Search Results (9,989)

Lung cancer is one of the most common cancers and the leading cause of cancer-related death worldwide. Despite advancements, the overall survival rate for lung cancer remains between 10% and 20% in most countries. However, recent progress in diagnostic tools and therapeutic strategies has led to meaningful improvements in survival outcomes, highlighting the growing importance of personalized management based on accurate disease assessment. ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) has become essential in the management of lung cancer, serving as a key imaging modality for initial diagnosis, staging, treatment response assessment, and follow-up evaluation. Recent developments in radiomics and artificial intelligence (AI), including machine learning and deep learning, have revolutionized the analysis of complex imaging data, enhancing the diagnostic and predictive capabilities of FDG PET/CT in lung cancer. However, the limitations of FDG, including its low specificity for malignancy, have driven the development of novel oncologic radiotracers. One such target is fibroblast activation protein (FAP), a type II transmembrane glycoprotein that is overexpressed in activated cancer-associated fibroblasts within the tumor microenvironment of various epithelial cancers. As a result, FAP-targeted radiopharmaceuticals represent a novel theranostic approach, offering the potential to integrate PET imaging with radioligand therapy (RLT). In this review, we provide a comprehensive overview of FDG PET/CT in lung cancer, along with recent advances in AI. Additionally, we discuss FAP-targeted radiopharmaceuticals for PET imaging and their potential application in RLT for the personalized management of lung cancer. Full article

In an era where digitalization shapes economic and social landscapes, the intersection of digital skills, ethics, and integrity plays a crucial role in understanding the vulnerability of youth classified as NEET (Not in Education, Employment, or Training). This study explores how risky internet use and digital skill gaps contribute to socio-economic exclusion, integrating a multivariate and spatial approach to assess regional disparities in Europe. This study adopts a systems thinking perspective to explore digital exclusion as an emergent outcome of multiple interrelated subsystems. The research employs logistic regression, Principal Component Analysis (PCA) with Promax rotation, and Geographic Information Systems (GIS) to examine the impact of digital behaviors on NEET status. Using Eurostat data aggregated at the country level for the period (2000–2023) across 28 European countries, this study evaluates 24 digital indicators covering social media usage, instant messaging, daily internet access, data protection awareness, and digital literacy levels. The findings reveal that low digital skills significantly increase the likelihood of being NEET, while excessive social media and internet use show mixed effects depending on socio-economic context. A strong negative correlation between digital security practices and NEET status suggests that youths with a higher awareness of online risks are less prone to socio-economic exclusion. The GIS analysis highlights regional disparities, where countries with limited digital access and lower literacy levels exhibit higher NEET rates. Digital exclusion is not merely a technological issue but a multidimensional socio-economic challenge. To reduce the NEET rate, policies must focus on enhancing digital skills, fostering online security awareness, and addressing regional disparities. Integrating GIS methods allows for the identification of territorial clusters with heightened digital vulnerabilities, guiding targeted interventions for improving youth employability in the digital economy. Full article

Air pollution is linked to childhood mortality and morbidity in low- and middle-income countries globally. There is growing evidence linking air pollution to asthma and other respiratory diseases in children. Studies have shown that children are likely to experience asthma due to their narrow airways and their heightened sensitivity to environmental irritants. This study aims to investigate the relationship between ambient air pollution and respiratory diseases in children under the age of 5. The study will be conducted in the informal township of Alexandra, north of Johannesburg, South Africa. A quantitative approach will be used in this cross-sectional analytical study. Data will be collected using different tools that include a questionnaire to determine the prevalence of asthma and respiratory disease and potential risk factors. While environmental air pollution will be measured using Radiello passive samplers and Gillian pumps. Data will be analyzed using the latest version of the STATANow/MP 19.5 software. Furthermore, health risk assessment will be conducted for lifetime non-carcinogenic and carcinogenic risk estimation following the USEPA framework. The study will identify environmental triggers that exacerbate asthma and other respiratory conditions in other similar community settings and will contribute to the body of knowledge in public health. Ethical approval was obtained from the Research Ethics Committee, Faculty of Health Sciences at the University of Johannesburg. Full article

Enhancing farmers’ digital literacy is both an inevitable requirement for adapting to the digital age and an important measure for promoting the sustainable development of livestock and poultry manure resource utilization. This study surveyed and obtained data from 1047 farm households in Ningxia and Gansu, two provinces in China that have long implemented livestock manure resource utilization policies, from December 2023 to January 2024, and employed the binary probit model to analyze how digital literacy influences farmers’ willingness to adopt two livestock manure resource utilization modes, as well as to analyze the moderating role of three policy regulations. This paper also explores the heterogeneous results in different village forms and income groups. The results are as follows: (1) Digital literacy significantly and positively impacts farmers’ willingness to adopt both the “household collection” mode and the “livestock community” mode. For every one-unit increase in a farmer’s digital literacy, the probability of farmers’ willingness to adopt the “household collection” mode rises by 22 percentage points, and the probability of farmers’ willingness to adopt the “livestock community” mode rises by 19.8 percentage points. After endogeneity tests and robustness checks, the conclusion still holds. (2) Mechanism analysis results indicate that guiding policy and incentive policy have a positive moderation effect on the link between digital literacy and the willingness to adopt the “household collection” mode. Meanwhile, incentive policy also positively moderates the relationship between digital literacy and the willingness to adopt the “livestock community” mode. (3) Heterogeneity analysis results show that the positive effect of digital literacy on farmers’ willingness to adopt two livestock manure resource utilization modes is stronger in “tight-knit society” rural areas and in low-income households. (4) In further discussion, we find that digital literacy removes the information barriers for farmers, facilitating the conversion of willingness into behavior. The value of this study is as follows: this paper provides new insights for the promotion of livestock and poultry manure resource utilization policies in countries and regions similar to the development process of northwest China. Therefore, enhancing farmers’ digital literacy in a targeted way, strengthening the promotion of grassroots policies on livestock manure resource utilization, formulating diversified ecological compensation schemes, and establishing limited supervision and penalty rules can boost farmers’ willingness to adopt manure resource utilization models. Full article

This study synthesizes the rapidly expanding evidence on how digital technologies reshape international trade, with a particular focus on small and medium-sized enterprises (SMEs). Guided by two research questions—(RQ1) How do digital tools influence the volume and composition of cross-border trade? and (RQ2) How do these effects vary by countries’ development level and firm size?—we conducted a PRISMA-compliant systematic literature review covering 2010–2024. Searches across eight major databases yielded 1857 records; after duplicate removal, title/abstract screening, full-text assessment, and Mixed Methods Appraisal Tool (MMAT 2018) quality checks, 86 peer-reviewed English-language studies were retained. Findings reveal three dominant technology clusters: (1) e-commerce platforms and cloud services, (2) IoT-enabled supply chain solutions, and (3) emerging AI analytics. E-commerce and cloud adoption consistently raise export intensity—doubling it for digitally mature SMEs—while AI applications are the fastest-growing research strand, particularly in East Asia and Northern Europe. However, benefits are uneven: firms in low-infrastructure settings face higher fixed digital costs, and cybersecurity and regulatory fragmentation remain pervasive obstacles. By integrating trade economics with development and SME internationalization studies, this review offers the first holistic framework that links national digital infrastructure and policy support to firm-level export performance. It shows that the trade-enhancing effects of digitalization are contingent on robust broadband penetration, affordable cloud access, and harmonized data-governance regimes. Policymakers should, therefore, prioritize inclusive digital-readiness programs, while business leaders should invest in complementary capabilities—data analytics, cyber-risk management, and cross-border e-logistics—to fully capture digital trade gains. This balanced perspective advances theory and practice on building resilient, equitable digital trade ecosystems. Full article

Background/Objectives: Understanding the impact of dietary habits in terms of obesity, health outcomes, and functional decline is critical in Europe’s growing elderly population. This study analyzed trends in Mediterranean diet (MD) adherence, obesity prevalence, and grip strength among middle-aged and elderly Europeans using data from the Survey of Health, Ageing and Retirement in Europe (SHARE). Methods: Data from four SHARE waves (2015–2022) across 28 countries were analyzed. Dietary patterns were assessed through food frequency questionnaires classifying participants as MD-adherent or non-adherent where adherent implies daily consumption of fruits and vegetables and occasional (3–6 times/week) intake of eggs, beans, legumes, meat, fish, or poultry (an unvalidated definition of the MD pattern). Handgrip strength, a biomarker of functional capacity, was categorized into low, medium, and high groups. Body mass index (BMI), self-perceived health (SPHUS), chronic disease prevalence, and CASP-12 scores (control, autonomy, self-realization, and pleasure evaluated on the 12-item version) were also evaluated. Statistical analyses included descriptive methods, logistic regressions, and multiple imputations to address missing data. Results: A significant majority (74–77%) consumed fruits and vegetables daily, which is consistent with MD principles; however, the high daily intake of dairy products (>50%) indicates limited adherence to the MD, which advocates for moderate consumption of dairy products. Logistic regression indicated that individuals with two or more chronic diseases were more likely to follow the MD (odds ratio [OR] = 1.21, confidence interval [CI] = 1.11–1.32), as were those individuals who rated their SPHUS as very good/excellent ([OR] = 1.42, [CI] = 1.20–1.69). Medium and high maximal handgrip were also strongly and consistently associated with higher odds of MD adherence (Medium: [OR] = 1.44, [CI] = 1.18–1.74; High: [OR] = 1.27, [CI] = 1.10–1.48). Conclusions: The findings suggest that middle-aged and older adults are more likely to adhere to the MD dietary pattern if they have more than two chronic diseases, are physically active, and have a medium or high handgrip. Although an unvalidated definition of the MD dietary pattern was used, the results highlight the importance of implementing targeted dietary strategies for middle-aged and elderly adults. Full article

Cancer disparities in low- and middle-income countries (LMICs) arise from multifaceted interactions between environmental exposures, infectious agents, and systemic inequities, such as limited access to care. The exposome, a framework encompassing the totality of non-genetic exposures throughout life, offers a powerful lens for understanding these disparities. In LMICs, populations are disproportionately affected by air and water pollution, occupational hazards, and oncogenic infections, including human papillomavirus (HPV), hepatitis B virus (HBV), Helicobacter pylori (H. pylori), human immunodeficiency virus (HIV), and neglected tropical diseases, such as schistosomiasis. These infectious agents contribute to increased cancer susceptibility and poor outcomes, particularly in immunocompromised individuals. Moreover, climate change, food insecurity, and barriers to healthcare access exacerbate these risks. This review adopts a population-level exposome approach to explore how environmental and infectious exposures intersect with genetic, epigenetic, and immune mechanisms to influence cancer incidence and progression in LMICs. We highlight the critical pathways linking chronic exposure and inflammation to tumor development and evaluate strategies such as HPV and HBV vaccination, antiretroviral therapy, and environmental regulation. Special attention is given to tools such as exposome-wide association studies (ExWASs), which offer promise for exposure surveillance, early detection, and public health policy. By integrating exposomic insights into national health systems, especially in regions such as sub-Saharan Africa (SSA) and South Asia, LMICs can advance equitable cancer prevention and control strategies. A holistic, exposome-informed strategy is essential for reducing global cancer disparities and improving outcomes in vulnerable populations. Full article

Introduction: Low medication adherence and low hypertension control are a public health challenge, particularly in low- and middle-income countries (LMICs). Healthcare system- and patient-related barriers hinder the successful management of hypertension. This study aimed to identify the perceptions of barriers and facilitators to hypertension management among health system stakeholders in Santander, Colombia. Materials and Methods: We conducted a qualitative, phenomenological, and interpretative study, comprising five focus groups, to explore the barriers and facilitators to managing people with hypertension. Each focus group was formed by stakeholders from territorial entities, healthcare insurers, or healthcare providers. Meetings were held between December 2022 and February 2023. The sessions were recorded and transcribed using NVivo Transcription and analyzed using NVivo version 1.6.1. Results: Seven categories of barriers and facilitators were identified: strategies, resources, access, risk assessment, cross-sector collaboration, articulation, and stewardship. Of these categories, articulation and stewardship emerged as the main barriers, as revealed through axial coding and cluster analysis, which highlighted deficiencies in stewardship practices, a lack of clear objectives, and misalignment with public policy frameworks. Conclusions: Multisectoral actions extending beyond healthcare providers and aimed at improving coordination and intersectoral collaboration are essential for enhancing hypertension control in LMICs, such as Colombia. Addressing social determinants and strengthening primary healthcare through community-based strategies are critical, making stewardship and improved access key priorities. Full article

Background: Type 2 diabetes (T2D) is a growing public health concern, particularly in low- and middle-income countries. Although prediabetes is a major risk factor for T2D, it remains largely underdiagnosed and untreated. Structured lifestyle interventions have proven effective in preventing diabetes, but their feasibility within the Brazilian public health system remains unclear. Methods: This multicenter pilot randomized controlled trial assessed the feasibility of a culturally adapted lifestyle intervention (PROVEN-DIA) across the five regions of Brazil. A total of 220 adults at high risk for T2D were randomized to an intervention group or a control group (usual care) and followed for three months. Both groups received similar educational content on healthy eating and physical activity, but the intervention group participated in a structured and personalized lifestyle program with regular follow-up sessions. The primary outcome was adherence to dietary recommendations, assessed using the BALANCE Index—a validated dietary score (range: 0–40) based on the Brazilian Cardioprotective Diet that classifies foods into color-coded groups according to nutritional quality—along with engagement in moderate-to-vigorous physical activity (MVPA). Secondary outcomes included diet quality (DQIR), anthropometric and metabolic parameters. Results: Feasibility was demonstrated by a 93.2% retention rate (n = 205). There was no significant difference in the primary outcome (simultaneous improvement in diet and MVPA). However, the PROVEN-DIA group exhibited significantly greater improvements in diet quality, with a 2.8-point increase in the BALANCE Index (vs. 0.5 in the control, p = 0.03), and a significant improvement in the DQIR (p < 0.001). No significant differences between groups were observed in MVPA, HbA1C, glycaemia, or body weight. Conclusions: The PROVEN-DIA intervention proved feasible within the Brazilian public health context, resulting in significant improvements in dietary quality among individuals at high risk for T2D. A larger trial with longer follow-up is warranted to evaluate its effectiveness in preventing the progression to diabetes. However, to enhance physical activity outcomes, specific adaptations and targeted strategies may be required to better support participant engagement in exercise. Full article

Climate change mitigation Official Development Assistance (ODA) primarily aims to reduce greenhouse gas (GHG) emissions in developing countries while also seeking to enhance human welfare as a fundamental goal of development aid. This study investigates whether climate mitigation ODA contributes to achieving the principles of the doughnut framework—staying within the ecological ceiling (mitigating GHG emissions) while meeting the social foundation (enhancing human development index, HDI). We analyzed data from 77 developing countries between 2010 and 2020, including subgroup analyses by income level (high-, middle-, and low-income groups), using an instrumental variable–fixed effect approach. The results show that climate change mitigation ODA significantly improved the HDI but had no impact on reducing overall GHG emissions, including fossil fuel-based and land use change and forestry-based mitigations. When disaggregated by income level, ODA was found to improve the HDI and reduce fossil fuel-based GHG emission in low-income countries; however, these effects weakened as income levels increased. Across all income groups, there was no significant reduction in GHG emissions resulting from land use change or forestry. These findings suggest that climate change mitigation ODA can yield a greater impact when prioritized for low-income countries and that current ODA strategies for addressing GHG emissions related to land use change and forestry should be reconsidered. Full article

The education sector in Tanzania faces significant challenges, especially in public primary schools. Unmanageably large classes and critical teacher–pupil ratios hinder the provision of tailored tutoring, impeding pupils’ educational growth. However, artificial intelligence (AI) could provide a way forward. Advances in generative AI can be leveraged to create interactive and effective intelligent tutoring systems, which have recently been built into embodied systems such as social robots. Motivated by the pivotal influence of teachers’ attitudes on the adoption of educational technologies, this study undertakes a qualitative investigation of Tanzanian primary school mathematics teachers’ perceptions of contextualised intelligent social robots. Thirteen teachers from six schools in both rural and urban settings observed pupils learning with a social robot. They reported their views during qualitative interviews. The results, analysed thematically, reveal a generally positive attitude towards using social robots in schools. While commended for their effective teaching and suitability for one-to-one tutoring, concerns were raised about incorrect and inconsistent feedback, language code-switching, response latency, and the lack of support infrastructure. We suggest actionable steps towards adopting tutoring systems and social robots in schools in Tanzania and similar low-resource countries, paving the way for their adoption to redress teachers’ workloads and improve educational outcomes. Full article

Background: Since the current increase in antimicrobial resistance globally, parasitic infectious diseases have become a greater public health crisis than ever before and an absolute priority. The Egyptian community pharmacist, as a health care provider and advisor, has a potential role to play in deworming. Objective: To evaluate the outcomes of community pharmacist-led deworming-related counseling services. Methods: A prospective randomized controlled study was conducted in Damanhur, Behera, Egypt. The intervention group received community pharmacy counseling, and the control group received the usual care. Both groups were monitored for 12 months for recurrence evaluation. Results: A total of 173 patients were included, of whom 96 (55.5%) received patient counseling. The types of infection included Oxyuris (44.5%), Entamoeba histolytica (28.9%), Ascaris (8.7%), Entamoeba Cyst (8.7%), Giardiasis (4.6%), Schistosomiasis (2.9%), and pinworm (1.7%). A total of 119 participants (68.8%) reported a need for dose repetition. Personal hygiene practices were reported by 71 participants (41%). Recurrence of infection was observed in 101 cases (58.4%). Patient counseling was significantly associated with lower recurrence rates and higher rates of personal hygiene application (p < 0.001). Multivariate logistic regression analysis revealed that patient counseling and personal hygiene measures were the only significant predictors of infection recurrence rate. Conclusions: Community pharmacists’ deworming-related counseling had positive behavioral and clinical outcomes. Full article

In recent years, recovering precious and base metals such as silver and copper from end-of-life products has become a fundamental factor in the sustainable development of many countries. This not only supports environmental goals but is also a profitable economic activity. Therefore, in this study, we investigate the recovery of silver and copper from an end-of-life photovoltaic panel powder using an alternative leaching system containing sulfuric acid and ferric sulfate instead of nitric acid-based leaching systems, which are susceptible to producing hazardous gases such as NO_x. To obtain this goal, a series of experiments were designed with the Central Composite Design (CCD) approach using Response Surface Methodology (RSM) to evaluate the effect of reagent concentrations on the leaching rate. The leaching results showed that high recovery rates of silver (>85%) and copper (>96%) were achieved at room temperature using a solution containing only 0.2 M sulfuric acid and 0.15 M ferric sulfate. Analysis of variance was applied to the leaching data for silver and copper recovery, resulting in two statistical models that predict the leaching efficiency based on reagent concentrations. Results indicate that the models are statistically significant due to their high R² (0.9988 and 0.9911 for Ag and Cu, respectively) and the low p-value of 0.0043 and 0.0003 for Ag and Cu, respectively. The models were optimized to maximize the dissolution of silver and copper using Design Expert software. Full article

On-farm emergency slaughter (OFES) is employed when cattle are unfit for transport but still suitable for human consumption, thereby ensuring animal welfare and reducing food waste. This study analysed OFES patterns in Northern Italy, where a large cattle population is housed but information on the practice is rarely analysed. A total of 12,052 OFES cases from 2021 to 2023 were analysed. Most involved female cattle (94%) from dairy farms (79%). Locomotor disorders were the leading reason (70%), particularly trauma and fractures, followed by recumbency (13%) and calving-related issues (10%). Post-mortem findings showed limbs and joints as the most frequent condemnation sites (36%), often linked to trauma. A significant reduction in OFES cases occurred over time, mainly due to fewer recumbency and calving issues, likely reflecting stricter eligibility criteria introduced in 2022. Weekly variations, with peaks on Mondays and lows on Saturdays, suggest that logistical constraints may sometimes influence OFES promptness. These findings suggest that on-farm management and animal handling could be improved further to reduce welfare risks and carcass waste. Due to the lack of standardised data collection and regulatory harmonisation, a multi-country investigation could improve our understanding of this topic and inform best practice. Full article

Background: The quality of decision-making processes is increasingly recognized as critical to public trust and policy sustainability. Objectives: This narrative review aims to identify and describe process-focused decision support models (DSMs) applied in pharmaceutical policy, and to examine their potential contributions to improving procedural quality in decisions related to pricing, reimbursement, and access to medicines. Methods: Relevant peer-reviewed and gray literature published between 2000 and 2025 was considered, drawing from key databases (e.g., PubMed and Scopus) and international policy reports (e.g., WHO, ISPOR, and HTA agencies). Studies were included if they provided insights into DSMs addressing at least one dimension of decision process quality. Results: Findings are synthesized narratively and organized by tool type, application context, and key quality dimensions. Frequently referenced tools included the Quality of Decision-Making Orientation Scheme (QoDoS), WHO-INTEGRATE, and AGREE II. QoDoS emerged as the only tool applied across regulatory, HTA, and industry settings, evaluating both individual- and organizational-level practices. WHO-INTEGRATE highlighted equity and legitimacy considerations but lacked a structured format. Overall, most tools demonstrated benefits in promoting internal consistency, transparency, and stakeholder engagement; however, their adoption remains limited, especially in low- and middle-income countries. Conclusions: Process-focused DSMs offer promising avenues for enhancing transparency, consistency, and legitimacy in pharmaceutical policy. Further exploration is needed to standardize evaluation approaches and expand the use of DSMs in diverse health systems. Full article