Search Results (10,024)

The persistently high prevalence of gender-based violence and harassment (GBVH) in higher education institutions is a well established phenomenon, as is the inadequacy of institutional responses and the silencing of those who aim or attempt to report it. Drawing on Ahmed’s concept of ‘non-performativity’, ‘institutional speech acts that do not bring into effect what they name’, this paper argues that the non-performativity of anti-bullying and harassment policy is an exercise of power, consistent with Agócs concept of institutionalised resistance. Reporting misconduct is intentionally transformational, but seen as a threat to powerful organisational actors, who exercise institutional power to enact procedures in such a way that victim-survivors are unvoiced and tricked into ‘reluctant acquiescence’ with adverse consequences on their personal and occupational health. We employ documentary analysis to critique policies and procedures for GBVH in Irish universities, and specifically how institutional power is exercised through policy documents. The analysis is based on ten pseudonymised universities, rendering a sample size of 23 documents, pertaining to GBVH for staff. We find that the tone and language employed in policies, and the way in which the informal and formal approaches in anti-bullying and harassment policies frame the problem, serve the interests of the institution. Confidentiality clauses, the framing of the problem as an individualistic, incident-based problem, to be resolved case-by-case, and quasi-legal processes facilitate non-performativity, preserving institutional power and the status quo. From a public health perspective such inertia undermines efforts to prevent harm and promote workplace wellbeing. Meaningful reform will require that HEIs employ alternative tools capable of unsettling these entrenched institutional arrangements and to adopt alternative, proactive tools that prioritise accountability, transparency, prevention and health gain. We suggest new tools in the form of victim-centred, trauma-informed, remediation- and restorative-based approaches. Full article

Background: The 2-benzylbenzimidazoles or nitazenes are an evolving class of highly potent mu-opioid receptor agonists. Nitazenes were originally developed in the late 1950s for pharmaceutical use as analgesics; however, due to their extreme potency and the risk of adverse health outcomes, pharmaceutical research was discontinued. Since 2019, nitazenes have emerged as illicit drugs of abuse, causing significant concern. From 2021, they have been detected in both coronial and clinical casework in Victoria, Australia. This study examined nitazene-related coronial casework in Victoria from 2021 to 2025 to explore the trends and characteristics of nitazene-related deaths. Methods: Relevant cases were identified from the Victorian Institute of Forensic Medicine’s (VIFM’s) case management system. Data were collated and analysed from all coronial cases where a nitazene was detected by a toxicological analysis between 1 January 2021 and 31 December 2025. Trend comparisons were made with nitazene detections reported in other countries. Results: Nitazenes were detected in 23 deaths from a total of approximately 33,108 coronial cases admitted to the VIFM for investigation over the time period. The age range was 17–45 years, with a median of 32 and with 87% of the deaths being male. The nitazenes detected were protonitazene (n = 14), metonitazene (n = 5), isotonitazene (n = 2), N-pyrrolidino etonitazene (n = 2), N-desethyl isotonitazene (n = 1), methylenedioxynitazene (n = 1) and etodesnitazene (n = 1). Two cases contained more than one nitazene; both involved protonitazene, one involved metonitazene, and the other involved N-desethyl isotonitazene and methylenedioxynitazene. The timeline of detection of these nitazenes displays similarities with emergence trends in other countries. The nitazene concentrations ranged from 0.1 to 33 ng/mL. Broad polydrug usage was evident in all cases, with other drugs co-detected in the blood including stimulants (particularly, methylamphetamine (48%) and cocaine (44%)) as well as pharmaceutical benzodiazepines (43%) and pharmaceutical opioids (22%), and 13% had 6-monoacetylmorphine detected in either blood or urine. Novel benzodiazepines (39%) were also common, including bromazolam, which was co-detected in 35% of cases. Nineteen deaths were attributed solely to nitazene-related mixed-drug toxicity, while the remaining four cases were attributed to cardiac- and pulmonary-related disease, with polydrug use deemed a contributing factor. Conclusions: This novel case series adds comprehensive toxicological information to the body of evidence reinforcing the high risk of harm associated with the use of nitazenes. It is imperative that toxicology services continue to monitor for nitazenes to promote community awareness against nitazene-related harm. Full article

Background: Maternal healthcare access is a critical determinant of women’s and neonatal health, especially in rural areas of low- and middle-income countries. Despite high reported utilization in South Africa, rural communities continue to experience adverse childbirth outcomes. Objective: To evaluate the association between maternal healthcare access and childbirth outcomes in Ingquza Hill Local Municipality, Eastern Cape Province of South Africa. Methods: A cross-sectional study was conducted among 213 pregnant and postpartum women receiving maternal healthcare services at St Elizabeth Hospital, a regional referral hospital serving multiple primary healthcare clinics across the municipality. Data were collected using structured questionnaires and maternity access indicators (including ANC attendance, timing of first ANC visit, number of visits, physical accessibility, and place of delivery), and childbirth outcomes. Logic regression analyses were performed to identify associations between access indicators and unfavorable childbirth outcomes. Results: Utilization of maternal healthcare services was high, with 96% of participants reporting ANC attendance, 92% receiving skilled care during pregnancy, and 91% delivering in a health facility. Unfavorable childbirth outcomes were observed in 12% of participants. Conventional indicators of maternal healthcare access, including ANC attendance, number of visits, physical accessibility, and place of delivery, were not statistically associated with childbirth outcomes in regression analyses. However, initiation of antenatal care was notably delayed, with a mean gestational age at first ANC visit of 21.7 weeks. The limited number of adverse outcomes constrained statistical power to detect modest associations. Conclusions: High maternal healthcare utilization alone did not ensure improved childbirth outcomes in this rural setting. Delayed initiation of antenatal care emerged as a critical gap that may limit the effectiveness of subsequent care, highlighting the limitations of coverage-based access indicators. Strategies to improve maternal and neonatal outcomes should prioritize early antenatal engagement, quality and continuity of care, and move beyond utilization metrics toward measures of effective coverage in rural and resource-limited contexts. Full article

Background: Chronic obstructive pulmonary disease (COPD) is a progressive respiratory condition where many patients are given antibiotics like amoxicillin and macrolides (clarithromycin, azithromycin, roxithromycin) for bacterial infections. Recent concerns about clarithromycin’s potential link to cardiovascular events have arisen, despite its effectiveness against respiratory pathogens. This study aims to compare the cardiovascular risk of macrolide antibiotics versus amoxicillin in suspected COPD patients. Method: We used the Danish National Health Service Prescription Database (DNHSP) to identify COPD patients and their use of antibiotics. The included COPD patients were divided into four groups: amoxicillin users, roxithromycin users, clarithromycin users and azithromycin users. Data from multiple registries were merged to track hospitalizations, causes of death, and major adverse cardiovascular events (MACEs) as the primary endpoint. Patients were followed for a 3-year period. We applied adjusted Cox regression and sensitivity analyses with IPTW and IPCW to address confounders and censoring. Results: Our study involved 45,869 patients who were prescribed a long-acting muscarinic antagonist, over the age of 40 years old and who received one of the following antibiotics: amoxicillin, azithromycin, clarithromycin, or roxithromycin. No increased risk of MACEs was observed in macrolide-treated patients compared to those treated with amoxicillin (azithromycin: HR 0.97: 95% CI 0.83–1.13 p = 0.69, clarithromycin: HR 1.06 95% CI 0.87–1.28 p = 0.57, roxithromycin: HR 1.04 95% CI 0.91–1.18 p = 0.60), as confirmed by the sensitivity analysis (azithromycin: HR 0.95 95% CI 0.82–1.11 p = 0.52, clarithromycin: HR 1.05 95% CI 0.87–1.27 p = 0.60, roxithromycin: HR 1.05 95% CI 0.92–1.19 p = 0.48). Similarly, hazard ratios for all-cause mortality and cardiovascular death among the antibiotic groups showed no significant statistical differences. Conclusions: These findings suggest that there is no difference in the risk of MACEs, all-cause mortality, or cardiovascular death between the amoxicillin group and the macrolide group in a large and unselected population of COPD patients. Full article

Background: Lipid peroxidation is a primary driver of biological membrane damage and mediates the relationship between environmental exposure and adverse health outcomes. Malondialdehyde (MDA) is a widely recognized biomarker for quantifying oxidative stress intensity. Despite numerous studies on oxidative stress and metal exposure, nonlinear relationships between physiological characteristics, serum metal profiles and MDA levels in pubertal children remain insufficiently studied. Methods: The study included 105 conditionally healthy children aged 12–14 years from urban and rural regions of Tatarstan, Russia. Serum MDA concentrations were determined spectrophotometrically using the thiobarbituric acid assay, while Zn, Cu, Fe, Sr and Pb concentrations were measured by atomic absorption spectrometry. A multilayer perceptron neural network was applied to model nonlinear relationships between MDA levels, environmental exposure indicators and morphophysiological characteristics. Because the original relational dataset contained partially replicated participant-derived relational structures, primary validation was performed using independently reconstructed datasets without repeated observations. Additional repeated cross-validation and SHAP-based feature importance analysis were performed. Results: Urban-residing children demonstrated significantly higher serum MDA levels than rural counterparts, independent of sex, with girls consistently showing higher values. Reduction of predictor dimensionality improved model generalization behaviour. Validation using independently reconstructed datasets without repeated observations demonstrated reproducible exploratory predictive behaviour of the reduced neural network model, with independently reconstructed validation datasets yielding mean R² values of 0.901 ± 0.052 and 0.914 ± 0.046, respectively. SHAP analysis demonstrated that zinc, copper and iron consistently represented the dominant contributors to the nonlinear model, although substantial variability in the relative ranking of zinc and copper was observed between validation datasets. Conclusions: The proposed neural network model demonstrated the ability to capture reproducible nonlinear relationships between oxidative stress markers and environmental exposure parameters in a limited biomedical dataset. The model should primarily be interpreted as an exploratory explanatory tool rather than an individual clinical prediction instrument. Because of the limited dataset size, partially reconstructed relational structure and exploratory study design, the findings require cautious interpretation and further external validation. Full article

Background/Objectives: The global aging population has placed escalating demands on long-term care systems, with nursing homes facing persistent challenges including chronic understaffing, high staff turnover, complex resident acuity, and elevated risk of adverse events. Artificial intelligence (AI)—encompassing machine learning, natural language processing, and computer vision—presents a transformative opportunity to address these systemic pressures by enabling proactive, data-driven care delivery. This rapid review aims to systematically map the existing literature on AI applications in nursing facilities, categorize how these technologies contribute to improvements in quality of care, and identify gaps warranting further investigation. Methods: Following Arksey and O’Malley’s framework and PRISMA-ScR guidelines, we conducted a comprehensive search of academic literature using a predefined Boolean string. The extracted data were organized and analyzed thematically. Results: The synthesized literature (n = 28 studies) revealed seven primary themes: (1) Clinical management, risk prediction, and monitoring; (2) Pressure injuries, wound management, and diagnostics; (3) Objective assessment, mental health, and end-of-life care; (4) Nutrition and personalized daily support; (5) Operational efficiency and staffing; (6) Technical, infrastructure, and economic barriers; and (7) Social, ethical, and demographic considerations. Conclusions: AI holds considerable promise for enhancing the quality of care in nursing homes across clinical, operational, and social domains. However, widespread adoption remains constrained by prohibitive infrastructure costs, data privacy regulations, algorithmic bias, staff resistance, and limited generalizability of findings across diverse populations. Successful integration requires evidence-based implementation frameworks and standardized and interoperable platforms. Full article

Introduction: Extended half-life (EHL) factor VIII (FVIII) products aim to reduce treatment burden and improve bleeding control in hemophilia A. Real-world evidence remains essential to complement clinical trials. Aim: To evaluate clinical outcomes following switching from standard half-life (SHL) rFVIII to efmoroctocog alfa in routine clinical practice in Greece. Methods: Multicenter observational pre–poststudy including patients with moderate to severe hemophilia A. Outcomes were assessed during the 12 months before and after switching. The primary endpoint was change in annualized bleeding rate (ABR). Secondary endpoints included annualized joint bleeding rate (AjBR), infusion frequency, joint health, pain, and FVIII consumption. Results: Sixty patients were included. Following switching, ABR decreased from 6.8 to 3.2 (53%), and AjBR from 6.4 to 2.9 (55%), p < 0.001. Reductions were more pronounced in patients switching from on-demand treatment, while more modest improvements were observed among patients already on prophylaxis. HJHS significantly decreased from 17.9 to 11.5 (p < 0.007), accompanied by a decrease in pain scores (p < 0.001), in available paired subsets. Weekly infusion frequency decreased (3.2 to 2.2; p < 0.001), while mean dose per infusion increased, resulting in no consistent reduction in total annual FVIII consumption. No inhibitor or treatment-related adverse events have been observed. Conclusions: Switching to efmoroctocog alfa in routine practice was associated with improved bleeding outcomes, reduced infusion frequency, and better joint-related parameters. These findings support the real world feasibility and clinical utility οf EHL FVIII therapy, while further controlled studies are needed to better define the independent effect of product switching from changes in treatment regimen and other potential confounders. Full article

Certain medications may adversely affect health during hot days and heatwaves by altering chronic conditions, comorbidities, fluid balance, or impairing heat adaptation. This study aims to develop evidence-based cross-sectoral recommendations for the safe administration of heat-sensitive medications, compiled into a so-called ‘CALOR’ list (calor: Latin for ‘heat’). Development of the CALOR list will follow a four-pillar process. First, a scoping review of scientific literature and best practices will identify potentially inadequate medications during heat events (heat-PIMs) and adaptation measures, resulting in a first draft. Second, an expert panel will refine this draft through a Delphi process to reach consensus on clinically relevant recommendations. Third, German statutory health insurance (SHI) claims data will be analysed to determine heat-PIMs prevalence; data from Cologne residents will additionally be linked with climate data to investigate health outcomes during heat events. Fourth, thirty health professionals (i.e., medical doctors, nurses, pharmacists) will field-test the CALOR list in summer, providing qualitative feedback on feasibility, leading to further refinement of the CALOR list. To our knowledge this study protocol presents the first study attempting to collate a comprehensive and actionable list of recommendations for drug safety management during hot days and heatwaves. Full article

Background and Aim: Passive smoking (PS) is a well-established risk factor associated with systemic and oral health impairments in children. However, its influence on perioperative physiological stability and recovery profiles during pediatric dental sedation remains insufficiently elucidated. This study investigated the association between PS exposure and perioperative vital parameters, recovery characteristics, and emergence behavioral outcomes in children undergoing dental extractions under sedation. Methods: This prospective cohort study (ClinicalTrials.gov: NCT06780189) included 100 ASA I children aged 4–6 years scheduled for primary molar extraction under midazolam-remifentanil-propofol sedation. Participants were stratified into three groups: no exposure, caregiver and household exposure, and household exposure only. An exposure-related relationship was evaluated based on daily household cigarette consumption. Perioperative vital signs (HR, blood pressure, and SpO₂) were continuously monitored. Postoperative recovery and emergence profiles were assessed using the Modified Aldrete Recovery Score (MASS), Richmond Agitation–Sedation Scale (RASS), and Pediatric Anesthesia Emergence Delirium (PAED) scale. Results: Children exposed to PS demonstrated significantly lower SpO₂ levels across all perioperative phases compared with non-exposed counterparts (p < 0.001), reflecting an exposure-related effect. In contrast, no statistically significant differences were observed in cardiovascular parameters (p > 0.05). Recovery time was significantly prolonged in PS-exposed children (p = 0.002). Furthermore, PS exposure was associated with significantly higher RASS and PAED scores, indicating increased agitation and emergence delirium (p < 0.001). Conclusions: Passive smoking adversely affects perioperative oxygenation, delays recovery, and exacerbates emergence neurobehavioral disturbances in children undergoing dental sedation. Environmental tobacco exposure must be integrated into preoperative risk assessments. Full article

Microplastic pollution has attracted significant attention in recent years due to evidence that these particles can accumulate in organisms’ tissues and organs and induce adverse health effects, with oxidative stress being a key underlying mechanism of toxicity. The present study investigated the effects of polystyrene microplastics (0.1 μm in diameter) administered at a dose of 0.1 mg/day/animal for 4 weeks, followed by a 2-week recovery period without exposure, on oxidative stress markers in the liver, kidney, and spleen and on hematological and blood biochemical parameters in mice. The results showed a statistically significant increase in white blood cell counts, including lymphocytes, granulocytes, and monocytes, at week 5, indicating the development of an inflammatory response. During the last week of the recovery period (week 6), values returned to levels that approached baseline. Changes in lipid peroxidation demonstrated an induction of oxidative stress, accompanied by alterations in glutathione levels and antioxidant enzyme activities, with a tendency toward recovery after cessation of polystyrene microplastic exposure. In conclusion, these findings demonstrated that even short-term exposure to low doses of polystyrene microplastics could trigger oxidative stress and inflammatory responses, highlighting their potential health risks and the need for further investigation into their long-term biological effects. Full article

The relationship between forest ecosystem services and human health has emerged as a key topic in forest economics and health policy research. This study develops a spatial modelling framework to quantify the health benefits of forest ecosystem services and proposes policy mechanisms to incorporate these benefits into governmental health strategies. Using county-level panel data from 66 administrative units in Zhejiang Province, China, covering the period 2013–2023, we analyse the relationship between forest-mediated air purification services and two population health outcomes: the incidence of respiratory diseases and cardiovascular disease mortality. We employ a Spatial Durbin Model (SDM) to estimate both direct and spatial spillover effects across county boundaries. The findings indicate that forest ecosystem services exert significant negative effects on adverse health outcomes, with spillover effects extending beyond administrative boundaries. The monetised health benefit of forests is estimated at approximately RMB 1108.6 per hectare per year, substantially exceeding current ecological compensation standards and suggesting systematic undervaluation of forest health services. Heterogeneity analysis reveals that health benefits are greater in urbanised regions and among vulnerable population groups, including the elderly. These findings provide an empirical basis for reforming health-oriented ecological compensation mechanisms and offer implications for sustainable land use governance aligned with SDG 3 (Good Health and Well-being) and SDG 15 (Life on Land). Full article

Probiotic supplements are increasingly being touted to have health benefits for pregnant women consuming such supplements and their unborn offspring. The placenta is in direct communication with maternal blood, and bioactive agents can thus easily be transferred to this organ where they may influence gene expression by the different trophoblast (TB) cell lineages. The underlying hypothesis assessed herein is that maternal probiotic supplementation can influence the placenta and fetal brain. The composition of bacterial short-chain fatty acids (SCFAs) was examined in fecal boli of mouse dams on a maternal probiotic supplement relative to control dams. Further, SCFA and transcriptomic profiles were examined in placenta and fetal brain from conceptuses derived from dams on the probiotic supplement and conceptuses from control dams. While this treatment did not affect bacterial SCFAs, placenta and fetal brain changes were evident in male and female conceptuses carried by dams receiving probiotics relative to controls. For the placenta, females were more sensitive to maternal probiotic supplementation, whereas the opposite was the case for the fetal brain. Slc6a4 showed increased expression in female placenta from probiotic-treated dams, which could enhance uptake of maternal 5-HT. Male placenta from probiotic-treated dams had dramatic reduction in Hsd11b2 that may render them more vulnerable to maternal stress. In the fetal brain, maternal probiotic supplementation was associated with genes linked to forebrain development, suggesting this treatment might impact life-long neurobehavioral responses. Current studies suggest that maternal probiotic supplementation might lead to adverse changes in the placenta and fetal brain of their unborn children. Full article

Background: Sleep disorders, particularly insomnia, represent a major public health concern, while currently available hypnotic drugs are often limited by adverse effects and poor long-term tolerability. Methods: In this study, we investigated the sleep-promoting effects of a mixture of Hypericum perforatum L. and Melissa officinalis L. extract (HME) and its underlying mechanisms in male ICR and C57BL/6 mice. In a pentobarbital-induced sleep model in mice, sleep onset latency and total sleep time were measured. Pharmacological studies using various antagonists and agonists were conducted to elucidate receptor-mediated mechanisms. Immunohistochemical and immunofluorescence analyses were performed to assess neuronal activity, and cortical mRNA expression was evaluated by quantitative analysis. HPLC analysis was used to identify the major constituents of HME, and their pharmacological profiles were functionally evaluated. Results: HME significantly reduced sleep onset latency and prolonged total sleep time. These hypnotic effects were shown to be mediated through adenosine and melatonin receptor signaling pathways. Immunohistochemical and immunofluorescence analyses showed that HME suppressed neuronal activity in wake-promoting cholinergic and orexinergic neurons of the basal forebrain and lateral hypothalamus, while enhancing activation of sleep-promoting GABAergic neurons in the ventrolateral preoptic nucleus. At the molecular level, HME increased cortical mRNA expression levels of adenosine A₁ receptor, adenosine A_2A receptor, melatonin receptor ₁, and melatonin receptor ₂. From the HPLC analysis, rosmarinic acid and hyperoside were identified as the major constituents of HME. Functional evaluation of these compounds revealed complementary pharmacological profiles, with hyperoside primarily acting through adenosine receptors and rosmarinic acid engaging both adenosine and melatonin receptor pathways. Conclusion: These findings suggest that HME enhances both sleep initiation and maintenance through adenosine and melatonin receptor signaling pathways, thereby supporting its potential as a multitarget therapeutic agent for improving sleep quality. Full article

Exposure to air pollution is linked to adverse health outcomes. To better reflect real-world conditions, we employed a mobile exposure system enabling direct field exposure of the human airway epithelial model MucilAir™ to ambient air in a traffic-burdened locality. This study represents a follow-up to our previous work, in which a 5-day exposure period under extreme traffic-related pollution conditions resulted in premature cell loss. Under different meteorological conditions characterized by increased precipitation and lower particle number concentrations, MucilAir™ cultures were exposed to traffic-polluted air for 2 days. The exposure resulted in a mild but significant increase in cytotoxicity markers, including lactate dehydrogenase release and elevated levels of 15-F_2t-isoprostane, indicating induction of the cellular stress response rather than severe cytotoxicity. A transcriptomic analysis revealed extensive gene expression changes; the enrichment of the pathways related to polycyclic aromatic hydrocarbon detoxification and amino acid biosynthesis suggests adaptive metabolic responses to oxidative and genotoxic stress. In parallel, the pathways associated with epithelial proliferation and repair, extracellular matrix organization, focal adhesion, and immune signaling were suppressed, indicating potential disruption of the epithelial homeostasis. Overall, these findings demonstrate that 2 days of exposure to real-world traffic-polluted air elicits adaptive stress responses in airway epithelial cells while simultaneously impairing the processes essential for epithelial integrity, potentially leading to airway dysfunction. Full article

The concept of architecturally mediated allostatic overload has established that chronic exposure to stress-inducing built environments can elicit stress responses within the body, overwhelming regulatory systems and contributing to adverse health outcomes through sustained activation of stress response pathways. Recent advances in epigenetics, combined with emerging evidence of environmental stress-induced epigenetic modifications, suggest that the health impacts of chronic built environment stress may extend far beyond previously understood physiological consequences. This paper introduces the theoretical concept of “built environment-modulated epigenetics” (BEME), extending the framework of architecturally mediated allostatic overload to consider how chronic exposure to stress-inducing built environments may create lasting epigenetic modifications with potential transgenerational implications. We propose that prolonged activation of the hypothalamic–pituitary–adrenal (HPA) and sympathetic-adreno-medullary (SAM) axes by built environment stressors may result in maladaptive DNA methylation and histone modifications affecting stress-responsive genes, similar to documented effects of environmental toxins, air pollution, and psychosocial stressors. Given robust evidence that environmental stressors can create transgenerational epigenetic effects, this theoretical framework suggests that stress-inducing built environments may impact not only current occupants, but future generations through heritable epigenetic modifications. This extension of architecturally mediated allostatic overload theory fundamentally challenges traditional approaches to architectural design and urban planning, positioning the built environment as a potential determinant of long-term epigenetic programming. Full article