European Journal of Public Health最新文献

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.

During the COVID-19 pandemic, most countries implemented non-pharmaceutical interventions (NPIs) to mitigate virus transmission and decrease morbidity and mortality. The aim of this umbrella review was to identify and map systematic reviews on the effectiveness of NPIs to reduce widespread community transmission of infectious diseases with pandemic potential. We searched electronic databases (Medline, Embase, Scopus, INAHTA [International Network of Agencies for Health Technology Asseesment], and World Health Organization COVID-19) and websites (January 2024). Systematic reviews on NPIs during outbreaks, epidemics, or pandemics of COVID-19, severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS), influenza, or Ebola were included and organized in an interactive evidence map grouped by type of intervention (individual/population/environmental), disease, risk of bias, and search date. Five of the 132 included reviews were assessed as having low, 43 moderate, and 84 high risk of bias. COVID-19 was targeted in 100 reviews, influenza 66, SARS 39, MERS 34, and Ebola in five reviews. The most frequently investigated NPIs were use of face masks, hand washing, physical distancing, travel restrictions, restrictions on public gatherings, and school closures. The five reviews at low risk of bias concluded at low level of evidence about the effectiveness of most NPIs, with exceptions of hand hygiene and some measures in school settings where low- to moderate-certainty evidence was found. There is substantial lack of evidence regarding the effectiveness of several commonly used NPIs, including restrictions on public gatherings, travel restrictions, and visiting restrictions in long-term care facilities. There is a paucity not only of systematic reviews but also of primary studies at low risk of bias.

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.

We examined sociodemographic, clinical, and functional characteristics influencing avoidable and unavoidable hospital admissions in older adults over 15 years. The study included 3166 participants aged 60+ years from the Swedish National Study on Aging and Care in Kungsholmen. Hospital admissions were identified through national registers and classified as avoidable using official Swedish criteria. Multistate models estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for both admission types. During the 15-year follow-up, the incidence rates of avoidable and unavoidable hospital admissions were, respectively, 5.74 and 35.17 per 100 person-years. Avoidable admissions due to chronic conditions were more common than those due to acute conditions (3.94 vs. 1.80 per 100 person-years over 15 years). Women had lower risk of both avoidable and unavoidable admissions compared to men (HRs range 0.46-0.76), while being unpartnered increased the risk for both hospitalization types (HRs range 1.13-1.33). Receiving formal care lowered the risk of unavoidable admissions (HR 0.78, 95% CI 0.73-0.84), whereas informal care increased the likelihood of avoidable admissions due to chronic condition (HRs range 1.17-1.34). Multimorbidity, slow gait speed, and polypharmacy associated strongly with avoidable admissions (HRs range 1.41-2.50). Conversely, cognitive impairment and disability lowered risk of avoidable admissions for chronic conditions (HRs range 0.62-0.83). Multimorbidity, slow gait speed, and polypharmacy predicted higher risks for avoidable admissions from chronic conditions, while disability and cognitive impairment showed lower risks. These findings underscore the need for timely and comprehensive evaluation strategies to reduce the burden of avoidable hospital care.

Individuals with immigrant background generally perform less well in school than non-immigrants. Performing well in school may decrease the risk of substance use disorder (SUD). We investigated whether higher school performance is associated with a decreased risk of SUD in early adulthood among immigrants and non-immigrants and whether subsequent educational attainment and employment status partly explain the association. We used nationwide longitudinal Swedish data on 1 365 634 individuals born 1985-2000. Study individuals were categorized as non-immigrants, second-generation immigrants, and first-generation immigrants. School performance was based on the final school grades of compulsory education when most individuals were 16 years old. SUD was assessed between 20 and 30 years old using medical/legal registers. Cox proportional hazard models were used to examine the association between school performance and SUD by immigrant status, and whether it was partly explained by subsequent educational attainment and employment status. Higher school performance was associated with a decreased risk of SUD among all non-immigrant and immigrant groups where most immigrant groups had higher SUD risks. One standard deviation increase in school grades was associated with a 30%-37% decreased hazard of SUD. The significant hazard ratios varied between 0.63 and 0.70. The association between school performance and SUD was partly explained by subsequent educational attainment and employment status. Improving school performance during compulsory education may prevent SUD in early adulthood, particularly among immigrants who had higher risks. Securing subsequent educational attainment and employment could be additional prevention strategies against SUD.

Breastfeeding, especially exclusive, is associated with long-lasting health benefits to mothers and babies and healthcare cost-savings; however, breastfeeding rates are low in many high-income countries. Education and support interventions are effective in promoting breastfeeding but evidence on their cost-effectiveness is limited, uncertain, or negative. Our study objective was to assess the cost-effectiveness of group-based breastfeeding interventions from the National Health Service (NHS) and Personal Social Services (PSS) perspective in England. We used decision-analytic modelling to estimate incremental costs, clinical benefits (prevention of infections and death in babies, prevention of breast cancer in mothers) and quality-adjusted life-years (QALYs) of group breastfeeding interventions from the NHS/PSS perspective in England. A systematic review and meta-regression of randomized controlled trials was performed to estimate intervention effectiveness, while data on the benefits of breastfeeding were obtained from large published meta-analyses. Other model inputs were derived from published literature and national statistics. Compared with standard care alone, group breastfeeding interventions resulted in fewer infections and deaths in babies, fewer cases of breast cancer in mothers and higher QALYs (0.004 per mother-baby dyad), through increased rates of breastfeeding, and yielded cost-savings (£89 per mother-baby dyad) that outweighed intervention costs (£28 per mother-baby dyad). Group interventions that promote breastfeeding by providing education, advice and support to mothers are likely cost-effective in England. Further research should enhance the evidence base on the clinical and cost-effectiveness of breastfeeding interventions, considering their differential effects on different socioeconomic groups and a wider range of clinical benefits of breastfeeding.

Experiences of interpersonal discrimination in outpatient care (e.g. being treated disrespectfully) are a frequent phenomenon in Germany and in other countries. It can be expected that such experiences contribute to the production and perpetuation of health inequalities. We explored intersectional inequalities in interpersonal discrimination in outpatient care according to sex, history of migration, and income. Analyses were based on an online survey in a random sample of the adult population in Germany (n = 3246). A modified version of the Everyday Discrimination Scale was used to assess frequencies of interpersonal discrimination experiences in outpatient care. Sex, history of migration, and net income were considered as indicators of social inequalities. Intersectional multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) was conducted. Analyses showed significantly higher frequencies of interpersonal discrimination experiences for females and respondents with a low income while associations with migration history were not significant. Social inequalities in discrimination experiences were attributable to additive (and not multiplicative) effects of sex, migration history, and income, with sex contributing most and migration history least to these inequalities. Analyses across the 18 intersectional strata (combining subgroups of sex, income, and migration history) revealed significant differences in frequencies of discrimination experiences between the most (female second-generation migrants with low income) and least affected strata (men with high income and no migration history). As such discrimination experiences can result in reduced health care engagement and adverse health outcomes, these findings point to an important public health issue.

We analyzed age-specific changes in obesity and associated cardiometabolic risk factors from 2000 to 2023 in Finland. The study is based on two cross-sectional health examination surveys in years 2000 and 2023, representing the Finnish adults (aged 30-64 years). Associations between obesity and cardiometabolic risk factors were assessed using age-adjusted logistic regression. From 2000 to 2023, the overall prevalence of obesity (BMI ≥30 kg/m2) increased from 21% to 30% in men, and from 22% to 30% in women. Class II-III obesity (BMI ≥35 kg/m2) doubled reaching 9.9% and 12.6% in men and women, respectively, in 2023. Most marked changes were observed in younger adults, among whom the obesity rates doubled, and class II-III obesity tripled. Obesity was strongly associated with other cardiometabolic risk factors in both 2000 and 2023. Over 90% of individuals with obesity had at least one associated cardiometabolic risk factor. In 2023, the age-adjusted odds of glucose metabolism abnormalities, hypertension, and dyslipidemia in individuals with obesity, compared to normal-weight individuals, were 5.67 (95% CI 3.24-9.94), and 6.52 (4.49-9.46), and 3.91 (2.52-6.06) in men, and 7.49 (3.09-18.13), and 4.79 (3.64-6.29) and 3.22 (2.23-4.64), in women, respectively. Obesity rates in Finland have increased significantly over the past two decades, especially in young adults. Given the persistent risk of cardiometabolic complications in individuals with obesity, the increasing obesity rates are projected to place a substantial public health burden. These findings underscore the urgent need for effective strategies to address the obesity epidemic and mitigate its health impacts.

Previous research has suggested an association between emotional and behavioral problems and asthma in school-aged children. However, research on the relation between emotional and behavioral problems during preschool years and subsequent asthma is lacking. We aimed to estimate the association between emotional and behavioral problems during preschool years and the risk of subsequent asthma among children in Sweden. In this longitudinal cohort study, we used data on children (n = 6269), 3-5 years of age, whose mothers, fathers and/or preschool teachers had responded to the Strengths and Difficulties Questionnaire (SDQ) for assessment of emotional and behavioral problems, and who were followed for a mean of 7 years with regard to asthma diagnoses collected from the National Patient Register. Children identified with emotional symptoms as rated by mothers (hazard ratio [HR]: 1.65, 95% confidence interval [CI]: 1.21-2.25), fathers (HR: 1.50, 95% CI 1.09-2.07) and preschool teachers (HR: 1.55, 95% CI 1.09-2.23) during the preschool years had an increased risk of asthma, compared to children with no emotional symptoms. Conduct problems, peer-relationship problems, and hyperactivity/inattention were not associated with the risk of asthma. Emotional symptoms during preschool years were associated with an increased risk of subsequent asthma. If our findings are replicated by future studies, children with emotional symptoms during preschool years might benefit from interventions targeting both psychological and somatic aspects of asthma.