European Journal of Public Health最新文献

{"title":"Measuring bio-psycho-social frailty in older adults across multiple surveys and indicators: evidence from Italy for public health policy.","authors":"Tommaso Aicardi, Elisabetta Listorti, Benedetta Pongiglione","doi":"10.1093/eurpub/ckag120","DOIUrl":"10.1093/eurpub/ckag120","url":null,"abstract":"<p><p>Detecting and measuring frailty is essential to inform health policy. Numerous frailty tools exist, but their application to population data remains limited. This study focuses on Italy and adopts a policymaker's perspective to identify practical, nationally applicable tools for bio-psycho-social frailty assessment using existing survey data. Three validated bio-psycho-social indicators-the Tilburg Frailty Indicator (TFI), the Groningen Frailty Indicator (GFI), and the Edmonton Frail Scale (EFS)-were operationalized across four population surveys (SHARE, EU-SILC, EHIS, and AVQ). The study proceeded in three steps: (i) reconstruction of each indicator within each dataset to assess items' replicability; (ii) validation of reproducible indicators by examining their psychometric properties; (iii) comparison of prevalence and predictive validity across indicators to illustrate their relative strengths and limitations. The GFI was the most replicable across surveys, while the EFS showed the strongest predictive ability. Among datasets, EHIS emerged as the most suitable platform, offering higher indicators' reproducibility and strong validity. Regional analyses revealed a clear North-South gradient, and regression models confirmed that frailty adds explanatory power for health outcomes beyond chronological age and other sociodemographic characteristics. The study demonstrates that bio-psycho-social frailty can be measured using existing national surveys, providing a low-cost and reproducible framework for national monitoring. By highlighting the added value of frailty over age in predicting health needs, it lays the groundwork for integrating frailty assessment into public health planning and supporting more equitable and effective policy responses to population ageing.</p>","PeriodicalId":12059,"journal":{"name":"European Journal of Public Health","volume":"36 4","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13368811/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148445063","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Socioeconomic inequalities and health behaviours in depression: a picture of mental health in Portugal.","authors":"Maria R Paiva Pessoa, Joana Alves, Cristiana Duarte, Carolina Reis, Amélia Nunes, João Pereira","doi":"10.1093/eurpub/ckag087","DOIUrl":"10.1093/eurpub/ckag087","url":null,"abstract":"<p><p>Depressive disorders represent the second leading cause of disability globally, and Portugal reports the second highest prevalence in Europe. Nevertheless, the role of socioeconomic factors, behavioural determinants, and potential differences in treatment remain underexplored. This study assessed socioeconomic inequalities in depression and inequity in mental healthcare utilization among Portuguese adults aged 25-65 years, and evaluated whether health behaviours mediate the socioeconomic status (SES) and depression association. We used microdata from the 2019 Portuguese National Health Interview Survey. Depression was measured through self-report and PHQ-8 (≥10, moderate and moderately-severe; ≥20, severe). Concentration curves and indices, standardized by sex and age, assessed SES-related inequality in depression; horizontal inequity in mental healthcare utilization was estimated by adjusting for morbidity. Logistic regression models estimated the SES-depression association, and mediation by health behaviours (smoking, alcohol, sedentary lifestyle, diet, BMI) was evaluated using attenuation analysis. Overall, 13.0% reported depression in the previous year and 6.8% met PHQ-8 criteria. Both were disproportionately concentrated among lower-income groups, with the strongest inequality observed for severe depression. Horizontal inequity was also observed: specialist consultations were disproportionately used by higher-income groups when adjusting for self-reported depression, whereas medication was more concentrated among lower-income individuals meeting PHQ-8 criteria. Sedentarism, BMI, and alcohol drinking partially mediated SES-depression association, reducing effect estimates by up to 23.9%. Marked socioeconomic inequalities exist in depression and mental healthcare utilization in Portugal. Strengthening equitable access to evidence-based mental healthcare and addressing upstream behavioural and socioeconomic determinants are critical to reducing the national mental health burden.</p>","PeriodicalId":12059,"journal":{"name":"European Journal of Public Health","volume":"36 4","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13330925/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148381799","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Age at menarche association with metabolic, reproductive, and sociodemographic factors: a population-based cross-sectional analysis using an outcome-wide framework in Geneva, Switzerland.","authors":"Claire Chevalier, Roxane Dumont, Shannon Mechoullam, Stephanie Schrempft, Idris Guessous, Mayssam Nehme","doi":"10.1093/eurpub/ckag118","DOIUrl":"10.1093/eurpub/ckag118","url":null,"abstract":"<p><p>A global decline in age at menarche has raised concerns about its long-term health and social consequences. This study investigates temporal trends in age at menarche in a Swiss population born between 1936 and 1989 and assesses associations with sociodemographic, metabolic, and reproductive health factors. Age at menarche was examined across birth cohorts to assess temporal trends. Using an outcome-wide analytical framework, adjusted for age, survey year, and education, logistic and linear regression models examined the associations between menarche timing and sociodemographic, metabolic, and reproductive health factors. The sample included 6462 women aged 34-75. Mean age at menarche was 13.1 years, decreasing from 14.1 (born in 1936) to 12.9 (born in 1989). Early menarche (<12 years) was associated with lower income (aOR = 0.79; 95% CI: 0.67-0.93), higher odds of hypertension (aOR 1.41; 1.18-1.67), diabetes (aOR 1.40; 1.05-1.83), hypercholesterolemia (aOR 1.27; 1.07-1.49), shorter stature (-2.12 cm), higher BMI, increased hysterectomy prevalence (aOR 1.69; 1.33-2.13), and longer reproductive lifespan (+1.59 years). Late menarche (>14 years) was associated with increased stillbirth (aOR 1.80; 1.12-2.84) and ectopic pregnancy risks (aOR 1.45; 1.04-2.00) (however to be seen as exploratory as not significant after FDR correction), different menstrual patterns, reduced reproductive lifespan (-3.12 years), and lower education (aOR 0.81; 0.71-0.93). Age at menarche has declined in Geneva and is associated with various health outcomes. Including menarche timing in clinical assessments could improve risk stratification and preventive care.</p>","PeriodicalId":12059,"journal":{"name":"European Journal of Public Health","volume":"36 4","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13329075/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148374923","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Qualitative perceptions of child and youth mental health services by caregivers in the WHO European Region: a systematic review of qualitative literature.","authors":"Tania Cardona, Katie H Atmore, Raffaella Sibilio, Jennifer Hall, Anastasia Giannaki, Penny Kalpaxi, Joao Breda, Ledia Lazeri, Tatiana Taylor Salisbury","doi":"10.1093/eurpub/ckag115","DOIUrl":"10.1093/eurpub/ckag115","url":null,"abstract":"<p><p>The rising prevalence of mental health conditions in children and young people requires responsive, high-quality care from child and adolescent mental health services (CAMHS) that consider the needs of service-users and their caregivers. This systematic review seeks to contribute evidence-based recommendations from caregivers' perspectives to inform the development of quality standards for CAMHS in the World Health Organization (WHO) European Region. A systematic review of qualitative literature on caregiver perspectives on CAMHS quality published in the WHO European Region between 1 January 2010 and 9 October 2023 in Embase, OVID MEDLINE, APA PsycINFO, Global Health, and CINAHL databases was conducted. Quantitative studies, studies focusing on neurodevelopmental disorders, inpatient, general practitioner, joint working, early-intervention, or transitional care services were excluded. The search strategy was registered on PROSPERO (ref: CRD42023467689). Data from 18 papers including the perspectives of 754 caregivers, mostly from Western Europe and particularly the UK, were thematically analysed into three main themes and sub-themes covering help-seeking, service provision, and caregiving. The study outcomes highlight the need to consider the wellbeing of caregivers as well as service-users, address the mental health literacy of caregivers, the wider community, and frontline professionals, ensure sufficient resources for a competent and appropriate workforce to address stigma and support the delivery of appropriate care, engage caregivers in care provision, design responsive and holistic services that enhance smooth care transitions, and support the active participation of young people and their caregivers in care delivery.</p>","PeriodicalId":12059,"journal":{"name":"European Journal of Public Health","volume":"36 4","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13344432/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148410865","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Europe must learn from America's assault on science.","authors":"Martin McKee, Christina Pagel, Tiago Correia","doi":"10.1093/eurpub/ckag116","DOIUrl":"10.1093/eurpub/ckag116","url":null,"abstract":"","PeriodicalId":12059,"journal":{"name":"European Journal of Public Health","volume":"36 4","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13344421/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148410873","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Heterogeneous and dynamic lung cancer mortality among immigrants relative to native-born populations in France, 2000-2021.","authors":"Patricia MacNeil, Fanny Godet, Simon Ducarroz, Gwenn Menvielle","doi":"10.1093/eurpub/ckag134","DOIUrl":"10.1093/eurpub/ckag134","url":null,"abstract":"<p><p>Immigrants tend to have lower lung cancer mortality compared to natives, with some exceptions by region of birth. To date, findings on cancer mortality among immigrants in Europe show that cancer mortality trends vary by host country, region of birth, sex, and cancer type. We aim to describe immigrant lung cancer mortality relative to natives and disparities by region of birth, clarify the role of social factors, and assess temporal trends. We used data from France's national mortality registry and population censuses to evaluate immigrant and native lung cancer mortality rates for the 2000-2021 period. We estimated sex-specific mortality rate ratios (MRRs) to assess relative lung cancer mortality by region of birth. Interaction was tested and analyses were further stratified by social deprivation and subperiod. Within-region of birth social gradients in lung cancer mortality were assessed. Foreign-born women (MRR: 0.82; 95% CI: 0.75-0.90) and men (MRR: 0.93; 95% CI: 0.88-1.00) had lower lung cancer mortality relative to natives, with some exceptions by region of birth. Interaction and stratified analysis results show that region of birth trends differed across social deprivation groups. Results for within-group social gradients show a divergence between men and women. Differences between immigrants and natives tended to widen over time. Our study adds to our understanding of the complex mechanisms underlying lung cancer mortality among immigrants, and how they diverge from native-born population patterns. These findings highlight questions about how sex, region of birth, and social deprivation intersect in lung cancer mortality.</p>","PeriodicalId":12059,"journal":{"name":"European Journal of Public Health","volume":"36 4","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13424438/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148629860","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Moving beyond moral indignation: global health governance in an era of defunding.","authors":"Marleen Bekker","doi":"10.1093/eurpub/ckag073","DOIUrl":"10.1093/eurpub/ckag073","url":null,"abstract":"","PeriodicalId":12059,"journal":{"name":"European Journal of Public Health","volume":"36 4","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13260856/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148224102","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Europe's hot weather: a health emergency hiding in plain sight.","authors":"Hans Henri P Kluge","doi":"10.1093/eurpub/ckag140","DOIUrl":"10.1093/eurpub/ckag140","url":null,"abstract":"","PeriodicalId":12059,"journal":{"name":"European Journal of Public Health","volume":"36 4","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13401473/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148591298","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring primary care access in Finland: a mixed-methods study in the context of the updated waiting-time guarantee.","authors":"Markku Satokangas, Laura Kihlström, Satu Paatela, Ilmo Keskimäki, Henna Paananen, Liina-Kaisa Tynkkynen","doi":"10.1093/eurpub/ckag121","DOIUrl":"10.1093/eurpub/ckag121","url":null,"abstract":"<p><p>Prompt primary care (PC) access is salient for equitable care. Finland has a high level of unmet health needs, characterized by stark socioeconomic disparities and accounted for by long waiting times. In September 2023, Finland updated its legislation regulating waiting times to non-urgent general practitioner (GP) consultations, reducing the maximum waiting time to 14 days. Hereafter, PC access statistics improved. We assessed patients' views towards PC access after the policy update and how they reflect against national statistics. This is an exploratory sequential mixed-methods study in rural North Karelia, Finland. Interviews with patients and staff (n = 40) and observations (150+ hours) were conducted in a public PC centre in January-March 2024. Data on GP consultations including waiting times were obtained annually from individual-level national registers in 2017-24. Older patients with chronic health needs stated increased difficulties in navigating an increasingly digital PC and lack of access to in-person consultations. Staff reported an accelerated need for 'gatekeeping' access to GP consultations due to lack of resources. The number of all GP consultations increased 1.69-fold from 2017 to 2024, but in-person ones reduced 0.60-fold. A change in definition explained the improvement of waiting time statistics. A more robust waiting-time guarantee in Finland took place in tandem with austerity measures and a rapid shift to telemedicine. Improved PC access statistics conflict with local experiences and ignore reduced provision of in-person GP consultations, thus hiding the associated equity impacts. Our results call for investing in more nuanced monitoring of policy changes.</p>","PeriodicalId":12059,"journal":{"name":"European Journal of Public Health","volume":"36 4","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13368859/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148445023","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The relationship between social mobility and mortality: analysis of intercensal data (1991, 2001, and 2011).","authors":"Michael Rosato, Rachel McCarter, Gerard Leavey","doi":"10.1093/eurpub/ckag097","DOIUrl":"10.1093/eurpub/ckag097","url":null,"abstract":"<p><p>Persisting social disadvantage is associated with poor health and higher mortality. Increasing social mobility is, therefore, a major policy goal in the United Kingdom and other Western nations. However, the extent to which mortality is attenuated by upward social mobility is unclear, evidence from lifecourse studies suggests the persisting effects of early disadvantage. We sought to examine the relationship between intercensal social mobility and all-cause mortality. Census returns from three waves of the Northern Ireland Longitudinal Study (1991 n = 439 553; 2001 n = 446 573; 2011 n = 480 031) linked with mortality data. Using census data on 'educational attainment', 'occupational social class', 'housing tenure', and 'household car access' we derived an index of individual and household-level disadvantage and examined intercensal social mobility and all-cause mortality between 1991-2001 and 2001-2011. At each census point, all-cause mortality was positively associated with increasing social disadvantage. Relative to the least disadvantaged at each census, populations in the most disadvantaged areas recorded (hazard ratios = 3.23 (95% CI 2.49, 4.19); HR = 5.09 (4.21, 6.17), and HR = 5.30 (4.56, 6.16)) for 1991, 2001, and 2011, respectively. Compared with the socially static groups, those with generally downward social mobility showed an excess mortality, while mortality in the upwardly social mobility groups was generally lower than (or similar to) those in more socially static groups. Perhaps predictably, all-cause mortality was strongly associated with downward social mobility across time periods. Of greater concern, the Hazards associated with downward mobility appear to intensify over time. Moreover, increased social mobility appears to have little positive impact on mortality.</p>","PeriodicalId":12059,"journal":{"name":"European Journal of Public Health","volume":"36 4","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13259631/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148224087","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}