Search Results (429)

Background/Objectives: Compared to in the general pregnant population, pregnancy in women with type 1 diabetes (T1D) is still associated with an increased number of perinatal complications affecting both the fetus and the mother. The Great Orchestra of Christmas Charity Foundation (GOCCF) program enables the use of continuous subcutaneous insulin infusion (CSII) enhanced by a hypo-stop function and real-time continuous glucose monitoring (rtCGM) during the preconception or early pregnancy period in patients with T1D. This observational study aimed to analyze the association between pregnancy planning and pregnancy outcomes in patients who qualified for the GOCCF program. Methods: Ninety-eight women with T1D, aged 21–41 years, who began using the CSII + rtCGM system at the planning/early pregnancy stage or at a later stage in the case of an unplanned pregnancy, were eligible for this study. We analyzed glucose control, the insulin requirements, the pregestational BMI, the maternal weight gain, the occurrence of preterm births, congenital malformations and the birthweight of newborns. Results: Women who planned their pregnancies had significantly better glycemic control before and throughout the entire pregnancy, and a significantly higher proportion of them achieved a TIR (time in range) > 70% (58.7% vs. 28.9%, p = 0.014) and TAR (time above range) < 25% (65.2% vs. 24.4%, p < 0.001). Their glucose variability at the end of the pregnancy was significantly lower (29.4 ± 5.5 vs. 31.9 ± 5.1, p = 0.030). They also gave birth later, at a mean of 37.8 ± 0.9 weeks compared to 36.9 ± 1.8 weeks in the non-planned group (p = 0.039). Preterm birth occurred in five women (10.4%) who planned their pregnancies and in fifteen women (30%) who did not, with p = 0.031. Conclusions: Pregnancy planning in women with type 1 diabetes (T1D) is associated with better glucose control before conception and throughout the entire pregnancy, resulting in better pregnancy outcomes. Full article

This article utilises Max-Neef’s Human Scale Development (HSD) framework (1991) to answer two research questions: what impact does government and community-based social protection (SP) have on UK asylum-seeker wellbeing; how are interactions with all forms of SP, both as giver and receiver, supporting or harming the satisfaction of asylum-seekers’ fundamental human needs at this time? The research study utilised a mixed-methods, collaborative, case study design situated within a refugee and asylum-seeker (RAS) support charity in Southwest England. Methods included peer-led Qualitative Impact Protocol interviews, Photovoice, surveys, and staff interviews. Data were subjected to an inductive, bottom-up process on Causal Map software (version 2, Causal Map Ltd., 39 Apsley Rd., Bath BA1 3LP, UK) and the analysis used the HSD framework. We found eight over-arching themes. The four main needs-violators/destroyers of asylum-seeker wellbeing were dehumanisation, unfreedoms, enforced ignorance, and (re)traumatisation, and the four main needs-satisfiers were common humanity, autonomy and resistance, exerting agency through knowledge exchange, and healing. Five policy and practice-focused bridging satisfiers are recommended to help move individual and collective experience from a negative to a positive state in the research population. Policy and practice should be transparent and evidence-based, efficient and equitable, supportive of participation and productivity, trauma-informed, and multi-agency. Full article

This study examines the complex process of Islam’s localization in Sudan, focusing on how hospitality, Sufi dhikr, and Mawlid celebrations integrate with Islamic practices. Drawing on three years of qualitative fieldwork, it demonstrates how Sudan’s geography, ethnic diversity, and historical heritage enable the blending of core religious principles with local customs. Sufi brotherhoods—particularly Qādiriyya, Tījāniyya, Shādhiliyya, and Khatmiyya—play a pivotal role in local culture by incorporating traditional musical, choreographic, and narrative art forms into their rituals, resulting in highly dynamic worship and social interaction. In Sudan, hospitality emerges as a near-sovereign social norm, reflecting the Islamic ethics of charity and mutual assistance while remaining deeply intertwined with local traditions. Islam’s adaptability toward local customs is further illustrated by the vibrant drumming, chanting, and dancing that enhance large-scale Mawlid al-Nabi celebrations, uniting Muslims under a religious identity that goes beyond dogmatic definitions. Beyond their spiritual meanings, these Sufi practices and networks also serve as tools for social cohesion, often functioning as support systems in regions with minimal state presence. They help prevent disputes and foster unity, demonstrating the positive impact of a flexible Islam—one that draws on both scripture and local traditions—on peacebuilding in Sudan. While highlighting the country’s social realities, this study offers insights into how Islam can function as a transformative force within society. Full article

In the current era, when civilizations are in constant conflict and humankind is facing a series of serious existential crises, there is an urgent need for universal love to unite humankind. As models of world religions, Christianity and Buddhism provide rich intellectual resources for the construction of such universal love. Regarding Thomistic Christianity, its philosophy of friendship has gradually achieved a dual transformation from virtue-oriented to love-oriented, and from God-centered to human-centered. In the case of Mahayana Buddhism, its philosophy of friendship has evolved with the “Humanistic Buddhism” movement, increasingly demonstrating a compassionate spirit of saving the world. By comparing Thomistic Christianity with Mahayana Buddhism, we can see that although they exhibit different models of friendship, their main developmental trends are consistent. Both are committed to demonstrating a human-centered model of friendship, both emphasize the value of self-reduction in friendship, and both demonstrate the unique and irreplaceable role of religion in friendship. The goal of the philosophy of friendship is universal love and harmonious development of civilizations, while its future development depends on the joint efforts of contemporary religious scholars and philosophers. Full article

Background and aim: Low-density lipoprotein cholesterol (LDL-C) is an important and well-established modifiable risk factor for cardiovascular disease, including peripheral artery disease (PAD). We aimed at evaluating the lipid profile at admission in PAD patients with an indication for invasive treatment. Methods: Among patients with PAD diagnosis admitted to the vascular surgery department, those receiving statins and those with LDL-C values in the recommended target (<55 mg/dL) were identified. The correlation of LDL-C values with different clinical variables was investigated. Results: Of the 399 patients, 259 (65%) were on statin therapy. According to multivariate linear regression analysis, diabetes (p = 0.004), previous CAD history (p < 0.001), and statin therapy (p < 0.001) were independently associated with LDL-C levels. Patients with LDL-C < 55 mg/dL at admission were 89 (22% of the overall cohort). Among these patients, diabetes (48.3% versus 35.8%, p = 0.036), CAD history (52.8% versus 30%, p < 0.001), and statin use (91% versus 57.4%, p < 0.001) were more frequent as compared with patients not at target. Conclusion: Despite the very high cardiovascular risk of our group, the rate of statin prescription was very low and far from ideal. Only a small percentage of patients achieved target LDL-C values. Patients with coexistent diabetes and CAD had lower LDL-C values, suggesting management by specialists with greater attention to lipid profile and pointing out an urgent need for information on cardiovascular disease management. Full article

The Morehouse School of Medicine Prevention Research Center (MSM-PRC) conducted a Community Health Needs and Assets Assessment (CHNAA) survey using a Community-Based Participatory Research (CBPR) approach. In this article, we will demonstrate the application of CBPR in informing research agenda and implementation strategies. We will discuss the practical considerations and potential benefits of engaging the community in data collection, interpretation, and utilization to address community health challenges. Emphasizing collaboration, co-learning, and respect, and guided by the CBPR principles, CHNAA ensured that community voices led to the identification and integration of the research priorities. Overseen by the Community Coalition Board (CCB) and its Data Monitoring and Evaluation (DME) Committee, the survey featured closed- and open-ended questions addressing social determinants of health. Out of 1000 targeted participants, 754 provided valid responses, with a 75% response rate. Most respondents were female and represented a racially diverse group. Descriptive statistics and thematic analysis revealed that key health concerns were diabetes, COVID-19, mental health, and high blood pressure. Barriers to care included lack of food access, affordable housing, and limited mental health services. The findings led to five public health initiatives launched between 2023 and 2024 demonstrating the CBPR model’s effectiveness in aligning community needs with actionable solutions. Full article

Background/Objectives: Community benefit (CB) obligations by not-for-profit (NFP) hospitals have attracted renewed scrutiny at federal and state levels due to wide variation in CB spending. In 2020, Oregon implemented a CB policy for all NFP hospitals that included requirements to expand patient financial assistance and a hospital-specific minimum CB spending floor. We examined trends in CB spending after the implementation of Oregon’s CB policy. Methods: Interrupted time-series analyses to compare hospital CB spending before and after policy implementation. Results: Overall, Oregon’s CB policy was not associated with changes in CB spending, except for a 0.2% decrease in the Social Determinants of Health spending (−0.0018; p < 0.05). Among hospitals in the first tercile of pre-policy CB spending, Oregon’s policy was associated with a 0.4% decrease in charity care (−0.0041; p < 0.05) and a 0.6% increase in subsidized health services spending (0.0063; p < 0.05). Hospitals in the second tercile of pre-policy CB spending experienced a 0.7% decrease in subsidized health services (−0.0074; p < 0.05). Among frontier hospitals, total CB spending and Medicaid shortfalls increased by 2.9% (0.0292; p < 0.10) and 2.2% (0.0220; p < 0.10) respectively, while non-frontier hospitals experienced a 0.7% decrease in Medicaid shortfall (−0.0068; p < 0.05). Critical access hospitals experienced a 1.3% increase in subsidized health services spending (0.0131; p < 0.05). Conclusions: Although total CB spending did not change in the two years following Oregon’s CB policy implementation, findings suggest that hospitals may be shifting the composition of their CB spending. Oregon’s CB policy encourages proactive CB spending tailored to community needs, but opportunities exist to fine-tune the policy to boost hospital CB spending. Specifically, planned spending in categories such as charity care may alleviate the increasing burden of medical debt and its financial implications for patients. Full article

Oxidative stress is a common feature of various pathological conditions, including tissue remodeling and dysfunction. Cardiac fibroblasts, which play a key role in maintaining extracellular matrix homeostasis, are sensitive to oxidative injury. Curcumin and tetrahydrocurcumin are plant-derived polyphenols with antioxidant properties, yet their relative efficacy in preventing oxidative stress–induced dysfunction in cardiac fibroblasts remains unclear. In this study, cardiac fibroblasts were treated with curcumin or tetrahydrocurcumin prior to exposure to tert-butyl hydroperoxide (t-BHP), a widely used inducer of oxidative stress. Cell viability, apoptosis, reactive oxygen species (ROS) production, and Tgfb1 expression were assessed. Both curcuminoids significantly attenuated oxidative stress–induced cell death, decreased cell viability, and reduced Tgfb1 expression. Notably, tetrahydrocurcumin demonstrated superior protective effects across most parameters. These findings suggest that both compounds help mitigate oxidative-stress–induced cellular dysfunction in cardiac fibroblasts and highlight tetrahydrocurcumin as a potentially more effective antioxidant. Further studies are needed to explore their role in the context of tissue remodeling and fibrotic progression. Full article

The increasing disparity in global food distribution has amplified the urgency of addressing food waste and food insecurity, both of which exacerbate economic, environmental, and social inequalities. Traditional food bank models often struggle with logistical inefficiencies, limited accessibility, and a lack of transparency in food distribution, hindering their effectiveness in mitigating these challenges. This study proposes a novel Food Bank Network Redesign (FBNR) that leverages the Quito Metro system to create a decentralized food bank network, enhancing efficiency and equity in food redistribution by introducing strategically positioned donation lockers at metro stations for convenient drop-offs, with donations transported using spare metro capacity to designated stations for collection by charities, reducing reliance on dedicated transportation. To ensure transparency and operational efficiency, we integrate a blockchain-based traceability system with smart contracts, enabling secure, real-time tracking of donations to enhance stakeholder trust, prevent food loss, and ensure regulatory compliance. We develop a multi-objective optimization framework that balances food waste reduction, transportation cost minimization, and social impact maximization, supported by a mixed-integer linear programming (MIP) model to optimize donation allocation based on urban demand patterns. By combining decentralized logistics, blockchain-enhanced traceability, and advanced optimization techniques, this study offers a scalable and adaptable framework for urban food redistribution, improving food security in Quito while providing a replicable blueprint for cities worldwide seeking to implement circular and climate-resilient food supply chains. Full article

This paper analyzes the Hindu concept of sevā—selfless service—as a theo-ethical practice that reconfigures the relationship between religion and economy, offering a snapshot of an Indian perspective on the convergence between postsecularism and postcapitalist discourses. Rather than being reducible to acts of charity, sevā integrates spiritual, ethical, and social dimensions that challenge the neoliberal emphasis on individual self-interest and material accumulation. Rooted in the pursuit of liberation and relational well-being, sevā frames economic and moral agency in terms of embeddedness, reciprocity, and care. To illustrate sevā’s unique attributes, the paper engages with two case studies. The first explores Mahatma Gandhi’s philosophy, where sevā is articulated through a non-anthropocentric ethic of nonviolence (ahiṃsā), obliging the reconstruction of eco-economic mechanisms and environmental responsibility. The second examines contemporary guru-bhakti communities in Delhi’s urban peripheries, where sevā functions as spiritual discipline (sādhana), a means for communal uplifting, and the expression of kalyāṇ—holistic well-being that transcends individual boundaries. In both contexts, sevā emerges as a practice that intervenes in and reshapes socio-economic life. By foregrounding sevā as a lived practice, the paper situates Indian religious traditions as a distinctive contribution to broader postcapitalist and postsecular debates. It argues that sevā offers an alternative model of personhood and ethical intentionality—one that contests dominant binaries of spiritual/material, secular/religious, and human/nature, and reimagines human flourishing through the lens of relational ontology and collective responsibility. Full article

Background/Objectives: Wastewater treatment plants (WWTPs) serve as a sink for both antimicrobial residues and bacteria carrying resistant genes, which are later disseminated into the environment, facilitating the spread of antimicrobial resistance. This study investigated the presence of extended-spectrum beta-lactamase (ESBL) producing Escherichia coli (Ec), Klebsiella pneumoniae (Kp), and Enterobacter cloacae (Enc) in effluent from WWTP in Blantyre, Malawi, to generate evidence and provide baseline information for interventions. Methods: Selective chromogenic agar was used to identify ESBL-producing bacteria. Results: A total of 288 samples were collected between April 2023 and March 2024, and 97.6% (281/288) yielded one or more presumptive ESBL isolates. Bacterial growth was confirmed as 48.9% Ec (255/522), 33.0% Kp (172/522), and 10.0% Enc (52/522). Antibiotic susceptibility testing showed the highest resistance to ceftriaxone (Ec, 100.0%; Kp, 98.3%; Enc, 100.0%) and the lowest resistance to meropenem (Ec, 6.3%, Kp, 1.2%; Enc, 3.8%) among the antibiotics that were tested. Multiple antibiotic resistance phenotypes were observed in 73.1% of the isolates, with the most prevalent phenotype being amoxicillin + clavulanate/cotrimoxazole/doxycycline/ciprofloxacin/gentamicin/azithromycin/ceftriaxone (55, 15.7%). Conclusions: The study demonstrated ongoing environmental contamination with antibiotic-resistant bacteria from sewage effluent. Therefore, the functionality of WWTPs should be improved to minimize the release of these organisms into the environment. Full article

Background: Dietary intake plays a crucial role in health research, yet existing methods for its measurement can lead to participant burden, lengthy recording, and human errors, and do not account for age-specific variations. Libro is a real-time diet-tracking mobile-based app offering flexible features. An automated food recording program within Libro was customized for young people vulnerable to eating misbehaviour. This preliminary study assessed its relative validity using a self-administered 24 h recall method as the reference method. Methods: The relative validity of Libro was tested by adopting a cross-over design that recorded food intake over a period of 3 non-consecutive weekdays and 1 weekend day with both methods. The participants were recruited online through a mental health research charity, and this study was conducted fully online. The primary outcome was the concordance of total energy intake between the two methods, with secondary outcomes focusing on the intake of protein, carbohydrates, fats, free sugars, fibre, and trans-fatty acids. Test–retest validity was assessed per method with the intraclass correlation coefficient; a Bland–Altman plot and t-test were performed to test agreement at the group level; correlation coefficient and cross-classification were performed to assess agreement at the individual level. Results: Forty-seven participants were included in the final analysis. The average intraclass correlation coefficient for energy intake measured by Libro over four days was 0.85 (95% CI: 0.76–0.91). Compared to Intake24, the average energy intake recorded using Libro was significantly lower (mean difference: −554 Kcal, 95% CI: −804.1 to −305.6 Kcal, p < 0.001), potentially driven by the reduced reporting of foods rich in free sugars. The correlation coefficient for average energy intake measured by Libro vs. Intake24 was 0.32 (95% CI: 0.03, 0.55), with only 27.7% of subjects classified in the same quartile with both methods (κ = 0.31, 95% CI: −0.03, 0.55). Concordance varied across specific dietary component measures. Conclusions: While Libro had good test–retest reliability if adopting a multiple administration method, it underreported energy and other aspects of dietary intake, along with poor classification performance compared to Intake24 in a population vulnerable to eating misbehaviour. We suggest that future studies improve user experience to increase compliance and data accuracy. Full article

Background: Prostate cancer is the most common malignancy among UK men, yet the lack of a national screening program creates disparities in early detection. PSA testing during primary care is inconsistent, limiting timely diagnosis. The Graham Fulford Charitable Trust (GFCT) and its associated support groups offer community-based PSA testing to help bridge this gap. Objectives: This study evaluates GFCT’s historical testing records and a participant survey (2021–2024) to assess their community-based PSA testing program, which is widely used and offers shared decision support. Additionally, we examine the GFCT’s alignment with emerging initiatives such as the UK TRANSFORM trial and other PSA screening developments across Europe and the USA. Methods: The GFCT systematically collects PSA testing data, conducting over 50,000 tests annually. The study assesses the performance of their traffic light scoring system and a previously defined combination algorithm, “Riskman”, which incorporates PSA, PSAft%, and age to classify individuals into risk categories. Multivariable logistic regression was used to evaluate and compare the predictive performance of each approach. Results: Based on the self-reported data in the survey, the GFCT’s traffic light system—using age-specific PSA thresholds to assign green, amber, or red risk—showed good predictive ability. Men in the red group had over 15-fold increased odds of clinically significant cancer (Grade Group ≥ 3) compared to those in the green group. While the Riskman score achieved a higher AUC (0.84 vs. 0.76), both tools were effective in identifying high-risk individuals. Conclusions: This study highlights the GFCT’s role in improving access to PSA screening and integrating practical risk stratification. Its alignment with evolving screening initiatives demonstrates the value of community-based, data-driven approaches for earlier detection of aggressive prostate cancer. Full article

Patients on hemodialysis have signs of chronic systemic inflammation and a higher incidence of sarcopenia. Poor oral health can also trigger systemic inflammation and thus affect sarcopenia. The study included 100 patients on chronic hemodialysis who underwent oral status, routine laboratory measurements, bioimpedance analysis, hand grip strength measurement, and two questionnaires regarding oral health and sarcopenia. Data were analyzed using the Fisher exact test and the Mann–Whitney U test. In total, 28.0% of the participants had sarcopenia. The median total number of erupted teeth in all patients was 12.0 (7.0–23.0). A positive correlation of the total number of erupted teeth and erupted premolars with sarcopenia was confirmed (p = 0.035). CRP was significantly elevated in patients with sarcopenia (p = 0.035). Laboratory parameters showed that the blood albumin level was reduced in all patients (p = 0.002). The median overall score of the SarQoL questionnaire for all participants was 60.37 (43.87–70.61), which indicates that patients on hemodialysis are aware of their limitations caused by sarcopenia. Moreover, SarQoL was significantly negatively correlated with sarcopenia. This study confirmed poorer oral health in hemodialysis patients who had sarcopenia. Therefore, intervention studies are needed to improve the oral health of patients on HD, which could possibly influence the incidence of sarcopenia. Full article

Metabolic-Associated Fatty Liver Disease (MAFLD) is a public health concern that is constantly expanding, with a fast-growing prevalence, and it affects about a quarter of the world’s population. This condition is a significant risk factor for cardiovascular, hepatic, and oncologic diseases, such as hypertension, hepatoma, and atherosclerosis. Sarcopenia was long considered to be an aging-related syndrome, but today, it is acknowledged to be secondarily related to chronic diseases such as metabolic syndrome, cardiovascular conditions, and liver diseases, among other comorbidities associated with insulin resistance and chronic inflammation, besides inactivity and poor nutrition. The physiopathology involving MAFLD and sarcopenia has still not been solved. Inflammation, oxidative stress, mitochondrial dysfunction, and insulin resistance seem to be some of the keys to this relationship since this hormone target is mainly the skeletal muscle. This review aimed to comprehensively discuss the main metabolic and physiological pathways involved in these conditions. MAFLD and sarcopenia are interconnected by a complex network of pathophysiological mechanisms, such as insulin resistance, skeletal muscle tissue production capacity, chronic inflammatory state, oxidative stress, and mitochondrial dysfunction, which are the main contributors to this relationship. In addition, in a clinical analysis, patients with sarcopenia and MAFLD manifest more severe hepatitis fibrosis when compared to patients with only MAFLD. These patients, with both disorders, also present clinical improvement in their MAFLD when treated for sarcopenia, reinforcing the association between them. Lifestyle changes accompanied by non-pharmacological interventions, such as dietary therapy and increased physical activity, undoubtedly improve this scenario. Full article