European Journal of Public Health最新文献

Background: Interprofessional collaboration across sectors is a major challenge for the health and care workforce. Collaboration often remains weak, as fragmented services cannot match complex needs. Working with the underlying professional, organisational, and administrative boundaries may help to address the challenge, but we know little about how managers and professionals do this. This study examines how boundary work can strengthen interprofessional collaboration, based on the introduction of mental health teams in three Danish municipalities.

Methods: A qualitative case study was conducted involving three intersectoral teams consisting of health and social care professionals in Central Denmark Region. Data collection included observations of interactions, 27 semi-structured interviews with users, professionals, and middle managers, and three focus group interviews. Key themes and dynamics in boundary work were identified using thematic network analysis.

Results: Findings indicate that boundary work by management established shared frameworks for interprofessional collaboration, such as weekly board meetings and risk categorization systems. In two municipalities, these frameworks fostered collaborative boundary work among professionals, agreeing on how to share information and adjust care plans collectively. However, in the third municipality, professionals competed to defend existing boundaries, hindering the introduction of new collaborative practices.

Conclusions: Working with boundaries can help to address the challenge of interprofessional collaboration across sectors by combining top-down and bottom-up strategies by managers and professionals. However, implementation needs fine-tuning to existing professional hierarchies and local organisational contexts. Managers also need to acknowledge the limits of steering boundary work, which thrives on autonomy in daily interactions among professionals.

Background: Physician shortages threaten healthcare system sustainability across Europe. Retaining physicians is critical to maintaining service capacity and quality. Despite its importance, physician retention remains a pressing issue in Europe, including in Portugal, where the Portuguese National Health Service (NHS) continues to face significant retention challenges.

Methods: We conducted a quantitative, observational, cross-sectional study to identify determinants of physician retention in Portugal. A validated survey was developed using a Nominal Group Technique and Delphi Panel with stakeholders. The questionnaire measured job satisfaction with Likert scales. A stratified sampling strategy ensured representation across Portugal's five mainland health regions, yielding 1398 physicians. Data were collected via self-administered electronic questionnaires. Analyses included descriptive statistics, ANOVA, t-tests, and linear regression to assess predictors of retention.

Results: Physicians with longer seniority reported higher intention to remain, with those over 10 years showing the strongest intention (mean = 3.72; SD = 1.05; p < .001). Fixed schedules were linked to higher intended retention than shift work (mean = 3.42 vs. 3.18; p = .015). Job satisfaction was the strongest predictor (β = .267; p < .001), followed by age (β = .222; p < .001), satisfaction with work characteristics (β = .125; p = .002), and career development (β = .097; p = .011). Satisfaction with human resources and work-life balance was not significant.

Conclusions: Physician retention is shaped by seniority, schedule stability, work environment, and career development. Policies fostering supportive environments, predictable schedules, and professional growth are needed to sustain the workforce, to European systems.

Adverse childhood experiences (ACEs) increase the risk of various health issues, including oral problems. ACEs also heighten the risk of revictimization, though the impact of adulthood revictimization on oral health is less understood. Conversely, positive influences, such as a trusted adult in childhood, may buffer these effects. This study examines how different dimensions of adversity relate to oral health. This cross-sectional study included 37 559 adults from the HUNT4 Survey, a general population study in Norway. We examined distinct ACE exposures: (i) specific ACEs (i.e. sexual, physical and psychological abuse, bully victimization, parental divorce, and death of a parent), (ii) cumulative ACE, (iii) combined exposure of ACE and adult support, and (iv) adversity trajectories identified by group-based trajectory modelling of ACE and adulthood sexual, physical and psychological abuse. Associations with oral health were assessed by logistic regression, estimating odds ratios with 95% confidence intervals. Most ACE types were associated with poorer adult oral health outcomes, exhibiting a dose-response gradient, where one-unit ACE increase indicated a higher likelihood of self-reported poor dental health (28%), dental fear (31%), and no dental visit in the last 2 years (10%). Combined exposure of ACE and adult support showed that those with high support had lower odds of reporting poor oral health. The revictimized trajectory exhibited the strongest association with impaired oral health outcomes. Our findings support that ACEs are linked to poor oral health later in life, especially among those revictimized as adults, whilst supportive childhood relations may buffer this effect.

Vaccine hesitancy is a significant 21st Century public health challenge, with vaccines being increasingly politicized in public and government discourse and policymaking, particularly since the introduction of COVID-19 vaccines. We evaluate the potential roles of national political and policy context for individuals' COVID-19 vaccine hesitancy across 27 European Union countries at two timepoints of the pandemic-assessing the extent to which national-level populism and government trustworthiness are associated with individuals' COVID-19 vaccination attitudes and receipt (actual or intended)-directly and indirectly via COVID-19-related policies. We analyzed May 2021 and February 2022 Eurobarometer survey data merged with nation-level populist parties' vote share, Transparency International's Corruption Index, the COVID-19 Policy Stringency Index, plus nation- and respondent-level controls. Increased levels of government trustworthiness and COVID-19 policies, but not populism, were each associated with more positive COVID-19 vaccine attitudes (though not substantively) and, respectively, lower odds of anti-vaccine and uncertain (vs. pro-vaccine) COVID-19 vaccination receipt/intentions. These associations were limited to only the May 2021 period that followed government and scientific scrutiny of vaccine safety signals. No evidence indicated that attitudes and receipt/intention were indirectly associated with populism and trustworthiness via COVID-19 policies. Our findings indicate that governments viewed as more trustworthy have citizens more accepting of government-run vaccination programs. These pandemic era analyses corroborate prior pre-COVID-19 research on nation-level evaluations of populism and vaccine acceptance. Our study highlights the value of multilevel approaches and multiple time periods and measures for advancing understanding of how political context may contribute to vaccination decision-making.

Cross-country comparisons of socioeconomic inequalities in mortality/life expectancy (LE) face limitations regarding the comparability of population subgroup data. One potential alternative which can overcome this limitation is lifespan variation (LV). Our aims were to: (i) compare long-term trends in LV across Western European countries, focussing on Scotland as a country with known wide LE inequalities; and (ii) explore the validity of LV through comparisons with ranked measures of socioeconomic inequalities in mortality/LE within Scotland. We calculated e† (one measure of LV) using Human Mortality Database data from 1855 to 2021 for European nations, by sex. We then compared e† with absolute inequalities in mortality and LE by ranked area-level socioeconomic deprivation for all 32 local government areas in Scotland. Male and female LV in Scotland is the highest in Western Europe. For males especially, this resulted from increases in the 1980s-1990s, and was made worse by further increases in the early 2010s. All UK nations have relatively high LV, especially among females. Comparisons of sub-national, area-based, data show a moderate level of correlation between ranked LV and absolute socioeconomic inequalities in mortality (0.57), and male (0.48) and female (0.51) LE. For cross-country comparisons, LV may be a useful proxy for absolute socioeconomic inequalities in mortality/LE where comparable socioeconomic measures are not available; however, it requires cautious interpretation. Given the high level of, and recent increases in, LV in Scotland and the UK, the need for socioeconomic policies to narrow health inequalities has never been more urgent.

Prior research on the relationship between health risk behaviours (HRBs), obesity, and gambling has primarily focused on problem gambling, while studies focusing on lower severity levels are scarce. Moreover, this relationship has rarely been analysed separately for women and men. This study aimed to investigate the association between HRBs, obesity, and the full spectrum of gambling severity in women and men. Cross-sectional population-based data from Healthy Finland Survey 2022-23 was exploited, including adults aged 20+ years (n = 28 154, response rate 46%, mean age 52 years). The Problem Gambling Severity Index (PGSI) was used as the dependent variable, both in continuous (score 0-27) and categorical (non-problem, low-risk, moderate-risk, and problem gambling) form. Independent variables included HRBs (daily smoking, excessive drinking, low fruit and vegetable (F & V) consumption, low physical activity, and insufficient sleep) and obesity. Sociodemographic factors, suboptimal self-rated health, and psychological distress were adjusted for. Daily smoking, excessive drinking, low F & V consumption, and insufficient sleep were less prevalent in the non-problem gambling category (PGSI score = 0) compared to the low-risk (score 1-2), moderate-risk (score 3-7), and problem gambling (score ≥8) categories. After adjusting for potential confounding variables, all HRBs and obesity, except for physical inactivity, were significantly associated with higher PGSI scores. These findings highlight the need for public health strategies that address gambling across the entire risk spectrum. Moreover, a holistic approach that considers the individual's broader life context could strengthen both research and prevention efforts.

Background: The WHO Regional Office for Europe conducted 9 country studies of migration of doctors and nurses. This paper identifies similarities and variations in migratory flows, factors that influence them, and related policy responses.

Methods: The 9 countries include 4 that integrate the European Economic Area (EEA), Ireland, Malta, Norway and Romania, and 5 non-EEA, Albania, Armenia, Georgia, Moldova, Tajikistan. Case writers used a common study template that covered international outflows and inflows, mobility push and pull factors, and related policy interventions. Data sources include the WHO/Europe-OECD- Eurostat and country databases.

Results: Emigration is motivated by low wages, dissatisfaction with working conditions, inadequate practice environment, excessive workloads and lack of opportunities for professional development. Flows for doctors and nurses vary in volume over time, and in countries of origin and destination.Pull factors include the free circulation of persons within the EEA for citizens of member states, easy access to work permits, common or easily learned language, and the presence of a diaspora in a destination country.Policies to improve retention include increasing the number of training places, making remuneration and working conditions more attractive and compulsory service. All countries have some health workforce development plan, but implementation is a challenge everywhere.

Conclusions: Policies should be tailored to country labour market conditions, migration trends, and institutional capacity. Better understanding of migration flows will improve the effectiveness of policy responses.

Background: Health workforce shortages pose a challenge to European health systems. Challenging working conditions in healthcare were intensified by the global financial crisis and the COVID-19 pandemic. In Ireland deteriorating working conditions for hospital doctors triggered a pattern of emigration and an increased dependence on international medical graduates. This paper seeks to better understand doctor emigration and its implications for Ireland's future workforce, drawing on the case of Irish doctors who emigrated to Australia.

Methods: The paper draws on three forms of data : 1) secondary data from the Australian Department of Home Affairs on visas issued to Irish citizen doctors; 2) open-ended survey responses from hospital doctors working in Ireland (2019, N = 469) and, 3) qualitative interview data from Irish doctors (2018, N = 51) in Australia. Research ethics permission was granted by the host institution.

Results: Significantly more Irish doctors were issued with Australian work visas in 2024 (624) than in 2005 (72). Hospital doctor survey respondents described how emigration decision-making was informed by poor working conditions, inadequate staffing levels, poor wellbeing and dissatisfaction with the quality of care delivered. Emigrant Irish doctors in Australia indicated that similar issues deterred their return.

Conclusions: This paper shows that Ireland has high rates of outward and inward doctor migration with retention/return not a policy priority. Our findings indicate that challenging working conditions are a driver of emigration and a deterrent to return. We call for a more person-centred approach to the medical workforce which would improve doctor working conditions, prioritise their wellbeing and promote retention/return.

Background: Nurse retention is a critical challenge across Europe, directly affecting workforce sustainability, quality of care, and health systems resilience. Despite persistent shortages and increasing emigration, evidence on nurse retention determinants within the Portuguese National Health Service (NHS) remains limited. This study aims to identify factors influencing nurses' intention to stay in the NHS, contributing to national and European debates on sustainable workforce strategies.

Methods: A quantitative, observational, cross-sectional survey was conducted among a representative sample of 1 494 nurses working in NHS. A validated questionnaire was developed using a Nominal Group Technique and Delphi Panel with stakeholders, to measure job satisfaction with Likert scales. Inferential statistical analyses, including t-tests and multiple linear regression, examined associations between intention to stay and factors such as job satisfaction, work-life balance, career development opportunities, remuneration, and sociodemographic characteristics.

Results: Fixed work schedules, overall job satisfaction, age, satisfaction with work-life balance, and career development emerged as significant predictors of intention to stay. Satisfaction with salary and financial incentives, while low, was not statistically significant. Findings highlight the importance of integrated workforce retention strategies combining organisational improvements, career progression pathways, and work-life balance policies. These findings differ from those observed among physicians in parallel research, confirming the need for profession-specific retention approaches.

Conclusion: This study provides new evidence on nurse retention in Portugal, reinforcing the need for human resources policies aligned with European Union priorities on workforce sustainability. Cross-country policy learning and evidence-informed, context-sensitive strategies are crucial for supporting nurse retention and health system resilience.