Search Results (129)

Economic inequities in healthcare access persist globally, yet the impact of income on palliative care (PC) utilization in Middle Eastern contexts remains empirically understudied. This cross-sectional study of 200 cancer patients in Riyadh, Saudi Arabia, employed a socioeconomic stratification analysis to examine income-stratified differences in PC awareness and access. Using chi-square and linear-by-linear association tests, results revealed pronounced income gradients; awareness increased from 41.9% in the low-income group to 71.9% in the high-income group (p = 0.001), demonstrating a significant dose–response trend. Access disparities were even more striking, with only 35.5% of low-income patients utilizing services compared to 76.1% of high-income patients (p < 0.001), representing a 40.6 percentage-point gap. After multivariable adjustment, after controlling for age, gender, education, and geographic living region, the results of logistic regression analysis showed that cancer patients with high income were more than three times as likely to access PC services compared with lower-income cancer patients (OR = 3.32; 95% CI: 1.83–6.02; p < 0.001). Geographic stratification further indicated that income disparities were significantly amplified in peripheral regions compared to the Central region (p = 0.072 for interaction), where service scarcity exacerbates economic barriers. These findings underscore that economic barriers operate through awareness gaps and structural obstacles like transportation and opportunity costs. Addressing these inequities requires multifaceted strategies, including financial support and geographic service expansion, to ensure equitable PC distribution under the Vision 2030 framework. Full article

The COVID-19 pandemic caused stark global mortality disparities, influenced by a complex interplay of demographic, economic, and health factors. This ecological study investigates associations between country macroscopic variables and COVID-19 accumulated mortality ratio (AMR) across 174 countries and may serve as a preparation for new pandemics. Methods: The study applies bidirectional stepwise multiple linear regression. To ensure statistical validity, we conducted diagnostic tests for multicollinearity and heteroscedasticity, applying robust M-estimation where necessary to minimize root mean squared error. The analysis covered six distinct stratifications based on development status (developed, developing, least developed, and combinations), and incorporated temporal analyses across three specific annual periods: 21 January 2020–20 January 2021; 21 January 2021–20 January 2022; and 21 January 2022–10 January 2023. Data: AMR per country values, accumulated between 21 January 2020 and 10 January 2023, and data on the prevalence of health conditions, and socioeconomic descriptive variables were extracted from Our World in Data (OWID) and other public data sites, like the World Bank. Results: The percentage of population aged over 65 years has the most consistent association with increased AMR globally. Obesity prevalence and income inequality (Gini index) were positively associated with AMR regardless of country development status. Conversely, the study finds a consistent negative correlation with diabetes prevalence, while the prevalence of respiratory diseases is a significant association only for developed nations. Socioeconomic factors were significantly associated with AMR, but this influence is stronger in developed countries than in the developing and least developed countries. Conclusions: While population aging is the primary association with increased AMR, the mortality impact of comorbidities and socioeconomic factors is heavily conditioned by a country’s development stage, pointing to the necessity of development-status-aware public health strategies for incoming pandemics. Full article

Background and Objectives: Depression has emerged in recent years as a significant global health issue, drawing considerable research interest and attention. The development of depression could be impacted by a range of environmental factors. Aim: To investigate the relationship between depressive symptoms and various indoor environmental factors, such as microclimate, odors, mold, and room ventilation, in association with some sociodemographic and lifestyle factors. Materials and Methods: This epidemiological health survey of the study “Chronic diseases and their risk factors in the adult population” was performed during 2023–2024 in Kaunas city (Lithuania) following the methodology of the WHO MONICA study. A random sample of Kaunas inhabitants aged 25–69 years, stratified by sex and age, was randomly selected from the Lithuanian population register. The 3426 individuals were screened. The associations of various indoor environmental factors with depressive symptoms were investigated using binary logistic regression analysis. Results: Depressive symptoms were associated with sociodemographic, lifestyle, and indoor environmental factors. Poor microclimate conditions, unpleasant household odors, mold exposure, and insufficient room ventilation were associated with increased odds of depressive symptoms. The significance of these associations varied across sex, age, marital status, socioeconomic status, and physical activity of responders. Additional multivariable logistic regression analyses, including interaction terms between each indoor environmental factor and the stratification variables (sex, age groups, marital status, family economic situation, and physical activity), were performed. Significant interaction was found only between family status and room ventilation (p = 0.007). This indicates that the association between ventilation and depressive symptoms differed by family status. Conclusions: This study contributes to the cross-disciplinary understanding of the role of indoor environmental quality, sociodemographic, and lifestyle factors in the development of depression, adding to the evidence on the role of other factors in depression inequalities. Full article

Low back pain (LBP) remains a leading cause of disability worldwide, imposing substantial socioeconomic burdens. Among its many causes, facetogenic pain accounts for a significant proportion of cases and is generally attributed to irritation of the richly innervated facet joint capsule, mediated by the medial branches of the dorsal rami. This narrative, hypothesis-driven review synthesises the current anatomical, biomechanical, neurophysiological, and clinical literature and advances a conceptual framework proposing a novel anatomical mechanism that may contribute to LBP. We hypothesise that ossification of the mamillo-accessory ligament (MAL) may be a plausible but under-recognised anatomical variant that may influence lumbar biomechanics and neural interfaces. The MAL connects the mammillary and accessory processes of lumbar vertebrae, serving as a stabilising anchor for deep paraspinal muscles and forming a conduit for the medial branch of the dorsal ramus (MBDR). Ossification of the MAL, resulting in a mamillo-accessory foramen, may theoretically impair spinal biomechanics via three principal mechanistic domains: (1) disruption of muscle attachment and segmental stabilisation, (2) potential compression of the MBDR causing denervation and muscle atrophy, and (3) chronic nerve entrapment leading to asymmetrical postural adaptations and persistent pain. Collectively, these pathways may contribute to spinal instability, facet degeneration, and variable response to standard interventional treatments such as radiofrequency ablation. Recognition of MAL ossification may have potential implications for clinical assessment, targeted imaging strategies, and treatment stratification in patients with chronic, non-specific LBP. Full article

Background and objective: Obstructive sleep apnea (OSA) is a common pediatric sleep disorder, most often caused by adenotonsillar hypertrophy. Although adenotonsillectomy (AT) is the standard first–line treatment, a substantial proportion of children experience residual OSA (rOSA). This systematic review aimed to synthesize current evidence on risk factors associated with rOSA in children following AT. Materials and Methods: A systematic review was conducted in accordance with PRISMA guidelines. PubMed and the Cochrane Library were searched without date restrictions using English–language terms related to rOSA, children, and adenotonsillectomy. Studies assessing postoperative persistence of OSA and associated risk factors were included. Results: Thirteen studies published between 2010 and 2024 met the inclusion criteria. The reported prevalence of rOSA varied widely (18.6–85.0%), reflecting heterogeneity in study design, patient populations, baseline disease severity, and follow–up methods. Obesity emerged as the most consistently identified risk factor, with significantly higher rOSA rates reported among children with elevated body mass index. Age also influenced outcomes, with both very young (<3 years) and older (>7 years) children demonstrating an increased likelihood of persistent disease. Comorbid conditions, particularly asthma and Down syndrome, were associated with poorer postoperative improvement. Additional contributors included craniofacial or developmental abnormalities and higher preoperative apnea–hypopnea index. Limited evidence also suggested that socioeconomic and environmental factors may affect postoperative outcomes. Conclusions: Residual OSA is common following adenotonsillectomy in children. Obesity, age, and comorbidities are key predictors, underscoring the need for comprehensive preoperative risk stratification and structured postoperative follow–up. Full article

Background: Tuberculosis (TB) outcomes remain suboptimal in high-burden, resource-constrained settings. Clinical and socio-economic factors contribute to loss to follow-up, failure, and mortality, yet their relative importance remains underexplored. Methods: We analyzed a retrospective cohort of patients treated for pulmonary TB in the Eastern Cape, South Africa. Treatment outcomes were dichotomized as success (cured or treatment completed) versus unsuccessful (loss to follow-up, failure, or death), excluding transfers and patients still on treatment. Predictors included age, gender, income, occupation, comorbidities, HIV status, previous treatment history, patient category, and drug resistance status. Regularized logistic regression was used to estimate odds ratios, while the best decision tree model was applied to identify hierarchical risk profiles. Results: Logistic regression demonstrated high accuracy (86%) and identified drug susceptibility, age, income stability, and comorbidity burden as the strongest predictors of treatment success. The decision tree achieved lower accuracy (65%) but improved detection of unsuccessful outcomes, highlighting a clear hierarchy of risk: (1) drug resistance status, (2) age, (3) income source, and (4) comorbidities. Patients with drug-resistant TB, older age, no income or reliance on grants, and coexisting conditions were at the highest risk of poor outcomes. Conclusions: Drug resistance, age, income, and comorbidity burden shape a hierarchical risk profile for TB treatment outcomes in rural South Africa. Logistic regression offered robust overall classification, while the decision tree provided transparent stratification of at-risk groups. These findings underscore the need for integrated clinical and socio-economic support strategies to improve outcomes in high-burden settings. Full article

Background/Objectives: Out-of-hospital cardiac arrest (OHCA) outcomes remain poor and vary widely across communities with socioeconomic deprivation. This study examines whether delays in emergency medical services (EMS) activation, the earliest link in the Chain of Survival, mediate the association between regional deprivation and OHCA outcomes, and whether this effect is modified by bystander cardiopulmonary resuscitation (CPR) status. Methods: We analyzed adult patients (aged 18–80 years) with witnessed, EMS-treated OHCA of presumed cardiac etiology from the Korean nationwide OHCA registry (2015–2022). Regional deprivation was defined by the Regional Deprivation Index and dichotomized into deprived (top 20%) vs. non-deprived areas. Timely EMS activation, defined as collapse to EMS activation, was measured as an awareness time interval (ATI) < 5 min. Outcomes were good neurological recovery (CPC 1–2) and survival to discharge. Causal mediation analysis within the counterfactual framework quantified the proportion of the association mediated by timely EMS activation, with stratification by bystander CPR status. Results: Among 43,032 patients, 6.1% resided in deprived areas. Deprived areas had lower bystander CPR (22.6% vs. 36.3%) and timely EMS activation (67.8% vs. 75.6%) (p < 0.05 for all). Regional deprivation was associated with poorer outcomes (good neurological prognosis: aOR 0.46, 95% CI 0.39–0.55; survival: aOR 0.65, 95% CI 0.57–0.73). Mediation analysis showed that ATI < 5 min accounted for 3.7% of the total deprivation effect on good neurological outcome and 7.9% on survival, with stronger mediation among patients receiving bystander CPR (7.9% and 14.7%, respectively). Conclusions: Regional deprivation is significantly associated with poorer OHCA outcomes, partly mediated by delays in EMS activation, particularly among patients who received bystander CPR. Interventions to enhance early recognition, rapid EMS activation, and bystander CPR in deprived communities are critical to improving survival equity after OHCA. Full article

This article examines the persistence of structural racism and the process of ethno-stratification affecting immigrants from the Global South in Spain. Drawing on national survey data and recent research, it analyses the socio-economic incorporation of immigrants in the aftermath of the Great Recession and subsequent economic recovery, emphasising both their rootedness in Spanish society and their continued segregation. The findings indicate that immigrants remain disproportionately concentrated in low-wage and temporary employment, positioned beneath the native-born precariat and distant from average living standards. This persistent segmentation cannot be explained solely by immigrants’ qualifications or cultural adaptation, but rather by an interplay of structural, institutional, social, and ethnic factors. At the core lies the Spanish “Mediterranean” development model, characterised by a low-productivity economy dependent on cheap labour, a limited welfare state, and strong family-based social protection, which together generate continuous demand for flexible immigrant workers. Additional drivers include migration and labour policies, gendered labour segmentation, and ethnic discrimination, all reinforcing immigrants’ vulnerability. The article concludes that immigrant labour has become essential to Spain’s economic and demographic model, yet its enduring segregation underscores the need for renewed public policies that promote social cohesion and intercultural integration. Full article

Massive phytoplankton blooms threaten lake ecosystems, causing significant ecological and socio-economic damage. While remote sensing is vital for monitoring, the vertical stratification of algae influences light propagation and distorts remote sensing reflectance signals. This effect is particularly understudied in high-latitude lakes, leaving a gap in understanding phytoplankton biomass patterns. To address this, our study investigated three high-latitude water bodies: Lake Hulun, Fengman Reservoir, and Lake Khanka. We collected water samples from three depths based on total and euphotic zone depth and developed layer-specific inversion models for chlorophyll-a (Chal) and phycocyanin (PC) using a random forest algorithm. These models demonstrated strong performance and were applied to Sentinel-3 OLCI imagery from 2016–2024. Our results show that Chla generally decreases exponentially with depth, whereas PC exhibits a Gaussian-like vertical distribution with a pronounced subsurface maximum at approximately 1 m. In addition, a significant positive correlation between Chla and PC was observed in surface waters. In Lake Khanka, the northern basin exhibited a significant interannual increase in phytoplankton biomass. At 3 m, PC correlated negatively with turbidity and responded strongly to cyanobacterial blooms, while organic suspended matter correlated positively with Chla. This work establishes a robust framework for multilayer water quality monitoring in high-latitude lakes, providing critical insights for eutrophication management and cyanobacterial bloom early warning. Full article

Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) is increasingly common and linked to obesity; however, its association with colorectal cancer (CRC) risk in women remains unclear. Materials and Methods: This retrospective cohort study used the Korean National Health Insurance Service health-screening database, including 483,401 women aged 40–59 years examined between 2013 and 2016, followed through 2021. MASLD was defined as hepatic steatosis (hepatic steatosis index ≥ 36 or ICD-10 K76.0) with ≥1 metabolic abnormality and no heavy alcohol use (≥20 g/day). Incident CRC (ICD-10 C18–C20) was analyzed using Cox regression adjusted for demographic, socioeconomic, and metabolic variables. Effect modification was tested across key covariates. Results: MASLD was found in 128,642 participants (26.6%). During a median 7.5-year follow-up, 2432 CRC cases occurred (702 with MASLD). The 7-year cumulative CRC risk was higher in the MASLD group (0.47% vs. 0.43%; p = 0.006). MASLD independently increased CRC risk (adjusted HR 1.10; 95% CI 1.00–1.20). Effect modification was observed for age, dyslipidemia, and waist circumference. MASLD significantly increased CRC risk among women aged 40–49 years (HR 1.26; 95% CI 1.05–1.49), those without dyslipidemia (HR 1.15; 95% CI 1.03–1.28), and with waist < 85 cm (HR 1.15; 95% CI 1.02–1.30). Conclusions: MASLD modestly increases CRC risk in Korean women, particularly among younger, normolipidemic, and non-obese individuals, indicating the need for age- and metabolism-specific risk stratification and suggesting a need for closer clinical attention and metabolic optimization. Full article

Chronic obstructive pulmonary disease (COPD) is a progressive and preventable respiratory disorder associated with a significantly increased risk of cardiovascular disease (CVD), including ischemic heart disease, heart failure, pulmonary hypertension, and arrhythmias. The association is bidirectional, with CVD adversely affecting COPD prognosis and vice versa. Beyond shared risk factors such as smoking, aging, and socioeconomic status, COPD itself, through mechanisms including systemic inflammation, oxidative stress, hypoxia, and hyperinflation, contributes independently to cardiovascular morbidity and mortality. Recent research has focused on identifying circulating biomarkers that can aid in early detection, risk stratification, and treatment optimization for patients at risk of both conditions. This review summarizes current evidence on the pathophysiological mechanisms linking COPD and CVD, highlights emerging biomarkers with potential prognostic utility for major adverse cardiovascular events (MACE) and all-cause mortality, and it discusses clinical and research implications for biomarker-guided, personalized treatment strategies. Full article

Background: Individuals with severe disability require intensive and long-term healthcare, rehabilitation and social support. Updated population data are essential to inform planning and resource allocation. This study aimed to quantify—with a cross-sectional analysis conducted in 2025—the demographic, clinical, socioeconomic, and geographic characteristics of individuals with severe disability within the Provincial Health Authority (ASP) of Catania (Sicily) in Italy, and to identify statistically significant differences across subgroups. Methods: A cross-sectional analysis was conducted on 3277 individuals officially certified as having severe disability under the Italian Ministerial Decree of 26 September 2016. Data were extracted from administrative records and stratified by age, sex, clinical classification, income level, and healthcare district. Associations were tested using chi-square statistics. Results: Participants had a mean age of 39.14 ± 28.64 years; Minors represented 33% of the disability cohort (vs. 19.4% minors in the general provincial population) with a mean age 10.28 ± 3.55. Adults accounted for 67% of the cohort (vs. 81% adults in the general population), with a mean age of 69.94 ± 24.61 years. Females constituted 43% of the sample (compared with 51% females in the provincial population), whereas males represented 57% (vs. 49% males in the general population). Most individuals (95.9% of the cohort) had an income level below €25,000/year. Conclusions: The study reveals substantial demographic, socioeconomic, and clinical heterogeneity among individuals with severe disability and highlights significant district-level disparities. Notably, minors appear markedly over-represented in the disability cohort compared with the general population, while females are under-represented, indicating potential age- and sex-related differences in disability burden, access to assessment, or underlying diagnostic patterns. These findings indicate the need for stratified, district-sensitive planning approaches, ensuring equitable access to services and optimizing allocation of healthcare and social resources. Full article

Background: As South Korea transitions into a super-aged society, promoting sport participation among older adults is increasingly vital for physical health, emotional well-being, and social inclusion. Objective: This study examines how the interplay between gender and social stratification influence sport participation and health among South Koreans aged 60 and above. Methods: Using data from the 2024 Korea National Sports Participation Survey (n = 1779), this study employed Multiple Correspondence Analysis (MCA), cross-tabulation, and one-way ANOVA with Scheffé’s post hoc tests to examine differences in sport participation and health by gender and social stratification such as income, education, and occupation. Results: The analysis revealed significant differences in sport participation and subjective health outcomes by gender and social stratification. Among older men, sport participation varied strongly by socioeconomic status: higher-status men participated in golf, cycling, and bodybuilding, whereas those from lower strata mainly engaged in walking and gateball. In contrast, older women’s participation types were less stratified and more influenced by gender norms, with consistent involvement in walking, aerobics, yoga, and stretching. One-way ANOVA showed statistically significant differences (p < 0.001) in subjective health status and physical fitness by all socioeconomic variables for both genders. Conclusions: Older adults’ sport participation and health in South Korea are constrained by both socioeconomic inequality and entrenched gender norms. Promoting equitable active aging requires policies that both reduce socioeconomic barriers and challenge restrictive gender norms. Full article

The conceptual foundation of this study is that a country’s exposure to risk when using green bonds as a mechanism for financing sustainable development is shaped by a combination of macroeconomic, market, and social factors. This paper develops and empirically validates a fuzzy-set model to assess national-level risks associated with green financing projects within the Water–Energy–Food (WEF) Nexus in BRICS countries. Building on established theoretical frameworks and empirical evidence, the study conceptualises risk as a function of economic development, the scale of the domestic green bond market, institutional trust, and performance on the Multidimensional Poverty Index (MPI). The study employs fuzzy-set modelling to integrate these heterogeneous indicators into a unified quantitative risk score. This approach enables cross-country comparison and captures the non-linear nature of relationships between socio-economic and institutional factors. The country sample includes Brazil, Russia, India, and China, which have successively chaired the BRICS association between 2021 and 2025, thereby ensuring methodological consistency and representativeness. The empirical results reveal a clear stratification of green-finance risk levels across the four economies: China demonstrates the lowest risk (Y = 0.243), followed by Russia with a below-average risk (Y ≈ 0.41), while India (Y = 0.53) and Brazil (Y = 0.51) exhibit the highest relative risks. These outcomes highlight the critical role of institutional trust and market maturity in reducing financing uncertainty within the WEF nexus. The study contributes to the literature by integrating macroeconomic, social, and institutional indicators into a unified fuzzy-logic model of green-finance risk; offering a transparent methodology for country-level comparison; and providing policy insights for improving the enabling environment for green bond markets in emerging economies. Full article

Background: Heart failure with preserved ejection fraction (HFpEF) is a major cause of hospitalization and mortality in older adults. Sudden cardiac arrest (SCA) is a leading cause of death in this population, yet national trends in incidence, outcomes, and disparities remain poorly defined. Methods: We performed a retrospective cohort study using the National Inpatient Sample from 2016 to 2020. Hospitalizations for patients aged ≥65 years with HFpEF and in-hospital cardiac arrest (CA) were identified using ICD-10-CM codes. Demographics, comorbidities, hospital outcomes, and temporal trends were examined. The primary outcome was in-hospital mortality. Secondary outcomes included length of stay, hospital charges, and discharge disposition. Results: Among 7,738,108 HFpEF admissions, 93,440 (1.2%) involved CA. Incidence rose from 1.1% in 2016 to 1.5% in 2020 (36% relative increase). The median age was 81 years; 54% were female, 70% White, 19% Black, and 8% Hispanic. CA incidence increased across all groups, with the largest relative rises among Native American (1.0% to 1.9%), Black (1.7% to 2.3%), and Hispanic patients (1.4% to 2.0%). In-hospital mortality was high, increasing from 58.2% to 61.7% over the study period (p < 0.001). Mortality rose most steeply among Black and low-income patients. Comorbidity patterns shifted toward greater metabolic complexity, including higher rates of complicated diabetes, hypertension, hyperlipidemia, and obesity. Conclusions: Elderly patients hospitalized with HFpEF are experiencing rising rates of in-hospital CA and persistently high mortality, with marked racial and socioeconomic disparities. These findings highlight the need for better risk stratification, targeted metabolic and inflammatory therapies, and more equitable care delivery. Full article