Scandinavian Journal of Public Health最新文献

Background: Resignations among general practitioners (GPs) have been cited as a contributing factor to challenges in Norway's GP scheme. Aim: To analyse trends in GP exit rates and examine whether there is evidence of systematic changes in these rates over time. Design and setting: Registry-based observational study of all GPs in Norway since the scheme's implementation in 2001. Method: Exit rates were calculated for the entire study period and by year. Significant deviations were identified using 95% confidence intervals with Bonferroni corrections for multiple hypothesis testing. Results: GP exit rates declined until age 50 years and remained low until retirement at 67. This pattern was stable throughout the study period (2002-2022). Only two significant deviations occurred: higher-than-expected rates for 67-year-olds in 2007 and 41-year-olds in 2010. Conclusions: GP exit rates remained stable over the study period, with no evidence suggesting increased exits as a major factor in the current challenges facing Norway's GP scheme.

Collaborative initiatives like Joint Action PreventNCD are essential in addressing non-communicable diseases (NCDs), which account for over 80% of the disease burden in European Union (EU) countries. By targeting health determinants such as tobacco use, harmful use of alcohol, unhealthy diets, and physical inactivity, while leveraging technology and innovation, the European Union aims to prevent and manage NCDs efficiently. Through sustained investment and collaboration, preventive measures can significantly reduce the NCD burden, promoting healthier lives and reducing pressures on healthcare systems.

Aims: Adolescence is a critical period for mental health development, yet research exploring how contextual factors influence the development of depressive symptoms remains limited. This study explored trajectories of depressive symptoms during early to mid-adolescence and their association with various aspects of school climate.

Methods: The study sample comprised 3671, 7th-grade students (aged 12-13 years) from 101 schools across Sweden, followed longitudinally across three time points spanning grades 7, 8 and 9. Depressive symptom trajectories were identified using latent class growth modelling. The Pedagogical and Social Climate questionnaire assessed school climate, and multinomial logistic regression was employed to predict trajectory membership based on sociodemographic and school climate factors.

Results: Four distinct developmental patterns of depressive symptoms emerged: 'Sustained low symptoms' (76.7%), 'Low-increasing' (10.9%), 'Sustained high symptoms' (7.9%), and 'High-decreasing' (4.5%). Gender, parental education and six specific school climate factors, out of the total 19 examined, significantly distinguished these trajectory classes. Positive teacher expectations and strong principal involvement were associated with more favourable trajectories, whereas teaching activities, teacher support and communication between school and home were associated with less favourable trajectories, suggesting a nuanced understanding of their relationship with depressive symptom trajectories.

Conclusions: Few school factors were found to be relevant to depressive symptoms, highlighting the importance of considering external factors beyond the school environment in supporting adolescents during this developmental stage. Although the findings are multifaceted, it is primarily positive interpersonal relationships, especially through teacher expectations, that stand out as significant factors in promoting youth mental health.

Aims: Psychosomatic complaints are common in youth and are often assumed to indicate stress. Although several studies have confirmed that a cross-sectional association exists, few have empirically investigated whether or not perceived stress influences psychosomatic complaints. The objective of the present study was to build upon previous research by exploring whether changes in perceived stress over time are associated with corresponding changes in psychosomatic complaints. This analytical approach takes unmeasured time-invariant confounding into account, thereby offering more robust evidence for a causal association between the variables under study.

Methods: Data was derived from the Swedish national cohort study Futura01, with information from 2,708 participants aged 17-18 in 2019 and 20-21 in 2022. Perceived stress was measured by Cohen's Perceived Stress Scale. Psychosomatic complaints were measured by questions on the frequency of stomach aches, headaches and difficulties falling asleep, which were added to an index. Information on gender, parental education, and parental country of birth was derived from registries. Linear regression analyses were conducted and the first difference (FD) approach was used.

Results: Perceived stress and psychosomatic complaints exhibited cross-sectional associations at both time points. The FD analyses showed that increases in perceived stress were associated with increases in psychosomatic complaints, and this was the case irrespective of sociodemographic characteristics.

Conclusions: This study provides further empirical support for the assumption that psychosomatic complaints can be partially attributed to stress. Societal efforts aimed at reducing stressors and strengthening coping resources and strategies among young people may help mitigate perceived stress and, consequently, the likelihood of developing psychosomatic complaints.

Aims: This study examined the incidence of attention-deficit/hyperactivity disorder medication among children and adolescents by sex and age group in Finland during 2008-2019.

Methods: The data on children and adolescents aged 6-18 years receiving reimbursement for any attention-deficit/hyperactivity disorder medication was collected from the nationwide register on reimbursed purchases. The incidence was calculated as a ratio of the number of new users and the number of age and sex-matched population at risk. Negative binomial models were used to calculate rate ratios (RRs).

Results: In 2019, the incidence of attention-deficit/hyperactivity disorder medication was 13.4 per 1000 boys and 4.8 per 1000 girls. Among boys, the incidence became 3.7 times greater during the observed years (RR 95% confidence interval (CI) 2.0, 6.5, P<0.0001), whereas in girls it was 7.6 times greater (RR 95% CI 2.1, 27.4, P=0.0019). The boys had 2.8 times the incidence rate compared with the girls (RR 95% CI 2.2, 3.6, P<0.0001). The increase was associated with age only among boys (P=0.0001). The highest incidence rate 23.4 per 1000 individuals (95% CI 22.5, 24.4) was found in 2019 among 6-8-year-old boys.

Conclusions: The incidence of attention-deficit/hyperactivity disorder medication use among children and adolescents increased significantly in Finland during the study period. Incidence was higher among boys, but the increase was greater among girls. The most common group to start attention-deficit/hyperactivity disorder medication was 6-8-year-old boys. These findings warrant critical evaluation of the diagnostic and treatment policies currently available in Finland for the treatment of attention-deficit/hyperactivity disorder and related symptoms.

Aims: The Joint Action project on Cancer and other Non-communicable Diseases (NCDs) prevention, Action on Health Determinants, includes a dedicated workstream on structural and population-level interventions. The overarching objective of this workstream is to strengthen the compliance, coherence, implementation and enforcement of evidence-based regulatory measures that support governmental efforts to reduce the burden of NCDs.

Methods: The workstream adopts a multi-method approach, informed by existing academic literature and previous European studies. Key methodologies include policy mapping, evidence reviews, behavioural assessments, policy impact modelling, and pilot testing. Governmental alcohol and tobacco policies will be evaluated using comparative policy scales, while the health and economic impacts of health taxation policies will be projected through and microsimulation modelling. Nutrient profile modelling and food composition databases will be developed to inform strategies for food reformulation. The effectiveness of labelling interventions will be examined. Tools for monitoring digital marketing exposure will be developed, and the impact of environmental policy impact will be assessed.

Expected results: The workstream is expected to deliver comprehensive policy analyses, demonstrate the potential impact of health taxation, propose harmonized nutrient profiling frameworks, assess the effectiveness of food and alcohol labelling practices and contribute to the development of cross-national structures for public food procurement. Additionally, it will provide guidance on the implementation of effective measures and evaluate divergences in national policy approaches across Europe.

Conclusions: The workstream will generate actionable evidence and documentation to inform and support public policy processes, thereby contributing to reductions in the burden of preventable disease across the region.

Aims: The evaluation of the Joint Action on Cancer and Other Non-Communicable Diseases (JA PreventNCD) is considered a relevant contribution to guiding future public health activities in European countries. It will assess the project outputs and evaluate their contribution to achieving the outcomes of the joint action (JA), as well as their impact at both the European Union (EU) and member state (MS) levels.

Methods: The evaluation, informed by a logic model, assesses project-level outputs as well as outcomes and impacts at the MS and EU levels using mixed-methods approaches. This involves data collection and analysis to address the evaluation questions. Accompanying evaluation approaches will include monitoring selected implementation case studies and examining the influence of contextual factors across diverse settings.

Conclusions: The evaluation will provide essential insights to guide the adaptation and scaling-up of interventions to prevent non-communicable diseases (NCD) across diverse settings and countries. These insights can assist decision-makers in designing and implementing future public health initiatives.

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: Effective non-communicable diseases prevention and risk reduction require a personalised approach tailored to individuals' characteristics. This work package of the Joint Action PreventNCD focuses on prevention at the individual level, providing evidence on the role that genetic susceptibility, as well as behavioural risk factors (such as tobacco use, or physical inactivity) play in prevention, and integrating the outcomes into a holistic approach for the prevention of cancer and other non-communicable diseases. An overview of existing personalised risk-stratified prevention strategies in the area of cancer and major non-communicable diseases will be provided, together with their ethical, legal and social implications. Finally, we will contribute to the development of a health communication framework for the prevention of non-communicable diseases, building on the risk communication strategies used during COVID-19 pandemic period.

Methods: To achieve the aims of this work package, a combination of different methods will be used, spanning from literature reviews, to public engagement activities, to innovative pilot studies covering different genetic and behavioral risk factors driving cancer and some other non-communicable diseases (namely, genetic susceptibility, tobacco and nicotine consumption, and physical inactivity).

Conclusions: The interventions and activities in this work package will provide evidence on how the adoption of prevention strategies based on the concept of 'personalisation' and 'risk stratification' can contribute to alleviating the burden of cancer and non-communicable diseases by targeting the right population with the right intervention.