European Journal of Public Health最新文献

Background: 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, organisational, 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.

Methods: 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.

Results: 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.

Conclusions: 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 organisational contexts. Managers also need to acknowledge the limits of steering boundary work, which thrives on autonomy in daily interactions among professionals.

Background: Physician shortages threaten healthcare system sustainability across Europe. Retaining physicians is critical to maintaining service capacity and quality. Despite its importance, physician retention remains a pressing issue in Europe, including in Portugal, where the Portuguese National Health Service (NHS) continues to face significant retention challenges.

Methods: We conducted a quantitative, observational, cross-sectional study to identify determinants of physician retention in Portugal. A validated survey was developed using a Nominal Group Technique and Delphi Panel with stakeholders. The questionnaire measured job satisfaction with Likert scales. A stratified sampling strategy ensured representation across Portugal's five mainland health regions, yielding 1398 physicians. Data were collected via self-administered electronic questionnaires. Analyses included descriptive statistics, ANOVA, t-tests, and linear regression to assess predictors of retention.

Results: Physicians with longer seniority reported higher intention to remain, with those over 10 years showing the strongest intention (mean = 3.72; SD = 1.05; p < .001). Fixed schedules were linked to higher intended retention than shift work (mean = 3.42 vs. 3.18; p = .015). Job satisfaction was the strongest predictor (β = .267; p < .001), followed by age (β = .222; p < .001), satisfaction with work characteristics (β = .125; p = .002), and career development (β = .097; p = .011). Satisfaction with human resources and work-life balance was not significant.

Conclusions: Physician retention is shaped by seniority, schedule stability, work environment, and career development. Policies fostering supportive environments, predictable schedules, and professional growth are needed to sustain the workforce, to European systems.

Background: The WHO Regional Office for Europe conducted 9 country studies of migration of doctors and nurses. This paper identifies similarities and variations in migratory flows, factors that influence them, and related policy responses.

Methods: The 9 countries include 4 that integrate the European Economic Area (EEA), Ireland, Malta, Norway and Romania, and 5 non-EEA, Albania, Armenia, Georgia, Moldova, Tajikistan. Case writers used a common study template that covered international outflows and inflows, mobility push and pull factors, and related policy interventions. Data sources include the WHO/Europe-OECD- Eurostat and country databases.

Results: Emigration is motivated by low wages, dissatisfaction with working conditions, inadequate practice environment, excessive workloads and lack of opportunities for professional development. Flows for doctors and nurses vary in volume over time, and in countries of origin and destination.Pull factors include the free circulation of persons within the EEA for citizens of member states, easy access to work permits, common or easily learned language, and the presence of a diaspora in a destination country.Policies to improve retention include increasing the number of training places, making remuneration and working conditions more attractive and compulsory service. All countries have some health workforce development plan, but implementation is a challenge everywhere.

Conclusions: Policies should be tailored to country labour market conditions, migration trends, and institutional capacity. Better understanding of migration flows will improve the effectiveness of policy responses.

Background: Health workforce shortages pose a challenge to European health systems. Challenging working conditions in healthcare were intensified by the global financial crisis and the 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 paper 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.

Methods: The paper draws on three forms of data : 1) secondary data from the Australian Department of Home Affairs on visas issued to Irish citizen doctors; 2) open-ended survey responses from hospital doctors working in Ireland (2019, N = 469) and, 3) qualitative interview data from Irish doctors (2018, N = 51) in Australia. Research ethics permission was granted by the host institution.

Results: 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.

Conclusions: This paper shows that Ireland has high rates of outward and inward doctor migration with retention/return not a policy priority. 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, prioritise their wellbeing and promote retention/return.

Background: 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.

Methods: A quantitative, observational, cross-sectional survey was conducted among a representative sample of 1 494 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.

Results: 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 organisational 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.

Conclusion: 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.

Background: Moral Injury is an emerging concept initially studied in the military context, capturing the profound psychological, emotional, and spiritual suffering experienced by individuals who perceive that they have transgressed their deeply held moral or ethical beliefs. In healthcare, Moral Injury occurs when systemic constraints, organizational policies, or professional commitments force healthcare workers (HCWs) to act in ways that dissent from their values. Our study aimed to explore qualitatively the phenomenon of Moral Injury among physicians in healthcare settings in Romania and the Republic of Moldova, focusing on how systemic and organizational factors contribute to their experiences.

Methods: The study employed a qualitative research design. We collected and analysed 17 interviews with doctors from Romania and Republic of Moldova.

Results: We identified four central themes and subsequent sub-themes: Perception and Understanding of Moral Injury; Factors contributing to Moral Injury; Impact on Patient Safety and Quality of Care; Coping Strategies and Emotional Survival Mechanisms.

Conclusion: Our findings suggest that Moral Injury is not the result of isolated events but rather the outcome of persistent exposure to systemic dysfunctions, including coercive hierarchies, politicized leadership, inadequate resources, and the prioritization of economic performance over patient welfare. Physicians described feelings of shame and betrayal when compelled to comply with orders that contradicted their professional ethics.

Waiting times for health care is a significant health policy concern across many health systems, which has been exacerbated by the COVID-19 pandemic. Long waiting times for non-emergency care generate health losses to patients because health benefits are postponed. They can increase the risk of mortality or morbidity and reduce patient ability to benefit from health care. Waiting times can also generate negative spill-over effects on labour market outcomes. For individuals in the working age, employed individuals might end up on sick leave and claim sickness benefits, or experience reduced productivity if they continue to work. Individuals looking for a job may find it harder to find employment or become economically inactive. We conduct a narrative review of the literature on the effect of waiting times on health losses and labour market outcomes. There is growing literature documenting the effect of longer waiting times on labour market outcomes. Although limited, the literature identifies potentially harmful effects in particular when patients are waiting for mental health services and orthopaedic treatment. The findings have implications for prioritization of patients on the list and for allocation of resources within the health sector and across sectors.

There is limited information on changes over time in the incidence, age, sex, and comorbidities of obstructive sleep apnoea. We extracted data from the Finnish Secondary Care Register to assess the incidence of obstructive sleep apnoea, the age and sex distribution, and the prevalence of 26 comorbidities of incident obstructive sleep apnoea patients in Finnish specialized care in 2010 and 2020. Analyses were conducted for three age groups (18 - 39, 40 - 64, and ≥65 years), stratified by sex, and for the total population. From 2010 to 2020, the incidence of clinically diagnosed obstructive sleep apnoea increased from 1.7 to 6.1 per 1000 (from 2.4 to 7.6 per 1000 for men and from 1.0 to 4.6 per 1000 for women). The proportion of the youngest group increased from 11.0% to 12.7% and the oldest group from 20.2% to 27.2%. The largest increase in incidence was observed in the youngest group for both sexes. Among men, the prevalence of six comorbidities decreased, and of eight increased. Among women, the prevalence of seven comorbidities decreased, and of four increased. Obstructive sleep apnoea is being diagnosed increasingly in young adults and those aged 65 years and older. Changes in comorbidities suggest increased recognition and treatment of cardiovascular risk factors and, on the other hand, the ageing of the population. A decrease in some comorbidities suggests that incident obstructive sleep apnoea patients are less morbid despite their increased age.

Understanding local level impact of socio-economic and spatial disparities on health outcomes is crucial for informing effective public health interventions. This study examines the association between socio-economic factors, centrality, and premature mortality-measured as years of life lost (YLLs)-across Norwegian municipalities. We conducted an ecological, cross-sectional registry-based study across municipalities and districts, each with populations exceeding 1000 as of 1 January 2019. Data on mortality, demographics, education, income, and centrality were sourced from Statistics Norway. All-cause YLLs were calculated by multiplying age-specific mortality numbers by aspirational life expectancy from the Global Burden of Disease 2019 life tables. Municipalities were divided into quartiles based on a composite socio-economic position (SEP) score that integrated education and income, and grouped into centrality categories. Mixed-effects negative binomial regression models, crude and adjusted for age categories and sex, evaluated both relative and absolute associations. The lowest SEP quartile, assessed with a composite SEP score, had a 15% higher YLL rate compared to the highest quartile [incidence rate ratio (IRR) = 1.15; 95% confidence interval (CI) = 1.07-1.24], amounting to an absolute difference of 2127 YLLs per 100 000 population. Similarly, the least central quartile exhibited a 15% higher YLL rate compared to the most central one (IRR = 1.15; 95% CI = 1.09-1.21), translating to an absolute difference of 2057 YLLs per 100 000 population. There are substantial inequalities in premature mortality across Norwegian municipalities, strongly linked to municipal SEP and centrality.