Search Results (2,533)

Exposure to PM_2.5 poses severe risks to public health and sustainable development, with exposure inequalities exacerbated by variations in atmospheric activity and uneven regional development. However, the urban-rural inequalities and natural-human driving mechanisms underlying PM_2.5 exposure inequalities within urban agglomerations are poorly understood. Taking the Central Plains Urban Agglomeration (CPUA) in China as an example, this study investigated the spatio-temporal variations of PM_2.5 and considered its future trends. The Theil index was employed to quantify PM_2.5 exposure inequalities. An interpretable machine learning model (RF-SHAP) was applied to identify the raster natural and socioeconomic driving factors. We found that 99.68% of the CPUA exhibited a decreasing trend in ground-level PM_2.5. The overall Theil index decreased from 0.168 to 0.142, with a rural decline from 0.115 to 0.084, suggesting an overall reduction in air pollution inequalities, particularly in rural areas. Conversely, the urban Theil index increased from 0.096 to 0.208, highlighting an increasing inequality in urban PM_2.5 exposure. Resource-based cities, such as Changzhi, Jincheng, and Jiaozuo, exhibited the largest PM_2.5 exposure inequality. Elevation was identified as the dominant factor influencing overall and rural PM_2.5 exposure inequalities, while population density was the primary driver of urban inequalities. This study highlighted the differences in urban−rural PM_2.5 inequalities and their drivers at the city agglomeration scale. The aims were to mitigate PM_2.5 exposure inequalities through socio-environmental systems, provide evidence for the integrated management of PM_2.5 exposure inequalities in city agglomerations, and support regional sustainable development. Full article

Background/Objectives: Equitable access to childhood vaccines remains a challenge in many low- and middle-income countries. This study assessed coverage of WHO-recommended childhood vaccines in Cambodia and the Philippines, focusing on urban–rural and wealth disparities, and examined maternal demographic and socioeconomic factors influencing vaccination coverage. Methods: Cross-sectional data from Demographic and Health Surveys from Cambodia (2000–2021/22) and the Philippines (2003–2022) were used. Descriptive analyses were performed to elucidate vaccination coverage trends (BCG, hepatitis B birth dose, DTP, OPV, PCV, and measles). Urban–rural and wealth-related disparities were assessed by calculating absolute differences and Slope Index of Inequality. Logistic regression was used to analyze the impact of maternal demographics and socioeconomic status on vaccination coverage. Results: Cambodia showed significant increases in BCG, DTP, and OPV coverage over the past two decades, whereas those coverage in the Philippines declined slightly since 2017. In 2022, 75.2% of Filipino children received the BCG and hepatitis B (birth dose) vaccines, and around two-thirds completed DTP, OPV, and PCV vaccinations on schedule, lower than the rates in Cambodia. Only half of the children completed measles vaccination in both countries. Urban–rural disparities declined over time in both countries, but wealth inequalities persisted and widened in the Philippines between 2017 and 2022. Women with higher education attainment, from a wealthy household and having fewer children, was associated with increased likelihood of completing childhood vaccinations in both countries. Conclusions: Persistent socioeconomic disparities in childhood vaccination in low- and middle-income countries highlight the need for targeted pro-poor and community-based strategies to ensure equitable access. Full article

As Saudi Arabia accelerates digital transformation under Vision 2030, the sustainable adoption of Health 4.0 technologies depends on equitable digital health literacy (DHL) and population-level readiness for eHealth engagement. Despite growing interest, empirical data on the behavioral, social, and contextual determinants of digital health adoption remain limited in Middle Eastern settings. This study investigates the readiness of Saudi adults for eHealth services, identifies key behavioral factors influencing digital tool adoption, and proposes an equity-centered, network-aware DHL framework to support inclusive and sustainable Health 4.0 implementation. A multi-phase, cross-sectional study was conducted among 430 Saudi adults using validated instruments including eHEALS, TRI 2.0, UTAUT, and EQ-5D. Quantitative analysis employed multiple linear regression (R² = 0.79), structural equation modeling (CFI = 0.96; RMSEA = 0.04), social network analysis (centrality scores), and network-based diffusion analysis (s = 0.17). Additionally, a three-round Delphi method (CI ≤ 0.25) ensured expert consensus on framework development. Significant predictors of digital health tool adoption included eHealth readiness (β = 0.18), perceived usability, and system trust. Social network metrics identified central actors who facilitated peer-driven behavioral diffusion, validated through NBDA modeling. Based on these findings, a comprehensive DHL Equity Framework was synthesized, integrating behavioral drivers, network diffusion pathways, and principles from the Triple Bottom Line (TBL) framework to mitigate structural disparities while addressing environmental, economic, and social dimensions of sustainable digital health access. The framework was also systematically mapped to relevant Sustainable Development Goals (SDGs), highlighting its alignment with global health and sustainability targets. This study presents a scalable and policy-relevant model to guide inclusive eHealth strategies in Saudi Arabia and similar developing contexts. The proposed framework advances national digital resilience, reduces inequities, and promotes sustainable Health 4.0 service delivery. Full article

Discrimination has been linked to greater stress and higher levels of depressive symptoms. However, there has been no research to date that has examined how life course inequality due to everyday discrimination is associated with mental health outcomes later in life. Using data from Waves I, IV, and V of the National Longitudinal Study of Adolescent to Adult Health (Add Health) from 1994 to 2018, we examined how everyday discrimination in young adulthood (Wave IV) was associated with depressive symptoms at early midlife (Wave V). We also examined how parent–child relationships in young adulthood (maternal and paternal closeness; satisfaction of communication with mothers and fathers) moderated this association. We analyzed two sub samples: a mother sample (n = 9390) and a father sample (n = 8229). Results from both showed that everyday discrimination in young adulthood was significantly associated with depressive symptoms at early midlife, and parent–child relationships served as significant protective factors against depression. Mental health policy and intervention efforts should address how discrimination experienced in young adulthood can have enduring adverse effects on mental health into early midlife and invest in strategies that promote supportive parent–child relationships as protective resources. Full article

Relevance: Obstructive sleep apnea (OSA) is a major public health problem with significant social and economic consequences. With increasing prevalence associated with urbanization and aging, untreated OSA is a considerable burden to the healthcare system, work productivity, and accident costs. Objectives: To analyze the global socioeconomic burden of OSA and evaluate epidemiological, economic, and healthcare policy perspectives across different regions and income levels. Materials and Methods: We conducted a narrative comprehensive review of published studies and WHO reports, covering direct medical costs, indirect social costs, and the cost-effectiveness of both existing and emerging diagnostic and therapeutic techniques. Results: OSA is estimated to afflict some 936 million adults around the world, and if it remains untreated, OSA results in 2.5 times higher healthcare costs compared to non-OSA individuals. The annual societal cost of untreated OSA in the U.S. now exceeds USD 150 billion, when considering direct medical expenses, productivity losses, and accident-related costs. Recent studies also highlight significant global costs, with annual per-patient estimates up to EUR 28,000 in the U.S. and EUR 1700–5000 in Europe. The inequality of treatment access continues between the affluent and the poor regions. Novel approaches as AI diagnostics and telemedicine, hold promise for reducing costs and improving treatment adherence among underserved populations with limited access to conventional care. Discussion: This review underscores the importance of uniform care throughout the world, timely diagnosis initiatives using portable technology, and scalable technological solutions to help reduce the social toll of OSA. Policymaker support, public education campaigns, and insurance changes are necessary to optimize both the cost and effectiveness of OSA management worldwide. Full article

Folic acid supplementation during the periconceptional period is a well-established strategy to prevent neural tube defects (NTDs). However, emerging uncertainties surrounding optimal dosage, alternative folate forms, duration of use, and the role of genetic variability have sparked scientific and policy debates. In Brazil, these challenges are amplified by unique contextual factors, including the routine distribution of high-dose folic acid (5000 µg) through the public health system, social vulnerability, low adherence, and limited population-specific evidence for the country’s highly admixed population. This narrative review critically examined the scientific evidence and public health policies surrounding folic acid supplementation, with a focus on Brazil. We examined historical developments, international recommendations, and emerging controversies, including the emerging influence of misinformation. Despite the worldwide progress in NTD prevention, both local and global challenges persist, including delayed initiation, inconsistent adherence, and uncertainty regarding alternative supplementation regimens. Addressing these demands requires the development of context-specific guidelines, alongside coordinated strategies in provider training, public education, monitoring, and research investments to ensure effective, safe, and equitable folic acid supplementation. Full article

Substance use during pregnancy is an increasingly important yet under-recognized threat to maternal and child health. This narrative review synthesizes the current evidence available on the epidemiology, pathophysiology, clinical management, and policy landscape of prenatal exposure to alcohol, tobacco, opioids, benzodiazepines, cocaine, cannabis, methamphetamines, and other synthetic drugs. All major psychoactive substances readily cross the placenta and can remain detectable in breast milk, leading to a shared cascade of obstetric complications (hypertensive disorders, placental abruption, pre-term labor), fetal consequences (growth restriction, structural malformations), and neonatal morbidities such as neonatal abstinence syndrome and sudden infant death. Mechanistically, trans-placental diffusion, oxidative stress, inflammatory signaling, and placental vascular dysfunction converge to disrupt critical neuro- and cardiovascular developmental windows. Early identification hinges on the combined use of validated screening questionnaires (4 P’s Plus, CRAFFT, T-ACE, AUDIT-C, TWEAK) and matrix-specific biomarkers (PEth, EtG, FAEE, CDT), while effective treatment requires integrated obstetric, addiction, and mental health services. Medication for opioid use disorders, particularly buprenorphine, alone or with naloxone, confers superior neonatal outcomes compared to methadone and underscores the value of harm-reducing non-punitive care models. Public-health strategies, such as Mexico’s “first 1 000 days” framework, wrap-around clinics, and home-visiting programs, demonstrate the potential of multisectoral interventions, but are hampered by structural inequities and punitive legislation that deter care-seeking. Research gaps persist in polysubstance exposure, culturally tailored therapies, and long-term neurodevelopmental trajectories. Multigenerational, omics-enabled cohorts, and digital longitudinal-care platforms represent promising avenues for closing these gaps and informing truly preventive perinatal health policies. Full article

(1) Background: Data literacy is becoming increasingly important for healthcare professionals in both outpatient care and research. Since healthcare data and the possibilities for its use and misuse are increasing in these areas, healthcare professionals need diverse knowledge regarding the collection, use and evaluation of data. A core component of this is an understanding of the ethical, legal, and social implications (ELSI) of working with health data. (2) Methods: Within the DIM.RUHR project (Data Competence Center for Interprofessional use of Health Data in the Ruhr Metropolis), the challenge of training in data literacy for different healthcare professionals is addressed. Based on a learning objectives matrix for interprofessional data literacy education, an ELSI concept was developed through collaboration with interprofessional project partners. The study was conducted between December 2024 and April 2025. (3) Results: The foundational structure of the ELSI concept was based on the learning objectives matrix and an unstructured literacy search for ELSI concepts in similar contexts. Using an iterative design-based research approach, a group of experts from different fields (didactics, applied ethics, health sciences, law, sociology, informatics, and psychology) developed an ELSI concept for healthcare professionals. The following categories were identified as crucial: 1. philosophy of science: a basic understanding of science and the hurdles and opportunities; 2. ethics: an overview of the biomedical principles and a technological assessment; 3. law: an overview of the reservation of permission and self-determination; 4. social aspects: an overview of health inequalities and different forms of power relations and imbalances. (4) Conclusions: The ELSI concept can be used in the orientation of healthcare professionals in outpatient care and research—regardless of their profession—to develop data competencies, with the aim of providing a holistic view of the challenges and potential in the collection, use, and evaluation of healthcare data. The DIM.RUHR project’s approach is to develop open educational resources that build on the ELSI concept to teach specific skills at different competence levels. Full article

Background: Children with disabilities face complex, systemic health access barriers rooted in societal, institutional, and structural inequities, requiring urgent global policy attention. Publications on access to health services for this population category have been found to have a significant growth in both quantity and content. The article aims to examine the structure and evolution of scientific literature in analyzing the healthcare system through the lens of inclusive services. Methods: We present the bibliometric profile of the global literature on access to health services for children with disabilities, the publication trends, the structure of research in this field concerning geographical distribution, methodological approaches, and interdisciplinary collaborations, and the core research topics, conceptual clusters, and future research directions in the field. The publications were screened from Web of Science databases, using PRISMA methodology. Finally, 1100 academic publications published between 1984 and 2025, obtained from a total of 432 different sources, the majority of which were peer-reviewed journals, were screened. Results: The calculated annual publication growth rate of 8.37% and the distinct upward trend observed, especially after 2015. The highest level was reached in 2023, with over 90 publications showing that the topic has become a focus of international academic interest. The USA (33.5%), the United Kingdom (15.7%), Australia (9.5%), and Canada (9.5%) stood out in publications, and there were strong collaborative networks among European nations (8.2%). Conclusions: Although high-income countries still appear to play a dominant role in research production, expanding international collaborations and distributing resources more equitably will contribute to the development of more inclusive solutions on a global scale. Temporal trends show an evolution toward diagnostic processes, family-centered approaches, and psychosocial dimensions. The results draw a clear picture of the current research landscape regarding access to health services for pediatric disability populations and identify potential directions for future research. Full article

Despite global commitments to universal health coverage, persons with disabilities (PwD) continue to face significant barriers in accessing appropriate healthcare, including diagnostics, treatments and preventive healthcare, with lower participation in cancer screening and vaccination programs. These disparities are driven by diverse, intersecting obstacles (structural, financial, communicative, and social) that vary by disability type and context. Inclusive approaches, co-designed with PwD and supported by standardized assessment tools, are urgently needed to address persistent inequities in healthcare access and outcomes. Full article

Invasive candidiasis (IC) in Latin America is undergoing a significant epidemiological shift, increasingly driven by non-albicans strains such as Candida tropicalis, Candida parapsilosis, and Candidozyma auris. These pathogens often exhibit multidrug resistance, which complicates treatment and increases mortality. Diagnostic limitations, particularly in rural and public hospitals, delay detection and hinder the provision of rapid care. Environmental pressures, such as climate change and the widespread use of azoles in agriculture, appear to favor the selection of resistant and thermotolerant strains. Migratory birds may also play a role in the environmental transmission of pathogenic fungi. These factors are amplified by socioeconomic inequalities that restrict access to diagnostics and first-line antifungals. To help mitigate this emerging challenge, a One Health-oriented framework combining integrated environmental surveillance, robust antifungal-stewardship programmers, broader diagnostic access, and coordinated cross-sector public health actions should be developed. Reinforcing these pillars could lessen the regional burden of IC and slow the advance of antifungal resistance. Full article

Background: Respiratory viral infections such as influenza, COVID-19, and respiratory syncytial virus (RSV) are considered as major public health threats in Africa. Despite global advancements in vaccine development, persistent inequities in access, delivery infrastructure, and public trust limit the continent’s capacity to control these diseases effectively. This review aimed at providing insights on challenges, efforts, impacts, and opportunities for the future related to vaccination against respiratory viral infections in Africa. Methods: This narrative review synthesizes the peer-reviewed literature and global health reports to examine vaccination efforts against respiratory viruses in Africa. The analysis focuses on disease burden, vaccine coverage, barriers to uptake, enabling factors, progress in local vaccine production, and strategies for integrating vaccines into national immunization programs (NIPs). Results: Respiratory vaccines have significantly reduced hospitalizations and mortality among high-risk groups in African countries. Nonetheless, key challenges, including limited cold chain capacity, vaccine hesitancy, donor-reliant supply chains, and under-resourced health systems, continue to undermine vaccine delivery. Successful interventions include community mobilization, use of mobile health technologies, and leveraging existing immunization platforms. Emerging initiatives in local vaccine manufacturing, including Rwanda’s modular mRNA facility and Senegal’s Institut Pasteur, signal a shift toward regional self-reliance. Conclusions: Maximizing the impact of respiratory vaccines in Africa requires a multifaceted strategy: integrating vaccines into NIPs, strengthening domestic production, expanding cold chain and digital infrastructure, and addressing sociocultural barriers through community-driven communication. These efforts are essential to achieving vaccine equity, health resilience, and pandemic preparedness across the continent. Full article

Urban green spaces are important nature-based solutions to mitigate climate change. While the distribution of green spaces within cities is well documented, few studies assess whether inequities in green space quantity (i.e., percent cover) are mirrored by inequities in green space quality (i.e., vegetation health or sensitivity to stressors). Green space quality is important to measure alongside green space quantity because vegetation that is healthier and less sensitive to stressors such as climatic fluctuations sustain critical ecosystem services through stressful environmental conditions, especially as the climate changes. We use a 40-year remote sensing dataset to examine the spatial patterns and underlying drivers of vegetation sensitivity to short-term (monthly) climate fluctuations in Chicago. Our results show that although vegetation cover was not equitably distributed between racially and ethnically segregated census tracts, socio-demographic composition was not a key driver of spatial variation in short-term vegetation sensitivity to climate. Instead, we found that vegetation growth form was a strong predictor of differences in vegetation sensitivity among communities. At the census tract level, higher herbaceous/shrub cover was associated with increased sensitivity to climate, while higher tree cover was associated with decreased sensitivity. These results suggest that urban green spaces comprising trees will be less sensitive (i.e., more resistant) to short-term climate fluctuations than those comprising predominately herbaceous or shrub cover. Our findings highlight that urban green space quality can vary spatially within cities; however, more work is needed to understand how the drivers of vegetation sensitivity vary among cities, especially those experiencing different climatic regimes. This work is key to planning and planting high-quality, climate change-resilient and equitable urban green spaces. Full article

Background: Cancer remains a leading cause of morbidity and mortality worldwide. In Puerto Rico, patients face additional burdens due to the structural inequalities affecting access to employment, nutritious food, and mental health services. This study examined the associations between employment status, perceived economic hardship, dietary behaviors, and depressive symptoms among 334 adult cancer patients in Puerto Rico. Methods: Using a cross-sectional design, participants provided sociodemographic data, dietary patterns, and self-reports of depression. Results: Statistical analyses revealed that full-time employment was associated with a higher consumption of low-nutritional-value foods (ρ = 0.157, p = 0.015) and significant differences in their consumption having a higher mean against unemployment were observed (mean ranks = 146.09 and 177.08, p = 0.010). A higher employment status also served as a protective factor against depression (p = 0.005). A higher body mass index (BMI) was linked to an increased risk of depression (p = 0.002), and perceived economic hardship was significantly associated with depression (OR= 0.54, p = 0.033). Conclusions: The findings underscore the necessity for comprehensive interventions that account for the synergistic effects of economic perception, employment, nutrition, and psychological well-being in cancer treatment in Puerto Rico. Full article

Background: The COVID-19 pandemic exposed major structural deficiencies in global health governance, including stark inequities in vaccine access, intervention timing, and mortality outcomes. While economic resources played a role, the influence of governance performance remains insufficiently examined. This study addresses a significant gap by integrating governance metrics with pandemic response data to assess how governance quality, independent of income level, affected national outcomes. Although the Oxford COVID-19 Government Response Tracker (OxCGRT) dataset has been widely used to document policy responses, this study offers a novel contribution by linking these policy interventions with governance performance and evaluating their joint effect on health outcomes and vaccine equity. Methods: This mixed-methods study combines quantitative analysis of global datasets with a qualitative literature review. Quantitative data were mainly obtained from the Oxford COVID-19 Government Response Tracker (OxCGRT), the World Bank’s Worldwide Governance Indicators (WGIs), and World Bank/WHO databases. A governance performance index was constructed using two WGI components: Government Effectiveness and Regulatory Quality. Countries were grouped into high, medium, or low governance categories. Statistical tests included ANOVA, Kaplan Meier survival analysis, and multivariable OLS regression. The qualitative component reviewed 45 academic and institutional sources on governance performance during COVID-19. Results: Countries with high governance performance had earlier public health interventions, lower mortality, and broader vaccine coverage, independent of income level. Kaplan Meier analysis revealed faster school closures in these countries (p < 0.01). Multivariable regression showed governance remained a significant predictor after adjusting for income and health spending. Qualitative findings highlighted recurring weaknesses in legal enforceability, intergovernmental coordination, and global financing mechanisms. Conclusions: Governance performance had a decisive impact on pandemic outcomes. The COVID-19 crisis revealed the need for robust governance systems capable of responding to complex emergencies that extend beyond the health sector into institutional, economic, and social spheres. Full article