Search Results (99)

Today’s medical professionals function within an increasingly complex landscape—one that is medical, scientific, social, cultural, political, ethical, and technological in nature. Responding to these complexities, U.S. medical education has emphasized Systems-Based Practice and Health Systems Science competencies to prepare learners to deliver excellent patient-centered care within dynamic clinical environments. Despite recognition of these competencies and broader calls for developing health systems citizens, operationalized and scaffolded learning and assessment across undergraduate medical education remain limited, with few validated assessment tools or defined learning trajectories to help novices become experts. In this conceptual synthesis article, the authors argue for the relevance of health systems thinking to everyday clinical situations and introduce a metacognitive systems thinking framework to conceptualize how professionals navigate systems-level complexities embedded in daily work. Drawing from the literature across disciplines, the framework highlights three related yet distinct processes: recognizing salient features of a complex situation (sensemaking), aligning and coordinating relevant knowledge, skills, and attitudes (integration), and making decisions and taking action in response (action). Emphasizing these as separable processes enables scaffolding learning and assessment as well as targeted formative feedback. The authors further integrate this framework with an evidence-centered design approach, associating concrete and measurable knowledge and skills with each process. This structure allows health systems thinking to be elicited and evaluated across diverse clinical scenarios (e.g., objective structured clinical examinations), supporting intentional development of systems-informed, reflective, and adaptive clinicians. Full article

Background: Translating urban environmental health evidence into actionable policies remains challenging in South-Eastern Europe, where environmental epidemiology has yet to reach maturity and institutional capacity and cross-sector coordination are suboptimal. This study assessed stakeholders’ awareness, perceived roles, and prioritization of urban health challenges, alongside the barriers and evidence needs related to healthy and sustainable urban development. Methods: A cross-sectional online survey was conducted between March and May 2025 among 108 stakeholders identified through a collaborative evaluation process. Participants represented national institutions, municipal actors, academia, non-governmental organizations, business, and citizens. They reported on their role and influence, and were asked to identify priority urban health problems, relevant policies and actions, perceived barriers to decision-making, and expected benefits of addressing priority problems. Results: Most respondents reported limited or moderate influence on urban decision-making. Priority problems clustered around air pollution, traffic, and land-use pressures, with climate change and heat also frequently cited. Dominant barriers included lack of coordination and policy continuity, insufficient political support, and limited funding and institutional capacity. Anticipated gains centered on improved public health, cleaner air, and citizen satisfaction, with broader quality-of-life and economic co-benefits also identified. Conclusions: Prioritized urban environmental problems are largely consistent with scientific evidence on their health impacts, though certain risk factors remain underestimated. Access to specific, actionable scientific evidence and the co-production of solutions with broad stakeholder representation are essential prerequisites for effective urban health policy and practice. Full article

Particulate matter pollution in northern Utah comes from various sources, including industry, traffic and the western desert, plus dried shoreline sediments of the Great Salt Lake (GSL). Particulate matter air pollution, particularly that containing heavy metals, can have severe effects on human health. Since the high-water levels in the 1980s, the GSL has been drying and reached record low water levels in 2022. Accurate Environmental Protection Agency (EPA) PM_2.5 and PM₁₀ sensors within northern Utah are few. This makes the mapping of particulate matter air pollution difficult. We show spatial patterns in particulate matter air pollution using a combination of PM_2.5 and PM₁₀ levels from 7 years of Purple Air Network data (a network of inexpensive air quality sensors installed by private citizens or businesses) and atmospheric optical depth (AOD) data from Sentinel imagery. We also show that PM_2.5 and PM₁₀ levels are significantly higher on a regular basis within 10 km of the Great Salt Lake and close to Farmington and Bear River Bays, which are upwind of large population centers. The levels of heavy metals (arsenic, copper, lead and zinc) were particularly high for the Farmington Bay and Saltair study sites, and the percentage of silt-sized particles that are most susceptible to wind erosion was largest for Farmington Bay, which is upwind of large population centers. Links between heavy metal concentrations, particle size and PM air pollution and asthma outcomes are investigated. Closeness to the lake was a significant predictor of asthma emergency room visits in 2018–2022 but not in 2016. Full article

Background: Parents of children undergoing liver transplantation face substantial caregiving demands that may adversely affect their mental health across multiple domains. Systematic evaluation of psychosocial outcomes in this population remains limited, particularly in settings that include immigrant families. Method: This was a single-center, cross-sectional study including the parents of 50 children after liver transplantation. Major sociodemographic variables included parental age, sex, education, chronic disease, and immigration status. We also recorded children’s demographics, transplant-related data, follow-up findings, and mental health status. Instruments for psychiatric assessment included the Generalized Anxiety Disorder 7-item scale (GAD-7; anxiety), Patient Health Questionnaire-9 (PHQ-9; depression), Perceived Stress Scale-10 (PSS-10; stress), and Pittsburgh Sleep Quality Index (PSQI; sleep quality). Results: We enrolled 50 parents of 50 pediatric liver transplant recipients (43 Turkish citizens, 7 Syrian immigrants; 28 fathers, 22 mothers; mean age: 40.10 ± 6.65). Time since transplantation showed weak negative correlation with PHQ-9 and GAD-7. Stress (PSS) levels had weak to strong positive correlation with PSQI, PHQ-9, and GAD-7. Sleep quality (PSQI) was positively correlated with PHQ-9 and GAD-7. Depressive findings (PHQ-9) were strongly and positively correlated with GAD-7. In Firth-penalized multivariable models, high PHQ-9 scores were independently associated with shorter time since transplantation (p = 0.001) and high PSS (p = 0.003). High GAD-7 scores were independently associated with shorter time since transplantation (p = 0.025) and high PSS (p = 0.001). Conclusions: The parents of pediatric liver transplant recipients experience high levels of stress, sleep issues, depression, and anxiety, which demonstrate multiple correlations. Full article

Urban greening has transitioned from a supplementary component of urban development to a central element in contemporary planning policies, driven by its recognized environmental, social, and health benefits. This paper explores urban greening processes through the lens of Human-Centered Design (HCD), an approach that emphasizes iterative, participatory, and user-oriented approaches. While public participation in urban planning is traditionally framed through statutory procedures and deliberative models, HCD offers a distinct perspective by treating engagement as a design process aimed at deeply understanding and integrating citizen needs into the process. This study compares two internationally acclaimed cities, Melbourne, Australia, and Vitoria-Gasteiz, Spain, focusing on their urban greening strategies and citizen engagement mechanisms. Using HCD as an analytical framework, the research investigates how socio-political and cultural contexts shape participatory practices, the barriers planners face, and how these impact the effectiveness and sustainability of greening initiatives. The findings underscore the value of HCD in fostering long-term citizen relationships, adapting greening solutions to local contexts, and addressing the methodological gaps in participatory urban design. Ultimately, the paper advocates for a more structured, context-sensitive, and human-centered approach to citizen engagement. Full article

Plastic pollution constitutes a critical planetary health challenge, undermining the integrity of Earth systems while generating cascading harms to human health, livelihoods, and social equity particularly in low- and middle-income countries. Conventional top-down regulatory and technological responses have proven insufficient to address the complexity of plastic pollution, often excluding those most affected from decision-making and solution design. This paper examines how democratizing plastic governance through grassroots leadership can advance planetary health by simultaneously protecting ecosystems, improving human well-being, and strengthening socio-ecological resilience. Drawing on empirical evidence from the #RestorationX10000 initiative led by Community Action Against Plastic Waste (CAPws), this paper documents implementation processes and outcomes achieved between 2021 and 2025 across 71 impacted communities in 21 countries spanning Africa, Asia-Pacific, and Latin America. The initiative was designed to empower 10,000 youths and women as community leaders, practitioners, and advocates by equipping them with leadership, technical, and policy engagement skills to drive systemic change in plastic governance and circular economy practice. Using a transdisciplinary, community-based action research approach aligned with planetary health principles, the initiative integrates capacity building, citizen science, circular economy interventions (collection, sorting, repair, reuse, repurposing, and recycling), and policy advocacy. Quantitative and qualitative evidence demonstrates that grassroots-led interventions can simultaneously reduce plastic leakage, create decent green livelihoods, and strengthen environmental governance. We argue that inclusive, community-centered plastic governance is not only an environmental intervention but a planetary health strategy, offering policy-relevant insights for national plastic action plans, extended producer responsibility frameworks, and global negotiations toward a legally binding instrument on plastic pollution. Full article

Amid increased immigration enforcement and the rollback of health reform in the United States, immigrants’ healthcare access is at the center of these policy debates. Though previous research has examined the impact of language barriers on healthcare access, few studies have examined it since health policies have been implemented. This article explores how various language barriers undermined Latino/a immigrants and citizens’ ability to access coverage and care under comprehensive health reform in the United States. Specifically, this paper examines how language barriers affect: (1) coverage enrollment experiences; (2) navigation of the US healthcare system; and (3) patient-provider interactions. Using interviews from 209 immigrants, healthcare providers, and immigrant and healthcare advocates in Boston, MA, this article shows that language barriers reduced healthcare access for limited English proficient (LEP) individuals despite health reform in three ways: (1) negatively affected coverage enrollment; (2) made it more difficult to navigate the system; and (3) hindered patient-provider interactions. Nevertheless, respondents described immigrants and advocates’ efforts to reduce those barriers and improve healthcare experiences. This article elucidates our understanding of persistent healthcare language barriers despite reforms to increase healthcare access. This article concludes with a discussion regarding how the current socio-political climate will undermine healthcare access in the United States. Full article

This study investigates the environmental impact of combined missile and drone attacks on Kyiv, the capital of Ukraine, with a focus on the release of particulate matter (PM) into the urban atmosphere. These military strikes frequently result in the destruction of residential and industrial infrastructure, as well as fires, leading to acute increases in ambient concentrations of fine particulate matter (PM2.5). Observational data were collected between 1 and 30 June 2025 using a distributed network of low-cost air quality monitoring stations aggregated by the SaveEcoBot platform. The optical particle counters, based on light scattering technology, enable real-time monitoring of airborne particulate fractions of PM2.5 along with meteorological parameters and gas pollutants. The study period included two significant attacks (10 and 17 June), during which the temporal and spatial dynamics of PM2.5 concentrations were analyzed in comparison to baseline levels observed under non-attack conditions. Raw concentrations of PM2.5 up to 241 μg/m³ were observed in the epicenters of air-strike-induced fires, while smog plumes covered half of the city area. Elevated PM2.5 concentrations were recorded during and for several hours following the attacks and corresponding air raid alerts. The findings show days of PM2.5 exceedances above the World Health Organization (WHO) daily threshold of 15 μg/m³. These results underscore the acute environmental and public health hazards posed by military assaults on urban centers. Furthermore, this research highlights the role of citizen-driven environmental monitoring as a valuable tool for both scientific documentation and potential evidentiary support in assessing the environmental impacts of warfare. Full article

Background/Objectives: The demand for accessible and reliable digital health services has increased significantly in recent years, particularly in regions facing physician shortages. HomeDOCtor, a conversational AI platform developed in Slovenia, addresses this need with a nationally adapted architecture that combines retrieval-augmented generation (RAG) and a Redis-based vector database of curated medical guidelines. The objective of this study was to assess the performance and impact of HomeDOCtor in providing AI-powered healthcare assistance. Methods: HomeDOCtor is designed for human-centered communication and clinical relevance, supporting multilingual and multimedia citizen inputs while being available 24/7. It was tested using a set of 100 international clinical vignettes and 150 internal medicine exam questions from the University of Ljubljana to validate its clinical performance. Results: During its six-month nationwide deployment, HomeDOCtor received overwhelmingly positive user feedback with minimal criticism, and exceeded initial expectations, especially in light of widespread media narratives warning about the risks of AI. HomeDOCtor autonomously delivered localized, evidence-based guidance, including self-care instructions and referral suggestions, with average response times under three seconds. On international benchmarks, the system achieved ≥95% Top-1 diagnostic accuracy, comparable to leading medical AI platforms, and significantly outperformed stand-alone ChatGPT-4o in the national context (90.7% vs. 80.7%, p = 0.0135). Conclusions: Practically, HomeDOCtor eases the burden on healthcare professionals by providing citizens with 24/7 autonomous, personalized triage and self-care guidance for less complex medical issues, ensuring that these cases are self-managed efficiently. The system also identifies more serious cases that might otherwise be neglected, directing them to professionals for appropriate care. Theoretically, HomeDOCtor demonstrates that domain-specific, nationally adapted large language models can outperform general-purpose models. Methodologically, it offers a framework for integrating GDPR-compliant AI solutions in healthcare. These findings emphasize the value of localization in conversational AI and telemedicine solutions across diverse national contexts. Full article

The pressing ecological challenges of the twenty-first century underscore the need for biodiversity protection. The “One Health” approach, which integrates human, animal, and environmental health, has become increasingly vital. This study investigates the relationship between bird species richness, an important indicator of biodiversity, and both all-cause and cause-specific mortality rates in China. This nationwide county-level ecological study combined citizen science bird data from the China Bird Report Center, all-cause and cause-specific mortality rates of 2021 from the National Mortality Surveillance System, and county-level statistics of population characteristics, socio-economics, education, and healthcare services. We employed univariate and multivariate linear regressions to explore the association between bird diversity and mortality rates. Overall, data from 421 counties revealed a negative association between bird species richness and all-cause mortality rates, with a regression coefficient (95% confidence interval) of −0.197 (−0.376, −0.017). This study also found significant negative associations between bird species richness and cause-specific mortality rates for several diseases, such as cardiovascular diseases (including cerebrovascular and ischemic heart diseases) and cancers (including lung cancer). The effects of associations were similar between both genders. Our findings underscore the significance of biodiversity conservation for public health and highlight the importance of integrated environmental and health policies. Full article

Cities’ role as major hubs of human activity and economic development is essential in attaining sustainable development, fostering a balance between economic, social, and environmental development, especially in light of the growing concern over Anthropocene-induced environmental issues like global warming and climate change. The United Nations Sustainable Development Goals (SDGs) represent a historic call for coordinated international action in this area, with SDG 11 specifically identifying “Sustainable Cities and Communities” as a primary objective. Therefore, it is clear that a paradigm shift in our approach to these challenges in terms of our thinking, sensibility, behavior, and responses is necessary. Implicitly, in view of their pivotal role in environmental sustainability, development of “smart” cities as healthy, citizen-friendly, economically viable, and sustainable cities for our future generations in today’s globally integrated world, as predominant centers of human settlement and activity with multinational enterprises driving economic growth, gains the immediate attention of researchers. In this light, this study aims to identify and thereafter prioritize key indicators of a smart city using the structured and consistency-focused best–worst multi-criteria decision-making (BWM) method, suitable for expert-driven decision-making with limited comparisons. While the UN’s SDG 11 promotes safe and resilient cities, our findings suggest a disparity in how local officials prioritize certain dimensions such as safety or recreation. This disconnect warrants closer examination of localized policy drivers. The findings of this study indicate that according to experts, among others, the priority themes are, in order, water and sanitation, wastewater, health, the environment, and the economy. Thus, these represent a key take-away for multinational enterprises for identifying and assessing significant thrust domains and areas of opportunity for intervention and contribution to the UN SDGs. It also enables a replicable framework for synergy between the public and private sectors towards contrastive intervention in other cities across the globe. Full article

Public buildings are crucial to creating healthy and sustainable cities. These buildings promote social cohesion and enrich urban life by transforming existing facilities into hybrid models that integrate medical content. Historical developments highlight shifts in residential, economic, and healthcare infrastructure. The healthcare system aims to enhance public health while ensuring financial equity. Reforms in healthcare privatization, governed by public health and insurance policies, involve liberalizing service provision and are supported by the Ministry of Health and Finance. This study examines how public buildings can adapt to enhance health and social sustainability. Through case studies, it assesses architectural adaptability in analyzing spatial, economic, and social impacts. Diagrams illustrate spatial dynamics, while surveys compare efficiency, sustainability, and user experience. Statistical analysis highlights the role of spatial adaptability in fostering sustainable urban environments. The results, which express significant differences between means for different locations and citizens’ satisfaction, suggest that the hypothesis offers substantial results in every area. Besides commercial programs in commercial buildings, healthcare also gives satisfactory results. This study advocates for adaptive architecture as a key strategy, aligning with evolving societal and health demands. Hybridizing healthcare facilities and commercial spaces transforms shopping centers into sustainable models, enhancing social cohesion and economic viability. Full article

Background: Health-related quality of life (HRQoL) can be impacted by various environmental factors: lifestyle habits, food insecurity, social–economic status, and dietary patterns. The Mediterranean diet (MedDiet) has been associated with a healthier lifestyle and better health outcomes. The aim of this study was to determine whether greater adherence to the MedDiet was associated with better HRQoL in communities with low social and economic statuses living in two social neighborhoods, “Bairro da Rosa” and “Ingote”, in Portugal. Methods: A cross-sectional analysis was performed on 102 citizens currently receiving government social support and attending the “Health Kiosk”, a community center created within the Europe Enabling Smart Healthy Age-Friendly Environments (EU_SHAFE) project enhancing educative sessions and screening by health professionals. The participants answered a 36-item questionnaire about their HRQoL (SF-36) and a 14-item questionnaire about their adherence to the Mediterranean diet (MEDAS). Spearman correlation analysis between variables and multiple linear regression models were used to estimate the effect of the baseline characteristics and MedDiet adherence on HRQoL scores (SF-36). Results: No statistically significant correlation was found between MedDiet adherence and total HRQoL scores across the eight health concepts. However, age was shown to negatively influence HRQoL, whereas daily physical activity had a positive impact on health. SF-36 physical health concepts exhibited a linear trend with respect to MedDiet adherence, while emotional health concepts showed inconsistent patterns across adherence groups. Education and waist circumference influence HRQoL, with higher levels of education correlating with better quality of life and greater waist circumference being negatively associated with aspects such as energy and vitality. These findings suggest that factors beyond dietary patterns, such as physical activity, education, and body composition, play pivotal roles in shaping HRQoL in disadvantaged communities, emphasizing the need for multifaceted public health interventions. Full article

In recent years, advances in both technology and medicine have made great progress. With the development of technology, low-cost and high-precision sensors have emerged and microcontrollers with high computing power and low power consumption have been created. In densely populated urban areas, health care is provided by a set of hospitals and medical centers where every patient can find an immediate response to their health concerns. However, medical care, particularly in non-urban areas, remains limited as many such areas do not have a hospital or medical center nearby. This results in inadequate medical care, both diagnostic and preventive, for the inhabitants of these areas. Today, the development of microprocessors, high-speed internet, and the low-cost sensors that have been developed can enable the creation of autonomous, accessible health monitoring units. In this work, an integrated low-cost, wearable electrocardiograph system is presented. The system is able to operate wherever there is an active internet connection. The proposed system consists of two parts. Firstly, the wearable ECG which can be located in the patient’s home. Secondly, the information system, in which the data from wearable ECG are collected and visualized, so that the doctor has direct access to the patient’s condition. Health is a precious commodity, and the application of technology is imperative, especially for the health care of citizens in remote areas. Full article

Social network analysis (SNA), or the application of network analysis techniques to social media data, is an increasingly prominent approach used in computational public health research. We conducted a systematic review to investigate trends around SNA applied to social media data for public health and epidemiology while outlining existing ethical practices. Following PRISMA guidelines, we reviewed articles from Web of Science and PubMed published between January 2019 and February 2024, leading to a total of 51 papers surveyed. The majority of analyzed research (69%) involved studying Twitter/X, followed by Sina Weibo (16%). The most prominent topics in this timeframe were related to COVID-19, while other papers explored public health topics such as citizen science, public emergencies, behavior change, and various medical conditions. We surveyed the methodological approaches and network characteristics commonly employed in public health SNA studies, finding that most studies applied only basic network metrics and algorithms such as layout, community detection, and standard centrality measures. We highlight the ethical concerns related to the use of social media data, such as privacy and consent, underscoring the potential of integrating ethical SNA with more inclusive, human-centered practices to enhance the effectiveness and community buy-in of emerging computational public health efforts. Full article