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Background Evidence on the long-term employment consequences of SARS-CoV-2 infection is lacking. We used data from a large, community-based sample in the UK to estimate associations between Long Covid and employment outcomes. Methods This was an observational, longitudinal study using a pre–post design. We included survey participants from 3 February 2021 to 30 September 2022 when they were aged 16–64 years and not in education. Using conditional logit modelling, we explored the time-varying relationship between Long Covid status ≥12 weeks after a first test-confirmed SARS-CoV-2 infection (reference: pre-infection) and labour market inactivity (neither working nor looking for work) or workplace absence lasting ≥4 weeks. Results Of 206 299 participants (mean age 45 years, 54% female, 92% white), 15% were ever labour market inactive and 10% were ever long-term absent during follow-up. Compared with pre-infection, inactivity was higher in participants reporting Long Covid 30 to <40 weeks [adjusted odds ratio (aOR): 1.45; 95% CI: 1.17–1.81] or 40 to <52 weeks (aOR: 1.34; 95% CI: 1.05–1.72) post-infection. Combining with official statistics on Long Covid prevalence, and assuming a correct statistical model, our estimates translate to 27 000 (95% CI: 6000–47 000) working-age adults in the UK being inactive because of Long Covid in July 2022. Conclusions Long Covid is likely to have contributed to reduced participation in the UK labour market, though it is unlikely to be the sole driver. Further research is required to quantify the contribution of other factors, such as indirect health effects of the pandemic. [ABSTRACT FROM AUTHOR]

We compare the impact of the first two waves of the COVID-19 pandemic on risk of age-standardized mortality by sex, UK country, and English region. Each wave is defined as lasting 26weeks and are consecutive beginning in 2020week 11. The expected rate is estimated from 2015 to 2019 mean and the projected mortality trend from the same period are used to estimate excess mortality. By both measures, excess mortality was highest and lowest in regions of England, London and the South-West, respectively. Excess mortality was consistently higher for males than females. [ABSTRACT FROM AUTHOR]

Background In the last few decades, suicide rates have decreased in most European countries. However, periodic changes in risk by occupational class have not been studied as much in detail. Methods Representative cohorts of Finnish working-age men were followed for nine years on suicide mortality starting from five different census years (1970, 1980, 1990, 2000, 2010). Each cohort included between 300 970 and 332 318 men. Cox regression modelling was used to estimate hazard ratios by census year, occupational class and their interactions. Further models adjusted for age and its interactions with census year and occupational class. Results The risk of male suicide has more than halved between 1991 and 2019. The relative hazard ratio of suicide in manual workers compared to managers and professionals was around 1.6 to 1.8 times higher. The period when the suicide risk started to decline differed by occupational class: a significant decrease compared to 1970s' levels was seen for managers and professionals already in the 1990s and for lower non-manual employees around 10 years later (in the 2000s). Manual workers only reached the 1970s suicide risk of managers and professionals in the 2000s and 2010s. Conclusion A delayed reduction of suicide rates among lower occupational classes suggests that the impact of social changes can occur at different speed in different population groups. [ABSTRACT FROM AUTHOR]

Background Patterning of cigarette and e-cigarette use among young people remains poorly characterized. We aimed to describe these patterns in the UK Millennium Cohort Study at age 14 and 17 years. Methods Data on cigarette and e-cigarette use come from 9731 adolescents. Latent class analysis assigned participants to membership of classes of product use and multinomial logistic regression analyses assessed differences in the likelihood of belonging to classes by sociodemographic (age, gender, ethnicity, household income, maternal education and country of residence) and smoking-related social factors (caregiver tobacco use, caregiver e-cigarette use and peer smoking). Results We identified four classes of use: 45.8% of adolescents 'continued to abstain' from cigarettes or e-cigarettes; 21.3% 'experimented' (used once or in the past but not currently) with cigarettes and/or e-cigarettes by age 17 but were not current users; 19.0% were 'late adopters', characterized by low levels of use at age 14 but high levels of experimentation and current use at age 17; and 13.9% were 'early adopters', characterized by high levels of experimentation and current use at ages 14 and 17. At age 17, 70.4% of 'early adopters' smoked cigarettes regularly plus an additional 27.3% experimented with cigarettes. Corresponding percentages for e-cigarettes were 37.9% and 58.9%. Tobacco and e-cigarette use by caregivers, and cigarette use by peers, were associated with being both 'late adopters' and 'early adopters'. Conclusions Approximately one in seven adolescents in the UK are 'early adopters' of nicotine products. This highlights the need to develop and implement effective policies to prevent nicotine use uptake. [ABSTRACT FROM AUTHOR]

Background In Europe, more than 15 million people live with heart failure (HF). It imposes an enormous social, organizational and economic burden. As a reaction to impending impact on healthcare provision, different country-specific structures for HF-care have been established. The aim of this report is to provide an overview and compare the HF-care approaches of Germany, Ireland, the Netherlands and the UK, and to open the possibility of learning from each other's experience. Methods A mixed methods approach was implemented that included a literature analysis, interviews and questionnaires with HF-patients and caregivers, and expert interviews with representatives from healthcare, health service research and medical informatics. Results The models of HF-care in all countries analyzed are based on the European Society of Cardiology guidelines for diagnosis and treatment of HF. Even though the HF-models differed in design and implementation in practice, key challenges were similar: (i) unequal distribution of care between urban and rural areas, (ii) long waiting times, (iii) unequal access to and provision of healthcare services, (iv) information and communication gaps and (v) inadequate implementation and financing of digital applications. Conclusion Although promising approaches exist to structure and improve HF-care, across the four countries, implementation was reluctant to embrace novel methods. A lack of financial resources and insufficient digitalization making it difficult to adopt new concepts. Integration of HF-nurses seems to be an effective way of improving current models of HF-care. Digital solutions offer further opportunities to overcome communication and coordination gaps and to strengthen self-management skills. [ABSTRACT FROM AUTHOR]

Background There is growing evidence that common strategies are used across unhealthy commodity industries (UCIs) to influence policy decisions in line with their commercial interests. To date, there have been relatively few studies comparing corporate political activity (CPA) across UCIs, especially comparing the alcohol and gambling industries. Methods A comparative and inductive thematic analysis of alcohol and gambling industry submissions to two House of Lords (HoL) inquiries in the UK was conducted. Themes in the framing, arguments and strategies used by the alcohol and gambling industries in CPA were compared. Results Alcohol and gambling industry responses largely used the same framings, both in terms of the problems and solutions. This included arguing that harms are only experienced by a 'minority' of people, emphasising individual responsibility and shifting blame for harms to other industry actors. They promoted targeted or localised solutions to these harms, in place of more effective population level solutions, and emphasised the perceived harms of introducing regulation not in the industries' interests. Conclusions These findings are consistent with previous literature suggesting that UCIs use the same framing and arguments to shape the narrative around their harms and solutions to those harms. This study also identified novel strategies such as shifting blame of harms to other industry actors. Policy makers should be aware of these strategies to avoid undue industry influence on policy decisions and understanding commonalities in strategies may help to inform more effective public health responses across all UCIs. [ABSTRACT FROM AUTHOR]

Background Parental smoking strongly influences adolescent smoking, yet few studies have examined factors that may protect against this. We investigated whether skills-based components of positive mental health ('mental health competence', MHC) modified the association between parental and teenager smoking, in the UK-representative Millennium Cohort Study (approximately 18 000 children, born 2000–02; analytic sample: n  =   10 133). Methods Cohort members (CMs) reported at 14 years (y) whether they had ever smoked cigarettes. A dichotomized variable indicated whether one/both parents smoked when CMs were 11 y. A four-class latent MHC measure captured learning skills and prosocial behaviours at 11 y: High, High–Moderate, Moderate, Low. We examined effect measure modification (on the additive scale) by comparing risk differences (RDs) for CM smoking according to parental smoking, within each MHC class. We then estimated RDs for CM smoking according to combinations of parental smoking and MHC. Analyses accounted for confounding, sample design, attrition and item missingness. Results CMs were more likely to smoke cigarettes if their parent(s) smoked (27%) than CMs with no parent(s) who smoked (11%; RD: 16%). When stratified by MHC, RDs were stronger for low MHC (21%; 95% CI 11–31%) than other MHC classes (ranging: 7–11%). Compared to CMs with high MHC and non-smoker parents, those with low MHC and parent(s) who smoked had an RD of 28% (95% CI 20–36%). This was greater than the sum of RDs for those with low MHC and non-smoker parent(s) [7% (2–14%)] plus those with high MHC and whose parent(s) smoked [11% (7–15%)]. There was limited effect measure modification by moderate or High–Moderate MHC. Conclusion Improving MHC to moderate levels may help reduce intergenerational transference of smoking. [ABSTRACT FROM AUTHOR]

Background People from South Asian and black minority ethnic groups are disproportionately affected by the COVID-19 pandemic. It is unknown whether deprivation mediates this excess ethnic risk. Methods We used UK Biobank with linked COVID-19 outcomes occurring between 16th March 2020 and 24th August 2020. A four-way decomposition mediation analysis was used to model the extent to which the excess risk of testing positive, severe disease and mortality for COVID-19 in South Asian and black individuals, relative to white individuals, would be eliminated if levels of high material deprivation were reduced within the population. Results We included 15 044 (53.0% women) South Asian and black and 392 786 (55.2% women) white individuals. There were 151 (1.0%) positive tests, 91 (0.6%) severe cases and 31 (0.2%) deaths due to COVID-19 in South Asian and black individuals compared with 1471 (0.4%), 895 (0.2%) and 313 (0.1%), respectively, in white individuals. Compared with white individuals, the relative risk of testing positive for COVID-19, developing severe disease and COVID-19 mortality in South Asian and black individuals were 2.73 (95% CI: 2.26, 3.19), 2.96 (2.31, 3.61) and 4.04 (2.54, 5.55), respectively. A hypothetical intervention moving the 25% most deprived in the population out of deprivation was modelled to eliminate between 40 and 50% of the excess risk of all COVID-19 outcomes in South Asian and black populations, whereas moving the 50% most deprived out of deprivation would eliminate over 80% of the excess risk of COVID-19 outcomes. Conclusions The excess risk of COVID-19 outcomes in South Asian and black communities could be substantially reduced with population level policies targeting material deprivation. [ABSTRACT FROM AUTHOR]

Background: Monitoring obesity and overweight prevalence is important for assessing interventions aimed at preventing or reducing the burden of obesity. This study aimed to provide current data regarding the prevalence of overweight and obesity of adults, from 20 European countries. Methods: Participants were 34814 (16482 men) adults with mean age 50.8± 17.7. Data from European Social Survey round 7, 2014, were analysed. Body mass index (BMI) was calculated from self-reported height and weight. Results: The proportion of underweight was only 2%, and 44.9% for normal weight. Overweight and obese accounted for 53.1%. More men than women were overweight (44.7% vs. 30.5%). Older adults were significantly more overweight (42.4%) and obese (20.9%) than middle age and younger adults. Retired people account for a greater proportion of overweight (42.0%) and obese (21.5%), when compared with employed, unemployed and students. People from rural areas were significantly more overweight (39.1 vs. 36.1%) and obese (17.0 vs. 15.3%) than those who lived in urban areas. The estimates indicate that the highest prevalence of overweight was in Czech Republic (45.2%), Hungary (43.7%) and Lithuania (41.7%). For obesity, Slovenia (20.8%), Estonia (19.7%) and the United Kingdom (19.2%) were the countries with the highest prevalence. Conclusion: Even though data was self-reported, and individuals tend to overestimate their height and underestimate their weight, the prevalence of overweight and obesity is considered high. More than half of the European population is overweight and obese. This study strengthens and updates the claims of an excessive weight epidemic in Europe. [ABSTRACT FROM AUTHOR]

Background: Differences in dietary habits have been suggested as an important reason for the large health gap between Eastern and Western European populations. Few studies have compared individual-level nutritional data directly between the two regions. This study addresses this hypothesis by comparing food, drink and nutrient intakes in four large population samples. Methods: Czech, Polish and Russian participants of the Health, Alcohol and Psychosocial Factors in Eastern Europe (HAPIEE) study, and British participants in the Whitehall II study, altogether 29 972 individuals aged 45-73 years, were surveyed in 2002-2005. Dietary data were collected by customised food frequency questionnaires. Reported food, drink and nutrient intake data were harmonised and compared between cohorts using multivariable adjusted quantile regression models. Results: Median fruit and vegetable intakes were lower in the pooled Eastern European sample, but not in all country cohorts, compared with British subjects. Median daily consumption of fruits were 275, 213, 130 and 256 g in the Czech, Polish, Russian and Whitehall II cohort, respectively. The respective median daily intakes of vegetables were 185, 197, 292 and 246 g. Median intakes of animal fat foods and saturated fat, total fat and cholesterol nutrients were significantly higher in the Czech, Polish and Russian cohorts compared with the British; for example, median daily intakes of saturated fatty acids were 31.3, 32.5, 29.2 and 25.4 g, respectively. Conclusion: Our findings suggest that there are important differences in dietary habits between and within Eastern and Western European populations which may have contributed to the health gap between the two regions. [ABSTRACT FROM AUTHOR]

Background: Many popular childcare books recommend feeding babies to a schedule, but no large-scale study has ever examined the effects of schedule-feeding. Here, we examine the relationship between feeding infants to a schedule and two sets of outcomes: mothers’ wellbeing, and children’s longer-term cognitive and academic development. Methods: We used a sample of 10 419 children from the Avon Longitudinal Study of Parents and Children, a cohort study of children born in the 1990s in Bristol, UK. Outcomes were compared by whether babies were fed to a schedule at 4 weeks. Maternal wellbeing indicators include measures of sleep sufficiency, maternal confidence and depression, collected when babies were between 8 weeks and 33 months. Children’s outcomes were measured by standardized tests at ages 5, 7, 11 and 14, and by IQ tests at age 8. Results: Mothers who fed to a schedule scored more favourably on all wellbeing measures except depression. However, schedule-fed babies went on to do less well academically than their demand-fed counterparts. After controlling for a wide range of confounders, schedule-fed babies performed around 17% of a standard deviation below demand-fed babies in standardized tests at all ages, and 4 points lower in IQ tests at age 8 years. Conclusions: Feeding infants to a schedule is associated with higher levels of maternal wellbeing, but with poorer cognitive and academic outcomes for children. [ABSTRACT FROM PUBLISHER]

Background: The increasing concentration of populations into large conurbations in recent decades has not been matched by international health assessments, which remain largely focused at the country level. We aimed to demonstrate the use of routine survey data to compare the health of large metropolitan centres across Europe and determine the extent to which differences are due to socio-economic factors. Methods: Multilevel modelling of health survey data on 126 853 individuals from 33 metropolitan areas in the UK, Republic of Ireland, Sweden, Norway, Finland, Spain, Belgium and Germany compared general health, longstanding illness, acute sickness, psychological distress and obesity with the average for all areas, accounting for education and social class. Results: We found some areas (Greater Glasgow; Greater Manchester, Cheshire and Merseyside; Northumberland, Tyne and Wear and South Yorkshire) had significantly higher levels of poor health. Other areas (West Flanders and Antwerp) had better than average health. Differences in individual socio-economic circumstances did not explain findings. With a few exceptions, acute sickness levels did not vary. Conclusion: Health tended to be worse in metropolitan areas in the north and west of the UK and the central belt and south east of Germany, and more favourable in Sweden and north west Belgium, even accounting for socio-economic composition of local populations. This study demonstrated that combining national health survey data covering different areas is viable but not without technical difficulties. Future comparisons between European regions should be made using standardized sampling, recruitment and data collection protocols, allowing proper monitoring of health inequalities. [ABSTRACT FROM PUBLISHER]

Background: The government set a series of targets to reduce health inequalities in England by 2010. Primary care has an important role in reducing health inequalities. The aim of the study was to assess the impact of general practice on reducing area-based health inequalities. Methods: Analysis of differences in achievement on clinical indicators between practices in Spearhead and non-Spearhead Primary Care Trusts (PCTs) using data from the Quality and Outcomes Framework (QOF) for 2004/05 and 2005/06, practice characteristics and Spearhead status of PCTs. The study used data on 8339 primary care practices in England. Unweighted mean reported achievement on subset of 26 clinical indicators was calculated. The study analysed differences in achievement by Spearhead status and deprivation in both years and the change between years. Multiple regression analysis of relationship between Spearhead status, income deprivation, reported achievement and other factors also were carried out. Results: Practices in Spearhead PCTs performed worse than practices in non-Spearhead PCTs in both years but showed greater improvement. Among the most deprived practices, there were no differences in QOF achievement between Spearhead and non-Spearhead PCTs. Previous year’s achievement was the strongest predictor of performance. Conclusion: The narrowing in performance between practices in Spearhead and non-Spearhead PCTs may have indirectly contributed to a reduction in area-based health inequalities but the differences are small. The lack of difference between the most deprived practices in Spearhead and non-Spearhead PCTs suggest that area-based initiatives to tackle inequalities have not yet had an observable impact on deprived practices. Unobserved factors explain most of the variation in achievement. [ABSTRACT FROM PUBLISHER]

The aim of this study is to estimate the contributions of changes in population distribution by marital status to the changes in adult mortality in six developed countries. The change in total mortality was decomposed into the contributions of: (i) mortality changes within each marital status category; and (ii) changes in population composition by marital status. The study provides evidence that changes in population composition contributed to increases in male mortality in Russia and Lithuania, whereas in the remaining male populations this was a significant obstacle for faster health improvements. The compositional changes had only small impacts on female mortality. [ABSTRACT FROM AUTHOR]