Search Results (5,120)

Background: Respiratory tract candidiasis, primarily caused by Candida species, is a prevalent opportunistic fungal infection in individuals with HIV/AIDS. A high HIV viral load is considered a significant risk factor for developing respiratory fungal infection. This study aimed to identify the yeast species isolated from sputum samples of HIV-positive and HIV-negative adults, determine their antifungal susceptibility patterns, and investigate associated risk factors. Methods: A hospital-based comparative cross-sectional study was conducted from March to May 2022. Sputum samples were collected from 190 HIV-positive and 190 HIV-negative participants. Candida and other yeast species were isolated and identified, followed by antifungal sensitivity testing. Results: Of the 190 specimens from each group, 77 (40.53%) from HIV patients and 12 (6.31%) from HIV-negative participants tested positive for yeasts. Candida albicans was the most prevalent species, found in 52 (67.53%) HIV-positive patients and 12 (100%) HIV-negative patients. This was followed by Nakaseomyces glabratus (15.58%), Pichia kudriavzevii (9.09%), Candida tropicalis (6.49%), and Candida parapsilosis (1.29%) in HIV-positive patients. Notably, all 12 isolates from HIV-negative participants demonstrated 100% sensitivity to all ten tested antifungal drugs. In contrast, isolates from HIV patients showed significant resistance to fluconazole and ketoconazole (32.5% each). High viral load (p < 0.001), dermatophyte infection (p < 0.001), and antiretroviral (ARV) regimen (p = 0.030) were significantly associated with respiratory tract fungal infections in HIV patients. Conclusions: Based on this exploratory study, respiratory mycosis is frequent in HIV-positive patients in Cameroon, and identified fungi show increased resistance to azoles. While these results must be interpreted with care due to the sample size relative to the high national HIV prevalence, they suggest that public health education is needed to improve awareness. These preliminary findings prompt a review by health authorities concerning the use of fluconazole for prophylaxis in HIV-positive patients in Cameroon. Full article

Background: Self-rated health (SRH) is a widely used indicator reflecting overall physical, psychological, and functional health status. Chronic diseases and physical activity (PA) are associated with SRH in middle-aged and older adults; however, the contribution of chronic disease burden and different types of PA to SRH requires further investigation. This study investigated the associations of chronic diseases and PA with SRH among middle-aged and older adults. Methods: This cross-sectional study included adults aged ≥40 years who participated in the 2024 Korea National Health and Nutrition Examination Survey (KNHANES), the ninth survey cycle. SRH was classified as poor or favorable based on self-reported health status. Sociodemographic characteristics, chronic diseases, and PA were evaluated using multivariable logistic regression analysis. The reported ORs were adjusted for age, sex, BMI, education level, household income, smoking, alcohol consumption, and employment status. Additional adjustment for other chronic diseases was applied in Model 3 of the overall analysis and in the subgroup analyses. Machine learning was additionally applied to evaluate the contribution of individual predictors to SRH. Model performance was evaluated using the Area Under the Receiver Operating Characteristic curve (AUROC) with five-fold cross-validation. Results: A total of 4079 participants were included, of whom approximately 58.1% were women, and 748 (18.3%) reported poor SRH. Participants with poor SRH were older, had lower income and education levels, and were less likely to meet the aerobic and muscle-strengthening PA guidelines than those with favorable SRH (all p < 0.001). All chronic diseases were significantly associated with poor SRH. Stroke (OR = 2.66, 95% CI = 1.74–4.06) and myocardial infarction or angina (OR = 2.69, 95% CI = 1.91–3.79) showed relatively high ORs, and the likelihood of poor SRH increased progressively with the number of chronic diseases. Participants with three or four chronic diseases had a 7.15-fold higher likelihood of reporting poor SRH than those without chronic diseases (95% CI = 4.63–11.04). Muscle-strengthening PA was related to lower odds of poor SRH (OR = 0.548, 95% CI: 0.435–0.690) and showed consistent inverse associations across most chronic disease groups, whereas aerobic PA showed weaker associations. The XGBoost model showed an AUROC of 0.631 based on five-fold cross-validation. SHAP analysis showed relatively greater contributions of chronic disease burden and household income to the prediction of poor SRH, while muscle-strengthening PA showed a greater contribution than the other PA variables. Conclusions: Chronic diseases and PA were associated with SRH among middle-aged and older adults. The likelihood of poor SRH increased with the number of chronic diseases, whereas muscle-strengthening PA was consistently associated with favorable SRH. These findings suggest that muscle-strengthening PA is associated with favorable SRH among middle-aged and older adults; however, longitudinal studies are needed to further examine this association. Full article

Research on educational virtual reality (VR) has focused on learning outcomes, but less on the design strategies that create those outcomes or whether benefits are consistent across different learners. This study created user experience (UX) design guidelines for educational VR by analyzing strategies from print, video, and digital media, then adapting their functions for immersive VR. A two-dimensional framework combined five instructional functions from Gagné’s events of instruction and Merrill’s four content types. Guided by cognitive load theory and multimedia learning theory, five guidelines were developed: Space-Centered Stimulus Presentation, Environment-Intrinsic Context Learning Guidance, Body-Tracking-Based Direct Performance Induction, Integrated Structural Real-Time Feedback, and Multi-Scenario Retention and Transfer Training. A CPR prototype focused on compression-only resuscitation was tested with 40 adults in experimental and comparison groups. The experimental group showed significantly larger gains in knowledge (r = 0.704, large), performance (r = 0.395, medium), and usability (r = 0.385, medium). An exploratory analysis found that all experimental participants improved, compared to 45% and 75% in the comparison group (Fisher’s exact p < 0.001 and p = 0.047). Semi-structured interviews with 22 participants revealed that both groups experienced hand-tracking errors; however, the comparison group also reported issues such as feedback separation, redundant presentation, and unclear flow, causing extraneous cognitive load, whereas the experimental group cited the spatially integrated guidance (heart character, sternum display) as beneficial for learning. These results suggest that VR design guided by these guidelines can lead to greater and more consistent learning improvements among users. Full article

Background/Objectives: Fruit and vegetable, fish, and sugar-sweetened beverage (SSB) intake are important modifiable determinants of cardiovascular risk, yet data on these dietary behaviours among middle-aged adults in Poland remain limited. This study assessed their prevalence and sociodemographic correlates. Methods: We conducted a cross-sectional study of 4935 adults aged 40–65 years (mean age 54.2 ± 7.0 years; 59.4% women) participating in the “Bet on Prophylaxis—Program for the Prevention of Cerebral Vascular Diseases, in the Masovian, Podlaskie and Warmian-Masurian Voivodeships”. Dietary habits and physical activity (PA) were assessed using a structured questionnaire. Multivariable logistic regression identified independent correlates of each dietary behaviour, including sex × education interactions. Results: Daily fruit and vegetable consumption was reported by 67.7% of participants, fish consumption ≥1–2 times/week by 64.1%, and frequent SSB consumption by 14.0%. Daily fruit and vegetable intake was independently associated with female sex (OR = 1.92), higher education (OR = 2.24), older age, and PA (all p < 0.001). Women reported healthier fruit and vegetable and SSB habits than men, while fish intake did not differ by sex. Neither body mass index (BMI) nor waist-to-hip ratio (WHR) was independently associated with any dietary behaviour after full adjustment, although WHR showed a weak unadjusted association with poorer fruit and vegetable and SSB habits. A global test of the sex × education interaction was significant for fish consumption (Wald χ² = 15.2, df = 3, p = 0.002), but not for fruit and vegetable (p = 0.622) or SSB consumption (p = 0.083). Conclusions: Dietary behaviours differed by sex and education, with central adiposity showing a weaker, non-independent association compared with the unadjusted analysis. The association between education and diet differed by sex for fish consumption, being evident mainly among men; a similar pattern for SSB consumption did not reach statistical significance. Full article

Background/Objectives: Individual-level data on ultra-processed food (UPF) intake among Polish young adults are limited. This study quantified absolute UPF intake and its weight-based dietary contribution, identified major dietary sources, and examined associations of the UPF weight ratio with sociodemographic and anthropometric factors. Methods: This cross-sectional study included 429 Polish adults aged 18–30 years recruited by convenience sampling through an online questionnaire in March–April 2026, using a non-probabilistic sampling procedure. Habitual dietary intake was assessed using an 82-item semi-quantitative food-frequency questionnaire; body height and weight were self-reported. Foods were classified according to NOVA, supported by a market analysis of 605 retail products. Absolute UPF intake (g/day) and the UPF weight ratio (% of total food and non-water beverage intake) were calculated. Group comparisons used non-parametric tests, and independent associations were examined using multiple linear regression. Results: Median UPF intake was 394.4 g/day, while the mean UPF weight ratio was 23.8 ± 14.67%. Men had significantly higher UPF intake and weight ratio than women (p < 0.001, p = 0.002). The largest contributors to total UPF intake were non-alcoholic beverages (22.7%), animal protein products (19.7%), ready-to-eat/convenience meals (9.2%), and sweets and snacks (7.0%). In multivariable analysis, higher age (B = −1.47) and higher education (B = −3.55) were independently associated with a lower UPF weight ratio, while male sex (B = 2.87) and higher BMI (B = 0.36) were associated with a higher ratio (model R² = 25.0%). Conclusions: UPF intake was substantial in this convenience sample. A higher UPF weight ratio was observed among younger participants, men, and those with lower educational attainment, while beverages were the leading dietary source. These findings may help identify priority groups and dietary sources for public health strategies. Full article

Background: Diabetes distress is a key mental health dimension of type 2 diabetes (T2D) and a growing concern as populations age, yet its determinants in older adults remain insufficiently characterized. The independent contributions of demographic and metabolic factors to severe distress and their implications for multidisciplinary screening across the lifespan remain unclear. Methods: In this cross-sectional study, we assessed 453 adults with T2D using the 17-item Diabetes Distress Scale (DDS-17). We categorized participants as experiencing low (<2), moderate (2–2.9), or severe (≥3) distress. We compared categories using the Kruskal–Wallis H test and chi-square tests. Logistic regression models were constructed with severe distress (DDS ≥ 3) as the outcome, adjusting for sex, educational level, and HbA1c. Results: Severe distress was identified in 19 participants (4.2%). Age differed significantly across DDS categories (Kruskal–Wallis H test, p = 0.003), with the severe group being significantly older (72.95 ± 4.38 years). Emotional burden was the dominant subscale across all groups. In multivariable logistic regression, increasing age (aOR = 1.163 per year; 95% CI: 1.055–1.282; p = 0.002) and lower educational level (high school vs. basic: aOR = 0.187; p = 0.020) were independently associated with severe distress, whereas metabolic variables were not independently associated with severe distress. ROC analysis identified age ≥ 70 years as an exploratory, sample-derived cut-off (AUC = 0.726, 95% CI 0.602–0.827; sensitivity 84%, specificity 55%). Results were robust in sensitivity analyses that excluded patients with diabetes duration < 5 years. Conclusions: Severe diabetes distress is more strongly associated with demographic vulnerability than with metabolic burden. Age ≥ 70 years and lower educational attainment may help identify older adults at increased risk of diabetes-related distress, supporting targeted psychological screening strategies in this lifespan stage. Full article

Research in many parts of the world reports cases of sexual harassment and abuse in schools. However, the concept of sexual abuse and harassment can be contested based on various factors. Unfortunately, when such violence occurs, it may affect pedagogical practices and learner performance, hence the need for contextual research to determine such a relationship. To address this need, this study examined primary school learners’ perceptions of sexual harassment and abuse in two primary schools in Ado-Ekiti Local Government Area, Ekiti State, Nigeria, and analysed the effects of the violence on these learners’ attitudes toward sex education. Using Bronfenbrenner’s Ecological Systems Theory, the study implements a survey design involving 130 learners (aged 9–12) from two primary schools. Data were collected using a validated questionnaire (SVAQ), adapted from the Child Sexual Abuse Questionnaire (CSAQ). The analysis involved descriptive statistics and regression analysis. Results reveal a low level of sexual abuse and harassment; however, significant percentages of learners reported exposure to inappropriate behaviours: 14.6% experienced unwanted physical contact, 15.4% received requests to disclose private body parts, and 19.2% acknowledged having received sexually arousing touch by adults. Female learners were identified as more vulnerable, with a prevalence of 78.5%. Respondents demonstrated strong support for sex education, with 85.3% advocating for its inclusion in school curricula and 77.7% recognising its significance in preventing teenage pregnancies and STDs. Regression analysis indicated a significant positive correlation between experiences of sexual harassment and favourable attitudes towards sex education (B = 0.196, p < 0.001), suggesting that affected individuals view it as a protective measure. Recommendations highlight the importance of thorough, age-suitable sex education initiatives, improved teacher training, and community-focused approaches to create safer school settings, and the critical need to incorporate sex education into primary school curricula to address vulnerabilities, empower learners, and break the cycles of abuse (whether sexual or otherwise). Full article

Multilingual students’ repertoires are often framed either as resources for participation or as possible sources of difficulty, yet their situated use in special education remains underexamined. This study investigated how students in German special schools for social, emotional and behavioral development (SEBD) mobilized migration-related multilingual repertoires to address practical interactional problems and how situational conditions shaped the functions and consequences of these practices. A multi-sited ethnography was conducted in six SEBD special schools in the Rhine-Ruhr metropolitan region (North Rhine-Westphalia) between April 2024 and March 2025. Data comprised participant observation, written and talking fieldnotes, and informal ethnographic conversations. They were analyzed through a constant-comparative approach informed by reflexive grounded theory. Six recurring practice types were grouped into four result domains: Participation and Meaning-Making, Relational Positioning and Communicative Accessibility, Affective Mobilization and Counter-Positioning, and Navigation of Institutional Language Orders. Repertoire use had no fixed inclusive, disruptive, or resistant function. Its meaning emerged within interaction and changed with participation structures, public visibility, adult comprehension, and peer responses. In SEBD settings, migration-related linguistic marking and behavioral interpretation could reinforce one another. Multilingual practices should therefore be analyzed sequentially and situationally rather than treated as direct indicators of competence or disturbance. Full article

Background/Objectives: Vaccination represents one of the most significant achievements of modern medicine and public health. However, the scope, mandatory status, and vaccination coverage vary considerably across European countries. Methods: This narrative review compares selected elements of vaccination programmes in Poland, purposively selected EU/EEA countries, and the United Kingdom. Official data from the WHO, UNICEF, ECDC, EMA, and national sources were used to delineate vaccination policies, reimbursement models, delivery arrangements, coverage rates, and educational approaches. Due to temporal and methodological heterogeneity, the findings were interpreted descriptively. Results: Poland, together with Latvia, has the largest number of vaccinations classified as mandatory among the EU/EEA countries included in this comparison. Vaccination is mandatory in only nine EU/EEA countries; however, several countries without such policies also report high vaccination coverage in settings characterized by extensive public education and accessible vaccination services. Adult vaccination policies, recommendations, and reimbursement frameworks for influenza, pneumococcal, and RSV vaccines vary significantly depending on the country, target population, age criteria, and scope of funding. Conclusions: This comparison indicates a potential gap between the structured delivery of childhood vaccinations and the predominantly recommendation-based adult vaccination approach in Poland. Strategies utilized in selected European countries suggest that life-course vaccination continuity can be enhanced through accessible delivery systems, adequate reimbursement, systematic assessment of vaccination status, active engagement of healthcare professionals, sustained public communication, and trust-building. Mandatory status alone should not be regarded as sufficient to ensure high vaccination coverage. Full article

Background: Cancer survivors are at increased risk for developing subsequent cancers, including HPV-associated cancers, compared to the general population. However, evidence regarding the receipt of HPV vaccination and cancer diagnosis status is limited. Methods: We analyzed 2019 and 2022 National Health Interview Survey data, focusing on adults aged 18–45 years who were eligible for HPV vaccination. We performed descriptive statistics and evaluated associations using survey-weighted bivariable and multivariable logistic regression to assess the association between a personal history of any cancer diagnosis and receipt of HPV vaccination, adjusting for sociodemographic and behavioral factors. Results: Among 20,917 participants (mean [SD] age (years): 31.41 [13.58]), 489 (2.0%) were cancer survivors; 99 (19.3%) received HPV vaccination. Among 20,423 adults without a cancer diagnosis, 5317 (27.8%) had received HPV vaccination. Five participants had missing data on cancer history. Cancer survivors had significantly lower odds of HPV vaccination compared to adults without a personal cancer history (Adjusted Odds Ratio [aOR]: 0.67, 95% CI: 0.52–0.87, p = 0.003). Living in non-metro areas (aOR: 0.77, 95% CI: 0.66–0.89, p < 0.001), smokers [current (aOR: 0.82, 95% CI: 0.71–0.94, p = 0.005), and former (aOR: 0.75, 95% CI: 0.67–0.84, p < 0.001)], non-US-born (aOR: 0.54, 95% CI: 0.47–0.61, p < 0.001), uninsured (aOR: 0.60, 95% CI: 0.52–0.69, p < 0.001) had significantly lower odds of receiving HPV vaccination. Those who were 18–26 years (aOR: 5.49, 95% CI: 4.73–6.37, p < 0.001), non-Hispanic others (aOR: 1.40, 95% CI: 1.11–1.75, p = 0.004), females (aOR: 3.18, 95% CI: 2.84–3.56, p < 0.001), higher education [some college/bachelor’s education (aOR: 1.57, 95% CI: 1.41–1.74, p < 0.001), and graduate degree/professional scholar (aOR: 1.91, 95% CI: 1.65–2.22, p < 0.001)], living in rented housing (aOR: 1.18, 95% CI: 1.08–1.29, p < 0.001) had significantly higher odds of receiving HPV vaccination. Conclusions: HPV vaccination uptake is low among cancer survivors. Targeted interventions such as strong oncologists’ recommendations, patient reminders, and care coordination between oncology and primary care professionals are needed to increase HPV vaccination uptake in this population. Full article

Explicit gender stereotypes are shifting toward neutrality, yet how widely a stereotype is endorsed and how consistently it appears across domains within those who endorse it are separable properties of a stereotype climate. The same Romanian adults, parents alongside teachers and school counsellors (N = 121), reported gender-stereotyped beliefs about children’s play and traits in the abstract, together with two applied judgements: gender-differentiated educational expectations and gender suitability of occupations. Stereotyped judgement covaried across all three domains, substantially among parents and moderately among teachers. This cross-domain covariation indexes consistency within respondents rather than a common latent construct, which the confirmatory models did not support. Stereotyping was voiced more strongly as abstract belief than in either applied domain. Explicitly gender-typing occupations was a minority position, yet those who did so held the strongest beliefs, a concentration that direction-cancelling coding rendered undetectable. Because gendered channelling is concentrated rather than diffuse, awareness work is better targeted than universal and better timed before high-stakes transitions such as allocation to high-school tracks. Teachers resembled parents, suggesting professional training does not by itself displace such judgement. Where access is no longer the binding constraint, monitoring that tracks only how prevalent gender bias is will miss what remains coherent in a shrinking minority. Full article

Achieving the Sustainable Development Goals (SDGs) requires education that extends beyond formal schooling and fosters inclusion, lifelong learning, and social participation. Informal learning communities remain underexplored in this respect. This study examines how members of the speedcubing community perceive its educational and social potential in relation to SDG 4, 5, 10, and 11. The case was chosen for its open participation, intergenerational interaction, and the absence of age and gender categories in competitions. Anonymous questionnaires concerning 112 speedcubers, recruited in Poland, were completed by the speedcubers, by their parents or guardians, or jointly. Responses were analysed using descriptive statistics, non-parametric tests with effect sizes, and correspondence analysis by experience, gender, and respondent role. The community was rated as easy to enter (71.4% positive on five-point scales) and as accessible through free online resources (94.6%), with strong affirmation of its intergenerational character (93.8%) and culture of mutual respect (89.3%). Perceived equality of opportunity did not differ between female and male speedcubers, in contrast to patterns reported for other mind sports. Respondents also saw potential for engaging older adults socially. In formal education, potential was recognised above all in extracurricular clubs, without significant subgroup differences. These perceptions suggest that inclusive informal learning communities may complement formal education in supporting the SDGs. Full article

Community pharmacists play an increasingly important role in the care of transgender individuals receiving gender-affirming hormone therapy (GAHT). However, the content of structured pharmaceutical consultations tailored to this population has not yet been clearly defined. This systematic review aimed to identify therapeutic issues relevant to community pharmacy practice in order to inform the development of structured pharmaceutical consultations. A systematic literature review was conducted in accordance with the PRISMA 2020 Statement. The review question was structured using the PICo framework, with transgender individuals as the population, treatment-related issues associated with GAHT as the phenomenon of interest, and community pharmacy practice as the context. Electronic searches of Medline, Google Scholar, and APA PsycINFO were performed on 17 July 2024. Studies involving transgender adolescents or adults receiving GAHT and reporting therapeutic effects, adverse events, monitoring requirements, or medication-related issues were eligible. Two reviewers independently screened the studies and extracted data using a standardized form. Owing to the heterogeneity of study designs, the findings were synthesized narratively according to therapeutic domains relevant to community pharmacy practice. Among 755 screened records, 116 articles met the inclusion criteria. Seven therapeutic domains relevant to pharmacist-led consultations were identified: cardiovascular and cardiometabolic effects, dermatologic effects, gynecologic effects, musculoskeletal effects, biological and pharmacological effects, psychiatric effects, and other adverse effects or specific clinical situations. The evidence highlighted treatment-specific monitoring needs, medication-related risks, fertility and contraceptive considerations, laboratory monitoring requirements, drug–drug interactions, and mental health outcomes. Community pharmacists may contribute to the monitoring and optimization of GAHT, adverse effect management, patient education, fertility and contraceptive counseling, pharmacovigilance, and interdisciplinary collaboration within the scope of their professional practice. These findings provide an evidence-informed basis for the future development of structured pharmaceutical consultations tailored to transgender individuals. Full article

Diabetes disproportionately affects African American and Native American populations in the United States; however, diabetes disparities are frequently examined either collectively across minority populations or within individual groups, limiting understanding of the distinct mechanisms that drive inequities. This narrative review compares differences in diabetes diagnosis, culturally grounded management, diabetes self-management education and support (DSMES), and diabetes-related complications among African American and Native American adults in the United States to identify both shared and population-specific pathways contributing to disparities. A narrative review of peer-reviewed literature published between 2010 and 2025 was conducted using PubMed, Scopus, and Google Scholar. Studies addressing diabetes diagnosis, management, diabetes education, or complications among African American and Native American adults were included and synthesized using a comparative thematic approach. Disparities were evident across the continuum of diabetes care, but their underlying drivers differed substantially between populations. Among African Americans, diagnostic challenges reflected both structural inequities and limitations of commonly used glycemic markers such as hemoglobin A1c. Among Native Americans, delayed diagnosis was more closely associated with geographic isolation and under-resourced healthcare systems. Culturally grounded management also differed, with Native American communities demonstrating greater integration of Indigenous frameworks and traditional practices, whereas African American communities relied more heavily on family- and faith-based support systems. DSMES remained underutilized in both populations because of referral gaps, structural barriers, and limited cultural tailoring, with access barriers particularly pronounced in rural and tribal settings. Both populations experienced disproportionately high rates of diabetes-related complications, although Native Americans frequently exhibited earlier onset while African Americans often experienced greater severity of outcomes. Findings suggest that similar diabetes disparities emerge through different structural, cultural, and healthcare system pathways. Recognizing these differences can inform the development of more targeted clinical interventions, community-based programs, and health policies aimed at reducing diabetes inequities in underserved populations. Full article

Multiple chemical sensitivity (MCS) is a chronic condition characterized by adverse multisystem reactions triggered by chemical exposures, including at low levels. The use of fragranced and disinfectant products within healthcare institutions was frequently reported by individuals with MCS as a challenge to accessing healthcare. This study was conducted during the COVID-19 pandemic, when infection control measures may have intensified the pre-existing chemical-exposure barriers for people with MCS. This study examines healthcare access among adults with MCS in Canada, including access to diagnosis and physicians and satisfaction with in-person and virtual care. A national cross-sectional online survey was conducted between January and February 2021 among adults living with MCS for at least one year prior to the pandemic. Quantitative and open-ended questions captured experiences related to diagnosis, access to physicians, and satisfaction with virtual and in-person healthcare. Of the 119 participants who completed the survey, most reported having a formal diagnosis of MCS (78.2%, n = 93, 95% CI 69.9–84.6). Among those who could not obtain an MCS diagnosis (N = 26), common barriers included obtaining any other diagnosis but MCS (61.5%, n = 16; 42.5–77.6), and the belief among medical professionals that MCS does not exist (57.7%, n = 15; 38.9–74.5). Among participants who gave reasons for dissatisfaction with virtual care (n = 32), 87.5% (71.9–95.0) cited the clinician’s lack of understanding of the condition, whereas technical problems were rarely reported (12.5%, 5.0–28.1). Among participants who reported dissatisfaction with in-person care (n = 41), 85.4% (71.6–93.1) cited the clinician’s lack of understanding of the condition, and 85.4% (71.6–93.1) cited chemical exposures, including scented disinfectants, soaps or sanitizers, while 80.5% (66.0–89.8) cited cleaning products on surfaces. Participants’ responses suggest that pandemic-related public health responses intensified pre-existing barriers to care for people with MCS by increasing chemical exposures and constraining access to knowledgeable providers. These findings highlight the need for healthcare systems and emergency preparedness frameworks that integrate chemical safety, disability inclusion, and provider education to ensure equitable access, including during public health crises. Full article