Search Results (1,408)

Obesity is a disease characterized by excessive accumulation of adipose tissue. It is a multifactorial condition arising from complex interactions among genetic background, lifestyle-related factors (such as physical inactivity, socioeconomic and cultural determinants), and environmental factors, including dietary patterns and exposure to environmental pollutants. In this context, exposure to environmental pollutants has been considered an independent risk factor for the development of obesity. However, the evidence linking herbicide exposure and obesity is limited. Therefore, the present scoping review aimed to map the available evidence regarding the obesogenic effects of herbicides across in vitro, in vivo, and epidemiological models, evaluate their translational concordance, and identify methodological gaps in the available literature. A systematic literature search was conducted in PubMed, Web of Science, and Scopus to identify studies reporting the effect of herbicide exposure and obesity-related endpoints. The search was limited to March 2026. A total of 24 studies fully met our eligibility criteria and were classified into in vitro, in vivo, and epidemiological evidence categories. The findings revealed a substantial disconnect across the different levels of evidence. In both in vitro and in vivo studies, the concentrations and doses tested often did not reflect realistic exposure scenarios, thereby limiting the applicability of these findings to human health risk assessment. In contrast, epidemiological studies frequently relied on obesity indicators with limited sensitivity and specificity, such as body mass index (BMI). Overall, the evidence suggests limited external validity in population-based studies and the arbitrary selection of concentrations and doses in experimental models. Full article

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

Parenting practices involving violent discipline are a global health concern, particularly among low-income families. While the current literature offers general prevalence data, it lacks a comprehensive global perspective evaluating how diverse sociodemographic, cultural, and historical contexts intersect within disadvantaged households. This scoping review protocol aims to map the global evidence on parenting practices related to physical and psychological violence used as disciplinary practices against children within low-income contexts. Following the JBI Manual for Evidence Synthesis and PRISMA-ScR guidelines, we will conduct a comprehensive search across databases, including MEDLINE/PubMed (via the National Library of Medicine), CINAHL (EBSCO), APA PsycINFO (APA), Embase (Elsevier), ERIC, IBECS (via the VHL) and the WHO Global Index Medicus to capture global evidence published in recent years. Studies published in English, Portuguese, and Spanish between January 2015 and June 2026 that report violent disciplinary practices by parents or caregivers of children aged 1–8 years will be included. Rayyan software will assist with study selection. Mapping these practices across diverse socioeconomic settings may clarify current research gaps and synthesize the characteristics of families globally, shifting the interpretation of violent discipline from isolated parental choices to broader understanding of its social determinants and providing a clearer baseline to support future child protection research. Full article

Background: Lifestyle behaviors and psychosocial factors are key determinants of cardiometabolic health across the life course. Beyond traditional risk factors, emerging evidence suggests that chronic stress and burnout may influence metabolic risk through behavioral pathways such as physical inactivity and poor diet. However, their joint contribution to type 2 diabetes risk in working populations remains insufficiently understood. Objectives: Our objectives were to examine the joint contribution of lifestyle habits, sociodemographic factors, and burnout to type 2 diabetes risk, and to explore potential behavioral pathways linking psychosocial stress to metabolic risk in a large adult population. Methods: A cross-sectional study was conducted in 92,480 Spanish workers undergoing routine occupational health assessments between 2021 and 2023. Type 2 diabetes risk was assessed using validated tools (FINDRISC, QDScore, CANRISK). Lifestyle indicators included adherence to the Mediterranean diet and physical activity levels; burnout was assessed using the Burnout Assessment Tool (BAT). Multivariable logistic regression models were used to evaluate associations between determinants and diabetes risk. Mediation analyses were performed to assess the contribution of lifestyle behaviors to the association between burnout and diabetes risk, and predictive performance analyses evaluated the incremental value of burnout. Results: Burnout was independently associated with a higher probability of moderate-to-high diabetes risk across all screening tools. Exploratory cross-sectional mediation analyses indicated that lifestyle behaviors, particularly physical inactivity and low adherence to the Mediterranean diet, statistically accounted for approximately 45% of the observed association. Adding burnout to the models significantly improved discrimination and reclassification of moderate-to-high diabetes-risk classification. In addition, higher diabetes risk was consistently observed among individuals from lower socioeconomic groups and those with unhealthy lifestyle profiles. Conclusions: Lifestyle behaviors and psychosocial stress were associated with estimated diabetes risk across adulthood. Burnout was independently associated with a higher probability of moderate-to-high diabetes-risk classification, with exploratory analyses suggesting that lifestyle behaviors may statistically account for part of this association. These cross-sectional findings highlight the potential relevance of considering both behavioral and psychosocial factors when studying cardiometabolic risk in working populations, while prospective studies are needed to establish temporal and causal relationships. Full article

Remarkable advances in paediatric oncology over recent decades have transformed acute leukaemia and central nervous system (CNS) tumours from largely fatal diagnoses to conditions with survival rates exceeding 80% in many cases. This epidemiological success, however, has shifted the clinical and research focus toward survivorship and the long-term consequences of curative therapies. Health-related quality of life (HRQoL) has emerged as a critical outcome measure that captures the multidimensional impact of disease and treatment on children’s physical, psychological, social, and educational functioning. This review synthesises current evidence on HRQoL in children with acute leukaemias, particularly acute lymphoblastic leukaemia (ALL) and acute myeloid leukaemia (AML), and CNS tumours, the two most common childhood malignancies. We examine measurement approaches, disease-specific HRQoL patterns, comparative outcomes between diagnostic groups, biopsychosocial determinants, and emerging interventions. The evidence consistently demonstrates that while ALL survivors generally experience HRQoL comparable to or slightly below population norms, children with CNS tumours face substantially greater and more persistent impairments across multiple domains. Treatment-related factors, particularly cranial irradiation, neurocognitive sequelae, family functioning, and socioeconomic status emerge as key determinants. Full article

Despite longstanding vaccine availability, human papillomavirus (HPV) remains the most common sexually transmitted infection in the United States and a leading cause of preventable cancers. Additionally, HPV vaccination rates remain below other routinely recommended adolescent immunizations, particularly in rural populations. This study aimed to identify barriers related to healthcare access, socioeconomic conditions, cultural beliefs, and provider–patient communication in rural communities. A bibliographical review of articles published in English from 2020 to 2025 and an analysis of national datasets were conducted to establish trends in HPV vaccination rates. State-level HPV vaccination data for adolescents aged 13–17 years were obtained from America’s Health Rankings and the Centers for Disease Control and Prevention National Immunization Survey-Teen. States were classified as predominantly rural or urban using Rural–Urban Continuum Codes, and mean vaccination completion rates were compared. The mean HPV vaccination completion rate was lower in rural states (60.55%) compared to urban states (67.31%); however, this difference did not meet the selected threshold for statistical significance (p = 0.025). Barriers identified in the literature included reduced access to healthcare, differences in provider communication, socioeconomic constraints, and limited health literacy in rural communities. Of the identified barriers, healthcare provider recommendations emerged as one of the strongest predictors of vaccine acceptance. These findings highlight multilevel determinants contributing to differences in HPV vaccine uptake and underscore the need for targeted, evidence-based strategies to improve vaccine access and coverage in underserved adolescent populations. Full article

Background: Black communities in England experience health inequalities rooted in structural racism, socioeconomic deprivation, and systemic exclusion from health systems that fail to address their specific needs. Digital health technologies offer potential for reducing these disparities, yet the existing evidence reveals an absence of culturally appropriate digital interventions designed with and for Black communities in England. Objective: To synthesise evidence on the structural and cultural determinants of health inequality affecting Black people in England and examine the potential of health apps for delivering culturally appropriate health promotion. Methods: This is a purposive, critical narrative literature review, not a systematic review; it does not aim for exhaustive or fully reproducible search coverage but for a structured, purposive synthesis of the evidence base relevant to four thematic domains. Purposive sampling was used to identify literature across the PubMed/MEDLINE, PsycINFO, Google Scholar, and policy databases. Findings were thematically synthesised around four domains: structural determinants of health inequality; cultural diversity and representation within Black communities; digital inclusion and health app access; and theoretical frameworks for culturally appropriate intervention design. Findings: Three intertwined problems underpin the absence of culturally appropriate digital health tools for Black communities: structural exclusion from health systems; methodological shortcomings of aggregating heterogeneous populations under broad ethnic labels such as BAME; and the systematic exclusion of Black people from digital health design processes. We propose a multi-layered theoretical framework combining the Health Belief Model, Beattie’s community development paradigm, and McCurdie’s user-centred design principles to guide the co-design of a culturally appropriate health promotion app. Conclusions: A culturally appropriate health promotion app for Black communities in England appears to be a promising and potentially feasible direction, provided it is developed through authentic community partnership and grounded in theories that account for structural determinants of health; this conclusion is conceptual, and no user research, prototype testing, or feasibility study has yet been undertaken to confirm it. These are identified as necessary next steps rather than results already achieved. Full article

This study analyzes the determinants and spatial dependence of happiness across the 27 European Union Member States during 2015–2024. It uses a panel of 270 observations based on the Cantril Ladder and the six explanatory factors from the World Happiness Report: GDP per capita, social support, healthy life expectancy, freedom, generosity, and perceptions of corruption. The empirical strategy combines panel models and spatial econometrics. Specification tests support a model with country random effects and year fixed effects. Spatial autocorrelation is assessed using Moran’s I, and random effects (RE), spatial autoregressive random effects (SAR-RE), the spatial error model with random effects (SEM-RE), and the spatial autoregressive model with spatially autocorrelated errors and random effects (SARAR-RE) are considered, using a three-nearest-neighbor matrix. The results show a strong and persistent spatial concentration of happiness. However, the non-spatial model absorbs most of this dependence, leaving no significant residual spatial autocorrelation for the full period. Consistently, neither SAR-RE nor SEM-RE significantly improves model fit, and the information criteria, likelihood-ratio tests, and Baltagi–Song–Koh tests support the non-spatial RE model with year fixed effects. GDP per capita, social support, and freedom show positive associations with happiness, while perceptions of corruption show a negative association. Healthy life expectancy and generosity are not statistically significant. Moreover, all six WHR determinants exhibit significant spatial autocorrelation, suggesting that the geographic clustering of happiness largely reflects the spatial concentration of its underlying socioeconomic, social, health, and institutional determinants rather than a direct contagion of happiness between neighboring countries. The study underscores the importance of considering the spatial dimension in wellbeing analysis and of accounting for shared regional socioeconomic and institutional conditions when designing European wellbeing policies. Full article

Background/Objectives: Oral diseases are common, largely preventable and closely associated with social determinants, noncommunicable diseases and quality of life. Greece has historically had a high dentist-to-population ratio; however, oral health care remains highly dependent on private provision and out-of-pocket payment. This structured evidence synthesis and health-system mapping aims to summarize the current situation of oral health care in Greece, focusing on access, financing, workforce capacity, epidemiology, prevention, and quality measurement. Methods: A structured evidence synthesis and health-system mapping were conducted using publicly available and verifiable sources, including World Health Organization documents, OECD/European Observatory country health profiles, Eurostat data, official Greek government information, and peer-reviewed studies identified through PubMed, Google Scholar, publisher records, and reference-list searching. The final synthesis included 29 sources: 15 peer-reviewed articles and 14 official or institutional documents/data sources. A formal systematic review, with or without meta-analysis, was not methodologically feasible because the research question was not based on a single intervention, exposure, comparator, or outcome, and because key evidence on oral health-system organization, financing, and governance is contained in heterogeneous policy documents, administrative sources, official reports, and country profiles that are not consistently indexed in bibliographic databases. Evidence was organized across predefined health-system domains: governance, service delivery, financing, workforce, epidemiology, equity, information systems, and quality measurement. Results: Greece combines high dentist density with limited public dental coverage and major financial barriers. Current EOPYY rules list age-specific preventive and treatment benefits, and Dentist Pass provided a preventive dental-care voucher for children; however, no ring-fenced national dental-treatment allocation or nationwide uptake estimate was identified. Most routine adult dental care remains privately financed. Recent Eurostat data indicate that Greece has the highest reported unmet dental care needs in the European Union. Comparative WHO country-profile indicators suggest that Greece’s high dentist density does not, by itself, correspond to lower unmet dental care needs or stronger publicly reported coverage of routine and preventive oral health care. Epidemiological studies show persistent caries, periodontal disease and tooth loss, particularly among children, older adults and socioeconomically disadvantaged groups. Major system-level gaps include limited financial protection, weak integration with primary care, insufficient standardized referral pathways and limited routine measurement of oral health quality and outcomes. Conclusions: The findings suggest that strengthening oral health care in Greece would require a shift from fragmented, curative and privately financed care toward prevention-oriented, publicly accountable and measurable services integrated with universal health coverage and national quality-of-care reforms. Full article

Background/Objectives: Diet is a modifiable determinant of kidney health, and sex differences in kidney physiology support sex-specific evaluation of dietary patterns. We examined the association of Planetary Health Diet Index (PHDI) adherence with cystatin C-based eGFR decline, and its modification by sex, in US adults aged 50 years and older. Methods: We analyzed 2126 Health and Retirement Study participants (950 men, 1176 women) with diet assessed by food frequency questionnaire in 2013 and cystatin C-based eGFR measured in 2012 and 2016. Survey-weighted regression models, adjusted for baseline eGFR and for demographic, socioeconomic, lifestyle and clinical covariates, related PHDI to eGFR change and to a ≥30% relative eGFR decline; sex interaction was tested on the multiplicative and additive scales. Results: PHDI adherence was nonsignificantly associated with lower eGFR decline (β per 10-point increment 0.218; 95% CI −0.065 to 0.466). Among women, each 10-point-higher score was associated with slower eGFR decline (β 0.355; 95% CI 0.029 to 0.681; p = 0.034) and 20% lower odds of ≥30% eGFR decline (OR 0.799; 95% CI 0.687 to 0.930; p = 0.005); no significant association was observed in men (β 0.080; 95% CI −0.294 to 0.454; OR 1.080; 95% CI 0.901 to 1.295). Sex modified the association with ≥30% eGFR decline on both a multiplicative (p = 0.002) and additive scale (p < 0.001). Conclusions: PHDI adherence was associated with slower kidney function decline in women aged 50 years and older, with non-significant effect in men. Sex merits consideration as a biological modifier when plant-forward diets are evaluated as potentially nephroprotective strategies. Full article

Introduction: The Roma, historically referred to as “Gypsies” (a term now widely considered pejorative in many contexts), appear to have originated in northern India and settled in Europe in the 14th century, spreading mainly to Eastern and Southern Europe. In Greece, they make up 1.13% of the total population and live in all geographical areas of the country. Aim: The aim of this article is to investigate and study the dietary habits of Roma and their health consequences. Methodology: A literature review was conducted in Medline, PubMed and Scopus databases, using the keywords “nutrition”, “health”, “outcomes”, and “Roma”. Results: In Europe, as well as in Greece, Roma continue to experience poverty, unemployment, socioeconomic inequalities, limited access to health services, and phenomena of racism, despite the efforts of states. These conditions negatively affect their dietary choices, leading to an unhealthy and unbalanced diet, with consequences such as obesity, cardiovascular diseases and diabetes mellitus. Conclusions: The profound gap between Roma and non-Roma populations in Europe requires not only targeted policies but also active interventions by health professionals. These interventions should aim at improving the nutritional status and general healthcare of Roma. Full article

Introduction: India’s immunization initiatives are among the largest globally, characterized by a substantial birth cohort of 27 million children annually, and have achieved significant progress in increasing coverage through the UIP. However, there are still challenges that persist, and multiple determinants contribute to the existing challenges; migration is one of them. Migration has always been a key driver of socio-economic and demographic changes, particularly in low and middle-income countries (LMICs). Specifically, there is a need to better understand the vulnerabilities of immunization among recent migrants. To examine this, the study explores the association between a mother’s recent migration and the full immunization coverage of children aged 12–23 months in India. Data & Methods: Our study utilized data from the National Family Health Survey-5 (2019–21). The outcome variable of interest in this study is the full immunization among children aged 12–23 months (receipt of all basic vaccinations). The primary predictor variable in this study was recent maternal migration, defined as the mother’s duration of residence at the current place of residence. We used a series of multivariate logistic regression models to examine the relationship between full Immunization among children and maternal migration status, with some data restrictions in the models. Results: The results show a 17 percentage-point difference in full immunization between children of migrant and non-migrant mothers. The adjusted odds ratios of children of mothers who had recently migrated had significantly lower odds of full immunization (aOR: 0.39, 95% CI: 0.35–0.43) compared to children whose mothers had not recently migrated. Even across the household wealth quintile and social groups, the recent migration of the mother was associated with being less likely to be fully immunized among children 12–23 months. Conclusions: The findings of this study provide significant quantitative evidence that recent migration (less than 3 years) of mother is a key factor influencing Immunization coverage and is a predictor of full immunization among children aged 12–23 months in India. The recent migration was consistently linked with lower odds of full immunization coverage across different household wealth levels and social groups. This study suggests that children of recently migrated mother are a vulnerable subgroup of the population at risk of not receiving full immunization among children aged 12–23 months. Full article

Background: Long-acting monoclonal antibodies have become an important strategy for preventing respiratory syncytial virus (RSV) disease in infants. Nirsevimab is the first product for which substantial post-licensure implementation data are available, whereas real-world evidence on clesrovimab remains limited. Although nirsevimab has demonstrated high efficacy, its uptake varies considerably across countries, healthcare systems, delivery settings, and population subgroups. This World Association for Infectious Diseases and Immunological Disorders (WAidid) consensus document examines the policy, organizational, economic, and equity-related determinants that shape real-world implementation of long-acting monoclonal antibodies for infant RSV prevention. Methods: This study was conducted as a structured narrative review and WAidid expert consensus document. A structured literature search was performed in PubMed and Embase for English-language publications relevant to nirsevimab uptake and implementation, complemented by targeted review of surveillance reports, policy documents, and public health guidance from the ECDC, UKHSA, and CDC, as well as reference lists of selected publications. Eligible sources included observational and real-world implementation studies, systematic reviews and meta-analyses, economic evaluations, guidelines, policy statements, surveillance reports, and relevant narrative reviews. Evidence was synthesized qualitatively according to policy frameworks, financing and reimbursement, delivery pathways, demographic and socioeconomic determinants, and healthcare-system factors influencing uptake. No statistical software was used because no quantitative re-analysis or meta-analysis was performed. Results: Nirsevimab uptake was strongly influenced by national RSV prevention policies, particularly whether countries adopted universal infant monoclonal antibody programs, maternal RSV vaccination strategies, dual maternal–infant approaches, or targeted risk-based models. Universal, publicly funded programs integrated into neonatal care achieved the highest and most homogeneous coverage, especially when administration occurred before hospital discharge and was supported by registry-based recall systems for infants born outside the RSV season. In contrast, fragmented, outpatient-only, insurance-dependent, or partially reimbursed models were associated with lower, delayed, or more variable uptake. Additional determinants included product cost, reimbursement pathways, provider practices, caregiver awareness and health literacy, insurance status, income, race and ethnicity, geographic deprivation, and access to primary pediatric care. Most available evidence comes from high-income countries, limiting generalizability to low- and middle-income settings, where RSV burden is greatest and implementation constraints may differ. Conclusions: Successful implementation of long-acting monoclonal antibodies for infant RSV prevention requires more than regulatory approval and demonstrated efficacy. Equitable uptake depends on clear national recommendations, sustainable public financing, reliable product supply, integration into neonatal and primary pediatric care, proactive identification and recall of eligible infants, and targeted strategies to reduce socioeconomic and geographic disparities. Although many determinants identified in high-income settings are likely relevant globally, their feasibility, relative importance, and impact require dedicated evaluation in low- and middle-income countries. Full article

Background/Objectives: Social determinants of health, including income, age, education, and gender, have been proposed to shape diabetes self-care capacity, yet their joint associations within Saudi Arabian primary healthcare populations remain poorly delineated. Anchored within the World Health Organization’s Commission on Social Determinants of Health framework and the Social Ecological Model, this study examined both the unadjusted and, via multivariable regression, adjusted associations of four sociodemographic factors with diabetes self-care management and health literacy among adults in southern Riyadh. Methods: A cross-sectional correlational design was employed with 92 adults with type 2 diabetes recruited from primary healthcare centers in southern Riyadh. Data were collected using the Arabic HLS-Q12 (health literacy) and SDSCA-Arabic (self-care management). Non-parametric Spearman rank-order correlations were conducted to examine bivariate associations. Multivariable linear regression was subsequently performed to estimate adjusted associations for each sociodemographic variable. Bivariate analyses were conducted using IBM SPSS Statistics for Windows, Version 25.0 (IBM Corp., Armonk, NY, USA), while multivariable linear regression analyses were performed using Python version 3.12 with the statsmodels package. Results: Income level showed significant, moderate positive unadjusted correlations with both self-care management (rs = 0.40, 95% CI [0.21, 0.56], p < 0.01) and health literacy (rs = 0.41, 95% CI [0.22, 0.57], p < 0.01). Age showed the strongest negative unadjusted correlation with self-care management (rs = −0.49, 95% CI [−0.63, −0.31], p < 0.01) and a significant negative correlation with health literacy (rs = −0.36, 95% CI [−0.53, −0.17], p < 0.01). Educational attainment was significantly associated with both self-care management (rs = 0.29, 95% CI [0.09, 0.47], p < 0.01) and health literacy (rs = 0.26, 95% CI [0.06, 0.44], p < 0.05). Gender did not reach statistical significance for either outcome. A multivariable model adjusting for all four sociodemographic variables confirmed that income and age remained independently associated with both outcomes, whereas education and gender did not. These findings do not establish independent or causal effects from the bivariate correlations alone; the adjusted results are reported separately below. Conclusions: Income and age were independently associated with both diabetes self-care and health literacy after multivariable adjustment, whereas education and gender were not. Findings support equity-focused nursing interventions and age-responsive diabetes education attentive to the social patterning of self-care disparities in southern Riyadh. Full article

Sex differences in intensive care unit (ICU) admission and treatment are reflected in the underrepresentation of women, poorer outcomes, and higher mortality risk. Historical exclusion from clinical trials has limited evidence for providing sex-specific care. This study aims to examine demographic and admission data from MIMIC-IV electronic health records to understand sex differences in ICU admissions, treatments, and outcomes, addressing critical gaps in care. Using the MIMIC-IV database of de-identified electronic health records, multiple correspondence analysis (MCA) was applied as an exploratory method to identify patterns and associations across categorical variables, including ICU type and demographic factors, for both heart failure (HF) and myocardial infarction (MI) patients. The study aimed to determine whether demographic or socioeconomic factors influenced assignment to specialty cardiac ICUs, and to evaluate differences in critical care delivery among patients with HF and MI. We observed that women were associated with admission to non-specialty ICUs, whereas men were admitted to specialty cardiac ICUs. MCA uncovered subgroup patterns showing that admission to cardiac ICUs is not uniform across sex, race, insurance, age, or marital status. There were also racial discrepancies noted in assignments to specialty ICUs, with minority groups being underrepresented in specialty ICUs. Marital status was a factor in admissions: widowed and single people were more frequently admitted to non-specialty ICUs. Length of stay (LOS) was comparable between HF and MI patients; however, chi-square analysis showed LOS being significantly associated with sex, age and marital status in HF, and with insurance status in the MI cohort. This data exploration illustrates systemic inequities in ICU allocation based on sex, race, and socioeconomic factors. Evidence of sex-based bias in the medical community highlights the need to address these inequalities in treatments and critical care to achieve better outcomes in the future. Full article