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This study examines the long-term impact of the COVID-19 pandemic on loneliness among adults aged 65 and over across 27 European countries, focusing on gender differences and the role of government-imposed containment measures. Using longitudinal data from four waves of the Survey of Health, Ageing and Retirement in Europe (SHARE), pre-pandemic (Wave 8), two SHARE Corona surveys (2020-2021), and post-pandemic (Wave 9), the analyses include 49,351 observations from 15,497 individuals. Logistic growth curve models (wave-individual-country) were estimated to assess changes in loneliness across pandemic periods and to explore how gender and policy stringency shaped these patterns. The results show that loneliness increased significantly during the second COVID-19 phases and remained elevated in the post-pandemic period compared with pre-pandemic levels, indicating a sustained rise in emotional vulnerability among older adults, especially for women. Higher policy stringency was associated with greater loneliness, following a curvilinear pattern: Loneliness rose with increasing restriction levels but leveled off and declined at the highest stringency levels. Interaction analyses showed that women were more sensitive to increases in policy stringency. The findings underscore the persistent and gendered effects of the COVID-19 pandemic on loneliness among Europe's older population. Public health and social policy interventions should adopt gender-sensitive and context-aware approaches to reduce loneliness and enhance resilience during and after large-scale crises.

Stunting and wasting are major public health challenges in India, contributing to high child morbidity and mortality. Beyond inadequate nutrition, poor access to water, sanitation, and hygiene (WASH) is increasingly recognized as a key risk factor. This study assessed the association between household WASH access and undernutrition among children under five years. We analyzed data on 143,467 under-5 children from the National Family Health Survey (2019-21). Undernutrition was defined using WHO growth standards for stunting, wasting, and underweight. Household WASH access was defined as improved drinking water, improved sanitation, and a handwashing facility. Kernel-based propensity score matching (PSM) estimated the average treatment effect on the treated (ATT). Undernutrition was consistently higher among children without WASH access (stunting 37% vs. 31%; wasting 19% vs. 17%; underweight 30% vs. 24%). After PSM, WASH access was significantly associated with reduced prevalence of stunting (ATT = -0.009, p < 0.05) and underweight (ATT = -0.008, p < 0.05), but not wasting. The protective effects were stronger among urban, wealthier households and female children, with no significant associations in rural or poorest households. Improved WASH access is modestly associated with lower stunting and underweight, highlighting the importance of equity-focused interventions.

Background: People who inject drugs (PWID) face premature mortality, particularly from opioid overdose. In Sweden, harm reduction has expanded, including increased access to opioid agonist therapy (OAT) and the 2018 introduction of Take-Home Naloxone (THN). This study aimed to examine trends in all-cause and cause-specific mortality and to estimate predictors of all-cause and opioid overdose mortality among PWID in Stockholm.

Methods: We conducted a retrospective cohort study from April 2013 to March 2023. Data from the national Cause of Death Register were linked to Stockholm Needle and Syringe Program (NSP) records. Causes of death were categorised as opioid overdoses, external causes, internal/natural causes, or other/unknown. Crude mortality rates and age- and sex-standardised mortality ratios were calculated. Time-dependent Cox regression models estimated risk of all-cause death, and Fine and Gray subdistribution hazard models estimated opioid overdose mortality, accounting for competing risks. Person-time began at first NSP visit and ended at death, study end or censoring (> 365 days without a visit).

Results: Among 4192 participants, 685 (16%) died. The crude mortality rate declined from 36.75 to 27.04 deaths per 1,000 person-years and the standardised mortality ratio from 17.24 to 10.94. In multivariable models, reporting opioids as the latest injected drug was the strongest driver for both all-cause and opioid mortality. Other significant predictors included infrequent injecting and current contact with social services, psychiatry or addiction care, while OAT participation was associated with a lower risk. Male sex and age over 56 at enrolment were associated with a higher risk of all-cause mortality. Opioid overdose was the most common cause of death (53%). However, the opioid overdose mortality rate declined from 29.40 to 5.88 deaths per 1,000 person-years over the study period, coinciding with the 2018 introduction of THN and declining reported opioid injecting drug use among NSP clients.

Conclusions: All-cause mortality among PWID in Stockholm declined over the study period, alongside significant reductions in opioid overdose deaths, during a period of broadened harm reduction and reduced reporting of opioid injecting drug use. Our findings support continued scale-up of OAT and THN and consideration of supervised consumption sites to further reduce preventable deaths.