Search Results (748)

Rapid socio-spatial change in China’s traditional villages threatens living heritage and weakens locally grounded identity. This paper theorizes place identity as a dynamic, embodied and performative ecology and examines it in Dali Dong Village across four dimensions, emotional attachment, symbolic meaning, continuity and behavioural commitment, using a triangulated qualitative design that integrates interviews, spatial observation and visual ethnography. Findings show that identity is enacted around ritual architectures and everyday settings, particularly the Drum Tower, Flower Bridge, and Sa altar. Emotional attachment and symbolic meaning are expressed consistently across sources, whereas continuity and behavioural commitment are uneven, shaped by ritual fatigue (compressed rehearsal windows), symbolic commodification under tourism, and selective continuity in intergenerational transmission. These mechanisms identify where the identity fabric is most fragile and where intervention leverage lies. Conceptually, the study relocates place identity from cognition-centred, urban models to ritualized rural lifeworlds. Practically, it offers a portable framework for community-anchored stewardship that can be adapted to similar settlements and aligned with policy aims for safeguarding living heritage. Full article

Background/Objectives: Headache disorders, including migraine and tension-type headache (TTH), are among the most prevalent and disabling neurological conditions globally. This study aimed to evaluate temporal changes, demographic disparities, and socio-geographic variation in the burden of headache disorders across European countries. Methods: We analyzed data from the Global Burden of Disease Study 2021, covering 45 European countries grouped into Western, Central, and Eastern regions. We examined age-standardized prevalence, incidence, and disability-adjusted life year (DALY) rates for headache disorders between 1990 and 2021. Analyses were stratified by sex, age group, region, and country-level socio-demographic index (SDI). All estimates were reported with 95 percent uncertainty intervals where relevant. Spearman correlation was used to assess associations between disease burden and SDI. Results: Between 1990 and 2021, the number of individuals with headache disorders in Europe rose from 345.0 to 370.6 million, although age-standardized prevalence remained stable. The burden of migraine slightly increased, with age-standardized DALY rates rising from 648.35 to 657.27 per 100,000 population. Conversely, TTH showed a minor decline in both prevalence and DALY rates. Women and individuals aged 30 to 44 years consistently exhibited the highest burden, particularly for migraine. Higher SDI scores were positively correlated with DALY rates for migraine (rho = 0.392, p = 0.008) but negatively correlated for TTH (rho = −0.466, p = 0.001). Conclusions: Headache disorders continue to pose a major and largely unmitigated health burden across Europe. Regionally targeted strategies are essential to reduce disability and improve outcomes across diverse European populations. Full article

Understanding the relative contribution of modifiable risk factors to cancer morbidity and mortality is crucial for designing effective cancer prevention and control strategies. Our study estimated cancer-related deaths and disability-adjusted life years (DALYs) lost attributable to potentially modifiable risk factors in Australia using data from the Global Burden of Diseases 2021 study. In 2021, an estimated 20,409 cancer deaths (37.5%) and 431,575 cancer DALYs lost (37.9%) in Australia were attributable to potentially modifiable risk factors. Males had higher modifiable risk attributed to cancer death and DALY rates than females. Behavioral risks accounted for 25.0% of cancer deaths and 26.5% of DALYs. Metabolic risks and environmental/occupational risks accounted for 9.4% and 9.3% of deaths, respectively. Smoking remained the leading attributable risk factor, accounting for 12.2% cancer deaths and 13.1% DALYs lost. Dietary risks accounted for 40.0% of colorectal cancer deaths and DALYs lost. Cervical, larynx, liver, lung, and colorectal cancers had a high proportion of deaths and DALYs lost attributed to modifiable risks. Liver and nasopharyngeal cancers had the highest burden attributed to alcohol use (39.1% and 39.0%, respectively), while 21.3% liver cancer deaths were attributed to drug use. Strengthening public health interventions, such as multi-disciplinary approaches to promote a healthy lifestyle, is required. Full article

Background: Dengue virus infection is a significant challenge for global health, with 100 million symptomatic cases, 2.3 million DALYs and 20,000 deaths annually. Dengue vaccines must provide long-lasting immunity against all four virus serotypes, especially in dengue-naïve individuals, in order to avoid the severe manifestations of secondary infections. Methods: This scoping review summarizes current evidence on licensed dengue vaccines and vaccine candidates, focusing on immunogenicity, efficacy, and safety outcomes. To identify relevant trials, in October 2023 we queried ClinicalTrials.gov using the search term “dengue vaccines” to identify past and present vaccine candidates; the search was repeated in February 2025. Vaccines were categorized into licensed (CYD-TDV and TAK-003), late-stage (TV003/TV005), and early-stage candidates (TDEN, DPIV, V180, TVDV). Results: CYD-TDV (Dengvaxia^®) showed moderate efficacy in large trials, with higher efficacy in seropositive than in seronegative individuals. Following commercialization, an increased hospitalization risk was discovered in the latter group. Due to these findings and impossibility of screening for prior exposure in endemic settings newer vaccines are now preferred and CYD-TDV production has recently been discontinued due to declining demand. TAK-003 (Qdenga^®) demonstrated high efficacy against virologically confirmed dengue (VCD) and dengue-related hospitalization. This vaccine was generally well tolerated and is currently recommended by scientific societies and national authorities for travelers and by WHO for routine use in adults and children in endemic settings. TV003 and TV005, developed by NIAID, showed strong immunogenicity and efficacy in phase II trials and human challenge models. Preliminary results show that a single-dose of TV003 has an efficacy of 79.6% in seronegatives and 89.2% in seropositives against VCD at a 2-year follow-up. Both formulations elicited tetravalent responses with an acceptable safety profile. Other vaccine strategies, including TDEN (live-attenuated), DPIV (purified inactivated), V180 (subunit), and TVDV (DNA-based) are still in early-phase development and suffer from waning antibody titers and limited efficacy in naïve subjects. Conclusions: The development of a safe and effective vaccine remains complex due to immunologic challenges. Currently, TAK-003 is regarded as the best option for broad implementation, while TV003 and TV005 remain promising candidates due to their shorter schedule and robust immunogenicity. Further research is needed to optimize vaccine strategies in seronegative populations, immunocompromised subjects, older adults, and travelers. Full article

Background/Objectives: Mental fatigue during driving, whether passive (arising from monotony) or active (caused by cognitive overload), is a critical factor for road safety. Despite the growing interest in monitoring techniques based on neurophysiological signals, current biomarkers are primarily validated only for detecting passive mental fatigue under monotonous conditions. The objective of this study is to evaluate the sensitivity of the MDrow index, which is based on EEG Alpha band activity, previously validated for detecting passive mental fatigue, with respect to active mental fatigue, i.e., the mental fatigue occurring in cognitively demanding driving scenarios. Methods: A simulated experimental protocol was developed featuring three driving scenarios with increasing complexity: monotonous, urban, and urban with dual tasks. Nineteen participants took part in the experiment, during which electroencephalogram (EEG), photoplethysmogram (PPG), and electrodermal activity (EDA) data were collected in addition to subjective assessments, namely the Karolinska Sleepiness Scale (KSS) and the Driving Activity Load Index (DALI) questionnaires. Results:The findings indicate that MDrow shows sensitivity to both passive and active mental fatigue (p < 0.001), thereby demonstrating stability even in the presence of additional cognitive demands. Furthermore, Heart Rate (HR) and Heart Rate Variability (HRV) increased significantly during the execution of more complex tasks, thereby suggesting a heightened response to mental workload in comparison to mental fatigue alone. Conversely, electrodermal measures evidenced no sensitivity to mental fatigue-related changes. Conclusions: These findings confirm the MDrow index’s validity as an objective and continuous marker of mental fatigue, even under cognitively demanding conditions. Full article

Engaging vulnerable migrants in nature-based activities demonstrates that access to green space can provide a safe place to process trauma, allowing vulnerable forced migrants to enhance their sense of subjective well-being, to breathe and to be. Framed by the feminist ethics of care concept of ‘universal care’, this qualitative study utilised semi-structured interviews, focus group discussion and participant observation to explore asylum seekers’ opportunities for giving and receiving care for people and planet in green spaces outside of institutional international protection accommodation, particularly among those who have access to community gardens. This research contributes to understanding the multigenerational benefits of green space and the potential of forms of horticultural therapy to support the health and well-being of vulnerable forced migrants of all ages. This research has implications for how care for international protection applicants could be enhanced in Ireland and elsewhere through expanding access to safe and inclusive green spaces. It provides a model of a landscape of care support mitigation of pre- and post-migration trauma and mental stress. Full article

This study integrates the health impacts of environmental burdens and dietary intake using disability-adjusted life years (DALYs) to inform a healthier, more sustainable Japanese diet. Climate change, air pollution, ozone depletion, photochemical oxidants, and water consumption were quantified with Life cycle Impact assessment Method based on Endpoint modeling (LIME), while eleven dietary risks were converted to DALYs using dietary risk factors. Recipes collected online on a per-serving basis were classified into staple, main, side, and soup dishes and stratified into quartiles based on a nutrient profiling system (NPS) tailored to Japanese well-consumed dishes—the Ajinomoto Group NPS (ANPS) for dishes. ANPS—a culturally adapted NPS emphasizing protein, vegetables, sodium, and saturated fatty acids—was regressed against total DALYs to test whether higher ANPS scores correspond to lower combined health impacts of environment and diet. The analysis identified dish groups and high-scoring quartiles that minimized environmental and nutrition-related DALYs, revealing practical dish combinations that balance reduced sodium and red meat with increased vegetables, seafood, and nuts. These findings demonstrate the utility of coupling nutrient profiling with life cycle assessment (LCA) and provide a scientific basis for dietary guidelines that jointly advance human and planetary health within the emerging nutritional LCA framework. Full article

Person-centred cultures are increasingly recognised as essential to the delivery of compassionate, safe, and effective healthcare. While Lean Six Sigma (LSS) is widely adopted as a process improvement methodology, its application is often critiqued for lacking alignment with relational or values-based care. This study aimed to test the transferability of three previously developed Programme Theories (PTs), generated through realist inquiry in a public hospital setting, within a large private acute hospital. Realist-informed adjudication workshops were conducted with interdisciplinary staff who had completed university-accredited training in LSS. Structured workbooks, visual artefacts, and thematic synthesis were used to identify how context–mechanism–outcome configurations (CMOCs) held, shifted, or evolved in the new setting. All three PTs were confirmed, with six CMOCs refined, and eight new configurations generated. Key refinements included the role of strategic intent, informal improvement communities, and intrinsic motivation. These findings suggest that values-based mechanisms underpinning person-centred LSS are not confined to public systems and may be equally active in private settings. The study confirms the explanatory strength of the original PTs while contributing new insights into their adaptability. It offers practical guidance for healthcare leaders seeking to embed person-centred improvement approaches across diverse systems, regardless of sectoral funding or governance structures. Full article

Fibrotic diseases contribute to nearly half of all deaths in industrialized countries, yet effective early detection strategies remain lacking, particularly in low-resource settings. This study aimed to quantify the global burden of fibrosis-related diseases using updated global burden of disease (GBD) 2021 data across 204 countries and territories and establish a cost-effective diagnostic approach targeting vestigial-like family member 3 (VGLL3), a fibrosis-associated transcriptional co-regulator. Our analysis revealed that from 1990 to 2021, fibrosis-related disability-adjusted life years (DALYs) and mortality increased by 16.71% and 4.83%, respectively, with neoplasms and chronic obstructive pulmonary disease (COPD) being the main contributors. We also found a growing burden disproportionately concentrated in low socio-demographic index (SDI) regions. To address the diagnostic gap, we developed a novel immunoassay targeting VGLL3, an intrinsically disordered transcriptional co-regulator implicated in early fibrotic remodeling. The assay demonstrated a detection range of 27.01–2512.36 nM and a limit of detection of 12.55 nM. Immunohistochemical validation in a mouse myocardial infarction model confirmed the antibody’s specificity in fibrotic tissues. This work highlights widening global health disparities in fibrosis burden and introduces a cost-effective, scalable diagnostic strategy for early fibrosis detection, particularly suitable for resource-limited settings. Full article

Background/Objectives: Emotional fear memories are increasingly recognized as contributors to the development of specific fears and phobias. Despite this, relatively little dental fear research has specifically focused on patient memories or their potential role in the etiology of dental fear. Methods: This two-study paper employs qualitative thematic analysis of memories for dental visits among traumatized patients (study 1) and the general patient population (ranging from endorsing no dental fear to severe fear). Recollections were evaluated based on the characteristics (i.e., sensory descriptors, affectively laden, intrusive) of emotional fear memories (studies 1 and 2) and according to a modified cognitive vulnerability model of dental fear (study 2). Results: Characteristics of emotional fear memories were ubiquitous across recollections of individuals who endorsed traumatic dental visits in childhood. Among the general patient population, these characteristics and cognitive vulnerability themes (particularly perceptions of the visit and dentist as dangerous and untrustworthy) were more prevalent in the earliest remembered visits for fearful individuals. When individuals were asked to recall their worst dental visits, emotional fear memory characteristics and vulnerability perceptions were evident across the spectrum of current fear (none to severe). Conclusions: This study contributes to nascent work examining memory in specific fears and phobias and suggests that worst recollections across a general sample share many of the characteristics that might otherwise imply vulnerability for anxiety. We recommend that dental practices universally screen patients for fear, inquire about past negative experiences, partner with patients to minimize evoking their specific vulnerabilities, and diligently implement these personalized care plans. Full article

The health risks of PM_2.5-bound metals highlight the need for burden assessment, metal prioritization, and key factor analysis to support effective air quality management, yet relevant studies remain limited. Shandong Province is one of the most polluted regions in northern China, providing an ideal setting for this investigation. We monitored 17 PM_2.5-bound metals for three years across Shandong, China and performed disease burden assessment based on disability-adjusted life years (DALYs). Furthermore, key influencing factors contributing to high-hazard metals were identified through explainable machine learning. The results showed that PM_2.5-bound metal concentrations were generally higher in inland areas than in coastal regions, with Ni concentrations elevated in coastal areas. K, Ca, Zn, and Mn exhibited the highest three-year average concentrations among the metals, while Cr averaged 6.12 ng/m³, significantly exceeding the recommended annual limit of 0.025 ng/m³ set by Chinese Ambient Air Quality Standards. Jinan carried the greatest burden at 4.67 DALYs per 1000 people, followed by Zibo (3.78), Weifang (2.98), and Rizhao (2.80). CKD, interstitial pneumonia, and chronic respiratory diseases account for the highest DALYs from PM_2.5-bound metals in Shandong Province. Industrial emissions are the largest contributors to the disease burden (>34%), with Cr, Cd, and Pb as the primary contributing metals requiring priority control. Fractional vegetation cover was identified as the key factor contributing to the reduction in their concentrations. These results underscore that prioritizing the regulation of industrial combustion, particularly concerning Cr, Cd, and Pb, and enhancing fractional vegetation cover could reduce disease burden and provide public health benefits. Full article

Background/Objectives: Hepatocellular carcinoma (HCC) remains a leading cause of global cancer mortality, with increasing incidence and persistently poor survival. Hepatitis C virus (HCV) is a major risk factor for HCC, and while the advent of direct-acting antivirals (DAAs) has significantly altered HCV-related hepatocellular cancer (HCC-HCV) risk, the global burden remains substantial. With the World Health Organization (WHO) aiming to reduce hepatitis-related deaths by 2030, we set out to evaluate global HCC-HCV trends from 1990 to 2021, stratified by sex, WHO region, and sociodemographic index (SDI), using data from the Global Burden of Disease (GBD) 2021 study. Methods: We analyzed age-standardized incidence (ASI), deaths, and disability-adjusted life years (DALYs) due to HCV-HCC from 1990 to 2021 using GBD 2021 data. Trends were stratified by WHO region, sociodemographic index (SDI), and sex. Joinpoint regression modeling was used to identify statistically significant temporal inflection points and calculate the annual percent change (APC) in unique time segments and average annual percent change (AAPC) over the entire study period (1990 to 2021). Results: Globally, deaths and DALYs attributable to HCV-HCC increased over the study period while ASI declined modestly. The region of the Americas exhibited the highest AAPC in all three metrics, potentially driven by an aging HCV-infected population, rising comorbidities (e.g., obesity, diabetes), and improved case detection. Nevertheless, on a global level, high-SDI regions showed the most favorable trends, particularly after 2016, likely reflecting the earlier adoption of DAAs and a differential success of WHO goals. Lower-SDI regions continued to exhibit increasing burden. Notably, ASI began to rise again between 2019 and 2021, suggesting an ongoing need to critically evaluate and restructure our approach to reducing HCV and HCV-HCC. Conclusions: Our findings underscore the urgent need for equity-driven, region-specific strategies to achieve better control of this highly morbid disease. Full article

Vector-borne parasitic diseases (VBPDs), including malaria, schistosomiasis, leishmaniasis, Chagas disease, African trypanosomiasis, lymphatic filariasis, and onchocerciasis, impose a significant global health burden. This study analyzes the global disease burden of VBPDs from 1990 to 2021 using Global Burden of Disease (GBD) 2021 data and projects trends to 2036. Metrics include prevalence, deaths, disability-adjusted life years (DALYs), and age-standardized rates (ASRs) across regions, sexes, age groups, and Socio-demographic Index (SDI) levels. Key findings reveal persistent disparities: malaria dominated the burden (42% of cases, 96.5% of deaths), disproportionately affecting sub-Saharan Africa. Schistosomiasis ranked second in prevalence (36.5%). While African trypanosomiasis, Chagas disease, lymphatic filariasis, and onchocerciasis declined significantly, leishmaniasis showed rising prevalence (EAPC = 0.713). Low-SDI regions bore the highest burden, linked to environmental, socioeconomic, and healthcare access challenges. Males exhibited greater DALY burdens than females, attributed to occupational exposure. Age disparities were evident: children under five faced high malaria mortality and leishmaniasis DALY peaks, while older adults experienced complications from diseases like Chagas and schistosomiasis. ARIMA modeling forecasts divergent trends: lymphatic filariasis prevalence nears elimination by 2029, but leishmaniasis burden rises across all metrics. Despite overall progress, VBPDs remain critical public health threats, exacerbated by climate change, drug resistance, and uneven resource distribution. Targeted interventions are urgently needed, prioritizing vector control in endemic areas, enhanced surveillance for leishmaniasis, gender- and age-specific strategies, and optimized resource allocation in low-SDI regions. This analysis provides a foundation for evidence-based policy and precision public health efforts to achieve elimination targets and advance global health equity. Full article

This study examined the prevalence of intentionally unreported and potentially unrecognized concussions in community rugby players and whether nondisclosure reasons vary by sex, position, or playing history. An online survey was completed by 1037 players (41.0% female; mean age 31.6 ± 11.3 years; 10.1 ± 8.1 years playing) who reported diagnosed, unreported, and unrecognized concussions. Poisson regression models estimated prevalence ratios (PRs), and Fisher’s exact tests compared reasons for nondisclosure. The diagnosed, unreported, and unrecognized concussion rates were 66.5%, 32.4%, and 42.2%, respectively. Players with diagnosed concussions had a 7.2-fold higher prevalence of nondisclosure and a 2.3-fold higher prevalence of nonrecognition. A longer playing history was linked to greater nondisclosure (PR: 1.2), and males had a higher prevalence of nonrecognition (PR: 1.4). Position and sex were not associated with nondisclosure; position and playing history did not affect recognition. While nondisclosure reasons were mostly consistent across demographics, players with a history of concussion were more likely to report avoiding removal from games or practices (38.5% vs. 13.6%, p = 0.021). Concussions are common in community rugby, with high rates of underreporting and unawareness, influenced by experience and prior concussions. These findings underscore the need for better education and reporting systems to improve player safety. Full article