Search Results (3,256)

Background/Objectives: Rheumatic fever is preventable and can be treated successfully; however, a lack of understanding of the disease and barriers to timely healthcare can impact outcomes. Pacific people in Aotearoa New Zealand experience inequitable burdens, and a Pacific community group and health professional network are working together to co-design education initiatives. This descriptive, mixed-methods study aimed to (1) explore Pacific people’s awareness and understanding of rheumatic fever, (2) describe where Pacific people access health information. Methods: An online survey co-developed with Pacific community members was run from December 2024 to February 2025. Questions related to sore throats, rheumatic fever, medication adherence, long-term outcomes and where Pacific people access health information. Quantitative data was analyzed descriptively using SPSS version 28 and open-ended qualitative responses were analyzed using an inductive content analysis approach. Results: A total of 400 Pacific respondents were included: 34% were aged 16–24 years and 66% were female. Based on the analysis, 71% of Pacific participants knew that a sore throat should always be checked by a health professional and 65.3% had heard of rheumatic fever. Fever and sore throats were commonly identified as symptoms of rheumatic fever, with joint pain, body aches and chest pain mentioned less. Barriers to health services such as cost, long waiting times and cultural factors were discussed as reasons why many Pacific people often utilize social media and online forums for health information. Conclusions: This study highlights gaps in rheumatic fever knowledge and thus opportunities for health education initiatives for Pacific communities, potentially utilizing social media and online platforms. Full article

Background: Healthy aging involves ensuring a good quality of life and maintaining autonomy. Physical performance is a key indicator of health and autonomy in old age, and it is influenced by social determinants of health. The aim of this study was to evaluate differences in physical performance and geriatric health outcomes among older adults attending a community center, according to their educational level, pension status, and access to health services. Methods: An observational, descriptive, retrospective and cross-sectional study was carried out using the database of subjects aged 60 and over who attend a community gerontological center. Results: A total of 536 older adults (mean age 70.7 ± 8.4 years, 71.5% women, 86.9% with public health coverage) with an average age of 70.7 ± 8.4 years were included; subjects with higher education had higher weight, as well as better indicators of physical functionality: higher scores in the Barthel and Lawton–Brody indices, greater walking speed, less time in the test to get up from the chair and in the test “Time Up and Go” (TUG), and increased prehensile strength. Conclusion: Social determinants, including education, economic independence, health coverage, and pension status, significantly influence physical performance and geriatric syndromes in older adults. Full article

The 15 min city concept seeks to promote health, well-being, and quality of life by ensuring that essential services are located within a 15 min walking or cycling distance from housing and are accessible through sustainable modes of transportation. This study aims to evaluate the compliance of this concept in a developing country context and provide supporting evidence by examining if residing within the 15 min reach to basic services affects perceived health, perceived accessibility, and life satisfaction. To assess pedestrian accessibility in Lahore, Pakistan, we adapted the NEXT proximity index—originally developed as part of the Landscape Metropolis Project in Italy—which scores 15 min access using open data sources. A network analysis was conducted to determine the shortest travel times to various points of interest, including education, transportation, healthcare, shops, restaurants, leisure spaces, places of worship, and financial services. Each hexagonal unit in the study area was assigned an access score proportional to its proximity to these facilities. These access scores were then analyzed using multiple regression models, based on survey data collected from 519 university students regarding their perceived health, perceived accessibility, and life satisfaction. According to the network analysis conducted using WorldPop estimates of Lahore’s population, only up to 30% of the population resides in areas that qualify as a 15 min city for each facility type. Moreover, access to bus stops significantly enhances both perceived accessibility and life satisfaction, while proximity to healthcare services shows the strongest positive association with life satisfaction. Full article

This paper evaluates the Enhancing Mobile Populations’ Access to HIV and AIDS Services, Information and Support (EMPHASIS) programme implemented by CARE International across Bangladesh, India, and Nepal. Using individual-level data, we estimate the programme’s impact on HIV-related knowledge and preventive behaviours among migrant workers. Results show that participation in EMPHASIS significantly increased correct knowledge of HIV transmission, reduced misconceptions, and improved partner communication. These informational gains translated into higher condom use and fewer unsafe sexual practices, with stronger effects among women. The findings provide evidence that peer-led, information-based interventions can improve health behaviours among mobile populations. Integrating such approaches with gender empowerment and mobile health services offers a promising model for addressing HIV vulnerability in cross-border migration settings. Full article

Background: Preconception care (PCC) is a key element of preventive reproductive health, aiming to optimise maternal and child outcomes by addressing biomedical, behavioural, psychosocial, and genetic risks before conception. International frameworks provide clear guidance, yet implementation in many low- and middle-income countries remains inconsistent. Methods: A structured narrative review was conducted across PubMed, Web of Science, Cochrane Library, and Google Scholar, focusing on literature published between 2010 and 2025. Eligible sources included empirical studies, clinical guidelines, policy documents, and high-quality grey literature from health authorities. Quality, relevance, and applicability were assessed, with particular emphasis on European and Bulgarian contexts. Results: Evidence from diverse settings demonstrates that PCC interventions—such as chronic disease management, vaccination, lifestyle optimisation, and expanded carrier screening (ECS)—can reduce adverse pregnancy outcomes and prevent severe genetic disorders. Effective international models integrate PCC into primary care, leverage digital health tools, and ensure equitable access through public funding. In Bulgaria, PCC remains underdeveloped: genetic screening is not part of routine care, there are no national guidelines or surveillance systems, and only ~4% of women initiate folic acid supplementation before pregnancy. NGOs and EU-funded digital initiatives provide partial outreach but cannot replace state-supported services. Conclusions: Bulgaria urgently requires a coordinated national PCC strategy, incorporating standardised guidelines, provider training, digital platforms, and phased ECS introduction. Strengthening PCC delivery can reduce preventable maternal and neonatal morbidity, advance reproductive justice, and enhance the long-term sustainability of public health systems. These findings support the development of a publicly funded, guideline-driven national PCC strategy with phased introduction of expanded carrier screening under NHIF to improve equity and long-term system sustainability. Full article

Background: Poor nutrition drives chronic disease, health disparities, and rising health care costs in the United States. Medically tailored meals (MTMs), designed by registered dietitians, are a Food-as-Medicine intervention with potential to improve outcomes and reduce costs. This review synthesizes evidence on the clinical, economic, and policy implications of MTMs. Methods: We conducted a narrative review of peer-reviewed studies, real-world program evaluations, and policy analyses. Sources included PubMed, Google Scholar, and grey literature from government, nonprofit, and industry organizations. Articles and reports were included if they examined MTMs in Medicare, Medicaid, or other high-risk populations. Results: Evidence demonstrates that MTMs improve health outcomes, reduce hospitalizations, and lower total cost of care. Case studies from Medicaid and Medicare Advantage plans, including those administered by Mom’s Meals^®, report reductions in emergency department visits, hospital readmissions, and total cost of care, alongside sustained high member satisfaction. Despite these findings, gaps in coverage and limited stakeholder awareness hinder broader access and adoption. Conclusions: Federal policy action can expand MTM availability and maximize utilization of existing benefits. Opportunities include establishing a Medicare Fee-for-Service demonstration, expanding and encouraging use in Medicare Advantage, and leveraging MTMs within Center for Medicare and Medicaid Innovation models. Broader implementation and utilization could reduce the nation’s chronic disease burden, advance health equity, and promote value-based care. Full article

Urological cancers are associated with reduced quality of life and high psychological burden, yet affected patients receive less psychosocial support than other cancer groups. Electronic health literacy (eHL) may facilitate independent access to resources, but its role for psychological outcomes and quality of life in this group is unclear. This study examined associations between eHL, psychological symptoms, and quality of life during transition from inpatient to outpatient care. A prospective, single-centre observational study was conducted. Eligible inpatients (urological cancer, Distress Thermometer ≥5 and/or request for psycho-oncological support) received an initial psycho-oncology consultation and completed surveys during inpatient treatment (T1) and three months later (T2). Measures included socio-demographics, PO-BADO, eHL (eHEALS), distress, depression (PHQ-2), anxiety (GAD-2), and quality of life (EORTC QLQ-C30). Of 108 patients completing T1, 71 completed T2. After controlling for age, eHL was not significantly associated with distress, depression, anxiety, or quality of life. Age did not moderate these relationships. In this sample, eHL showed no significant associations with psychological outcomes or quality of life. However, higher age was linked to lower eHL, suggesting that older patients may face barriers to digital health engagement. Age-related differences in eHL should be considered when designing digital support services for urological cancer patients. Full article

Ethiopia is among the most climate-vulnerable countries in Africa, with agriculture, water resources, health, and disaster risk management highly exposed to climate variability and change. This study examines the role of climate services in supporting climate change adaptation in Ethiopia by combining analyses of historical climate trends, future projections, national policy frameworks, and survey data from both users and providers of climate information. Results show that rainfall and temperature time-series exhibit significant variability, with increasing frequency of droughts and rising temperatures already threatening livelihoods and food security. Climate projections indicate continued warming and uncertain but increasingly extreme rainfall patterns, underscoring the urgency of adaptation. National strategies—including the Climate Resilient Green Economy (CRGE) Strategy, Growth and Transformation Plans (GTP I and II), and the National Adaptation Plan (NAP-ETH)—highlight the centrality of climate services in guiding adaptation across sectors. Survey findings reveal that climate services provided by the Ethiopian Meteorological Institute (EMI) are widely valued, particularly seasonal climate predictions, but challenges persist in accessibility, capacity, infrastructure, and alignment with user needs. Despite high satisfaction levels among users and providers, gaps remain in technical expertise, dissemination mechanisms, and service co-production. Strengthening climate services—through improved technical capacity, institutional coordination, and user-driven design—will be critical for enhancing Ethiopia’s resilience. The lessons drawn are also relevant to other African countries where climate services can play a critical role in bridging the gap between climate science and climate-resilient development. Full article

Women with disabilities often face unique barriers to accessing healthcare, potentially increasing their vulnerability and reducing engagement with vital health services, including human immunodeficiency virus (HIV) testing. This study assessed the prevalence and associated factors of HIV-testing among women with disabilities in Ghana. Cross-sectional data from the 2017–2018 Ghana Multiple Indicator Cluster Survey, encompassing 819 women with disabilities, were analysed both descriptively and inferentially. The overall prevalence of HIV testing was 48.0% (95%CI = 44.6–51.4). Educational attainment, marital status, and geographical region were key determinants of HIV testing uptake. Women possessing a Senior High School or Tertiary level education demonstrated higher odds of HIV testing compared to those with no formal education. Women residing in Greater Accra, Volta, Brong Ahafo, and Upper West regions were more likely to have undergone HIV testing than those in the Western Region. Never-married women exhibited lower odds of HIV testing uptake than their married counterparts. No statistically significant association was found between various disability types and HIV testing uptake. Less than half of women with disabilities in Ghana had ever tested for HIV, highlighting a substantial unmet need and underscoring the urgent need for targeted interventions, including enhanced, region-specific educational and health promotion initiatives, and tailored support for never-married women with disabilities. Full article

Background/Objectives: Transportation is a critical social determinant of health with direct impacts on healthcare access and utilization. This study examines transportation challenges faced by low-income individuals with chronic conditions who participated in the Food as Medicine (FAM) program offered by their primary care provider and explores the strategies they employ to overcome those challenges, particularly during the COVID-19 pandemic. Methods: We conducted semi-structured interviews with 36 FAM participants from Grady Health System in Atlanta, Georgia between May 2022 and October 2023. Interviews explored their ability to access routine care, FAM, and healthy food as prescribed by their physicians and nutritionists, as well as how the COVID-19 pandemic affected their transportation challenges and solutions. Results: Participants reported various transportation barriers including long wait times, delays, cost burdens, unreliable services, and coordination failures, which contributed to missing doctor appointments and FAM attendance. To overcome those challenges, participants planned trips in advance, used multiple transportation options, relied on social networks, or reduced and sometimes forwent trips. The COVID-19 pandemic limited their accessibility to healthcare, FAM, and healthy food options by reducing business hours and disrupting transportation services. Alternatives such as telemedicine and online ordering were less utilized due to distrust, dissatisfaction, and limited digital literacy. Conclusions: Transportation barriers can substantially restrict healthcare and food access for low-income individuals managing chronic conditions, especially during public crises that may lead to service disruptions. Transportation assistance that accommodates individuals’ financial circumstances and health conditions, implemented through collaborative efforts of healthcare institutions, transportation agencies, and governments, is essential to facilitating chronic disease management and reducing health disparities. Full article

Background: Elderly individuals living in Romanian long-term care facilities encounter substantial challenges in accessing oral healthcare, despite the high prevalence of dental disease and prosthetic needs. This study aimed to evaluate the oral health status, treatment needs, and access barriers among elderly residents in a long-term care facility in Timișoara, Romania, while also analyzing the current legislative framework and public funding mechanisms for geriatric dental care. Methods: A cross-sectional clinical and interview-based study was conducted among 70 residents aged 65–89 years from a residential center. Data collection included intraoral examinations, caregiver-assisted surveys, and individual interviews. Outcomes included oral health status (edentulism, caries, prosthetic use), service utilization, perceived barriers, and quality of life impact. The results were compared to existing literature and analyzed within the framework of Romanian and European healthcare legislation. Results: Total edentulism was found in 66.6% of participants, with only 28% having functional dentures. Caries and periodontal disease were prevalent, and 84% of residents lacked financial resources for dental care. Only 17% had accessed any dental services in the past year. Structural limitations, including the absence of mobile dental services and the lack of institutional protocols, further restricted access. Romanian Law no. 17/2000 guarantees healthcare in residential settings, but oral health is not explicitly included. Conclusions: The study highlights a critical gap in the provision of oral healthcare to institutionalized elderly in Romania. Neglect compromises nutrition, autonomy, and psychosocial well-being, underscoring the urgent need for legislative clarity, dedicated funding, mobile dental services, and integration into geriatric care. Full article

Background/Objectives: Schizophrenia Spectrum Disorder (SSD) represents a major challenge for healthcare systems due to its chronic nature, comorbid conditions, and high socioeconomic impact. Ensuring high-quality care for patients with SSD requires well-defined quality criteria based on consensus from healthcare professionals, patients, and caregivers. This study aims to identify and prioritize quality criteria for SSD care. Methods: A qualitative research approach was applied, including incorporating two focus groups—one with patients and caregivers (n = 7) and another with healthcare professionals (n = 8)—alongside the Delphi technique. The Delphi panel included 32 participants from psychiatry, primary care, mental health nursing, social work, and patient associations. The first round had an 88.9% response rate, while the second round achieved full participation (100%). The Delphi process was conducted and reported according to recommended guidelines for consensus methods (ACCORD checklist), specifying panel composition, rounds, predefined consensus thresholds, and controlled feedback between rounds. Results: A total of 26 quality criteria were ultimately selected, categorized into 16 identified barriers to effective care. Key priorities included early diagnosis protocols, coordinated multidisciplinary care, and improved access to specialized mental health services. Conclusions: The findings underscore the necessity of integrating patient experience into healthcare evaluation and highlight the potential for implementing a certification system to standardize SSD care across healthcare settings. Full article

The objective of the study is to describe the health status and use of public healthcare services by undocumented migrant sex workers (UMSWs) attended in Catalonia between 2013 and 2018. This study utilized a descriptive observational research design. Non-parametric tests were applied to estimate differences in the use of public healthcare services, and incidence and prevalence of selected sexually transmitted diseases (STDs) according to gender and region of origin. Out of 1464 women and 199 men UMSWs, 855 (51.4%) contacted primary care services once or more, and 378 (22.7%) used emergency services. Differences between regions of origin were found in the use of primary care services (Sub-Saharan Africa had 65.9% while Europe and Central Asia 43.0%, p < 0.001). Facilitating early diagnosis and improving access to healthcare resources among key populations such as men who have sex with men or transgender women can be achieved through interventions such as community-led point-of-care testing, which increases the frequency of HIV and STD screening and may also prove effective among UMSWs. Full article

Childhood immunization is one of the most effective public health measures, yet inequities remain in marginalized populations across Asia, where parental adherence is essential to sustaining the Expanded Program on Immunization. This narrative review examines determinants of adherence among under-five children in disadvantaged communities. Following PRISMA guidelines, searches of PubMed, Scopus, and Google Scholar identified studies published between 2015 and 2025, with earlier key works included as relevant. Twenty-one studies from South, Southeast, and East Asia were analyzed. Five domains were associated with adherence: socioeconomic and access factors, where maternal education, household income, and possession of immunization cards were positive predictors, while remote residence was a barrier; trust, cultural beliefs, and social norms, with misinformation and vaccine controversies reducing uptake, and provider trust and supportive norms improving it; migration and mobility, as migrant, stateless, and left-behind children had lower coverage due to weak registration and disrupted caregiving; household and caregiver dynamics, where decision-making by family or community members shaped uptake, while large family size and maternal employment limited adherence; and health system capacity, with inadequate infrastructure and follow-up hindering coverage and integration with maternal–child health services facilitating it. Addressing these intersecting barriers through equity-focused strategies is critical to achieving universal immunization coverage. Full article

Background: Tobacco use remains a leading preventable cause of morbidity and mortality in the United States, with persistent disparities in cessation outcomes across socioeconomic and racial groups. While numerous interventions exist, their effectiveness is shaped by complex interrelated factors at individual, social, and healthcare system levels. Identifying and modeling these causal pathways is essential to inform equitable intervention design. Methods: This study applied the Evidence Synthesis for Constructing Directed Acyclic Graphs (ESC-DAG) protocol to integrate empirical findings from 35 quantitative studies examining barriers and facilitators of tobacco cessation intervention uptake in the United States. Using the Andersen and Aday Health Services Research Model as a guiding framework, we extracted, harmonized, and synthesized significant causal relationships into a unified DAG, distinguishing exposures, outcomes, mediators, and confounders. Results: The integrated DAG revealed that structural factors such as socioeconomic disadvantage, digital inequities, rurality, and cultural barriers exerted substantial influence on cessation outcomes. These upstream determinants operated through mediators including motivation, treatment engagement, and access barriers, while healthcare system factors such as provider engagement and proactive outreach emerged as consistent facilitators. Digital access and culturally tailored interventions were identified as underexplored yet potentially high-impact pathways. Discussion: The ESC-DAG methodology provided a structured approach to visualize and synthesize causal mechanisms beyond traditional review synthesis, highlighting points of intervention at both policy and practice levels. The findings underscore the importance of multi-level strategies, including financial support, digital equity initiatives, provider outreach, and culturally tailored cessation services. Conclusions: By applying ESC-DAG methodology, this study contributes a novel causal framework for understanding disparities in tobacco cessation intervention uptake. The resulting DAG can inform future statistical modeling, simulation studies, and equity-focused program design, supporting more effective public health strategies to reduce smoking prevalence and associated inequities. Full article