Search Results (14)

Background/Objectives: Western Canadian and U.S. communities outside urban centres remain underserved by primary, specialist, emergency, mental health, and chronic-disease services. These access problems reflect distance, weather, workforce shortages, specialist maldistribution, primary care attachment gaps, broadband limitations, and the governance realities of Indigenous and Tribal communities. This scoping review with narrative synthesis examined how telehealth and virtual-care models affect rural access in western Canada and the western/frontier United States. Methods: Searches were completed on 21 May 2026 in PubMed/MEDLINE, Embase, CINAHL, Scopus, the Cochrane Library, and PubMed Central. Supplementary searches included Google Scholar, publisher platforms, reference-list checking, and official Canadian and U.S. health-system sources. Peer-reviewed evidence published from 1 January 2016 to 21 May 2026 was eligible when it addressed rural, remote, frontier, Indigenous, underserved, western, or northern healthcare settings and reported access, implementation, safety, continuity, equity, or service-use outcomes. Results: The search identified 112 records; 27 duplicates were removed, 85 records were screened, 37 full texts were assessed, and 28 peer-reviewed records were included. Seven official sources were retained separately. Evidence was mainly observational, qualitative, mixed-methods, implementation-focused, or review-level. Moderate confidence supported telehealth for travel reduction and specialist input, especially through eConsultation, provider-to-provider consultation, telementoring, and real-time emergency support. Confidence was low to moderate for hybrid primary care and telemental health, and low for durable reductions in emergency department use. Conclusions: Telehealth may be most appropriately implemented as a hybrid, locally anchored, culturally safe access model, not as a stand-alone substitute for rural primary care, specialist capacity, or emergency services. Implementation should include broadband support, local physical assessment capacity, documentation, continuity, patient education, and clear escalation pathways. Full article

Background: The COVID-19 pandemic has contributed to the increase in maternal mortality due to the direct effects of the viral infection and the indirect effects caused by the overload of health services, and the resulting economic and social crises. This study aims to analyze sociodemographic, gestational, and clinical factors associated with maternal deaths from COVID-19 in Pernambuco between 2020 and 2021. Method: The study included 37 cases (deaths) and 112 controls (survivors). Crude and adjusted odds ratios were estimated using conditional and Firth’s penalized logistic regression models, respectively, to evaluate sociodemographic, gestational, and clinical factors. Results: In the bivariate analysis, the main factors associated with maternal death from COVID-19 were ≤8 years of schooling, the postpartum period, multiparity, oxygen saturation below 95%, obesity, and diabetes mellitus. The presence of fever and cough was associated with a lower probability of death. The independent factors that remained associated with maternal death were the postpartum period (aOR: 80.78; 95% CI: 16.54–394.37), parity ≥ 1 (aOR: 5.74; 95% CI: 1.16–28.22), and oxygen saturation below 95% (aOR: 7.16; 95% CI: 1.37–37.44), with fever acting as a possible protective factor (aOR: 0.08; 95% CI: 0.01–0.42). Factors such as obesity and diabetes were not independent predictors in the final multivariable model. Conclusions: The findings reinforce that maternal death is a multifactorial phenomenon. The relevance of this investigation lies in identifying clinical and obstetric vulnerability profiles in a region heavily impacted by the health crisis. Knowledge gained from past crises contributes to the improvement of public health strategies and clinical management protocols, aiming to mitigate preventable maternal deaths in future public health emergencies. Full article

Social changes have significantly impacted the educational system at various levels, for example, through legislative reforms, and have consequently guided the teaching–learning process. One of the emerging methodologies is Service-Learning (SL), which directly affects student competence and promotes habits related to physical activity and health. The present quasi-experimental study examined the impact of an SL program on secondary school students (n = 112). The aim of the 16-session SL program, which was part of the Physical Education course, was to improve the physical condition and health of 18 sedentary older adults. The influence of this program on motivation, the prosocial climate, and the importance that the students attribute to the subject of Physical Education was assessed. The most significant results were found to be those related to the School Prosocial Climate linked to empathy (p < 0.05) and the motivational variable of Intrinsic Motivation for Stimulating Experiences (p < 0.01). In conclusion, it was determined that the implementation of a methodology based on SL has positive effects on students’ empathy and intrinsic motivation. Full article

Background: Italy, particularly the northern region of Lombardy, has experienced very high rates of COVID-19 cases and deaths. Several indicators, i.e., the number of new positive cases, deaths and hospitalizations, have been used to monitor virus spread, but all suffer from biases. The aim of this study was to evaluate an alternative data source from Emergency Medical Service (EMS) activities for COVID-19 monitoring. Methods: Calls to the emergency number (112) in Lombardy (years 2015–2022) were studied and their overlap with the COVID-19 pandemic, influenza and official mortality peaks were evaluated. Modeling it as a counting process, a specific cause contribution (i.e., COVID-19 symptoms, the “signal”) was identified and enucleated from all other contributions (the “background”), and the latter was subtracted from the total observed number of calls using statistical methods for excess event estimation. Results: A total of 6,094,502 records were analyzed and filtered for respiratory and cardiological symptoms to identify potential COVID-19 patients, yielding 742,852 relevant records. Results show that EMS data mirrored the time series of cases or deaths in Lombardy, with good agreement also being found with seasonal flu outbreaks. Conclusions: This novel approach, combined with a machine learning predictive approach, could be a powerful public health tool to signal the start of disease outbreaks and monitor the spread of infectious diseases. Full article

In Italy, studies investigating gender identity and expression in gender non-conforming adults are lacking, as well as data regarding the non-binary population. The present study aimed at dimensionally exploring how transgender and non-binary Italian adults identify and express their gender. The Gender Diversity Questionnaire (GDQ) was administered to a sample of 112 adult subjects aged 18–60 years accessing a gender-specialized service in Rome. The majority of the participants were aged 18–24 years (53.6%), whereas fewer subjects were aged 25–35 years (32%) and 35 years and older (14.3%). Most participants (83.9%) identified themselves as trans binary, while the remaining (16.1%) identified as non-binary. Trans binary participants reported a stable gender identity, whereas non-binary participants reported a more fluid gender identity over time and across contexts. Younger subjects recognized the use of chosen names, pronouns, and clothes as important for their gender expression, whereas older subjects attributed more importance to physical appearance and emotions. Differences regarding gender-affirmative interventions emerged between non-binary and transbinary participants. Findings evidence that gender non-conforming adults accessing gender-specialized services have unique needs and features, thus it is essential to shed light on this population by providing greater visibility and recognition. Full article

Human interaction in natural language with computer systems has been a prime focus of research, and the field of conversational agents (including chatbots and Interactive Voice Response (IVR) systems) has evolved significantly since 2009, with a major boost in 2016, especially for industrial solutions. Emergency systems are crucial elements of today’s societies that can benefit from the advantages of intelligent human–computer interaction systems. In this paper, we present two solutions for human-to-computer emergency systems with critical deadlines that use a multi-layer FreeSwitch IVR solution and the Botpress chatbot platform. We are the pioneers in Romania who designed and implemented such a solution, which was evaluated in terms of performance and resource management concerning Quality of Service (QoS). Additionally, we assessed our Proof of Concept (PoC) with real data as part of the system for real-time Romanian transcription of speech and recognition of emotional states within emergency calls. Based on our feasibility research, we concluded that the telephony IVR best fits the requirements and specifications of the national 112 system, with the presented PoC ready to be integrated into the Romanian emergency system. Full article

Background: An efficient ambulance service is a vital component of emergency medical services. We determined the emergency ambulance response and transport times and ambulance exit outcomes in Bhutan. Methods: A cross-sectional study involving real-time monitoring of emergency ambulance deployments managed by a central toll-free (112) hotline (20 October 2021 to 20 January 2022) was carried out. Results: Of 5092 ambulance deployments, 4291 (84%) were inter-facility transfers, and 801 (16%) were for emergencies. Of the latter, 703 (88%) were for non-pregnancy-related emergencies (i.e., medical, surgical, and accidents), while 98 (12%) were for pregnancy-related emergencies. The median ambulance response and patient transport times were 42 (IQR 3–271) and 41 (IQR 2–272) minutes, respectively. The median round-trip distance travelled by ambulances was 18 km (range 1–186 km). For ambulance exit outcomes that were pregnancy-related (n = 98), 89 (91%) reached the health facility successfully, 8 delivered prior to ambulance arrival at the scene or in the ambulance during transport, and 1 had no outcome record. For the remaining 703 non-pregnancy deployments, 29 (4.1%) deployments were deemed not required or refusals, and 656 (93.3%) reached the health facility successfully; 16 (2.3%) died before the ambulance’s arrival at the scene, and 2 (0.3%) were not recorded. Conclusions: This first countrywide real-time operational research showed acceptable ambulance exit outcomes. Improving ambulance response and transport times might reduce morbidities and mortalities further. Full article

We investigated the scientific reasoning competencies of pre-service science teachers (PSTs) using a multiple-choice assessment. This assessment targeted seven reasoning skills commonly associated with scientific investigation and scientific modeling. The sample consisted of 112 PSTs enrolled in a secondary teacher education program. A latent class (LC) analysis was conducted to evaluate if there are subgroups with distinct patterns of reasoning skills. The analysis revealed two subgroups, where LC1 (73% of the PSTs) had a statistically higher probability of solving reasoning tasks than LC2. Specific patterns of reasoning emerged within each subgroup. Within LC1, tasks involving analyzing data and drawing conclusions were answered correctly more often than tasks involving formulating research questions and generating hypotheses. Related to modeling, tasks on testing models were solved more often than those requiring judgment on the purpose of models. This study illustrates the benefits of applying person-centered statistical analyses, such as LC analysis, to identify subgroups with distinct patterns of scientific reasoning skills in a larger sample. The findings also suggest that highlighting specific skills in teacher education, such as: formulating research questions, generating hypotheses, and judging the purposes of models, would better enhance the full complement of PSTs’ scientific reasoning competencies. Full article

Suaeda salsa saltmarshes are an important coastal wetland habitat of China’s northern Yellow Sea, which plays a critical role in sequestering carbon (blue carbon), protecting shorelines, maintaining biodiversity, and has substantial economic value (e.g., ecotourism). However, the area of S. salsa has been rapidly declining due to several different threats from reclamation and invasive species that impact its natural succession. Here, we map the changes in the distribution of the S. salsa saltmarshes along the northern Yellow Sea of China (NYSC) at 5-year intervals by applying the supervised maximum likelihood method to analyze Landsat images from 1988 to 2018 and investigate the potential impact of three important factors on habitat change by analyzing the temporal changes in S. salsa saltmarshes with other land covers. S. salsa saltmarsh areas have decreased by 63% (264 km² ha to 99 km²), and the average loss of S. salsa saltmarshes was 5.5 km²/year along the NYSC over the past three decades. There have been many dramatic declines in the two main distribution areas of S. salsa saltmarshes with a 77% loss of habitat area in Liaodong Bay (from 112 km² to 26 km²) and a 52% loss in the Yellow River Delta wetland-Guangli-Zhima estuarine wetland (from 137 km² to 65 km²). Land reclamation is the most important impact factor in the loss of S. salsa saltmarshes, while there have been limited effects of natural succession and smooth cordgrass (Spartina alterniflora) invasion. In light of the important ecological services and economic value of the S. salsa habitat, emergency conservation actions (e.g., habitat restoration, strictly supervision) are needed to limit the rapid habitat loss, which should include the immediate cessation of extensive land reclamation along the NYSC. Full article

Understanding how screen time behaviors changed during the COVID-19 pandemic is important to inform the design of health promotion interventions. The purpose of this study was to quantify and describe changes in recreational screen time from 2018 to 2020 among a diverse sample of emerging adults. Participants (n = 716) reported their average weekly recreational screen time in 2018 and again during the pandemic in 2020. Additionally, participants qualitatively reported how events related to COVID-19 had influenced their screen time. Weekly recreational screen time increased from 25.9 ± 11.9 h in 2018 to 28.5 ± 11.6 h during COVID-19 (p < 0.001). The form of screen time most commonly reported to increase was TV shows and streaming services (n = 233). Commonly reported reasons for changes in screen time were boredom (n = 112) and a desire to connect with others (n = 52). Some participants reported trying to reduce screen time because of its negative impact on their mental health (n = 32). Findings suggest that screen time and mental health may be intertwined during the pandemic as it may lead to poorer mental health for some, while promoting connectedness for others. Health professionals and public health messaging could promote specific forms for screen time to encourage social connection during the COVID-19 pandemic and beyond. Full article

Background: Previous studies of minority groups in times of emergency have tended to focus on risk reduction or on individual resilience, overlooking the community factors that could be bolstered to promote better health and safety outcomes. The current study aimed to examine the role of health-care services in the perceived community resilience of urban and suburban Arab communities in Israel during the COVID-19 outbreak. Method: The study included 196 adults age 17–76 years, who filled out on-line questionnaires in May 2020; 112 participants lived in an urban community and 84 lived in a suburban community. Community resilience was evaluated using the Conjoint Community Resiliency Assessment Measure (CCRAM), a validated five-factor multidimensional instrument. Results: Residents of the suburban community reported higher community resilience than residents of the urban community. This difference was related to increased preparedness levels and strength of place attachment in the suburban community. Residents of suburban communities were also more satisfied and confident in health-care services than those of urban communities. Regression analysis showed that the satisfaction with primary health-care services, and not community type, significantly predicted community resilience. Conclusions: Our results support the pivotal role of primary health care in building community resilience of minority communities in times of emergency and routine. Full article

Tax evasion, which is typically considered an illegal activity, is a critical problem and is considered a barrier to economic growth. A review of the literature shows that tax and social security contributions, regulations, public sector services, the quality of institutions and tax compliance, play important roles in determining the degree to which firms attempt to evade taxes. Measuring tax evasion is problematic due to data requirements and inadequacies. Few tax evasion indices have been estimated but it appears that they cannot be used for international comparisons across countries. This important issue has largely been ignored in the literature, in particular for emerging markets. Consequently, this paper is conducted to develop a new tax evasion index (TEI) using the most substantial and recent data from the standardized World Bank Enterprises Survey 2006–2017. In addition, using the newly developed TEI, the paper examines the importance and contribution of information sharing and bank penetration to the degree of tax evasion in emerging markets. The paper uses a sample of 112 emerging markets from 2006–2017 and the Tobit model in estimation. The empirical findings from the paper indicate that the average TEI during the 2006–2017 period for emerging markets is 0.62, with a range of (0.25, 0.75). In addition, we find that information sharing and bank penetration negatively affect the degree of tax evasion, as proxied by the TEI, in emerging markets. The empirical results also confirm the view that large firms are considered to have adopted good tax compliance practices, while firms located in remote areas are more likely to evade taxes. Policy implications have emerged on the basis of the empirical findings from the paper. Full article

Calibration and validation of flood risk maps at a national or a supra-national level remains a problematic aspect due to the limited information available to carry out these tasks. However, this validation is essential to define the representativeness of the results and for end users to gain confidence in them. In recent years, the use of information derived from social networks is becoming generalized in the field of natural risks as a means of validating results. However, the use of data from social networks also has its drawbacks, such as the biases associated with age and gender and their spatial distribution. The use of information associated with phone calls to Emergency Services (112) can resolve these deficiencies, although other problems are still latent. For example, a bias does exist in the relationship between the size of the population and the number of calls to the Emergency Services. This last aspect determines that global regression models have not been effective in simulating the behavior of related variables (calls to Emergency Services–Potential Flood Risk). Faced with this situation, the use of local regression models (such as locally estimated scatterplot smoothing (LOESS)) showed satisfactory results in the calibration of potential flood risk levels in the Autonomous Community of Castilla-La Mancha (Spain). This provides a new methodological path to the calibration studies of flood risk cartographies at national and supra-national levels. The results obtained through LOESS local regression models allowed us to establish the correct relationship between categorized potential risk levels and the inferred potential risk. They also permitted us to define the cases in which said levels differed ostensibly and where potential risk due to floods assigned to those municipalities led to a lower level of confidence. Therefore, based on the number of calls to the Emergency Service, we can categorize those municipalities that should be the subject of a more detailed study and those whose classification should be revised in future updates. Full article

Levonorgestrel emergency contraception and other contraceptive methods are available over-the-counter (OTC); however youth continue to face a number of barriers in accessing healthcare services, including lack of knowledge of the method, fear of loss of privacy, difficulties in finding a provider, and cost. A descriptive, nonexperimental, cross-sectional study of a sample of 112 community pharmacies in San Diego, California was conducted between December 2009 and January 2010 to assess community pharmacy practices related to the availability and accessibility of family planning health pharmacy services and products, particularly to youth. A majority (n = 79/112, 70.5%) of the pharmacies carried a wide selection of male condoms; however, the other OTC nonhormonal contraceptive products were either not available or available with limited selection. A majority of the pharmacies sold emergency contraception (n = 88/111, 78.6%). Most patient counseling areas consisted of either a public or a semi-private area. A majority of the pharmacy sites did not provide materials or services targeting youth. Significant gaps exist in providing family planning products and services in the majority of community pharmacies in San Diego, California. Education and outreach efforts are needed to promote provision of products and services, particularly to the adolescent population. Full article