European Journal of Public Health最新文献

Multimorbidity refers to the co-occurrence of multiple health conditions in a single individual. The objective of this systematic review was to synthesize and evaluate research on the prevalence of multimorbidity (including both mental and physical health conditions) for people who have experienced homelessness. MEDLINE, EMBASE, PsycINFO, Web of Science, and OpenGrey were searched for relevant studies between 1997 and 2025. Studies were included if the sample consisted of adults in high-income countries, where the exposure was current or former homelessness, and the outcome was multimorbidity including both mental and physical conditions. Random-effects meta-analyses were used to calculate pooled prevalence estimates. The studies were narratively synthesized, and quality assessed. The search retrieved 6043 papers, 30 of which were eligible for inclusion in the review. Most studies recruited participants from specialist homelessness services (n = 21). More than half of the study samples were over 75% male (N = 16). When excluding studies which applied non-probability sampling strategies, the pooled prevalence was 45% (95% CI, 25-66) for multimorbidity. There was a 34% (95% CI, 22-48) pooled prevalence for trimorbidity (co-occurring mental, physical, and substance/alcohol use conditions). High heterogeneity was observed across studies (I2 > 99%). To conclude, multimorbidity is highly prevalent for people who experience homelessness. There is a lack of research on multimorbidity for women who are or have been homeless, and for those who are not accessing specialist homelessness services. These findings demonstrate the need for the integration, collaboration, and co-ordination between services to support the multimorbid health needs of people who experience homelessness.

During the COVID-19 pandemic, a noticeable decrease in medical care utilization occurred which may contribute to increased morbidity and mortality rates associated with treatable conditions. In Italy, severely impacted by the pandemic, a comprehensive data source on healthcare renunciation is essential for policy formulation and intervention strategies. This study used data from the PASSI d'Argento (PdA) surveillance system to investigate healthcare renunciation among people aged ≥65 years in Italy from August 2020 to December 2021 and to estimate the health and sociodemographic profiles associated with barrier-renunciation (due to service disruption) and refusal-renunciation (because of fear of contagion). A total of 4364 out of 10 827 individuals needing healthcare reported foregoing at least one medical visit or diagnostic test, with the major reasons being fear of COVID-19 contagion (33%) and service disruptions (29%). Sociodemographic inequalities existed: regression analysis revealed significant associations between healthcare renunciation and being female [adjusted prevalence ratio (aPR) 1.17, 95% CI: 1.08-1.26], reporting economic difficulties (aPR 1.15, 95% CI: 1.02-1.28), having two or more chronic conditions (aPR 1.18, 95% CI: 1.04-1.34), and having at least one sensory problem (aPR 1.13, 95% CI: 1.06-1.22). Compared to 2020, healthcare renunciation decreased in 2021. The relevant healthcare renunciation among elderly in Italy during the pandemic highlights widening health gaps and barriers to care access. Long-term monitoring tools are crucial to mitigate the pandemic's impact on public health, especially for vulnerable populations.

To investigate the associations between tobacco smoking and mortality, focusing on all-cause, cardiovascular, and cancer mortality, with analyses stratified by sex. A total of 333 559 participants were included. Smoking status was categorized as current, past, or never. Cox proportional hazards regression models estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for mortality outcomes, adjusted for potential confounders. During a median follow-up of 11.8 years, 20 381 deaths occurred, including 4024 cardiovascular deaths. Current smokers had substantially increased risks of all-cause mortality (HR 2.37 [2.25-2.50] in males; HR 2.65 [2.47-2.84] in females), cardiovascular mortality (HR 2.58 [2.31-2.87] in males; HR 3.79 [3.17-4.54] in females), and cancer mortality (HR 2.47 [2.30-2.66] in males; HR 2.46 [2.25-2.69] in females) compared with never-smokers. Past smokers also exhibited elevated risks, and a clear dose-response relationship was observed with increasing smoking intensity and pack-years. Overall survival was higher in females, but the relative risks associated with smoking were largely comparable across sexes. Tobacco smoking is strongly associated with increased mortality risk, showing a clear dose-response relationship and long-term adverse effects even after cessation. The detrimental impact of smoking was broadly similar in males and females, with only minor differences. These findings reinforce the urgent need for universal prevention and cessation strategies to reduce the burden of smoking-related disease.

Though central nervous system (CNS) cancers have become a critical health concern in the United States, a comprehensive understanding of the nationwide and group-specific trends over time is still limited. This surveillance-based study used data obtained from the National Center for Health Statistics. Age-standardised mortality trends and the Average Annual Percent Change (AAPC) trends were estimated by demographic. We calculated the relative risks between various county-level socioeconomic factors and mortality for CNS cancers. CNS cancers death rates have decreased from 1999 to 2020 in the U.S., while they increased by 2% annually (AAPC, 0.2%, 95% CI [0.0% to 0.4%]) among people aged ≥65 years. The highest increase in CNS cancer was observed among Asian or Pacific Islanders (AAPC, 1.3%, 95% CI [0.8% to 2.3%]), followed by American Indian/Alaska Native individuals (AAPC, 1.2%, 95% CI [-0.3% to 3.0%]). Additionally, individuals residing in counties with greater poverty, more rural area, and lower education levels tended to have higher age-standardised mortality. There were varying degrees of increased mortality rates from CNS cancers by demographic. The strong association of CNS cancers mortality with county SES and rurality suggests that county-based public health strategies are needed to reduce this disparity in mortality.

Large language models (LLMs) like OpenAI's ChatGPT (generative pretrained transformers) offer great benefits to systematic review production and quality assessment. A careful assessment and comparison with standard practice is highly needed. Two custom GPTs models were developed to compare a LLM's performance in "Risk-of-bias (ROB)" assessment and "Levels of engagement reached (LOER)" classification vs human judgments. Inter-rater agreement was calculated. ROB GPT classified a slightly higher "low risk" overall judgments (27.8% vs 22.2%) and "some concern" (58.3% vs 52.8%) than the research team, for whom "high risk" judgments were double (25.0% vs 13.9%). The research team classified slightly higher "low risk" total judgments (59.7% vs 55.1%) and almost double "high risk" (11.1% vs 5.6%) compared to "ROB GPT" (55.1%), which rated higher "some concerns" (39.4% vs 29.2%) (P = .366). With regards to LOER analysis, 91.7% vs 25.0% were classified "Collaborate" level, 5.6% vs 61.1% as "Shared leadership", and 2.8% as "Involve" vs 13.9% by researchers, while no studies classified in the first two engagement level vs 8.3% and 13.9%, respectively, by researchers (P = .169). A mixed-effect ordinal logistic regression showed an odds ratio (OR) = 0.97 [95% confidence interval (CI) 0.647-1.446, P = .874] for ROB and an OR = 1.00 (95% CI = 0.397-2.543, P = .992) for LOER compared to researchers. Partial agreement on some judgments was observed. Further evaluation of these promising tools is needed to enable their effective yet reliable introduction in scientific practice.

In an online-based survey conducted among a representative sample (n = 5000) of the French general population, the category of alcohol use, i.e. no-alcohol use (NAU: 18.5%), low-risk drinking (LRD: 59.4%), hazardous drinking (HD: 14.9%), and alcohol use disorder (AUD: 7.2%) was determined, using the AUDIT questionnaire. Multinomial logistic regression models, using LRD as the reference, showed that younger adults were more likely to report NAU, but also HD, and AUD; women were less likely to report HD and AUD, while high occupational status was associated with reduced NAU and increased HD.

Multiple deprivation indices (MDIs) measure community-level deprivation using various socio-economic indicators such as education level, unemployment rate, or family structure. With their growing use across Europe and the need to evaluate health impacts on vulnerable populations, this scoping review provides an overview of MDIs in the region. Insights into their construction methods will help provide guidance to researchers in developing future indices. This scoping review was conducted as part of the four-year research project funded through EU Horizon Europe-Burden of disease-based methods for estimating the socio-economic cost of environmental stressors (BEST-COST). We searched Medline, Embase, and Web of Science using terms covering deprivation in Europe. Articles meeting the inclusion criteria were reviewed to identify MDIs and their methodologies. Those including a health indicator were excluded from the study. From 163 articles meeting our inclusion criteria, 18 MDIs were identified. The number of underlying indicators ranged from 4 to 22 across MDIs. Most indices were built for small geographical areas, such as municipalities, districts, or census tracts. Ten indices applied weights derived from statistical methods such as principal components analysis, while the other eight applied equal weights and calculated the index as a simple arithmetic sum or mean composite score. The review highlights high variability in MDI methodologies and emphasizes that aligning MDI selection with the context and objectives of a study. Furthermore, due to the vast cultural and geographical diversity across European countries, developing a Europe-wide index requires careful consideration of the methodologies to be employed.

Since 2022, Estonia, a north-east European nation of 1.3 million people, has faced challenges with nitazenes, a class of novel synthetic opioids, which present a new threat to public health. The purpose of this article is to provide the timeline of the nitazene epidemic in Estonia, examining the prevalence and health consequences of nitazene use in the country. This case study uses a multifaceted approach. Data sources include administrative statistics, surveillance and research data, national service provision information, and government documentation from 2015 to 2024, with a focus on health consequences from 2019 to 2024. Quantitative data is complemented by qualitative interviews with nitazene users. The number of drug-related deaths in Estonia has more than doubled since 2022 (39 vs. 80 cases), exceeding over 100 cases in 2023. The increasing prevalence of nitazenes from 2022 is confirmed by syringe residue studies and seizure data. Nitazenes are often sold on the drug market, usually with no or limited information to the user about the substance being sold. Users frequently describe the effect of nitazenes as stronger, faster, sharper and more short-lived compared to fentanyl. Harm reduction services have seen increased utilization since 2022, with first responders facing growing challenges linked to the emergence of the nitazene phenomenon. This study provides the first comprehensive description of the nitazene epidemic. Results indicate a need for more evidence-based information on the use of nitazenes and their consequences to effectively address emerging challenges.

Montenegro has been at the top of the European antibiotic (AB) consumption list for a decade. Also, the invasive isolates of significant Gram "-" pathogens have one of the highest rates of resistance to key AB in Europe. A COVID-19 pandemic announced in 2020 had a significant impact on AB consumption globally. We analysed the consumption of AB in the pre-COVID (2019) and COVID-19 pandemic (2020, 2021, and 2022) period, and compared it with data on the resistance of Gram "-" invasive isolates of important pathogens to key AB. Data on total AB consumption in Montenegro (2011-2022) show that the growth rate in 2021 compared to 2020 was 14.04%, which is a statistically significantly higher value compared to previous years (P < .005, Z-value = 7.43). Additionally, there was a change in the structure of AB consumed, including hospital AB. Resistance of Escherichia coli to the third generation of cephalosporins increased significantly from 38% (9/24) in 2019 to 67% (16/24) in the COVID (2022) year (χ2 = 4.0904, P < .05). The highest rate of Klebsiella pneumoniae resistance to carbapenems was recorded in 2022, 47% (18/38), and was significantly higher compared to 2019 (17% (4/23)) (χ2 = 5.5838, P < .05). The rate of resistance to macrolides of Staphylococcus aureus strains increased significantly from 11% (101/920) in 2019 to 18% (134/735) in 2022 (χ2 = 17 640; P < .001). COVID-19 pandemic altered the resistance map of important pathogens to key antibiotics in Montenegro. A complete national stewardship program must be developed, and the surveillance should be rigorously enhanced and maintained.

Vaccine hesitancy (VH) is a growing threat to global health. In Albania, VH has increased over the past decade, with childhood immunization rates declining from 94% in 2008-2009 to 75% in 2017-2018. Current literature exploring sociodemographic influences on VH in Albania is limited. This study aims to identify key sociodemographic factors associated with VH among caregivers of children aged 0-18 years. A total of 4082 Albanian parents or legal caregivers participated in this cross-sectional study. A validated, anonymous questionnaire was used to collect sociodemographic data, behaviours and attitudes towards vaccines, and beliefs regarding vaccines safety and efficacy. Caregivers were randomly selected from health centres across Albania. VH and vaccine refusal were self-reported by 27.3% and 17.6% of respondents, respectively. Regression analysis identified significant factors influencingVH: marital status (single, widowed, separated, or divorced) (OR 1.91, 95% CI 1.4-2.7), urban residency (OR 1.7, 95% CI 1.4-2.0), having more than four children (OR 10.02, 95% CI 5.2-19.3), doctorate level education (OR 1.99, 95% CI 1.2-3.4), very poor income (OR 13.82, 95% CI 7.0-27.5), Roma ethnicity (OR 18.03, 95% CI 8.2-39.6), Evangelical Christian affiliation (OR 3.33, 95% CI 2.3-4.8), and Muslim faith (OR 1.33, 95% CI 1.1-1.7). Consulting a paediatrician or healthcare professional increased the odds of VH/refusal by 1.88 and 2.09 times, respectively. Sociodemographic factors are significant factors influencing parental VH in Albania. These insights can lead public health decision-makers in targeting hesitant parent groups and developing educational interventions that address specific barriers and concerns.