European Journal of Public Health最新文献

Problematic alcohol use has been suggested to be associated with higher prevalence of musculoskeletal pain (MSP) among manual workers; however, such relationship remains understudied among non-manual workers. This cross-sectional study investigated the association between alcohol consumption and MSP patterns among non-manual workers. We analysed 6847 non-manual civil servants and retirees aged 50-75 years from the phase 7 of the British Whitehall II Cohort study. Self-reported alcohol consumption was measured as average weekly intake and an alcohol dependency score. MSP was assessed through self-reported anatomical pain sites in the upper body and their frequency. We used multiple-group latent class analysis to identify MSP patterns by age, sex, and employment status. Multinomial logistic regression was used to assess the association between alcohol and pain patterns, adjusting for covariates. There were 3651 (53.3%) reported MSP, with four patterns identified: all upper-body pain sites (6.9%), low back pain (LBP) alone (10.3%), combined LBP and cervical pain (24.8%), and upper-extremity pain (11.3%). We did not observe any significant association between alcohol consumption/dependency and any pain patterns (Ps > .05). Above-moderate alcohol consumption was associated with combined LBP/cervical pain (OR: 1.31, 95% CI: 1.05-1.31) among retirees. Potential alcohol dependency was associated with upper-extremity pain among women (OR: 2.04, 95% CI: 1.15-3.60) and early retirees (OR: 1.81, 95% CI: 1.15-2.84). No overall association between alcohol consumption and MSP was found. Increased spinal pain was found in retirees who exceeded recommended limits, and increased extremity pain was found in women and early retirees with potential alcohol dependency.

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 (2018-24), identifying practices, patterns, and reporting gaps. Following the Joanna Briggs Institute guidance and PRISMA-ScR checklist, Medline, Embase, Global Health, and WorldCat were searched (2018-24) 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. Fifty-eight 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. 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.

WHO's Immunization Agenda 2030 has placed renewed focus on life-course vaccination, including among migrants. Despite the availability of a seasonal vaccine, influenza remains a key contributor to winter excess mortality in Northern Europe, yet limited data on influenza vaccination uptake in migrants has been published. We analyzed Danish national registry data to determine influenza vaccine uptake across six flu seasons (2015/16-2020/21) among migrants (asylum-pathway and quota refugees, family reunified migrants) ≥65 years matched 1:6 on age and gender to Danish-born individuals. We used multivariate logistic regression models controlling for migrant status (immigration status, time in Denmark) and other sociodemographic variables (age, gender, nationality, urban/rural residence) to identify factors associated with influenza vaccination uptake. All analyses were done in R v4.2.1. Across all six seasons, overall flu vaccination uptake was 49.3% (Danish-born: 50.9%; migrant cohort: 39.4%). Migrants were less likely [odds ratio (OR): 0.66; 95% confidence interval (CI): 0.64-0.67] to receive an influenza vaccine across all seasons, with this gap widening from 2015/16 (OR: 0.78; 95% CI: 0.74-0.84) to the 2020/21 season (OR: 0.44; 95% CI: 0.42-0.46). Family-reunified migrants were less likely to receive an influenza vaccine across the study period than asylum-pathway and quota refugees and those from the Sub-Saharan Africa region had the lowest uptake in terms of area of origin. This large and unique dataset shows that migrant groups have lower uptake rates for influenza vaccination compared with Danish-born individuals, with the gap widening over time. Going forward, developing tailored interventions, co-developed in collaboration with communities themselves, will be key.

Adolescence is a life stage characterized by physical, social, and emotional changes including a shift towards peer orientation and an explorative approach to substance use. Previously, we identified distinct adolescent substance use patterns. Here we characterized adolescents with distinct patterns of substance use and tested whether patterns were associated with acute outcomes. Data from the Danish National Youth Cohort 2014, comprising 68 301 participants aged 15-19 years attending upper secondary education, were used. Previously identified substance use patterns were Alcohol Only (48.8%), Frequent Binge Drinking (23.3%), Experimental Use (16.3%), and Early Multiple Use (11.6%). Adolescents with distinct substance use patterns were characterized by adverse childhood experiences, social networks, parental support, and mental health. Associations between patterns and the risk of unintentional injury, violence, and mortality were assessed over an 8.2-year follow-up period. An accumulation of adverse childhood experiences, lack of parental support and poor mental health were observed in adolescents with most substance use. Substance use patterns were associated with the risk of unintentional injury, violence, and mortality in a dose-dependent manner. For instance, compared to Alcohol Only, hazard ratios (95% CI) for severe unintentional injury were 1.25 (1.08-1.44), 1.40 (1.17-1.66), 1.50 (1.25-1.79) for adolescents with Frequent Binge Drinking, Experimental Use, and Early Multiple Use. Adolescent substance use patterns were associated with short- and long-term risks of acute health outcomes. Additionally, disadvantages cluster in adolescents with more substance use, highlighting the aggregation and potential interaction of challenges faced by vulnerable subgroups that extend into adulthood.

Injuries lead to heath loss, disability, and significant costs. The aim of this study was to evaluate self-reported home and leisure injuries outside school by the 8th and 9th graders in Finnish secondary schools, and potential explanatory factors associated with their injuries. Data were gathered on 383 550 pupils in cross-sectional surveys (every second school year) done between years 2013 and 2021. Associations between injuries and the explanatory variables were assessed using logistic regression analysis. Bronfenbrenner's bioecological model and the KINDL-R health-related quality of life measurement were used as the framework for this study. Nearly a third of the respondents (n = 120 494, 31.4%) had been injured one or more times during leisure time or at home. The most common injuries among all respondents were sport-related injuries (19.8%), other injuries sustained during leisure time (13.8%) and at home or nearby (9.4%). The use of safety equipment was quite low. The potential risk for injuries was highest among those who were severely anxious, those who often consumed enough alcohol to become heavily drunk, those who had tried or used drugs before, and adolescents of foreign background who had been born abroad. Adolescents with no close friends had a lower association with injury. Boys were more likely to sustain injuries than girls. Injuries suffered in leisure time and at home were linked to risky behaviour, emotional well-being, social and family relationships, and housing. Professionals in preventive work need to take the complex factors behind injuries into account.

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.

Interprofessional collaboration across sectors is a major challenge for the health and care workforce. Collaboration often remains weak, as fragmented services cannot match complex needs. Working with the underlying professional, organizational, and administrative boundaries may help to address the challenge, but we know little about how managers and professionals do this. This study examines how boundary work can strengthen interprofessional collaboration, based on the introduction of mental health teams in three Danish municipalities. A qualitative case study was conducted involving three intersectoral teams consisting of health and social care professionals in Central Denmark Region. Data collection included observations of interactions, 27 semi-structured interviews with users, professionals, and middle managers, and three focus group interviews. Key themes and dynamics in boundary work were identified using thematic network analysis. Findings indicate that boundary work by management established shared frameworks for interprofessional collaboration, such as weekly board meetings and risk categorization systems. In two municipalities, these frameworks fostered collaborative boundary work among professionals, agreeing on how to share information and adjust care plans collectively. However, in the third municipality, professionals competed to defend existing boundaries, hindering the introduction of new collaborative practices. Working with boundaries can help to address the challenge of interprofessional collaboration across sectors by combining top-down and bottom-up strategies by managers and professionals. However, implementation needs fine-tuning to existing professional hierarchies and local organizational contexts. Managers also need to acknowledge the limits of steering boundary work, which thrives on autonomy in daily interactions among professionals.