Background/Objective: Influenza vaccination is recommended for patients at increased cardiovascular risk. Yet, despite Lithuania’s high cardiovascular mortality, it remains unclear whether uptake is higher among patients at greater cardiovascular risk, particularly those receiving secondary prevention. Vaccination uptake and its associated factors were assessed among statin users, a population at increased cardiovascular risk. Methods: A nationwide registry-based cohort study of Lithuanian statin users was conducted using national e-health records covering the 2020/21 to 2025/26 influenza seasons (1 September to 31 May). Patients were classified into primary- and secondary-prevention groups based on prescription indications coded according to ICD-10-AM. Factors associated with vaccination uptake were examined via multivariable logistic regression. Results: The final cohort included 812,086 unique statin users (81.6% primary, 18.4% secondary prevention). Crude uptake was higher among secondary-prevention (~21%) than primary-prevention patients (~14%; OR 1.73, 95% CI 1.71–1.75); after adjustment for age, prior vaccination and other covariates, the association was small (aOR 1.07, 95% CI 1.06–1.08). A documented prior influenza vaccination was strongly associated with vaccination (aOR 22.18, 95% CI 21.95–22.41). Statin non-persistence (aOR 0.76) and non-initiation (aOR 0.61) were associated with lower odds of vaccination. Conclusions: Influenza vaccination uptake only slightly differed among prevention groups and remained below the WHO 75% coverage target, suggesting that cardiovascular risk status may add little to vaccination uptake beyond age and vaccination history. Prior vaccination and statin treatment persistence were strongly associated with vaccination. This may reflect a shared pattern of engagement with preventive care, but engagement was not measured, and this interpretation remains a hypothesis. Whether bundling vaccination promotion with medication reviews, or involving pharmacists, would raise uptake in higher-risk patients needs to be tested.
Background and Objectives: Family physicians are central to HPV vaccination delivery in Romania, yet little is known about how they perceive recent changes in parental attitudes and the barriers encountered in routine practice. We described these perceptions and examined factors associated with reporting a perceived change. Materials and Methods: A cross-sectional online survey of a non-probability convenience sample of 525 primary-care physicians was conducted in February 2025. Closed responses were summarised descriptively, free-text responses underwent structured thematic content analysis, and robust Poisson regression estimated adjusted prevalence ratios (aPRs), with nominal inference. Results: Amongst respondents, 82.9% reported perceiving a change in parental attitudes; 67.4% provided content meeting a conservative favourable-coding definition and 76.8% a broader definition. Safety concerns and fear (51.9%) and distrust or resistance (46.8%) were the most frequent barriers. Digital sources were perceived as the principal origins of myths (95.6%). Urban respondents reported perceived change more often than rural respondents (88.2% versus 69.9%; aPR 1.265, 95% CI 1.133–1.413; p < 0.001), with similar estimates across sensitivity analyses. Conclusions: In this convenience sample, most physicians reported perceiving changes in parental attitudes and many descriptions were coded as favourable. These reports generate hypotheses for studies using direct parental measures and documented vaccination outcomes.
Background/Objectives: Early-life exposures, including maternal psychosocial profile, can shape an individual’s lifelong development. There is growing interest in the effects of prenatal exposures on cardiometabolic health through childhood. The present study used latent profile analysis to identify psychosocial profiles among pregnant women by examining the co-occurrence of personality traits, anxiety, depression, and social capital and compared them with offspring health outcomes. Methods: Latent analysis identified three distinct psychosocial profiles for 638 participants from the Rhea cohort, following the use of multiple imputation techniques, based on a total analytic sample of 1340 participants. Results: The “Normative” profile (51.2%) had near-zero scores across all standardised psychosocial indicators, representing the baseline group. The “Resilient-Socially Resourced” profile (28.7%) was characterised by low anxiety, neuroticism, and prenatal depression, and high extraversion and social engagement. The “Psychosocially Vulnerable” profile (20.1%) exhibited high anxiety, neuroticism, and prenatal depression, with low extraversion and social connectedness. Associations between maternal psychosocial profiles and offspring cardiometabolic outcomes at ages 4, 7, and 11 years were generally weak and inconsistent. On the contrary, latent socioeconomic classes showed larger effects. Children of “Younger and socioeconomically vulnerable individuals” showed a three-fold higher risk of hypertension at age 4, compared to those from “Professional and well-resourced families”. Conclusions: Findings suggest that although distinct maternal psychosocial profiles can be identified, they may have limited influence on offspring cardiometabolic risk through mid-childhood. Further research is needed to clarify how psychosocial and socioeconomic exposures interact across the life course and influence offspring health trajectories.
Background/Objectives: We examined cause-specific mortality and years of life lost in Romania during 1980–2023 against estimates for the Global Burden of Disease (GBD) regions of central, eastern and western Europe. Methods: This national ecological study used GBD 2023 estimates and published aggregated civil-registration tables. We analysed deaths, years of life lost, age-standardised and age-specific rates, grouped mean age at death and the probability of death before age 70. An exact endpoint decomposition separated population-size, age-structure and age-specific-rate contributions. Counterfactual counts applied comparator rates to Romania’s population. Results: Between 1980 and 2023, the all-cause age-standardised death rate fell 38.7% in Romania, 42.5% in central Europe, 28.8% in eastern Europe and 48.4% in western Europe, whereas Romanian deaths increased 7.8%. Between 1980 and 2023, the male probability of death before age 70 fell from 44.2% to 38.1% in Romania and from 37.8% to 19.4% in western Europe. The age-standardised neoplasm death rate increased from 125.2 (95% uncertainty interval 121.9–128.8) per 100,000 in 1980 to 139.9 (133.6–144.5) in 2023. In 2023, western European rates applied to Romania’s population yielded 95,237 fewer deaths, 87,165 of them from cardiovascular diseases. Conclusions: Romania’s remaining mortality gap with western Europe was concentrated in cardiovascular diseases. For several cancers, the derived contributions to the probability of death before age 70 had higher point estimates in 2023 than in 1980, and the grouped mean age at death was below the value produced by western European rates; these measures have no propagated uncertainty intervals.
Background/Objectives: Nurses are central to artificial intelligence (AI) implementation in healthcare, yet estimates of AI-related anxiety are difficult to compare because Artificial Intelligence Anxiety Scale (AIAS) versions have different total-score ranges. This review estimated AI anxiety using separate syntheses of range-compatible raw scores, with percent-of-maximum-possible (POMP) normalization as a secondary exploratory analysis. Methods: Following PRISMA 2020, PubMed, Scopus, CINAHL, and Google Scholar were searched from inception to 16 July 2026. Methodological quality was appraised using Joanna Briggs Institute checklists. Random-effects models used restricted maximum likelihood estimation with Hartung–Knapp inference; DerSimonian–Laird models were retained for sensitivity analysis. Prediction intervals, leave-one-out analyses, and influence diagnostics were examined. The protocol was retrospectively registered on OSF (DOI: 10.17605/OSF.IO/K3B56). Results: Twenty-five studies included 7271 nurses. The pooled mean was 45.85 (95% CI 44.45–47.26; 95% PI 41.75–49.96; I2 = 80.0%) for the 16–80 AIAS (10 studies; N = 2545) and 69.28 (95% CI 62.03–76.53; 95% PI 50.58–87.97; I2 = 94.4%) for the 21–147 AIAS (six studies; N = 2066). Pooled means were essentially unchanged under the alternative estimator. Extreme heterogeneity limited interpretation of the exploratory POMP synthesis. Conclusions: Mean AIAS scores were below theoretical midpoints. Raw AIAS totals from incompatible versions should not be pooled. Wide prediction intervals indicate substantial between-study variation, and the absence of validated severity cut-offs precludes clinical severity classification. Longitudinal, controlled, and psychometrically rigorous research is needed before specific anxiety-reduction interventions can be recommended.
