The colorectal cancer screening programme was fully implemented in the Community of Madrid in 2019. This study aimed to analyse factors related to participation during the subsequent 4 years. We conducted a cross-sectional study using data from the Community of Madrid's Noncommunicable Disease Risk-Factor Surveillance System (SIVFRENT) (2020-23). Study population included individuals aged 50-69 years. We analysed the association between faecal occult blood test (FOBT) performance and demographic, socioeconomic, and lifestyle variables. Crude and adjusted prevalence ratios (aPR) were calculated using Poisson regression models, stratified by sex. Among 3813 participants, 52.1% were women. Overall, 55.3% (95% CI: 53.6-57.0) underwent an FOBT for screening purposes, with a greater proportion of men (57.8%) than women (53.1%) (P < .05). The highest participation occurred during 2023. Among men, being separated or divorced (aPR: 0.80; 95% CI: 0.67-0.94) and being aged 50-59 years old (aPR: 0.92; 95% CI: 0.85-0.99) were associated with a lower likelihood of undergoing an FOBT. Among women, lower participation was associated with being underweight (aPR: 0.63; 95% CI: 0.40-0.97), widowed (aPR: 0.78; 95% CI: 0.66-0.93), born outside Spain (aPR: 0.82; 95% CI: 0.72-0.95), a current smoker (aPR: 0.84; 95% CI: 0.75-0.95), and being under 60 years of age (aPR: 0.86; 95% CI: 0.79-0.94). Overall, a gradual improvement in colorectal cancer screening participation was observed, with men participating at higher rates than women. The associated factors differ between men and women and need to be accounted for when strategies to increase programme coverage are implemented.

Cardiovascular disease (CVD) is a major contributor to global morbidity and mortality. While the transportation industry is recognized as high-risk for CVD, variation across subsectors and occupations remains unclear. We evaluated CVD risk across subsectors and occupations in South Korea's transportation industry. This retrospective cohort study used linked data from Korean National Health Insurance Service and Employment Insurance databases. Male workers aged 35-54 years in 2013 who remained in the same occupation during 2012 and underwent health screening in 2012-2013 were included. Follow-up continued through 2022. We calculated age-standardized incidence rates, standardized incidence ratios (SIRs), and population-attributable fractions across industries, with stratified analyses by subsector, occupation and lifestyle factors. Among 2 300 512 workers, transportation industry exhibited the highest age-standardized CVD incidence rate (558.9 per 100 000 person-years) and population-attributable fraction (1.49%) of all industries. Within 182 551 transportation workers, driving-related occupations showed the highest SIRs, especially in land and freight subsectors. Aviation subsectors had lower CVD incidence and more favorable health indicators. These patterns remained consistent after stratification by obesity and smoking status. Substantial heterogeneity exists in CVD risk across transportation subsectors and occupations. Targeted prevention strategies are needed for high-risk groups, particularly drivers.

Eating disorders (EDs), including anorexia nervosa (AN) and bulimia nervosa (BN), are severe mental health conditions affecting physical and psychosocial health. Structural gender inequality may shape the burden of EDs across sexes and regions. We analyzed Global Burden of Disease Study 2023 estimates to assess the relationship between gender inequality and ED burden in Europe. Years Lived with Disability (YLD) for AN and BN were extracted by sex and five-year age groups (10-39 years) from 1990 to 2023 across 35 countries. Gender inequality was measured using the Gender Inequality Index (GII). Mixed linear regression was applied with year, age group, sex, GII, and their interactions as fixed effects, and country and year as random intercept and slope, respectively. YLDs increased over time across most countries and age groups, with females consistently experiencing the highest burden. For AN, higher levels of GII were significantly associated with greater YLD rates in both males (β = 29.28; 95% CI: 22.2 to 36.4) and females (β = 85.3; 95% CI: 42.1 to 128.6), with a stronger effect for females. For BN, GII was inversely associated with YLDs among males (β = -645.6; 95% CI: -732.8 to -558.3), whereas a positive association was observed among females (β = 794.7; 95% CI: 659.1 to 930.2). Higher burden of AD and BN among young Europeans in more gender-equal settings coexisted with sex-specific patterns associated with increasing gender inequality, underscoring the complexity of gender-related factors and the need for gender-sensitive mental health strategies.

Abstract Multimorbidity, the coexistence of two or more chronic diseases, has become a defining challenge for ageing societies. Yet evidence on when and how chronic diseases begin to cluster, and on the prognostic importance of this timing, remains limited. We used nationwide primary care electronic health records covering 17.4 million people in Spain to reconstruct the onset and progression of chronic disease over the life course. The first recorded diagnosis was used to trace temporal trajectories of multimorbidity by age and sex. We examined how the first condition, age at diagnosis, and time since that diagnosis were associated with advanced (≥3 diseases), multisystem (≥2 organ systems), and complex multimorbidity (≥3 organ systems), as well as premature mortality (&amp;lt;50 and &amp;lt;65 years) and outcomes related to polypharmacy and high-risk prescribing, using multivariable regression and gradient boosting models. By 2021, more than one in three Spaniards lived with a chronic condition, and over half of adults aged 45 years or older had multimorbidity. Among them, nearly 60% had complex multimorbidity. The time elapsed since the first diagnosis showed the closest link to further accumulation, followed by age at first diagnosis and current age. Later onset, particularly after the mid-50s, was associated with faster decline once disease emerged. The timing of the first chronic condition is a powerful but often overlooked prognostic marker. Public health strategies delaying onset and integrating early management could substantially reduce the long-term burden of multimorbidity in European populations.

In Wales, 24.8% of children aged 4-5 years live with overweight/obesity. Obesity is linked to developing multiple long-term conditions. We aimed to predict childhood obesity using healthcare and wider demographic, socioeconomic, and area-level data. The Secure Anonymized Information Linkage (SAIL) Databank in Wales contains routinely collected individual-level anonymized data from health records and administrative data. Two subsamples were created. The first restricted to singleton births between 15 March 2010 and 28 March 2012 to include Census 2011 data. The second included births after 1 January 2014 to include early-life measurements. Age- and sex-adjusted body mass index (BMI) at 4-5 years was used to define outcome of overweight/obesity (≥91st centile). Backward stepwise logistic regression models with multivariable fractional polynomials were used to develop models in stages. Data were available on 53815 children at 4-5 years in census and 60990 children in early-life subsample. Maternal BMI, smoking, marital status, birthweight, ethnic group, gender, and breastfeeding at birth were retained in all models. Additional variables were retained on adding census and area-level factors but increase in discrimination (Area Under the Curve, AUC) was marginal (0.66-0.67). In the second subsample, AUC improved from 0.67 to 0.79 as factors up to weight at 27 months were incorporated. Factors from healthcare records were largely consistent with existing literature. Additional insights were provided by including census data, though increase in model discrimination was marginal. Childhood obesity can act as a mediator on the pathway to multiple long-term conditions, and risk identification tools may target early prevention.

As the rate of vaccine non-acceptance creates alarming public health challenges, it becomes essential to understand how the interplay between parental and child characteristics influences the uptake of voluntary vaccinations among children. The experiences gained during the COVID-19 pandemic are crucial for developing more targeted communication strategies and increasing vaccination rates in the future. This research analyses data from 13 representative Hungarian surveys focusing on parents' attitudes towards vaccinating their children against COVID-19, giving information of 2482 respondents altogether. The reasons for vaccine non-acceptance are investigated using both quantitative and qualitative methods, with attention given to characteristics of both the parent and the child. The interplay of parental and child characteristics significantly shapes vaccination decisions on voluntary paediatric vaccination. Parental attributes-such as previous COVID-19 experience, sources of information about the virus and vaccination, socioeconomic status, and gender-and child attributes, including age, gender, and the presence of chronic illness, affected not only the likelihood of vaccine non-acceptance but also the underlying rationale. These rationales included, e.g. beliefs that the pandemic does not pose a threat, concerns about potential side effects, distrust, and arguments rooted in misinformation. The quantitative and qualitative results explain interactions of individual factors, proving that subgroup patterns may be modified by individual experience, and individualized information could further decrease the rate of non-acceptance.

Opioid-related mortality is a global issue, and France shows high opioid use disorder indicators. Despite recommendations for wider take-home-naloxone distribution, access remains limited in France, and many primary care professionals lack training. The SINFONI project aims to enhance naloxone education for these providers. A motion-design training program was created and sent to general practitioners (GPs) and pharmacists. A total of 138 GPs and 207 pharmacists participated in the knowledge assessment before and after training. Post-training, significant improvements were observed, and the greatest knowledge gains were in understanding naloxone's safety (P < .001). Our findings primarily identified critical "red flags" that may hinder prescription and dispensing practices.

A health-promoting, supportive, and inclusive labor market is essential to sustainable working life. However, knowledge is warranted on working life patterns from midlife on. We aimed to map 20-year histories of labor market and healthcare use among women and men aged 66. A 20-year retrospective cohort study of 52 920 women and 51 823 men aged 66 in 2019 who lived in Sweden 2000-19, using microdata on type of economic activity, income, secondary healthcare use, and prescribed medications, linked from nationwide registers. Sequence and cluster analysis were performed on yearly dominant labor market states, separately for women and men. Women spent more time in "low-income" and "sickness absence/disability pension (SA/DP)" and less time in "high-income" states than men. Time spent in "unemployed," "no/minimal income," "social assistance" and "retired" states were similar in both sexes. Probabilities of transitioning from "SA/DP," "social assistance," and "retired" to other states were low (<.09). The largest sequence cluster in men (68%) was mostly characterized by sequences with "high-income" and in women by "low-" and "high-" income states (74%). Other clusters were represented by "unemployed" (14% of women, 17% of men), "no/minimal income" (10%, 11%), and "SA/DP" (3%, 3%) states. Most women and men were active in the labor market when aged 46-66, nevertheless, around 30% followed less active paths, dominated by long-term SA/DP, social assistance, or unemployment. Transitions from these states were unlikely. The most pronounced sex-difference in working life was time spent in "low"- and "high-income" states.

Against the backdrop of population ageing and growing labour shortage, Healthy Life Expectancy (HLE) in working age represent a key resource for individual wellbeing and economic growth. This study investigates how age-specific trends shape the development of HLE within working age and whether these trends differ between health indicators. We used the German Socioeconomic Panel to calculate HLE between age 18 and 64 for three periods between 2002 and 2022 (N = 232393) based on Self-rated Health (SRH), mental and physical Health-related Quality of Life (p/mHRQoL). We decomposed changes in HLE over time into the contributions by age group and distinguished between morbidity and mortality contributions. For men, HLE increased in terms in SRH but remained largely unchanged in terms of mHRQoL and pHRQoL. For women, HLE decreased in terms of SRH and pHRQoL while it remained stable for mHRQoL. Deteriorating health in younger working-age groups strongly contributed to decreases in HLE while improving health at older working age fostered increases in HLE. Mortality contributions were minor. We found divergent contributions to trends in HLE by age group with the younger working-age population fostering decreases in HLE while older age groups fostered an increase. Furthermore, trends differed by health indicator, which underlines the importance of analysing more than one indicator whenever possible. The findings are worrying and suggest that the labour force may decline not only due to population ageing, but also due to the deteriorating health, posing growing challenges for both health and labour market policies.

Human error in healthcare and public health remains a major contributor to patient harm and inefficiency globally. In high-income countries, it is estimated that 1 in 10 patients are harmed during hospital care, with nearly half of these incidents being preventable. In low- and middle-income countries (LMICs), the situation is even more concerning. The World Health Organization (WHO) has identified adverse events in healthcare as a major source of preventable harm in LMICs, highlighting persistent systemic weaknesses in quality of care and patient safety. While human errors occur, most patient harm stems from complex systemic factors rather than negligence. High-reliability organizations show that proactive leadership, transparent communication, and organizational learning reduce error likelihood and impact. Continuous quality improvement and simulation-based training strengthen resilience, enabling systems to anticipate and adapt to challenges. Technology-assisted tools, such as electronic health records and decision-support systems, further enhance error detection, though their success depends on integration and engagement. Building health system resilience therefore requires coordinated strategies that prioritize leadership, organizational learning, and adaptive design over punitive responses.