Kuhlmann E, Czabanowska K, Lotta G
… +2 more, Paina L, Sriharan A
Eur J Public Health
· 2026 Mar · PMID 41859915
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The health and care workforce crisis and gender inequalities are interconnected, threatening healthcare and equity. We turn this 'unhealthy' connection upside down, aiming to explore how health policy can create co-benef...The health and care workforce crisis and gender inequalities are interconnected, threatening healthcare and equity. We turn this 'unhealthy' connection upside down, aiming to explore how health policy can create co-benefits for gender equality and how governance can support policy implementation. A conceptual approach on SDG3 'Health' and SDG5 'Gender Equality' co-benefits served our analysis. We applied a qualitative explorative approach to identify co-benefits; following a rapid scoping review of the literature, we focus on document analysis and an illustrative case study of artificial intelligence in the health and care workforce. The literature reveals an overall lack of attention to co-benefits in research. Policy documents pay some attention to co-benefits, but primarily consider the benefits for the healthcare sector rather than for gender equality. The case of artificial intelligence illustrates that technological innovations provide opportunities for change, but to create co-benefits, they need gender-responsive and equity-based policy approaches to enhance economically effective and socially fair transformations. We discuss how transformational leadership and gender-transformative governance approaches can support implementation of co-benefits policies. Strengthening the policy and implementation of co-benefits provides novel opportunities for improving gender equality and responding to the health and care workforce crisis.
Subiza-Pérez M, Pérez K, Roué-Le Gall A
… +3 more, Pearce J, Lakerveld J, Franco M
Eur J Public Health
· 2026 Mar · PMID 41859914
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Urban health is the study of how the physical, social, and cultural features of cities contribute to the unequal distribution of health, disease and overall well-being of urban dwellers. The widespread implications of cl...Urban health is the study of how the physical, social, and cultural features of cities contribute to the unequal distribution of health, disease and overall well-being of urban dwellers. The widespread implications of climate change and other global environmental phenomena are increasingly recognized as major threats to urban health. Shifting from a 'Health in all Policies' to a 'Health for all Policies' approach, policies from different sectors are to be planned and implemented to achieve shared and specific goals. With the aim of considering how urban health interventions and policies interact across sectors, we selected three integrated urban health policies and interventions developed at various governance levels in different parts of Europe. We also offer guidance on how to establish fruitful collaborations with policymakers, stakeholders and citizens in the pursuit of healthier and more sustainable cities. Selected case studies were (i) the local clean air zone implemented in Bradford (UK), (ii) a regional urban renewal policy developed in Barcelona (Spain), and (iii) a European multi-city consortium for healthy and sustainable school meals. We were able to identify impacts beyond health and map their contribution to the UN's Sustainable Development Goals. Well-designed urban health research can address the multiple health, social and ecological challenges of our time by generating the evidence needed to design and evaluate urban policies and translating this evidence into population health and well-being.
Eur J Public Health
· 2026 Apr · PMID 41857786
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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 nea...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.
Sell K, Nigg S, Leibinger A
… +3 more, Voss S, Klinger C, Rehfuess E
Eur J Public Health
· 2026 Mar · PMID 41849675
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Commercial products such as tobacco, alcohol, ultra-processed food and fossil fuels drive the global burden of non-communicable diseases (NCDs) and the escalating climate crisis. The concept 'commercial determinants of h...Commercial products such as tobacco, alcohol, ultra-processed food and fossil fuels drive the global burden of non-communicable diseases (NCDs) and the escalating climate crisis. The concept 'commercial determinants of health' (CDOH) offers a framework for understanding the ways in which commercial actors, processes, and products influence health. With most CDOH research originating from Anglo-Saxon countries, we sought to map Germany's CDOH research landscape and related scientific discourse. We conducted a scoping review according to a pre-registered protocol. Records were identified through systematic searches in Medline, Embase, Web of Science, and Google Scholar, last updated 6 December 2024, and by searching seminal CDOH literature. We included peer-reviewed articles (co-)authored by researchers affiliated with German institutions, which examined the public health effects of corporate sector practices; results were presented in an evidence map. We included 136 articles, comprising 64 original research articles (47.1%), 36 overview type articles (26.5%), and 17 opinion pieces (12.5%). Fifteen mentioned the 'commercial determinants of health' (11.0%). Research activities focused on the tobacco, alcohol, food, and pharmaceutical industries; articles were primarily concerned with political, scientific, marketing, and reputational management practices. A supplementary social network analysis showed fragmented authorship networks. CDOH are key upstream determinants to consider in the prevention of NCDs. Germany faces a substantial and growing burden of disease from NCDs but the country's research on the CDOH is limited. We suggest that researchers embrace the scholarship on CDOH, and that practitioners harness relevant insights in addressing the commercially driven NCD burden.
Fontanarosa A, Carle F, Papa R
… +6 more, Pompili M, Corrao G, Valero-Bover D, Roca J, González-Colom R, Skrami E
Eur J Public Health
· 2026 Mar · PMID 41849674
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Multimorbidity places increasing pressure on healthcare systems, requiring effective tools to assess clinical complexity. Existing comorbidity indices are often setting-specific and lack generalizability. The Multisource...Multimorbidity places increasing pressure on healthcare systems, requiring effective tools to assess clinical complexity. Existing comorbidity indices are often setting-specific and lack generalizability. The Multisource Comorbidity Score (MCS), developed in Italy, has shown strong predictive value. This study aimed to externally validate MCS and to test recalibrated and context-adapted versions to enhance its performance in a different healthcare system. A longitudinal observational study included 198 753 residents aged ≥50 in the Barcelona-Esquerra health district, followed between 2016 and 2019. The original MCS was validated, and two adapted versions were tested: a recalibrated MCS with locally derived weights and an enhanced MCS incorporating primary care data. Predictive validity for 1-year mortality (primary outcome) and secondary outcomes (4-year mortality, hospitalizations, and healthcare use) was assessed using the Area Under the Receiver Operating Characteristic (AUROC) curve, survival analysis, and net reclassification improvement (NRI). All MCS versions showed good discrimination. AUROCs for 1-year mortality were 0.742 (original), 0.756 (recalibrated), and 0.771 (enhanced). Adapted versions achieved better risk reclassification and higher discrimination for long-term mortality. Higher MCS scores were associated with progressively lower survival probabilities and increased healthcare resource utilization. The MCS demonstrated satisfactory external validity in the validation context, with adapted versions offering modest improvements.
Eur J Public Health
· 2026 Mar · PMID 41847870
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With increasing life expectancy, multimorbidity represents a growing global challenge, affecting quality of life. We analyzed electronic health records of individuals aged 45-74 from Catalonia, Spain (2007-2021), who wer...With increasing life expectancy, multimorbidity represents a growing global challenge, affecting quality of life. We analyzed electronic health records of individuals aged 45-74 from Catalonia, Spain (2007-2021), who were healthy at the end of 2007. We use sequence and cluster analysis to describe and categorize monthly disease accumulation patterns, from healthy to one or multiple conditions or death, involving four disease groups with the highest global morbidity and mortality burdens. We further investigate the association between identified clusters and sociodemographic factors and the association of cluster membership with healthcare utilization. Approximately 36% of individuals remained healthy throughout the study, while the remainder transitioned to single or multiple morbidity and/or died. A higher number of conditions in a given month increased transition probability, with metabolic and hypertensive conditions being the most common entry points. We identified nine disease accumulation trajectories linked to sociodemographic characteristics: Women were more likely to be in clusters involving neurodegenerative conditions and men in those involving cardiovascular and cancer conditions. Higher-income individuals were more likely to be in lower morbidity clusters, except the cancer multimorbidity cluster. Healthcare utilization was elevated in all clusters relative to the healthy group, with notably higher emergency use in cardiovascular clusters and more hospital admissions in cancer-related clusters. The study shows that disease accumulation follows identifiable patterns linked to sociodemographic factors and underscores the propagative nature of multimorbidity. Further, healthcare utilization is shaped more by condition type than by the number, highlighting the need for targeted health services.
Eur J Public Health
· 2026 Mar · PMID 41847869
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Despite consistent evidence of higher anxiolytic, hypnotic, and sedative (AHS) use among adolescent girls, influence of country-level context in shaping gendered patterns remains unexplored. This study examines how natio...Despite consistent evidence of higher anxiolytic, hypnotic, and sedative (AHS) use among adolescent girls, influence of country-level context in shaping gendered patterns remains unexplored. This study examines how national gender inequality and economic factors affect adolescent AHS use and its gender differences in Europe. We analysed cross-sectional data from 96 954 adolescents aged 15-16 across 32 European countries using the 2019 European School Survey Project on Alcohol and Other Drugs (ESPAD). Countries were grouped into tertiles according to the Gender Inequality Index (GII), GDP per capita and Gini index. We calculated lifetime AHS use prevalence and gender prevalence ratios (PRs). Multilevel logistic regressions estimated the contribution of country-level context to consumption variability, and the association of national inequalities and wealth with boys' and girls' consumption, adjusting for individual sociodemographic variables and AHS accessibility. Most countries showed significantly higher AHS use among girls. Countries with higher gender and income inequality and lower GDP per capita reported overall lower consumption and wider gender gaps (e.g. PRGII-Low = 1.18 [1.12-1.25], PRGII-High = 1.49 [1.40-1.59]). Country-level context accounted for 6.7% of between-country consumption variance. Significant interactions between country level context and gender were found, such that gender gaps were wider in countries with greater gender inequality (ORGII-Med*Girls = 1.16 [1.05-1.28], ORGII-High*Girls = 1.33 [1.19-1.48]), lower GDP per capita (ORGDP-Low*Girls = 1.25 [1.12-1.38]), and higher income inequality (ORGini-High*Girls = 1.19 [1.07-1.32]). Structural inequalities in gender and wealth were associated with adolescent AHS use across Europe. Focusing on cultural factors, medicalisation processes and their gendered impact could provide a meaningful framework for mental health interventions.
Falcon M, Rodríguez-Blázquez C, Fernández-Gutiérrez M
… +3 more, Forjaz MJ, Bas-Sarmiento P, Romay-Barja M
Eur J Public Health
· 2026 Mar · PMID 41847868
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Vaccination is a modifiable behaviour resulting from a complex decision-making process influenced by a wide range of factors, including the '7Cs' model (confidence, complacency, constraints, calculation, collective respo...Vaccination is a modifiable behaviour resulting from a complex decision-making process influenced by a wide range of factors, including the '7Cs' model (confidence, complacency, constraints, calculation, collective responsibility, compliance, and conspiracy) and the ability to find, understand, evaluate and use vaccine information. This work aimed to analyse the intention to receive a booster dose of the COVID-19 vaccine in Spain in the subsequent rollout of the COVID-19 vaccination campaign and how it was influenced by COVID-19 vaccination health literacy and the '7Cs' determinants of vaccine hesitancy. A descriptive cross-sectional study was conducted in February 2022 using an online survey. The sample comprised 1067 participants aged 18 or older, representative of the Spanish general population. Willingness to receive an additional booster dose of the COVID-19 vaccine was assessed using a single yes/no answer question. Determinants of vaccine readiness were evaluated through seven statements aligned with the 7Cs model, adapted to the COVID-19 context. A multivariable logistic regression showed that vaccination intention was influenced by Confidence (OR = 3.79; 95% CI = 2.58-5.58), Calculation (OR = 0.63; 95% CI = 0.45-0.90), Collective Responsibility (OR = 0.52; 95% CI = 0.32-0.86), Compliance (OR = 2.10; 95% CI = 1.42-3.09), Conspiracy (OR = 0.46; 95% CI = 0.29-0.74), and vaccine related HL (OR = 1.03; 95% CI = 1.02-1.06). Fostering vaccination health literacy, strengthening trust in science and health professionals, fighting misinformation and enhancing collective responsibility are relevant aspects for designing effective vaccination campaigns.
Ďurček P, Nechalová L, Špánik M
… +2 more, Bleha B, Bielik V
Eur J Public Health
· 2026 Apr · PMID 41758579
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This study explores regional differences in physical fitness among Slovak school children, focusing on predictors such as school infrastructure, socioeconomic factors, life expectancy, and body mass index (BMI). It aims...This study explores regional differences in physical fitness among Slovak school children, focusing on predictors such as school infrastructure, socioeconomic factors, life expectancy, and body mass index (BMI). It aims to provide a comprehensive, gender-specific analysis of systemic and environmental determinants influencing physical fitness. Data from the Slovak Olympic and Sports Committee's National Physical Fitness Project during the 2023-24 academic year included 42 741 students aged 12-16 from all eight regions of Slovakia. Physical fitness was assessed using the EUROFIT test battery. Predictors included regional socioeconomic indicators (e.g. unemployment, education), health determinants (e.g. BMI, life expectancy), and school infrastructure. Factor analysis reduced multicollinearity, and regression models were stratified by gender across Grades 6-7 and 8-9. BMI emerged as the strongest negative predictor of physical fitness (-0.64 for younger boys, -0.41 for older boys). Life expectancy positively influenced fitness (up to 0.50 for older boys). Higher knowledge capital was associated with lower fitness, especially in younger students (-0.26 for boys and -0.15 for girls). Social vulnerability and gender equality had a pronounced negative impact on girls (-0.68), while insufficient school infrastructure reduced fitness in older boys (-0.44). The regression models explained 58%-71% of variance in physical fitness (R2 = 0.58-0.71). This study highlights the multifactorial nature of physical fitness disparities among school children, emphasizing the roles of BMI, socioeconomic factors, and school infrastructure. The findings underscore the need for targeted interventions addressing systemic inequalities to improve physical fitness and health equity in school-aged populations.
Elonheimo HM, Cucu A, Cristisor G
… +9 more, Ursu C, Dima C, Milos P, Franceschini G, Dibiagio K, Papa R, Petrelli M, Zaletel J, Tolonen H
Eur J Public Health
· 2026 Apr · PMID 41740001
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Cardiovascular diseases and diabetes mellitus are major noncommunicable diseases contributing significantly to disease burden on individuals and societies. Both are largely preventable through early intervention and effe...Cardiovascular diseases and diabetes mellitus are major noncommunicable diseases contributing significantly to disease burden on individuals and societies. Both are largely preventable through early intervention and effective risk factor management. Prevention requires timely data about population-level risk factors and identification of high-risk individuals. The Joint Action JACARDI reviewed self-measuring methods for blood glucose and cholesterol. Results indicate that dried blood spot and capillary blood stored in microtubes/capillary tubes provide close agreement with venous samples for glycated hemoglobin, and dried blood spot samples for triglycerides, but sample collection and handling require standardization. Meanwhile, they are not suitable for diagnostic purposes.
de Groot S, Wijbenga L, Bültmann U
… +6 more, Amick BC, Reijneveld SA, Korevaar EL, Hofstra J, de Winter AF, Veldman K
Eur J Public Health
· 2026 Mar · PMID 41738385
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Associations between household dysfunction in childhood and school-to-work trajectories throughout young adulthood were examined along with the mediating role of adolescent mental health problems. Data from 1134 particip...Associations between household dysfunction in childhood and school-to-work trajectories throughout young adulthood were examined along with the mediating role of adolescent mental health problems. Data from 1134 participants in the Dutch prospective cohort TRacking Adolescents' Individual Lives Survey (TRAILS) with 18-year follow-up were used. Factors of household dysfunction were assessed at age 11; (1) parental socio-economic status (SES), (2) parental mental health, and (3) parental divorce. Mental health was assessed at age 16. School-to-work trajectories from ages 20 to 28 were identified using sequence and hierarchical clustering analysis. Structural equation modelling was used to examine direct effects of household dysfunction on school-to-work trajectories, and the mediating role of mental health. Young adults with low parental SES backgrounds were more likely to follow trajectories of Neither in Education, Employment, nor Training or early work (adjusted odds ratio [aOR] 3.83, 95% confidence interval [CI] 2.24-6.54 and aOR 5.15, 95% CI 3.13-8.49, respectively) compared to a study to work trajectory. Young adults whose parents divorced in childhood were less likely to follow an early work trajectory, compared to a study to work trajectory (aOR 0.63, 95% CI 0.40-0.92). Parental mental health problems were not associated with school-to-work trajectories. Adolescent mental health did not mediate the associations between household dysfunction and school-to-work trajectories. Our study showed the importance of childhood parental SES, relative to other parental factors, for young adults' school-to-work trajectories. More research in larger samples is needed to unravel the underlying mechanisms to better inform policy and practice.
Kokole D, Neufeld M, Olsen A
… +4 more, Ferreira-Borges C, Paradis C, Rehm J, Correia D
Eur J Public Health
· 2026 Mar · PMID 41719141
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Understanding how knowledge of alcohol-related harms relates to policy support can inform strategies to increase acceptance of alcohol policies. This study examines the relationship between the two across five EU countri...Understanding how knowledge of alcohol-related harms relates to policy support can inform strategies to increase acceptance of alcohol policies. This study examines the relationship between the two across five EU countries. Online survey measuring knowledge of alcohol-related health consequences and alcohol policy support was conducted in October-November 2024 (N = 3620). Associations were analysed using adjusted linear regression models. Support for alcohol control measures was largely consistent across the countries and was lowest for increasing alcohol price and highest for implementing drink-driving measures. Factor analysis of 15 policy items showed four factors: Supportive and Educational interventions, Marketing and Youth Protection policies, Point of Sale and Display Regulation policies and Pricing and Physical Availability control policies. After adjusting for sociodemographic characteristics and alcohol consumption patterns, knowledge of alcohol causing cancer was positively associated with support for Point of Sale and Display Regulation (β = 0.18, 95% CI: 0.11 to 0.25) and Pricing and Physical Availability control policies (β = 0.12, 95% CI: 0.05 to 0.19). Belief that wine benefits heart health was negatively associated with support for Marketing and Youth Protection policies (β = -0.09, 95% CI: -0.16 to -0.02) and Pricing and Physical Availability control policies (β = -0.11, 95% CI: -0.18 to -0.04). This study replicates the previous findings demonstrating the relationship between cancer knowledge and support for population-level alcohol policies in the European context. Interventions aimed at increasing this knowledge should be considered a critical foundation for effective alcohol control efforts, as informed publics are more likely to support and engage with population-level measures.
Yang H, Martin A, Dawkins B
… +2 more, Relton S, Howdon D
Eur J Public Health
· 2026 Apr · PMID 41700845
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Rising fuel prices have increased the prevalence of fuel poverty, forcing households to make trade-offs between spending on energy and food, a dilemma often described as 'heat or eat'. While prior studies have mentioned...Rising fuel prices have increased the prevalence of fuel poverty, forcing households to make trade-offs between spending on energy and food, a dilemma often described as 'heat or eat'. While prior studies have mentioned reductions in food expenditure or intake under these circumstances, less is known about the impact on overall diet quality among older adults. We analysed the association between fuel poverty and diet quality among adults aged over 50 in England using cross-sectional data from Wave 9 of the English Longitudinal Study of Ageing (ELSA; n = 3919). Diet quality was assessed using the Healthy Diet Indicator (HDI) score and daily fruit and vegetable intake. Fuel poverty was defined using three measures: the 10% threshold, the Low-Income High Costs (LIHC) indicator, and a subjective self-reported measure. Ordinal logistic regression was used for HDI, and ordinary least squares regression for fruit and vegetable intake. Older adults identified as fuel poor under the LIHC indicator had lower HDI scores (OR = 0.83) and consumed 0.41 fewer portions of fruit and vegetables per day compared with those not in fuel poverty. No consistent associations were observed when fuel poverty was defined using the 10% threshold or the subjective measure. Fuel poverty, when defined by the LIHC indicator, is negatively associated with diet quality in later life. Addressing fuel poverty may therefore support improved nutrition and health among older adults.
Serra-Prat M, Lavado À, Burdoy E
… +3 more, Papiol M, Muñoz L, Cabré M
Eur J Public Health
· 2026 Mar · PMID 41698004
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The Electronic Screening Index of Frailty (e-SIF) was first validated in 2022 in a sample of 9315 people, but further studies in larger populations were recommended to corroborate those findings. The objective was to eva...The Electronic Screening Index of Frailty (e-SIF) was first validated in 2022 in a sample of 9315 people, but further studies in larger populations were recommended to corroborate those findings. The objective was to evaluate e-SIF construct validity, in a large and independent sample from that used for its initial validation, by analysing score associations with age, sex, hospitalizations, institutionalizations, mortality, and health resource use. An observational 2-year longitudinal study (2018-2019) was conducted of the Catalan population aged ≥65 years (1.4 million people) using retrospectively collected data. Frailty was established according to e-SIF score. Study variables included sociodemographic characteristics, mortality, hospitalizations, institutionalizations, primary care visits, emergency visits, and day hospital sessions during the study period. The study included 1 465 312 people (mean age 75.8 years, 57.2% women). Frailty prevalence was 14.0% in women and 9.1% in men (P < .001) and progressively increased with age from 2.2% in the 65-69 age group to 38.9% in ≥95 age group. As frailty status increased, mortality, hospitalizations, institutionalizations, and health resource use also increased. Hospitalization-free survival and institutionalization-free survival worsened as frailty increased. Multivariate logistic regression models based on all 42 e-SIF items showed areas under the curve of 0.85, 0.75, and 0.82 in predicting 1-year mortality, hospitalizations, and institutionalizations, respectively. This large study corroborates the findings of the initial e-SIF validation study and reaffirms its good construct validity.
Koskinen J, Hakko H, Riipinen P
… +2 more, Sihvola N, Halt AH
Eur J Public Health
· 2026 Mar · PMID 41697988
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Antipsychotics, antidepressants, and benzodiazepines are commonly used among patients with psychotic disorders. The use of psychotropic medication, alcohol, and illicit drugs may have a major role in the fatal motor vehi...Antipsychotics, antidepressants, and benzodiazepines are commonly used among patients with psychotic disorders. The use of psychotropic medication, alcohol, and illicit drugs may have a major role in the fatal motor vehicle accidents (FMVA) involving drivers with psychotic disorders. This study on drivers involved in FMVAs in Finland investigates the post-mortem toxicology findings regarding the presence of psychotropic medication, alcohol and illicit drugs among 94 drivers with psychotic disorders and their 188 matched controls without psychiatric disorders. Drivers' suicidal intention, death category, and role in the accident were also investigated. Psychotropic medication was present in 53.2% of drivers with psychotic disorders and in 9.6% of controls at the time of their FMVA. Among the drivers with psychotic disorders, the presence of antipsychotics was detected in 30% of them, and their suicidal intentions behind FMVA were significantly associated with the presence of antipsychotics (OR 2.7) and mood stabilizers (OR 6.0). Our results suggest that, in some cases, traffic suicides among drivers with psychotic disorders may originate from long-term suicidal thoughts and occur despite antipsychotic medication. A thorough fitness-to-drive assessment should be conducted for patients with psychotic disorders, irrespective of their antipsychotic medication status.
Scarcella P, Ciccacci F, Doro Altan A
… +8 more, Madaro O, Emberti Gialloreti L, Orlando S, Donnoli C, Bisogno M, Riccardi F, Cutini R, Liotta G
Eur J Public Health
· 2026 Mar · PMID 41693330
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Biopsychosocial frailty, integrating physical, psychological, and social dimensions, significantly affects health outcomes in older adults. Hospitalization, a major contributor to healthcare burden, is strongly associate...Biopsychosocial frailty, integrating physical, psychological, and social dimensions, significantly affects health outcomes in older adults. Hospitalization, a major contributor to healthcare burden, is strongly associated with frailty. However, the role of socioeconomic determinants within frailty trajectories remains insufficiently explored. This study aimed to evaluate the association between biopsychosocial frailty trajectories and hospitalization rates, with a focus on social determinants. We conducted a retrospective cohort study involving 6086 individuals (mean age 83.6 ± 4.9 years; 65.9% women). They underwent serial frailty assessments between 2016 and 2024 using the Short Functional Geriatric Evaluation (SFGE). Frailty trajectories were categorized as improved, stable, or worsened. Hospitalization rates were analyzed through parametric/non-parametric tests and negative binomial regression models adjusted for age, baseline frailty, and psycho-physical status. Hospitalization rates increased with frailty severity: 84‰ in robust, 97‰ in pre-frail, 149‰ in frail, and 136‰ in very frail individuals (P < 0.001). Improved or stable financial conditions significantly reduced hospitalization risk (rate ratio [RR] 0.24 and 0.41, respectively), as did stable or restored informal support networks (RR 0.45 and 0.79, respectively). Improved living arrangements were also associated with reduced hospital admissions. Robust and pre-frail individuals accounted for ∼50% of all admissions. Social and economic stability are key protective factors against hospitalization in older adults, independent of physical frailty. Community-based interventions addressing social isolation and financial vulnerability could substantially reduce hospital admissions, particularly among robust and pre-frail individuals. A holistic approach integrating social, economic, and physical frailty dimensions is recommended to optimize public health strategies for aging populations.
Verhaegen KA, Charafeddine R, Paredis M
… +6 more, Taeldeman V, Loeys T, Demarest S, Bracke P, Delaruelle K, Braekman E
Eur J Public Health
· 2026 Apr · PMID 41693323
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The COVID-19 pandemic required substantive preventive measures to stop the spread of the SARS-CoV-2 virus. As the effectiveness of these measures highly depended on public adherence, understanding the determinants of com...The COVID-19 pandemic required substantive preventive measures to stop the spread of the SARS-CoV-2 virus. As the effectiveness of these measures highly depended on public adherence, understanding the determinants of compliance with preventive measures is crucial. While some influencing factors have been identified already, the role of social connection is not fully understood. Interestingly, social connection might be reciprocally affected by compliance with preventive measures in a way that poses a trade-off between social connection and compliance. Therefore, the aim of the current study was to evaluate the bidirectional relationship between social connection and compliance with preventive measures. This was done using longitudinal data from six waves (April 2020-March 2021) of the Belgian online COVID-19 Health Surveys, of a cohort of 11 974 adults. Random-intercept cross-lagged panel modelling was used to test whether social connection positively predicted subsequent compliance, and whether compliance negatively predicted subsequent social connection. Social support and social satisfaction served as social connection indicators. Compliance was modelled per separate preventive measure. The results showed that social support and social satisfaction were positively associated with subsequent compliance with several measures. Some effects were particularly pronounced in the most stringent waves. In the other direction, compliance with social restriction negatively predicted subsequent social satisfaction. Through its relation with compliance, social connection can be relevant for tackling public health crises that require public response. Vice versa, our results stress social connection as an area of concern in such crises. Thus, sustainably fostering social connection could benefit future pandemic preparedness.