Hajo Zeeb

Background: Older adults are particularly vulnerable to the effects of heatwaves and extreme heat due to physiological changes often exacerbated by chronic diseases and decreased mobility. Although cool indoor temperatures can moderate the health consequences of extreme outdoor heat to some extent, it is important to recognize that access to cool indoor temperatures is distributed unequally across population groups. This study aimed to assess the mediating effect of (indoor) domestic heat exposure on the relationship between socioeconomic position and heat exhaustion in older adults. Methods: In August 2024, 10,000 participants from the DigiHero cohort were invited to take part in an online survey. Of the 5,026 respondents, persons aged 65 or older were included in the analysis ( n = 1,457). Domestic heat exposure was assessed through self-reported indoor temperatures during the day and at night, as well as the availability of cooler rooms at night. Heat exhaustion was measured using self-reported symptoms. Income and education were used as indicators for socioeconomic position. We applied structural equation modelling to assess the total impact of socioeconomic position (education/income) on heat exhaustion and the portion of this effect mediated through domestic heat exposure. Additionally, the analyses were stratified by sex/gender and degree of urbanization. Results: In the study sample, 54% were female; mean age was 72.8 (SD = 5.1); 50% had a high education level; and 70% were not exposed to domestic heat. Lower income and education were linked to more frequent symptoms of heat exhaustion. Lower income, but not education, was associated with higher domestic heat exposure which mediated the income–heat exhaustion relationship (total effect β = -0.09 (-0.14, -0.03); indirect effect β = -0.01 (-0.02, -0.003)). Sex/gender-stratified analyses showed these associations only among women. Sensitivity analyses indicated a stronger mediation in urban settings. Conclusion: The analysis revealed that lower income result in more frequent symptoms of heat exhaustion in older women, partially due to differential domestic heat exposure. Potential sex/gender differences in the effects of heat exposure warrant further exploration.

Large Language Models (LLMs) are increasingly used for health and mental health purposes, yet evidence on associated risks remains scarce. Using a dual-cohort design comprising a general population cohort (N = 28,910) and a clinical cohort of mental health help-seekers (N = 2,313), with adverse effects benchmarked against an outpatient face-to-face psychotherapy cohort (N = 1,775), we investigated the prevalence, correlates, and adverse effects of LLM-based health-seeking behavior. General LLM adoption was associated with sociodemographic early-adopter profiles, whereas general health- and mental health-related use inverted this pattern, being associated with clinical vulnerability. Notably, current psychiatric or psychotherapeutic treatment did not predict either form of health-related use. Adverse effects were more common among clinical cohort members using LLMs for mental health purposes than in the psychotherapy cohort, with the odds of dependency 2.82 times higher (95% CI 2.34, 3.40) and the odds of reduced decision-making autonomy 5.25 times higher (95% CI 3.99, 6.90). While men had lower mental health-related LLM use, they exhibited higher odds of adverse effects than women across both cohorts (OR = 1.50 in the general population cohort and 1.46 in the clinical cohort). Our findings underscore the need for regulatory frameworks and practitioner education to address the unsupervised use of generative AI in healthcare.

We are researchers from six different countries with diverse research backgrounds. We gathered at Schloss Dagstuhl to reflect on data visualizations for public health communication during the COVID-19 pandemic. There, we shared what we had learned and discussed our experiences visualizing COVID-19 data to gain useful insights into the role of data visualization in future pandemics. In this article, we highlight missed opportunities and considerations and provide recommendations. We learned that visualization practices should include cross-disciplinary collaborators with socio-technical expertise, consider personalization and audience more extensively, and use coordinated communication pathways to ensure effective, timely communication in future pandemics.

BACKGROUND Informal caregivers play a central role in long-term care but face elevated risks of stress, depressive symptoms, and caregiver burden, alongside barriers to accessing preventive support. Low-threshold digital public health interventions may offer scalable, evidence–based support, however, evidence on feasibility, usability, and contextual fit remains limited, particularly for intersectionally diverse caregiver populations. OBJECTIVE This study describes the development and implementation of an intersectionality–informed WhatsApp–based chatbot intervention (PflegeBot) and evaluates its feasibility, usability, and acceptability among informal caregivers in Germany. METHODS A single-arm, non-randomized feasibility study with pre-post assessments was conducted between December 2023 and October 2024. Informal caregivers aged ≥18 years were recruited via community, institutional, and online channels. PflegeBot, a bilingual (German/Turkish) WhatsApp-based chatbot delivering 84 scheduled messages over 12 weeks, including psychoeducation, self-care, and CBT-informed self-help elements, plus optional FAQ and “ask” functions, was co-designed with caregivers and stakeholders. This paper reports the feasibility evaluation. Outcomes were self-assessed via online survey. Primary outcomes were usability (System Usability Scale, SUS) and user satisfaction; secondary outcomes included perceived stress (PSS-4), caregiver burden (ZBI-4), depressive symptoms (CES-D), and loneliness. Descriptive and exploratory pre-post analyses were conducted, complemented by qualitative feedback from open-ended survey items interpretation workshops. Intersectionality-informed principles guided intervention development and the Conceptual Model for the Relationship of Social Networks and Social Support to Health informed content structure and sequencing. RESULTS Of 140 individuals entering the study dataset, 102 (mean age of 56.2 years (SD 12.2); 82.4% women) met eligibility criteria at baseline and 70 initiated the chatbot. Sixty-seven actively received the intervention; 57 provided at least one follow-up data point and 49 completed the full follow-up survey. Mean usability was good (mean SUS 73.5, SD 13.1). Higher usability scores were descriptively observed among participants with higher educational attainment, with no consistent variation by caregiving language or caregiving characteristics. Satisfaction was high across key features. Exploratory pre-post analyses showed small reductions in perceived stress, depressive symptoms, and loneliness, alongside a modest increase in caregiver burden. Qualitative findings highlighted heterogeneity in perceived relevance and engagement depending on caregiving context and available resources. Message frequency, timing, and content personalization emerged as key aspects of acceptability. Implementation challenges included platform-related verification procedures, changing terms of service, and the introduction of messaging costs. CONCLUSIONS A co-designed, intersectionality–informed caregiver intervention delivered via WhatsApp was feasible and acceptable in this sample. While no definitive conclusions about effectiveness can be drawn, findings support further evaluation in controlled trials and highlight important considerations for the sustainable implementation of messenger–based digital public health interventions.

Background Problem Management Plus (PM+) effectively reduces symptoms of depression, anxiety, and psychological distress, demonstrating efficacy and cost-effectiveness in over 23 randomized controlled trials. However, real-world implementation through lay health workers often encounters significant challenges, particularly concerning intervention fidelity and feasible delivery. To address these challenges, Technology-assisted Problem Management Plus (TA-PM+), a digital adaptation of PM+, was co-developed. This study aims to evaluate the feasibility and acceptability of delivering TA-PM + through government-employed primary healthcare outreach lay health workers known as Lady Health Workers (LHWs), in Pakistan. Methods A pre-post, non-randomized feasibility study was conducted in Islamabad, Pakistan, involving 12 LHWs delivering TA-PM + face-to-face to 77 women experiencing psychological distress. TA-PM + is digital intervention designed to support LHWs in delivering five sessions of PM+, featuring psychoeducational videos for patients, automated assessments, and a guiding interface to enhance participant engagement and experience while ensuring intervention fidelity. Feasibility was assessed through session completion rates, participant retention, and qualitative interviews exploring implementation barriers and facilitators. Fidelity was evaluated using the ENACT checklist and digital automated session logs. Psychological distress was measured using the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) at baseline and post-intervention. Data analysis included descriptive statistics, paired t-tests, and thematic analysis of qualitative data. Results TA-PM + demonstrated high feasibility, with 92% of participants completing all five sessions. Fidelity was high, with a mean ENACT score of 48 out of 54. Over 60% of the sessions met the minimum threshold with a mean session length of 45 to 50 minutes. Psychological distress showed preliminary improvements, with reduction in PHQ-9 (mean reduction: 6.07, p < 0.0001) and GAD-7 (mean reduction: 5.25, p < 0.0001). Participants valued structured sessions and psychoeducational videos. Identified challenges included internet connectivity issues, difficulties aligning session times with participants’ household responsibilities and availability, and cognitive fatigue among health workers. Conclusions TA-PM + intervention delivery by government-employed primary healthcare outreach staff was feasible, acceptable, and preliminary effective in reducing psychological distress among women in a community setting in Pakistan. The digital adaptation maintained high fidelity and efficiently reduced session durations, indicating its strong potential for scale-up within primary healthcare systems. Further research is necessary to examine long-term outcomes and cost-effectiveness. Trial registration: Not applicable.

Objective: Provide a systematic overview of assessment approaches for treatment decisions after internal contamination with plutonium, americium, or curium and the efficacy of decorporation treatment with diethylenetriamine pentaacetate (DTPA) among humans and animals. Methods: MEDLINE, EMBASE, and Cochrane Library were searched until December 06, 2023. Controlled experimental animal studies and human studies were eligible. Hand search of relevant reports continued until December 24, 2024. Risk of bias was assessed with the OHAT and JBI critical appraisal tools. Narrative synthesis was performed. Results: A total of 37 studies and 1 report were included. Two studies reported averted dose in humans following DTPA ranging from 150 μSv to 1.1 Sv, but the contribution of rapid contamination assessments to treatment decisions was unclear. Numerous outcomes across different treatment schedules and observation periods were studied in animal populations. Studies provided very low certainty evidence of positive treatment effects. Conclusions: Whether rapid dose assessment contributes to timely treatment decisions could not be assessed with the limited amount of informative studies. In animal studies, DTPA treatment seems to be effective in reducing radiation burden and other proximal outcomes, but risk of bias is high. Evidence for humans is based on a small number of case studies where reductions in body burden have been reported.

Background: Long-term unemployment is associated with various health risks and low health literacy. Occupational rehabilitation organizations that employ individuals with a history of long-term unemployment may be ideal settings for promoting health literacy. The purpose of this study was to develop and test an intervention to enhance health literacy in this setting. Methods: The intervention was developed using the steps of the Intervention Mapping protocol. It focused on nutrition, physical activity, and mental health literacy, and included both problem-based learning and practical activities. The intervention was tested using a single-arm pre-post design. Health literacy was assessed at the individual level using the European Health Literacy Scale (HLS-EU-Q16) for general health literacy, the Newest Vital Sign test for functional health literacy, and domain-specific literacies for food, physical activity and mental health literacy. Additionally, structured interviews were conducted with social workers and management staff in the participating organizations to evaluate organizational readiness for change, covering domains such as knowledge of existing efforts, leadership support, implementation climate, health literacy of participants, and available resources. Changes in individual outcome parameters over time were analyzed using paired t-tests. Regression models were used to assess the association between participation in the intervention activities and changes in outcomes. Results: A total of nine organizations participated in the study. The organizational readiness assessment revealed an increase in management support, though a slight decline in the implementation climate was noted. A total of 171 participants (65% men; mean age = 51.9 years, SD = 9.9) were included in the baseline assessment, and 110 were included in the six-month follow-up. Approximately 50% of participants took part in the intervention activities. Positive trends over time were observed for food literacy and mental health literacy, but not for other outcomes. No clear pattern emerged in the relationship between participation in the intervention activities and changes in the outcome variables. Conclusion: This study revealed small improvements in proximal outcome variables indicating feasibility and potential impact. However, more research is necessary to determine the effectiveness of this novel problem-based learning intervention.

Zusammenfassung: Hintergrund und Ziel: Die chronisch obstruktive Lungenerkrankung (COPD) geht mit einem erhöhten Bedarf an medizinischer Versorgung einher. Insbesondere in ländlichen Regionen, wie z. B. der Lausitz, in der es Lücken in der wohnortnahen Versorgung gibt, können digitale Anwendungen bei der medizinischen Betreuung von chronisch Erkrankten eine hilfreiche Ergänzung sein. Im Rahmen der Studie wurde erfasst, ob aus Sicht der in der Lausitz lebenden COPD-Erkrankten ein Bedarf an COPD-Gesundheits-Apps zusätzlich zu ihrer bestehenden Versorgung besteht und unter welchen Bedingungen sie diese nutzen würden. Methoden: Im Sommer 2024 wurden 1 Fokusgruppe und 3 Doppelinterviews in der Lausitz durchgeführt. An der Studie nahmen 12 COPD-Erkrankte teil, die in Cottbus, Senftenberg oder Welzow und Umgebung lebten. Die Diskussionen wurden qualitativ inhaltsanalytisch mit einem deduktiv-induktiven Ansatz ausgewertet. Ergebnisse: Die Teilnehmenden haben bislang noch keine COPD-Gesundheits-App verwendet. Einzelne zeigten sich jedoch offen für eine zukünftige Nutzung. Es wurde von den Teilnehmenden nicht angegeben, dass sie einen Bedarf an COPD-Gesundheits-Apps sehen, der Wunsch nach einer Lösung für den Ärztemangel wurde jedoch geäußert. Besonders wichtig war den Teilnehmenden, dass Ärzt*innen in die App eingebunden sind und eine Kommunikation mit diesen möglich ist. Zudem wünschten sie sich einen/eine kompetente/n Ansprechpartner*in in der App, der/die Fragen beantwortet und in Notfällen kontaktiert werden kann. Schlussfolgerung: Eine COPD-Gesundheits-App könnte den Bedarf der Teilnehmenden decken. Unklar ist jedoch, welche Anreize es bedarf, damit insbesondere Lungenärzt*innen sich an einer COPD-Gesundheits-App beteiligen, und welche Bedenken sie haben.