European Journal of Public Health最新文献

Knowledge about health literacy challenges among the general population is valuable for initiatives targeting social inequity in health. We investigated health literacy in various population groups and the impact of healthcare-seeking behaviour by analysing the associations between (i) lifestyle, socioeconomics, self-rated health, chronic disease, and health literacy and (ii) symptom burden, contact to general practitioner (GP), and health literacy. In total, 27 488 individuals participated in a population-based survey. Questionnaire data comprised information about symptoms, GP contact, lifestyle, self-rated health, chronic disease, and four aspects of health literacy: feeling understood and supported by healthcare providers, having sufficient information about health, having social support for health, and being able to actively engage with healthcare providers. Socioeconomics were obtained from registers. Descriptive statistics and multivariable linear regression models were applied. Individuals who smoked, lived alone, had different ethnicity than Danish, and low self-rated health had more health literacy challenges reflected in lower scores for all aspects of health literacy. Individuals with high symptom burden and those who had presented a high absolute number of symptoms to their GP were less likely to have sufficient information about health and be able to actively engage, whereas individuals reporting GP contact with a high relative percentage of their symptoms were more likely to feel understood and supported by healthcare providers. Health literacy challenges are related to healthcare-seeking behaviour and several individual factors. To address social inequity in health and society, interventions aimed at both the individual and community-based health literacy are essential.

Risks to older adults (OA) (aged 65+ years) associated with hot and cold weather in the UK are well-documented. The study aim is to explore OA perception of health risks from high and low temperatures, health-protective measures undertaken, and implications for public health messaging. In 2019/20, Ipsos MORI conducted face-to-face surveys with OA in England (n = 461 cold weather survey, n = 452 hot weather survey). Participants reported temperature-related symptoms, risk perceptions for different groups, and behaviours during hot and cold weather. Analysis involved binomial logistic regression models to assess potential factors (demographics, vulnerability, behaviours) associated with older adults' health risk perception in hot and cold weather. Less than half of OA in both surveys agreed that hot or cold weather posed a risk to their health. OA with higher education, annual income >£25 000 or home ownership were less likely to perceive their health at risk during cold weather and regional differences in hot weather were identified. OA who recognized those the same age or living alone as at an increased risk were more likely to perceive their own health as at risk. OA were more likely to self-identify health risks when reporting those aged 65 yrs+ to be at an increased risk in cold weather. Various temperature-related protective behaviours were associated with older adults' risk perception in hot and cold weather. These findings provide evidence for public health agencies to target high risk individuals, and modify temperature-related public health messaging to protect OA.

Hugely concerning changes to health outcomes have been observed in the UK since the early 2010s, including reductions in life expectancy and widening of inequalities. These have been attributed to UK Government 'austerity' policies which have profoundly affected poorer populations. Studies in mainland Europe have shown associations between austerity and increases in adverse birth outcomes such as low birthweight (LBW). The aim here was to establish whether the period of UK austerity was also associated with higher risks of such outcomes. We analysed all live births in Scotland between 1981 and 2019 (n = 2.3 million), examining outcomes of LBW, preterm birth (PB) and small-for-gestational-age (SGA). Descriptive trend analyses, segmented regression (to identify changes in trends) and logistic regression modelling (to compare risk of outcomes between time periods) were undertaken, stratified by infant sex and quintiles of socioeconomic deprivation. There were marked increases in LBW and PB rates in the austerity period, particularly in the most deprived areas. However, rates of SGA decreased, suggesting prematurity as the main driver of LBW rather than intrauterine growth restriction. The regression analyses confirmed these results: trends in LBW and PB changed within 1-3 years of the period in which austerity was first implemented, and that period was associated with higher risk of such outcomes in adjusted models. The results add to the European evidence base of worsening birth outcomes associated with austerity-related economic adversity. The newly elected UK government needs to understand the causes of these changes, and the future implications for child and adult health.

This study aims to investigate the relationship between education and alcohol-related morbidity and the role that low job control and heavy physical workload play in explaining these associations among men and women in Sweden. This register-based cohort study (SWIP cohort) includes over three million individuals registered in Sweden in 2005. Job control and physical workload were measured using a job exposure matrix linked to the index person based on their registered occupation at baseline. Alcohol-related morbidity was measured through diagnoses in the national patient registers between 2006 and 2020. Cox proportional hazards regression models were built to estimate associations between education and alcohol-related morbidity. Reductions in hazard ratios (HRs) were calculated after adjusting for job control, physical workload, and other covariates. Models were also stratified by sex. Lower levels of education predicted a higher risk of alcohol-related morbidity (HR: 2.55 95% confidence interval: 2.49-2.62 for the lowest educated compared to the highest). Low job control and heavy physical workload both played roles in explaining educational differences in alcohol-related morbidity even after accounting for sociodemographic and health factors (15.1% attenuation for job control and 18.3% for physical workload among the lowest educated). Physical workload explained a larger proportion of the associations among men compared to women. Lower levels of education were associated with an increased risk of alcohol-related morbidity and working conditions partly explained these associations beyond what was explained by sociodemographic and health factors. Improving working conditions could therefore prevent some cases of alcohol-related morbidity.

Migrant mortality advantage is established in various studies, but there is a lack of evidence on migrant mortality trends in old age. Previous studies have primarily concentrated on all-cause mortality, and few include older age groups. Discussions about the migrant mortality advantage continue due to concerns about data availability and accuracy. Additionally, the mechanisms explaining the migrant mortality advantage remain unclear. This study examines all-cause and cause-specific mortality among older migrant and nonmigrant adults aged 70 and above using Finnish Cause of Death register data (2002-20) and the corresponding risk population. We investigate differences in overall and cause-specific mortality between migrant and Finnish-born population and by geographical region of origin. We calculated direct age-standardized mortality rates and age group-specific death rates followed by Poisson regression to study relative mortality differences. Age at death, sex, income, region of residence, and year of death were controlled for in the regression analysis. We found evidence of migrant mortality advantage across various causes of death, but there was variation by regions of origin groups and sex. Notably, women exhibit the strongest advantage in respiratory and digestive system diseases, while men demonstrated pronounced advantages in external causes and respiratory diseases. Our study challenges the notion of a general diminishing healthy migrant effect in old age. Our findings emphasize the need for nuanced investigations into socioeconomic factors and tailored interventions for older migrants.

Prior research has indicated that residents who perceive their neighborhood as more cohesive have better mental and physical health than those with lower perceived neighborhood social cohesion. However, because most studies are based on cross-sectional data, it remains unclear whether improving the perceptions of social cohesion leads to better health over time. This study applied random effects within-between models to examine the within-individual and between-individual associations of perceived neighborhood social cohesion and poor self-assessed health (SAH) in a cohort of Dutch adults with 17-year follow-up. We also tested whether such associations varied by age, educational level, and gender. The results of pooled analyses indicated that higher perceived neighborhood social cohesion was associated with better SAH [odds ratio (OR): 0.72; 95% confidence interval (CI): 0.65, 0.80], but did not find conclusive evidence that within-individual changes in perceived neighborhood social cohesion were associated with SAH (OR: 0.96; 95% CI: 0.89, 1.04). We also did not observe any moderating effects for age, educational level, or gender. This study provides some evidence that improving social cohesion in neighborhoods may be a beneficial health promotion strategy.

The integration of human, animal, and environmental health in the One Health framework is crucial for tackling complex health and environmental issues. Governance structures in One Health initiatives are essential for coordinating efforts, fostering partnerships, and establishing effective policy frameworks. This systematic review, registered with PROSPERO, aims to evaluate governance architectures in One Health initiatives. Searches in PubMed, Scopus, WoS, and Cochrane from 2000 to 2023 were conducted. Key terms focused on peer-reviewed articles, systematic reviews, and relevant grey literature. Nine eligible studies were selected based on inclusion criteria. Data synthesis aimed to assess governance mechanisms' functionality and effectiveness. Among 1277 sources screened, nine studies across diverse regions were eligible. An adapted framework assessed implementation mechanisms of international agreements, categorizing them into Engagement, Coordination, Policies, and Financial domains. The findings highlight the importance of effective governance, stakeholder engagement, and collaborative approaches in addressing One Health's challenges. Identified challenges include deficient intersectoral collaboration, funding constraints, and stakeholder conflicts. Robust governance frameworks are pivotal in One Health paradigms, emphasizing stakeholder engagement and collaboration. These insights guide policymakers, practitioners, and researchers in refining governance structures to enhance human-animal health and environmental sustainability. Acknowledging study limitations, such as methodological variations and limited geographical scope, underscores the importance of further research in this area.

The Community Acute Respiratory Infection (CARI) surveillance programme, established by Public Health Scotland (PHS) in November 2021, aims to monitor respiratory infections in communities, replacing prior schemes to ensure early detection of outbreaks and inform public health interventions. Positioned as a cornerstone of PHS's national infectious respiratory diseases plan, CARI is pivotal for safeguarding public health. This study presents key findings from the 2022/23 CARI season and evaluates the programme's performance during this period. CARI uses a network of sentinel general practitioner (GP) practices across Scotland to monitor patients with acute respiratory infection symptoms, employing multiplex polymerase chain reaction testing for 10 common pathogens. Results are linked to enhanced surveillance data, providing insights into infection trends during the season. The evaluation comprised an online GP survey and a quantitative assessment of programme performance. In the 2022/23 season, 180 GP practices participated in CARI, testing 15,823 samples. Swab positivity peaked in December 2022, driven by a large spike in influenza A activity. The evaluation showed that CARI is highly useful, with positive feedback on simplicity, flexibility, and acceptability. Representativeness varied across health boards and age groups. Despite occasional laboratory processing delays, data quality remained good, with timely reporting and stable participation. CARI reflected patterns in infections observed in secondary care in Scotland and Europe, providing valuable insights into disease patterns and impact. It also provided timely intelligence to key decision-makers, enabling prompt public health response. Changes for the 2023/24 season aim to further optimize the programme.

Despite significant therapeutic advances, lung cancer remains the biggest killer among cancers. In France, there is no national screening program against lung cancer. Thus, in this perspective, the Foch Hospital decided to implement a pilot and clinical low-dose CT screening program to evaluate the efficiency of such screening. The purpose of this study was to describe the prevalent findings of this low-dose CT screening program. Participants were recruited in the screening program through general practitioners (GPs), pharmacists, and specialists from June 2023 to June 2024. The inclusion criteria included male or female participants aged 50 to 80 years, current smokers or former smokers who had quit less than 15 years prior, with a smoking history of over 20 pack-years. Chest CT scans were conducted at Foch Hospital using a low-dose CT protocol based on volume mode with a multi-slice scanner (≥60 slices) without contrast injection. In total, 477 participants were recruited in the CT scan screening, 235 (49%) were males with a median age of 60 years [56-67] and 35 smoke pack-years [29-44] and 242 females (51%) with a median age of 60 years [55-60] and 30 smoke pack-years [25-40]. Eight participants showed positive nodules on CT scan, as a 1.7% rate. 66.7% of diagnosed cancers were in early stages (0-I). It is feasible to implement structured lung cancer screening using low-dose CT in a real-world setting among the general population. This approach successfully identifies most early-stage cancers that could be treated curatively.