European Journal of Public Health最新文献

Social inequalities in alcohol-related morbidity and mortality are well-established, but the reasons are not fully understood. One possible reason is labor market difficulties stemming from lower educational qualifications, leading to alcohol-related harm. The present study aims to investigate the extent to which differences in labour market marginalization (LMM) (including differences in timing and type of LMM) explain educational differences in alcohol-related mortality, and whether this is independent of pre-labor market selection factors. A register-based cohort study included all men born between 1949 and 1951 who underwent Swedish military conscription in 1969/70 and were alive at age 55 (n = 45 168). Nationwide registers provided data on education level and alcohol-related mortality. LMM was measured by unemployment, sickness absence, and disability pension. Pre-labor market factors included health behaviors, cognitive ability, and health from conscription exams. Cox regression analyses were used to obtain hazard ratios (HR) with 95% confidence intervals (CI). The explanatory role of LMM was assessed by percentage attenuation of HR. Men with primary and secondary education had higher risks of alcohol-related mortality (HR: 4.23, HR: 2.92) compared to those with university education. LMM explained a substantial part of these differences (42% and 37%). However, LMM's effect was smaller (18% and 7%) when pre-labor market factors were considered. Men with lower education levels in Sweden are more likely to die from alcohol-related causes compared to higher educated men. While differences in LMM contribute to these disparities, its explanatory power diminishes when considering pre-labor market factors, suggesting potential selection effects.

The organization of healthcare for nursing home residents varies widely between systems, even between neighbouring countries such as Germany and the Netherlands. This study compares healthcare professionals' perspectives on strengths and challenges in medical care for nursing home residents in Germany and the Netherlands. Semistructured interviews were conducted in Germany with six nursing staff from six nursing homes and six general practitioners (GPs) in private practice and in the Netherlands with one elderly care physician (ECP) and seven nursing staff members from six nursing homes between August 2023 and March 2024. Interviews were audio recorded, transcribed, translated, and analysed using qualitative content analysis. Participants reported that Germany and the Netherlands face rising long-term care demands due to aging populations, however, their nursing home care models differ substantially. In Germany, care is reactive and fragmented, with external professionals, especially GPs, providing care. Challenges include delays, limited communication, and a lack of standardized processes. Conversely, the Netherlands adopts a structured, preventive approach, led by ECPs supported by multidisciplinary teams. This model emphasizes proactive monitoring, team collaboration, and holistic care but faces workload challenges and limited specialist access. Interprofessional collaboration is more hierarchical and record-based in Germany, while it is team-oriented and conversational in the Netherlands. This study highlights key differences in the organization of nursing home care in Germany and the Netherlands, particularly in access to specialists, interprofessional collaboration, and structures. Potential adaptations to improve care must fit within the existing structures of each healthcare system.

Alcohol-free drinks [beers, ciders, wines, and spirits containing <0.05% alcohol by volume (ABV)], and low-alcohol drinks (between 0.05% and 1.2% ABV) are increasingly available and may be used as a harm reduction measure. However, it is not known what pregnant women think and feel about these drinks and how regularly they are consumed before and during pregnancy. A cross-sectional online survey was developed and piloted. Women ≥18 years in the UK who were pregnant, or recently pregnant, were recruited via targeted social media advertising. Of the 2092 respondents, 47.8% (n = 1001) were currently pregnant; 55.7% (n = 1167) were between 25 and 34 years, 90.0% were White (n = 1881); 6.1% (n = 128) were drinking alcohol at "increasing risk" levels (>14 units/week) before pregnancy. During pregnancy, 13.5% (n = 282) consumed alcohol, which was more common in the increasing risk category (P < .01). Alcohol-free or low-alcohol drinks were consumed by 71.3% (n = 1491) of respondents during pregnancy; 91.4% of the increasing risk category versus 69.9% of the lower risk category (P < .01). The most common reasons for consuming alcohol-free or low-alcohol drinks were "to choose a safer alternative" (71.9%, n = 1073) and "to feel included in social events involving alcohol" (68.8%, n = 1026). More than half of respondents (56.7%) thought there was insufficient information available about consuming alcohol-free and low-alcohol drinks during pregnancy, with internet searching the primary source of information. Although alcohol-free and low-alcohol drinks are commonly consumed during pregnancy, there are some safety concerns. Their role as a harm reduction measure in those who are drinking alcohol at increasing risk levels prepregnancy needs further investigation.

The aging in place policy emphasizes the older people's own desire to live at home. However, there is limited evidence on preferences for place of residence and long-term care, especially regarding the oldest old people. This study aims to fill this knowledge gap by identifying the preferences and associated factors of community-dwelling people aged 90+. Survey data, including a total age cohort of 90 years and older in one geographic area in Finland was analyzed descriptively and with multinomial logistic regression. The total study population was 1834 of which two-thirds were community-dwellers. Of the community-dwellers 71% preferred to live at their current homes, 18% preferred to live at their current homes if they received more help, and 11% would prefer to live in a residential care facility. Those who preferred to live at home had better functioning, rarely experienced dizziness, tiredness, loneliness, and pain, were more often satisfied with their life, and had better self-rated health compared to other preference groups. Preferences shifted gradually: the poorer the respondents' health, functional capacity, and well-being, the more likely they preferred to get more help at home or live in residential care. One-third of the respondents either preferred to have more help in their current home or to move to residential care, indicating that home was not the best place for them to live at that time. Findings suggest that the preferences for living at home are not stable but a dynamic process among the oldest old people.

Background: Digital health offers promising solutions for enhancing patient care, yet adoption varies among physicians, partly due to concerns about administrative burdens and burnout. This study assessed digital health use and burnout among primary care physicians in 10 OECD countries and examined their relationship.

Methods: We conducted a secondary analysis of "The Commonwealth Fund's 2022 International Health Policy Survey," including 9526 randomly selected primary care physicians (general practitioners or pediatricians in ambulatory care) from 10 OECD countries. We created a digital health score based on the use and frequency of digital tools. Self-reported burnout and related outcomes were analyzed. Cross-country differences were assessed using stratified analyses. Associations between digital health and burnout and related outcomes were explored using stratified analyses and logistic regressions.

Results: Most physicians used electronic records; video consultations or connected tools for chronic care. Digital health scores were highest in the Netherlands and UK, and lowest in Germany and Switzerland. 35% of physicians reported burnout, with the highest prevalence in New Zealand (49%) and Canada (46%), and lowest in the Netherlands (12%) and Switzerland (18%). Digital health use positively correlated with workload dissatisfaction but not with burnout, stress, satisfaction with administrative work, or work-life balance.

Conclusion: Physicians' digital health use and burnout varied substantially across countries but were not correlated. While digital health is often considered a factor linked to physician burnout, our results do not support this view. They also highlight the need to ensure that digital health reduces, rather than exacerbates, physicians' workload.

Our aim was to provide new data on the incidence, prevalence, and secular trend of type 2 diabetes (T2D) in Sweden, specifically early-onset T2D. We followed the Swedish population 2006 to 2021 and calculated age-standardized incidence (per 100 000) and prevalence (%) of T2D (overall) and early-onset T2D (age 23-39 years) stratified by sex, region of birth, and educational level. We projected the future prevalence of early-onset T2D by combining observed trends with population projections. From 2006 to 2021, the prevalence of T2D rose from 4.87% to 7.50%, and incidence from 477 [95% confidence interval (CI) 471-482] to 574 (CI 568-579). Early-onset T2D incidence increased from 54 to 107 (4.7% annual rise; CI 3.7%-5.7%) during this period. Incidence of early-onset T2D was higher in individuals born outside Europe (211, CI 195-226 vs 89, CI 84-93 in 2021) or low education (204, CI 185-223 vs 71, CI 65-77 in 2021), but a rise in incidence was seen irrespective of educational level, region of origin, and sex. If the incidence of early-onset T2D continues to increase at the same pace, its prevalence is projected to increase from 0.64% in 2021 to 3.2% in 2050. While T2D incidence rose marginally in Sweden 2006 to 2021, there was a significant rise in early-onset T2D, seen across different socioeconomic characteristics, with prevalence more than doubling and incidence nearly doubling. This development calls for targeted preventive efforts.

Ageing populations and longer life expectancies challenge healthcare systems due to rising noncommunicable diseases (NCDs) and multi-morbidity. Designing healthier living environments may reduce population risks of NCD onset, but knowledge is needed on environmental factors related to NCDs in older adults. We therefore examined associations between residential neighbourhood built, physico-chemical, and sociodemographic environmental factors and NCD prevalence in the Netherlands among older adults. Cross-sectional data from 1578 older adults from the Longitudinal Aging Study Amsterdam (2008-09) were matched with environmental data from the Dutch Geoscience and Health Cohort Consortium (GECCO). Multivariable logistic regression analyses were conducted to assess the odds of having a single NCD versus no NCD and multi-morbidity versus no NCD, adjusted for sociodemographic factors. Participants had a mean age of 73.2 years, 55% were female, and 77% reported at least one NCD. Multi-morbidity was more common in women, who were also older and had lower education and income. Higher green space density within 500 m was significantly associated with lower odds of single NCD [odds ratio (OR): 0.52, 95% confidence interval (CI): 0.33-0.83]. A higher number of cars in a household also showed lower odds of single NCD (OR: 0.14, 95% CI: 0.04-0.55). No significant associations were observed for physico-chemical exposures. Results were consistent in sensitivity analyses. The findings underscore the need for urban planning and policies that support healthy ageing while embracing a longevity-ready perspective, accounting for the built, physico-chemical, and sociodemographic environments across the life-course.

Due to the many health impacts of climate change, it is imperative to equip public health professionals with the skills and knowledge to work on climate mitigation and adaptation. However, it is unclear to what extent Masters of Public Health (MPH) include climate change and related subjects in their curricula. A survey was sent to MPH directors in the UK with questions about inclusion of climate change and related subjects in the curriculum. Russell group universities and those commissioned by NHS England Workforce, Training and Education were invited to take part. A total of 27 MPH courses were included (100% response rate). Climate change and related subjects were included in optional or core modules on other subjects, with health protection and health improvement being the most common. Two MPHs had only one lecture/seminar on climate change and one MPH did not cover these topics in the syllabus. The most common subject included in curricula was climate change (24, 89%). Most MPH directors wanted to increase the inclusion of climate change and planetary health in the curriculum (12, 55%) but could not do so due to lack of space within an already overloaded curriculum (10, 37%). Despite the recognition of the importance of climate change and health education by MPH course directors, the inclusion of those subjects in curricula remains variable and not as thorough as required given the importance of the topic. Addressing barriers is warranted to enable public health professionals to gain the required skills in climate mitigation and adaptation.