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The eResearch system \"Prospective Monitoring and Management App (PIA)\" allows researchers to implement questionnaires on any topic and to manage biosamples. Currently, we use PIA in the longitudinal study ZIFCO (Integrated DZIF Infection Cohort within the German National Cohort) in Hannover (Germany) to investigate e.g. associations of risk factors and infectious diseases. Our aim was to assess user acceptance and compliance to determine suitability of PIA for epidemiological research on transient infectious diseases. ZIFCO participants used PIA to answer weekly questionnaires on health status and report spontaneous onset of symptoms. In case of symptoms of a respiratory infection, the app requested participants to self-sample a nasal swab for viral analysis. To assess user acceptance, we implemented the System Usability Scale (SUS) and fitted a linear regression model on the resulting score. For investigation of compliance with submitting the weekly health questionnaires, we used a logistic regression model with binomial response. We analyzed data of 313 participants (median age 52.5 years, 52.4% women). An average SUS of 72.0 reveals good acceptance of PIA. Participants with a higher technology readiness score at the beginning of study participation also reported higher user acceptance. Overall compliance with submitting the weekly health questionnaires showed a median of 55.7%. Being female, of younger age and being enrolled for a longer time decreased the odds to respond. However, women over 60 had a higher chance to respond than women under 60, while men under 40 had the highest chance to respond. Compliance with nasal swab self-sampling was 77.2%. Our findings show that PIA is suitable for the use in epidemiologic studies with regular short questionnaires. Still, we will focus on user engagement and gamification for the further development of PIA to help incentivize regular and long-term participation.

Background and Aims Connectedness to nature (CN) refers to the degree to which individuals feel a connection with the natural environment. CN has been associated with physical activity, life satisfaction, well‐being, and pro‐environmental behavior, making it a potential resource for both human and planetary health. This study aimed to compare self‐reported CN levels among three groups of physically active individuals in the general adult population using two established CN measures: the Nature Relatedness‐6 Scale (NR‐6) and the Connectedness to Nature Single Item (CN‐SI). Methods A large sample of 3357 participants, consisting of 1214 fitness enthusiasts, 1115 golfers, and 1028 climbers, participated in three targeted cross‐sectional online surveys. CN levels were assessed using the NR‐6 and CN‐SI scales. Differences between groups were analyzed using statistical comparisons. Results Climbers exhibited significantly higher NR‐6 scores compared to fitness enthusiasts and golfers, indicating a stronger sense of nature relatedness. However, CN‐SI scores were highest among golfers. These findings suggest variations in CN perceptions depending on the type of physical activity performed. Conclusion Engaging in physical activity that involves direct interaction with nature, such as outdoor climbing, may enhance individuals' sense of connection with the natural environment. Given the negative health impacts of sedentary lifestyles, promoting outdoor physical activity could serve as a dual approach to improving both personal well‐being and environmental awareness, fostering sustainability in the long term.

SARS-CoV-2 variants accumulating immune escape mutations provide a significant risk to vaccine-induced protection against infection. The novel variant of concern (VoC) Omicron BA.1 and its sub-lineages have the largest number of amino acid alterations in its Spike protein to date. Thus, they may efficiently escape recognition by neutralizing antibodies, allowing breakthrough infections in convalescent and vaccinated individuals in particular in those who have only received a primary immunization scheme. We analyzed neutralization activity of sera from individuals after vaccination with all mRNA-, vector- or heterologous immunization schemes currently available in Europe by in vitro neutralization assay at peak response towards SARS-CoV-2 B.1, Omicron sub-lineages BA.1, BA.2, BA.2.12.1, BA.3, BA.4/5, Beta and Delta pseudotypes and also provide longitudinal follow-up data from BNT162b2 vaccinees. All vaccines apart from Ad26.CoV2.S showed high levels of responder rates (96–100%) towards the SARS-CoV-2 B.1 isolate, and minor to moderate reductions in neutralizing Beta and Delta VoC pseudotypes. The novel Omicron variant and its sub-lineages had the biggest impact, both in terms of response rates and neutralization titers. Only mRNA-1273 showed a 100% response rate to Omicron BA.1 and induced the highest level of neutralizing antibody titers, followed by heterologous prime-boost approaches. Homologous BNT162b2 vaccination, vector-based AZD1222 and Ad26.CoV2.S performed less well with peak responder rates of 48%, 56% and 9%, respectively. However, Omicron responder rates in BNT162b2 recipients were maintained in our six month longitudinal follow-up indicating that individuals with cross-protection against Omicron maintain it over time. Overall, our data strongly argue for booster doses in individuals who were previously vaccinated with BNT162b2, or a vector-based primary immunization scheme.

Objective Depression often follows a recurrent or chronic course influenced by various factors. Social support is associated with depression both by quantity and quality, however, the concurrent change with depression is unclear. This study aimed to determine the trajectories of depressive symptoms and social support over 23 years as well as their interrelationship. Methods We analyzed data from 6787 participants of a Swedish population‐based cohort study at four time points and across 23 years. Depressive symptoms were assessed using the Major Depression Inventory and social support was assessed with the Interview Schedule for Social Interaction. The trajectories of depressive symptoms and social support were determined using group‐based dual trajectory modeling. Multinomial logistic regression analysis assessed the association between the trajectories of depressive symptoms and social support. Results Six trajectories of depressive symptoms and three trajectories of social support were identified. The trajectories were highly associated. Individuals without depressive symptoms were likely to have a stable high availability of social support, and those with persistent depressive symptoms were likely to experience a stable low availability of social support. Conclusions Our findings imply that social support should be considered in the management of depressive symptoms. Highlights Significant Outcomes: There were heterogeneous trajectories of depressive symptoms and social support in this general adult population. Trajectories of depressive symptoms and social support were highly associated. Limitations: The loss to follow‐up might have led to an underestimation of the group with persistent depressive symptoms. The self‐reported information on treatment and medications might underestimate the true situation. The relationship between depressive symptoms and social support is cross‐sectional, so causal claims cannot be made.

Background Lyme borreliosis (LB) is the most common tick-borne infectious disease in the northern hemisphere. The diagnosis of LB is usually made by clinical symptoms and subsequently supported by serology. In Europe, a two-step testing consisting of an enzyme-linked immunosorbent assay (ELISA) and an immunoblot is recommended. However, due to the low sensitivity of the currently available tests, antibody detection is sometimes inaccurate, especially in the early phase of infection, leading to underdiagnoses. Methods To improve upon Borrelia diagnostics, we developed a multiplex Borrelia immunoassay (Borrelia multiplex), which utilizes the new INTELLIFLEX platform, enabling the simultaneous dual detection of IgG and IgM antibodies, saving further time and reducing the biosample material requirement. In order to enable correct classification, the Borrelia multiplex contains eight antigens from the five human pathogenic Borrelia species known in Europe. Six antigens are known to mainly induce an IgG response and two antigens are predominant for an IgM response. Results To validate the assay, we compared the Borrelia multiplex to a commercial bead-based immunoassay resulting in an overall assay sensitivity of 93.7% (95% CI 84.8–97.5%) and a specificity of 96.5% (95%CI 93.5–98.1%). To confirm the calculated sensitivity and specificity, a comparison with a conventional 2-step diagnostics was performed. With this comparison, we obtained a sensitivity of 95.2% (95% CI 84.2–99.2%) and a specificity of 93.0% (95% CI 90.6–94.7%). Conclusion Borrelia multiplex is a highly reproducible cost- and time-effective assay that enables the profiling of antibodies against several individual antigens simultaneously.

Fish embryos are widely used as an alternative model to study toxicity in vertebrates. Due to their complexity, embryos are believed to more resemble an adult organism than in vitro cellular models. However, concerns have been raised with respect to the embryo's metabolic capacity. We recently identified allyl alcohol, an industrial chemical, to be several orders of magnitude less toxic to zebrafish embryo than to adult zebrafish (embryo LC50 = 478 mg/L vs. fish LC50 = 0.28 mg/L). Reports on mammals have indicated that allyl alcohol requires activation by alcohol dehydrogenases (Adh) to form the highly reactive and toxic metabolite acrolein, which shows similar toxicity in zebrafish embryos and adults. To identify if a limited metabolic capacity of embryos indeed can explain the low allyl alcohol sensitivity of zebrafish embryos, we compared the mRNA expression levels of Adh isoenzymes (adh5, adh8a, adh8b and adhfe1) during embryo development to that in adult fish. The greatest difference between embryo and adult fish was found for adh8a and adh8b expression. Therefore, we hypothesized that these genes might be required for allyl alcohol activation. Microinjection of adh8a, but not adh8b mRNA led to a significant increase of allyl alcohol toxicity in embryos similar to levels reported for adults (LC50 = 0.42 mg/L in adh8a mRNA-injected embryos). Furthermore, GC/MS analysis of adh8a-injected embryos indicated a significant decline of internal allyl alcohol concentrations from 0.23-58 ng/embryo to levels below the limit of detection (< 4.6 µg/L). Injection of neither adh8b nor gfp mRNA had an impact on internal allyl alcohol levels supporting that the increased allyl alcohol toxicity was mediated by an increase in its metabolization. These results underline the necessity to critically consider metabolic activation in the zebrafish embryo. As demonstrated here, mRNA injection is one useful approach to study the role of candidate enzymes involved in metabolization.

Recent increases in SARS-CoV-2 infections have led to questions about duration and quality of vaccine-induced immune protection. While numerous studies have been published on immune responses triggered by vaccination, these often focus on studying the impact of one or two immunisation schemes within subpopulations such as immunocompromised individuals or healthcare workers. To provide information on the duration and quality of vaccine-induced immune responses against SARS-CoV-2, we analyzed antibody titres against various SARS-CoV-2 antigens and ACE2 binding inhibition against SARS-CoV-2 wild-type and variants of concern in samples from a large German population-based seroprevalence study (MuSPAD) who had received all currently available immunisation schemes. We found that homologous mRNA-based or heterologous prime-boost vaccination produced significantly higher antibody responses than vector-based homologous vaccination. Ad26.CoV2S.2 performance was particularly concerning with reduced titres and 91.7% of samples classified as non-responsive for ACE2 binding inhibition, suggesting that recipients require a booster mRNA vaccination. While mRNA vaccination induced a higher ratio of RBD- and S1-targeting antibodies, vector-based vaccines resulted in an increased proportion of S2-targeting antibodies. Given the role of RBD- and S1-specific antibodies in neutralizing SARS-CoV-2, their relative over-representation after mRNA vaccination may explain why these vaccines have increased efficacy compared to vector-based formulations. Previously infected individuals had a robust immune response once vaccinated, regardless of which vaccine they received, which could aid future dose allocation should shortages arise for certain manufacturers. Overall, both titres and ACE2 binding inhibition peaked approximately 28 days post-second vaccination and then decreased.

Background: Urban gardening enhances public health in urban environments by creating green spaces that encourage physical activity, provide access to fresh food, and support mental well-being. These initiatives also strengthen social connections, alleviate stress, and contribute to environmental sustainability, thus addressing health disparities and enhancing quality of life. This study offers a bibliometric analysis of urban gardening research from 1991 to 2020, highlighting trends and implications for public health. Methods: We employed a bibliometric analysis using the free mapping software VOSviewer (version 1.6.19) to generate co-occurrence networks of keywords and bibliographic coupling networks of documents. The dataset spans three decades, focusing on the evolution of research topics and geographical patterns. Results: This research field has grown steadily since the early 1990s. Over the last two decades, the focus has shifted from addressing poverty and food security to exploring urban gardening’s impact on human well-being and quality of life, predominantly in developed countries. Recent studies highlight the differentiated impacts of urban gardening on various socioeconomic groups. Despite robust evidence of public health benefits, policy implementation remains limited, with researchers emphasizing the need for more quantitative data to inform decisions. Conclusions: Urban gardening research has evolved to address contemporary urban health challenges, showcasing its potential to improve well-being and foster community resilience. Strengthening data quality and fostering collaboration between researchers and policymakers are critical for advancing the role of urban gardening in creating healthier cities.

The eResearch system \"Prospective Monitoring and Management App (PIA)\" allows researchers to implement questionnaires on any topic and to manage biosamples. Currently, we use PIA in the longitudinal study ZIFCO (Integrated DZIF Infection Cohort within the German National Cohort) in Hannover (Germany) to investigate e.g. associations of risk factors and infectious diseases. Our aim was to assess user acceptance and compliance to determine suitability of PIA for epidemiological research on transient infectious diseases. ZIFCO participants used PIA to answer weekly questionnaires on health status and report spontaneous onset of symptoms. In case of symptoms of a respiratory infection, the app requested participants to self-sample a nasal swab for viral analysis. To assess user acceptance, we implemented the System Usability Scale (SUS) and fitted a linear regression model on the resulting score. For investigation of compliance with submitting the weekly health questionnaires, we used a logistic regression model with binomial response. We analyzed data of 313 participants (median age 52.5 years, 52.4% women). An average SUS of 72.0 reveals good acceptance of PIA. Participants with a higher technology readiness score at the beginning of study participation also reported higher user acceptance. Overall compliance with submitting the weekly health questionnaires showed a median of 55.7%. Being female, of younger age and being enrolled for a longer time decreased the odds to respond. However, women over 60 had a higher chance to respond than women under 60, while men under 40 had the highest chance to respond. Compliance with nasal swab self-sampling was 77.2%. Our findings show that PIA is suitable for the use in epidemiologic studies with regular short questionnaires. Still, we will focus on user engagement and gamification for the further development of PIA to help incentivize regular and long-term participation.

Background: Climate change poses significant challenges to global health, At the same time, the healthcare sector itself, with its high resource demands, also contributes substantially to global warming. Anesthesia, particularly through the use of volatile inhalation anesthetics, is a key contributor in this respect. The present exploratory study examines staff perceptions of precycling and recycling strategies aimed at reducing the environmental impact of anesthetic gases at the General Hospital Vienna, Austria. This large institution has recently implemented major changes, including the shutdown of the centralized nitrous oxide supply and the introduction of anesthetic gas recycling systems on anesthesia machines, alongside other precycling measures. Methods: We conducted a cross-sectional online survey of anesthesia team members (n = 103, 61.2% females) to assess current perceptions related to anesthetic gas usage, focusing on precycling and recycling aspects, and their willingness to engage in further sustainability efforts. Results: We found that participants expressed an, in general, positive attitude towards environmental protection measures and a high willingness to make additional efforts to recycle anesthetics. Thus, the anesthesia team members in our institution may be inclined to support strategies like minimizing the use of volatile anesthetics. Conclusions: These preliminary insights could inform actionable recommendations for advancing sustainable practices in anesthesiology at our hospital.