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\"Using human skeletal remains, this volume traces health, workload and violence in the European population over the past 2,000 years. Health was surprisingly good for people who lived during the early Medieval Period. The Plague of Justinian of the 6th century was ultimately beneficial for health because the smaller population had relatively more resources that contributed to better living conditions. Increasing population density and inequality in the following centuries imposed an unhealthy diet - poor in protein - on the European population. With the onset of the Little Ice Age in the late Middle Ages, a further health decline ensued, which was not reversed until the nineteenth century. While some aspects of health declined, other attributes improved. During the early modern period, interpersonal violence (outside of warfare) declined possibly because stronger states and institutions were able to enforce compromise and cooperation. European health over the past two millennia was hence multifaceted in nature\"-- Provided by publisher.

The Strengths and Difficulties Questionnaire (SDQ) is widely used to assess child and adolescent mental health problems. However, the factor structure of the SDQ is subject to debate and there is limited evidence investigating measurement equivalence invariance (ME/I) between treatment groups, informants, and across time. A randomised controlled trial (RCT) recruited 250 participants (6-17 years) who had been referred for an attention deficit hyperactivity disorder (ADHD) assessment. Participants and their clinician either received or did not receive a QbTest report (computer task measuring attention, impulsivity and activity). Parents and teachers completed the SDQ at baseline and 6-months later. This study aimed to understand the factor structure of the SDQ in a clinic referred ADHD sample, and validate the scale as a screening/diagnostic aide and as a measure of treatment outcome both in clinical and research settings. Exploratory Structural Equation Modelling (ESEM) was performed to examine the factor structure, and ME/I was assessed between treatment groups, informants, and time points. The criterion validity of the SDQ predictive algorithm for ADHD was compared with clinician and research diagnoses using logistic regression and tests of diagnostic accuracy. A 5-factor structure provided the best fit with strong factorial invariance between treatment groups and across time points, but not across informants (parent and teacher ratings). SDQ ratings of 'probable' hyperactivity disorder were good predictors of clinical (OR = 10.20, 95%CI 2.18-48.71,p = 0.003) and research diagnoses of ADHD (OR = 6.82, 95%CI 1.95-23.84,p = 0.003), and research diagnoses of Hyperkinetic disorder (OR = 4.02, 95%CI 1.13-14.25,p = 0.031). Further examination of the SDQ hyperactivity 'probable' rating showed good specificity (84.5%-74.5%) but poor sensitivity (45.0-42.5%) for ADHD. The findings indicate the SDQ is a valid outcome measure for use in RCTs and clinical settings. However, care should be taken when using the SDQ predictive algorithm to screen for ADHD in clinically referred samples.

Background Early childhood education and care (ECEC) settings offer a potentially cost-effective and sustainable solution for ensuring children have opportunities to meet physical activity (PA) and sedentary time (ST) guidelines. This paper systematically reviewed the association between childcare environment and practice and children’s PA and ST. Methods Three electronic databases were searched, and citation tracking of eligible studies performed between June–July 2020 (updated March 2022). Studies were eligible when (i) participants attended ECEC settings, (ii) they reported the association between use of outdoor space, including factors of time, availability, play, size and equipment, and children’s device-measured PA and ST, and (iii) where applicable, they compared the exposure to use of indoor space. Risk of bias was assessed using the Critical Appraisal Skills Program (CASP) tools. A synthesis was performed using effect direct plots and charts to visualise effect sizes. Results Of 1617 reports screened, 29 studies met the inclusion criteria. Studies provided data on outdoor versus indoor time ( n  = 9; 960 children), outdoor versus indoor play ( n  = 3; 1104 children), outdoor play space ( n  = 19; 9596 children), outdoor space use external to ECEC ( n  = 2; 1148 children), and portable ( n  = 7; 2408 children) and fixed ( n  = 7; 2451 children) outdoor equipment. Time spent outdoors versus indoors was associated with increased moderate-to-vigorous PA (MVPA), light PA (LPA) and total PA, while the association with ST was inconclusive. The mean (standard deviation) levels of outdoor MVPA (4.0 ± 3.2 to 18.6 ± 5.6 min/h) and LPA (9.9 ± 2.6 to 30.8 ± 11.8 min/h) were low, and ST high (30.0 ± 6.5 to 46.1 ± 4.3 min/h). MVPA levels doubled when children played outdoors versus indoors. Outdoor play space, and outdoor portable equipment, were associated with increased MVPA. A dose-response relationship for outdoor play area size was observed, demonstrating increased MVPA with areas ≥505m 2 (5436 ft 2 ), but no further increases when areas were > 900m 2 (9688 ft 2 ). No studies reported on injuries in outdoor settings. Conclusions ECEC policies and practices should promote not only outdoor time but also the availability of resources such as portable play equipment and sufficient size of outdoor play areas that enable children to be physically active for sustained periods while outdoors. Systematic review registration International prospective register of systematic reviews (PROSPERO) Registration Number: CRD42020189886.

Strategies to improve food and nutrition security continue to promote increasing food via agricultural intensification. Little (if any) consideration is given to the role of natural landscapes such as forests in meeting nutrition goals, despite a growing body of literature that shows that having access to these landscapes can improve people’s diets, particularly in rural areas of low- and middle-income countries. In this study, we tested whether deforestation over a 5-y period (2008–2013) affected people’s dietary quality in rural Tanzania using a modeling approach that combined two-way fixed-effects regression analysis with covariate balancing generalized propensity score (CBGPS) weighting which allowed for causal inferences to be made. We found that, over the 5 y, deforestation caused a reduction in household fruit and vegetable consumption and thus vitamin A adequacy of diets. The average household member experienced a reduction in fruit and vegetable consumption of 14 g·d−1, which represented a substantial proportion (11%) of average daily intake. Conversely, we found that forest fragmentation over the survey period led to an increase in consumption of these foods and dietary vitamin A adequacy. This study finds a causal link between deforestation and people’s dietary quality, and the results have important implications for policy makers given that forests are largely overlooked in strategies to improve nutrition, but offer potential “win–wins” in terms of meeting nutrition goals as well as conservation and environmental goals.

In response to COVID-19, there has been increasing momentum in telehealth development and delivery. To assess the anticipated exponential growth in telehealth, it is important to accurately capture how telehealth has been used in specific mental health fields prior to the pandemic. This systematic review aimed to highlight how telehealth has been used with clinical samples in the neurodevelopmental field, including patients with neurodevelopmental disorders (NDDs), their families, and health care professionals. To identify which technologies show the greatest potential for implementation into health services, we evaluated technologies for effectiveness, economic impact, and readiness for clinical adoption. A systematic search of literature was undertaken in April 2018 and updated until December 2019, by using the Medline, Web of Science, Scopus, CINAHL Plus, EMBASE, and PsycInfo databases. Extracted data included the type of technology, how the technology was used (ie, assessment, treatment, and monitoring), participant characteristics, reported outcomes and authors' views on clinical effectiveness, user impact (ie, feasibility and acceptability), economic impact, and readiness for clinic adoption. A quality review of the research was performed in accordance with the Oxford Centre for Evidence-Based Medicine Levels of Evidence. A total of 42 studies met the inclusion criteria. These studies included participants and family members with autism spectrum disorders (21/42, 50%), attention deficit hyperactivity disorders (8/42, 19%), attention deficit hyperactivity or autism spectrum disorders (3/42, 7%), communication disorders (7/42, 17%), and tic disorders (2/42, 5%). The focus of most studies (33/42, 79%) was on treatment, rather than assessment (4/42, 10%) or monitoring (5/42, 12%). Telehealth services demonstrated promise for being clinically effective, predominantly in relation to diagnosing and monitoring NDDs. In terms of NDD treatment, telehealth services were usually equivalent to control groups. There was some evidence of positive user and economic impacts, including increased service delivery efficiency (eg, increased treatment availability and decreased waiting times). However, these factors were not widely recorded across the studies. Telehealth was demonstrated to be cost-effective in the few studies that considered cost-effectiveness. Study quality varied, as many studies had small sample sizes and inadequate control groups. Of the 42 studies, only 11 (26%) were randomized controlled trials, 12 (29%) were case studies or case series, 6 (14%) were qualitative studies, and 5 (12%) were noncomparative trials. Telehealth has the potential to increase treatment availability, decrease diagnosis waiting times, and aid in NDD monitoring. Further research with more robust and adequately powered study designs that consider cost-effectiveness and increased efficiency is needed. This systematic review highlights the extent of telehealth technology use prior to the COVID-19 pandemic and the movement for investing in remote access to treatments. PROSPERO International Prospective Register of Systematic Reviews CRD42018091156; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42018091156.

Background Practitioners and decision makers in the medical and insurance systems need knowledge on the relationship between work exposures and burnout. Many burnout studies – original as well as reviews - restricted their analyses to emotional exhaustion or did not report results on cynicism, personal accomplishment or global burnout. To meet this need we carried out this review and meta-analyses with the aim to provide systematically graded evidence for associations between working conditions and near-future development of burnout symptoms. Methods A wide range of work exposure factors was screened. Inclusion criteria were: 1) Study performed in Europe, North America, Australia and New Zealand 1990–2013. 2) Prospective or comparable case control design. 3) Assessments of exposure (work) and outcome at baseline and at least once again during follow up 1–5 years later. Twenty-five articles met the predefined relevance and quality criteria. The GRADE-system with its 4-grade evidence scale was used. Results Most of the 25 studies focused emotional exhaustion, fewer cynicism and still fewer personal accomplishment. Moderately strong evidence (grade 3) was concluded for the association between job control and reduced emotional exhaustion and between low workplace support and increased emotional exhaustion. Limited evidence (grade 2) was found for the associations between workplace justice, demands, high work load, low reward, low supervisor support, low co-worker support, job insecurity and change in emotional exhaustion. Cynicism was associated with most of these work factors. Reduced personal accomplishment was only associated with low reward. There were few prospective studies with sufficient quality on adverse chemical, biological and physical factors and burnout. Conclusion While high levels of job support and workplace justice were protective for emotional exhaustion, high demands, low job control, high work load, low reward and job insecurity increased the risk for developing exhaustion. Our approach with a wide range of work exposure factors analysed in relation to the separate dimensions of burnout expanded the knowledge of associations, evidence as well as research needs. The potential of organizational interventions is illustrated by the findings that burnout symptoms are strongly influenced by structural factors such as job demands, support and the possibility to exert control.

Introduction The experiences of UK Government response-focused employees, who were considered frontline workers during the coronavirus response, are missing from current literature. Meeting the demands of being on the frontline, whilst also adjusting from a normal and practiced way of working to having to work from within one’s home, may bring a plethora of new barriers and facilitators associated with providing an effective pandemic response. Method This interview study collected and analysed data from 30 UK Civil servants who worked on the COVID-19 pandemic response from their own homes. Interviews aimed to: (1) explore UK Government employee’s experiences of working from home whilst contributing to the pandemic response; and, (2) establish what support and guidance employees were offered, and what they would recommend for future public health emergencies requiring homeworking. Results Seven themes were extracted from the data: overall experience of working from home; preparedness for working from home; experience of contributing to the response effort; work life balance; relationships with colleagues; space and equipment; and, inclusivity. Findings suggested that during the pandemic, participants reported feeling a strong sense of purpose and achievement for contributing to the response. But, the work was demanding, particularly for those who had to rapidly, and unexpectedly, transition from office or lab work to home working. More generally, the nature of their homeworking experience depended on a range of practical (e.g., space in the home), organisational (e.g., relationships with managers) and personal factors (e.g., caring responsibilities). Many participants were underprepared to work from home, but participants provided a plethora of information relating to what support offers they would find useful during future work on the frontline from their own homes. Conclusion The results of this study demonstrate that frontline UK Civil servants may need more tailored and flexible multilevel support (i.e., from peers, managers, organisations) during future public health emergencies when they are required to work from home. A series of data-informed recommendations are created and discussed.

Background A recent research project sought to explore the experience of UK response-focused civil servants asked to work from home during the COVID-19 pandemic and to create a series of recommendations for future public health emergencies requiring response-focused homeworking. In general, civil servants from one select government organisation were able to convey a plethora of lessons learnt, reflections on experience, and suggestions for future support offers should another public health emergency require homeworking. Recommendations were derived from the evidence, but it remained important to ensure that the recommendations were useful, fit for purpose, and actionable. This required collaboration with experts in appropriate fields (in this case, mental health, occupational health, and government affiliated individuals). Method This Delphi study sought to refine and operationalise evidence-based recommendations designed to support the mental health and wellbeing of future UK response-focused civil servants asked to work from home during public health emergencies. A total of 32 experts were recruited into the study; these individuals provided feedback and rated recommendations over three iterative rounds. Results A total of 19 recommendations reached consensus at a > 90% level of agreement. In line with feedback from experts, these were categorised into preparedness and response focused recommendations to aid with implementation. Collectively, these recommendations establish the importance of organisation/employer level initiatives to protect mental health and wellbeing in response-focused civil servants working from home. Conclusion The key outcome of this work has been the importance of employees, managers, and organisations retaining flexibility when working from home, as a range of factors (e.g., living circumstances, others in household, relationships with colleagues) can influence experience, and each employee will face theird own barriers and facilitators to working from home.

Introduction: The concept of “working from home” is extremely topical following the COVID-19 pandemic; therefore, it is unsurprising that there has been an increased interest in collating research related to homeworking. This has been carried out by multiple reviews, all with slightly different research aims and methodologies. Collating the findings from the available reviews is therefore highly beneficial to establish the experience of homeworking to create recommendations for the future of home-based work.Methods: An umbrella review was carried out. In June 2022, literature searches were conducted across 4 electronic databases. Published reviews of literature that used a systematic process, were focused on working from home populations, and detailed factors that could be related to the personal experience of homeworking (eg, barriers, facilitators, advantages, disadvantages) were included.Results: A total of 1930 records were screened and 6 review articles were included. Results report on the following sections: working environment (eg, workplace design, space conditions), personal impact (eg, satisfaction, career impact), and health (eg, physical health, well-being) including a total of 19 themes. Mixed findings were apparent for nearly all included themes, highlighting the need to consider individual and contextual circumstances when researching working from home.Conclusions: This review establishes the importance of retaining flexibility while homeworking for employees, managers, and organizations. Essentially, a one-size-fits-all approach to working from home is impractical as individual circumstances limit application. Eight recommendations for the future of working from home are suggested.

Background Depressive symptoms are potential outcomes of poorly functioning work environments. Such symptoms are frequent and cause considerable suffering for the employees as well as financial loss for the employers. Accordingly good prospective studies of psychosocial working conditions and depressive symptoms are valuable. Scientific reviews of such studies have pointed at methodological difficulties but still established a few job risk factors. Those reviews were published some years ago. There is need for an updated systematic review using the GRADE system. In addition, gender related questions have been insufficiently reviewed. Method Inclusion criteria for the studies published 1990 to June 2013: 1. European and English speaking countries. 2. Quantified results describing the relationship between exposure (psychosocial or physical/chemical) and outcome (standardized questionnaire assessment of depressive symptoms or interview-based clinical depression). 3. Prospective or comparable case-control design with at least 100 participants. 4. Assessments of exposure (working conditions) and outcome at baseline and outcome (depressive symptoms) once again after follow-up 1-5 years later. 5. Adjustment for age and adjustment or stratification for gender. Studies filling inclusion criteria were subjected to assessment of 1.) relevance and 2.) quality using predefined criteria. Systematic review of the evidence was made using the GRADE system. When applicable, meta-analysis of the magnitude of associations was made. Consistency of findings was examined for a number of possible confounders and publication bias was discussed. Results Fifty-nine articles of high or medium high scientific quality were included. Moderately strong evidence (grade three out of four) was found for job strain (high psychological demands and low decision latitude), low decision latitude and bullying having significant impact on development of depressive symptoms. Limited evidence (grade two) was shown for psychological demands, effort reward imbalance, low support, unfavorable social climate, lack of work justice, conflicts, limited skill discretion, job insecurity and long working hours. There was no differential gender effect of adverse job conditions on depressive symptoms Conclusion There is substantial empirical evidence that employees, both men and women, who report lack of decision latitude, job strain and bullying, will experience increasing depressive symptoms over time. These conditions are amenable to organizational interventions.