European Journal of Public Health最新文献

Health workforce shortages pose a challenge to European health systems. Challenging working conditions in healthcare were intensified by the global financial crisis and the coronavirus disease of 2019 (COVID-19) pandemic. In Ireland deteriorating working conditions for hospital doctors triggered a pattern of emigration and an increased dependence on international medical graduates. This article seeks to better understand doctor emigration and its implications for Ireland's future workforce, drawing on the case of Irish doctors who emigrated to Australia. The paper draws on three forms of data: (i) secondary data from the Australian Department of Home Affairs on visas issued to Irish citizen doctors; (ii) open-ended survey responses from hospital doctors working in Ireland (2019, N = 469) and, (iii) qualitative interview data from Irish doctors (2018, N = 51) in Australia. Research ethics permission was granted by the host institution. Significantly more Irish doctors were issued with Australian work visas in 2024 (624) than in 2005 (72). Hospital doctor survey respondents described how emigration decision-making was informed by poor working conditions, inadequate staffing levels, poor wellbeing, and dissatisfaction with the quality of care delivered. Emigrant Irish doctors in Australia indicated that similar issues deterred their return. This article shows that Ireland has high rates of outward and inward doctor migration a limited policy focus on retention or return. Our findings indicate that challenging working conditions are a driver of emigration and a deterrent to return. We call for a more person-centred approach to the medical workforce which would improve doctor working conditions, prioritize their wellbeing and promote retention/return.

Nurse retention is a critical challenge across Europe, directly affecting workforce sustainability, quality of care, and health systems resilience. Despite persistent shortages and increasing emigration, evidence on nurse retention determinants within the Portuguese National Health Service (NHS) remains limited. This study aims to identify factors influencing nurses' intention to stay in the NHS, contributing to national and European debates on sustainable workforce strategies. A quantitative, observational, cross-sectional survey was conducted among a representative sample of 1494 nurses working in NHS. A validated questionnaire was developed using a Nominal Group Technique and Delphi Panel with stakeholders, to measure job satisfaction with Likert scales. Inferential statistical analyses, including t-tests and multiple linear regression, examined associations between intention to stay and factors such as job satisfaction, work-life balance, career development opportunities, remuneration, and sociodemographic characteristics. Fixed work schedules, overall job satisfaction, age, satisfaction with work-life balance, and career development emerged as significant predictors of intention to stay. Satisfaction with salary and financial incentives, while low, was not statistically significant. Findings highlight the importance of integrated workforce retention strategies combining organizational improvements, career progression pathways, and work-life balance policies. These findings differ from those observed among physicians in parallel research, confirming the need for profession-specific retention approaches. This study provides new evidence on nurse retention in Portugal, reinforcing the need for human resources policies aligned with European Union priorities on workforce sustainability. Cross-country policy learning and evidence-informed, context-sensitive strategies are crucial for supporting nurse retention and health system resilience.

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.

Socioeconomic inequalities in mortality are large and persistent. While the differential timing and impact of the smoking, alcohol, and obesity epidemics among socioeconomic groups likely influenced past trends in socioeconomic mortality inequalities, the evidence is scarce. We estimated the combined impact of smoking, alcohol, and obesity on past trends in educational inequalities in remaining life expectancy at age 30 (e30) in England and Wales, Finland, and Italy (Turin). To do so, we used long-term timeseries of annual individually-linked mortality data by educational level (low, middle, high), sex, and age (30+). We multiplicatively aggregated estimates of smoking-, alcohol-, and obesity-attributable mortality by educational level to obtain "lifestyle-attributable mortality" (LAM) by educational level. We compared trends in educational inequalities in e30 with and without LAM using segmented regression. We found that smoking-, alcohol-, and obesity-attributable mortality individually contributed 23%, 14%, and 10%, respectively, to the average educational inequality in e30 of 4.4 years in 1992-2017, and 44% combined (males: 51%; females: 34%). LAM contributed 57%, 63%, and 43%, respectively, to the increase in educational inequalities in e30 among Finnish males (1987-2008), Finnish females (1987-2017), and Italian males (1990-2018); tempered the decline in inequalities among British females (1992-2017); and was responsible for the reversal in 2008 from increasing to declining inequalities among Finnish males. Targeting socioeconomic inequalities in smoking, alcohol, and obesity could, thus, substantially reduce socioeconomic inequalities in e30, and the increasing time trends in these inequalities. The observed country differences in the importance of these lifestyle factors demonstrate the need for context-specific strategies.

There have been mixed findings on whether mortality is socially patterned among people with diabetes. We compared all-cause mortality trends by socioeconomic position (SEP) among people with and without diabetes for 2004-21 in four high-income countries. We conducted open cohort studies in Australia, Denmark, the Netherlands, and Scotland and included national or regional populations aged 35-69 years. We used the European standard population in 2013 to calculate age-standardized mortality rates (ASMRs) by calendar year, SEP quintile, diabetes status, and sex. SEP quintiles were defined using standardized disposable household income in Denmark and the Netherlands, and area-based indices in Australia and Scotland. We calculated the age-standardized slope index of inequality and age-adjusted relative index of inequality using Poisson regression as absolute and relative measures of socioeconomic inequality, respectively across the study populations stratified by calendar year, diabetes status, and sex. About 208 011 deaths occurred during 17 million person years (py) of follow-up among 35- to 69-year olds with diabetes, and 1.1 million deaths during 298 million py of follow-up among people without diabetes. ASMRs generally increased with increasing deprivation and varied between 1.3 (95% CI: 1.2-1.4) deaths per 1000 py to 29.4 (95% CI: 26.0-32.8) deaths per 1000 py. We found absolute and relative mortality inequality that increased during the follow-up period among adults without diabetes. Measures of absolute and relative inequality among adults with diabetes widened in some populations by country and sex. To conclude, disparities in mortality by SEP increased during follow-up in most countries. Strategies are needed to reduce excess mortality associated with low SEP and diabetes and related socioeconomic inequality.