The study aims to describe the methodology for developing the PIECES repository and to present its content. The PIECES repository is a digital catalogue compiling evidence-based primary cancer prevention (PCP) programs targeting six behavioral risk factors (tobacco, alcohol, diet, physical activity, HPV infection, and UV exposure), providing standardized, context-specific information to support local implementation. The repository was designed and assembled as part of the EU-funded PIECES project (2023–2027), and built through a structured search of the Cochrane Library (up to Nov 2023), the NCI Evidence-Based Cancer Control Programs (EBCCP) database, and project partners’ contributions. Inclusion criteria required experimental/quasi-experimental designs, positive behavioral effects, and publication from 2010 onward. Two independent reviewers screened articles. For each selected program, implementation data (target population, settings, resources) were extracted. As of January 2026, the repository includes 136 evidence-based programs: tobacco control (n = 57), physical activity (n = 23), diet (n = 8), alcohol (n = 5), UV exposure (n = 11), HPV (n = 6), and mixed targets (n = 26). To operationalize implementation support, the repository translates each program into a standardized logic model detailing required prerequisites, core activities, mechanisms of action, outputs, and underlying mechanisms of behavioral change. The PIECES repository represents a structured tool designed to support policymakers and practitioners in implementing PCP programs. By making the implementation components and mechanisms of action explicit, it has the potential to bridge the gap between evidence-based research and local implementation, although future real-world evaluation is needed to confirm its practical impact.
BACKGROUND:Individuals with cardiovascular disease (CVD) experienced high mortality during coronavirus disease 2019 (COVID-19), yet most live with multiple long-term conditions (MLTCs). We examined the association between MLTCs burden and mortality following COVID-19 among people with CVD. METHODS:In this population-based cohort study, linked national electronic health records from England were analysed. Adults aged ≥18 years with CVD and a positive COVID-19 test between 31 January 2020 and 31 October 2022 were included. MLTCs burden was defined as the number of additional long-term conditions beyond CVD (0, 1, 2, or ≥3). One-year mortality was assessed using adjusted flexible parametric Royston-Parmar models. RESULTS:In 1 081 695 individuals with CVD and COVID-19, 89.7% had at least one long-term condition (LTC) and 67.9% had two or more. Increasing MLTC burden showed a dose-response association with mortality. Compared to individuals without additional LTCs, mortality risk was doubled for those with one LTC (adjusted hazard ratio: 1.86, 95% CI: 1.76-1.96), tripled among those with two LTCs (3.00, 2.85-3.16), and five-fold higher in those with ≥3 LTCs (5.00, 4.75-5.27). Associations were consistent across CVD subtypes. CONCLUSIONS:MLTCs burden was a stronger determinant of mortality risk than CVD subtype alone. Findings support moving beyond single-disease models towards integrated, MLTC-informed care, and pandemic preparedness.
Traditional methods of detecting incidences of drug and alcohol presentations to Emergency Departments are often underestimated and are time and resource intensive. Triage narratives can be a timely and cost-effective alternative using ED data. Our systematic review examines the case identification of drug and/or alcohol-related ED presentations using triage narratives compared to other existing methods, such as International Classification of Disease (ICD) codes. Five databases were screened for relevant peer-reviewed articles between 1990 and 2023. We used controlled terminology to identify articles, pre-piloted screening and extraction tools to identify eligible articles. Two independent reviewers were used to identify relevant articles, for data extraction, and for data analysis. Descriptive statistics were used to compare triage narratives and diagnostic codes. Articles were summarized and described narratively. 22,096 articles were screened. 119 articles were identified after title and abstract screening. 24 underwent full-text review. A total of 10 quantitative articles were identified. Drug and alcohol presentations to the ED were found to have a higher likelihood of arriving on evening, night, or weekend shifts; be male; and were correlated with concurrent injuries or mental health presentations. Triage narratives capture a greater volume of case identification, but can be offset by a higher false-positive rate. Missed cases using ICD codes were due to discharge codes capturing symptoms rather than an illness; concurrent diagnoses; or patients leaving before physician assessment. ICD codes capture only a portion of true drug and alcohol presentations to the ED. The use of triage narratives provide a more complete estimate of presentations, but may be offset by lower specificity and a greater number of false-positive cases. In a context where timely case identification and syndromic classification is needed, further analysis and discussions are needed to balance comprehensive, timely data and data accuracy.
Given the diversity of stakeholder engagement in co-creation research and the absence of an operational classification of stakeholder roles, this study aimed to develop a classification framework for co-creator roles and demonstrate its practical application in classifying stakeholder engagement. To develop the co-creation roles framework, we searched Google Images and Google Scholar to identify concepts and frameworks relevant to co-creation roles. To demonstrate its application, we applied the framework to classify stakeholder roles in studies on youth co-creation in public health interventions. Studies were identified through a systematic review using four databases (OVID/Medline, Ebsco/APA PsycINFO, Ebsco/CINAHL, Elsevier/Scopus), following PRISMA guidelines and registering the protocol on PROSPERO (CRD42024628813). The Google Images and Google Scholar search yielded five articles addressing co-creation role elements such as ‘stages of co-creation’ and ‘stakeholder levels of engagement’. The systematic review included 39 articles describing n = 19 youth-focused public health projects underpinned by co-creation (n = 9), youth participatory action research (n = 7) or community-based participatory research (n = 3), revealing stakeholder engagement at multiple levels. This study presents an operational classification framework for describing co-creation roles among diverse stakeholders, providing a practical approach to improving transparency and comparability across co-creation research.
Children from socioeconomically disadvantaged families often have lower developmental outcomes than their socioeconomically more advantaged peers. In early childhood, language development (LD) in particular is a key competence for further socialization. There is a need to explore the mechanisms underlying the relationship between a family socioeconomic position (SEP) and LD. This study examines the role of parents’ intangible investments, such as interactions between parents and children, in explaining socioeconomic differences in LD in 3-year old children. Using data from the German birth cohort study BaBi (n = 694), a structural equation model (β, 95
To assess the mental health status of Tuscany adolescents and to determine whether there is an association between various health determinants and both severe psychological distress and self-injury in the post-pandemic era. A total of 8833 students (aged 14–19 years) completed a survey with 14 sections covering sociodemographic characteristics, well-being, mental health, COVID-19, driving, health behaviours (smoking, alcohol consumption, recreational drug consumption, physical activity, and dietary habits) and risk behaviours (gambling, bullying and cyberbullying, gender identity). Analysis showed that severe distress (female = 70.3
To map and synthesize the available scientific evidence on the relationship between chronic low back pain and sleep-related outcomes among agro-industrial and industrial workers exposed to high physical demands. A scoping review was conducted following the Joanna Briggs Institute methodology and the PRISMA-ScR checklist. Searches were performed in PubMed/MEDLINE, Scopus, Web of Science, Embase, and LILACS for studies published between 2000 and 2025. Quantitative observational studies in Portuguese, English, or Spanish involving adult workers in industrial or agricultural settings were included. Thirteen studies met the inclusion criteria, predominantly with cross-sectional designs from Brazil and the United States. Chronic low back pain was consistently associated with poorer sleep quality, increased daytime sleepiness, fatigue, and sleep fragmentation. No study utilized objective diagnostic tools, such as polysomnography, for obstructive sleep apnea; evidence relied exclusively on self-reported measures. Biomechanical overload and psychosocial factors were identified as key modulators of this relationship. There is a consistent association between chronic low back pain and sleep disturbances in high-demand occupational settings. However, the lack of longitudinal data and objective sleep apnea diagnoses remains a significant gap. Integrated occupational health strategies addressing musculoskeletal health and sleep as interdependent components are essential for worker health surveillance.
This study aimed to identify employee risk groups and transitions between work–family conflict clusters over time by investigating possible clusters of work–family conflict frequency. Latent class and transition analyses were conducted on 767 white-collar employees using two repeated questionnaire assessments. Four clusters depicting infrequent or nonexistent, seldom, sometimes, and frequent work–family conflict were identified. The clusters differed in demographic, work-related, and dispositional characteristics, as well as well-being outcomes. Employees who frequently experience work–family conflict were observed to be a stable cluster, where transitions toward less frequent conflict occurred rarely compared to other clusters. Employees who sometimes experience work–family conflict were observed to be transitional and susceptible to shifts toward both less and more frequent work–family conflict. Both clusters were overrepresented by part-time workers and characterized by more job demands and less job autonomy. Although not experiencing the poorest outcomes, employees in the sometimes conflict cluster still exhibited negative outcomes, including higher performance-based self-esteem, exhaustion, and long-term sick leave risk. Overall, the findings highlighted employees at risk of frequent work–family conflict and demonstrated the value of person-centered approaches like latent transition analysis in understanding how work–family conflict develops and changes over time.
(1) To assess the feasibility, acceptability of, and experience with heart rate variability (HRV)-guided physical activity (PA) in perimenopausal women; (2) explore associations between daily HRV and perimenopausal symptoms, sleep quality, and stress. A single-group mixed methods feasibility study was conducted. Participants completed assessments at baseline (T1) and were provided with a wearable smartwatch. Participants wore the smartwatch for a 3-week familiarization period (to establish one’s typical HRV), then completed a second assessment (T2) and were given a PA booklet providing information to support HRV-guided PA. Following this, participants were advised to utilize their HRV and guidebook to inform their PA over a 4-week intervention period. Following the intervention period, a semi-structured interview was conducted to explore the feasibility, acceptability, and experience of the HRV-guided PA (T3). Data were analyzed using means and standard deviations (SD), repeated measure correlations, and reflexive thematic analysis. Fifty-one participants were screened and 14 were included (mean age 47.1, SD 4.6). Participants reported moderate severity of symptomology and described the varied ways it influenced their well-being and levels of PA. Feasibility was mixed with low-to-moderate ratings and acceptability was rated low, which was expounded upon in interviews. Repeated correlations indicated that higher rated daily sleep was associated with higher daily HRV. While HRV-guided PA was neither feasible nor acceptable, participants appreciated that HRV-guided PA may be beneficial to support rest and recovery among active women. Continued exploration of the role of HRV-guided PA is needed in both active and inactive perimenopausal women.
Gambling is increasingly accessible because of online platforms and the expansion of legalized sports betting. Earlier gambling initiation has been associated with greater risks of later gambling-related harm. This study examined generational differences in the age of gambling onset and whether patterns differed between individuals who bet on sports and those who gamble but not on sports. Data were drawn from a US online panel sample of more than 1600 adults who reported gambling participation in the past 6 months. Self-reported age of gambling initiation, sports betting participation, and generational cohort differences were examined to assess whether associations between sports betting and onset have changed over time. Sports bettors reported earlier gambling initiation than non-sports gamblers, although this association varied across generational cohorts. In older cohorts, individuals who bet on sports began gambling substantially earlier, whereas in more recent cohorts this difference was markedly smaller. The proportion of gamblers who participated in sports betting also increased across cohorts, shifting from a minority to a majority practice among younger adults. Gambling initiation patterns may be changing alongside the normalization and mobile availability of sports betting. Monitoring cohort differences in gambling onset and sports betting participation may help inform targeted public health prevention and harm-reduction strategies.
Multimorbidity is increasing globally and poses significant challenges for individuals and health systems. Disease-specific models of care often fail to address the complex and overlapping needs of older adults with multiple chronic conditions, contributing to fragmented services and treatment burden. This scoping review aimed to identify gaps in the knowledge base related to interventions targeting community-dwelling older adults with chronic multimorbidity in primary care settings. A comprehensive search of five databases identified peer-reviewed studies describing interventions targeting older adults aged 65 years and above with multimorbidity. Titles, abstracts, and full texts were screened by at least two independent reviewers. Reported facilitators and barriers to implementation were analysed using the Consolidated Framework for Implementation Research (CFIR). Twenty-three studies describing 21 interventions were included, most published from 2020 onwards. Care was the dominant intervention focus, often combined with rehabilitation, treatment, or prevention, and many interventions incorporated digital technologies to support self-management and care coordination. Implementation factors reflected differing perspectives: older adults emphasised comprehensibility, relational continuity, and alignment with everyday routines, whereas health professionals highlighted organisational fit, workload, and care coordination. Overall, interventions reflect a care-oriented and increasingly technology-enabled approach to multimorbidity management. However, important gaps remain in preventive and palliative strategies and in system-level integration across sectors. The review has been registered in OSF ( https://osf.io/mxjfg/overview ).
Adverse childhood experiences (ACEs) have been linked to poorer health and well-being across the lifespan. This study examined the associations of two dimensions of ACEs (threat and deprivation) with 30 chronic conditions (CCs) and their multimorbidity. Further, we assessed whether social support availability (SSA) moderated these associations. This study used data from the Canadian Longitudinal Study on Aging (CLSA). The sample included 38,191 adults aged 45–89 from the CLSA baseline (2011–2015) cohort. Participants self-reported chronic physical health conditions and ACEs. Logistic regression was used to assess associations between ACE dimensions and CC outcomes, including CC domains based on functional and physiological linkages, adjusting for sociodemographic factors. Effect modification by overall SSA was also assessed. Of 38,191 participants, 44
To assess informal caregivers’ physical activity in different domains in Germany. A sample of 20,216 adults was analysed using data from the representative survey German Health Update (GEDA 2019/2020-EHIS). Bivariate and multivariate (logistic regression) analyses were performed to compare different types of physical activity (walking, cycling, leisure-time activity, strength training, sitting) of informal caregivers and non-caregivers, taking caregiving intensity into account (< 10 h per week vs. ≥ 10 h per week). Overall, caregiving was correlated to favourable physical activity behaviour when considering various covariates. Caregivers were more likely to walk at least 60 min per week compared to non-caregivers by 4.0 percentage points (average marginal effect [AME] = 0.040; 95
BACKGROUND:Harmful alcohol use is a major modifiable risk factor for self-harm. We aimed to examine associations between minimum unit pricing for alcohol, introduced in Scotland in 2018, and rates of hospital-admitted self-harm. METHODS:Data were obtained from Public Health Scotland and English Hospital Episode Statistics. Interrupted time series (ITS) analysis compared pre- and post-intervention self-harm admission rates per 100 000 population, including controlled comparisons with England. RESULTS:The before-after slope reduction in Scotland corresponded to -5.6 (95% CI -7.5 to -3.7) admissions per quarter, per 100 000 population, over the intervention period. Using controlled ITS, a greater slope reduction was observed in Scotland relative to England: -3.5, CI -6.4 to -0.6. No differences in slope change were observed when examining only pre-pandemic study quarters. Findings were consistent with a possible postintervention rate reduction in the two most deprived population quintiles, while no between-nation slope difference was observed in the three least deprived quintiles. CONCLUSIONS:Findings were consistent with possible postintervention reductions in hospital-admitted self-harm in Scotland compared to England, with reductions concentrated in more deprived populations. Population-level alcohol pricing policies may contribute to reducing self-harm frequency, although causal interpretation is limited by the observational, quasi-experimental study design and differing between-nation pre-intervention trajectories.
Moral distress has been widely documented among registered nurses and is associated with considerable psychological strain. However, little isknown about the extent to which nursing students experience moral distress during their education. This study aimed to investigate theprevalence, symptoms, and sources of moral distress among student nurses in Germany. A quantitative cross-sectional online survey was conducted among nursing students enrolled in qualifying nursing programs in Germany (n =136). Existing validated instruments measuring moral distress were translated, adapted to the educational context, and combined with aframework categorizing potential sources of moral distress. Descriptive statistical analyses were performed. Of the respondents, 84.6
In many countries, the health systems allow patients to have free selection of the hospital where they wish to receive treatment. The market for hospital services is a competitive market, where competition not necessarily happens over costs but over the quality of care. So far, only limited information on patient preferences of hospital choice is available. The aim of this study was to provide a systematic review about the relevance of the quality indicators for patients when making a choice of hospital for inpatient treatment, which we conducted according to the PRISMA guidelines. We retrieved studies from PubMed, Web of Science, and EconLit and assessed them according to predefined criteria. To be eligible for our purposes, studies needed to examine inpatient preferences for hospital choice in North America, Europe, Australia, and New Zealand. The extracted quality indicators were then sorted according to study type (quantitative or qualitative), main indication (cancer, orthopedics, gastrointestinal, cardiology, and other), and structure, process, or outcome quality following Donabedian’s framework. Study quality was assessed with the Mixed-Methods-Appraisal-Tool (MMAT). Fifty-one studies met inclusion criteria. We extracted 24 quality indicators (ten structure, five process, five experiences and recommendations as a sub-category of process indicators, and four outcome). The most frequently examined one was “proximity to hospital/travel distance or time” (n = 38). Structure and process indicators were examined often, as well as experiences and recommendation indicators, while outcome indicators were examined seldom. We found few studies conducting qualitative research and more studies examining stated preferences than revealed preferences. Structure and process quality indicators were examined frequently, while outcome quality indicators were examined seldom, potentially either because patients do not consider them important or because little information on them is available. More qualitative and mixed methods studies are needed, as well as information on additional quality indicators.
The local public health authority (LPHA) in Duesseldorf received notification of two SARS-CoV-2 outbreaks in nursing home A and nursing home B in October 2021 and embarked on an outbreak investitation to identify the source of the outbreak and epidemiological links between cases. The LPHA conducted a retrospective outbreak investigation involving residents and staff and combined results of active case finding, weekly point-of-care testing (POCT), and integrated genomic surveillance (IGS) with structured case interviews, whole-genome sequencing, and cluster analysis. The LPHA identified two linked outbreaks of SARS-CoV-2 infections in nursing homes A and B, with a total of 32 cases occurring from 12 to 29 October 2021. First case notification and routine contact tracing revealed a cluster of six SARS-CoV-2 cases in nursing home A and two cases in nursing home B. Weekly POCT independent of symptoms and IGS data revealed that the true extent of the outbreak involved 27 cases associated with nursing home A and five additional, genetically identical cases that were linked to nursing home B. Routine contact tracing identified 20.0
We explored patients’ experiences, perceptions, and expectations regarding communication with healthcare providers (HCP) about sexual health in Austria. We identified challenges, barriers, and potential improvements to enhance patient-centered communication on sexuality, sexual orientation, gender identity, and sexually transmitted infections (STI). During March-December 2024, we conducted an online survey in Austria (25 items survey). We used descriptive and multivariate logistic regression analysis (Odds Ratio (or), 95
