Search Results (840)

Background/Objectives: South Korea is rapidly transitioning into a super-aged society, increasing the importance of care services to ensure the health and quality of life of older adults. Although the number of professional caregivers has steadily grown, these workers face a high risk of depression due to the emotional labor inherent to their roles. This study aimed to analyze factors influencing depression among female professional caregivers by employment type (full-time and part-time) and to explore policy and practical intervention strategies to promote their mental health. Methods: Using data from the Korea Occupational Safety and Health Agency, we selected 223 professional caregivers with at least 1 year of work experience. After excluding insincere responses and male participants, 217 participants were included in the final analysis: 121 full-time and 96 part-time professional caregivers. Results: We found that full-time workers experienced higher levels of depression when they lacked access to health and safety education and could not use paid leave. Part-time workers experienced high levels of depression when engaging in physical activity <3 days per week and when exposed to violence. Conclusions: Based on these findings, the study recommends regular and systematic health and safety education, the establishment of substitute worker support to facilitate paid leave use, promotion of physical activity through education and community programs, regular violence prevention education, and comprehensive support systems for victims. This study is significant in empirically identifying depression risk factors by employment type among female professional caregivers. Future research should include male professional caregivers and employ more advanced measurement tools and longitudinal designs. Full article

Background: Ambatoboeny District in northern Madagascar faces significant health challenges due to widespread poverty, poor access to healthcare, and limited diagnostic capabilities. Despite high disease burden, data on morbidity patterns in the region are scarce. This study aims to identify the most prevalent diseases and most affected demographic groups, thus providing valuable insight into the region’s health profile. Methods: A retrospective analysis was conducted on medical records from 3678 patients who were admitted at Clinique Médicale BEYZYM, a secondary-level referral facility in Manerinerina, Boeny Region between January and December 2024. Diagnoses were retrieved from physician registration ledgers, hospitalization records, monthly laboratory reports, monthly general hospital activity reports and monthly reports from Centre de Traitement et de Diagnostic de la Tuberculose, which were cross-referenced and verified by trained clinical staff. Records were included if they contained identifiable demographic data and at least one clinical diagnosis. Diagnoses were coded using ICD-11 and were classified into 15 major categories. Results: The median patient age was 19.5 years (IQR: 7–42), with females accounting for 54% of the cohort. Most patients (87.2%) resided in Ambatoboeny. The most common reasons for admission were infectious and parasitic diseases (35.75%, 95% CI: 34.20–37.30), respiratory diseases (22.73%, 95% CI: 21.38–24.08), and diseases of the genitourinary system (13.95%, 95% CI: 12.83–15.07), collectively accounting for 72.43% of all recorded cases. Statistically significant differences in morbidity patterns were observed across age and sex groups. Conclusions: The findings underscore the multifaceted burden of disease in the Ambatoboeny District, where both infectious and chronic conditions coexist in a resource-limited setting. Delayed healthcare-seeking behavior, cultural beliefs, and diagnostic limitations further complicate care delivery. This study provides foundational data to inform targeted health policies, humanitarian medical missions, and diagnostic capacity-building tailored to local needs. Full article

The periphery of Lomami National Park in the Democratic Republic of the Congo (DR Congo) is experiencing intense and increasing hunting pressure, driven by both local subsistence needs and growing urban demand for bushmeat. This situation poses a serious challenge to sustainable natural resource management and underscores the need to realign protected-area policies with the realities faced by surrounding communities. In the absence of comprehensive ecological monitoring, this study used hunters’ perceptions to assess the current availability of mammalian wildlife around the park. From October to December 2023, surveys were conducted using a snowball sampling method with 60 hunters from nine villages bordering the park. Results show that hunting is a male-dominated activity, mainly practiced by individuals aged 30–40 years, with firearms as the primary tools. It occurs both in the park’s buffer zones and, alarmingly, within its core protected area. This practice has contributed to the local disappearance of key species such as African forest elephant (Loxodonta cyclotis), African buffalo (Syncerus caffer), and African leopard (Panthera pardus pardus), and to the marked decline of several Cephalophus species. These patterns of overexploitation reveal critical weaknesses in current conservation strategies and point to the urgent need for integrated, community-based resource management approaches. Strengthening law enforcement, improving ranger support, and enhancing participatory governance mechanisms are essential. Equally important is the promotion of sustainable alternative livelihoods—including livestock farming, aquaculture, and agroforestry—to reduce hunting dependence and build long-term resilience for both biodiversity and local communities. Full article

By 2030, the world population is projected to reach approximately 9.7 billion. One of the core objectives of the global sustainable development goals (SDGs), adopted from the 1996 World Food Summit, is to eradicate hunger by that time, meaning ensuring food security for all. The Food and Agriculture Organization (FAO) defines food security as follows: “Food security exists when all people, at all times, have physical and economic access to sufficient, safe, and nutritious food that meets their dietary needs and food preferences for an active and healthy life.” Conceptually, it is posited that food security can be understood as a nexus of four elements: Food security = Availability + Access + Utilization + Stability of a food system. This study focused specifically on the food availability component of food security. It addresses a critical gap in the existing literature: the limited understanding of the role farmworkers and their families play in sustaining food systems. Specifically, it explores how the children of Haitian farmworkers in the United States perceive agricultural labor through the lens of their family’s experiences, including their personal willingness to engage in it and their advocacy for others to pursue such work. Although qualitative in nature, this study employed the Political Economy of the Food System, also referred to as Agrifood Systems Theory or the Political Ecology of Food Systems, as its guiding theoretical framework, as it aligns closely with the study’s objectives. The data were collected between December 2022 and June 2023. The sample consisted of eight young adults (ages 18 to 29), all of Haitian descent. Overall, the findings indicated that participants commonly reported feeling a sense of inferiority and a lack of interest in and respect for farmwork as a profession during their upbringing, particularly in comparison to peers from non-farmworker households and those outside of their immediate communities. This sense of inferiority was attributed to several factors, including their upbringing, the inherent vulnerability associated with farm work, and the long-term physical toll agricultural work had on both themselves and their parents. The study’s findings carry important implications for practitioners, scholars, policymakers, and all stakeholders involved in achieving food security. They underscore the urgent need to reform labor policies and improve the conditions surrounding farm work, making it a more appealing, dignified, desirable, and sustainable occupation in the face of a growing world population. Full article

Active school transportation (AST), including walking or cycling to school, is common among children and youth in India. However, rising air pollution and public health advisories may encourage parents to restrict outdoor activities. The role of parental restrictions on children’s and youths’ participation in AST remains largely unexplored. This study examines how parental restrictions on outdoor activity influence children’s and youths’ engagement in AST. We surveyed children and youth aged 5 to 17 from 41 schools across 28 urban and rural locations in five Indian states, collecting data on AST, parental restrictions, perceptions of air pollution, sociodemographic factors, and school distance. Data were analyzed using multiple logistic regression models, adjusted and unadjusted for children’s and youths’ perceptions of air pollution, segregated by age, gender, and location. Reported parental restrictions due to air pollution were associated with lower odds of engaging in AST overall (OR = 0.625, 95% CI = 0.400–0.971), for ages 5–12 (OR = 0.460, 95% CI = 0.208–0.985, and in urban areas (OR = 0.433, 95% CI = 0.198–0.881). Adjusting for children’s and youths’ air pollution perceptions, these associations persisted in overall and urban analyses. Living over 2 kilometres from school also lowered odds of AST participation (p < 0.05 across all models). The interplay between AST, air pollution, and parental restrictions is self-reinforcing: air pollution can trigger parents to restrict child and youth mobility and reduce AST and, in turn, lower AST may contribute to worsening air quality because of increased motorized transport. Integrated policies are required to simultaneously mitigate pollution and enhance active transportation infrastructure. Full article

In Tehuacán, Puebla, Mexico, the agricultural sector is primarily dedicated to corn cultivation, which is reflected in the region’s economy, culture, and diet. This sector follows an agro-industrial production model dependent on pesticides and chemical fertilizers, which impacts both soil health and the population’s well-being. The objective of this study was to assess cytotoxic damage using the Buccal Micronucleus Cytome Assay (BMCA) in a population engaged in agricultural activities in San Diego Chalma, Tehuacán, Puebla, Mexico. Sociodemographic parameters were analyzed, along with the buccal micronucleus cytome assay, in a sample of 35 individuals composed of an agricultural group (18) and a control group (17). The agricultural group showed a significantly higher number of total micronucleated cells (Median = 714), which was 19.8 times greater than the non-agricultural group. Age, sex, basic education level, time of residence, and involvement in agricultural activities were key factors contributing to the development of buccal cell micronuclei, in addition to the use of pesticides as lambda-cyhalothrin, spinetoram, ethoprophos, carbofuran, methomyl, and chlorpyrifos ethyl without safety measures. There was an increased risk of developing micronucleated cells in males from the control group (OR = 2.386, 95% CI = 2.123–2.681) and in individuals aged 30–59 years (OR = 16.464, 95% CI = 14.315–18.935). The agricultural population for the 0–29 years presented a risk probability developing micronucleated cells of 99.8% in men and 99.9% in women, with a higher risk observed in women and in individuals who had lived their entire lives in San Diego Chalma, where they are continuously exposed to pesticides. Therefore, it is crucial to provide guidance, training, and improved public policies in the region of Puebla, Mexico. Full article

This study examines the transformative effects of gamification and active learning strategies in inclusive education, with a specific focus on students with disabilities. The objective was to explore how these methodologies can improve participation, motivation, and accessibility in post-pandemic educational contexts, where virtuality has become more relevant. A descriptive methodological approach was employed, consisting of three phases: data collection through surveys, analysis of results using descriptive statistics, and comparison with previous studies. The population consisted of 111 Ecuadorian teachers from different educational levels. The findings indicate that teachers between the ages of 31 and 35 are most likely to implement gamification, particularly in virtual environments. Barriers such as poor training and technological limitations were identified. It was concluded that gamification is an effective pedagogical tool for promoting inclusion, provided it receives institutional support and is tailored to individual needs. These results support the need to promote educational policies that strengthen teaching innovation in favor of a more equitable education. The findings should be interpreted with caution, as the study relied on a single-country sample of Ecuadorian teachers, which restricts the generalizability of results. Nevertheless, the outcomes suggest promising directions for future research, particularly through the application of multivariate analyses and longitudinal intervention studies to assess the sustained effects of gamification on inclusive education. Full article

Occupational burnout is ubiquitous yet still debated as a disease entity. Previous reviews surveyed multiple biomarkers but left their neural substrate unclear. We therefore asked: What, if any, reproducible magnetic-resonance signature characterises burnout? Following PRISMA principles adapted for mechanistic synthesis, two reviewers searched PubMed, Scopus, Google Scholar, ResearchGate and Cochrane from January 2000 to May 2025 using “MRI/fMRI” AND “burnout”. After duplicate removal and multi-stage screening, 17 clinical studies met predefined inclusion criteria (English language, MRI outcomes, validated burnout diagnosis). In total, ≈1365 participants were scanned, 880 with clinically significant burnout and 470 controls. Uniform Maslach Burnout Inventory thresholds defined cases; most studies matched age and sex, and all excluded primary neurological disease. Structural morphometry (8/17 studies) revealed consistent amygdala enlargement—predominantly in women—and grey-matter loss in dorsolateral/ventromedial prefrontal cortex and striatal caudate–putamen, while hippocampal volume remained unaffected, distinguishing burnout from PTSD or depression. Resting-state and task fMRI (9/17 studies) showed fronto-cortical hyper-activation, weakened amygdala–ACC coupling, and progressive fragmentation of rich-club networks, collectively indicating compensatory executive overdrive and global inefficiency. Two longitudinal cohorts and several intervention sub-studies demonstrated partial reversal of cortical thinning and limbic hyper-reactivity after mindfulness, exercise, cognitive-behavioural therapy, neurofeedback, or rTMS, underscoring plasticity. Across heterogeneous paradigms and populations, MRI converges on a coherent, sex-modulated but reversible brain-networkopathy that satisfies objective disease criteria. These findings justify early neuro-imaging-based triage, circuit-targeted therapy, and formal nosological recognition of burnout as a mental disorder, with policy ramifications for occupational health and insurance parity. Full article

Older adults with a refugee life experience have a disproportionate burden of mental health problems compared to non-refugee aging populations. Community-based participatory research (CBPR) is a promising approach to identify the challenges and strengths of older refugee adults and identify solutions to mental health disparities. We present a case study of one such CBPR program of research with older ethnic Nepali Bhutanese adults resettled in North America, Project Bhalakushari. We highlight the many opportunities to integrate older adults and members of the broader Bhutanese community in activities throughout the research process, starting with forming academic–community partnerships, identifying the needs and strengths of the community, conducting research, and sharing study findings with a broad audience of community members, health practitioners, policy-makers, and academics. Our case study emphasizes that a successful, culturally informed partnership should consider the involvement of the entire community, regardless of age, in the initiative to secure buy-in and support and maximize the positive impact of the work. We identify concrete strategies to overcome challenges specific to conducting research, with a focus on recruitment, outreach, and data collection. Full article

Background and Aim: In 2021, healthcare expenditure in Italy represented 7.3% of the national gross domestic product, with approximately 80% attributed to the management of chronic diseases—an increasing burden associated with population aging. Population stratification tools have emerged as critical instruments for the efficient allocation of healthcare resources, particularly for high-need, high-cost individuals. This systematic review aimed to identify, classify, and evaluate existing population stratification tools based on their characteristics, validation status, and practical applications. Methods: A systematic literature review was conducted in accordance with the PRISMA 2020 guidelines to examine adult population stratification models grounded in healthcare needs. The review encompassed studies retrieved from major scientific databases and included both national and international implementations. Results: The initial search yielded 140,111 records, from which 17 distinct stratification tools were identified. Of these, nine had undergone validation through peer-reviewed studies. Within the Italian context, only six tools were in active use—three of which were developed as region-specific algorithms, while the remaining three employed internationally established software platforms. Conclusions: Population stratification tools provide a robust framework for assessing both clinical complexity and resource utilization, thereby facilitating the design of integrated care pathways and evidence-based policy decisions. In the context of proactive and personalized healthcare delivery, such tools play a pivotal role in enhancing system efficiency, informing strategic planning, and promoting equitable access to care. Full article

Background: As global populations age, the demand for effective and compassionate geriatric care has intensified. Humanized nursing emphasizes empathy and person-centered care, while community-based nursing builds on local resources and networks to support health and well-being. Together, these approaches offer promising strategies for improving care for older adults. This integrative review explores the evolution, clinical contributions, and implementation barriers of these models. Methods: A comprehensive literature search was performed using PubMed, CINAHL, Scopus, and Web of Science, targeting peer-reviewed studies, including qualitative and quantitative studies published between 2010 and 2025, that involved adults aged 60 years and older. Inclusion criteria emphasized humanized and community-based nursing interventions while excluding non-nursing and pediatric-focused studies. Quality appraisal was performed using CASP and JBI checklists, and data were thematically synthesized. Results: Evidence indicates that these care models significantly improve functional independence and psychosocial well-being and reduce hospital readmissions. For instance, community-based care in Taiwan improved activities of daily living in dementia patients by 15%, while U.S.-based programs reduced depressive symptoms by 30% among Latino older adults. Interdisciplinary, nurse-led interventions in South Korea and Puerto Rico showed a 22% reduction in readmissions and an 85% increase in care access. Despite these benefits, numerous barriers hinder widespread implementation, including workforce shortages, inadequate funding, fragmented healthcare systems, cultural resistance, digital literacy challenges, and policy constraints, particularly in low-resource settings such as the Philippines and Nepal. Conclusions: These findings underscore the transformative potential of humanized and community-based nursing while highlighting the need for targeted strategies such as task-shifting, inclusive technologies, and policy reform to advance equitable, sustainable geriatric care globally. Full article

Background: Cardiovascular morbidity and mortality are alarmingly high in Bulgaria, partly due to behavioral risk factors such as smoking. Purpose: This study aimed to assess and compare smoking habits, second-hand smoke exposure, and attitudes of Bulgarian and foreign medical students to better understand smoking behavior in this population. Methods: A cross-sectional survey was conducted among 1063 medical students at the Medical University of Plovdiv (60.8% women; 53% Bulgarian). Results: More Bulgarian students were active smokers and ever-smokers than foreign students (24.7% vs. 14% and 29.3% vs. 18.8%, p < 0.001). Bulgarian women smoked nearly as much as Bulgarian men (24.1% vs. 25.6% for active smokers, p > 0.05), whereas foreign women smoked less than foreign men (15.7% vs. 23.7%, p = 0.034). Women more often replaced classic cigarettes with tobacco heating systems (THSs) than men (40.7% vs. 25.3%, p = 0.020). Nearly 85% of the respondents started smoking by the age of 19. Exposure to second-hand smoke among friends, among colleagues, and in the family was associated with a higher risk of being an ever-smoker (ORs ~8.9; 3.4 and 3.7, respectively). About 20% of students were unsure or disagreed that smoking fewer cigarettes, THSs, or e-cigarettes posed health risks. The majority (61.3%) of active smokers acknowledged negative health effects. Conclusions: These findings highlight a concerning smoking prevalence among Bulgarian medical students and emphasize the need to strengthen medical education and health policies with updated tobacco risk information and targeted prevention programs to reduce smoking and improve future physicians’ cessation counseling skills. Smoking likely contributes significantly to Bulgaria’s high cardiovascular morbidity. Full article

Over the past 30 years, the City of Portland, Oregon, USA, has emerged as a national leader in green stormwater infrastructure (GSI). The initial impetus for implementing sustainable stormwater infrastructure in Portland stemmed from concerns about flooding and water quality in the city’s two major rivers, the Columbia and the Willamette. Heavy rainfall often led to combined sewer overflows, significantly polluting these waterways. A partial solution was the construction of “The Big Pipe” project, a large-scale stormwater containment system designed to filter and regulate overflow. However, Portland has taken a more comprehensive and long-term approach by integrating sustainable stormwater management into urban planning. Over the past three decades, the city has successfully implemented GSI to mitigate these challenges. Low-impact development strategies, such as bioswales, green streets, and permeable surfaces, have been widely adopted in streetscapes, pathways, and parking areas, enhancing both environmental resilience and urban livability. This perspective highlights the history of the implementation of Portland’s GSI programs, current design and performance standards, and challenges and lessons learned throughout Portland’s recent history. Innovative approaches to managing runoff have not only improved stormwater control but also enhanced green spaces and contributed to the city’s overall climate resilience while addressing economic well-being and social equity. Portland’s success is a result of strong policy support, effective integration of green and gray infrastructure, and active community involvement. As climate change intensifies, cities need holistic, adaptive, and community-centered approaches to urban stormwater management. Portland’s experience offers valuable insights for cities seeking to expand their GSI amid growing concerns about climate resilience, equity, and aging infrastructure. Full article

(1) Background: Dioxins and dioxin-like polychlorinated biphenyls (dl-PCBs) are persistent organic pollutants (POPs), characterized by high toxicity and strong lipophilicity, which promote their bioaccumulation in human tissues. Their detection in breast milk raises concerns about early-life exposure during lactation. Although dietary intake is the primary route of maternal exposure, environmental pathways—including inhalation, dermal absorption, and residential proximity to contaminated sites—may also significantly contribute to the maternal body burden. (2) Methods: This narrative review examined peer-reviewed studies investigating maternal and environmental determinants of dioxin and dl-PCB concentrations in human breast milk. A comprehensive literature search was conducted in PubMed, Scopus, and Web of Science (2000–2024), identifying a total of 325 records. Following eligibility screening and full-text assessment, 20 studies met the inclusion criteria. (3) Results: The included studies consistently identified key exposure determinants, such as high consumption of animal-based foods (e.g., meat, fish, dairy), living near industrial facilities or waste sites, and maternal characteristics including age, parity, and body mass index (BMI). Substantial geographic variability was observed, with higher concentrations reported in regions affected by industrial activity, military pollution, or inadequate waste management. One longitudinal study from Japan demonstrated a declining trend in dioxin levels in breast milk, suggesting the potential effectiveness of regulatory interventions. (4) Conclusions: These findings highlight that maternal exposure to dioxins is influenced by identifiable environmental and behavioral factors, which can be mitigated through public health policies, targeted dietary guidance, and environmental remediation. Breast milk remains a critical bioindicator of human exposure. Harmonized, long-term research is needed to clarify health implications and minimize contaminant transfer to infants, particularly among vulnerable populations. Full article

Background/Objectives: Despite growing interest in oral frailty as a public health issue, no nationwide study has assessed regional differences in oral frailty awareness, and the factors associated with such differences remain unclear. This study investigated regional differences in oral frailty awareness among older adults in Japan and identified the associated individual- and municipal-level factors, focusing on local policy measures and community-based oral health programs. Methods: A cross-sectional analysis was conducted using data from the 2022 wave of the Japan Gerontological Evaluation Study. The analytical sample comprised 20,330 community-dwelling adults aged ≥65 years from 66 municipalities. Awareness of oral frailty was assessed via self-administered questionnaires. Individual- and municipal-level variables were analyzed using multilevel Poisson regression models to calculate prevalence ratios (PRs). Results: Awareness of oral frailty varied widely across municipalities, ranging from 15.3% to 47.1%. Multilevel analysis showed that being male (PR: 1.10), having ≤9 years (PR: 1.10) or 10 to 12 years of education (PR: 1.04), having oral frailty (PR: 1.04), and lacking civic participation (PR: 1.06) were significantly associated with lack of awareness. No significant associations were found with municipal-level variables such as dental health ordinances, volunteer training programs, or population density. Conclusions: The study found substantial regional variation in oral frailty awareness. However, this variation was explained primarily by individual-level characteristics. Public health strategies should focus on enhancing awareness among socially vulnerable groups—especially men, individuals with low educational attainment, and those not engaged in civic activities—through targeted interventions and community-based initiatives. Full article