Search Results (14,973)

Background/Objectives: Antimicrobial resistance (AMR) constitutes a major public health and economic burden in contemporary society. This work aims to identify the patterns and temporal trends of Klebsiella pneumoniae resistance to carbapenems across several European countries. Methods: Data on K. pneumoniae resistance to carbapenems in several countries from 2005 to 2021 (with data available up to 2023) were retrieved from the public ECDC website in 2023. Agglomerative Hierarchical Cluster Analysis (HCA), based on the new generalised affinity coefficient, was applied to the estimated ARIMA models. Results: The dendrogram at the cut-off presented four clusters: the first cluster with Slovenia, Luxembourg, Italy and Estonia; the second cluster with Romania, Malta, Greece, Portugal and Spain; the third cluster Denmark, France and Czechia; and finally the fourth cluster with Lithuania, Cyprus, Finland, Austria, Belgium and Slovakia. Although the resistance values showed an increasing trend over the years in clusters II and III, the increase was more pronounced in cluster II. Conclusions: The application of data analysis, for the first time, using HCA based on a new similarity coefficient, namely, the generalised affinity coefficient, enables the evaluation of time-series patterns in different regions and enables the identification of clusters of countries showing similar temporal patterns of antimicrobial resistance. Carbapenem resistance in K. pneumoniae among countries belonging to cluster II showed increasing trends throughout the study period. Full article

Enterotoxigenic Escherichia coli (ETEC) infection severely impairs post-weaning piglet health, causing intestinal dysfunction, systemic inflammation, and significant economic losses in the swine industry. This study aims to evaluate a synthesized palmatine-intercalated montmorillonite composite (MP) for improving growth performance, immune response, and intestinal health in ETEC-challenged piglets. Following structural characterization, an in vivo trial was conducted using 30 crossbred piglets (Yorkshire × Landrace × Duroc; 15.12 ± 2.95 kg BW) challenged with ETEC K88 and supplemented with 0.02%, 0.5%, and 1.5% MP. Structural analysis confirmed successful intercalation of palmatine into montmorillonite, with enhanced antibacterial and anti-inflammatory properties. In vivo, dietary inclusion of the 1.5% MP significantly alleviated ETEC-induced growth depression, as evidenced by increased average daily gain and improved apparent total tract digestibility of crude protein. These effects were associated with improved jejunal morphology and upregulation of PEPT1, B0AT1, and SGLT1. Moreover, MP supplementation attenuated systemic inflammation and hepatic stress, as indicated by reduced serum AST, TNF-α, and IL-1β levels. Microbiota analysis showed that MP modulated ETEC-associated alterations in the cecal microbial community. In conclusion, the MP represents a promising nutritional approach to improve intestinal resilience, nutrient utilization, and growth performance of ETEC-challenged piglets. Full article

Bacterial self-healing cement-based materials (BSHCMs) couple microbial mineralization with cement-based material design to autonomously seal cracks and potentially restore durability. However, their performance depends on a complex interaction among bacterial viability and physiological state, mineralization pathway, carrier and nutrient systems, calcium availability, matrix chemistry, crack characteristics, moisture, and exposure history. This review, supported by bibliometric mapping of 805 Scopus-indexed records, examines these interdependencies through the specific lens of artificial intelligence (AI) readiness. The mapping revealed six interconnected research themes spanning bacterial mineralization, sustainable cement-based systems, matrix chemistry and transport, encapsulation, durability, and machine learning (ML). AI evidence was classified as directly demonstrated in bacterial self-healing systems, transferable from adjacent concrete and structural health monitoring applications, or prospective. Although existing ML studies report high internal predictive performance, their engineering generalizability remains limited by heterogeneous and frequently literature-derived datasets, random train–test partitioning, potential feature leakage, synthetic data dependence, insufficient uncertainty reporting, and scarce independent laboratory or field validation. The analysis further shows that sustainability and economic benefits cannot be assumed from the biological nature of the technology but must be demonstrated through service life extension relative to the additional burdens of cultivation, nutrients, carriers, and processing. Advancing BSHCMs toward trustworthy AI-supported engineering, therefore, requires harmonized and machine-readable datasets, matched attribution controls, delayed cracking and realistic exposure experiments, explicit uncertainty and negative result reporting, study-grouped and external validation, and pilot- to field-scale testing. AI should consequently be regarded not as a substitute for biological healing, but as a decision support layer whose value depends fundamentally on the quality, traceability, and transferability of the underlying experimental evidence. Full article

Chronic pain is highly prevalent among older adults and represents a major health challenge due to its multifactorial aetiology, association with multimorbidity and frailty, and impact on quality of life. This narrative review synthesises evidence from the last few decades addressing chronic pain in older adults, with emphasis on risk factors, underlying mechanisms, and preventive strategies. Risk factors were organised according to the Dahlgren and Whitehead “Rainbow model” into individual, environmental, and social determinants. Individual-level factors—particularly physical inactivity, abnormal body weight, poor nutrition, mental health disorders, maladaptive pain beliefs, sleep disturbance, previous surgical and postoperative pain, multimorbidity, frailty, smoking, and alcohol use—were associated with pain persistence. Emerging evidence related to environmental and social determinants, including reduced nature and sunlight exposure, low socio-economic status, occupational factors, and social isolation, suggests further increased pain vulnerability. Mechanistic evidence indicates that ageing is associated with impaired descending pain modulation and increased susceptibility to peripheral and central sensitisation. Although randomised preventive trials in older adults remain scarce, converging evidence suggests that targeted lifestyle modification, early pain management, and multimodal non-pharmacological strategies may reduce progression to chronic pain. A prevention-oriented, risk-stratified approach integrating clinical care with broader public health strategies may help mitigate the growing burden of chronic pain in ageing societies. Full article

Public Food Procurement can shape diets, markets, and territorial food systems, yet its strategic potential depends on how policy objectives are translated into tender design, contract management, and territorial food policy governance. The study draws on a predominantly international literature-based review of recommendations and selected country experiences to contextualize the analysis and identify relevant good practices. At the European Union and Portuguese levels, it systematically compares the applicable policy and legal frameworks and examines how they are translated into Portuguese procurement practice. It also situates Public Food Procurement within recent Portuguese debates on food transition, metropolitan food-system planning, and multifunctional agrifood parks. A qualitative documentary and regulatory analysis was conducted using a four-pillar framework—health, environmental, social and economic—operationalized through 28 criteria. The empirical corpus comprised 53 school food procurement procedures published in Portugal in 2023. Technical specifications or equivalent documents were unavailable for 15 procedures; the cases were retained in the fixed denominator of every criterion and pillar index, so the results shown are conservative full-corpus measures of publicly observable documentary incorporation. The reliability matrix retained all 53 procedures, but ordinal Krippendorff’s alpha was estimated from the 1064 units containing pairable ratings and was 0.625 (95% bootstrap CI: 0.576–0.667). Health achieved the highest aggregate index (37%), followed by environmental (17%), social (15%), and economic criteria (8%). Although 58% used Most Economically Advantageous Tender (MEAT) terminology, only 13% applied genuine multi-factor evaluation, while approximately four in five procedures were effectively price-only. The findings should therefore be interpreted as evidence of documentary incorporation and observability rather than supplier compliance or direct health and environmental outcomes. They indicate that a major documented weakness lies not in lack of legal authority, but in weak translation into measurable award criteria, contract clauses, monitoring mechanisms, and integrated local or regional food-policy strategies. Full article

Drought is a natural hazard that poses significant threats to populations, economic sectors, and the environment. At its worst, it can have catastrophic impacts, particularly for vulnerable countries. Drought monitoring is critical in providing timely information about evolving conditions that can save lives and reduce economic losses, in turn building resilience to impacts from climate extremes. Timor-Leste, a least developed country in Southeast Asia, is highly vulnerable to natural hazards, with average acute food insecurity of 27%, and an economy largely based on subsistence agriculture. The severe 2015/16 El Niño-induced drought left 10% of total population at the time at immediate risk of starvation. This study examines agricultural drought monitoring in Timor-Leste using two satellite-derived precipitation and vegetation health products: the Standardised Precipitation Evapotranspiration Index (SPEI) and the Vegetation Health Index (VHI). It was found that both the SPEI and VHI were able to represent the onset, peak, end, and severity of the 2015/16 drought conditions across Timor-Leste in near real-time. The SPEI and VHI correlated well (r = 0.74 and r = 0.79, respectively) with surface-based precipitation observations from Timor-Leste over the 2015/16 study period. This study demonstrates that spaced-based drought monitoring can be a valuable tool for proactive drought management in Timor-Leste and the surrounding regions. Full article

Australia’s Great Barrier Reef is a national icon, World Heritage Area, and under sustained threat from climate change and terrestrial land-use. It is also a complex AUD 95 billion asset generating 77,000 jobs and contributing AUD 9 billion annually to Australia’s economy, a 69% increase over the 2017 valuation despite climate pressures and coral bleaching events. With 1.2 million residents in the GBR catchment, reef health directly impacts local economies and communities. We propose that alignment of reef investments with collaborative regional resilience through a Great Barrier Reef Economic Zone will improve the resilience of the regions sustained by and who care for the GBR. More inclusive than standard linear mechanistic thinking, this circular approach will leverage the GBR’s international status to attract continuing investment in regional resilience and sustainable growth and improve GBR management outcomes. Full article

Background/Objectives: Grandparent caregiving is a common and demanding role, and perceived economic strain is among the more consistent correlates of caregiver well-being. Guided by Hill’s ABC-X family stress model, this study examined whether perceived economic strain was associated with quality of life (QoL) among U.S. caregiving grandparents through two caregiving appraisals, caregiver burden and caregiver ambivalence, and whether perceived residential area type (a single self-classification item, with higher scores indicating a more urban perception) moderated the ambivalence–QoL relation. Methods: Participants included 424 caregiving grandparents recruited through an opt-in online panel. QoL was measured with the two-item WHOQOL-BREF general facet. Storage codes for the health-satisfaction item were verified against the survey instrument; a scoring error affecting them was corrected, and all results reflect the corrected scoring. A serial mediation model (PROCESS Model 6) and a moderated serial mediation model (PROCESS Model 87) were tested, controlling for age, sex, and marital status entered as categorical indicators, with percentile bootstrap confidence intervals (5000 samples). Results: Perceived economic strain was strongly and negatively associated with QoL (total effect B = −4.64, p < 0.001; the full QoL regression model explained 38% of the variance, R² = 0.38). Greater strain was associated with greater burden, and burden with greater ambivalence, but the hypothesized negative serial pathway was not supported, and the serial indirect relation was positive and small (effect = 0.20, 95% CI [0.04, 0.41]). Perceived area type moderated the ambivalence–QoL relation (interaction B = 0.63, p = 0.002). Ambivalence was associated with lower QoL among grandparents who perceived their communities as small towns (B = −3.97) and with higher QoL among those with urban (B = 0.93) or major metropolitan (B = 1.09) perceptions. The moderation held across robustness checks, including an ordinal specification of the outcome, but did not replicate with an objective metropolitan versus nonmetropolitan indicator. Conclusions: The findings are cross-sectional, come from a relatively advantaged and nonrepresentative sample, and rest on brief measures, so causal conclusions are not warranted, and practice implications remain preliminary. Even so, the results support the idea that the meaning of caregiving ambivalence for well-being may depend on the kind of community caregivers believe they live in, and the strong relation between perceived economic strain and QoL supports continued attention to financial hardship in policies and programs serving caregiving grandparents. Full article

Livestock production must reconcile animal health, food safety, ecological limits, and farm viability. This narrative review proposes proactive health-oriented livestock production (PHLP) as a testable conceptual framework for alpine pastoral systems and as a step toward theory development, rather than as an already validated general theory. PHLP does not claim novelty for vaccination, nutrition, welfare, biosecurity, precision monitoring, or low-carbon practices considered separately. Its proposed contribution is a decision architecture that forecasts context- and stage-specific risk, detects deviation with a feasible sentinel dataset, activates a matched intervention before avoidable loss becomes clinically or economically visible, and recalibrates local triggers from animal, product, ecosystem, and livelihood outcomes. The hypothesized pathway links cold, hypoxia, forage scarcity, pathogen exposure, and management stress to sentinel change, trigger-based action, lower cumulative stress, and greater immune–metabolic, rumen–gut, and behavioral stability. We define entry points, priority rules, initial boundary conditions, measurable indicators, and three testable propositions for Tibetan sheep, yak, and other alpine ruminants. PHLP is expected to be most useful when a consequential risk has usable lead time, a sentinel variable can be observed, and a feasible action is available; it complements rather than replaces emergency clinical care and statutory disease control. Comparative longitudinal and multisite studies are needed to calibrate triggers and test whether PHLP improves decision timeliness and reduces seasonal body-condition loss, morbidity, mortality, antimicrobial treatment, product-quality variability, and emission intensity relative to reactive or calendar-based management. Full article

Globally, the COVID-19 pandemic caused significant healthcare, economic and social impacts. This study described characteristics of COVID-19 mortality and determined risk of COVID-19 death by wave period in Jamaica. A cross-sectional analysis was conducted using data on confirmed COVID-19 cases reported to the National Surveillance Unit from 5 August 2020 to 4 October 2022. Multivariate logistic regression was used to determine odds of death by wave period, adjusting for age, sex and health region. 148,262 cases and 3654 COVID-19 deaths were included in the analysis. Increased odds of COVID-19 death were associated with male sex, age, and health region. Odds of death increased among males (OR:1.4, 95%CI: 1.3–1.5), residents in the Western health region (OR:1.4, 95%CI: 1.3–1.5) and persons ≥ 40 years (OR:18.2, 95%CI: 15.8–20.9). In comparison to Wave 4, odds of death were OR:3.4 (95%CI: 3.0–3.8) for Wave 3 and OR:2.6 (95%CI: 2.2–3.0) for Wave 1. Higher risk of death among males and older persons were observed across wave periods. Odds of death was greatest during Wave 3. This reinforces the need for responsive and adaptive health systems, as well as social and clinical interventions among high-risk groups. Full article

Background: Proton pump inhibitors (PPIs) serve as efficacious therapies for acid-related conditions; nonetheless, the possibility of unwarranted prolonged usage has led to heightened focus on PPI management and suitable deprescribing practices. Investigating supportive non-pharmacological approaches after the cessation of PPIs is necessary. Objective: This single-arm pilot study evaluated the feasibility and acceptability of a structured transition from proton pump inhibitor (PPI) therapy to papaya–oat food supplementation with Caricol^®-Gastro in adults with mild-to-moderate reflux/heartburn. Changes in patient-reported symptoms during supplementation were assessed as exploratory clinical outcomes. Adults with mild-to-moderate reflux/heartburn underwent a protocol-defined PPI treatment phase, followed by PPI discontinuation and five weeks of Caricol^®-Gastro supplementation. Symptoms reported by patients were evaluated utilizing a tailored 15-item questionnaire right prior to supplementation and at Week 5. Feasibility results encompassed research finalization, compliance, fulfillment of the protocol-specified transition, and the necessity for symptom-associated PPI reinstatement. A 14-day observation period without products following the intervention evaluated the short-term incidence of symptoms after the cessation of supplementation. Results: All 39 persons who enrolled finished the trial. The average compliance with supplementation was 93.2%, and no participant ceased using Caricol^®-Gastro due to exacerbation or recurrence of reflux/heartburn symptoms, nor did any require the reinitiation of protocol-allowed PPIs during the supplementation period. The average overall symptom score diminished from 37.38 (SD 2.88) before supplementation to 24.85 (SD 4.84) by Week 5, reflecting a mean within-participant alteration of −12.54 points (95% CI: −13.54 to −11.53; p < 0.001). Throughout the 14-day observation period following the intervention without product use, 11 subjects (28.2%) exhibited no symptoms, while 28 (71.8%) experienced symptoms on at most two occasions. Conclusions: The results support the feasibility and acceptability of the protocol-defined transition from PPI therapy to papaya–oat supplementation in this selected population. The noted decreases in symptoms within participants are preliminary and, due to the lack of a controlled design, cannot be causally linked to Caricol^®-Gastro. These results advocate for additional assessment of the supplementation as a possible supporting approach after the clinically suitable cessation of PPIs in a sufficiently powered randomized controlled trial employing a validated patient-reported primary outcome. Full article

Riparian ecosystems are among the most impacted by human activities despite their great importance as refuges for biodiversity and providers of environmental services. The Nazas River is one of the most important wetlands in north-central Mexico. This river boosted the development of La Comarca Lagunera, a region of great economic importance to the country. However, regional development has led to the deterioration of this vital socio-ecosystem and its services. Despite these efforts, no studies have integrated multiple indicators to comprehensively assess the overall health of the basin. Instead, previous research has largely relied on isolated indicators. For this reason, this study prioritized an initial health assessment of the Nazas River, considering three main indicators: a biological indicator based on the fish community, a physicochemical indicator of water quality, and a physical indicator of the condition of the territory surrounding the river. The study found a marked gradient in overall health, ranging from the least degraded in the upper reaches (0.76 Ramos River and 0.68 Sextín River) of the river to the most degraded in the lower reaches (0.63 Lower Nazas), and highlighted the Peñón Blanco River in the middle section as a priority area for conservation and a possible biodiversity refuge due the Comprehensive Health Assessment 0.80. Full article

Background/Objectives: Self-harm attempts among adolescents represent a major public health concern, often associated with depression, low self-esteem, and social withdrawal. While excessive smartphone use is generally linked to internalizing distress, digital engagement might play complex roles among socially isolated youth. This study examined factors associated with self-harm attempts among female adolescents with self-reported reclusive tendencies in South Korea, with a specific focus on evaluating the exploratory role of smartphone overdependence. Methods: Secondary data analysis was conducted on 893 female adolescents with self-reported reclusive tendencies who utilized or were admitted to crisis youth support organizations, drawn from the nationwide Survey on the Living Conditions of Users of Crisis Youth Support Organizations. Statistical procedures incorporated complex-sample descriptive statistics, Rao–Scott chi-square tests, and complex-sample hierarchical logistic regression. Results: In univariate analyses, economic status, self-esteem, self-control, depression, and parent–child relationships differed significantly according to self-harm history. In multivariable hierarchical logistic regression, higher self-esteem (OR = 0.44, p < 0.001) and positive parent–child relationships (OR = 0.57, p = 0.004) were associated with lower odds of self-harm attempts, whereas depression (OR = 2.23, p = 0.001) and lower self-control (OR = 1.40, p = 0.009) were associated with higher odds. The inclusion of smartphone overdependence in Step 3 (yielding a modest increase in explanatory power, ΔR² = 0.02) revealed that being in the smartphone overdependence risk group was associated with lower odds of self-harm attempts (OR = 0.55, p = 0.003). Conclusions: Self-harm attempts in this service-using population are strongly associated with core psychological and familial distress. The inverse multivariable association regarding smartphone overdependence is preliminary and hypothesis-generating; it may reflect statistical suppression, unmeasured confounding, or indirect digital connection among isolated youth, rather than a direct protective function. Findings apply specifically to crisis-service-using female youth and underscore the need for longitudinal research with refined clinical measures. Full article

Background/Objectives: Contemporary health systems continue to face persistent challenges in financing, equity, and governance, particularly under conditions of limited resources, workforce shortages, and demographic pressures. While the World Health Organization calls for strengthening social participation to achieve universal health coverage, evidence suggests that such participation often remains largely symbolic. Existing global examples of social participation in health are limited either by their short duration of implementation or by their limited scope. In contrast, the experience of former Yugoslavia (1945–1991) represents a distinctive case. In the early post-war period, health reforms were directed towards the development of a decentralised, self-managed health system that emphasised universal coverage, participatory governance, social solidarity, and local autonomy. The trajectory of these reforms was further shaped by global economic and political pressures, including neoliberal trends, international debt, and the oil crises, which constrained resources and exposed systemic vulnerabilities. The so-called Yugoslav Experiment may offer an alternative to existing market-oriented and, at times, inefficient health systems. This review aims to synthesise evidence on the governance, financing, organisation, and outcomes of Yugoslavia’s self-managed health system and to evaluate its relevance to contemporary debates on health system resilience, decentralisation, participatory governance, equity, and sustainability. It examines power relations, stakeholder interests, and resource allocation, and assesses the lessons that the Yugoslav experience offers for contemporary debates on participatory governance and the sustainability of healthcare systems, while identifying areas of convergence, debate, and gaps in the existing scholarship. Methods: We conducted a systematic narrative review of peer-reviewed articles, book chapters, conference papers, and commentaries published in English or Bosnian–Croatian–Montenegrin–Serbian that covered the period 1945–1991. Scopus, PubMed, and EBSCOhost (including CINAHL Plus with full text, Medline and PsychInfo) were searched on 19 January 2026. Studies were included if they addressed health system reform, self-management, governance, financing, or institutional continuity. Contextual studies of selected services—primary care, mental health, reproductive health, and vaccination—were included only if they illuminated reform trajectories. Data synthesis focused on reform phases, institutional transformations, financing arrangements, governance mechanisms, and power relations, with particular attention to continuity, path dependence, and critical junctures. Given the heterogeneous and predominantly historical, analytical, and policy-oriented nature of the literature, we did not apply conventional study-design-specific risk-of-bias tools. Instead, we used an overarching framework to classify and contextualise the included evidence according to five dimensions: source type, nature of contribution, evidentiary role, temporal context, and health-system domain. The protocol was not registered. The study was financed by the Provincial Secretariat for Higher Education and Scientific Research, Autonomous Province of Vojvodina, Republic of Serbia. Results: The database searches yielded 265 records, of which 193 were selected for title and abstract screening after removing 72 duplicates. At this stage, 133 publications were excluded because they did not meet the eligibility criteria and 60 publications were selected for full-text review. Application of the predefined inclusion and exclusion criteria resulted in 22 eligible publications. An additional 18 studies were identified through citation chaining and targeted Google Scholar searches. Twenty-two publications were coded as primary studies, directly examining health system reform, governance, or self-management, while 18 were classified as contextual studies addressing specialty areas. The analysis identified key reforms that followed the social participation, i.e., ‘self-management’, approach, which expanded primary care, preventive services, and local participation. It revealed institutional changes, as well as the role of power and health financing in health reforms aimed at strengthening social participation. Nonetheless, challenges—including bureaucratic and managerial elitism, unequal professional authority, resource scarcity, and tensions between market-oriented policies and social solidarity—were amplified by global economic forces and neoliberal trends, ultimately contributing to the system’s collapse by the late 1980s. This review was limited by its search strategy, the exclusion of grey literature, the potential omission or inaccessibility of relevant studies, and its focus on selected aspects of health reform, namely post-war recovery and self-management. Conclusions: The Yugoslav experience illustrates both the promise and the fragility of socially oriented, participatory health systems, demonstrating how international political alignments and global economic pressures can profoundly shape domestic health reform trajectories. Lessons from this case remain relevant to contemporary efforts to strengthen social participation for universal health coverage through designing sustainable, resilient, equitable, and socially accountable health systems under complex global conditions. Full article

Mycotoxins are secondary fungal metabolites that have continuously attracted research interest, both for their potential negative effects on animal and human health and for the economic losses they entail. Studies assessing exposure to mycotoxins have become increasingly widespread. The aim of this study was to provide a comprehensive description of mycotoxins and to evaluate the evolution of research on monitoring mycotoxin exposure using human urine samples, concerning analytical techniques and occurrence. Studies published in English over the last 25 years from four databases (Web of Science, PubMed, Science Direct, Scopus) were analyzed. Evaluating 73 original articles, a constant interest in the analysis of ochratoxin A in human urine samples could be observed (maximum level 148 ng/mL), a fact also justified by its demonstrated toxicity. The most commonly used analytical technique to evaluate mycotoxin presence in human urine was liquid chromatography coupled with high-performance detectors. The limitations of the review include the large period covered and the lack of mycotoxin concentrations expressed in ng biomarker/mL urine in some articles. Finally, an overview of how mycotoxin levels in human urine can be applied to mycotoxin exposure risk assessment was included. Full article