European Journal of Public Health最新文献

Antimicrobial resistance (AMR) is a growing global health problem. Several public interventions have been designed to increase AMR knowledge and awareness. This review assesses the availability and effectiveness of community-based AMR interventions in Europe. Four databases-Medline (OVID), Pubmed, Scopus, Web of Science- and grey literature were searched for AMR interventions in community settings in Europe between 2000 and 2024. Studies reporting empirical findings in English were considered. A narrative synthesis was performed, and findings were presented in text and tables. Forty-nine studies were eligible for inclusion from 14 European countries. Interventions were primarily educational to raise awareness, targeting individuals, small groups, or the general public through mass campaigns, school-based programmes, online games, and pledges. Some interventions also monitored adherence, consumption, and doctor consultation. The majority of interventions reported increased knowledge and awareness of antibiotics and AMR; reduced antibiotic prescription, purchase, use, and non-compliance; reduced respiratory incidence and doctor consultations, and increased overall adherence. Fluctuations in knowledge over time were observed, but evidence was insufficient to analyse the long-term sustainability of outcomes of the interventions. Our findings show that community-based interventions can enhance knowledge and awareness of appropriate antibiotic use and AMR risks among different population groups. These can also positively improve adherence, expectation, and prescribing. However, long-term engagement and interventions are needed to attain sustainability and bring behavioural changes.

Estonia is planning an update of its national alcohol policies where an economic return on investment (ROI) analysis is needed to guide decisions against their monetary returns. Using mostly national data sources, the ROI analysis was based on direct healthcare costs and productivity losses due to premature mortality. The interventions compared comprised availability restrictions and taxation increases. For taxation increases, associated revenue increases to government were included. All analyses used a one-year time horizon and different sensitivity analyses. In 2023, all alcohol-attributable harms in Estonia totalled €510.00 million (1.3% of the Gross Domestic Product of Estonia) with €263.91 million direct costs and €246.08 million indirect costs. The proposed availability reductions are expected to yield a net benefit of €6.33 million, whereas a 15% increase in alcohol excise taxation could lower healthcare costs and productivity losses by €1.77 million in addition to increasing tax revenue by €32.27 million. Moreover, the interventions were estimated to lead to substantial reductions in mortality and hospitalizations. In terms of ROI, the availability interventions would result in €15 gained for each euro invested, and the taxation increase in €477 per euro invested, and without revenue in €25 per euro invested. Positive ROI was also shown in all sensitivity analyses. The proposed alcohol control policies for Estonia would not only reduce mortality and morbidity but also bring sizeable gains for each euro invested. Higher ROI for taxation increase compared to availability restrictions was mainly due to the added tax revenue.

To assess the impact of large-scale severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination campaigns in real-world settings across regions, we performed a reproducible cross-border comparison of the real-world effectiveness of primary vaccination in preventing SARS-CoV-2 infections across three sites: Aragon (Spain), Brussels and Wallonia (Belgium), and Finland. This observational study emulated a target trial by daily matching primary vaccinated individuals 1:1 to un- or partially vaccinated individuals using propensity scores estimated on a set of relevant confounders from January to September 2021. Matched individuals were followed up until a SARS-CoV-2 infection was contracted or a censoring event occurred. Vaccine effectiveness in preventing infections was estimated by the difference in restricted mean survival time (RMST). Primary vaccination extended the average free-of-infection time by 35.9 [95% confidence interval (CI) (34.9-37.0)], 59.6 [95% CI (59.3-60.0)], and 1.6 [95% CI (1.1-2.0)] days over 365 days in the population cohort of Aragon (Spain), Brussels and Wallonia (Belgium), and Finland, respectively. This federated population-based observational study showed the effectiveness of the SARS-CoV-2 primary vaccination campaign in prolonging the mean time to infection in the Aragon (Spain) and Brussels and Wallonia (Belgium) population cohorts. Only a minor difference over this time frame was found in Finland's population cohort.

Trans and non-binary individuals are particularly vulnerable to discrimination in public spaces, workplaces, housing, and healthcare. The exclusion they experience also affects their participation in physical activity (PA). This study aimed to estimate the proportion of trans and non-binary individuals living in Spain that engage in PA several times per week and to explore potential associated factors. A cross-sectional study was conducted using data from 1473 participants aged 15 or older, recruited between October 2023 and March 2024 through an online national survey on trans and non-binary health. PA engagement was estimated with 95% confidence intervals (95% CIs). A Poisson regression model with robust variance was used to identify associated factors, obtaining adjusted prevalence ratios (aPRs) with 95% CI. Overall, 23.2% (95% CI: 21.1%-25.5%) reported engaging in PA several times per week. In the adjusted analysis, PA was less common among trans women (aPR = 0.46, 95% CI 0.35-0.62) and non-binary individuals (aPR = 0.67, 95% CI 0.52-0.85) compared to transmasculine individuals. Lower PA levels were also observed in those unable to legally change their name due to barriers (aPR = 0.71, 95% CI 0.52-0.97), and those with mental health issues in the past year (aPR = 0.76, 95% CI 0.62-0.93). Higher PA participation was associated with being ≥29 years old (aPR = 1.41, 95% CI 1.08-1.84) and better self-perceived health (aPR = 1.33, 95% CI 1.07-1.65). Trans women and non-binary individuals engage in PA less frequently. Sociodemographic factors, health, and legal barriers significantly impact PA participation. Policies should encourage PA, especially among young trans individuals, and ensure equitable and discrimination-free access.

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.

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.

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.

Sleep problems constitute a significant public health issue. Previous studies have found that regular leisure-time physical activity has the potential to improve sleep quality. However, stress may influence both physical activity and sleep, acting as a potential moderator in this association. The aim was to examine cross-sectional associations between self-reported leisure-time physical activity and sleep problems, as well as the potential moderating role of stress. The study population consists of 11 346 Danish adults (age ≥16 years) from the national representative Danish Health and Morbidity Survey conducted in 2021. Associations between leisure-time physical activity and sleep problems were analysed using multiple adjusted logistic regression, which included an investigation of effect modification by level of self-perceived stress. Adjusted odds ratios (ORs) for experiencing sleep problems were 1.37 [95% confidence interval (CI): 1.20-1.56] among participants who were mainly sedentary during leisure time, and 0.81 (95% CI: 0.72-0.91) among those with moderate to vigorous physical activity level compared to those with light physical activity level. Within all strata of stress levels, higher physical activity was positively associated with lower odds of sleep problems. For example, in the high stress level stratum, ORs were 0.80 (95% CI: 0.63-1.03) and 1.64 (95% CI: 1.28-2.11) in participants who were moderately to vigorously physically active and sedentary, respectively, compared to those who were lightly physically active. Higher levels of leisure-time physical activity appear to be associated with a lower prevalence of sleep problems, even among individuals who experience high levels of stress.