years were recruited in three different settings. Among these, 582 participated in a cardiovascular risk factor screening program including cardiopulmonary exercise testing. For the analyses of paper 1, 170 participants were eligible, agreed to wear an accelerometer, fulfilled the wearing regime, and completed the study period by wearing the accelerometer for seven consecutive days. Patterns in accelerometer data were classified based on time spent in SB per day applying growth mixture modeling. Model‐implied class‐specific peak oxygen uptake (VO2peak) means were compared using adjusted equality test of means (paper 1). The underlying study of paper 2 and 3 were based on data of a pilot study aiming to investigate the feasibility of a brief tailored letter intervention to increase PA and to reduce SB during leisure time. Among the individuals who agreed to be contacted again in study 1, a random sample of those aged between 40 and 65 years was drawn. Of those, 175 attended in a cardiovascular examination program. Assessment included giving blood sample, standardized measurement of blood pressure, waist circumference, body weight, and height at baseline, and after twelve months. Further, they agreed to complete a paper-pencil questionnaire on SB (Last 7-d Sedentary Behavior Questionnaire, SIT-Q-7d) and PA (International Physical Activity Questionnaire, IPAQ), and to receive seven-day accelerometery at baseline, and after 12 months. In addition, self-administered assessments were conducted at months one, three, four, and six after baseline. Only individuals of a random subsample (= intervention group) received up to three letters tailored to their self-reported SB and PA at months one, three, and four. For paper 2, associations between SBs and a clustered cardiometabolic risk score (CMRS) were analyzed using linear as well as quantile regression. To account for missing values at baseline, multiple imputations using chained equations were performed resulting in a total sample of 173 participants. Paper 3 comprised data of 136 individuals who participated at the baseline and twelve months assessments, and fulfilled the wearing regime. AMR was examined using latent growth modeling in each measurement period. Intraclass correlations (ICC) were calculated to examine the reproducibility of SB and PA data using two-level mixed-effects linear regression analyses.
Results: Results of paper 1 revealed four patterns of SB: 'High, stable', 'Low, increase', 'Low, decrease', and 'High, decrease'. Persons in the class 'High, stable' had significantly lower VO2peak values (M = 25.0 mL/kg/min, SD = 0.6) compared to persons in the class 'Low, increase' (M = 30.5 mL/kg/min, SD = 3.6; p = 0.001), in the class 'Low, decrease' (M = 30.1 mL/kg/min, SD = 5.0; p = 0.009), and in the class High, decrease' (M = 29.6 mL/kg/min, SD = 5.9; p = 0.032), respectively. No differences among the other classes were found. In paper 2, results revealed that the only factor positively associated with a CMRS in all regression models was watching television. Depending on the regression analysis approach used, other leisure-time SBs showed inconsistent (using a computer), or no associations (reading and socializing) with a CMRS. In paper 3, results revealed that time spent in SB increased (baseline: b = 2.3 min/d; after 12 months: b = 3.8 min/d), and time spent in light PA decreased (b = 2.0 min/day; b = 3.3 min/d). However, moderate-to-vigorous PA remained unchanged. Accelerometer wear time was reduced (b = 4.6 min/d) only at baseline. The ICC coefficients ranged from 0.42 (95% CI = 0.29 - 0.57) for accelerometer wear time to 0.70 (95% CI = 0.61 - 0.78) for moderate-to-vigorous PA. None of the regression models identified a reactivity indicator as a confounder for the reproducibility of SB and PA data.
Conclusions: The present thesis highlights SB in the field of cardiovascular and cardiometabolic research that have implications for future research. Individuals sit for different purposes and durations in multiple life domains, and the time spent in SB is accumulated in different patterns over time. Therefore, research should consider the fact that SB is embedded in an individual's daily life routine, hence might have differential effects on cardiovascular and cardiometabolic health. Further, methodological aspects have to be considered when dealing with SB. In order to detect how SB is 'independently' associated to an individual's health, an accurate measurement of SB is fundamental. Therefore, human-related sources of bias such as AMR should be taken into account when either planning studies or when interpreting data drawn from analysis of SB data.