Search Results (468)

Across East Asia, rapid population aging and regional decline threaten the sustainability of rural and island communities. Yeonpyeong Island provides a critical context for examining how spatial infrastructure shapes older residents’ daily challenges. The aim of this study is to identify how older adults evaluate their housing and community environments and to determine whether these perceptions signal a transition toward more integrated and community-based care settings. Using a primary quantitative survey of 102 older residents, supplemented by contextual input from a local representative, the study analyzes how health decline, mobility constraints, and housing obsolescence interact with aspirations for service-integrated and socially connected living. Composite scores for perceived home modification needs remained consistently in the mid-to-upper range (approximately 3.5–4.0 on a 5-point scale). Acceptance of alternative, cohousing-type community housing also remained above the midpoint (approximately 3.5–4.1), reflecting an unusually high level of openness in a setting traditionally characterized by low receptivity to residential change and limited local housing alternatives. Safety risks, poor accessibility, and inadequate facilities function as push factors, while preferences for shared programs, proximity-based reassurance, and integrated hubs operate as pull factors, together signaling readiness for more supportive communal living. By integrating Push–Pull Theory with Environmental Press and Life-Space perspectives, the study contributes theoretically by extending these frameworks to the community scale and empirically by providing resident-level evidence from an under-researched island context. The findings highlight how older adults act as evaluators of their environments, articulating practical signals for spatial restructuring and integrated care planning. Full article

Introduction: The informal food sector in Kisumu City, largely run by women informal food vendors, plays a crucial role in the urban food system. However, these female-led businesses faced disproportionate risks stemming from COVID-19-related policies, exacerbating gendered vulnerabilities. This paper explores the gender gaps of post-pandemic recovery strategies and their implications for resilience, recovery, and sustainability of women-led informal food businesses. Methods: This cross-sectional study was guided by the Intersectionality-Based Policy Analysis (IBPA) framework. In collaboration with the Pamoja Community-Based Organization, we employed qualitative methods grounded in community-based participatory approaches. Data were collected through key informant interviews (n = 20), depth interviews (n = 20), focus group discussions (n = 40), and a review of policy documents (n = 2). Data was analyzed guided by the eight principles of the IBPA framework alongside Braun and Clarke’s six-phased thematic analysis approach. Results: Findings indicated that power dynamics in the formulation of post-pandemic policies and top-down implementation approaches excluded women informal food vendors from meaningfully participating in policy processes. For example, female vendors were excluded from the recovery priorities as the strategies adopted had limited to no targeted gender-responsive interventions. As such, women informal food vendors faced several challenges during recovery, including limited government support, barriers to accessing credit facilities, heightened household and unpaid care work, gender-based violence, sexual exploitation, and insecurity. The female vendors employed both individual agency and collective action to facilitate recovery. Discussion: Gender-responsive COVID-19 policies were critical to addressing the disproportionate impact of the pandemic on women-led informal food businesses. Moving forward, a comprehensive understanding of existing sociocultural inequalities is crucial for designing post-pandemic strategies that are gender-inclusive and promote equitable recovery. Such an approach would enhance women informal food vendors’ resilience to emergencies and their contribution to urban household food security and livelihood. Full article

ESKAPE bacteria are a major global threat due to their rapid antibiotic resistance acquisition and severe healthcare-associated infections. Effective countermeasures require epidemiological surveillance and resistance transmission studies, particularly for antimicrobial-resistant (AMR) colonization in intensive care unit (ICU) patients. Whole-genome sequencing (WGS) provides critical information on resistance spread and mechanisms. In the provided protocol, rectal and oropharyngeal swabs, or endotracheal aspirate/bronchoalveolar lavage for intubated patients, are collected at ICU admission and twice weekly. Patient interviews and medical records identify risk factors for resistant microflora. Samples undergo cultivation, species identification, antibiotic susceptibility testing, and DNA extraction. Sequencing is performed using second- and third-generation platforms, with selected isolates subject to hybrid genome assembly. Resistance genes, virulence factors, and typing profiles (MLST, cgMLST) are determined. This protocol characterizes the ICU patient colonization by AMR pathogens, including species distribution, phenotypic and genotypic resistance profiles, clonal structure, and temporal changes. It estimates detection frequency and colonization patterns at each locus, identifies key risk factors, including prior community or inter-facility exposure, and analyzes associations between risk factors and admission colonization. The study aims to estimate AMR infection risk and severity in ICU patients through the comprehensive analysis of colonization dynamics, resistance patterns, and clonal characteristics using WGS data on pathogen composition and AMR trends. Full article

Background/Objectives: New vaccines designed to combat infections such as Group B Streptococcus and respiratory syncytial virus will soon be accessible in Africa. While outbreak response vaccines are given to pregnant women, safety data for maternal vaccines in low- and middle-income countries (LMICs) are limited. This study explored Ugandan pregnant women’s knowledge, attitudes, and engagement in adverse event reporting and vaccine decision-making. Methods: This nested qualitative study was part of a national gap analysis of pharmacovigilance systems for maternal vaccines. Five Focus Group Discussions (FGDs), each involving eight participants, were held with pregnant and or breastfeeding women at four healthcare facilities and one research center. The data collected from these discussions were analyzed thematically using a manifest content analysis, conducted in Atlas.ti software version 9 for qualitative data analysis. Results: Women valued maternal vaccines, particularly tetanus, but reported confusion about schedules and hesitancy when informed of potential side effects. Many adverse events were normalized, therefore not reported, and most participants were unaware of national reporting mechanisms beyond informing healthcare providers. Barriers included inadequate information, dismissive or rushed provider interactions and reliance on family, peers, and informal care networks to manage side effects. Women expressed a strong desire to be informed and actively involved in decisions about pregnancy vaccines, including the introduction of new vaccines. Conclusions: Strengthening maternal vaccine safety monitoring requires clearer, balanced communication; simplified and well-publicized reporting tools; supportive provider–patient interactions; and integration of community and informal networks. Pregnant women should be engaged as active partners in pharmacovigilance and maternal vaccine introduction to build trust, improve adverse event reporting, and support vaccine uptake. Full article

Background: In South Africa, diabetic foot complications (DFC) often present for the first time at the primary healthcare (PHC) level, where nurses are central to diabetes management and prevention. Despite their key role, there are limited data on nurses’ experiences in managing DFC, particularly in resource-constrained primary healthcare (PHC) settings. This study’s objective was to explore and describe nurses’ experiences in managing DFC at the PHC level, with the aim of informing future interventions and policy development. Methods: A descriptive phenomenological study was conducted with 21 PHC nurses working in community healthcare centres to explore their experiences in managing DFC within PHC facilities. Results: Five key themes emerged: limited knowledge, time and workload constraints, lack of referral feedback, need for targeted training, and resource constraints. These reflect systemic and practical barriers that hinder effective care and contribute to inconsistent patient outcomes. Nurses are vital to early detection and intervention but face structural challenges that limit their capacity to deliver optimal care. Conclusions: Nurses encounter significant challenges when implementing routine diabetic foot screening at the primary healthcare level. These challenges include limited training, inadequate resources, and poor interprofessional collaboration. To overcome these barriers, targeted capacity-building initiatives, improved referral and communication pathways, and the provision of essential tools and support are needed. Additionally, integrating podiatrists into primary healthcare teams and establishing multidisciplinary foot care services are crucial steps to enhance care quality and reduce complications in resource-limited settings. Full article

Background/Objective: The incidence of diabetic foot complications has been increasing in South Africa. While foot screening at the primary healthcare level is crucial for preventing these complications, the growing number of cases in hospitals indicates that persons with diabetes are not undergoing routine screening in primary healthcare settings. Method: This cross-sectional descriptive observational study was conducted at five community healthcare centres, one in each municipality in Gauteng. Participants included persons with diabetes who presented at these facilities for their routine diabetes care. Data were collected, which included patient demographics, a history of screening, risk factors for diabetic foot, and an assessment of diabetic foot was conducted for each participant. Results: A total of 597 diabetic patients volunteered for this study. Only 10% (n = 60) had received a diabetic foot assessment. No patient had been risk-stratified; the results showed that 30% (n = 178) were very low risk and 17% (101) were at high risk. Active ulcers were recorded in 19% (116), and 18% (106) were in remission. Neuropathy was recorded in 33% (197), peripheral arterial disease in 22% (131), and a history of amputation was recorded in 17% (103). Conclusions: Implementing routine diabetic foot assessment and risk stratification at the PHC level could be key in preventing diabetic-related complications. Full article

Background/Objectives: Integrating behavioral health and primary care services is a national public health priority in the US, especially in underserved settings like northern Arizona. This healthcare delivery model is crucial to meet the mental and physical health needs of people with SU/SUDs, particularly those belonging to culturally diverse populations. In collaboration with a behavioral health center in northern Arizona, the current study aimed to assess the perspectives of providers and administrative staff on the implementation of integrated primary care (IPC) services for people with SU/SUDs. Methods: In February 2023, twelve healthcare providers and administrative staff from diverse educational backgrounds were recruited using purposive sampling to capture a range of perspectives on IPC implementation at the behavioral health center. Participants completed individual, semi-structured interviews conducted via Zoom, which were audio recorded and lasted approximately 30 min. The interview recordings were transcribed verbatim using Trint Software, and analyzed on Google Docs using applied thematic analysis. Two researchers coded the transcripts, iteratively developing and refining themes through multiple cycles of review and team discussions. Additional team members provided feedback and verified the themes, with consensus reached through collaborative meetings. This rigorous, iterative approach ensured the reliability and validity of the final thematic framework. Results: We found that IPC supports SU/SUDs recovery by providing holistic care that integrates medical, mental health, and addiction services while addressing social and co-occurring needs. It fosters an empathetic environment where clients do not need to repeatedly disclose their SU/SUDs, improves access to preventive care, and offers continuous support and education. Implementation barriers included workforce shortages, limited internal communication, and insufficient interdisciplinary training. Gaps in culturally centered care were identified, including reliance on Western models, limited representation of Native American and sexual and gender minority staff, and inconsistent use of inclusive practices such as pronouns, traditional healing, and trauma-informed approaches. Additionally, community partnerships with multisectoral organizations help clients access supportive resources beyond the facility, including vision care, clothing, and dental services. Conclusions: The implementation of IPC was seen as important to support the behavioral health center in northern Arizona to foster an empathetic environment where clients with SU/SUDs can have their mental, physical, and social needs addressed, either within the facility or through community partnerships, thereby supporting their recovery. However, progress is hindered by barriers such as workforce shortages, limited internal communication, and insufficient interdisciplinary care training. Additionally, despite regular cultural competency training, gaps remain in culturally centered care for underserved populations, particularly Native American and sexual and gender minority clients. Full article

Population ageing and rural depopulation are reshaping the social and spatial structure of many European regions, producing new forms of social risk and care dependency. This study examines how institutionalization among older adults reflects the broader dynamics of demographic decline, migration, and uneven territorial development. Using a qualitative design, semi-structured interviews and social network mapping (ecomaps) were conducted with residents of an urban elderly care facility in Romania. Guided by frameworks of social sustainability, social capital, and territorial resilience, the analysis explores how the erosion of informal networks and migration-driven care deficits affects the wellbeing and social inclusion of older people. Findings show that institutionalization operates both a consequence and as an indicator of depopulation and spatial inequality, highlighting the disconnection between aging populations and community-based care infrastructures. Yet, residents develop micro-level forms of resilience and relational stability within institutional life. The study concludes that sustainable territorial development must integrate care and ageing into regional planning, encouraging decentralized, community-based services that rebuild local networks and restore social cohesion. Full article

Despite notable progress in reducing childhood morbidity and mortality, achieving Sustainable Development Goal 3 remains a challenge in sub-Saharan Africa, where many children under five die before accessing formal healthcare services. This study explored the roles of the community in the implementation of the Integrated Management of Childhood Illness (IMCI) programme from the perspectives of caregivers and professional nurses. Using an interpretative phenomenological analysis design, 18 participants were purposively selected from four primary healthcare facilities. Data was collected through audio-recorded interviews, transcribed verbatim and analysed using the IPA framework. The findings underscore the critical role of community health workers (CHWs) within the Integrated Management of Childhood Illness (IMCI) framework, particularly in health promotion, child assessments and follow-up home visits. Support from early childhood development educators and community leaders further enhances these efforts. Nurses highlighted mobile health teams as vital for delivering integrated services, though challenges such as limited transport and inadequate training hinder CHWs’ effectiveness. Community-based care offers a cost-effective, accessible model in low-resource settings by leveraging local structures. Strengthening the connection between communities and formal health systems is essential. To sustain IMCI, investment in CHW-led initiatives, including training and logistical support, is recommended to improve service delivery and child health outcomes. Full article

Background/Objectives: Chronic pain conditions are common among older residents in long-term care facilities (LTCFs), often leading to increased demand for analgesic drugs. Despite this, pain is frequently underdiagnosed and undertreated, especially in individuals with cognitive impairments such as dementia. Both underuse and overuse of analgesics remain a challenge in LTCFs, affecting patient outcomes and quality of life. This systematic review aimed to identify patient- and facility-level factors associated with variation in analgesic use in LTCFs. Methods: This review followed PRISMA guidelines. A comprehensive literature search was conducted in PubMed, CINAHL, Cochrane Library, and Scopus for studies published between 2013 and 2024. Eligible studies were focused on adults aged ≥ 60 years in LTCFs and examined patient and facility factors related to analgesic prescription. Risk of bias was assessed independently by two reviewers using STROBE, JBI, and MMAT tools. Disagreements were resolved by a third reviewer. Results: A total of 6266 studies were retrieved; 13 papers met the eligibility criteria after screening. Dementia was the most frequently reported factor associated with lower analgesic prescribing, largely due to difficulties in assessing pain and communication barriers. Other patient-related factors included pain severity and comorbidities. Facility-level factors such as staffing levels, staff qualifications, and facility size were also associated with variation in prescribing practices. Conclusions: Dementia highly impacts pain management due to assessment and communication challenges. Improved pain assessment tools and staff training are needed to recognize pain in cognitively impaired residents and ensure appropriate analgesic use in LTCFs. Full article

Background/Objectives: Vaccination is a critical public health measure for older adults in residential aged care facilities (RACFs). In Australia, COVID-19, influenza, pneumococcal, and shingles vaccines are recommended and funded for this group. However, vaccination coverage remains suboptimal, with limited understanding of the underlying causes. Methods: A mixed-methods design explored the enablers and barriers to vaccination from the perspectives of frontline providers, RACF staff, residents and family members. Descriptive statistics were used to quantify the prevalence of perceived enablers and barriers within stakeholder groups. Qualitative data—collected through open-ended questions—were analysed using manual, deductive-iterative coding to identify key themes. Key quotes illustrate the findings. Results: Input was gathered from seven in-reach geriatric staff, 40 general practitioners (GPs), 90 RACF staff, 17 RACF residents, and 84 family members of residents. Results were grouped under four key themes: operational, communication, coordination, and financial. RACF staff identified limited access to vaccination histories as the most significant barrier and relied on external providers to upload data to the Australian Immunisation Register (AIR). On-site clinics were essential, but organisational policies prevented nurse-led vaccination of residents. Most RACFs stored only influenza vaccines and depended on external providers for others. Simplified, translated information was called for. Healthcare provider and RACF endorsement was valued, but RACF staff felt ill-equipped to handle conversations around vaccine hesitancy. Consent processes were burdensome, and responsibility for tracking vaccination schedules was unclear with calls for streamlined processes. Low provider remuneration was also noted, with calls for increased government support. Conclusions: This work identifies key enablers and barriers to resident vaccination in RACFs. Improving delivery requires organisational policy change, staff support, digital access, and continued advocacy. Analysis of targeted interventions and coverage will be reported separately. The approach is replicable for other vulnerable groups. Full article

The built environment is one of the determinants of health as it acts as a promoter of healthy lifestyles. This research deals with design solutions to promote healthy and active ageing in socio–healthcare facilities for primary care in Italy. This three-year research study aims to develop Design Guidelines for waiting spaces in Casa della Comunità (CdC: House of the Community, a new model of primary care facility in Italy) to promote good health and well-being in sustainable cities and communities. In accordance with these goals, the study applied different research methods in three main phases: Background research, starting from three fundamental groups of theories derived from the scientific literature to define a Theoretical Framework; data collection and field research, dealing with technical analysis of international best practices, as well as perceptive analysis through interviews and questionnaires conducted with the staff, patients, and caregivers of the socio–healthcare facilities, in order to define spatial requirements for waiting spaces; and finally, the results phase, involving the development of tools and design solutions of health-promoting waiting spaces according to the Sustainable Development Goals (the Design Guidelines were applied in two experimental pilots: a VR-based pilot and a physical pilot conducted at an existing CdC in Florence, Italy). In this contribution, we focus on the background and field research phases, describing the process leading to the outcomes of the second phase: spatial requirements for CdC waiting spaces. Full article

Globally, women continue to die from pregnancy-related conditions that could be prevented through ensuring timely access to emergency obstetric care and facility-based deliveries supervised by skilled birth attendants. However, many women are reluctant to deliver in maternity healthcare facilities due to the widespread disrespect and abuse that patients have reportedly received. Respectful maternity care has been identified amongst the possible solutions. This study explored perceptions of respectful maternity care and the enabling conditions of a multidisciplinary group of maternity healthcare providers working at a busy, specialised public mother and child regional hospital in Gauteng, South Africa. An explorative, descriptive, and contextual study design with a phenomenological perspective was adopted. Semi-structured interviews were conducted with each of the 30 purposefully selected study participants. The interviews were digitally recorded, professionally transcribed, and analysed using Tesch’s Constant Comparison method. Two main categories, namely (1) healthcare providers’ perceptions of respectful maternity care and (2) enabling conditions for its practice emerged, encompassing seven themes: women-centred care, provision of high-quality care, preservation and promotion of women’s rights, creating an enabling environment for the practice of RMC, in-service training, accountability of healthcare providers for their actions, and community involvement. The perceptions of the study participants regarding respectful maternity care align with global standards; however, successful implementation requires the establishment of enabling conditions. Full article

Background/Objectives: Living with a disabled family member has extensive implications for the whole family involved in their care, and there is dependency on healthcare support for maintaining quality of life. This qualitative study, conducted in Northern Ireland, investigated the support needs of different family members living with a severely impaired individual across the lifespan. A key objective was to identify support needs for intervention. Methods: In-depth semi-structured interviews were conducted to obtain data from eight mothers, fathers, sisters and brothers of a profoundly disabled child or sibling. Data was analyzed using Interpretive Phenomenological Analysis, allowing for the application of double hermeneutic in which the researchers derived meaning from the lived experiences of participants. Results: The analysis yielded five themes in total. Three themes were related to gaps in healthcare systems: Support Needs in Childhood, Support in Transition into Adult Services, and Worry for the Future; and two themes were linked with support needs: Associative Disability in Family Members; and Stigma. All family members had caregiving roles, and these had similarities and differences according to the relationship with the care-receiver. Participants recognized their families were survivors, however maintained a family tragedy rather than positive change outlook. Conclusions: Recommendations derived from the findings to alleviate the stressors of the situation for family members include increasing community support and age-related respite facilities. Additionally, improving and enhancing education of disabilities in schools, and immersing and further integrating individuals with disability into society, will alleviate the alienation, isolation and loneliness experienced by family members. Full article

The formation of an emotional bond with young people’s parents is crucial for healthy development and serves as a model for future relationships. Disruptions to this bond can result in neurobiological consequences, manifesting as problematic behaviours and social deficits. Social-educational work in re-education facilities in Slovakia focuses on supporting and rehabilitating young people in conflict with the law, aiming for their reintegration into society. This study presents a qualitative analysis of social workers’ activities across 11 re-education facilities in Slovakia, utilizing semi-structured interviews, document analysis, and field observation. The findings reveal that social workers play an indispensable role in the re-education and resocialization process, providing emotional support, professional counselling, and coordination with multidisciplinary teams. Despite differences in client typology and methodologies among facilities, a shared emphasis exists on restoring social ties and personal development. The effectiveness of social work is influenced by adequate staffing, methodological support, and inter-ministerial cooperation. Implementing targeted recommendations could significantly enhance the effectiveness of the system and improve outcomes for children and young people in institutional care. This study contributes vital insights into how social workers must balance competing interests—such as individual therapeutic needs, institutional constraints, and family and community involvement—to successfully facilitate youth reintegration into society. Full article