European Journal of Public Health最新文献

Frailty is associated with adverse health outcomes in ageing populations, yet its long-term effect on the development of disability is not well defined. The study examines to what extent frailty affects disability trajectories over 15 years in older adults aged 50+. Using seven waves of data from the Survey of Health, Ageing and Retirement in Europe (SHARE), the study estimates the effect of baseline frailty on subsequent disability trajectories by multilevel growth curve models. The sample included 94 360 individuals from 28 European countries. Baseline frailty was assessed at baseline, using the sex-specific SHARE-Frailty-Instrument (SHARE-FI), including weight loss, exhaustion, muscle weakness, slowness, and low physical activity. Disability outcomes were the sum score of limitations in activities of daily living (ADL) and Instrumental ADL (IADL). Analyses were stratified by sex. Over 15 years, baseline frailty score was positively associated with disability trajectories in men [βADL = 0.074, 95% confidence interval (CI) = 0.064; P = .083; βIADL = 0.094, 95% CI = 0.080; P = 0.107] and women (βADL = 0.097, 95% CI = 0.089; P = .105; βIADL = 0.108, 95% CI = 0.097; P = .118). Frail participants showed higher ADL and IADL disability levels, independent of baseline disability, compared with prefrail and robust participants across all age groups. Overall, participants displayed higher levels of IADL disability than ADL disability. Study findings indicate the importance of early frailty assessment using the SHARE-FI in individuals 50 and older as it provides valuable insight into future disability outcomes.

Recognizing and addressing vulnerability during the first thousand days of life can prevent health inequities. It is necessary to determine the best data for predicting multidimensional vulnerability (i.e. risk factors to vulnerability across different domains and a lack of protective factors) at population level to understand national prevalence and trends. This study aimed to (1) assess the feasibility of predicting multidimensional vulnerability during pregnancy using routinely collected data, (2) explore potential improvement of these predictions by adding self-reported data on health, well-being, and lifestyle, and (3) identify the most relevant predictors. The study was conducted using Dutch nationwide routinely collected data and self-reported Public Health Monitor data. First, to predict multidimensional vulnerability using routinely collected data, we used random forest (RF) and considered the area under the curve (AUC) and F1 measure to assess RF model performance. To validate results, sensitivity analyses (XGBoost and Lasso) were done. Second, we gradually added self-reported data to predictions. Third, we explored the RF model's variable importance. The initial RF model could distinguish between those with and without multidimensional vulnerability (AUC = 0.98). The model was able to correctly predict multidimensional vulnerability in most cases, but there was also misclassification (F1 measure = 0.70). Adding self-reported data improved RF model performance (e.g. F1 measure = 0.80 after adding perceived health). The strongest predictors concerned self-reported health, socioeconomic characteristics, and healthcare expenditures and utilization. It seems possible to predict multidimensional vulnerability using routinely collected data that is readily available. However, adding self-reported data can improve predictions.

Advertising for unhealthy foods adversely affects children's food preferences and intake. The German government published plans to restrict such advertising in February 2023 and has revised them several times since. We assess the reach of the current draft from June 2023, and discuss its public health implications. We show that across 22 product categories covered by the current draft law, the median share of products permitted for marketing to children stands at 55%, with an interquartile range of 11-73%. Resistance from industry groups and from within government poses hurdles and leaves the prospects of the legislation uncertain.

Retention issues are widespread within the health workforce. This cross-sectional study used data collected from 1707 healthcare professionals in 2022-23 to identify with k-means clustering groups of individuals sharing similar working experiences. These profiles were linked with varying levels of turnover intentions and a range of healthcare professions. While occupational therapists and paramedics reported in average better working conditions, registered nurses and intermediate caregivers reported the poorest experiences. In other clusters, salaries were high where work-life balance was low, and inversely. By learning from similarities and differences in the working conditions of diverse healthcare professionals, shared initiatives aimed at improving retention across professions can be facilitated.

The aim of this study was to analyze the associations between healthcare services utilization and flight-related characteristics of asylum seekers and refugees in Germany. The 2020 wave of the German Socio-Economic Panel's Survey of Refugees was used to compile a sample of asylum seekers and refugees (n = 3134). Healthcare services utilization was measured using the self-reported number of visits to primary care physicians and hospitalization. Only the feeling of being welcome and worries about not being able to stay in Germany were identified as potential flight-related determinants of healthcare services utilization.

We studied the developmental trajectories of satisfaction with work-family reconciliation (WFS) and their associations with family-related factors and quality of life measures among municipal employees. The study was based on the Helsinki Health Study of municipal employees of the City of Helsinki in 2001-02 and its follow-up surveys in 2007, 2012, and 2017. Employees aged 40-50 at baseline and working at all timepoints were analysed (n = 1681, 84% women). Growth Mixture Models were applied to identify trajectories of WFS (dissatisfied vs. satisfied). Associations of family-related and quality-of-life factors (physical functioning and emotional well-being) with the WFS trajectories were studied using log-binomial regression models, adjusting for sociodemographic and lifestyle variables. Two WFS trajectories, low (women 45%; men 53%) and high were identified. In a fully adjusted model among women, having ≥1 children aged 0-6 years was associated with increased odds of belonging to the low WFS trajectory (OR 1.52, 95% CI 1.19-1.95). Among men, having ≥1 children aged 7-18 was associated with decreased odds (0.39, 0.19-0.80). High emotional well-being was inversely associated with the low WFS trajectory among both genders (women 0.32, 0.23-0.45; men 0.20, 0.09-0.46). High physical functioning (0.59, 0.42-0.83) was inversely associated with the low WFS trajectory among women only. Less than half of the women and more than half of the men participants belonged to a low WFS trajectory, which associated with the age of children in the family and quality-of-life measures.

Persons with intellectual disabilities (ID) face pronounced health disparities. The aim of this study was to describe premature mortality by causes of death and avoidable mortality among persons with ID compared to the general Danish population. This study is based on a Danish nationwide cohort of adults (aged 18-74 years) with ID (n = 57 663) and an age- and sex-matched reference cohort (n = 607 097) which was established by linkage between several registers. The cohorts were followed in the Register of Causes of Death between 2000 and 2020. Causes of death were categorized into preventable, treatable, or unavoidable deaths using the OECD/Eurostat classification and furthermore categorized into specific interventions. We compared the observed and expected number of deaths by calculating standardized mortality ratio (SMR). Among persons with ID the number of deaths was 9400 whereof 5437 (58%) were avoidable. SMR for preventable deaths, e.g. by reducing smoking and alcohol intake or by vaccination, was 2.62 (95% CI, 2.51-2.73), and SMR for treatable deaths, e.g. by earlier diagnosis and treatment, was 6.00 (5.72-6.29). Unavoidable mortality was also six-fold increased (SMR = 6.03; 5.84-6.22). Preventable deaths were higher for persons with mild ID compared to severe ID, while treatable and unavoidable mortality were highest for persons with severe ID. The study confirmed that persons with ID have an amplified risk of mortality across all categories. There is a need for competence development of social care and healthcare personnel and reasonable adjustment of health promotion programs and healthcare services for people with ID.

Burden of disease (BoD) studies quantify the health impact of diseases and risk factors, which can support policymaking, particularly in the European Union (EU). This study aims to systematically analyse BoD studies, which address EU public policies to contribute to the understanding of its policy uptake. A systematic search of six electronic databases and two grey-literature registries was carried out for articles published between 1990 and 2023. The thematic area, type of legislation and the respective policymaking stage were extracted. A textual analysis of the discussion was conducted to assess the inclusion of specific EU policy implications. Overton was used to detect citations in policy documents. Out of the 2054 records screened, 83 were included. Most studies employed secondary data, with 37 utilizing GBD data. Disability-adjusted life year was present in most of the studies (n = 53). The most common type of the EU legislation mentioned was the directive (n = 47), and the most frequent topic was environment (n = 34). Policy implications for EU laws were discussed in most papers (n = 46, 55.4%), with only 8 conducting evaluation of EU policies. Forty-two articles have been cited at the EU-level, in a total of 86 EU policies. Despite increasing efforts in integrating EU legislation impact within BoD studies, these results denote a low consideration of the legal and policy changes. Greater efforts in directing research towards policy effectiveness evaluation might increase their uptake in EU policies.

During the coronavirus disease 2019 (COVID-19) pandemic, Sweden emphasized voluntary guidelines over mandates. We exploited a rapid change and reversal of the Public Health Agency of Sweden's COVID-19 testing guidelines for vaccinated and recently infected individuals as a quasi-experiment to examine sociodemographic differences in the response to changes in pandemic guidelines. We analyzed daily polymerase chain reaction tests from 1 October 2021 to 15 December 2021, for vaccinated or recently infected adults (≥20 years; n = 1 596 321) from three Swedish regions (Stockholm, Örebro, and Dalarna). Using interrupted time series analysis, we estimated abrupt changes in testing rates at the two dates when the guidelines were changed (1 November and 22 November). Stratified analysis and meta-regression were employed to explore sociodemographic differences in the strength of the response to the guideline changes. Testing rates declined substantially when guideline against testing of vaccinated and recently infected individuals came into effect on 1 November [testing rate ratio: 0.50 (95% confidence interval, CI 0.41, 0.61)], and increased again from these lowered levels by a similar amount upon its reversal on 22 November [testing rate ratio: 2.19 (95% CI: 1.69, 2.85)]. Being Sweden-born, having higher household income, or higher education, were all associated with a stronger adherent response to the guideline changes. Adjusting for stratum-specific baseline testing rates and test-positivity did not influence the results. Our findings suggest that the population was responsive to the rapid changes in testing guidelines, but with clear sociodemographic differences in the strength of the response.

Knowledge about health literacy challenges among the general population is valuable for initiatives targeting social inequity in health. We investigated health literacy in various population groups and the impact of healthcare-seeking behaviour by analysing the associations between (i) lifestyle, socioeconomics, self-rated health, chronic disease, and health literacy and (ii) symptom burden, contact to general practitioner (GP), and health literacy. In total, 27 488 individuals participated in a population-based survey. Questionnaire data comprised information about symptoms, GP contact, lifestyle, self-rated health, chronic disease, and four aspects of health literacy: feeling understood and supported by healthcare providers, having sufficient information about health, having social support for health, and being able to actively engage with healthcare providers. Socioeconomics were obtained from registers. Descriptive statistics and multivariable linear regression models were applied. Individuals who smoked, lived alone, had different ethnicity than Danish, and low self-rated health had more health literacy challenges reflected in lower scores for all aspects of health literacy. Individuals with high symptom burden and those who had presented a high absolute number of symptoms to their GP were less likely to have sufficient information about health and be able to actively engage, whereas individuals reporting GP contact with a high relative percentage of their symptoms were more likely to feel understood and supported by healthcare providers. Health literacy challenges are related to healthcare-seeking behaviour and several individual factors. To address social inequity in health and society, interventions aimed at both the individual and community-based health literacy are essential.