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.

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.

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.

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.

To describe the pattern of contacts with the healthcare system associated with drug use in Spain in the years 2022 and 2023. For the period 2016-23, data derived from a registry of activity in specialized care, included in the clinical-administrative database of Spanish hospitals (Registro de Atención Especializada-Conjunto Mínimo Básico de Datos), were extracted. Contacts with the healthcare system associated with alcohol, cannabis, cocaine, morphine derivatives, and sedative-hypnotics use were analyzed. The methodology of endemic corridors was applied for each drug category based on data from 2016-21. The series of contacts in 2022 and 2023 were then represented in the corridors to compare their expected and observed pattern. A total of 193 433 contacts associated with the use of alcohol (90 735), cannabis (39 730), cocaine (23 485), morphine derivatives (4888), and sedative-hypnotics (34 595) were analyzed for the period 2016-23. Of the contacts, 70.3% corresponded to men and 23.4% corresponded to people aged 45-54. The number of contacts increased for all categories of drugs in 2022 and 2023. This increase was reflected in the corridors, where contacts were mainly located in alert zones, and sometimes in epidemic zones. The results of this study show that endemic corridors allow the surveillance of the pattern of contacts with the healthcare system associated with drug use and, indirectly, of drug use itself. This methodology should be further studied as a complement in epidemiological surveillance of addictive behaviors at a population level.

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.

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.

Prior research on the relationship between health risk behaviours (HRBs), obesity, and gambling has primarily focused on problem gambling, while studies focusing on lower severity levels are scarce. Moreover, this relationship has rarely been analysed separately for women and men. This study aimed to investigate the association between HRBs, obesity, and the full spectrum of gambling severity in women and men. Cross-sectional population-based data from Healthy Finland Survey 2022-23 was exploited, including adults aged 20+ years (n = 28 154, response rate 46%, mean age 52 years). The Problem Gambling Severity Index (PGSI) was used as the dependent variable, both in continuous (score 0-27) and categorical (non-problem, low-risk, moderate-risk, and problem gambling) form. Independent variables included HRBs (daily smoking, excessive drinking, low fruit and vegetable (F & V) consumption, low physical activity, and insufficient sleep) and obesity. Sociodemographic factors, suboptimal self-rated health, and psychological distress were adjusted for. Daily smoking, excessive drinking, low F & V consumption, and insufficient sleep were less prevalent in the non-problem gambling category (PGSI score = 0) compared to the low-risk (score 1-2), moderate-risk (score 3-7), and problem gambling (score ≥8) categories. After adjusting for potential confounding variables, all HRBs and obesity, except for physical inactivity, were significantly associated with higher PGSI scores. These findings highlight the need for public health strategies that address gambling across the entire risk spectrum. Moreover, a holistic approach that considers the individual's broader life context could strengthen both research and prevention efforts.

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.

The invasion of Ukraine by the Russian Federation on 24 February 2022 displaced millions. While the European Union's Temporary Protection Directive aims to facilitate the right to healthcare for Ukrainian citizens staying in European Union Member States, health systems were already heavily burdened. Ensuring efficient and accessible care for refugees requires insights into individual and context-specific barriers to and facilitators of uptake of health services. In depth interviews were conducted between May 2022 and September 2023 in five countries receiving refugees from Ukraine. Interview guides and rapid analysis procedures followed a modified capability, opportunity, motivation-behaviour (COM-B) framework. Language was a cross-cutting issue touching all COM-B factors. Mental health services use was characterized by specific barriers and drivers across COM-B factors. Additional barriers include health literacy, long wait times for appointments, and lack of sufficient focus on the most vulnerable groups. Drivers include peer and community support, perceived high quality of care and trust in health workers. Successful navigation of new health systems depends on strong health literacy, availability of actionable information, additional support for the most vulnerable and support for health workers. Study insights can inform revisions to health services being offered to refugees from Ukraine and provide considerations for future refugee health crises in any location.

Adolescence is a life stage characterized by physical, social, and emotional changes including a shift towards peer orientation and an explorative approach to substance use. Previously, we identified distinct adolescent substance use patterns. Here we characterized adolescents with distinct patterns of substance use and tested whether patterns were associated with acute outcomes. Data from the Danish National Youth Cohort 2014, comprising 68 301 participants aged 15-19 years attending upper secondary education, were used. Previously identified substance use patterns were Alcohol Only (48.8%), Frequent Binge Drinking (23.3%), Experimental Use (16.3%), and Early Multiple Use (11.6%). Adolescents with distinct substance use patterns were characterized by adverse childhood experiences, social networks, parental support, and mental health. Associations between patterns and the risk of unintentional injury, violence, and mortality were assessed over an 8.2-year follow-up period. An accumulation of adverse childhood experiences, lack of parental support and poor mental health were observed in adolescents with most substance use. Substance use patterns were associated with the risk of unintentional injury, violence, and mortality in a dose-dependent manner. For instance, compared to Alcohol Only, hazard ratios (95% CI) for severe unintentional injury were 1.25 (1.08-1.44), 1.40 (1.17-1.66), 1.50 (1.25-1.79) for adolescents with Frequent Binge Drinking, Experimental Use, and Early Multiple Use. Adolescent substance use patterns were associated with short- and long-term risks of acute health outcomes. Additionally, disadvantages cluster in adolescents with more substance use, highlighting the aggregation and potential interaction of challenges faced by vulnerable subgroups that extend into adulthood.

People with multiple sclerosis (MS) need to receive health and social care services from a diverse range of provider organizations, which carries risks such as disjointed care, discontinuities, and duplication. Many innovation programmes aim to provide better integrated and person-centred care (IPCC) for people with chronic conditions, including MS. Measuring patient experience is essential to evaluate interventions meant to shift the service model towards coordinated and personalized care. These transformations are central to global strategies for addressing the needs of ageing populations. AISM-Italian MS Association adapted an 8-item questionnaire, ICES-MS, from a set of questions originally designed for chronic patients in general. A total of 1602 persons with MS living in Italy completed the ICES-MS as a part of a broader survey that included other validated questionnaires on disability (Self-EDSS) and quality of life (EQ-5D-3L and EQ-VAS). Participants' responses were also linked with data from a previous AISM survey on 169 Italian Clinical Centres. Structural, construct, criterion, and known-groups validity of ICES-MS were evaluated. The ICES-MS scale is a robust unidimensional measure of patient experience of IPCC in MS, with strong internal consistency and appropriate convergent validity with EQ-5D-3L and EQ-VAS. ICES-MS scores varied as expected by participants' age and disability level. ICES-MS is a valid, succinct scale to measure patient experience of IPCC care in MS in Italy, and its original design suggests value in exploring its use in other chronic conditions and different countries.

Adolescent healthy behaviours may improve cardiometabolic health in adulthood differently across socioeconomic groups. We aimed to quantify the effects of adolescent healthy behaviours on multiple biomarkers of adult cardiometabolic health by socioeconomic backgrounds. We used a population-based cohort of Finnish adolescents from the Young Finns Study (1980-89, n = 2984) followed into adulthood (2001-11). Healthy behaviours (no smoking, no alcohol consumption, sufficient physical activity, daily fruit and vegetable consumption) and socioeconomic backgrounds (parental- and neighbourhood-related) were measured in adolescence (12-18 years). Biomarkers of adiposity [waist circumference, body mass index (BMI)], cardiovascular [blood pressure (BP), cholesterol, apolipoprotein B], and metabolic [plasma glucose, insulin resistance] outcomes were measured in adulthood (33-40 years). We estimated conditional average effects of healthy behaviours via inverse-probability-weighted marginal structural models. Sufficient physical activity lowered adiposity biomarkers to a greater extent among adolescents from disadvantaged neighbourhood, with additional decreases of 2.2 cm [95% confidence interval (CI): -0.1 to 4.7] in waist circumference and 1 kg/m2 (95% CI: 0.2 to 1.9) in BMI. In contrast, daily fruit and vegetable consumption lowered BP with additional 2.0-3.6 mmHg (95% CI: 0.3 to 6.1) among adolescents with advantaged either parental or neighbourhood socioeconomic backgrounds. There was little evidence for differential effects on other outcomes and for no smoking and alcohol. Socioeconomic backgrounds modified the effects of adolescent physical activity and fruit and vegetable consumption on adult cardiometabolic health. These findings indicate that population-wide interventions promoting healthy behaviours during adolescence have the potential to either mitigate or exacerbate long-term socioeconomic inequalities in cardiometabolic health.

Smoking remains a leading cause of preventable illness and death in the United Kingdom, but little is known about recent trends in smoking disparities between disabled and non-disabled adults, particularly in the context of the coronavirus disease 2019 (COVID-19) pandemic. We analysed UK Annual Population Survey data from 2017 to 2023 for adults aged ≥18 years. Smoking status was classified as current, ex-, or never smoker, and disability status was defined according to the Equality Act. Multinomial logistic regression was used to estimate pooled adjusted relative risk ratios (RRRs) for smoking outcomes by disability status, and then separately for periods before (2017-19) and after (2020-23) the pandemic onset. To test whether the pandemic had an effect beyond underlying trends, we fitted a joint model including survey year and a post-2020 indicator. Adjusted average marginal effects quantified absolute percentage point (pp) differences in predicted probabilities between disabled and non-disabled adults. The analytic sample comprised 1 087 678 adults, of whom 26.7% (n = 290 536) reported a disability. In pooled adjusted analyses covering all survey years, and controlling for age, sex, education, ethnicity, marital status, and region of residence, disabled adults had higher relative risk ratios of being current smokers (RRR = 1.78; 95% CI: 1.75-1.80; P < .001) and ex-smokers (RRR = 1.44; 95% CI: 1.42-1.45; P < .001) compared with never smokers. Period-stratified analyses (not adjusted for temporal trends) showed adjusted RRRs for current smoking of 1.65 (95% CI: 1.62-1.68; P < .001) before and 1.95 (95% CI: 1.91-1.99; P < .001) after the pandemic onset. In the fully adjusted joint model accounting for temporal trends (survey year) and pandemic period, the disability × pandemic period interaction was not statistically significant (χ2 = 3.11; P = .21). Adjusted average marginal effects from the trend-adjusted model showed that disabled adults had a higher predicted probability of current smoking both before (+5.63 percentage points; 95% CI: 5.30-5.96; P < .001) and after (+4.60 pp; 95% CI: 4.25-4.96; P < .001) the pandemic onset, representing a modest narrowing of the absolute gap (difference = -1.03 pp; P = .001). Disabled adults remained substantially more likely to smoke than their non-disabled counterparts. After accounting for underlying temporal trends, the onset of the COVID-19 pandemic did not independently change this association, highlighting the continued need for disability-inclusive cessation strategies.

Passive immunization plays a pivotal role in prenatal care. This study aimed to assess maternal awareness, knowledge, and adherence to vaccinations during pregnancy, specifically for pertussis, influenza, and respiratory syncytial virus (RSV), while also evaluating how the approval of the RSV vaccine during pregnancy has been received by women and healthcare professionals. A cross-sectional survey was conducted at Mangiagalli Hospital in Milan between August and November 2024. Pregnant women were asked to complete a self-administered questionnaire regarding socioeconomic characteristics, knowledge of vaccine-preventable diseases, and vaccination acceptance. Multivariate logistic regression examined associations between socioeconomic factors and vaccination behavior. A total of 390 participants were considered for final analysis. 89.7% of women had received or would receive the pertussis vaccine, 72.3% the influenza vaccine (P < .001), and 74.9% the RSV vaccine (P < .001). Education, employment status, and number of children were significantly associated with higher vaccination rates. The gynecologist was the primary source of information for most women (60.5%). Barriers to vaccination included a lack of prior discussion with healthcare providers and concerns about vaccine safety. Nevertheless, 83.8% of women would be favorable to receiving all vaccines together and 86.4% would prefer receiving the vaccine themselves rather than having monoclonal antibodies administered to their neonates. Maternal education and effective communication with healthcare providers are crucial in improving vaccination acceptance during pregnancy. Personalizing vaccination counseling for women with lower educational levels and those expecting their first child is essential.

Injuries lead to heath loss, disability, and significant costs. The aim of this study was to evaluate self-reported home and leisure injuries outside school by the 8th and 9th graders in Finnish secondary schools, and potential explanatory factors associated with their injuries. Data were gathered on 383 550 pupils in cross-sectional surveys (every second school year) done between years 2013 and 2021. Associations between injuries and the explanatory variables were assessed using logistic regression analysis. Bronfenbrenner's bioecological model and the KINDL-R health-related quality of life measurement were used as the framework for this study. Nearly a third of the respondents (n = 120 494, 31.4%) had been injured one or more times during leisure time or at home. The most common injuries among all respondents were sport-related injuries (19.8%), other injuries sustained during leisure time (13.8%) and at home or nearby (9.4%). The use of safety equipment was quite low. The potential risk for injuries was highest among those who were severely anxious, those who often consumed enough alcohol to become heavily drunk, those who had tried or used drugs before, and adolescents of foreign background who had been born abroad. Adolescents with no close friends had a lower association with injury. Boys were more likely to sustain injuries than girls. Injuries suffered in leisure time and at home were linked to risky behaviour, emotional well-being, social and family relationships, and housing. Professionals in preventive work need to take the complex factors behind injuries into account.

In the European Union (EU), one in five youth currently smoke, with over half establishing regular smoking by age 18. Yet, evidence on the historical trends of smoking initiation remains scarce despite its importance for tobacco control. Using four waves of the Special Eurobarometer survey (2012-20; n = 110 753, aged ≥15), we retrospectively estimated trends in initiation rates (IRs) of regular cigarette smoking in the EU from 1940 to 2019 among individuals aged 10-24 by sex, region, and country for each calendar decade. EU-wide smoking IRs have decreased compared to the peak period, with narrowing disparities by sex and region. For males, the IRs have declined from 5.7% (95% CI = 5.6-5.9) in the 1970s to 3.2% (95% CI = 3.0-3.3) in the 2010s, and for females from 3.9% (95% CI = 3.7-4.0) in the 1990s to 2.4% (95% CI = 2.3-2.5) in the 2010s. The decline was more pronounced among young adults aged 18-24 than minors aged 10-17, with minors' IRs surpassing those of young adults during the 2010s. Marked declines occurred among young adults in all regions, while among minors, a clear decrease was observed only for males in Northern Europe. Concerningly, the IRs among minors have trended upward in Eastern Europe for both sexes. Despite declining youth smoking initiation, an unacceptably high number of European youth still begin smoking regularly before the legal age of 18. Stricter and comprehensive tobacco control policies targeting youth, along with smoke-free generation initiatives, could substantially reduce future tobacco use and smoking-related mortality.

There is a need to efficiently identify groups at risk of unmet health service needs. In response, we developed and evaluated the performance of a regression model to assess unmet health service needs in the Finnish population. The study population consisted of population-based Healthy Finland 2022-cohort participants (N = 18 442), aged 20-104. The primary outcome was self-reported unmet need for physician's or nurse's services. A total of 38 potential risk factors were evaluated. Statistical models were developed using bootstrap-enhanced LASSO regression (bolasso). Of the participants, 5875 (32%) were classified as experiencing unmet health care need. The C-index from the final model including 15 predictors from the best bolasso models varied between 0.73 and 0.76 and pooled C-index over the imputed data sets was 0.75 (95% CI 0.70-0.79). Fifteen factors-including health-related, socioeconomic variables, heavy alcohol use, experiences with health services, caregiving for others, and language group-were found to be strongly associated with an increased risk of unmet health care needs and may be a useful targets for preventing unmet health care need.