Search Results (3,819)

Background: Public health in Greece has undergone substantial changes since the COVID-19 pandemic, while challenges related to governance, workforce distribution, regional inequalities and service organization remain. This study aimed to map the current public health landscape in Greece by examining its institutional frameworks, stakeholder roles, policy implementation and public health data systems. Methods: A structured situation analysis combining a review of peer-reviewed and gray literature, policy analysis, and stakeholder mapping was conducted. PubMed, EMBASE, and CINAHL were searched for English- and Greek-language publications issued between 2005 and 2026, supplemented by reports, legislation, and policy documents from the Greek Ministry of Health, the World Health Organization, the Organisation for Economic Co-operation and Development, the European Commission, and other relevant institutions. Results: Public health responsibilities were distributed across multiple national, regional, and local institutions, creating challenges concerning coordination and accountability. Regional and socioeconomic inequalities continued to affect access to services, while workforce shortages and skill-mix imbalances constrained public health capacity. Public health information was dispersed across different institutions and data systems, with limitations concerning standardization, accessibility, and interoperability. Recent legislation, prevention programs, and digital-health initiatives indicated increased policy attention to prevention and population health, although publicly available evidence regarding their implementation and outcomes remained limited. Conclusions: Strengthening public health in Greece requires clearer institutional responsibilities, improved coordination across governance levels, sustainable workforce planning and interoperable data systems that support routine monitoring of program coverage, equity, and population-level outcomes. Full article

In response to the increasingly complex secondary system of intelligent substations and the limitations of traditional evaluation methods such as data silos and single indicators, it is urgent to build a real-time high-precision status evaluation system. This article proposes a state evaluation method for the secondary system of intelligent substations based on digital twins and the combination weighting method. Firstly, a four-layer digital twin architecture consisting of physical entities, data interaction, virtual twins, and service applications is constructed to achieve precise mapping and real-time interaction of multi-source heterogeneous data in the secondary system. A comprehensive evaluation index system covering the operation status and information quality of key equipment in the secondary system of intelligent substations is built from multiple dimensions such as health status, information transmission, and environmental conditions. Next, a combined weighting evaluation model is established that integrates the subjective weights of the Analytic Hierarchy Process and the objective weights of the coefficient of variation method, and the principle of minimizing the sum of squares of subjective and objective deviations is introduced to achieve adaptive optimization of weight configuration. Finally, simulation analysis is conducted on the digital twin platform of the 220 kV intelligent substation, and the effectiveness and robustness of the proposed model are verified through multi-state evaluation, typical fault case verification, and ablation and sensitivity analysis. The results show that compared with the mainstream AHP entropy weight method, this method has a maximum deviation of 15.3% in evaluation indicators, a state evaluation score of 97.3164, a full process calculation time of about 2.6138 s, and communication delay that meets the requirements of the IEC 61850 standard. It can effectively improve the real-time accuracy of secondary system state perception and provide technical support for on-site operation and maintenance of intelligent substations. Full article

Background/Objectives: Socioeconomic indicators and geographic factors influence pediatric cancer outcomes, but evidence in Romania is limited. Methods: This retrospective cohort study included 6247 patients aged 0–19 years diagnosed with cancer and recorded in the Romanian National Pediatric Oncology and Hematology Registry between 1 January 2010, and 31 December 2024. Kaplan–Meier analysis was used to estimate the survival probabilities across four strata of regional and county socioeconomic categorization and two strata of community marginalization status. Unadjusted and multivariable Cox proportional hazards models estimated hazard ratios (HRs) and 95% confidence intervals (CIs), adjusting for sex, age group, primary cancer type (ICCC-3), tumor behavior, and geographical residence. Subgroup analyses assessed the association between rurality and pediatric cancer survival, irrespective of community marginalization status. Results: Survival probabilities were consistently lower among patients residing in more socioeconomically disadvantaged regions, counties, and marginalized communities (log-rank p ≤ 0.0001). In the most deprived strata, 5-year survival for regions, counties, and communities was 69.86% (95% CI: 67.49–72.10), 67.47% (95% CI: 63.32–71.26), and 65.51% (95% CI: 61.33–69.35), respectively. In adjusted models, residence in the least deprived regions (HR = 0.783, 95% CI = 0.744–0.952) and counties (HR = 0.749, 95% CI = 0.620–0.905) was associated with improved survival, a 22% and 25% lower risk of death, respectively, compared with residence in the most deprived categories. Community marginalization was associated with lower survival outcomes in unadjusted analyses, but was not significant after adjustment. Rural residence was associated with a 44% higher risk of death (HR = 1.436, 95% CI = 1.304–1.582), with a 5-year survival of 66.76% (95% CI: 64.91–68.53) among rural patients, compared with 75.93% (95% CI: 74.28–77.48) in urban patients. Conclusions: This is Romania’s first pediatric cancer survival study to evaluate persistent social and geographical disparities. Survival outcomes were consistently lower in more socioeconomically disadvantaged regions and counties, while the findings suggest that rural residence may explain the observed differences in survival at the community level. Policymakers and health systems in Romania should focus on covering pediatric cancer patients with appropriate proximity services across the entire national territory, thus enabling all patients to get timely access to quality care. Full article

Objective: Latines in the United States (US) experience disproportionate HIV-related inequities, exacerbated by immigration-related legal precarity and exclusionary policies. This study explores how racialized legal status (RLS), a mechanism by which race-neutral legal classifications disproportionately burden minorities, impacts the lived experiences of Latines with HIV (LWH) across the HIV care continuum. Methods: We conducted a secondary qualitative analysis of in-depth interviews with 21 LWH, 15 healthcare providers, and 10 key informants in Prince George’s County, Maryland. Drawing on RLS framework, data was analyzed thematically, focusing on emergent themes related to immigration, politics, and legal status and their impact on LWH. Results: Policies linking access to health and social services to legal status intensified economic instability and social exclusion, thus leading to suboptimal disease management. Fear of deportation, institutional mistrust, discrimination, and intersectional stigma contribute to healthcare avoidance, disrupting continuity and engagement across the HIV care continuum. Institutions providing services to LWH struggle to circumvent barriers caused by RLS, straining local and community-based resources. Conclusions: RLS erodes whole-person care by creating barriers for healthcare and social services access. Addressing inequities among Latines requires multilevel responses that reduce exclusionary policies and support the well-being of individuals at the intersection of immigration status and chronic disease management. Full article

Background: Effective HIV prevention in South Africa requires implementing pre-exposure prophylaxis (PrEP) service delivery options responsive to adolescents and young people (AYP) with diverse characteristics and needs. We aimed to identify characteristics associated with AYP’s choice of PrEP initiation setting. Methods: Fast-PrEP is an ongoing phase 4 HIV prevention programme in Cape Town, South Africa. Oral PrEP (TDF/FTC) is offered to AYP (15–29 years) within sexual and reproductive health services from four community-based mobile clinics and 12 public primary healthcare facilities. Descriptive statistics and logistic regression models evaluated sociodemographic, behavioural, and clinical factors associated with PrEP initiation from mobile clinics and public health facilities in 13,807 AYP between Aug’22 and Dec’24. Results: Most AYP (70.7%; n = 9760) initiated PrEP from mobile clinics. AYP with more complex healthcare needs, such as pregnancy, parenthood, known sero-different relationships, or currently having STI symptoms, were significantly more likely to use the public health facilities. Both male and female AYP initiating PrEP at mobile clinics had four times the odds of moderate-to-severe depression. Previous PrEP experience was not associated with the choice of PrEP service delivery platform. Conclusions: Our results indicate that offering community-based PrEP alongside public sector facilities increases the reach of a diverse group of AYP who may benefit from PrEP. Full article

Background/Objectives: Endometriosis is a chronic gynecological condition affecting approximately 10% of women of reproductive age and is associated with chronic pain, fatigue, infertility, and reduced quality of life. Beyond its physical burden, delayed diagnosis, healthcare dismissal, and inadequate support may contribute substantially to psychological distress. In line with growing efforts to promote mental health and wellbeing within healthcare settings, this study explored women’s experiences of healthcare services and the psychological impact of living with endometriosis. Methods: A qualitative study was conducted using thematic analysis of 2500 publicly available Twitter/X posts shared by accounts self-presenting as women discussing experiences of endometriosis. Results: Three overarching themes were identified: (1) Institutional Invalidation of Women’s Endometriosis Experiences, (2) Living with the Multidimensional Burden of Endometriosis, and (3) Reimagining Endometriosis Care. Participants described chronic pain, reproductive uncertainty, and significant emotional distress that were frequently intensified by delayed diagnosis and experiences of not being believed or taken seriously within healthcare settings. Accounts suggested that suffering was shaped not only by disease symptoms but also by interactions with healthcare systems that undermined the legitimacy of women’s experiences. Conversely, validation, empathy, and collaborative communication were associated with improved wellbeing and engagement with care. Participants advocated for greater awareness of endometriosis, earlier diagnosis, and more integrated models of support. Conclusions: Endometriosis should be understood as a biopsychosocial condition whose impact extends beyond physical symptoms alone. The narratives analyzed highlight how psychological distress may be amplified by experiences of invalidation, delayed recognition, and fragmented care. Improving outcomes requires timely diagnosis, patient-centered healthcare interactions, and the integration of psychological support within multidisciplinary endometriosis services. Full article

Understanding how vaccination-event characteristics relate to doses administered can inform public health delivery strategies. This study examined associations between modifiable characteristics of community-based COVID-19 vaccination events and doses administered per event. We conducted a retrospective analysis of 631 vaccination events coordinated by the Louisville Metro Department of Public Health and Wellness (LMPHW) in Jefferson County, Kentucky, between March 2021 and May 2022. The outcome was the number of COVID-19 vaccine doses administered per event. Multivariable regression models assessed associations between event characteristics and doses administered per event. Across all events, 27,767 COVID-19 vaccine doses were administered. Each additional hour of event duration was associated with 21.6% more doses administered per event (95% CI: 14.0–29.8%). Weekend events were associated with 87.8% more doses administered per event than weekday events (95% CI: 45.7–142.0%). Compared with government-hosted events, 44.7% more doses were administered at non-profit organizations, 110.0% more at business organizations, and 57.8% more at medical service providers. LMPHW-only events were associated with 198.4% more doses administered per event than partnered events (95% CI: 120.1–304.6%). Principal findings were generally consistent across sensitivity analyses. These findings may help inform planning of future community vaccination and other immunization initiatives. Full article

Background/Objectives: Virtual home health care (VHHC) is increasingly used to support chronic disease management, yet patient satisfaction is often examined through a linear barrier-focused lens, in which more barriers are assumed to produce lower satisfaction. This study introduced a satisfaction resilience framework to identify factors associated with preserved satisfaction among barrier-exposed VHHC users. Methods: This cross-sectional analysis included 517 adults with chronic diseases who had used VHHC services and were recruited across five regions of Saudi Arabia. Patients were classified by barrier load and overall satisfaction into four groups: Resilient, Vulnerable, Comfortable, and Disengaged. Group differences were examined using one-way ANOVA, chi-square tests with Cramér’s V, point-biserial correlations, and a linear probability model restricted to high-barrier patients. Results: Overall, 167 patients (32.3%) reported high barrier exposure. Among them, 109 (65.3%) were classified as Resilient and 58 (34.7%) as Vulnerable, despite statistically equivalent barrier counts. Resilient patients reported higher motivation count, provider trust, perceived effectiveness, and functional equivalence with in-person care. Lifestyle-integration motivations, particularly avoiding work absence and waiting rooms, differentiated Resilient from Vulnerable patients, whereas access-related motivations did not. Perceived functional equivalence showed the largest between-group effect. In the high-barrier subsample, motivation count and provider trust were independently associated with Resilient status, while demographic variables were not significantly associated with it. Conclusions: Satisfaction with VHHC among chronic disease patients is not determined by barrier exposure alone. Service-design and communication strategies that strengthen lifestyle integration, functional equivalence beliefs, and provider trust may help healthcare teams support satisfaction resilience among patients who experience barriers to virtual care. Full article

Background/Objectives: Infant male circumcision (IMC) is a long-established religious practice in Jewish, Muslim, and some Orthodox Christian communities. Since 2007, access to non-therapeutic request IMC in Australia has gradually shifted from the public healthcare system to the private sector. However, the equity implications of this shift, particularly for socio-economically disadvantaged religious families, have received limited scholarly attention. This study explores the potential equity impacts of this policy environment, with a focus on low-income families in the Greater Sydney region. Methods: A desk-based Equity-Focused Health Impact Assessment (EFHIA) was conducted using publicly accessible data from the Australian Bureau of Statistics (ABS) and Medicare Benefits Schedule (MBS). Suburbs in the Greater Sydney region with the highest proportion of Jewish, Muslim, and Orthodox Christians were identified and the proportion of households with children experiencing financial vulnerability were compared across these suburbs. Findings were discussed using an equity and healthcare-access lens. Results: Suburbs with higher proportions of Muslim residents consistently demonstrated a higher proportion of households living with financial vulnerability compared with suburbs with higher proportions of Jewish and Orthodox Christian households. These findings suggest greater potential exposure to financial barriers when accessing private IMC services among Muslim-majority suburbs. In turn, such barriers may increase reliance on lower-cost, unaccredited circumcision providers, with possible risk of complications. Conclusions: The privatisation of request IMC in Australia is likely to disproportionally affect socio-economically disadvantaged religious families, particularly within Muslim communities, potentially generating an inequitable barrier to safe circumcision. Policy responses should focus on mitigating access barriers and safety risks through accredited provider registries, standardised parental information, regulatory oversight, and targeted community-based financial support mechanisms. Full article

Digital ecosystems, misinformation exposure, mental-health vulnerability and unequal access to care create distinctive challenges for young people. Although youth participation in health governance is increasingly advocated internationally, structured evidence from youth deliberative processes remains limited in Portugal. This study synthesises priorities expressed in two Portuguese deliberative initiatives coordinated by the Sociedade Portuguesa de Literacia em Saúde: the Mini-Assemblies of Health 2022–2023, with particular attention to the 3rd Mini-Assembly on Fighting Health Misinformation, and the Youth Health Choices Forum 2024. Both processes used a structured nominal-group logic to support idea generation, clarification, recording and prioritisation. The analysis used low-inference cross-session thematic aggregation to preserve propositional integrity and remain close to participants’ formulations. Five priority domains were identified: digital health communication and information credibility; curriculum-integrated and peer-mediated health literacy; low-friction mental-health access and stigma reduction; equity and functional service accessibility and governance, accountability and youth participation. Participant quotations are retained, in translated form, to preserve youth voice and to show how recommendations emerged from concrete deliberative formulations. The findings suggest that nominal group technique (NGT)-based youth deliberation can generate operational recommendations for policy and practice, including credibility mechanisms for digital health information, school-based health-literacy integration, autonomy-preserving access routes for mental-health support, and permanent youth participation structures. The findings support recognising young people not only as vulnerable recipients of health information but also as interpreters of digital health ecosystems and contributors to the design of more responsive health governance. Full article

Point-of-care and near-patient diagnostics can shorten the time between testing and clinical or public-health action, but a technically effective test does not by itself create a sustainable diagnostic service. Evidence from diagnostic-access research, digitally connected point-of-care testing, human-centered design, and implementation science indicates that diagnostic technologies must be developed as components of wider service systems encompassing workflows, quality assurance, data governance, maintenance, supply chains, user trust, and linkage to care. Drawing on these bodies of literature, this Perspective introduces the I2Med digital infrastructure framework for point-of-care diagnostics in low-resource and infrastructure-constrained settings. These settings are defined functionally as clinical or public-health environments in which resource or infrastructure constraints can disrupt one or more stages between testing and appropriate action. The I2Med framework integrates six domains: (1) access and context of use; (2) the result-to-action diagnostic workflow; (3) digital interfaces and data governance; (4) quality, risk, usability, and design-control alignment; (5) sustainability, maintenance, and supply continuity; and (6) equity, trust, and community accountability. Operational tools—including a setting typology, a domain-to-artifact matrix, an evidence-to-scale maturity ladder, and a hypothetical application vignette—illustrate how the framework can guide development and implementation planning. The I2Med framework’s central contribution is to reposition the diagnostic device as one component of an interconnected service system and to provide academic, translational, and early-stage development teams with a common structure for identifying implementation dependencies, evidence gaps, and responsibilities. As a conceptual framework, it requires prospective application and evaluation across diverse settings before its utility and transferability can be established. Full article

Interdisciplinary dialogue between religion and psychoanalysis has long been regarded as an important approach to addressing modern psychological suffering. Erich Fromm sought to integrate Zen Buddhist practice with psychoanalytic reflections on integration of the unconscious, self-awareness, and personality, proposing a framework that links spiritual cultivation with psychological growth. However, this framework’s explanatory power and limitations in the contemporary Chinese context remain insufficiently explored through empirical research. Drawing on semi-structured interviews with 14 Chinese Zen practitioners in China, this study employs thematic analysis to examine their practices, psychological changes, and understandings of the relationship between Zen and mental health. Most participants regarded Zen practice as a long-term process involving cognitive reorientation, emotional regulation, and behavioral transformation, broadly resonant with Fromm’s integrative framework. However, the framework should not be treated as a directly applicable model of psychological intervention, as its practical relevance depends on sustained cultivation, community support, situated understanding, and clear professional and ethical boundaries. These qualitative findings underline potential risks when Zen cultural resources are introduced into contemporary mental health services, including decontextualization, instrumentalization, and an orientation toward immediate results. Therefore, within clearly defined ethical boundaries, a limited and responsible form of collaboration between Zen teachers and mental health professionals may be worth further exploration. Full article

Antiretroviral therapy (ART) is essential for preventing HIV transmission and improving the health outcomes of people living with HIV (PLHIV). However, many barriers limit PLHIV from starting and adhering to ART, which explains why HIV responses in many settings, including Indonesia, have produced limited gains. This qualitative phenomenological study explored multilevel barriers to ART adherence in urban Yogyakarta (locally known as Jogja) and rural Belu, Indonesia, from the perspectives of PLHIV and healthcare professionals (HCPs). Data were collected through one-on-one in-depth interviews with 92 PLHIV and 20 HCPs. Participants were recruited using the snowball sampling technique. Data were analysed using framework analysis informed by the Access to Healthcare Framework. The findings showed that PLHIV in Belu and Jogja had different experiences in terms of the provision of and ability to access and adhere to ART or HIV treatment. In rural Belu, ART was less available and visible, harder to approach, often unaffordable, less aligned with patients’ needs, and strongly influenced by the widespread use of traditional medicine. PLHIV in Belu also reported a more limited ability to perceive the need for ART, reach services, pay costs, engage in care, and seek ART than those in urban Jogja. Personal, psychological, and social barriers were also reported to hinder PLHIV’s ART adherence in both settings. These findings highlight the need for HIV policies that promote the equitable distribution of ART services and targeted interventions to improve understanding and acceptance of HIV care among PLHIV and the wider community. Full article

Introduction: Globally, disabled individuals experience persistent social inequalities and health inequities, yet the health and wellbeing of Deaf, DeafBlind, blind, and partially sighted (DDBBPS) people remain profoundly under-researched and excluded from social science and health policy agendas. Existing studies narrowly focus on narratives of hearing and vision impairments within a medical model of disability, which pathologizes difference and obscures the biomedical origins of social inequalities and health inequities experienced by these groups. Methods: Drawing on critical disability studies and community-based literature, this narrative review introduces and applies the concept of medical violence to examine how systemic ableism, audism, and ocularcentrism shape DDBBPS people’s healthcare experiences. Results: We identify six interrelated manifestations of medical violence: denied interpreting services, inaccessible health communication, harmful interpersonal practices, health inequities and medical avoidance, absence of DDBBPS practitioners, and gaps in community-based care. Conclusions: These conditions reinforce a cycle of exclusion and misrepresentation, wherein DDBBPS persons are denied equitable access to healthcare and are simultaneously constructed as objects of cure rather than as knowledge holders. We argue for a community-based participatory research agenda led by and for DDBBPS communities to challenge ableist research paradigms and advance health equity. Full article

Background: Adolescents in low- and middle-income countries (LMICs) continue to face substantial challenges related to sexual and reproductive health (SRH), including high rates of unintended pregnancy, sexually transmitted infections (STIs), and limited access to accurate reproductive health information and services. Rural provinces of South Africa, such as Limpopo, are no exception, with notably higher pregnancy rates. Aim: This study aimed to explore adolescent girls’ perceptions and experiences associated with school-based comprehensive sexuality education (CSE) programs and their perceived role in pregnancy prevention in Bolobedu, Limpopo province, South Africa. Methods: A qualitative, descriptive, and contextual design was employed. Data were collected through individual interviews and field notes from adolescent girls aged 14–19 years who were accessing contraceptives or had given birth. Content analysis was conducted using Tesch’s method. Findings: Results suggest that the quality and contents of CSE programs varied widely, leading to CSE intervention programs not being successfully implemented, leading to poor uptake and no behavior change. Implications: While research on CES programs shows that the CSE programming varies and can be vital to reducing adolescent pregnancy, its success depends on the quality of the implementation, which leads to behavior change. The research finds that the adoption of Comprehensive Sexual Education in schools and communities is vital to tackling the high incidence of adolescent pregnancy. However, its success depends on the quality of implementation, facilitator training, and resource availability. Full article