Search Results (13)

Introduction: In recent decades, demographic aging has led to an inversion of the population pyramid, with a marked increase in the proportion of older adults. This shift has been accompanied by a higher prevalence of chronic and life-limiting diseases, while there have also been significant technical and scientific advances. However, these developments have not been matched by a proportional expansion of healthcare human resources, including in palliative care (PC). Consequently, healthcare systems face increasing pressure, particularly in the provision of end-of-life care. Artificial intelligence (AI) has emerged as a promising tool to support and improve healthcare delivery. Objective: This study aims to review the literature on the impact of AI on palliative care, with particular emphasis on its clinical applications and ethical implications in end-of-life care. Methods: A narrative review was conducted using a structured search of PUBMED, CINAHL and Web of Science databases, covering publications from the last ten years (2015–2025). Search terms included combinations of “artificial intelligence”, “machine learning”, “palliative care”, “end-of-life care”, and “ethics”. Articles were included if they addressed clinical applications, implementation challenges or ethical aspects of AI in PC. Reference lists of selected articles were screened to identify additional relevant studies. The findings were analyzed and synthesized thematically into key domains of application and ethical concern. Results: The literature suggests that AI is currently a promising tool in PC, particularly in prognostication, symptom assessment, clinical decision support, and communication. These applications may represent a paradigm shift compared to conventional approaches. However, it is important not to forget that patients in PC need much more than algorithmic decision trees. Thus, current evidence is largely exploratory, with limited real-world validation. Empathetic emotional support, physical comfort and compassion are things that artificial intelligence cannot provide. AI does not replace humans in interpersonal relationships and dignity; it only complements them. Conclusions: AI-based technologies hold significant potential to address contemporary challenges in PC, including inequitable access, workforce strain, and the need for more efficient service delivery. Nevertheless, their implementation raises substantial ethical concerns related to autonomy, transparency, data governance, and the preservation of human dignity. AI should therefore be understood as a complementary tool that supports—but does not replace—the human dimension of PC. Full article

Background: Environmental factors are known to influence the clinical presentation of patients with multiple sclerosis. This study aims to compare the demographic and clinical characteristics of multiple sclerosis patients treated at two diverse geographical settings. Methods: A cross-sectional, observational cohort study was conducted in two MS centers: the Danish Multiple Sclerosis Center (DMSC) in Copenhagen, Denmark and the Regional MS Center in Târgu Mureș, Romania. We compared patients’ demographic and clinical characteristics between MS centers, including sex distribution, current age, MS onset age, latest EDSS scores, symptomatology at disease onset, MS phenotype and type of ongoing DMT. Results: In both cohorts, sex distribution was similar, with females constituting 69.2% in DMSC, and 65.7% in Târgu Mureș. Pyramidal symptoms at MS onset were predominant among Targu Mures patients (32.7%), while sensory symptoms were more frequent among DMSC patients (33%). Progressive forms of MS were more prevalent in Târgu Mureș (22.6%) compared to DMSC (9.9%). High-efficacy DMTs were on use by 58.3% patients in DMSC and only by 29.4% patients in Târgu Mureș, who were mostly on low-efficacy DMTs (54.4% vs. 12.4% in DMSC). Conclusions: The study highlights both shared and distinct characteristics of MS patients treated in these two centers. These findings underscore the importance of regional considerations in the management and treatment of MS. Full article

Rhododendron huadingense is a nationally protected wild plant species in China with a small population and narrow natural distribution, which is experiencing severe anthropogenic threats. The demographic structure and trends of R. huadingense on Mount Dapan in Zhejiang Province were analyzed to help researchers understand its population dynamics by using static life tables, quantitative dynamic indices, survivorship curves, and survival analysis based on three censuses of a 1 ha plot in 2012, 2017, and 2022. Over this decade, the population of R. huadingense declined by 9.58% from 668 to 604 individuals. From 2012 to 2022, the diameter class structure of the population consistently exhibited a pyramidal pattern, with the number of individuals initially increasing and then decreasing as diameter classes advanced. Over this decade, the diameter class structure of the population consistently showed a declining trend. Dynamic indices showed that the quantitative dynamic index of the population without external interferences was greater than with external interferences, and that both were greater than zero, suggesting growth potential. The maximum risk probability in response to random disturbance from 2012 to 2022 (2017 > 2022 > 2012) was greater than zero but relatively small, indicating underlying demographic instability. Life tables showed Deevey Type II survivorship with mortality rates decreasing in larger diameter classes. These demographic patterns indicate that R. huadingense is transitioning from recruitment-driven growth to senescence-dominated population dynamics. Urgent conservation interventions are needed, including (1) enhancing seedling establishment, (2) improving habitat quality, (3) promoting natural regeneration processes. Full article

The study presented in this paper is intended to be a contribution to the practical implementation of the “sustainability” concept, often misunderstood at times and incorrectly applied. The first sections describe a systematic procedure for a rigorous definition of “sustainability” and of “sustainable development” based on thermodynamics. A concept tightly connected with “sustainability” is “resource thriftiness”, i.e., the reduction in the anthropic extraction of irreplaceable supplies of fossil ores and fuels contained in the Earth’ crust and the reduction in the load posed on the environment by discharges, collectively referred to as “environmental conservation”: this is another concept that must be embedded in the definition of sustainability. An environmentally friendly society ought to concentrate on minimising such consumption by implementing an efficient and rational conversion of primary resources to final commodities while maintaining acceptable life standards. A thermodynamics-based approach can help identify the boundaries of the “sustainable region”: if sustainable development depends on a balance between primary input and final consumption, the internal allocation of the latter among citizens becomes a relevant parameter. The study presented in this paper introduces a direct link between demographics and pro capite final exergy use, showing how the age distribution of a society strongly impacts primary consumption. The paper presents some considerations about the quantitative link between the so-called “demographic pyramids” and the exergy budget of a country, with specific examples based on currently available data. Full article

The global population is experiencing a remarkable demographic shift. The population pyramid of African countries looks very different from that of the West, with a youthful population forming the base of the African population, while the population of Western countries has a larger share of an aging population. A broader understanding of the various facets of urban growth in Africa is needed, including the demographic makeup and drivers of growth. However, inadequate attention has been paid to this aspect of urban change in research, even though this knowledge can aid development planning. Demographic concerns like the interconnections between development and population are important issues of national dialogues and debates. Research from Southern Africa has also found a prevalence of female-headed households in urban areas and predicts a rise in this trend. This study thus set out to explore the primary factor behind urban population growth and the extent of prevalence of female-headed households in African cities using Port Harcourt, Nigeria, as a case study. Quantitative research was conducted. The findings revealed that natural increase was largely responsible for urban growth, given the proportion of participants in the age group 18–40 born in the city. This group currently forms the large base of the African urban population. Results also showed that male-headed households were still dominant in Port Harcourt city. This study highlights the need for expansion of similar research in other cities to enable a more holistic understanding of the wider African urban population demographics and dynamics. Full article

Background/Objectives: Patient navigation is vital for improving healthcare accessibility and patient experience in China’s public hospitals, where high patient demand meets limited medical resources. Patient navigators (PNs) assist patients through the complex healthcare system, but the lack of standardized training and evaluation hampers their ability to meet patient needs. This study piloted a Competencies Improvement Training Program (CITP) in a tertiary hospital to clarify PN competencies, design a feasible curriculum, assess its efficacy, and share insights with peer hospitals. Methods: The CITP used the Plan–Do–Check–Act (PDCA) framework and designed a curriculum with Miller’s Pyramid Model. Over 6 months, eight sessions were conducted, including theory, case studies, etc. The quasi-experimental design compared PN competencies and patient satisfaction before and after. Multiple instruments measured baseline competencies and program efficacy with a 6-month post-training follow-up. Results: A total of 75 PNs (75%) participated and completed all sessions. A total of 1189 patients were surveyed before training, 495 in the first month after training, and 502 in the 6-month follow-up. The CITP significantly boosted PN competency scores from 90.259 to 95.453, though it dipped to 92.721 by 6 months. Patient satisfaction with PN services improved modestly over 6 months. Challenges in applying theoretical knowledge to practical skills were noted, suggesting differentiated training based on navigator demographics. Patient satisfaction for aspects like politeness and tone was linked to patient age and education. Conclusions: The CITP enhanced PN core competencies and provided an evidence-based curriculum model. Future research should involve larger multi-center populations with longer-term follow-ups to validate the program’s effectiveness across diverse settings. Full article

This study aimed to investigate whether the Kenyan Food Pyramid (FP) can evaluate excess or insufficient nutrient intake. Participants were farmers (56 men and 64 women, aged 18–60 years) in Wangige Village, Kiambu County—a peri-urban area of Kenya. Cross-sectional data were collected for demographic characteristics, physical measurements, and 2-day and 24-h dietary recalls. The average adherence level to the FP (hereafter, “FP score”) was 25.0 out of 50.0, with a minimum and maximum of 14.1 and 41.5, respectively. Energy and protein % energy ratio were significantly higher (p for trend < 0.05) in the higher FP score group. A higher FP score was also associated with a higher energy-adjusted micronutrient intake, and it was more likely to meet nutrient requirements. However, the higher FP score group had a higher risk of excess sodium intake (p for trend < 0.001). The Kenyan FP could be a useful tool for avoiding the risk of insufficient nutrient intake, but not for avoiding high energy and sodium intake. It is necessary to include appropriate evaluations to limit energy, sugar, and salt. Food groups and recommendations of the FP should be optimised according to the dietary environment of the target population so as to promote their health. Full article

The differential spread and impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), causing Coronavirus Disease 2019 (COVID-19), across regions is a major focus for researchers and policy makers. Africa has attracted tremendous attention, due to predictions of catastrophic impacts that have not yet materialized. Early in the pandemic, the seemingly low African case count was largely attributed to low testing and case reporting. However, there is reason to consider that many African countries attenuated the spread and impacts early on. Factors explaining low spread include early government community-wide actions, population distribution, social contacts, and ecology of human habitation. While recent data from seroprevalence studies posit more extensive circulation of the virus, continuing low COVID-19 burden may be explained by the demographic pyramid, prevalence of pre-existing conditions, trained immunity, genetics, and broader sociocultural dynamics. Though all these prongs contribute to the observed profile of COVID-19 in Africa, some provide stronger evidence than others. This review is important to expand what is known about the differential impacts of pandemics, enhancing scientific understanding and gearing appropriate public health responses. Furthermore, it highlights potential lessons to draw from Africa for global health on assumptions regarding deadly viral pandemics, given its long experience with infectious diseases. Full article

In the Amazon, the Yasuní Biosphere Reserve (YBR) is considered a natural and cultural diversity hotspot. It is populated by several indigenous groups, including the Kichwa, who are characterized by their traditional systems of production, which are a means of subsistence and socio-ecological integration. The objective of this research was to evaluate the sustainability of small farmers who use a traditional agroforestry system (chakra) within the buffer, transition, and core zones of the YBR. We conducted 133 interviews with Kichwa heads of households. The socio-demographic structure and distribution were identified, and the response-inducing sustainability evaluation (RISE) methodology was used to evaluate chakra sustainability according to social, economic, and ecological dimensions, expressed using 10 indicators from 50 parameters, valued from 0 (worst case) to 100 (best case). The results are expressed in a polygon, defined by the areas: (1) good performance, (2) medium performance, and (3) poor performance. We employed the multivariate classification hierarchical cluster technique and analysis of variance (ANOVA) to identify dissimilarities between groups of chakras and the existence of statistical differences, respectively. Among the studied indigenous Kichwas, a pyramidal structure progressive type was identified, which is characteristic of young populations and the nonexistence of significant differences between the RISE indicators and chakras. The lowest-scoring indicators using the RISE guidelines were: use of materials and environmental protection, animal production, economic viability and chakra administration. We provide suggestions for decision makers who support Kichwa populations in socio-productive management with sustainability goals. We to taking actions on the indicators identified with high priority to improve the sustainability in the chakras and sociodemographic dynamics. Full article

Diet composition is a key determinant of childhood obesity. While whole grains and micronutrients are known to decrease the risk of obesity, there are no interventions originating from Southeast Asia that emphasize whole grain as a strategy to improve overall quality of diet in combating childhood obesity. The GReat-Child Trial aimed to improve whole grain intake and quality of diet among overweight and obese children. It is a quasi-experimental intervention based on Social Cognitive Theory. It has a 12-week intervention and 6-month follow-up, consisting of three components that address environmental, personal, and behavioral factors. The intervention consists of: (1) six 30 min lessons on nutrition, using the Malaysian Food Pyramid to emphasize healthy eating, (2) daily deliveries of wholegrain foods to schools so that children can experience and accept wholegrain foods, and (3) diet counseling to parents to increase availability of wholegrain foods at home. Two primary schools with similar demographics in Kuala Lumpur were assigned as control (CG) and intervention (IG) groups. Inclusion criteria were: (1) children aged 9 to 11 years who were overweight/obese; (2) who did not consume whole grain foods; and (3) who had no serious co-morbidity problems. The entire trial was completed by 63 children (31 IG; 32 CG). Study outcomes were measured at baseline and at two time points post intervention (at the 3rd [T1] and 9th [T2] months). IG demonstrated significantly higher intakes of whole grain (mean difference = 9.94, 95%CI: 7.13, 12.75, p < 0.001), fiber (mean difference = 3.07, 95% CI: 1.40, 4.73, p = 0.001), calcium (mean difference = 130.27, 95%CI: 74.15, 186.39, p < 0.001), thiamin (mean difference = 58.71, 95%CI: 26.15, 91.28, p = 0.001), riboflavin (mean difference = 0.84, 95%CI: 0.37, 1.32, p = 0.001), niacin (mean difference = 0.35, 95%CI: 1.91, 5.16, p < 0.001), and vitamin C (mean difference = 58.71, 95%CI: 26.15, 91.28, p = 0.001) compared to CG in T1, after adjusting for covariates. However, T1 results were not sustained in T2 when intervention had been discontinued. The findings indicate that intervention emphasizing whole grains improved overall short-term but not long-term dietary intake among schoolchildren. We hope the present trial will lead to adoption of policies to increase whole grain consumption among Malaysian schoolchildren. Full article

Introduction: Recent studies reported a decrease in the incidence of acute myocardial infarction. This favorable evolution does not extend to young women. The interaction between gender, risk factors and myocardial infarction incidence remains controversial. Objective: To compare the evolution of the age pyramid of patients with ST-elevation myocardial infarction (STEMI) according to gender. Methods: Data from patients with STEMI managed in pre-hospital settings prospectively collected in the greater Paris area. Evolution of patient demographics and risk factors was investigated. Results: 28,249 patients with STEMI were included in the registry between 2002 and 2014, 21,883 (77%) males and 6366 (23%) females. The sex ratio did not significantly vary over the study period (p = 0.4). Median patient age was 60.1 years (51.1–73.0) and was significantly different between males and females, respectively 57.9 (50.0–68.3) vs. 72.9 years (58.3–82.2) (p = 0.0004). The median age of males significantly (p = 0.0044) increased from 57.6 (50.1–70.0) in 2002 to 58.1 years (50.5–67.8) in 2014. The median age of females significantly (p = 0.0006) decreased from 73.7 (57.9–81.8) to 69.6 years (57.0–82.4). The median gap between the age of men and women significantly (p = 0.0002) decreased, from 16.1 to 11.5 years. Prevalence of risk factors was unchanged or decreased except for hypertension which significantly increased in males. The rate of STEMI without reported risk factors increased in both males and females. Conclusion: The age of STEMI onset significantly decreased in females, whereas it significantly increased in males. The prevalence of risk factors decreased in males, whereas no significant variation was found in females. Full article

Wild species are extremely rich resources of useful genes not available in the cultivated gene pool. For species providing staple food to mankind, such as the cultivated Triticum species, including hexaploid bread wheat (Triticum aestivum, 6x) and tetraploid durum wheat (T. durum, 4x), widening the genetic base is a priority and primary target to cope with the many challenges that the crop has to face. These include recent climate changes, as well as actual and projected demographic growth, contrasting with reduction of arable land and water reserves. All of these environmental and societal modifications pose major constraints to the required production increase in the wheat crop. A sustainable approach to address this task implies resorting to non-conventional breeding strategies, such as “chromosome engineering”. This is based on cytogenetic methodologies, which ultimately allow for the incorporation into wheat chromosomes of targeted, and ideally small, chromosomal segments from the genome of wild relatives, containing the gene(s) of interest. Chromosome engineering has been successfully applied to introduce into wheat genes/QTL for resistance to biotic and abiotic stresses, quality attributes, and even yield-related traits. In recent years, a substantial upsurge in effective alien gene exploitation for wheat improvement has come from modern technologies, including use of molecular markers, molecular cytogenetic techniques, and sequencing, which have greatly expanded our knowledge and ability to finely manipulate wheat and alien genomes. Examples will be provided of various types of stable introgressions, including pyramiding of different alien genes/QTL, into the background of bread and durum wheat genotypes, representing valuable materials for both species to respond to the needed novelty in current and future breeding programs. Challenging contexts, such as that inherent to the 4x nature of durum wheat when compared to 6x bread wheat, or created by presence of alien genes affecting segregation of wheat-alien recombinant chromosomes, will also be illustrated. Full article

In China, environmental pollution generated via industrialization as well as profound changes in the social structure and the gradual maturation of the social hierarchy have jointly contributed to the Chinese people’s increased environmental consciousness and appeals for environmental justice (EJ). Because of the absence of an EJ theory and a lack of empirical research focused on China, this paper proposes a “Pyramid Model” for EJ research in China that includes the following three factors: basic demographic and socioeconomic characteristics, U.S.-based EJ principles, and Chinese characteristics. A nationwide pilot analysis of environmental inequality at the prefecture level is conducted by empirically examining the association between the demographic variables and socioeconomic status with sources of industrial pollution in China. The prefecture-based results are shown to be robust, and they indicate that areas inhabited by ethnic minorities and western regions of China carry disproportionate environmental burdens. However, a different picture for migrants is presented, revealing that Chinese migrants are not currently exposed to greater levels of industrial pollution. Relevant interpretations of these findings are provided. The results also show that environmental inequality associated with income level, which is observed in the U.S., does not occur in China. Full article