Search Results (5,323)

Background/Objectives: Dementia is a leading cause of cognitive decline, with significant challenges for early detection and timely intervention. The lack of effective, user-centred technologies further limits clinical response, particularly in underserved areas. This study aimed to develop and describe a co-design process for creating a Diagnostic and Statistical Manual of Mental Disorders (DSM-5)-compliant, AI-powered Smart Assistant (SmartApp) to monitor neurocognitive decline, while ensuring accessibility, clinical relevance, and responsible AI integration. Methods: A co-design framework was applied using a novel combination of Agile principles and the Double Diamond Model (DDM). More than twenty iterative Scrum sprints were conducted, involving key stakeholders such as clinicians (psychiatrist, psychologist, physician), designers, students, and academic researchers. Prototype testing and design workshops were organised to gather structured feedback. Feedback was systematically incorporated into subsequent iterations to refine functionality, usability, and clinical applicability. Results: The iterative process resulted in a SmartApp that integrates a DSM-5-based screening tool with 24 items across key cognitive domains. Key features include longitudinal tracking of cognitive performance, comparative visual graphs, predictive analytics using a regression-based machine learning module, and adaptive user interfaces. Workshop participants reported high satisfaction with features such as simplified navigation, notification reminders, and clinician-focused reporting modules. Conclusions: The findings suggest that combining co-design methods with Agile/DDM frameworks provides an effective pathway for developing AI-powered clinical tools as per responsible AI standards. The SmartApp offers a clinically relevant, user-friendly platform for dementia screening and monitoring, with potential to support vulnerable populations through scalable, responsible digital health solutions. Full article

By 2030, the world population is projected to reach approximately 9.7 billion. One of the core objectives of the global sustainable development goals (SDGs), adopted from the 1996 World Food Summit, is to eradicate hunger by that time, meaning ensuring food security for all. The Food and Agriculture Organization (FAO) defines food security as follows: “Food security exists when all people, at all times, have physical and economic access to sufficient, safe, and nutritious food that meets their dietary needs and food preferences for an active and healthy life.” Conceptually, it is posited that food security can be understood as a nexus of four elements: Food security = Availability + Access + Utilization + Stability of a food system. This study focused specifically on the food availability component of food security. It addresses a critical gap in the existing literature: the limited understanding of the role farmworkers and their families play in sustaining food systems. Specifically, it explores how the children of Haitian farmworkers in the United States perceive agricultural labor through the lens of their family’s experiences, including their personal willingness to engage in it and their advocacy for others to pursue such work. Although qualitative in nature, this study employed the Political Economy of the Food System, also referred to as Agrifood Systems Theory or the Political Ecology of Food Systems, as its guiding theoretical framework, as it aligns closely with the study’s objectives. The data were collected between December 2022 and June 2023. The sample consisted of eight young adults (ages 18 to 29), all of Haitian descent. Overall, the findings indicated that participants commonly reported feeling a sense of inferiority and a lack of interest in and respect for farmwork as a profession during their upbringing, particularly in comparison to peers from non-farmworker households and those outside of their immediate communities. This sense of inferiority was attributed to several factors, including their upbringing, the inherent vulnerability associated with farm work, and the long-term physical toll agricultural work had on both themselves and their parents. The study’s findings carry important implications for practitioners, scholars, policymakers, and all stakeholders involved in achieving food security. They underscore the urgent need to reform labor policies and improve the conditions surrounding farm work, making it a more appealing, dignified, desirable, and sustainable occupation in the face of a growing world population. Full article

The most recent scientific literature shows the effects of the COVID-19 pandemic on socially vulnerable groups such as Roma people. Non-profit social initiative organizations were active agents in overcoming the effects of the pandemic. This article shows the role that Third Sector of Social Action organizations played in alleviating the impact of the pandemic in collaboration with the Roma community itself, as part of the R&D&I research project ROM21, which studied the social agency of the Roma population in Spain regarding overcoming inequalities caused by the pandemic in relation to education, social services, and civic organizations. Based on the communicative methodology, discussion groups and interviews were conducted with Roma people and professionals from social services, civic organizations, and the health and education sectors, with 54 Roma women, 24 Roma men, 40 professionals, and 5 social activists participating. The results show the social initiative entities’ social action strategies in collaboration with the Roma community and the public administrations that responded to the needs that arose during the pandemic and in the post-pandemic context. Full article

Background: In the social context characterized by digitization and population aging, empty-nest older individuals have emerged as a particularly vulnerable group. This study examines the impact of digital finance on the mental health of empty-nest older individuals using data from the China Health and Retirement Longitudinal Study (CHARLS) spanning 2011 to 2018 and investigates its underlying mechanisms through the three dimensions of active aging. Results: The findings suggest that digital finance is associated with reduced likelihood and degree of depression among empty-nest older individuals. The beneficial effect of digital finance on depression is more pronounced among empty-nest older individuals with lower educational attainment, without supplementary pensions, and residing in rural areas. Furthermore, mechanism analysis shows that digital finance relates to better health outcomes, greater security, and increased social participation among empty-nest older individuals. Conclusions: These findings underscore the potential of digital finance to facilitate active aging among empty-nest older individuals. Full article

Background: COVID-19 vaccination and subsequent booster doses became critical components of public health strategies to control the pandemic and reduce disease severity, especially in fragile individuals. Among these, subjects undergoing dialysis represent one of the highly vulnerable populations. Methods: We conducted a multicenter case–control study among dialysis patients between March 2021 and May 2022 (study population n = 3264). We evaluated anti-S/RBD-IgG and anti-SARS-CoV-2 neutralizing antibodies before (T3) and after (T4) the third dose in individuals with a COVID-19 diagnosis after the third dose (cases) and in those who did not report infection (controls). Results: The study included 187 cases and 150 controls. Serological analysis showed a significant increase (p < 0.001) in anti-SARS-CoV-2 antibody levels after the third vaccine dose (from T3 to T4) in both groups. At T3, with the same number of days between the second dose and T3, the antibody levels detected were significantly lower in cases as compared to controls. At T4, we observed similar antibody titers in the two groups. Notably, the mean difference in time from the third dose to T4 was significantly greater in controls (73.0 days vs. 36.7, p < 0.001), suggesting a reduced antibody waning in controls. Accordingly, multivariate analysis showed that the risk of infection was considerably reduced by the pre-third-dose antibody levels. Conclusions: This study reinforces the critical role of the humoral response in preventing infections in the vulnerable population of dialysis patients. Regular monitoring of antibody levels and timely administration of booster doses are essential to optimize protection in this group. Full article

Vector-borne diseases (VBDs) continue to pose a persistent global health challenge, disproportionately impacting low- and middle-income countries where surveillance and healthcare infrastructure are constrained. Within these countries, residents of remote island communities are particularly vulnerable to emerging VBD threats; however, they remain critically understudied. We conducted a community-based cross-sectional survey of 300 residents from Shahpori Island, Bangladesh, and Gaya Island, Malaysia, to assess knowledge, attitudes, and practices (KAP) related to VBDs. Using a structured questionnaire and mixed-effects Poisson regression modeling, we identified socio-demographic predictors of VBD-related knowledge and compared KAP outcomes across the two islands. Significant disparities were observed between the two settings: the Gaya Island residents demonstrated a higher level of awareness regarding VBDs and preventive practices compared to the Shahpori residents. Education was a strong predictor of VBD knowledge, with individuals possessing secondary education or above exhibiting significantly better knowledge (β = 0.2024, p = 0.0003). Marital status was also a significant factor, with unmarried respondents showing lower levels of knowledge (β = –0.1657, p = 0.0372). Age was positively correlated with VBD knowledge (β = 0.0051, p = 0.0119), indicating a gradual increase with age, while income, gender, occupation, and household size were not significantly associated. Despite basic awareness of VBD symptoms and transmission, detailed understanding of mosquito ecology, disease symptoms, and breeding prevention strategies was remarkably poor, especially among the Shahpori residents. Our findings highlight critical gaps in VBD-related knowledge and prevention behaviors shaped by socio-economic and educational disparities. Community-focused public health strategies including educational campaigns, establishment of health infrastructure, access to trained healthcare providers, and integrated vector control interventions are urgently needed to enhance resilience against emerging VBD threats such as drug-resistant malaria in remote island populations. Full article

Background/Objectives: Emotional fear memories are increasingly recognized as contributors to the development of specific fears and phobias. Despite this, relatively little dental fear research has specifically focused on patient memories or their potential role in the etiology of dental fear. Methods: This two-study paper employs qualitative thematic analysis of memories for dental visits among traumatized patients (study 1) and the general patient population (ranging from endorsing no dental fear to severe fear). Recollections were evaluated based on the characteristics (i.e., sensory descriptors, affectively laden, intrusive) of emotional fear memories (studies 1 and 2) and according to a modified cognitive vulnerability model of dental fear (study 2). Results: Characteristics of emotional fear memories were ubiquitous across recollections of individuals who endorsed traumatic dental visits in childhood. Among the general patient population, these characteristics and cognitive vulnerability themes (particularly perceptions of the visit and dentist as dangerous and untrustworthy) were more prevalent in the earliest remembered visits for fearful individuals. When individuals were asked to recall their worst dental visits, emotional fear memory characteristics and vulnerability perceptions were evident across the spectrum of current fear (none to severe). Conclusions: This study contributes to nascent work examining memory in specific fears and phobias and suggests that worst recollections across a general sample share many of the characteristics that might otherwise imply vulnerability for anxiety. We recommend that dental practices universally screen patients for fear, inquire about past negative experiences, partner with patients to minimize evoking their specific vulnerabilities, and diligently implement these personalized care plans. Full article

Alcohol use disorder (AUD) is a widespread, multifaceted disorder involving overproduction of pro-inflammatory cytokines, oxidative liver injury, and dysfunction of the brain’s dopaminergic reward circuits. Korean red ginseng (KRG), an herbal supplement derived from Panax ginseng, has demonstrated qualities potentially useful to the treatment of AUD, including antioxidative, anti-inflammatory, neuroprotective, and anxiolytic effects. This review examines active constituents of KRG, their pharmacological actions, and evidence supporting KRG’s therapeutic potential in the context of AUD, while also assessing its safety profile, adverse effects, and potential drug interactions. KRG’s main bioactive constituents, ginsenosides, appear to have roles in modulating alcohol-metabolizing enzymes, ethanol-activated inflammatory cytokine cascades, and neurological systems disrupted by AUD, including GABAergic and dopaminergic pathways. Evidence from animal models and limited small-scale human trials suggests KRG may alleviate symptoms of alcohol withdrawal, enhance cognitive performance, and attenuate anxiety through these pathways. While generally safe for consumption, several case reports and animal studies have indicated KRG’s potential to pose a variety of risks in vulnerable populations at high, prolonged doses, including hepatotoxicity, cardiovascular changes, mood disturbances, and hormonal effects. Furthermore, KRG’s neuromodulating role and influence on cytochrome P450 enzymes make it liable to interact with several medications, including warfarin, midazolam, selegiline, and serotonergic agents. Overall, KRG shows promise as a complementary supplement in managing aspects of AUD, though current evidence is limited by low sample sizes, inconsistent reports regarding nuances of ginsenosides’ mechanisms, and a low number of human trials. Further human-focused research is needed to elucidate its safety, efficacy, and mechanism. Full article

In the developing countries (e.g., Palestine) a reliable assessment of climate vulnerability, exposure, and consequently risk is a key step in developing successful adaptation and mitigation plans. This study aims to examine the spatial distribution of climate risk across the different governorates of the West Bank (Palestine) by assessing climate-risk exposure. A GIS-based Multi-Criteria Decision Analysis approach was employed to estimate climate exposure across the West Bank governorates. Additionally, sensitivity analysis is used to explore the impact of indicator weight on the final climate-risk map. The climate-risk map was subsequently developed based on the exposure map, classifying the governorates into five risk categories: very high, high, moderate, low, and very low. This analysis revealed that 42% of the West Bank population resides in areas classified as having high to very high climate exposure, which corresponds to approximately 39% of the total land area. Conversely, about 21% of the West Bank area is categorized under low to very low risk conditions. By measuring risk based on this exposure, and considering vulnerability, it was determined that 82% of the population lives within areas identified as high to very high zones, underscoring the significant climate risk of populated regions. This study offers the first spatially explicit climate-risk assessment for the West Bank, applying a widely accepted approach that integrates vulnerability and exposure components. The results provide critical insights to inform targeted adaptation and mitigation efforts, supporting decision-makers in enhancing climate resilience across the region. Full article

Youth-onset type 2 diabetes (T2D) is a growing public health challenge. This narrative review aims to provide a comprehensive overview of epidemiology, pathophysiology, diagnosis, complications, and therapeutic strategies in children and adolescents with T2D, highlighting the most recent evidence and the distinctive features that differentiate youth-onset from adult-onset disease. Over recent decades, its incidence has increased worldwide, closely linked to rising rates of childhood obesity, sedentary behavior, and socioeconomic disparities. The disease typically emerges around puberty, a period marked by physiological insulin resistance, and is influenced by a complex interplay of genetic, environmental, and developmental factors. Diagnosis can be delayed or missed due to overlapping features with type 1 diabetes and limitations in current screening tools. The clinical course is often aggressive, with early onset of microvascular and macrovascular complications. Management is particularly challenging due to the limited number of pharmacologic agents approved for pediatric use and the psychological and behavioral complexities of adolescence. While metformin remains the first-line treatment, newer therapies such as GLP-1 receptor agonists and SGLT2 inhibitors show promise in improving metabolic outcomes. In conclusion, early diagnosis, multidisciplinary management, and equitable access to effective therapies are essential to improve long-term outcomes in this vulnerable population. Full article

Background: Hematopoietic cell transplantation (HCT) and chimeric antigen receptor T-cell (CAR-T) therapy have markedly improved survival in pediatric patients with hematological malignancies. However, these treatments cause profound immunosuppression, leading to significant susceptibility to vaccine-preventable diseases (VPDs), including invasive pneumococcal disease and measles. Timely and tailored immunization strategies are crucial to mitigate infectious risks in this vulnerable population. Methods: We conducted a narrative review of the English-language literature from 2000 to 2024, including clinical guidelines, surveys, and original studies, to evaluate immune reconstitution and vaccination practices in pediatric patients undergoing HCT and CAR-T therapy. Literature searches in PubMed, Scopus, and Web of Science used disease-specific, therapy-specific, and pathogen-specific terms. Data synthesis focused on vaccine schedules, immune recovery markers, and adherence challenges. Results: Profound immune deficits post-HCT and CAR-T therapy compromise both innate and adaptive immunity, often necessitating revaccination. Key factors influencing vaccine responses include time since therapy, graft source, immunosuppressive treatments, and chronic graft-versus-host disease. Although inactivated vaccines are generally safe from three to six months post-HCT, live vaccines remain contraindicated until documented immune recovery. CAR-T therapy introduces unique challenges due to prolonged B-cell aplasia and hypogammaglobulinemia, leading to delayed or reduced vaccine responses. Despite established guidelines, real-world adherence to vaccination schedules remains suboptimal, driven by institutional, logistic, and patient-related barriers. Conclusions: Effective vaccination strategies are essential for reducing infectious morbidity in pediatric HCT and CAR-T recipients. Personalized vaccine schedules, immune monitoring, and multidisciplinary coordination are critical to bridging gaps between guidelines and practice, ultimately improving long-term outcomes for immunocompromised children. Full article

Postpartum lactating people are particularly vulnerable to inequities in social determinants of health (SDH), yet no validated tool currently exists to assess these factors comprehensively. This study aimed to co-develop and establish the content validity of an instrument to integratively evaluate SDH in this population. Guided by the Mixed Methods Appraisal Tool, an interdisciplinary e-Delphi panel assessed item sufficiency, clarity, coherence, and relevance. Statistical analyses included the item-level (I-CVI) and scale-level (S-CVI/Ave) content validity indices, average agreement between experts (AABE), Fleiss’ kappa (κ), and Aiken’s V coefficient (V) (p < 0.05). Cognitive interviews were conducted with postpartum lactating participants representing diverse characteristics to assess interpretability. The initial version of the instrument included 135 items across nine sections addressing general demographics, education, employment, home environment, lifestyle, social support, healthcare access, stress, intimate partner violence, insomnia, and nutrition. Based on expert input, it was refined to 131 items through structural and lexical revisions. Content validity indices indicated strong agreement: I-CVI ranged from 0.66–1.00, S-CVI/Ave > 0.95, AABE > 14.26, and κ and V > 0.90. Final adjustments following cognitive interviews led to a 128-item version optimized for clarity and relevance. This instrument offers strong content validity for SDH assessment in postpartum lactating people and supports sustainable use in health research. Full article

Background: Social determinants of health (SDOH) are critical contributors to cancer disparities, influencing prevention, early detection, treatment access, and survival outcomes. Addressing these disparities is essential in achieving equitable oncology care. Artificial intelligence (AI) is revolutionizing oncology by leveraging advanced computational methods to address SDOH-driven disparities through predictive analytics, data integration, and precision medicine. Methods: This review synthesizes findings from systematic reviews and original research on AI applications in cancer-focused SDOH research. Key methodologies include machine learning (ML), natural language processing (NLP), deep learning-based medical imaging, and explainable AI (XAI). Special emphasis is placed on AI’s ability to analyze large-scale oncology datasets, including electronic health records (EHRs), geographic information systems (GIS), and real-world clinical trial data, to enhance cancer risk stratification, optimize screening programs, and improve resource allocation. Results: AI has demonstrated significant advancements in cancer diagnostics, treatment planning, and survival prediction by integrating SDOH data. AI-driven radiomics and histopathology have enhanced early detection, particularly in underserved populations. Predictive modeling has improved personalized oncology care, enabling stratification based on socioeconomic and environmental factors. However, challenges remain, including AI bias in screening, trial underrepresentation, and treatment recommendation disparities. Conclusions: AI holds substantial potential to reduce cancer disparities by integrating SDOH into risk prediction, screening, and treatment personalization. Ethical deployment, bias mitigation, and robust regulatory frameworks are essential in ensuring fairness in AI-driven oncology. Integrating AI into precision oncology and public health strategies can bridge cancer care gaps, enhance early detection, and improve treatment outcomes for vulnerable populations. Full article

Background: Unhoused individuals face significant health disparities and encounter numerous barriers to accessing adequate healthcare, resulting in high rates of chronic disease, mental illness, and untreated conditions in Houston, TX. The purpose of this study was to identify prevalent health conditions within a sample of unhoused adults and to identify patterns in patient characteristics and clinical health outcomes. Methods: This study utilized clinical and demographic data from n = 191 patients who received care at a student-run clinic embedded within a homeless drop-in center in Houston, TX. Data included patient demographics, chief complaints, social determinants of health (SDOHs), past medical history, on-site diagnoses, and provider actions. Results: The most prevalent issues were housing insecurity (36.1%), cardiovascular conditions (38.7%), and substance use (17.8%). Nearly half of all patients (46.6%) declined treatment or left before receiving care. Significant associations were found between patient demographics and provider responses, including differences by gender and age in treatment type and diagnostic categorization. Conclusions: These findings underscore critical challenges in treatment adherence, diagnostic bias, and retention among unhoused populations. The study provides actionable recommendations for improving care coordination and continuity in low-barrier, student-run clinics serving medically underserved communities. Full article

Climate change is increasingly recognized as a major driver of emerging infectious diseases, particularly vector-borne diseases (VBDs), which are expanding in range and intensity worldwide. Europe, traditionally considered low-risk for many arboviral infections, is now experiencing autochthonous transmission of pathogens such as dengue, chikungunya, Zika virus, West Nile virus, malaria, and leishmaniasis. Rising temperatures, altered precipitation patterns, and milder winters have facilitated the establishment and spread of competent vectors, including Aedes, Anopheles, Phlebotomus, and Culex species, in previously non-endemic areas. These climatic shifts not only impact vector survival and distribution but also influence vector competence and pathogen development, ultimately increasing transmission potential. This narrative review explores the complex relationship between climate change and VBDs, with a particular focus on pediatric populations. It highlights how children may experience distinct clinical manifestations and complications, and how current data on pediatric burden remain limited for several emerging infections. Through an analysis of existing literature and reported outbreaks in Europe, this review underscores the urgent need for enhanced surveillance, integrated vector control strategies, and climate-adapted public health policies. Finally, it outlines research priorities to better anticipate and mitigate future disease emergence in the context of global warming. Understanding and addressing this evolving risk is essential to safeguard public health and to protect vulnerable populations, particularly children, in a rapidly changing climate. Full article