Scandinavian Journal of Public Health最新文献

Aims: Personalised medicine in chronic complex diseases such as rheumatoid arthritis (RA) is within reach but requires international multi-stakeholder collaboration. We exemplify how national implementations of the General Data Protection Regulation (GDPR) have introduced administrative delays and created disincentives for data sharing and collaborative research.

Methods: Our Danish/Swedish/Norwegian research collaboration (the 3-year NordForsk-funded "NORA" project) aims to develop a personalised medicine approach for the management of RA, built on the exploitation of unique existing data sources: longitudinal data from clinical rheumatology registries, research cohorts, nationwide health care registries, and biobank material from >20 sample collections. Data and results are shared and accessed remotely by collaborators at secure servers. New biomarker assays and patient-centric implementations of the results are to be explored, validated, and disseminated to patients and health care via the development of digital tools.

Results: Following the advice of legal experts at the involved academic or public institutions and private companies, GDPR compliance resulted in >20 legal documents to govern the collaboration (consortium-, joint controller-, research collaboration-, data sharing-, and a series of unique two-way data processing-, and material transfer agreements). Lack of agreed-upon templates, policies, procedures, and a shortage of legal resources have caused considerable delays. Thus, our research consortium has spent more time ensuring GDPR compliance than on actual research activities.

Conclusions: The current interpretation and implementation of the legal premises (rather than the GDPR per se) for research collaborations caused unnecessary barriers and delays. Our experiences call for Nordic trust-based code-of-conduct-like framework agreements, and for harmonisation of procedures and templates, lest the Nordic advantage in research be lost.

Objective: This study examined the geographical variations in quality-adjusted life expectancy (QALE) in the North Denmark Region.

Methods: QALE was used to measure health expectancy within each municipality of the North Denmark Region. Measures of health-related quality of life (HRQoL) were obtained from a representative sample of 19,598 responses to the EQ-5D-5L questionnaire in the 2021 regional health survey. Abridged periodic life tables were constructed using mortality data from Statistics Denmark stratified by age, sex, and municipality. The stepwise replacement algorithm developed by Andreev et al. was applied to decompose QALE into its mortality and HRQoL components and investigate the main drivers of the QALE variations between municipalities.

Results: The regional average QALE at 16 years of age was 52.6 quality-adjusted life years (QALYs) (95% CI: 52.1-53.0) for men and 53.1 QALYs (95% CI: 52.7-53.5) for women. No statistically significant variations in QALE were found between municipalities. Comparing the highest and lowest scoring municipalities for males, Rebild had 54.5 QALY (95% CI: 51.7-57.2) while Hjørring had 51.9 QALY (95% CI: 49.9-54.1), showing a variation of 2.57 QALE driven by higher HRQoL scores and lower mortality rates. For females, Rebild had 54.3 QALY (95% CI: 52.1-56.5) and Vesthimmerland had 51.3 QALY (95% CI: 49.1-53.4), showing a variation of 3.03 QALE, mostly driven by increased HRQoL scores and to some extent lower mortality rates.

Conclusions: Variations in QALE, although not statistically significant, existed between the municipalities in the North Denmark Region. Further research should explore the reasons for these variations to inspire future policy development.

Aims: The aim of this study was to explore the association between preschool-level socio-economic deprivation and emotional and behavioural problems among preschool children in Sweden using a multilevel approach.

Methods: In this cross-sectional study, we used data on 2267 children whose parents and preschool teachers had responded to items measuring individual-level socio-economic deprivation and the Strengths and Difficulties Questionnaire (SDQ) for assessment of emotional and behavioural problems. Further, the Socioeconomic Structure Compensation Index (SSCI), collected from Uppsala municipality, was used to assess preschool-level socio-economic deprivation. Unadjusted and adjusted multilevel logistic regression models were used to explore the relations between preschool-level socio-economic deprivation and emotional and behavioural problems.

Results: In unadjusted models, children who attended preschools classified as highly deprived had elevated odds for emotional symptoms (odds ratio (OR) 1.71) as rated by parents. However, this association did not remain significant after adjusting for individual-level socio-economic deprivation factors. In both unadjusted and adjusted models, children who attended preschools classified as moderately deprived had elevated odds for peer-relationship problems as rated by parents (OR 1.63; adjusted OR 1.48). There were no significant associations between preschool deprivation and emotional and behavioural problems as rated by preschool teachers.

Conclusions: Swedish preschools may have a compensatory capacity in addressing children's emotional and behavioural problems, whereas preschool-level deprivation remained significantly associated with peer-relationship problems after controlling for individual-level socio-economic deprivation factors. This implies that peer-relationship problems in deprived preschools need to be addressed in a broader community context.

Background: A large part of the Swedish population is exposed to higher levels of air pollution than the health-centered air quality guidelines recommended by the World Health Organization (WHO).

Aim: The aim of the study was to illustrate the potential health benefits of cleaner air in Sweden by conducting a comprehensive health impact assessment, using a population sample of 100,000 individuals representing the country's demographics.

Methods: Exposure-response functions for various health outcomes were derived from epidemiological literature, mainly from systematic reviews and low-exposure settings. Two hypothetical scenarios were studied: a 1 µg/m³ decrease in particulate matter with an aerodynamic diameter <2.5µm (PM_2.5) and nitrogen dioxide (NO₂), and a reduction in PM_2.5 or NO₂ from average exposure corresponding to Sweden's Clean Air objectives to WHO's air quality guidelines.

Results: The findings demonstrated that even a modest decrease in air pollution concentrations can yield significant health benefits. For example, reducing PM_2.5 by 1 µg/m³ was projected to correspond to a 1% to 2% decrease in mortality, a 2% reduction in myocardial infarction cases, a 4% decrease in stroke incidence, a 2% decline in chronic obstructive pulmonary disease, and a 1% decreases in lung cancer and type 2 diabetes annually. Moreover, this reduction is estimated to lower childhood asthma cases, incidences of hypertension during pregnancy, and premature births by 3%, 3% and 2%, respectively, each year.

Conclusions: The results highlighted that even minor enhancements in air quality would lead to substantial improvements in public health.

Aim: In the context of mortality, heart failure (HF) represents an intermediate factor and should not be used to describe underlying cause of death (UCoD). We explored the potential educational gradients in use of HF to describe UCoD using national data spanning more than 30 years from Norway.

Methods: Using a cross-sectional design, we linked data from the Cause of Death Registry and the National Education Database. Logistic regression models were used to analyze the association between highest attained education and the odds of HF being listed as the UCoD: odds ratios (ORs) and corresponding 95% confidence intervals (CIs) are reported.

Results: HF was listed as UCoD in 46,331 (3.7%) of 1,254,249 deaths analyzed. Compared to primary education, secondary and tertiary education were associated with 10% (OR = 0.90, 95% CI: 0.88-0.92) and 17% (OR = 0.83, 95% CI: 0.80-0.86) lower odds of HF incorrectly listed as UCoD, respectively. We observed no significant differences for the association between education and study outcomes between men and women and across place of death categories. However, educational gradients were greater among younger compared to older individuals (p_interaction, = 0.002). Similar educational gradients were observed in the analyses restricted to cardiovascular deaths (OR = 0.93; 95% CI: 0.91-0.94 for secondary vs. primary education, and OR = 0.91; 95% CI: 0.88-0.95 for tertiary vs. primary education).

Conclusions: Education was inversely associated with the use of HF to incorrectly describe UCoD. Addressing the observed educational gradients, would improve the quality of mortality data and allow for less biased descriptions of cause-specific mortality.

Aims: In Nordic countries, the influx of immigrant doctors and nurses has been increasing since 2005, however retention remains a challenge. The aims of this scoping review were to examine the facilitators and barriers to the retention of immigrant doctors and nurses in the Nordic countries in order to inform future studies and interventions.

Method: A scoping review of peer-reviewed studies focusing on the retention of immigrant doctors and nurses in the Nordic countries was conducted using the framework developed by Arksey and O'Malley. In total, 37 studies were included. The analysis entailed both a numerical analysis to provide a descriptive view of frequencies and a thematic analysis utilising Pierre Bourdieu's concepts of field, capital, habitus and doxa.

Results: Facilitators for retaining immigrant doctors and nurses encompassed a sense of belonging, support from management and peers, collegiality, acknowledgement of diverse cultural competencies and the establishment of relevant professional networks. Barriers included unfamiliarity with local healthcare systems, discrimination, inadequate support in entry-level positions, poor psychosocial work environments, and limited professional networks. Few studies focused on the facilitators for retaining immigrant doctors or nurses, few examined the social and economic costs of immigration, and hardly any addressed the processes related to licencing, authorisation and accreditation.

Conclusions: The majority of the included studies framed immigrant doctors and nurses as challenges to management or the medical labour market. The findings indicated a need for a more comprehensive and inclusive approach to health workforce management across the Nordic countries to accommodate the increasingly diverse workforce in terms of international migratory backgrounds.

The aim of this paper is to argue for the need to bridge the discourses of health promotion and social sustainability as an important step toward healthy community development. By building on theories and empirical knowledge from both disciplines, we advocate for the field of health promotion to take a more assertive role within the social sustainability discourse because the theoretical and empirical knowledge from health promotion research is needed. Likewise, we argue that the strong emphasis on social justice and contextual community factors within the social sustainability discourse could contribute to developing the health promotion discourse. Furthermore, we suggest that place-based methods and analyses used in current health promotion research could serve as tools to better integrate knowledge on both physical and social dimensions, thereby enhancing inter-disciplinary collaboration to develop socially sustainable communities.

Objective: Social inequality in life expectancy (LE) and various indicators of health expectancy have received much attention. Mental health expectancy (MHE) has received less attention, although research has shown an increasing prevalence of poor mental health. We aimed to investigate educational differentials in LE in relation to good, moderate, and poor mental health.

Methods: Nationwide registry data on education and mortality were linked and combined with data from the Danish National Health Survey for 2017 and 2021 on mental health and education. The sample group consisted of data on Danes aged 30 and over. MHE was estimated by Sullivan's method.

Results: From 2017 to 2021, a general decline in the MHE of Danes was observed. Furthermore, the educational inequality in MHE remained substantial between genders, and was larger than the inequality in LE. Changes in MHE differed across educational groups. For Danes with short education, good MHE tended to increase for men, while the increase was statistically significant among women.

Conclusions: MHE is associated with educational attainment. Despite the observed changes in educational differential, substantial inequality persists, raising important questions about the underlying causes of social disparity in MHE.

Aims: The transition from adolescence to young adulthood, often referred to as 'emerging adulthood', is a challenging period in life, and mental health problems are common. Although a large number of studies have shown that social support is linked with fewer mental health problems, few longitudinal studies have examined these associations during this life phase. The aim of the current study was to examine the associations between perceived social support from different sources - family, friends and significant other - at age 17-18 and symptoms of depression and anxiety at age 20-21.

Methods: Data were obtained from the cohort study Futura01 based on a Swedish national sample of adolescents attending grade 9 in 2016/2017. We used survey information from 2019 (age 17-18) and 2022 (age 20-21) and linked registry information (N=2722). Symptoms of depression and anxiety were measured by the Patient Health Questionnaire-4 (PHQ-4) at age 20-21. Perceived social support was measured by the Multidimensional Scale of Perceived Social Support (MSPSS) at age 17-18. Control variables included sociodemographic characteristics and indicators of mental health problems at age 17-18. Binary logistic regressions were performed.

Results: When mutually adjusting for all sources of perceived social support, family support at age 17-18 had inverse associations with symptoms of both depression and anxiety at age 20-21. Perceived support from friends was associated with subsequent symptoms of anxiety only.

Conclusions: Perceived social support can be a protective factor against mental health problems in emerging adulthood. The family serves a particularly important source of social support.

Aims: Among international immigrants, health changes by duration of residence are commonly interpreted as an expression of acculturation to the receiving country context. This study compares changes in immigrants' health risk behaviors by duration of residence to changes by acculturation levels, in order to assess whether duration of residence can be regarded as a proxy for acculturation.

Methods: Using data from a previous systematic review, we identified 17 quantitative studies examining changes in alcohol, tobacco and drug use, physical inactivity, and diet by both duration of residence and acculturation level in the same population. We compared the directionality and consistency of these associations through tabulation and vote counting.

Results: The majority of studies reported no or inconsistent changes in health risk behaviors by duration of residence versus by acculturation, including with opposite directionality. Four studies reported significant estimates with consistent directionality, while five reported consistent, non-significant estimates.

Conclusions: Our findings suggest that duration of residence should not be used as a proxy for acculturation when studying health risk behaviors among immigrants. Researchers should consider additional time-dependent factors to explain behavioral changes by duration of residence.