European Journal of Public Health最新文献

Socioeconomic inequalities in healthcare costs are large, but the underlying behavioral mechanisms remain unclear. We examined how neighborhood socioeconomic status (NSES) and lifestyle behaviors-physical activity (PA), sport participation, smoking, and alcohol use-jointly relate to healthcare costs in the Netherlands. Using a population-wide ecological dataset of 6213 neighborhoods, we linked relative (i.e. age- and sex-standardized) healthcare costs with survey-based estimates of lifestyle behaviors. Linear regression models estimated the associations between lifestyle factors and relative healthcare costs, adjusting for demographic and urbanization characteristics. Additional models stratified by NSES decile assessed socioeconomic modification of lifestyle-cost associations. A strong socioeconomic gradient in relative healthcare costs was observed; the most deprived NSES decile having €1096 higher average costs than the most affluent decile. NSES alone explained over €300 of this inter-decile cost gap. Across all neighborhoods, each 1-percentage-point higher sport participation, PA adherence, and smoking prevalence were associated with cost changes of -€14.27 (95% CI -16.96 to -11.59), -€6.96 (95% CI -9.59 to -4.32), and +€22.06 (95% CI 17.96 to 26.16), respectively; alcohol use showed no association. Within-decile analyses revealed strong protective effects of sport in the most deprived neighborhoods (-€37.26, 95% CI -47.54 to -26.97) and consistent cost increases associated with smoking across all deciles. Lifestyle-cost associations differ markedly by socioeconomic context. Structured sport participation shows the greatest cost-saving potential in disadvantaged neighborhoods, while smoking remains the dominant cost driver nationwide. Addressing behavioral inequalities is key to narrowing socioeconomic disparities in healthcare expenditures.

Background: Previous studies indicate initial health improvements following resettlement for refugees, but the long-term trajectories remain unclear. This study explores health outcomes and healthcare use among Syrian refugees in Norway, focusing on the impact of early health and quality of life (QOL) on future outcomes.

Methods: This prospective cohort study used data from the Changing Health and health care needs Along the Syrian Refugees' Trajectories to Norway and Integration for Health projects. Baseline factors, self-rated health (SRH) and QOL, were collected 1 year after arrival. Health outcomes and healthcare use were assessed at 1 and 4 years (2019-2023) post-resettlement. Changes over time were analysed with generalized estimating equations, and associations with baseline factors were assessed using generalized linear models, presenting relative risks (RR) with 95% confidence intervals.

Results: A total of 132 individuals participated in both follow-ups. Chronic pain prevalence increased from 28% to 51% (RR 1.80, 1.46-2.23), with similar increases in non-communicable diseases, symptoms of poor mental health and chronic impairments. Use of emergency (RR 2.06, 1.50-2.82) and specialist care (RR 3.47, 2.62-4.60) also increased, while general practitioner visits and hospitalizations remained stable. Good SRH and higher QOL at baseline were associated with better health outcomes and reduced healthcare use over time.

Conclusion: Refugees reporting good SRH and higher QOL during the early postmigration period experienced more favorable health outcomes and decreased healthcare use later on. Our findings raise the subject of the possibility of capitalizing on early interventions to support refugee health and ease the burden on healthcare systems over time.

Despite decreasing overall smoking rates, ethnic inequalities in smoking persist. Although smoking is largely a social behavior, the underlying social network mechanisms for this are still unclear. We disentangled and tested potential social network mechanisms responsible for persistent ethnic inequalities in smoking. We applied Stochastic Actor-Oriented Models for 1644 friendships of 299 Roma and Non-Roma Hungarian adolescents in nine classes and 1605 antipathies of 294 adolescents in eight school classes over two panel waves. Adolescents were more likely to nominate same-ethnic peers as friends [odds ratio (OR) of Non-Roma nominating a Non-Roma = 1.15; 95% confidence interval (CI) = 1.03-1.28] and less likely to nominate them as antipathies (OR of Roma nominating a Roma = 0.77; 95% CI = 0.68-0.87). Smokers were more likely than non-smokers to receive friendship nominations (OR = 1.18; 95% CI = 1.01-1.38) but did not statistically significantly differ in antipathy nominations (OR = 1.16; 95% CI = 0.97-1.39). Non-Roma smokers tended to nominate as friends other Non-Roma smokers (OR = 1.37; 95% CI = 1.12-1.68) and avoided nominating Roma non-smokers (OR = 0.55; 95% CI = 0.35-0.87). Neither friends (OR = 1.28; 95% CI = 0.88-1.86) nor antipathies (OR = 1.15; 95% CI = 0.69-1.91) influenced peers' smoking behaviors significantly. We identified three processes that could potentially contribute to ethnic smoking inequalities: (i) adolescents tend to nominate same-ethnic peers as friends, (ii) smokers are attractive for friendship selection, and (iii) Roma received higher encouragement to smoke than Non-Roma since Non-Roma received more while Roma received less friendship nomination from Non-Roma peers if they do not smoke. We found no impact of antipathy on smoking.

The implementation of emergency care networks for ST-elevation myocardial infarction (STEMI), like Codi IAM in Catalonia, has reduced time to reperfusion. We hypothesized that Codi IAM would decrease the 28-day case-fatality rate for acute myocardial infarction (AMI) by enabling more patients with sudden cardiac death (SCD) to receive timely treatment. We linked the Codi IAM registry, Catalan hospital discharge records, and mortality registry. The study included 97 325 AMI patients aged 35-84 years hospitalized or deceased between 2008 and 2019. We compared trends in prehospital, in-hospital, and overall 28-day standardized case-fatality rates between the preimplementation (2008-10) and implementation periods (2011-19). Annual Percentage Change (APC) and spline trends were analyzed. During the study period, the mean age of AMI patients decreased from 70 to 67 years (P < .001), and the percentage of women declined from 29.2% to 25.7% (P < .001). Comorbidities increased, with higher rates of hypertension (38.8%-49.9%, P < .001), diabetes (23.9%-31.9%, P < .001), and cardiovascular disease history (26.5%-28.5%, P < .001). The overall 28-day AMI case-fatality significantly declined post-2010 (P < .001), mainly due to a decline in prehospital case-fatality (SCD) after 2010 (P < .001). In-hospital case-fatality declined until 2011 (P < .001) and stabilized afterward (P = .12). The decrease in prehospital 28-day AMI case-fatality paralleled the Codi IAM implementation, suggesting a possible transfer of recovered out-of-hospital SCD patients to hospitals, with limited changes in in-hospital mortality rates.

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.

Cervical cancer screening is a life-saving endeavour. The introduction of an organized population-based national screening programmes has potential to both reduce incidence of cervical cancer in an asymptomatic population and detect early-stage cancers for accelerated treatment. A methodology for estimating cancers prevented by such programmes has immediate utility. This work derives a model for estimating cancer prevented by screening, applied to data from Ireland's organized national cervical screening programme since its introduction in August 2008 to August 2022. A novel Markov-chain model for human papilloma virus (HPV) induced cervical cancer was derived with realistic transition probabilities validated against literature estimates. Data from the Irish National Screening Programme (CervicalCheck) and from the National Cancer Registry of Ireland (NCRI) was applied to estimate the number of cancers prevented by screening, changes in Irish cancer detection since the implementation of screening, and treatment costs saved by screening. Since its inception in 2008, the modelling in this work suggests that CervicalCheck has prevented an estimated 5557 cancers (95% confidence interval: 5114-6000 cancers) and saved €102 million in future treatment costs (95% confidence interval: €94-110 million) not including inflation costs. Additionally, 48.8% (95% confidence interval: 41.4%-56.2%) of all cervical cancers in Ireland have been detected through screening between 2008 and 2022. National screening in Ireland has been highly effective at reducing future cervical cancers, and detecting asymptomatic cancers. The model outlined here has direct future applicability for the assessment of national and regional cervical cancer screening programmes.

Prescribing by international non-proprietary name (INN) and substitution rules are advocated in the education and practice of rational prescribing, and for cost containment policy. Regulations that restrict or foster INN prescribing and substitution exist in all member states. The aim of this study is to describe the national regulations in European Union (EU) countries, to nation-specific tools for ePrescribing and eDispensation systems based on the standards for Identification of Medicinal Products (IDMP) in the European Health Data Space. A survey was sent to the policy makers from national competent authorities, active in UNICOM, and responsible for writing and monitoring national regulations. Data were collected from 14 EU countries. INN prescribing is mandatory in Greece, Portugal, and Estonia. It is allowed in Germany, Belgium, Norway, Spain, the Netherlands, and Italy (seldom used). Substitution based on precise substance and dose form is mandatory in Finland and Sweden, and allowed in Ireland (with a positive list). In Austria and Croatia, only brand substitution is possible. Rules for a substitution module in the cross-border ePrescribing and eDispensing services can be set up, with three possible levels of equivalent lists: brand substitution, PhPID substitution, and INN substitution. Harmonization of national rules is needed, also for exemptions and the possibility of physician's veto. This may be facilitated by the implementation of IDMP. The European Commission has the legal basis to foster this harmonization. It will have major implications for research, handling of drug shortages, and clinical care.

Problematic alcohol use has been suggested to be associated with higher prevalence of musculoskeletal pain (MSP) among manual workers; however, such relationship remains understudied among non-manual workers. This cross-sectional study investigated the association between alcohol consumption and MSP patterns among non-manual workers. We analysed 6847 non-manual civil servants and retirees aged 50-75 years from the phase 7 of the British Whitehall II Cohort study. Self-reported alcohol consumption was measured as average weekly intake and an alcohol dependency score. MSP was assessed through self-reported anatomical pain sites in the upper body and their frequency. We used multiple-group latent class analysis to identify MSP patterns by age, sex, and employment status. Multinomial logistic regression was used to assess the association between alcohol and pain patterns, adjusting for covariates. There were 3651 (53.3%) reported MSP, with four patterns identified: all upper-body pain sites (6.9%), low back pain (LBP) alone (10.3%), combined LBP and cervical pain (24.8%), and upper-extremity pain (11.3%). We did not observe any significant association between alcohol consumption/dependency and any pain patterns (Ps > .05). Above-moderate alcohol consumption was associated with combined LBP/cervical pain (OR: 1.31, 95% CI: 1.05-1.31) among retirees. Potential alcohol dependency was associated with upper-extremity pain among women (OR: 2.04, 95% CI: 1.15-3.60) and early retirees (OR: 1.81, 95% CI: 1.15-2.84). No overall association between alcohol consumption and MSP was found. Increased spinal pain was found in retirees who exceeded recommended limits, and increased extremity pain was found in women and early retirees with potential alcohol dependency.

Background: Competency frameworks are vital for the Public Health Workforce (PHW) capabilities, education, and standards. In the past years, several competency frameworks have been published for the PHW. However, methodologies to define the competencies and domains vary significantly. This scoping review maps methodologies for multi-professional PHW frameworks (2018-2024), identifying practices, patterns, and reporting gaps.

Methods: Following the Joanna Briggs Institute guidance and PRISMA-ScR checklist, Medline, Embase, Global Health and WorldCat were searched (2018-2024) for multi-professional PHW frameworks. Dual screening and extraction captured characteristics and sequential methods. Methods were categorized and analyzed descriptively for frequency, sequence, and reporting completeness.

Results: 58 frameworks met inclusion (from 813 records), mostly North America/Europe. Methods reported for 44 (75.9%) frameworks. Most frequent: literature/document reviews (45.4%), survey/questionnaire (29.5%), expert consultation/panels (22.7%), interviews (22.7%), Delphi (20.4%). Literature/document reviews was the most common first step (34.1%). Frameworks used 1-9 steps (avg 2.96); 82.6% multi-step (evidence synthesis + stakeholder engagement ± validation). Significant reporting gaps: 14 (24.1%) lacked details; quality varied.

Conclusion: PHW framework development shows diversity and multi-step processes but suffers from reporting gaps and inconsistencies. Standardization and transparency (e.g., following the CONFERD-HP) are crucial. Multi-method approaches integrating evidence synthesis, stakeholder engagement, and validation are recommended to enhance rigor, comparability, and utility for strengthening the global PHW.