European Journal of Public Health

Journal Information
ISSN / EISSN: 11011262 / 1464360X
Total articles ≅ 22,062

Latest articles in this journal

, Tobias Viere, Kevin Helms, Wolf Rogowski
Published: 26 November 2022
European Journal of Public Health; https://doi.org/10.1093/eurpub/ckac174

Abstract:
Background: Replacing single-use products with reusable ones may reduce the environmental impact of healthcare. This study aimed to broadly assess the environmental effects of that substitution. Methods: A systematic review of comparative cradle-to-grave life-cycle assessments (LCAs) of single-use and reusable healthcare products was conducted. The main outcomes assessed were changes in the environmental impact that resulted after switching from single-use to reusable products. As no standardized transparency checklist was available, one was developed here using DIN ISO 14040/14044. The final checklist included 22 criteria used to appraise the included studies. Results: After screening, 27 studies were included in the analysis. The healthcare products were assigned to four categories: invasive medical devices, non-invasive medical devices, protection equipment and inhalers. The outcomes revealed a reduction in mean effect sizes for all environmental impacts except water use. Non-invasive medical devices have greater relative mitigation potential than invasive devices. On average, information on 64% of the transparency checklist items was reported. Gaps included the reporting of data quality requirements. Conclusions: Switching to reusable healthcare products is likely to reduce most impacts on the environment except water use, but the effect size differs among product categories. Possible study limitations include location bias, no systematic search of the grey literature and small samples for some impacts. This study’s strengths are its approach to product categories and developed transparency catalogue. This catalogue could be useful to inform and guide a future process towards creating a standardized transparency checklist for the systematic reviews of LCAs.
Published: 18 November 2022
European Journal of Public Health; https://doi.org/10.1093/eurpub/ckac154

Abstract:
Background: COVID-19 has highlighted the importance of preparedness and response systems when faced with a pandemic. The rapid spread of the disease throughout Europe raised questions about the capacity of the European Union (EU) and its Member States to combat serious cross-border threats to health. This article provides an overview of institutional arrangements for pandemic preparedness before the COVID-19 pandemic and outlines the changes proposed by the European Health Union (EHU) framework. Methods: A systematic review of relevant EU law, EU policy documents and the scientific literature was conducted. EUR-lex, PubMed, Web of Science core collection and Google Scholar databases were searched for relevant records published after the year 2000. The proposed new regulatory framework was extracted from the EHU legislative package. The results were organized according to the Public Health Emergency Preparedness Logic Model. Results: The main EU bodies involved in preparedness and response are the European Centre for Disease Prevention and Control (ECDC), the European Commission and the Health Security Committee (HSC). The proposed changes of the EHU focus on strengthening the auditing capabilities of the ECDC, increasing the scope of EU action in managing medical countermeasures, and further formalizing the HSC. Conclusions: The proposal takes bold steps to address technical and political issues of preparedness and response; whereas, on the latter point, it is likely that amendments to the proposal will not address long-standing challenges in preparing for and coordinating national responses to a future EU-wide pandemic.
Katie Duffy, , Anne Nolan, Bertrand Maître
Published: 15 November 2022
European Journal of Public Health; https://doi.org/10.1093/eurpub/ckac167

Abstract:
Background: While perinatal mortality rates have decreased in Ireland in recent years, it is not known if this reduction was shared equally among all groups. The aim of this study is to examine inequalities in perinatal mortality by country of birth and socio-economic group in Ireland between 2004 and 2019. Methods: Data for the analysis was obtained from the National Perinatal Reporting System dataset, which includes all births (including stillbirths) in Ireland. The rate and risk ratios for perinatal death were calculated for mothers’ socio-economic group and country of birth for two time periods (2004–11 and 2012–19). Adjustment was made for mothers’ age, marital status, parity and country of birth/socio-economic group. A total of 995 154 births and 5710 perinatal deaths were included in the analysis. Results: With the exception of African born mothers, the perinatal mortality rate decreased for all groups over time; however, inequalities persisted. Relative to Irish born mothers, the risk for African born mothers increased from 1.63 to 2.00 over time. Adjusting for other variables including socio-economic status reduced but did not eliminate this elevated relative risk. Mothers who were classified as unemployed or engaged in home duties had a higher risk of a perinatal death relative to higher professional mothers, with the relative risk remaining relatively constant over time. Conclusions: Reducing inequalities in health is a key objective of the Irish government. Further research is required to identify why perinatal mortality continues to be higher in some groups so that targeted action can be implemented.
, , Mikael Rostila
Published: 15 November 2022
European Journal of Public Health; https://doi.org/10.1093/eurpub/ckac158

Abstract:
Background: Native–immigrant intermarriage is often regarded as a proxy for integration, given that intermarried immigrants are more socioeconomically and culturally similar to natives than intramarried immigrants. This study aimed to assess whether integration affects mental health and care-seeking behaviours, examining prescription hazards for psychotropic medications by native–immigrant marital composition in Sweden. Methods: Total population register data were used to identify first-time married couples residing in Sweden between 31 December 2005 and 31 December 2016. Index persons were distinguished by gender and partners’ origin (native vs. immigrant), as well as by immigrants’ regions of origin, with intramarried natives as references. Using Cox regression, hazard ratios (HRs) with 95% confidence intervals (95% CIs) were calculated for antidepressant and anxiolytic prescriptions and adjusted for socioeconomic factors, presence of children and length and quality of marriage. Results: Intramarried immigrant women had higher psychotropic prescription hazards than intramarried native references (HR 1.11, 95% CI 1.10–1.12), whereas intermarried immigrant women had equal hazards. Immigrant women’s hazards were lower than native references after adjustment. Intramarried immigrant men had the greatest prescription hazards (HR 1.33, 95% CI 1.32–1.34), and intermarried immigrant men slightly higher hazards (HR 1.11, 95% CI 1.10–1.13), than intramarried natives. All were partly attenuated after adjustment. Intermarriage hazards increased by similarities in regions of origin, especially among men. Conclusions: Integration indicated by intermarriage appears to be protective for the mental health of immigrants, especially for immigrant men. Future research should empirically disentangle the social, cultural and socioeconomic mechanisms underlying these health differences.
, Francesco Donato, , Filip Andersson, Yvonne Forsell,
European Journal of Public Health; https://doi.org/10.1093/eurpub/ckac155

Abstract:
Background: The aim of the present study was to compare the cross-sectional association between smoking and depressive symptoms among adolescents between Sweden and Italy, two countries historically characterized by different norms about tobacco use and different tobacco control efforts. Methods: A cross-sectional study including 3283 adolescents 15–16 years of age participating in the Swedish KUPOL study and 1947 same-age adolescents from the Italian BE-TEEN study. Current smoking was defined as any smoking in the past 30 days. Depressive symptoms were assessed using the Centre for Epidemiological Studies Depression Scale for Children (CES-DC) and the internalizing score of the Strengths and Difficulties Questionnaire (SDQ). Country differences were explored in stratified and interaction analyses. Results: Current smoking was associated with a 2- to 3-fold increased odds of depressive symptoms among Swedish adolescents using both CES-DC and SDQ internalizing scale. Among Italian adolescents, slightly lower increased odds of 1.5–2.5 for depressive symptoms with smoking were found using the CES-DC but not the SDQ scale. Both multiplicative and additive interactions for country were significant. The association between smoking and depressive symptoms was weaker among Italian compared with Swedish adolescents for both scores. Conclusions: Countries with different tobacco norms and control show different associations between smoking and depressive symptoms in adolescence, probably due to different psychosocial profiles of smokers. These findings need to be considered when planning tobacco prevention programmes, e.g. by focusing on early detection of mental health distress among adolescents in settings with declining smoking prevalence and restrictive tobacco control environments.
, Csilla Busa, Éva Pozsgai, Veronika Osztromok-Lukacs, Agnes Csikós, Lukas Radbruch, Jeroen Hasselaar, Johan Menten, Sheila Payne, Claudio Adile, et al.
European Journal of Public Health; https://doi.org/10.1093/eurpub/ckac153

Abstract:
Background: Palliative sedation is a commonly accepted medical practice. This study aims to clarify how palliative sedation is regulated in various countries and whether this may impact its practice. Methods: An online survey requesting regulations on palliative sedation was conducted in Belgium, Germany, Hungary, Italy, The Netherlands, Spain, Romania and the UK. Purposive sampling strategy was used to identify clinicians from different medical fields and legal experts for each country. Regulations were analyzed using the principles of the European Association for Palliative Care Framework on palliative sedation. Country reports describing how palliative sedation is regulated were elaborated. Results: One hundred and thirty-nine out of 223 (62%) participants identified 31 laws and other regulations affecting palliative sedation. In Spain, 12 regional laws recognize palliative sedation as a right of the patient at the end of life when there are refractory symptoms. In Italy, the law of informed consent and advance directives specifically recognizes the doctor can use deep sedation when there are refractory symptoms. There are also general medical laws that, while not explicitly referring to palliative sedation, regulate sedation-related principles: the obligation of doctors to honour advance directives, informed consent, the decision-making process and the obligation to document the whole process. In Germany, the Netherlands and the UK, palliative sedation is also regulated through professional guidelines that are binding as good practice with legal significance. Conclusions: Palliative sedation is considered in the general law of medical practice, in laws regarding the patient’s autonomy, and through professional guidelines.
, J Marieke Buil, Susanne Koot, Frank J van Lenthe, Tanja A J Houweling, , Hans M Koot, Pol A C Van Lier
European Journal of Public Health; https://doi.org/10.1093/eurpub/ckac143

Abstract:
Children of lower-educated parents and children in schools with a relatively high percentage of peers with lower-educated parents (lower parental education schools) are more likely to develop emotional and behavioural problems compared to children in higher-educated households and schools. Universal school-based preventive interventions, such as the Good Behaviour Game (GBG), are generally effective in preventing the development of emotional and behavioural problems, but information about potential moderators is limited. This study examined whether the effectiveness of the GBG in preventing emotional and behavioural problems differs between children in lower- and higher-educated households and schools. Using a longitudinal multi-level randomized controlled trial design, 731 children (Mage=6.02 towards the end of kindergarten) from 31 mainstream schools (intervention arm: 21 schools, 484 children; control arm: 10 schools, 247 children) were followed annually from kindergarten to second grade (2004–2006). The GBG was implemented in first and second grades. Overall, the GBG prevented the development of emotional and behavioural problems. However, for emotional problems, the GBG-effect was slightly more pronounced in higher parental education schools than in lower parental education schools (Bhigher parental education schools =−0.281, P <0.001; Blower parental education schools =−0.140, P= 0.016). No moderation by household-level parental education was found. Studies into universal school-based preventive interventions, and in particular the GBG, should consider and incorporate school-level factors when studying the effectiveness of such interventions. More attention should be directed towards factors that may influence universal prevention effectiveness, particularly in lower parental education schools.
Daniele Mipatrini, Chiara Montaldo, Barbara Bartolini, Giovanni Rezza, Sergio Iavicoli, , Alimuddin Zumla, Eskild Petersen
European Journal of Public Health; https://doi.org/10.1093/eurpub/ckac151

Abstract:
As the coronavirus disease 2019 (COVID-19) pandemic illustrates, current global public health systems are inadequately prepared for preventing zoonotic emerging infectious diseases (EIDs) threats. The WHO, in 2018, has included the ‘PathogenX’, in the list of priority pathogens with the potential to threaten global health security. PathogenX may be any type of microorganism and, although most of the 400 emerging pathogens are bacteria, experts believe that the next is likely to be a virus. 1
, Miyu Niwa, Sarah Bolongaita
European Journal of Public Health; https://doi.org/10.1093/eurpub/ckac134

Abstract:
Background: Similar to the study of the distribution of income within countries, population-level health disparities can be examined by analyzing the distribution of age at death. Methods: We sourced period-specific death counts for 18 OECD countries over 1900–2020 from the Human Mortality Database. We studied the evolution of country-year-specific distributions of age at death, with an examination of the lower and upper tails of these distributions. For each country-year, we extracted the 1st, 5th, 10th, 90th, 95th and 99th percentiles of the age-at-death distribution. We then computed the corresponding shares of longevity—the sum of the ages weighted by the age-at-death distribution as a fraction of the sum of the ages weighted by the distribution—for each percentile. For example, for the 10th percentile, this would correspond to how much longevity accrues to the bottom 10% of the age-at-death distribution in a given country-year. Results: We expose a characterization of the age-at-death distribution across populations with a focus on the lower and upper tails of the distribution. Our metrics, specifically the gap measures in age and share across the 10th and 90th percentiles of the distribution, enable a systematic comparison of national performances, which yields information supplementary to the cross-country differences commonly pointed by traditional indicators of life expectancy and coefficient of variation. Conclusions: Examining the tails of age-at-death distributions can help characterize the comparative situations of the better- and worse-off individuals across nations, similarly to depictions of income distributions in economics.
, Eirik Degerud,
European Journal of Public Health; https://doi.org/10.1093/eurpub/ckac149

Abstract:
Background: Work–life interference has been associated with adverse health outcomes. Here, we quantify the association between work–life interference and subsequent sick leave. Methods: Respondents from a randomly drawn cohort of the general working Norwegian population were interviewed in 2009, 2013 and/or 2016. Mixed-effects logistic regression models were used to assess prospective associations of self-reported work–life interference and risk of subsequent physician-certified sick leave of 1–16 days (low-level) and >16 days (high-level) in strata of men and women. To quantify the importance of work–life interference as risk factors for sick leave, we estimated the population attributable risk (PAR). Results: Both low- and high-level sick leave were most prevalent among women while the prevalence of work–life interference was similar between sexes. Risk of sick leave was higher among women reporting work–life interference sometimes or often in comparison with seldom or never {low- and high-level sick leave odds ratio (OR) = 1.21 [95% confidence interval (CI) = 1.07–1.37] and 1.30 (95% CI = 1.14–1.49), respectively}. The associations for high-level sick leave progressively increased with the level of work–life interference [highest OR = 1.44 (95% CI = 1.19–1.75)]. In men, there was no consistent higher risk of sick leave according to more frequent work–life interference [low- and high-level sick leave OR = 1.00 (95% CI = 0.87–1.14) and 0.98 (95% CI = 0.84–1.16), respectively], but the risk of high-level sick leave tended to be higher among men reporting work–life interference often (OR = 1.21, 95% CI = 0.98–1.50). Estimating PAR, 6.69% (95% CI = 1.52–11.74) of low-level and 9.94% (95% CI = 4.22–15.45) of high-level sick leave could be attributed to work–life interference among women. Conclusions: Self-reported work–life interference was associated with a higher risk of sick leave, with the most consistent results among women.
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