Search Results (1,176)

Background/Objective: To address the growing demand for mental health services, Nova Scotia Health introduced the Rapid Access Stabilization Program (RASP) through its Mental Health and Addictions Program (MHAP) in April 2023. RASP is designed to help reduce long wait times, frequent emergency department visits, and admissions to provide early intervention for individuals experiencing mental health problems. The RASP focuses on rapid access and early mental health intervention, aiming to prevent the worsening of patients’ symptoms, improve access to psychiatric care, and reduce service pressures on programs like the Community Mental Health Program (CMHP), which provide more extended, ongoing mental health support. This study compared participants’ sociodemographic and clinical profiles in the RASP and the CMHP. Methods: Data were collected from 1392 participants accessing mental health support either through the RASP or CMHP. A comparative analysis of sociodemographic factors (e.g., age, education, and income) and clinical characteristics (e.g., depression, anxiety, resilience, and substance use) was conducted. Chi-square tests and independent sample t-tests were used to evaluate the mean differences between the groups. Results: Significant sociodemographic and clinical differences emerged between the RASP and CMHP participants. The RASP group was older (M = 40.10 vs. 34.52 years) and more socioeconomically stable, with higher rates of employment (55.3% vs. 47.9%) and homeownership (36.5% vs. 17.7%). In contrast, the CMHP group had higher unemployment (25.7% vs. 16.5%) and lower income levels, with 47.5% earning <CAD 29,590 compared to 30.3% in the RASP group. Clinical profiles differed markedly: depression was more prevalent in the RASP (48.2% vs. 19.3%), whereas the CMHP had higher rates of psychosis (10.6% vs. 2.5%) and substance use disorder (7.8% vs. 1.9%). The RASP participants exhibited higher anxiety (GAD-7: M = 14.17 vs. 11.81) and depression symptoms (PHQ-9: M = 16.62 vs. 14.20) but lower resilience (BRS: M = 2.47 vs. 2.77). The CMHP participants had more adverse childhood experiences (ACE: M = 3.92 vs. 3.16) and lower suicidal intent (81.4% vs. 99.4% had no intention to act). Conclusions: The findings highlighted the unique profiles between the RASP and CMHP participants, suggesting the need for program-specific interventions. While the CMHP participants may benefit from integrated social support and trauma-informed care, the RASP participants may require cognitive behavioral therapy and resilience-building interventions. Tailoring mental health services to meet these unique needs could enhance program effectiveness and patient outcomes across both groups. Full article

Background: Children with disabilities, particularly in low- and middle-income countries (LMICs), face heightened risks of vaccine-preventable diseases due to a range of systemic and social barriers. Although immunization is a fundamental human right and a proven public health intervention, this vulnerable group is often overlooked in policy and practice. Understanding the factors compromising vaccine equity for these children is critical to reducing zero-dose prevalence and improving health outcomes. Methods: This scoping review examined peer-reviewed, gray literature from 2010 to 2024. Searches were conducted in PubMed, Google Scholar, and relevant organizational reports (WHO, UNICEF). Studies addressing children with disabilities and focusing on immunization barriers, interventions, or lessons learned were selected. English-language publications were screened in title/abstract and full-text stages. Key data extracted included population, barriers, and immunization outcomes. Since this review focused on articles in English, this is a key limitation. Results were synthesized thematically to identify recurring patterns and to guide improved interventions and policies. Results: Twelve articles met the inclusion criteria. Key barriers identified were inadequate healthcare infrastructure, insufficient provider training, limited follow-up services in rural regions, societal stigma, and pervasive misconceptions around both disability and vaccines. Factors such as maternal education, logistical support for caregivers, and using low-sensory, inclusive vaccination settings were consistently linked with better outcomes. Effective strategies included mobile vaccination units, tailored interventions (e.g., distraction or sedation techniques), school-based immunization programs, and robust community engagement to address stigma. Lessons learned underscored the importance of flexible, individualized care plans and empowering families through transparent communication. Conclusions: Children with disabilities continue to experience significant gaps in immunization coverage, driven by intersecting barriers at the individual, health system, and societal levels. Scaling tailored interventions, inclusive policies, strengthened infrastructure, and ongoing research can help ensure these children receive equitable access to life-saving vaccinations. Full article

Honeybees provide a variety of services and products that are beneficial to humans, including pollination, honey, propolis, and other harvested products. In South Africa, it is believed that honey harvesting from wild (unmanaged) honeybee (Apis mellifera L.) colonies is widely practiced. However, there is limited knowledge regarding this practice. Using structured questionnaire surveys and site visits for validation, we aimed to (1) confirm the practice of honey harvesting and ascertain the extent to which it is practiced; and (2) quantify the economic benefits of this practice to communities’ livelihoods. We found that honey and other products (i.e., brood and pollen) harvesting from wild honeybee colonies is still a common practice among the rural communities of selected areas within the Vhembe District, which was confirmed by 44% of the respondents. These products are either consumed by the harvesters or sold, helping to generate total household incomes ranging from R500.00 ($26USD) to R2000.00 ($112USD) South African Rands (ZAR), which contribute towards offsetting various household costs. Although the overall population and health status of the wild honeybees in the area is unknown, the survey respondents (29%) indicated that they are generally healthy. From these findings, we were able to establish a good level of dependence on wild honeybee colonies by rural communities for income generation, albeit at a small scale. Given the wide array of pressures on insect pollinators, particularly honeybees, from factors such as habitat loss, climate change, pests, pathogens, and pesticides, our findings serve as a strong basis for considering protection and preservation mechanisms for these populations. These could be accommodated under various local and provincial conservation efforts, especially those preventing habitat loss. Full article

This narrative review aims to evaluate the current evidence on the use of cardiac telerehabilitation (CTR) in patients after myocardial infarction, focusing on the effectiveness of e-learning platforms and remote monitoring for addressing cardiovascular risk factors, improving physical fitness, and enhancing patient adherence. The review also explores the limitations and gaps in the literature, highlighting the need for future research to optimize CTR approaches. A comprehensive literature search was conducted using PubMed and Scopus, focusing on specific keywords. The search yielded fifteen randomized controlled trials. Data from these studies were analyzed to evaluate the methodology, interventions, patient characteristics, and outcomes related to the use of CTR in managing cardiovascular risk factors and improving physical fitness. The included studies demonstrated that CTR interventions, delivered via online platforms, phone calls, and smart devices, were effective in improving cardiovascular risk factors, physical activity levels, and overall patient satisfaction. CTR appears to be associated with improvements in exercise tolerance, VO₂ max, body composition, and adherence. While the outcomes were promising, there is still limited evidence regarding the long-term impact of CTR on cardiovascular risk factors and lifestyle interventions, particularly in non-exercise components like dietary management and psychological support. Cardiac telerehabilitation presents a feasible and effective alternative to traditional in-hospital rehabilitation programs for patients recovering from myocardial infarction. The integration of e-learning platforms and smart devices enhances patient adherence, improves cardiovascular risk factors, and increases access to rehabilitation services, particularly for those who face barriers to traditional care. However, further large-scale studies are needed to establish standardized protocols and best practices for CTR. Additionally, future research should address disparities in access to digital health technologies, especially among rural and underserved populations, to ensure equitable access to these innovative approaches. Full article

Background/Objective: This retrospective observational study describes the social, health, and psychological conditions of children living in a disadvantaged and degraded suburb of Rome Metropolitan City during the COVID-19 pandemic as registered by the primary healthcare service of the Solidarity Medicine Institute, with the aim of fighting social exclusion and health disparities during lockdown and offering free health care to vulnerable families. Methods: The access to pediatric interventions was assessed from April 2020 to December 2022. For each child, biometric parameters were recorded, and the physical and psychological states of health were assessed. Furthermore, data regarding family socio-economic variables were collected. Results: From April 2020 to December 2022, 638 children, aged 0 to 18 years, had access to the healthcare system, which was provided by the Solidarity Medicine Institute, with a total of 2300 pediatric visits. Moreover, food supplements, drugs, and hygiene kits that were necessary for the containment of the COVID-19 infection were freely distributed at the center. The highest proportion of children included in this study were from African and Eastern European families (46% and 35.8%, respectively), and 41% of these children did not have a pediatrician from the public health service. Children aged 0 to 5 years comprised 50.81% of the entire population of this study. Nutritional status assessment indicated that among the 117 infants aged 0–12 months, 5.7% were below the 3rd weight percentile, while 28.9% exceeded the 85th weight percentile. BMI assessment for children aged 2 years and older (i.e., 521 children) indicated that 21.7% of these children were overweight, and 9.5% were obese. Sixty-nine cases of psychiatric disorders were also detected among these children, with a high frequency of cases of Specific Language Disorder (31.8%), Attention Deficit Hyperactivity Disorder (21.7%), and Specific Learning Disorder (14.5%). Psychiatric and rehabilitative interventions were also offered. Conclusions: The Solidarity Medicine Institute responded to the request of the municipality of Rome to remain open and offer social and health assistance to the most vulnerable people during the pandemic. The Solidarity Medicine Institute has efficaciously served a fragile pediatric population, intercepting social, health, and psychological needs and overcoming social exclusion, health disparity, and the fragmentation of welfare services exacerbated by the COVID-19 pandemic. Full article

Aim: This study aimed to determine the evolving rehabilitation needs in Brazil, considering five main impairment categories for nationwide health-service planning, stratified per age groups, as well as Brazilian regions with inequitable development. Methods: Secondary analysis of the Global Burden of Disease study (1990–2019), using Years Lived with Disability (YLD) rates for all ages and age-standardized metrics. The set of health conditions amenable to rehabilitation were selected and organized based on the five impairment types, derived from Brazil’s public-based Care Network for People with Disabilities. Results: A Brazil-wide 24% growth (1990–2019) in overall rehabilitation needs per capita (i.e., YLD rates per 100,000 population) was observed, in addition to a 6% negative growth for age-standardized YLD rates. “Physical” impairments accounted for 77% of the Brazilian rehabilitation needs in 2019; 69% of these impairments come from musculoskeletal conditions. Rehabilitation needs growth was also observed across the five Brazilian regions, ranging from 16% to 25%. Conclusions: Rehabilitation needs are growing across Brazil and its regions as a result of population ageing and epidemiological transition. Brazilian regions with lower income and lower population density (e.g., with more rural or remote populations) also experienced growth in rehabilitation needs, even though these regions are often underserved by rehabilitation professionals. Full article

Background: Thrombopoietin receptor agonists—romiplostim, eltrombopag and avatrombopag—are commonly used as second-line treatments for immune thrombocytopenia (ITP). Methods: A Markov model was developed to estimate the cost effectiveness of the three TPO-RAs in adults with insufficient response to previous treatment from the perspective of the UK National Health Service (NHS). The model considered the effects of bleeding events, concomitant ITP medications, rescue therapies and treatment related adverse events over a lifetime horizon. Model inputs for effectiveness were based on a network meta-analysis and other published literature on ITP management. Other model inputs included costs (e.g., drug acquisition and administration) and healthcare resource utilisation. Results: Avatrombopag was associated with higher quality-adjusted life-years (QALYs) (10.979) than romiplostim (10.628) and eltrombopag (10.085), producing incremental QALYs of −0.351 and −0.894, respectively. Avatrombopag was associated with lower total costs (GBP £319,334) compared with romiplostim (GBP 406,361 [cost saving of GBP 87,027]) and higher total costs compared with eltrombopag (GBP 313,987 [incremental cost of GBP 5347]). Avatrombopag therefore dominated romiplostim (more effective and less expensive) and was cost-effective versus eltrombopag (incremental cost-effectiveness ratio of GBP 5982 per QALY). Conclusions: Avatrombopag is a cost-effective treatment compared with romiplostim and eltrombopag for the second-line treatment of adults with ITP from the perspective of the UK NHS. Full article

Background: This study explores the multifaceted inequalities faced by informal waste pickers in Hong Kong, focusing on the impacts of gender and socioeconomic status in shaping their working environment, income, and psychological health. Recognizing that social stratification encompasses a series of structural factors, i.e., gender, race, and socioeconomic status, we aim to fill the gap in existing literature regarding the precarious employment of this population. Methods: Utilizing a comprehensive, territory-wide survey, we analyzed the experiences of male and female waste pickers across different socioeconomic backgrounds. Differences between genders for continuous variables were assessed using the independent samples t-test. Differences across categories defined by gender and socioeconomic status were analyzed using one-way ANOVA, followed by post hoc comparisons with the least significant difference (LSD) method. Results: Our findings indicate that both gender and socioeconomic status significantly influence working environment, occupational income, and psychological health outcomes. Specifically, female waste pickers from lower socioeconomic backgrounds face more adverse working environments, lower income levels, and heightened psychological health risks compared to their higher-status counterparts. Conclusions: These results underscore the urgent need for targeted outreach and tailored healthcare services for vulnerable female waste pickers, as well as social support systems that empower them to negotiate with intermediaries and recycling shop owners. By recognizing their essential role in Hong Kong’s urban recycling ecosystem, this study advocates for policies that address these disparities and promote psychological health and social well-being among this marginalized group. Full article

Health services through digital technologies (e-health) offer a promising solution, but some older adults may encounter difficulties in utilizing these resources due to varying levels of e-health literacy. This study investigated the relationship between depression, leisure activities, and e-health literacy among older adults in the EU and Japan using cross-sectional data from the e-ViTA baseline survey. Findings revealed that depression was negatively associated with e-health literacy in both regions (EU: β = −0.54, 95% confidence interval (CI): −0.79, −0.28; Japan: β= −0.24, 95%CI: −0.46, −0.02). Leisure activities were positively associated with e-health literacy only in the EU (β = 0.55, 95%CI: 0.23, 0.87). Moreover, leisure activities appeared to partially mediate the relationship between depression and e-health literacy in the EU group. These results highlight the need to address mental health issues and promote leisure activities to improve e-health literacy among older adults, emphasizing tailored interventions for different cultural contexts. Full article

Metastatic spinal cord compression (MSCC) is a common complication in cancer patients, occurring in 3–5% of diagnosed cases annually, and serves as the initial manifestation of malignancy in 20% of patients. Timely diagnosis and management are critical due to the risk of irreversible neurological damage and the significant impact on both quality and quantity of life. The National Institute for Health and Care Excellence (NICE) recommends that patients presenting with back pain accompanied by neurological signs and/or symptoms undergo whole-spine magnetic resonance imaging (MRI) within 24 h. This retrospective study at Medway Maritime Hospital in England aimed to assess adherence to these guidelines by reviewing the time from presentation to MRI for patients exhibiting symptoms and/or signs of MSCC. Data for 69 patients were collected over one year using electronic patient records and the acute oncology service database. Analysis revealed that MRI was conducted within 24 h in only 43 out of 69 cases (62%), and 16 out of 25 delayed cases (i.e., MRI done beyond the recommended 24 h window) experienced delays of more than 48 h. To improve guideline adherence, interventions such as informational flyers and regular MSCC training sessions, including trainee teaching and presentations during grand rounds, were implemented. A follow-up re-audit involving 113 patients over one year demonstrated improved adherence to the 24 h MRI guideline, with 81 out of 113 cases (71%) meeting the target. The second cycle also documented reasons for delays, identifying patient compliance and pain control as primary factors. Additionally, the timing of steroid administration following suspicion of MSCC was recorded. Future studies should re-assess adherence, focus on better documentation of delay causes, enhance pain management before MRI scans, and ensure prompt steroid administration. Full article

Reliable system design is an important component to ensure data processing speed, service availability, and an improved user experience. Several studies have been conducted to provide data processing speeds for health monitors using clouds or edge devices. However, if the system design used cannot handle many requests, the reliability of the monitoring itself will be reduced. This study used the Kubernetes approach for system design, leveraging its scalability and efficient resource management. The system was deployed in a local Kubernetes environment using an Intel Xeon CPU E5-1620 with 8 GB RAM. This study compared two architectures: MQTT (traditional method) and MQTT-Kafka (proposed method). The proposed method shows a significant improvement, such as throughput results on the proposed method of 1587 packets/s rather than the traditional methods at 484 packets/s. The response time and latency are 95% more stable than the traditional method, and the performance of the proposed method also requires a larger resource of approximately 30% more than the traditional method. The performance of the proposed method requires the use of a large amount of RAM for a resource-limited environment, with the highest RAM usage at 5.63 Gb, while the traditional method requires 4.5 Gb for the highest RAM requirement. Full article

Thalassemia and sickle cell disease remain the most common life-threatening non-communicable diseases in children worldwide and an increasing burden on affected families and health services. Significant progress has been made in terms of technologies to improve access to a cure by both allogeneic and autologous gene-modified hematopoietic stem cell transplantation (HSCT). However, the high cost of cutting-edge treatments often places them beyond the reach of individual families or even national healthcare systems. Advances in frugal innovation and simplified HSCT procedures for low-risk transplants have significantly reduced the costs and complexities associated with HSCT without compromising on quality and outcomes. Because of the geographical distribution of hemoglobinopathies, i.e., largely in low- and middle-income countries (LMICs), HSCT cost optimization has the potential to impact a huge number of patients, increasing hope for a cure and health-related quality of life normalization, which in turn may affect supportive care compliance. Furthermore, because of the high burden of disease, LMIC transplant centers are rapidly increasing in number and developing unique expertise for the cure of thalassemia and sickle cell disease, particularly in India, where the Sankalp India Foundation with the support of DKMS and Cure2Children has implemented several cost-conscious transplant services. In fact, the very high success rate, increasing cost-effectiveness of transplantation, as well as the chronic nature of these conditions make them ideal initial candidates for start-up transplant centers, so it is likely that the global capacity for a cure for severe hemoglobinopathies will substantially increase in the years to come. Full article

Background/Objectives: Brazil has a high incidence of new tuberculosis cases influenced by socioeconomic factors. Inadequate housing, limited access to health services, and insufficient food increase vulnerability to the disease. This study aimed to identify sociodemographic, nutritional, and anthropometric factors associated with active pulmonary tuberculosis. Methods: This case–control study was conducted at the tuberculosis (TB) Referral Hospital in São Luís, Maranhão, Brazil, from 2022 to 2024. It included 65 patients with active pulmonary TB and 73 comparison individuals. Sociodemographic and nutritional data were collected using an adapted semi-quantitative questionnaire with 77 items, based on the validated ELSA-BRASIL questionnaire for adults, to assess the consumption of calcium, phosphorus, iron, zinc, vitamin B3, vitamin B6, vitamin C, vitamin E, and vitamin D. The Brazilian Food Insecurity Scale (EBIA) was used to analyze food and nutrition security or insecurity. Body Mass Index (BMI) was calculated based on weight and height measurements. Results: The TB patients were predominantly men (73.8%), of mixed ancestry (69.4%), with low education levels (73.4%), and had a mean age of 39 years. Furthermore, 26.2% of the patients were underweight, and 64% experienced some degree of food and nutrition insecurity. The variables education level, vitamin D, and BMI were associated with the outcome in the final model. Conclusions: The study identified a high prevalence of food insecurity and vitamin E deficiency in individuals with active tuberculosis, in addition to associating low educational levels, inadequate vitamin D intake, and overweight with a higher risk of TB. Although it has limitations, such as the cross-sectional design and sample size, the results highlight the importance of these determinants and point to the need for longitudinal research to confirm and expand the evidence. Full article

Invasive insect pests pose a significant threat to forest ecosystems. Effective pest management relies on detecting these pests, which can be challenging when populations are sparse, newly introduced, or not easily observable. The spotted lanternfly (Lycorma delicatula White), a recent invader to North America, has caused extensive damage across the eastern United States since its introduction in 2014. Conventional monitoring methods, such as traps or visual inspections, are limited in their spatial coverage and may not reliably attract or capture target species. In this study, we explored the potential of bat guano as an additional tool for invasive insect detection. We collected guano samples from five bat species across three forested sites in New Jersey, USA, between 2018 and 2022 and used species-specific quantitative PCR (qPCR) to detect spotted lanternfly DNA. Spotted lanternfly DNA was detected in guano from two bat species: big brown bats (Eptesicus fuscus) and eastern red bats (Lasiurus borealis). Detection probability was strongly influenced by spotted lanternfly phenology, with higher detection rates occurring during the adult life stage. The detection of spotted lanternfly DNA in bat guano demonstrates the feasibility of using guano analysis as a complementary tool for insect pest surveillance. Integrating guano-based monitoring with traditional methods could enhance insect pest detection efforts across diverse forested and agricultural landscapes. Full article

Aims: High smoking rates and deprivation levels in the North East of England have led to an opportunity to pilot a tobacco dependency treatment offer for NHS (National Health Service) staff who smoke, to make a supported quit attempt. The direct and indirect benefits to staff, patients, and NHS organisations are well documented. This study aimed to evaluate service acceptability. Methods: The service included up to 12 weeks of free nicotine replacement therapy (NRT) and/or a refillable e-cigarette, motivational support, and premium access to the Smoke-Free app. The service evaluation used a mixed-methods design, combining the Theoretical Framework of Acceptability (TFA) questionnaire and semi-structured interviews with staff who had accessed the offer. The quantitative data were analysed using descriptive statistics and qualitative data via thematic analysis. Results: Sixty-eight survey responses reflected high acceptability and revealed four themes relating to the service familiarity and ease of access, suitability of the NRT/E-liquid ordering service, the vape kit, and behavioural support. Conclusions: The service was deemed highly acceptable, and service users’ experiences informed recommendations for improving future tobacco dependency services. This is the first known application of the TFA to an evaluation of a smoking cessation intervention, and it contributes to a broader body of research on reducing tobacco dependency. Full article