European Journal of Public Health最新文献

Lower socioeconomic position is linked to higher body mass index (BMI) across the life course, but the contributions of age, period, and cohort in this association are less understood. This study examined age, period, and cohort effects on educational differences in BMI over a 22-year follow-up. We used repeated Helsinki Health Study survey data from 2000 to 2022. In Phase 1 (2000-02 for the 'ageing cohort', aged 40-60, n = 8960; and 2017 for the 'employee cohort', aged 19-39, n = 5898), all participants were employees of the City of Helsinki, Finland. We calculated participants' BMI from their self-reported height and weight in each period and divided participants' educational attainment into high and low. The final sample comprised 11 636 women and 3037 men. We used generalised additive mixed models for the age-period-cohort analyses. Educational differences in BMI mostly widened until late midlife and then stabilised. Younger participants and more recent cohorts had the steepest increases in BMI over periods, and their educational differences moderately narrowed. However, BMI increased in all cohorts, educational groups, and both genders over periods. Although the educational differences in BMI were clear among earlier cohorts, the overall patterns in their BMI trajectories were highly similar between the educational groups. Since age, period, and cohort each affected the development of educational differences in BMI over time, they should be considered when estimating future trends in socioeconomic inequalities in BMI and when planning policy actions to tackle these inequalities.

Dental and periodontal infections can lead to serious systemic complications through bacterial dissemination. While global awareness of these risks is increasing, data on the incidence and outcomes of such complications remain limited. This study aims to quantify the incidence of serious extraoral infectious complications associated with dental infectious foci, using dental procedures as markers of active oral infection, in the Czech Republic between 2010 and 2022. A retrospective analysis was conducted using data from the National Register of Reimbursed Health Services. Patients who underwent invasive dental procedures indicating active dental/periodontal infection and were hospitalized for severe infectious conditions within 7 days were identified. This temporal criterion captured both cases where dental procedures preceded systemic spread and cases where dental foci were identified during workup for serious infections. Descriptive statistics and linear regression analysed incidence rates and temporal trends. Among 15 098 093 dental procedures over 13 years, annual hospitalizations for associated infectious complications ranged from 855 to 1252 cases. Overall incidence was 12.82 per 100 000 population annually. Oral region complications (cellulitis, abscesses, osteomyelitis) were most common (9.48 per 100 000), followed by systemic complications (sepsis and endocarditis) (2.89 per 100 000). Significant increasing trends were observed for jaw periostitis (P = .006), endocarditis (P < .001), and central nervous system abscesses (P = .027), while acute sinusitis declined (P < .001). This population-based analysis reveals a substantial incidence of serious infectious complications associated with dental infectious foci, with concerning increasing trends in potentially life-threatening conditions. These findings emphasize the importance of preventive dental care and early intervention strategies.

Removal of human papillomavirus (HPV) infection associated precancerous cervical lesions by conization is one of the most important causes of preterm birth. Prophylactic HPV-vaccinations can prevent these lesions and reduce the need of their ablative treatment, thereby preventing preterm births. We evaluated whether preterm birth rates vary between HPV-vaccinated and unvaccinated women. Study subjects comprised 6200 cluster-randomized cohorts of HPV-vaccinated and 1667 hepatitis B-virus vaccinated women born in 1992-1993, and age- and community-aligned reference cohort of 19 473 unvaccinated women born in 1990-1991. Age-aligned registry linkage data from the nationwide Finnish Medical Birth Registry were retrieved up to 2018 (older age cohorts) and 2020 (younger age cohorts). Preterm births were categorized as early (gestational age of 22 + 0-33 + 6 weeks) and late preterm births (gestational age 34 + 0-36 + 6 weeks). Logistic regression was used to evaluate the association of HPV-vaccination and preterm births. By the age 28, 23.9% (n = 1484) of HPV-vaccinees and 28.4% (n = 6006) of the unvaccinated women had at least one childbirth recorded. Precisely, 4.1% (n = 61) of HPV-vaccinated and 5.2% (n = 310) of unvaccinated primiparas had a preterm birth. The association of preterm birth with HPV-vaccination was protective with a borderline significant odds ratio of 0.79 (95% CI 0.59-1.04). Most preterm births were at late preterm among both HPV-vaccinees (3.1%) and unvaccinated women (3.4%). Prophylactic HPV-vaccination is likely to reduce the incidence of preterm births. The decrease of preterm births is crucial to reduce the need for extensive and costly postnatal care and life-long morbidity.

Adolescent healthy behaviours may improve cardiometabolic health in adulthood differently across socioeconomic groups. We aimed to quantify the effects of adolescent healthy behaviours on multiple biomarkers of adult cardiometabolic health by socioeconomic backgrounds. We used a population-based cohort of Finnish adolescents from the Young Finns Study (1980-89, n = 2984) followed into adulthood (2001-11). Healthy behaviours (no smoking, no alcohol consumption, sufficient physical activity, daily fruit and vegetable consumption) and socioeconomic backgrounds (parental- and neighbourhood-related) were measured in adolescence (12-18 years). Biomarkers of adiposity [waist circumference, body mass index (BMI)], cardiovascular [blood pressure (BP), cholesterol, apolipoprotein B], and metabolic [plasma glucose, insulin resistance] outcomes were measured in adulthood (33-40 years). We estimated conditional average effects of healthy behaviours via inverse-probability-weighted marginal structural models. Sufficient physical activity lowered adiposity biomarkers to a greater extent among adolescents from disadvantaged neighbourhood, with additional decreases of 2.2 cm [95% confidence interval (CI): -0.1 to 4.7] in waist circumference and 1 kg/m2 (95% CI: 0.2 to 1.9) in BMI. In contrast, daily fruit and vegetable consumption lowered BP with additional 2.0-3.6 mmHg (95% CI: 0.3 to 6.1) among adolescents with advantaged either parental or neighbourhood socioeconomic backgrounds. There was little evidence for differential effects on other outcomes and for no smoking and alcohol. Socioeconomic backgrounds modified the effects of adolescent physical activity and fruit and vegetable consumption on adult cardiometabolic health. These findings indicate that population-wide interventions promoting healthy behaviours during adolescence have the potential to either mitigate or exacerbate long-term socioeconomic inequalities in cardiometabolic health.

The healthcare sector faces a critical shortage of healthcare workers, creating significant challenges in healthcare delivery. The use of Information Technology (IT) solutions in healthcare presents potential remedies to reduce the negative consequences of this problem. The purpose of this study was to identify IT solutions implemented to mitigate the effects of medical shortages and improve administrative processes and care access. The study used a systematic approach integrating desk research, national expert consultations and comparative analysis to examine IT solutions in healthcare systems. Five European countries were selected for the in-depth analysis: Poland, the Netherlands, Spain, Finland, and Croatia. The impact on administrative processes, care access, and the functioning of healthcare systems was assessed. The study identified a variety of regulatory frameworks, common implementation strategies and the institutions responsible for these activities. All compared countries used telemedicine, e-prescriptions and various types of health applications. It was found that the most frequently used IT solutions were electronic health record (EHR) and e-prescription systems. However, IT training, its organization, financing and mandatory nature differed in individual countries. In addition, common barriers were identified across all countries, such as financial constraints and interoperability issues. Integrating IT solutions offers opportunities to address health workforce shortages and enhance healthcare efficiency. Tailored strategies and collaborative efforts are essential to address financial constraints and interoperability issues. Implementing best practices identified in this study can improve administrative processes and care access. Future research should prioritize longitudinal impact assessments and explore new technologies to optimize healthcare IT solutions.

Passive immunization plays a pivotal role in prenatal care. This study aimed to assess maternal awareness, knowledge, and adherence to vaccinations during pregnancy, specifically for pertussis, influenza, and respiratory syncytial virus (RSV), while also evaluating how the approval of the RSV vaccine during pregnancy has been received by women and healthcare professionals. A cross-sectional survey was conducted at Mangiagalli Hospital in Milan between August and November 2024. Pregnant women were asked to complete a self-administered questionnaire regarding socioeconomic characteristics, knowledge of vaccine-preventable diseases, and vaccination acceptance. Multivariate logistic regression examined associations between socioeconomic factors and vaccination behavior. A total of 390 participants were considered for final analysis. 89.7% of women had received or would receive the pertussis vaccine, 72.3% the influenza vaccine (P < .001), and 74.9% the RSV vaccine (P < .001). Education, employment status, and number of children were significantly associated with higher vaccination rates. The gynecologist was the primary source of information for most women (60.5%). Barriers to vaccination included a lack of prior discussion with healthcare providers and concerns about vaccine safety. Nevertheless, 83.8% of women would be favorable to receiving all vaccines together and 86.4% would prefer receiving the vaccine themselves rather than having monoclonal antibodies administered to their neonates. Maternal education and effective communication with healthcare providers are crucial in improving vaccination acceptance during pregnancy. Personalizing vaccination counseling for women with lower educational levels and those expecting their first child is essential.

Adolescents' failure to embrace healthy lifestyles constitutes a serious public health issue, such that its relationship to non-suicidal self-injury (NSSI) merits further research. The aim of the study was to ascertain the association between a Global Index of Lifestyle Quality (GILQ) and the presence of NSSI. Cross-sectional analysis of a sample of 2nd- to 4th-year ESO students (Obligatory Secondary Education, from ages 14 to 16) recruited for the SESSAMO project, a multicenter prospective cohort study. Exposure variables were collected, including eating patterns, physical activity, screen use, the consumption of cannabis, alcohol and tobacco, risky sexual behavior, gambling, spend time with friends, and sleep quality. To determine the presence of NSSI, a validated questionnaire was administered. The association between different lifestyles and the presence of NSSI was analyzed through multivariate logistic regression models. 2042 adolescents were included. Physical activity, screen use, risky sexual behavior, sleep quality, and daytime sleepiness showed inverse and statistically significant associations with the presence of NSSI in multivariate models. A higher lifestyle score was associated with a 71% reduction in the likelihood of engaging in NSSI (OR for extreme quartiles of GILQ adherence =0.29; 95% CI = 0.15-0.57). The result was similar when boys and girls were analyzed separately. A healthy lifestyle was inversely associated with the presence of NSSI in this sample of Spanish adolescents. Lifestyles could function as potential predictors of NSSI.

In Poland, 48 in 100 babies are born by cesarean section, which is among the highest rate of cesarean birth (CB) in the Organization for Economic Cooperation and Development (OECD) countries. Several factors are linked to higher CB rates, including childbirth fear prior to pregnancy (CFPP), and physician versus midwifery led models of care. In order to decrease CB rates, it is crucial to understand modifiable factors that are associated with childbirth preferences. In this study, we tested how confidence in knowledge of pregnancy and birth was related to: (i) fear of childbirth, preference for: (ii) mode of birth and (iii) prenatal care provider type. We recruited 782 women aged 18-35 (mean 24.7, SD 3.19) who had never been pregnant but desired to have at least one child in the future. Women with moderate and high levels of confidence in knowledge had lower odds of high fear of childbirth compared to women with low levels of confidence (aOR = 0.57, 95% CI: 0.39-0.83 and aOR = 0.54, 95% CI: 0.33-0.88, respectively). Neither moderate nor high levels of confidence in knowledge were associated with a preference for CB (aOR = 1.10, 95% CI: 0.73-1.67 and aOR = 0.92, 95% CI: 0.55-1.55, respectively) compared to low levels. In addition, women with high levels of confidence in knowledge had significantly lower odds of preferring obstetricians (aOR = 0.49, 95% CI: 0.26-0.89), compared to midwives. Our study provides evidence that confidence in knowledge is related to fear of childbirth and prenatal care provider preferences.

There is a need to efficiently identify groups at risk of unmet health service needs. In response, we developed and evaluated the performance of a regression model to assess unmet health service needs in the Finnish population. The study population consisted of population-based Healthy Finland 2022-cohort participants (N = 18 442), aged 20-104. The primary outcome was self-reported unmet need for physician's or nurse's services. A total of 38 potential risk factors were evaluated. Statistical models were developed using bootstrap-enhanced LASSO regression (bolasso). Of the participants, 5875 (32%) were classified as experiencing unmet health care need. The C-index from the final model including 15 predictors from the best bolasso models varied between 0.73 and 0.76 and pooled C-index over the imputed data sets was 0.75 (95% CI 0.70-0.79). Fifteen factors-including health-related, socioeconomic variables, heavy alcohol use, experiences with health services, caregiving for others, and language group-were found to be strongly associated with an increased risk of unmet health care needs and may be a useful targets for preventing unmet health care need.