European Journal of Public Health最新文献

Symptoms are a common reason for contact with primary care. This study investigated associations between symptom-related, demographic, social, and economic factors on general practice (GP) help-seeking. Secondary analysis of responses to a 25-symptom questionnaire, from 10 904 adults aged ≥50 years reporting at least one symptom in the preceding year. Cluster analysis and univariable and multivariable logistic regressions explored associations between self-reported GP help-seeking, symptom-related factors, and respondent characteristics. Most respondents, 7638 (70%), reported more than one symptom in the preceding year. Ten symptom clusters were identified. Most included common symptoms like headache and back or joint pain. There were increased odds of help-seeking in females, those with poorer health status and those unable to work due to illness/disability when multiple symptoms were reported, but not when single symptoms were reported. Age and sex had variable effects on help-seeking, depending on the symptom. Reporting poorer health status, more comorbidities, and being unable to work due to illness or disability increased odds of help-seeking across a diverse variety of symptoms. Single people and those reporting lower social contact had lower odds of help-seeking for some symptoms. Being a current smoker reduced odds of help-seeking for persistent indigestion/heartburn, persistent cough, coughing up phlegm, and shortness of breath. Factors associated with self-reported help-seeking vary for different symptoms. Poorer health and adverse economic and social factors are associated with increased GP help-seeking. These wider determinants of health interact with symptom experiences and will influence GP workload.

Providing health care is a balancing act among human resources, financial pressures and system-intrinsic factors. Understanding the utilization behaviour of primary and secondary care facilities [general practitioners (GPs) vs. specialists, as well as in- and outpatient hospital care] is crucial for a country like Austria, which has free access to all levels of care. The aim of this study was to reassess access point consultations in relation to sociodemographic variables over time. The databases used for this cross-sectional analysis were the Austrian Health Interview Surveys 2006/07, 2014, and 2019, with sample sizes of 15 474, 15 770, and 15 461 persons, respectively. Analyses included patterns of utilization behaviour, multivariable logistic regression models, and diff-in-diff analyses highlighting differences between the observation periods. GP and secondary care consultations increased from 2014 to 2019. While there were fewer GP visits in 2014 than in 2006/07, GP consultation rates grew by 3.2% between 2014 and 2019. Secondary care utilization increased by 5.4%-8.2% between 2006/07 and 2019, with the highest growth in older and less-educated persons. Secondary-level utilization without prior GP visits decreased again in 2019 after peaking in 2014. Utilization of all access points increased over the entire observation period, especially regarding secondary-level care. Higher GP visit rates do not seem to result in a drop in secondary-level consultations. These results emphasize the coordinator role of primary care in ongoing structural health reforms in European countries, such as Austria.

COVID-19 pandemic led to the adoption of a different working approach: "The remote working." Evidence about the association of remote working with stress outcomes and life quality is lacking. This systematic review provides an overview of the effects of COVID-19 pandemic on remote-workers' stress and life quality. We conducted systematic literature searches in databases including Pubmed, Scopus and Web of science, from September 2020 to September 2023. Screening of titles, abstracts, and full texts were performed according to the Preferred Reporting Item for Systematic Review and Meta-analyses. The quality of the included studies was assessed using the Newcastle-Ottawa Scale. The review highlighted possible predictors (work-family conflict or a condition of social isolation) associated with improvement or worsening of quality of life and stress. The results highlighted the association between stress and family difficulties (β: -0.02, P-value <0.05), isolation during the first (β: -0.22, P-value <0.05) and second pandemic waves (β: -0.40, P-value <0.05) or due to the advancing age of workers (β:0.19, P-value <0.05) and (β: -0.05, P-value <0.05), furthermore some job categories presented greater stress such as teachers (16.94 ± 5.46). Conversely, remote working positively affected life quality, enhancing factors such as creativity (Average Variance Extracted, AVE: 0.41, R2: 0.17) and self-efficacy (AVE: 0.60, R2: 0.36). Future research should focus more on the relationship between work and family and on interventions that counteract social isolation.

Chronic kidney disease (CKD) affects 10-15% globally and is a marked independent risk factor for cardiovascular disease. Prevalence estimations are essential for public health planning and implementation of CKD treatment strategies. This study aimed to estimate the prevalence and stages of CKD in the population-based Lolland-Falster Health Study, set in a rural provincial area with the lowest socioeconomic status in Denmark. Additionally, the study characterized participants with CKD, evaluated the overall disease recognition, including the awareness of CKD and compared it with other common conditions. Cross-sectional data were obtained from clinical examinations, biochemical analyses, and questionnaires. CKD was defined as albuminuria (urine albumin-creatinine ratio ≥30 mg/g), estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m², or by a diagnosis in the National Patient Register. Patient awareness was assessed by self-reported CKD, and overall disease recognition by either a registered hospital diagnosis or self-reported CKD. Among 16 097 adults (median age 58.6 years), CKD prevalence was 18.0% (n = 2903), with 70.1% identified by albuminuria, 28.4% by reduced eGFR, and 1.5% by a registered diagnosis alone. Of those with CKD, 98.8% had stages 1-3 (eGFR ≥30 ml/min/1.73 m²), and 1.2% had stages 4-5 (eGFR <30 ml/min/1.73 m²). Female sex, comorbidities, smoking, and low socioeconomic parameters were independently associated with CKD. Patient awareness of CKD was 4.4%, compared to >50% for hypertension and >80% for diabetes, and the overall CKD recognition (self-reported or registered diagnosis) was 7.1%. Thus, in this population-based study, CKD was highly prevalent but poorly recognized, indicating great potential for preventing CKD progression and related complications.

Marketing authorization holders of vaccines typically need to report brand-specific vaccine effectiveness (VE) to the regulatory authorities as part of their regulatory obligations. COVIDRIVE (now id. DRIVE) is a European public-private partnership for respiratory pathogen surveillance and studies of brand-specific VE with long-term follow-up. We report the final VE results from a two-dose primary series AZD1222 (ChAdOx1 nCoV-19) vaccine schedule in ≥18-year-old individuals not receiving boosters. Patients (N = 1,333) hospitalized with severe acute respiratory infection at 14 hospitals in Austria, Belgium, Italy, and Spain were included in the test-negative case-control study in 2021-2023. Absolute VE was calculated using generalized additive model (GAM), generalized estimating equation (GEE), and spline-based area under the curve (AUC, measuring VE up to 6 months after the last dose of AZD1222). Overall VE (against coronavirus disease 2019 [COVID-19] hospitalization) of an AZD1222 primary series was estimated as 65% using GEE (95% confidence interval [CI]: 52.9-74.5), and 69% using GAM (95% CI: 50.1-80.9) over the 22-month study period (comparator group: unvaccinated patients). The AUC of the spline-based VE estimate was 74.1% (95% CI: 60.0-88.3). VE against hospitalization in study participants who received their second AZD1222 dose 2 months or less before hospitalization was 86% using GEE (95% CI: 77.8-91.4), 93% using GAM (95% CI: 67.2-98.6). During this study period, where mainly the severe acute respiratory syndrome coronavirus 2 Omicron variant was circulating, a two-dose primary series AZD1222 vaccination conferred protection against COVID-19 hospitalization up to at least 6 months after the last dose.

Stillbirth rates have stalled or increased in some European countries during the last decade. We investigate to what extent time-trends and between-country differences in stillbirth rates are explained by the changing prevalence of advanced maternal age and teenage pregnancies or multiple births. We analysed data on stillbirths and live births by maternal age and multiplicity from 2010 to 2021 in 25 European countries using Kitagawa decomposition to separate rate differences into compositional and rate components. Rates significantly decreased in six countries, but increased in two. Changes in maternal age structure reduced national stillbirth rates by a maximum of 0.04 per 1000 in the Netherlands and increased rates by up to 0.85 in Cyprus. Changes in the prevalence of multiple births decreased rates by up to 0.19 in the Netherlands and increased rates by up to 0.01 across multiple countries. Maternal age differences explained between 0.11 of the below-European average stillbirth rate in Belgium and 0.13 of the above-average rate in Ireland. Excluding Cyprus, differences in multiple births explained between 0.05 of the below-average rate in Malta and 0.03 of the above-average rate in Ireland. For most countries, the increase in advanced-age pregnancies contributed to rising stillbirth rates over time, while reductions in multiples led to decreases in rates. However, large parts of the trends remain unexplained by those factors. By 2021, neither factor explained the differences between countries, due to increased compositional uniformity and declining stillbirth risk for advanced maternal age.

Personalized medicine (PM) has the potential to revolutionize healthcare by delivering treatments tailored to individual patients based on their unique characteristics. However, ensuring its effective implementation presents complex challenges, particularly in terms of long-term sustainability. To address these challenges, the IC2PerMed project fosters collaboration between the European Union and China. This study, building on insights from the project, aims to identify key priorities for advancing PM, focusing on Clinical Studies and Funding Systems, with special attention to optimizing resource management, distribution, and protection to support sustainable development. A two-round Delphi survey was conducted to achieve consensus on common priorities among China and Europe related to Clinical Studies and Funding Systems. Consensus was measured using the Content Validity Index, requiring an agreement level of 80% or higher for item inclusion. The survey identified 20 key priorities in PM research, split evenly between research initiatives and funding mechanisms. Notable priorities include developing technology for deep phenotyping, standardizing methodological approaches, and fostering public-private collaborations. In funding, the emphasis was placed on involving patient voices in research design and establishing synergies among funders to support larger projects. The findings underscore the importance of structured collaboration between Europe and China in advancing personalised medicine. By addressing identified priorities in research and funding, this initiative can significantly enhance the efficacy of PM, ultimately improving healthcare outcomes globally. The study sets a precedent for future international partnerships aimed at fostering innovation in health sciences.

A drug consumption monitoring revealed that Montenegro is one of the major consumers of antimicrobial drugs in Europe. The aim of this study is to obtain the first data on the knowledge, attitudes, and practices of the general population in Montenegro regarding antibiotics use. This cross-sectional study was designed according to the methodology of Eurobarometer survey on antimicrobial resistance, created by the European Commission. The standardized questionnaire was conducted in Podgorica, in October-November 2022. A total of 532 participants completed the questionnaire. More than a half of responders (60.9%) have received antibiotics within the last 12 months and among them 33.4% was missing a medical prescription, nor the antibiotic was administered by a medical practitioner. The rest of the responders mostly had some antibiotics left over from a previous course (13.0%), had taken it from a pharmacy (11.4%), or elsewhere without a prescription. The most frequent reasons for antimicrobial therapy were "cold" (22.5%), "sore throat" (21.0%), "cough" (19.4%), and "COVID-19" (coronavirus disease 2019) (17.9%). Throat swab, blood test, urine test, or other test that could identify the cause of the illness preceded antimicrobial therapy in 46.3% participants. Only one-half of the participants were convinced that antibiotics are ineffective in viral infection treatment. This study is the first report on public knowledge, attitudes and practices regarding antibiotics use and resistance in Montenegro and it highlights the need for the knowledge improvement among general population, better regulations for antibiotics procurement and a campaign regarding appropriate antibiotics use among youth.

Hodgkin's lymphoma (HL) is a lymphoid malignancy with an emphasized incidence in developed countries. This study aimed to assess the changes in the epidemiology of HL in Finland at the population level by utilizing data from six nationwide healthcare registries. A total of 2912 patients with HL, diagnosed and treated between 2000 and 2019 were matched by controls and divided into younger (<50 years) and older cohorts (≥50 years) for analysis. A slightly increasing trend in incidence per age group was observed. For the younger patients, the mean annual incidence was 3.19 for males and 2.89 for females. For the older patients, it was 3.07 and 1.59, respectively. Finland has higher incidence rates than other Scandinavian countries possibly due to unique human leucocyte antigen allele distribution. There was a notable increase in prevalence. For females, this was particularly emphasized between the ages of 30-50 years, while among males, it was more evenly distributed across all ages. As a result of improved disease management, the proportion of HL survivors is increasing.

Measurements of capacity to work (CTW) in relation to common mental disorders (CMD) are needed to improve research on determinants for maintained work participation (WP). The aim of this study was to assess the construct validity of the Capacity to Work Index (C2WI) in a heterogenous sample of the Swedish working population. Cross-sectional web survey data among Swedish employees (n = 8201) was used. The construct validity was assessed in terms of the unidimensionality of the scale, response categories appropriateness, and the differential item functioning with respect to gender and age. Rasch analysis was used in both the full sample and randomly selected subsets. The Rasch model (RM) was fitted using two versions of the C2WI construct: the original 17-item scale and a 7-item scale. The 17-item scale did not discriminate as required, whereas the 7-item scale demonstrated a better fit to the RM. However, statistically significant χ2 statistics indicated non-invariant item performance across the latent continuum. A third attempt assessed both scales on a subgroup, yielding improved results, but an overall fit to the RM was not achieved. CTW in relation to CMD assessed by the C2WI did not fulfil the requirements for construct validity outlined by the RM. Real-world experiences of CTW are complex and reflect expressions of mental health in diverse work environments. Further studies are required to determine the predictive capacity of C2WI and its individual items in relation to relevant outcomes, such as maintained WP in the working population.