Search Results (1,421)

The increasing interdependence between environmental degradation, geopolitical instability, and public-health pressures requires structured information-system architectures capable of integrating heterogeneous data and transforming them into decision-support knowledge. In this context, this study develops a data-driven information system architecture for the exploratory analysis of environmental, geopolitical, and health-related risks in the EU-27 during 2013–2023. The proposed system is structured as a multi-layered analytical pipeline designed to process country-year panel data and generate interpretable outputs. The methodological framework integrates Principal Component Analysis (PCA) for exploratory dimensionality reduction, K-Means clustering for structural pattern identification, a RandomTree classification model for translating cluster membership into decision rules, and a Two-Part Fixed Effects Model. Experimental results indicate an optimal and interpretable clustering configuration at k = 3, revealing three broad structural profiles among EU Member States. A moderate positive relationship is identified between greenhouse gas emissions per capita (GHGE) and health expenditure (SHA) (r = 0.34), while geopolitical risk (GPR) exhibits weak and statistically insignificant associations. This association is interpreted cautiously, as it may reflect the combined effect of industrial activity, environmental exposure, economic development, and the higher financial capacity of some Member States to allocate resources to healthcare systems. The results indicate the dominant contribution of GHGE and SHA in differentiating the identified profiles, while GPR shows limited explanatory power within the analyzed context. The RandomTree model achieved an accuracy of 93.58% in reproducing the cluster labels; however, it is used as an interpretability layer rather than as an independent validation of clustering. The system supports the identification of vulnerability-related structural patterns and provides an exploratory basis for future data-driven monitoring and early-warning applications. Full article

Sharps injuries and biological exposures remain a leading occupational safety risk in healthcare training environments. Preventing such injuries requires not only trainees’ declarative knowledge of biological hazards, but their threat appraisal—the cognitive process through which individuals evaluate personal risk and that motivates consistent adherence to standard precautions in practice. This cross-sectional study (N = 581) examined whether biological risk knowledge predicts cognitive threat appraisal in Italian health professions students surveyed prior to their first supervised clinical internship, and whether this relationship varies by gender. Drawing on Protection Motivation Theory (PMT), a multiple linear regression showed that biological risk knowledge significantly predicted personalized threat appraisal (β = 0.214, p < 0.001). Gender was also associated with threat appraisal, with female students reporting higher levels than male peers at equivalent knowledge levels (β = 0.184, p = 0.035). The overall model explained 16% of variance in threat appraisal (adjusted R² = 0.150), indicating that mandatory pre-placement occupational safety training is associated with risk appraisal activation, but only partially, and that a causal interpretation requires longitudinal confirmation. These findings suggest that knowledge transmission alone is insufficient to reduce biological risk exposure in clinical settings: appraisal-activating components—including scenario-based learning and near-miss incident review—should be integrated into occupational safety curricula for health professions students, with attention to gender differences in risk perception. Full article

Background: Effective notifiable disease surveillance depends on healthcare providers’ ability to identify and report cases. Evidence on factors associated with surveillance performance remains limited in high-risk regions such as Jazan, Saudi Arabia. Objective: This study examined factors associated with healthcare providers’ notification and case management skills, prevention and training competencies, and perceptions toward the Notifiable Disease Surveillance System (NDSS). Methods: A cross-sectional analytical study was conducted among 420 healthcare providers working in government hospitals and primary healthcare centers in Jazan. Data were collected using an adapted self-administered questionnaire. Composite scores were analyzed using t-tests, ANOVA, and linear regression. Results: Higher NDSS-related scores were associated with professional category, HESN+ training, epidemiology or surveillance training, and years of experience. In multivariable analyses, HESN+ training, formal epidemiology or surveillance training, professional category, and experience remained associated with notification and prevention-related outcomes. Notification and case management skills were also associated with more favorable NDSS perceptions. Conclusions: NDSS-related competencies and perceptions were associated mainly with training exposure, professional role, and experience. Strengthening HESN+ training and integrating surveillance education into workforce development programs may support disease reporting and surveillance capacity in Jazan. Full article

Sarcoma awareness among healthcare practitioners in our institution was limited, prompting an evaluation of their ability to recognize early presentations and initiate appropriate work-up for soft tissue and bone sarcomas. A structured survey assessed familiarity with key clinical features, recommended investigations, and perceived contributors to diagnostic delay. Overall awareness was modest, but higher among healthcare practitioners with prior sarcoma exposure, oncology-focused training, longer experience, or heavier patient loads; female practitioners and oncology nurses also scored higher. Confidence in identifying red-flag symptoms was strongly linked to familiarity with guideline-based practice. Despite these strengths, notable gaps persisted across specialties and training levels, indicating that exposure alone is insufficient. Targeted education, improved recognition of early warning signs, and clearer referral pathways are needed to reduce diagnostic delays and support timely management of suspected sarcomas. Full article

Therapeutic gardens are increasingly integrated into healthcare planning and design, supported by evidence showing that exposure to nature promotes health and well-being. As urbanisation and densification intensify, rooftop gardens offer a sustainable means of providing health-promoting green spaces in urban settings. This study aimed to deepen understanding of the EBD process behind a purpose-built rooftop garden at an urban Memory Clinic. It examined how the garden was experienced in terms of perceived successes and shortcomings and which design decisions or contextual factors were most influential. A POE was conducted through focus group interviews with healthcare professionals and an interview with the responsible landscape architect. Data were analysed using thematic analysis, producing five themes organised around three questions: How the garden turned out, why it turned out that way, and IF changes were desirable. Findings show that while the garden exceeded expectations regarding aesthetics, restorative qualities, and staff use, it was not used for patient-oriented therapeutic activities as intended. This divergence was linked less to physical design quality than to organisational change, the loss of key actors, insufficient documentation of design intentions, procurement disruptions, shifting clinical priorities, and maintenance arrangements. The study highlights “implementation drift” as a critical risk in EBD processes. Full article

Since its first description in the late nineteenth century, the epidemiology of infective endocarditis (IE) has changed considerably. Once primarily affecting younger individuals with structural heart disease, IE is now increasingly encountered in older patients with multiple comorbidities and frequent healthcare exposure. Population ageing, end-stage renal disease (ESRD), immunosuppression, and injection drug use (IDU) have broadened the pool of susceptible hosts. At the same time, the increasing use of prosthetic valves (PVs), cardiac implantable electronic devices (CIEDs), and transcatheter cardiac interventions has reshaped the clinical spectrum of IE. This epidemiological transition has also been accompanied by shifts in microbiological patterns, with a growing predominance of staphylococci and enterococci, as well as marked geographic and socioeconomic variation in disease burden. This review summarizes the contemporary epidemiology of IE, with an emphasis on the host-, healthcare-, and microbiological factors underlying its evolving clinical profile. Full article

We propose a secure biometric data protection (SBDP) system, which uses artificial intelligence (AI) and encryption methods to prevent forgery and keep the biometric data private and intact. The proposed SBDP approach integrates deep learning-based feature extraction with robust encryption and authentication mechanisms in a single pipeline. We use the optimized convolutional neural network (OCNN) to obtain unique features from multimodal biometric inputs like fingerprints, facial photos, and retinal scans. This works well because it learns how to represent data efficiently. To reduce the risks of raw biometric exposure, we adopt a generative adversarial network (GAN) to generate synthetic biometric representations that maintain essential characteristics while reducing sensitivity to data leakage. The biometric features and images are encrypted using the ElGamal cryptosystem to provide security assurance, while the digital signature scheme based on the SHA-256 hash function is used to provide data integrity and authenticity. Experimental results show good performance of all components of the framework. The optimized CNN obtains a classification accuracy of more than 99.8%, while the GAN shows stable training behavior with the discriminator and generator losses converging to around 0.3 and 4.0, respectively. The cryptographic module guarantees encryption dependability and signature verification efficacy across all evaluated scenarios. The integrated system provides effective protection of biometric data from unauthorized access, tampering and identity forgery. The SBDP framework is a promising solution for defense, healthcare and digital identity management, ensuring secure transmission and storage of biometric data. Full article

Background: Osteoporosis is increasingly understood as a complex population health condition shaped by interacting behavioral, metabolic, pharmacological, and healthcare system determinants rather than isolated skeletal risk factors. However, comparative studies integrating these dimensions across distinct healthcare and sociocultural settings remain scarce. We aimed to characterize cross-national differences in osteoporosis-related risk clustering between Romanian and Tunisian adults using an integrative multidimensional framework. Methods: We performed a comparative cross-sectional analysis of harmonized data from two pharmacy-based studies conducted in Romania and Tunisia, including adults aged ≥ 40 years (n = 349). Osteoporosis-related knowledge, lifestyle and metabolic risk factors, pharmacological exposures, preventive behaviors, and treatment patterns were assessed. Multivariable regression and mediation analyses were used to identify independent predictors of screening uptake and to evaluate the relationship between knowledge and preventive behavior. An exploratory cumulative preventive deficit score was used to estimate overall preventive burden within the pharmacy-based study sample. Results: Romanian participants demonstrated significantly higher osteoporosis knowledge than Tunisian participants (8.90 ± 2.20 vs. 7.83 ± 2.99; p < 0.001); however, knowledge was not independently associated with Dual-Energy X-ray Absorptiometry (DXA) uptake and did not mediate country-related differences in screening behavior. Compared with the Romanian cohort, the Tunisian cohort exhibited lower DXA screening rates (11.2% vs. 22.8%; p = 0.005), lower vitamin D supplementation (11.9% vs. 38.6%; p < 0.001), greater sedentary behavior, and a significantly higher cumulative preventive deficit burden (3.39 ± 1.08 vs. 2.77 ± 1.26; p < 0.001). Medication-related osteoporosis risk was also greater in Tunisia, particularly due to markedly higher corticosteroid exposure (7.5% vs. 0.5%; p = 0.002). Despite this less favorable preventive profile, the treatment gap among participants with diagnosed osteoporosis was significantly lower in Tunisia than in Romania (4.8% vs. 42.9%; p = 0.003). Conclusions: Distinct but convergent osteoporosis-related risk patterns were identified across the two populations, suggesting that osteoporosis vulnerability emerges through context-specific clustering of behavioral, pharmacological, and healthcare-access determinants rather than through isolated risk factors alone. The dissociation between knowledge and preventive behavior highlights the limited impact of awareness-based strategies when structural barriers remain unaddressed. These findings support a shift toward integrated, population-tailored osteoporosis prevention models that incorporate healthcare-system, medication-related, and behavioral determinants, in addition to conventional educational approaches. Full article

Sexually transmitted infections (STIs) remain a global health burden. Beyond classical pathogens, dermatophytes are increasingly identified within sexually linked transmission networks. Genital dermatophytosis is a superficial fungal infection of the genital area, primarily caused by anthropophilic and zoophilic dermatophytes. Recently, Trichophyton mentagrophytes genotype VII and Trichophyton indotineae have emerged as clinically significant dermatophytes, increasingly linked to human-to-human and sexually associated transmission within highly interconnected sexual networks. These infections are often marked by inflammatory, persistent, and treatment-refractory presentations, with prominent genital involvement and rising antifungal resistance—particularly to terbinafine—posing growing diagnostic and therapeutic challenges. Doxycycline post-exposure prophylaxis (Doxy-PEP) has recently emerged as a novel preventive strategy for bacterial STIs, involving the administration of 200 mg doxycycline within 24–72 h after activities associated with increased infection exposure, particularly among men who have sex with men (MSM) and transgender women. While effective in reducing infections such as syphilis and chlamydia, its broader implementation raises concerns regarding antimicrobial resistance. Chemsex is an increasingly prevalent behavioural phenomenon, defined as the intentional use of psychoactive substances during sexual activity to enhance or prolong the experience, particularly among MSM. It is associated with multiple adverse effects, including increased STI transmission, substance dependence, drug toxicity, psychological disturbances, and significant challenges in treatment adherence and healthcare engagement. This review aims to provide a comprehensive and clinically oriented overview of emerging trends in STIs, with a particular focus on dermatophyte infections as pathogens with potential sexually associated transmission, alongside evolving prevention strategies and behavioral factors influencing transmission. Full article

Moral injury has been gaining increasing prominence as a means of understanding psychological suffering in response to moral transgressions. Despite repeated evidence of exposure to moral transgressions among those detained in forensic services, moral injury as a construct within this population has not been widely explored. This research aimed to explore the lived experience of moral injury in service users detained in a forensic healthcare setting. Interviews with six service users and eight practitioners were conducted. Three themes were identified using multi-perspective interpretive phenomenological analysis: the mutuality of moral injury, pathways to harm, and a road to healing. Findings identified a complex trajectory towards moral injury, which significantly affected service users’ cognitive and emotional processes. Results also highlighted the impact of moral injury on risk to self and others. Implications for practice and policy are considered. These include: the need for wider recognition of moral injury and its effects within formulations and assessments, collective responsibility to reduce feelings of shame, and greater opportunities to seek forgiveness and generate a sense of purpose. Full article

Background: Nurse–patient communication is a nurse-associated, interprofessionally delivered care-process indicator captured by the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), but its hospital-level association with hospital-wide readmission after structural and case-mix adjustment remains incompletely characterized. Methods: We conducted a cross-sectional secondary analysis of publicly available Centers for Medicare and Medicaid Services (CMS) Hospital Compare data. The exposure was the HCAHPS nurse communication composite (April 2024–March 2025), and the outcome was the Hybrid Hospital-Wide All-Cause 30-day Readmission measure (July 2023–June 2024). The primary model adjusted for ownership and US Census region. Robustness was assessed using a six-model hierarchy, including linkage to Provider of Services and HCRIS data to account for teaching intensity, staffing density, and Disproportionate Share Hospital percentage. Additional sensitivity analyses examined survey weighting, survey-volume restriction, lagged HCAHPS scores, HCAHPS-domain specificity, CMS star-rating adjustment, non-linearity, regional interaction, health-system clustering, and alternative functional forms. Findings are interpreted as cross-sectional ecological associations, not causal or predictive effects. Results: Among 2844 acute care hospitals, each 10-percentage-point higher patient-perceived nurse communication score was associated with a 0.289 percentage-point lower 30-day readmission rate (95% CI −0.341 to −0.236; p < 0.001) in the primary model. The association was consistent across sensitivity analyses, although it was attenuated after additional adjustment for linked structural hospital characteristics. Among HCAHPS domains, discharge information showed the largest association with readmission. These findings indicate a modest but consistent hospital-level association rather than evidence of causality. Conclusions: Hospitals with higher patient-perceived nurse communication tended to have lower 30-day readmission rates, although the association was attenuated after adjustment for structural hospital characteristics. Patient-perceived nurse communication may therefore be a useful nurse-associated process indicator for readmission-related benchmarking, although it reflects interprofessional care and residual organizational confounding remains plausible. Longitudinal or interventional studies are needed to determine whether improving nurse communication can reduce readmissions. Full article

Background: Healthcare-associated infections (HAIs) and antimicrobial resistance are major burdens in tertiary care hospitals. Repeated point prevalence surveys (PPSs) offer a pragmatic approach to monitor temporal changes and guide infection prevention. Objectives: Characterize healthcare-associated infections (HAI) prevalence trends, microbiological profiles, antimicrobial resistance (AMR) patterns, and risk factors to refine prevention strategies and hospital policy. Methods: Four annual cross-sectional PPSs were conducted between 2022 and 2025 using the standardized ECDC protocol. Data from all eligible inpatients present at 08:00 on survey days were collected through systematic medical record review. Multivariable logistic regression was used to identify factors independently associated with HAI, with additional sensitivity analyses evaluating invasive device burden and hospital ward type. Results: Across the surveys, 3314 patients were included. Overall HAI prevalence was 11.3%. Infections were most frequent in intensive care units (31.2%), followed by medical (14.6%) and surgical (14.2%) wards. Bloodstream infections (25.7%) and lower respiratory tract infections (19.8%) were the most common. Multivariable analysis identified invasive device exposure as the strongest predictor, with central venous and urinary catheters showing robust independent associations and a clear dose–response relationship according to the number of devices. Pathogens were predominantly Gram-positive cocci (40.5%) and Enterobacterales (30.8%), with Klebsiella pneumoniae being the most frequent isolate (13.0%). Notably, 57.6% of K. pneumoniae isolates were resistant to third-generation cephalosporins. All tested Acinetobacter baumannii isolates were resistant to carbapenems. Conclusions: This repeated PPS reveals a persistently high HAI burden, associated with invasive device exposure and resistant pathogens. Because of the repeated cross-sectional design, causal inference cannot be established. Hospital-wide device stewardship and integrated surveillance are essential for guiding targeted prevention measures, refining antimicrobial policies, and adapting local responses to evolving resistance profiles. Full article

Background/Objectives: Healthcare workers (HCWs) were the most exposed job category to SARS-CoV-2, due to patient care, HCW-to-HCW transmission, and community exposure. However, the relative relevance of each source is still debated. To address this issue, this study investigated the dynamics of the professional and extra-professional determinants of infection across the pandemic among a large, multicenter cohort of HCWs. Methods: The study included 5576 HCWs from four Italian University Hospitals within a European Project, called ORCHESTRA. Socio-demographic and clinical data were collected retrospectively via online surveys from March 2020 to September 2022. Factors associated with SARS-CoV-2 infection during different pandemic periods were evaluated by a multinomial logistic regression model. Results were expressed as Relative Risk Ratios (RRR). Results: The cumulative incidence was 46.2%. The highest incidence period was the Omicron phase (OVP) (69.7%). The extra-professional source was the most reported (34.3%), followed by the occupational (26.8%). However, in almost 40%, the source was undetected. The RRR for occupational exposures was 0.39 (95% CI 0.25–0.61) during the Pre-Omicron variant Period (POP) and even lower (0.22, 95% CI 0.16–0.29) in the OVP, as compared to extra-professional exposures, using the Pre-Vaccination Period (PVP) as reference. Conclusions: The dominant source of infection among HCWs changed over time. While occupational contacts were more frequent during PVP, it significantly waned over the subsequent pandemic phases. Implementing procedures and guidelines to prevent infection, even outside the workplace during pandemics, would reduce the spread of infection among HCWs and patients. Full article

Urban logistics supports retail, public services, healthcare, construction, and household consumption, but delivery decisions often fail to account for the social costs imposed on congested roads, curbside space, air quality, noise exposure, safety, and public-space use. This study addresses the decision-maker mismatch that arises when the vehicle operator physically generates an externality while receivers, shippers, platforms, building managers, or consumers control delivery timing, shipment fragmentation, service level, fleet choice, and receiving conditions. It develops a Pigouvian policy framework that integrates dynamic road-user charging, curbside pricing, emission-based instruments, off-hour delivery incentives, clean-vehicle support, consolidation incentives, and revenue recycling. The study combines a structured narrative synthesis, decision-maker mapping, an illustrative Korean urban logistics scenario, cost–benefit comparison, and deterministic sensitivity screening. Under the stated scenario assumptions, a carrier-only peak charge reduces monetized daily external costs by only 1.3%, whereas a combined road-and-curbside package reduces them by 12.5%, and an integrated Pigouvian package reduces them by 23.6%. Sensitivity results preserve this ranking. The paper contributes a transferable policy design architecture for internalizing urban logistics externalities while maintaining freight functionality and stakeholder acceptability. Full article

Background: Health literacy plays an important role in medication understanding, self-management, and engagement with healthcare services among older adults. Limited health literacy may contribute to medication-related problems and reduced utilization of pharmacist-led services in geriatric populations. Methods: A cross-sectional, questionnaire-based survey was conducted among geriatric outpatients (≥60 years) attending a tertiary-care teaching hospital in Saudi Arabia. Health literacy was assessed using a four-domain functional tool—covering prescription label comprehension, understanding of healthcare instructions, confidence in completing medical forms, and comprehension of written health information—developed in alignment with established health literacy frameworks, including the Health Literacy Survey—European Union (HLS-EU) model and Baker’s conceptual framework. Participants were classified as having higher health literacy (0–2 domains impaired) or lower health literacy (3–4 domains impaired). Sociodemographic characteristics, clinical burden, medication self-management behaviors, and awareness of clinical pharmacist services were recorded. Multivariable logistic regression was used to identify factors independently associated with lower health literacy. Results: A total of 200 participants were included. Impairment in three or more domains was observed in 55.5% of participants. Lower health literacy was independently associated with older age, lower educational attainment, lower income, female sex, multimorbidity, and polypharmacy. Participants with lower health literacy reported higher rates of missed or incorrect medication dosing and unreported adverse drug reactions and lower use of medication management aids. Awareness of clinical pharmacist services and prior exposure to pharmacist counseling were significantly lower among participants with lower health literacy. Willingness to receive pharmacist counseling was higher among participants with higher health literacy and greater awareness of pharmacist roles. Conclusions: Health-literacy impairment is common among geriatric outpatients and is associated with medication self-management behaviors and engagement with pharmacist-led services. These findings highlight the relevance of functional health literacy in geriatric medication use and support further research on literacy-sensitive pharmacist-led interventions. Full article