This study examines the relationship between gratification crisis and burnout syndrome in German school leaders and explores how sociodemographic and school-level factors relate to burnout. Additionally, it investigates how these factors influence the likelihood of experiencing burnout and engagement based on sociodemographic and school characteristics. The research design focuses on the relationship between the effort-reward imbalance (ERI) model and latent profiles of the Maslach Burnout Inventory. Statistical analyses include group comparisons and logistic regression to examine the relationships between variables, such as ERI and sociodemographic and school-level characteristics. The ERI ratio significantly associated with burnout, indicating higher risk as the ratio rises. Sociodemographic and school-level factors showed significant variations by student numbers and school type. Regression models revealed a positive relationship between ERI and burnout, while age negatively correlated, suggesting lower burnout risk in older leaders. Logistic regression highlighted associations between age, gender, and engagement, with increasing age positively associated with engagement and lower ERI scores associated with higher engagement. The results of the study demonstrate a significant relationship between perceived reward crisis as measured by the ERI model and burnout syndrome among school leaders in Germany. School leaders who feel undervalued and overburdened are more susceptible to burnout. The reported ERI depends on specific contextual variables, including the type of school, the number of students, and the age of the school principal. It is important for schools and educational institutions to address the multiple factors that influence burnout and work engagement among school leaders.

The Community Acute Respiratory Infection (CARI) surveillance programme, established by Public Health Scotland (PHS) in November 2021, aims to monitor respiratory infections in communities, replacing prior schemes to ensure early detection of outbreaks and inform public health interventions. Positioned as a cornerstone of PHS's national infectious respiratory diseases plan, CARI is pivotal for safeguarding public health. This study presents key findings from the 2022/23 CARI season and evaluates the programme's performance during this period. CARI uses a network of sentinel general practitioner (GP) practices across Scotland to monitor patients with acute respiratory infection symptoms, employing multiplex polymerase chain reaction testing for 10 common pathogens. Results are linked to enhanced surveillance data, providing insights into infection trends during the season. The evaluation comprised an online GP survey and a quantitative assessment of programme performance. In the 2022/23 season, 180 GP practices participated in CARI, testing 15,823 samples. Swab positivity peaked in December 2022, driven by a large spike in influenza A activity. The evaluation showed that CARI is highly useful, with positive feedback on simplicity, flexibility, and acceptability. Representativeness varied across health boards and age groups. Despite occasional laboratory processing delays, data quality remained good, with timely reporting and stable participation. CARI reflected patterns in infections observed in secondary care in Scotland and Europe, providing valuable insights into disease patterns and impact. It also provided timely intelligence to key decision-makers, enabling prompt public health response. Changes for the 2023/24 season aim to further optimize the programme.

Recognizing and addressing vulnerability during the first thousand days of life can prevent health inequities. It is necessary to determine the best data for predicting multidimensional vulnerability (i.e. risk factors to vulnerability across different domains and a lack of protective factors) at population level to understand national prevalence and trends. This study aimed to (1) assess the feasibility of predicting multidimensional vulnerability during pregnancy using routinely collected data, (2) explore potential improvement of these predictions by adding self-reported data on health, well-being, and lifestyle, and (3) identify the most relevant predictors. The study was conducted using Dutch nationwide routinely collected data and self-reported Public Health Monitor data. First, to predict multidimensional vulnerability using routinely collected data, we used random forest (RF) and considered the area under the curve (AUC) and F1 measure to assess RF model performance. To validate results, sensitivity analyses (XGBoost and Lasso) were done. Second, we gradually added self-reported data to predictions. Third, we explored the RF model's variable importance. The initial RF model could distinguish between those with and without multidimensional vulnerability (AUC = 0.98). The model was able to correctly predict multidimensional vulnerability in most cases, but there was also misclassification (F1 measure = 0.70). Adding self-reported data improved RF model performance (e.g. F1 measure = 0.80 after adding perceived health). The strongest predictors concerned self-reported health, socioeconomic characteristics, and healthcare expenditures and utilization. It seems possible to predict multidimensional vulnerability using routinely collected data that is readily available. However, adding self-reported data can improve predictions.

A Digital Twin (DT) can be understood as a representation of a real asset, a virtual replica of a physical object, process, or even a system. They have been used in managing healthcare facilities, streamlining care processes, personalizing treatments, and enhancing patient recovery. The potential impact of this tool on our society and its well-being is quite significant. A quick review of the literature was carried out using the terms ('Digital Twins') and ('Digital Health'), and (Health Care) with a time interval of up to 5 years (2018-23). Using the PRISMA Method, the search was conducted in six academic databases: IEEE Xplore, Dimensions, Scopus, Web of Science, PubMed, and ACM. After applying the search strings and the exclusion criteria, a total of 13 publications were identified and listed to constitute and support the discussion of this article. The selected studies were categorized into 2 groups according to their application in healthcare: A group of clinical applications, subdivided into topics on personalized care and reproduction of biological structures and another group of operational applications, subdivided into topics such as optimization of operational processes, reproduction of physical structures, and development of devices and drugs. The use of DT in healthcare presents important challenges related to data integration, privacy, and interoperability. However, trends indicate exciting potential in personalizing treatment, prevention, remote monitoring, informed decision-making, and process management, which can result in significant improvements in quality and efficiency in healthcare.

Public health researchers employ quasi-experimental methods (QEM) to evaluate the effects of policies. Whilst some policies are designed to improve (health) equity, others may intentionally or unintentionally have detrimental effects on disadvantaged populations. We thus sought to investigate how health equity is addressed in policy evaluations which employ QEM. We conducted a content analysis on studies sourced from a scoping review. We drew a random sample of 350 records identified in systematic database searches in Medline, EMBASE, and EconLit (December 2022). Studies that employed QEM labels and examined public policies implemented in the WHO European region were included. We extracted data on study design, policies, and populations; assessed whether outcomes were examined in population sub-groups (as defined by PROGRESS-Plus criteria); and analysed discussion sections for equity-related conclusions. We included 59 studies, of which 39 (66.1%) studies considered health equity-albeit to variable depth. Twenty-five studies were focused exclusively on examining policy outcomes in a disadvantaged population (42.4%), of which 19 studies evaluated policies that targeted disadvantaged groups (e.g. minimum wage, social housing policies). Outcomes were stratified for one or more sub-populations in 22 studies (37.3%), most commonly for gender (n = 15, 25.4%) and a measure of socio-economic status (n = 13, 22%), particularly income and employment. Equity-related results and implications were discussed in 24 studies. While policy evaluations employing QEM have considerable value for informing decision-making in public health and other sectors that influence health, their potential to investigate equity impacts is currently not harnessed.

Providing health care is a balancing act among human resources, financial pressures and system-intrinsic factors. Understanding the utilization behaviour of primary and secondary care facilities [general practitioners (GPs) vs. specialists, as well as in- and outpatient hospital care] is crucial for a country like Austria, which has free access to all levels of care. The aim of this study was to reassess access point consultations in relation to sociodemographic variables over time. The databases used for this cross-sectional analysis were the Austrian Health Interview Surveys 2006/07, 2014, and 2019, with sample sizes of 15 474, 15 770, and 15 461 persons, respectively. Analyses included patterns of utilization behaviour, multivariable logistic regression models, and diff-in-diff analyses highlighting differences between the observation periods. GP and secondary care consultations increased from 2014 to 2019. While there were fewer GP visits in 2014 than in 2006/07, GP consultation rates grew by 3.2% between 2014 and 2019. Secondary care utilization increased by 5.4%-8.2% between 2006/07 and 2019, with the highest growth in older and less-educated persons. Secondary-level utilization without prior GP visits decreased again in 2019 after peaking in 2014. Utilization of all access points increased over the entire observation period, especially regarding secondary-level care. Higher GP visit rates do not seem to result in a drop in secondary-level consultations. These results emphasize the coordinator role of primary care in ongoing structural health reforms in European countries, such as Austria.

Controversial relationship of physical activity with lower lymphoma risk has been reported in observational studies. The purpose of this study was to explore the causal correlation of physical activity with lymphoma risk using two-sample Mendelian randomization (MR). Genetic variants associated with physical activity (moderate-to-vigorous physical activity (MVPA), average acceleration physical activity, number of days/week of moderate physical activity 10+ min, and number of days/week of vigorous physical activity 10+ min) and lymphoma [overall lymphoma, Hodgkin lymphoma, mature T/NK-cell lymphomas, diffuse large B-cell lymphoma (DLBCL), and follicular lymphoma] were obtained from published genome-wide association studies (GWAS) and the FinnGen database and used as instrumental variables. Primary results were based on inverse variance-weighted (IVW) analysis and were described as odds ratio (OR) and 95% confidence interval (CI). Higher levels of genetically predicted MVPA (OR = 0.079, 95% CI: 0.021-0.300, P = 0.0002) and number of days/week of vigorous physical activity 10+ min (OR = 0.237, 95% CI: 0.098-0.573, P = 0.0014) were negatively associated with Hodgkin lymphoma risk. There was a weak negative association between high levels of genetically predicted MVPA (OR = 0.114, 95% CI: 0.015-0.856, P = 0.0348) and average acceleration physical activity (OR = 0.830, 95% CI: 0.705-0.976, P = 0.0243) and risk of DLBCL. No causal relationship was observed between physical activity and the risk of overall lymphoma, mature T/NK-cell lymphomas, and follicular lymphoma (P > 0.05). This study supported the causal relationship between higher physical activity levels and lower risks of Hodgkin lymphoma and DLBCL.

Heatwaves pose significant threats to vulnerable populations, making resilience efforts crucial. This study aims to explore stakeholders' perspectives on heatwave resilience from a public health perspective, with a specific focus on operationalising the commitment to 'Leave No One Behind' (LNOB) as outlined in the United Nations 2030 Agenda for Sustainable Development. In-depth qualitative interviews were conducted with key stakeholders from national and local government, industry and business, academia, and civil society organizations. Interviews examined stakeholders' understanding of the progress and challenges associated with fulfilling the commitment of LNOB in the context of heat resilience from a public health perspective, in England, UK. Content analysis of interview transcripts was undertaken. Stakeholders emphasize the importance of equity, inclusivity, and public health priorities in heatwave resilience efforts while specifically addressing the commitment to LNOB. Disparities in vulnerability due to socioeconomic factors, challenges in identifying and supporting vulnerable populations, progress made in addressing heatwave resilience, and the role of government and society in improving resilience efforts were emphasized. Stakeholders highlighted the need for targeted interventions, strengthened community support networks, and policy changes to address systemic inequalities and promote inclusivity in resilience strategies. Stakeholders' perspectives underscore the importance of aligning heatwave resilience efforts with global goals, particularly in promoting public health equity and inclusivity. By addressing the challenges identified and implementing the recommendations for improvement, policymakers and practitioners should work towards more equitable and inclusive resilience strategies to safeguard public health during heatwaves.

Conjugal ties may contribute to a convergence of health behaviours between migrants and natives, but the association between intermarriage and health outcomes remains understudied. We investigated mortality patterns among Finnish migrants in Sweden according to the spouse's country of birth and compared these patterns with those observed in the native populations of both Sweden and Finland. Leveraging register data from Sweden and Finland, we identified all married Finnish migrants aged 40-64 and their spouses in Sweden in 1999 and corresponding reference groups in both countries. We used a combination of direct matching and inverse probability weighting to adjust for sociodemographic differences between the groups. We followed individuals for all-cause, alcohol-related, smoking-related, and cardiovascular disease (CVD) mortality during 2000-17. Accounting for sociodemographic characteristics, Finnish migrant men married to Swedish-born as opposed to Finnish-born spouses showed lower all-cause [incidence rate ratio (IRR) 0.94, 95% confidence interval (CI) 0.90-0.98], and CVD mortality (IRR 0.88, 95% CI 0.81-0.95), levels more akin to native Swedes. Migrant women with Swedish-born spouses instead had higher smoking-related mortality (IRR 1.41, 95% CI 1.24-1.61) than those married to Finnish-born spouses, mirroring the higher smoking-related mortality of native Swedish women. Individual-level regression analysis on migrants further indicated lower alcohol-related mortality for intermarried men, adjusted for duration of marriage (IRR 0.74, 95% CI 0.56-0.98). These findings suggest that intermarriage with a native spouse can facilitate the convergence of health behaviours and behaviour-related mortality between migrants and natives.

Despite significant therapeutic advances, lung cancer remains the biggest killer among cancers. In France, there is no national screening program against lung cancer. Thus, in this perspective, the Foch Hospital decided to implement a pilot and clinical low-dose CT screening program to evaluate the efficiency of such screening. The purpose of this study was to describe the prevalent findings of this low-dose CT screening program. Participants were recruited in the screening program through general practitioners (GPs), pharmacists, and specialists from June 2023 to June 2024. The inclusion criteria included male or female participants aged 50 to 80 years, current smokers or former smokers who had quit less than 15 years prior, with a smoking history of over 20 pack-years. Chest CT scans were conducted at Foch Hospital using a low-dose CT protocol based on volume mode with a multi-slice scanner (≥60 slices) without contrast injection. In total, 477 participants were recruited in the CT scan screening, 235 (49%) were males with a median age of 60 years [56-67] and 35 smoke pack-years [29-44] and 242 females (51%) with a median age of 60 years [55-60] and 30 smoke pack-years [25-40]. Eight participants showed positive nodules on CT scan, as a 1.7% rate. 66.7% of diagnosed cancers were in early stages (0-I). It is feasible to implement structured lung cancer screening using low-dose CT in a real-world setting among the general population. This approach successfully identifies most early-stage cancers that could be treated curatively.