Kathrin Burdenski

Little research has analysed the relation between childcare and positive psychological wellbeing, e.g., self-esteem and life satisfaction. Using data from the UK Millennium Cohort Study, this paper investigates the association of the age of starting and intensity of formal childcare with self-esteem trajectories between 11 and 17 years and life satisfaction at 11 and 14 years ( N = 5,484). Proportional odds for having greater psychological wellbeing and odds ratios for having good compared to poor psychological wellbeing (lowest 25% scores) were estimated. After controlling for children’s socio-economic position, childcare was not associated with self-esteem or life satisfaction. Changes in estimates after adjustment show that children from a lower socio-economic position attended less childcare and had lower odds of later psychological wellbeing.

Background: The rapid proliferation of medical apps has transformed the health care landscape by giving patients and health care providers unprecedented access to personalized health information and services. However, concerns regarding the effectiveness and safety of medical apps have raised questions regarding the efficacy of randomized controlled trials (RCTs) in the evaluation of such apps and as a requirement for their regulation as mobile medical devices. Objective: This study aims to address this issue by investigating alternative methods, apart from RCTs, for evaluating and regulating medical apps. Methods: Using a qualitative approach, a focus group study with 46 international and multidisciplinary public health experts was conducted at the 17th World Congress on Public Health in May 2023 in Rome, Italy. The group was split into 3 subgroups to gather in-depth insights into alternative approaches for evaluating and regulating medical apps. We conducted a policy analysis on the current regulation of medical apps as mobile medical devices for the 4 most represented countries in the workshop: Italy, Germany, Canada, and Australia. We developed a logic model that combines the evaluation and regulation domains on the basis of these findings. Results: The focus group discussions explored the strengths and limitations of the current evaluation and regulation methods and identified potential alternatives that could enhance the quality and safety of medical apps. Although RCTs were only explicitly mentioned in the German regulatory system as one of many options, an analysis of chosen evaluation methods for German apps on prescription pointed toward a “scientific reflex” where RCTs are always the chosen evaluation method. However, this method has substantial limitations when used to evaluate digital interventions such as medical apps. Comparable results were observed during the focus group discussions, where participants expressed similar experiences with their own evaluation approaches. In addition, the participants highlighted numerous alternatives to RCTs. These alternatives can be used at different points during the life cycle of a digital intervention to assess its efficacy and potential harm to users. Conclusions: It is crucial to recognize that unlike analog tools, digital interventions constantly evolve, posing challenges to inflexible evaluation methods such as RCTs. Potential risks include high dropout rates, decreased adherence, and nonsignificant results. However, existing regulations do not explicitly advocate for other evaluation methodologies. Our research highlighted the necessity of overcoming the gap between regulatory demands to demonstrate safety and efficacy of medical apps and evolving scientific practices, ensuring that digital health innovation is evaluated and regulated in a way that considers the unique characteristics of mobile medical devices.

Using data from the nationally representative Millennium Cohort Study, this study examined the association between age of starting and weekly hours in formal childcare between birth and 5 years with internalising and externalising behaviour trajectories from ages 5 to 14 years in England ( N = 6194 children). Associations were analysed using multilevel general linear regression models, with adjustment for socio-economic position, maternal mental health, demographics, and child temperament. Later entry was associated with more internalising behaviours at age 14 years. Children who spent > 40 h per week in childcare between birth and 3 years displayed more externalising behaviour at 5 years than children who did not attend childcare. Controlling for socio-economic position and parental mental health attenuated findings.

BACKGROUND The rapid proliferation of medical apps has transformed the health care landscape by giving patients and health care providers unprecedented access to personalized health information and services. However, concerns regarding the effectiveness and safety of medical apps have raised questions regarding the efficacy of randomized controlled trials (RCTs) in the evaluation of such apps and as a requirement for their regulation as mobile medical devices. OBJECTIVE This study aims to address this issue by investigating alternative methods, apart from RCTs, for evaluating and regulating medical apps. METHODS Using a qualitative approach, a focus group study with 46 international and multidisciplinary public health experts was conducted at the 17th World Congress on Public Health in May 2023 in Rome, Italy. The group was split into 3 subgroups to gather in-depth insights into alternative approaches for evaluating and regulating medical apps. We conducted a policy analysis on the current regulation of medical apps as mobile medical devices for the 4 most represented countries in the workshop: Italy, Germany, Canada, and Australia. We developed a logic model that combines the evaluation and regulation domains on the basis of these findings. RESULTS The focus group discussions explored the strengths and limitations of the current evaluation and regulation methods and identified potential alternatives that could enhance the quality and safety of medical apps. Although RCTs were only explicitly mentioned in the German regulatory system as one of many options, an analysis of chosen evaluation methods for German apps on prescription pointed toward a “scientific reflex” where RCTs are always the chosen evaluation method. However, this method has substantial limitations when used to evaluate digital interventions such as medical apps. Comparable results were observed during the focus group discussions, where participants expressed similar experiences with their own evaluation approaches. In addition, the participants highlighted numerous alternatives to RCTs. These alternatives can be used at different points during the life cycle of a digital intervention to assess its efficacy and potential harm to users. CONCLUSIONS It is crucial to recognize that unlike analog tools, digital interventions constantly evolve, posing challenges to inflexible evaluation methods such as RCTs. Potential risks include high dropout rates, decreased adherence, and nonsignificant results. However, existing regulations do not explicitly advocate for other evaluation methodologies. Our research highlighted the necessity of overcoming the gap between regulatory demands to demonstrate safety and efficacy of medical apps and evolving scientific practices, ensuring that digital health innovation is evaluated and regulated in a way that considers the unique characteristics of mobile medical devices.

Background and Objective: Childcare provides the first opportunity to stimulate children’s cognitive, social, and emotional development outside the home. We know little about how childcare is associated with mental health in childhood and adolescence. The Millennium Cohort Study, a large UK...

Background and Objective: UNESCO and other organisations have outlined the importance of early childcare for children’s psychological wellbeing. We aimed to investigate how the age of starting and the intensity of formal childcare in under-5s were associated with self-esteem trajectories...