Search Results (11,969)

Differences in the lifestyle and health-service-seeking behavior of persons experiencing homelessness (PEH) are well known. However, a comprehensive estimation of the resulting healthcare utilization differences and health outcome impacts are so far under-researched, especially at the national level. We aim to close this gap of evidence for lung cancer within the Hungarian universal healthcare system. We analyzed lung cancer-related information for the PEH population in the Hungarian national central health insurance register dataset and a matched control population between 2015 and 2021. In this period, 11,857 people were registered as homeless for the majority of at least one year. To capture the effect of homelessness, we created a categorical “homelessness length index” (HLI) according to the proportion of time an individual experienced homelessness during the investigation period (HLI 0: 0; HLI 1: >0–1/3; HLI 2: >1/3–2/3; HLI 3: >2/3). PEH individuals were matched 1:5 with a non-PEH control sample adjusted for age, sex and region. We conducted Kaplan–Meier survival analysis and Cox proportional hazards (CPH) regression adjusted for age, sex, HLI and average lung cancer-related healthcare costs. Our final analysis sample consisted of 641 patients (233 PEH, 408 control) who were newly diagnosed with lung cancer during the observation period. The lung cancer prevalence in the PEH group was 1.97% as opposed to 0.69% in the control group. The Kaplan–Meier curve showed lower average survival times for the PEH group, compared to the control group. Lung cancer associated costs between diagnosis and death/censoring were substantially different with average per patient cumulative costs of EUR 3668 in the PEH group compared to EUR 6827 in the control group (2018 prices). This translated to an average 47% lower annual lung cancer-related healthcare cost per PEH patient. CPH analysis showed that after disease severity, the degree of time spent in homelessness had the most significant effect on mortality, with a HR of 1.47 associated with both HLI 2 and 3 (95% CI: 1.08–2.00 and 1.01–2.14, respectively). We find that in Hungary, homelessness is associated with a much higher lung cancer burden linked to a three-times-higher prevalence, lower overall survival and almost 50% lower annualized disease-specific healthcare costs. Worse outcomes are mainly driven by long-term homelessness. Results could not be further refined according to lifestyle-related factors due to data availability limitations. Full article

Background: The health benefits associated with the consumption of nuts and seeds are well established, yet this food group is known to be the furthest from the recommended intake; therefore, actions aiming to increase nut intake are needed. The main front-of-pack communication device in Australia, the Health Star Rating (HSR), inadvertently penalises nuts with negative points associated with energy and saturated fat content. Methods: This study aims to suggest options to policy makers by (i) examining how the HSR rates a sample of 82 nuts, seeds and products containing them and (ii) testing three sets of moderate adjustments of the HSR algorithm on the sampled products: discounting the energy from nuts and seeds (S1), discounting the saturated fat from nuts and seeds (S2) and applying an adapted algorithm based on that for ‘oils and spreads’ for foods with ≥50% nuts and seeds (S3). Results: All three scenarios improved the Spearman correlation between the HSR score and the nut and seed content (−0.80, −0.75 and −0.71 for S1, S2 and S3, respectively) compared to the original HSR (−0.66). Products with more than 50% of their weight being nuts and seeds benefited much more from these adjustments than those below 50%. For all scenarios, but most clearly for S3, the products that had a lower HSR score than the original HSR (the healthier products) benefited more from the changes brought about by the adjusted algorithms than those of lower nutritional quality. The HSR of foods that contained no nuts or seeds remained unchanged. Conclusions: With minor changes to the HSR algorithm, nut and seed products could be brought into alignment with the current evidence, encouraging their regular inclusion in dietary patterns, which could help guide consumers at the supermarket shelf. Full article

Background/Objectives: The climate crisis has been associated with significant and complex challenges for youth mental health. Anxiety, sadness, and anger have been identified as core emotional responses to the climate crisis and its impacts. However, there are limited data on how these emotions correlate with climate awareness and engagement in pro-environmental behaviors. The present study explores parental accounts on climate crisis-related emotional responses, awareness levels, and engagement in climate actions among Greek youth, as well as the role of their parents’ emotional responses. Methods: This study employed a cross-sectional online survey of parents with children aged 10–18 years in Greece. A total of 186 parents completed questionnaires assessing their children’s and their own climate crisis-related emotional responses (worry, sadness, and anger), levels of climate awareness, and engagement in mitigating actions. Logistic regression analyses were conducted to examine associations between children’s emotions and sociodemographic factors, parental emotions, and climate-related behaviors. Results: The children in our study exhibited lower levels of climate-related worry, sadness, and anger compared to their parents. While 33.3% of parents reported worrying “very much”, only 7.5% of children were reported as experiencing this level of distress. Parental emotional responses were significant predictors of children’s emotions, with high parental worry associated with increased odds of child worry (adjusted OR: 7.80, 95% CI: 1.71–35.62). Climate awareness was higher among parents (64%) than children (44.7%), and children engaged less frequently in climate-mitigating behaviors than parents. Family communication about climate change was also strongly associated with children’s emotional responses. Conclusions: According to their parents’ accounts, children and adolescents in Greece exhibit moderate levels of overall climate distress, while parental emotions and communication within the family influence their responses. The present study’s findings support the need for climate education and policy initiatives that enhance emotional resilience and encourage active engagement among youth. Full article

Background/Objectives: Telemedicine has emerged as a transformative solution to healthcare access challenges in Sub-Saharan Africa, where many populations remain underserved. This systematic review focuses on the adoption, implementation, and technological prospects of telemedicine in South Africa, Kenya, and Nigeria, three countries leading the region in healthcare innovations. Methods: A systematic search of PubMed, Scopus, and Web of Science, guided by PRISMA protocols, identified 567 studies published between 2014 and 2024, of which 53 met the inclusion criteria with a focus on telemedicine adoption, implementation, and technological prospects in the selected countries. A structured critical appraisal was used to assess potential biases in the included studies’ design, selection criteria, and reporting, while findings were thematically analysed to provide actionable and comparative insights. Results: The findings reveal that South Africa has the highest adoption rate, focusing on specialist teleconsultations, chronic disease management, and mental health services. Kenya demonstrates strong mHealth integration and advanced mobile applications, particularly in maternal health, HIV care, and sexual and reproductive health. While facing infrastructural and regulatory constraints, Nigeria is advancing innovations for remote diagnosis and teleconsultation. Conclusions: By synthesising evidence from peer-reviewed literature, the review identifies adoption trends, enabling factors, and opportunities for scaling telemedicine in these contexts. Despite these advancements, challenges persist, including regulatory gaps, digital literacy limitations, and infrastructure constraints. Addressing these barriers requires targeted investments in broadband expansion, policy harmonisation, and healthcare workforce training to optimise telemedicine’s impact and ensure its sustainability as a healthcare delivery model in Sub-Saharan Africa. Full article

In the case of a high-risk infectious disease affecting two distinct (without demographic interactions) human populations, e.g., differentiated by their settlement areas, we assume the implementation of a health non-pharmaceutical mitigation policy. However, this policy is based solely on indicators from one of the populations. Using a mathematical model that integrates $\beta (·)$-SIR representations—where $\beta (·)$ is a variable specific to each population and is governed by a dynamic law (a differential equation coupled to state variables)—the dynamic consequences of the epidemiological processes in both populations are explored and compared analytically and numerically. Mainly, it studies the role of the so-called reaction (intensity of the mitigation) and restitution factor (human compliance). Full article

Introduction: In British Columbia (BC), Canada, COVID-19 and associated control measures impacted routine care for patients with diabetes. Some of these measures may have impacted timely screening and diagnosis of type 2 diabetes. We assessed the impact of control measures on screening and diagnosis of type 2 diabetes in BC. Methods: We used data from the BC COVID-19 Cohort, which includes COVID-19 and healthcare administrative data on all residents of BC. We assessed and compared screening (≥40 yrs) and diagnosis (≥18 yrs) of diabetes among the adult population during the pandemic period (1 April 2020–31 December 2022), with 1 January 2016–31 March 2020 used as a historical reference period. We used interrupted time series with generalized additive models to evaluate the impact of policy measures on screening and diagnoses trends. Results: We observed an initial decline in the mean number of screenings and diagnoses. In the third post-policy phase (January 2022–December 2022), there was a 4.8% (−5.1, 15.4) increase in screenings while after an initial reduction in diabetes diagnoses, we observed a significant increase of 31.6% (17.8, 46.6) in the third post-policy phase. Further stratification by age and sex showed the entire increase in diagnoses trends was driven by younger females with a 56.4% (25.1, 92.9) and 58.7% (38.2, 81.3) increment in diagnoses in the 18–29 and 40–49 age groups, respectively. Conclusions: The initial reduced number of screenings and diagnoses followed by the significant upward trend in diabetes diagnoses in the later post-policy phase have important clinical and public health implications. Further research is needed to understand the post-pandemic increase in diabetes among females. Full article

Background/Objectives: The prevalence of obesity is high among children living with disability. The present study aimed to examine the perceptions of parents and caregivers of children living with disability regarding children’s energy balance related behaviors (EBRBs) and their determinants. Methods: Parents/caregivers of children living with disability (n = 45) from Thessaly, Crete and Attica Regions of Greece, participated in semi-structured interviews between November and December 2023. The interviews were recorded, transcribed and transferred to N-VIVO software. The results were analyzed according to the framework of the socio-ecological model, using deductive thematic analysis. Results: Parents/caregivers reported that eating habits of children living with disability and their physical activity levels were poorer compared to the general population. At an individual level, certain disabilities may affect children’s food preferences and parents’ ability to prepare healthy foods. At a familial level, financial difficulties may influence healthy eating, whereas some parents/caregivers act as children’s role models to encourage them to be physically active. Home food environments may also influence children’s eating patterns and peer influence on their EBRBs. At a community level, lack of trained personnel, available amenities/equipment and food education initiatives and the availability of unhealthy foods in school canteens were described as major barriers to healthy EBRBs. At an organizational level, lack of accessible/safe facilities, the marginalization/stigma that children living with disability may experience and lack of dietitians/nutritionists in health centers were named as the main factors influencing children’s EBRBs. Conclusions: The findings of this study highlight the importance of designing multi-sectoral policy interventions to promote healthy EBRBs and tackle obesity in children living with disability in Greece. Full article

This study explores the impact of road transport on the environment, focusing on noise pollution. Using high-resolution, one-minute data from a low-cost environmental sensor, this research examines traffic flow dynamics, meteorological influences, and their relationship to noise along a major transport corridor. The methodology combines cluster analysis and descriptive statistics to evaluate the effects of deploying a Smart Motorway Variable Speed Limit (SMVSL) system over a six-month monitoring period. Results indicate that SMVSL systems not only smooth traffic flow but also significantly reduce noise variability, particularly during peak hours, thus mitigating noise peaks associated with adverse health outcomes. LAeq values were found to differ modestly between day and night, with clustering revealing a reduction in extreme noise events (LAmax > 70 dB(A)) in SMVSL scenarios dominated by heavy goods vehicles. This study further identifies associations between unmanaged speed regimes and elevated noise levels, enriching our understanding of the environmental impacts of unregulated traffic conditions. These findings inform sustainable planning and policy strategies aimed at improving urban environmental quality and enhancing public health outcomes. Full article

Chagas disease is a serious public health problem worldwide. In Brazil, the state of Pará has the largest number of reported cases. This article analyzes the spatial distribution of this disease and its relationship with socioeconomic, environmental, and public policy health variables in three mesoregions in the Pará state from 2013 to 2022. This ecological study used secondary data obtained from official Brazilian agencies. Spatial analysis was carried out using the flow, kernel, and bivariate global Moran techniques expressed in thematic maps. A total of 3664 cases of the disease were confirmed, with the highest number of cases being reported in the northeast of Pará. A seasonal pattern of the disease, an epidemiological profile similar to other diseases in the Amazon region, and the spatial dependence between the disease prevalence and socioeconomic indicators were observed. The most intense movement of patients for treatment was to the Belém metropolitan mesoregion, which has the majority of the health services and professionals. The disease showed an inhomogeneous pattern of cases in terms of the spatial distribution, with a direct relationship between areas with a higher number of cases and those with human clusters. The socioenvironmental origins of the disease transcend mesoregion boundaries and stem from the historically unsustainable development model in the Amazon. Full article

Background: Evaluating associations between fear of COVID-19 and psychopathology in clinical samples can yield valuable insights for the formulation of public health policies and for the training of mental health professionals in future major health crises. The objectives of our study were to evaluate the following aspects among patients diagnosed with insomnia disorder during the most critical period of the COVID-19 pandemic in Brazil: (a) the frequency of symptoms of depression and anxiety, fear of COVID-19, and severity of insomnia; (b) possible gender differences in the variables analyzed; and (c) associations between fear of COVID-19, symptoms of depression and anxiety, severity of insomnia, and sociodemographic variables. Method: A total of 353 individuals who sought treatment at a psychiatric hospital in the Brazilian public health system and were diagnosed with insomnia disorder (DSM-5) participated. The following instruments were used: the Hospital Depression and Anxiety Scale, Insomnia Severity Index, Fear of COVID-19 Scale, and a sociodemographic questionnaire. The assessments were carried out via the REDCap platform between March and July 2021. Results: Mild to moderate levels of fear of COVID-19 were identified in the majority of participants. Symptoms of depression, anxiety, and insomnia were reported at a moderate level. Although all scores were higher among women, only the fear of COVID-19 reached significant differences between groups. Fear of COVID-19 was positively correlated with symptoms of depression and anxiety and with the severity of insomnia. Anxiety scores had a positive and statistically significant effect on insomnia severity and on fear of COVID-19. Being a man and performing physical activity had a negative and statistically significant effect on fear of COVID-19. Conclusions: Being a woman, being sedentary, and having symptoms of anxiety were predictors of fear of COVID-19 among participants with insomnia disorder. This finding highlights the importance of gender-sensitive public health policies for the care of patients with insomnia during future major health crises. The associations between anxiety symptoms and fear of COVID-19 and the severity of insomnia verified in our study suggest the relevance of addressing anxiety symptoms through encouraging physical activity to mitigate the severity of insomnia and fear of pathogens in patients with insomnia. Full article

Background/Objectives: The COVID-19 pandemic has significantly affected public health and social behavior, contributing to increased psychoactive substance (PAS) use due to social isolation, economic stress, and uncertainty. This study aims to assess the impact of the pandemic on alcohol, cannabinoid, and opioid consumption among drivers involved in road traffic accidents (RTAs) in Kazakhstan. Understanding these patterns is essential for improving public health policies and road safety measures during crises. Methods: This retrospective cross-sectional study analyzed medical records from the Digital System of Medical Examination, a national database of drivers involved in traffic accidents in Kazakhstan. This study included 157,490 anonymized records from 1 January 2019, to 31 December 2020, categorizing cases into pre-COVID-19 and COVID-19 groups on the basis of the first nationwide lockdown on 16 March 2020. Statistical analyses, including prevalence rates and relative changes, were conducted via SPSS 20, while spatial distributions were visualized via QGIS software. Results: An analysis of all the records revealed a 12.9% decline in traffic accidents during the pandemic, with male drivers predominating during both periods. The mean age of the drivers in the compared groups was 36. Alcohol and cannabinoid use significantly increased during the COVID-19 period by 3.71% and 11.51%, respectively. In contrast, opioid use declined by 10.00%, but the difference was not statistically significant. The greatest increase in positive alcohol tests among drivers was observed in the Atyrau (94.80%), Pavlodar (35.43%), and North Kazakhstan (31.02%) regions, and Atyrau also presented the greatest increase in cannabinoid-positive cases. Conclusions: The results indicate that the COVID-19 pandemic and related lockdown measures have affected PAS consumption patterns among drivers. These findings are crucial for informing policies and developing strategies to improve road safety during future public health emergencies. Full article

The global COVID-19 pandemic posed a significant threat to public health, inflicting enduring hardships upon humanity, particularly among vulnerable populations. Artisanal cross-border fish traders from developing countries like Malawi were severely impacted by imposed control measures. Gender inequalities exacerbated these challenges, forming the basis of this study on informal cross-border traders along the Malawi–Mozambique border near Lake Chilwa during the pandemic. Using an intersectional theory, this research explores how gender disparities were shaped by COVID-19, considering social determinants, consequences, and coping mechanisms in cross-border fish trading. The study employed a cross-sectional qualitative approach, collecting data from 169 participants through focus group discussions (FGDs), Key Informant Interviews (KIIs), the Cognitive Edge Sensemaker Tool, and the Emergency Market Mapping and Analysis toolkit (EMMA) between April and November 2022. Findings indicate that COVID-19 control measures disproportionately affected female cross-border fish traders, leading to increased human rights violations, particularly sexual exploitation and rape. These violations left women with enduring health traumas, including sexually transmitted diseases. Both men and women employed coping strategies that exposed women to further marginalization and human rights violations. Given the widespread nature of violence across borders, inter-country coordination is crucial to protect the rights of cross-border traders. Policy measures should focus on educating vulnerable women about reporting mechanisms for abusive practices and establishing local support systems where reporting mechanisms are lacking. Full article

Background/Objectives: The aging population has increased the demand for home modifications to support aging in place. However, existing research primarily focuses on fall prevention and physical safety, leaving gaps in understanding long-term sustainability, social engagement, and cost-effectiveness. Additionally, the interaction between home modifications and health-related changes remains under-explored. This study systematically reviews home modifications, addressing these gaps by considering functional independence, quality of life, caregiving burden, and technological advancements. Methods: A systematic review was conducted following PRISMA 2020 guidelines. One researcher and an external expert performed study selection, data extraction, and quality assessment. Thematic analysis and narrative synthesis were applied to compare study results. Results: Among 20 studies, 13 (65%) confirmed the effectiveness of home modifications in fall prevention, functional independence, and cost savings. Seven studies (35%) highlighted housing accessibility and lifestyle factors. However, few studies examined personalized interventions, smart home technologies, and long-term adaptability. Conclusions: This study emphasizes the need for personalized, technology-driven, and long-term adaptable home modifications. Future research should explore smart home innovations, interdisciplinary approaches, and policy implementation feasibility to develop sustainable aging-in-place strategies. By adopting a holistic perspective, this study provides a new framework for advancing aging-in-place strategies. Full article

Food systems are difficult to model, given the challenge of defining socially desirable food system outcomes. Research that aims to advance agri-food systems must reveal opportunities for integrated food systems planning and assess its outcomes. The climate, biodiversity, health, and justice (CBHJ) nexus provides such a lens, and it is a potentially useful tool for understanding how (or whether) food systems planning and policy studies employ a systems-based, integrated perspective. Further, it may be used to identify how agri-food systems planning and policy engage with local objectives and co-benefits related to climate change adaptation and mitigation, biodiversity conservation, community health, and social justice. This research proposes an indicator framework to operationalize the CBHJ nexus, by undertaking a scoping review of over one hundred local agri-food planning and policy studies. Outcomes from this work reveal the nature and degree to which agri-food systems research adopts a systems lens that comprehensively models resilience, sustainability, and justice. Outcomes related to biodiversity, procedural justice, and mental wellbeing were not common in the dataset. Recommendations from the work include guidance on how the nexus can broaden the quantitative and qualitative data-driven measurements of food system outcomes. Future work is required to define appropriate CBHJ outcomes and their possible measurements across scales beyond just local levels. Full article

China’s coal industry is reckoned as one of the topmost contributors to global carbon emissions, and as a result, poses severe challenges both to human health and climate change mitigation efforts. Achieving carbon neutrality requires thorough analyses of mechanisms driving the coal sector’s transition. This study employs a structural model to investigate the transmission pathways through/by which the “dual carbon” goals influence the coal industry, using a policy text quantification approach to assess specific carbon reduction measures. Findings reveal that the impact of the “dual carbon” target on the coal industry operates through multiple pathways. Carbon reduction policies significantly enhance technical advancements, social and economic factors, energy-saving measures, and alternative energy development, all of which indirectly affect coal supply. Notably, the pathway from coal demand to coal supply shows a high path coefficient of 1.121, far surpassing the path coefficient from factor input to coal supply, measured at 0.169. This highlights coal demand as the pivotal intermediary variable in determining the “dual carbon” target’s impact on the coal industry. While current technologies and alternative energy sources have limited immediate effects on coal supply, they hold significant potential as transformative factors in the future. Full article