Search Results (1,208)

The Hwange Mining Area, located in the Mid-Zambezi Karoo Basin in northwestern Zimbabwe, is a major centre for coal mining, processing, and thermal power generation. This study evaluates the ecological and public health risks associated with these activities by characterising radionuclide (²²⁶Ra, ²³²Th, ⁴⁰K) activity concentrations in coal and surrounding soils using Hyper-Pure Germanium (HPGe) gamma spectrometry. Samples were collected from four locations, as follows: Hwange Colliery Company (underground and open-cast mines), Zambezi Gas open-cast operations, residential areas, and the Zimbabwe Power Company (ZPC) thermal power station. Radionuclide concentrations were measured using Hyper-Pure Germanium (HPGe) gamma spectrometry. Mean activity concentrations in coal were low at both mining sites (Hwange Colliery: ²²⁶Ra 16 ± 5.3 Bq/kg), ²³²Th 14 ± 5.7 Bq/kg), (⁴⁰K 51 ± 8.8 Bq/kg) and Zambezi Gas (²²⁶Ra 9.80 ± 2.3 Bq/kg), ²³²Th (11 ± 3.3 Bq/kg), ⁴⁰K (43 ± 26 Bq/kg), well below UNSCEAR world coal averages. In contrast, soils from residential areas): ²²⁶Ra (36 ± 15 Bq/kg), ²³²Th (36 ± 12 Bq/kg) and ⁴⁰K (220 ± 80 Bq/kg), and the ZPC power station (²²⁶Ra 47 ± 8.6 Bq/kg, ²³²Th (42 ± 10 Bq/kg), and ⁴⁰K 230 ± 92 Bq/kg, showed markedly elevated concentrations, consistent with the accumulation of coal-combustion by-products such as fly ash. Radiological hazard indices remained within internationally accepted limits at all sites, as follows: radium equivalent (Raeq) ranged from 29 ± 6.7 Bq/kg (Zambezi Gas) to 120 ± 18 Bq/kg (ZPC), well below the 370 Bq/kg safety ceiling, while external and internal hazard indices (H_ex, H_in) remained below unity throughout, peaking at 0.32 and 0.46, respectively, at ZPC. Annual effective dose equivalents (AEDE) ranged from 16 ± 3.8 to 69 ± 10 μSv/year, the latter (ZPC) representing approximately 7% of the ICRP public dose limit of 1 mSv/year. Excess lifetime cancer risk (ELCR) values ranged from 5.56 × 10⁻⁵ (Zambezi Gas) to 2.42 × 10⁻⁴ (ZPC), remaining below the global average outdoor reference of 0.29 × 10⁻³ but reaching approximately 83% of this reference at ZPC and 71% in residential areas. These findings indicate that, while coal mining activities in Hwange contribute minimally to environmental radioactivity, coal combustion at the ZPC thermal power station is the dominant driver of elevated radionuclide concentrations and radiological indices in the surrounding environment, with residential soils reflecting the same enrichment pathway. Although no immediate radiological hazard was identified at any location, the comparatively higher indices at ZPC and in nearby residential areas underscore the need for continuous environmental monitoring, strengthened regulatory control, and targeted radiation protection strategies to safeguard workers and nearby communities. Full article

Background/Objectives: Older adults residing in long-term care facilities (LTCFs) are at increased risk of poor oral health because of functional dependence and limited access to professional oral healthcare. Although oral healthcare education programs for care workers improve knowledge and performance, evidence of their effects on residents’ biological oral health outcomes remains limited. This study evaluated the effects of a care worker-centered oral healthcare program on oral inflammatory status in LTCF residents using salivary interleukin-1 beta (IL-1β) as an objective biomarker. Methods: A single-group pretest–posttest quasi-experimental study was conducted in two LTCFs in the Republic of Korea. Forty care workers completed a structured oral healthcare education program and provided daily oral healthcare to residents for 4 weeks. Saliva samples were collected before and after the intervention, and salivary IL-1β concentrations were measured using enzyme-linked immunosorbent assay. Changes in IL-1β concentrations were analyzed using the Wilcoxon signed-rank, Mann–Whitney U, and Kruskal–Wallis tests. Results: Thirty-seven residents completed the study. Median salivary IL-1β concentrations significantly decreased from 19.33 pg/mL (interquartile range [IQR], 11.49–34.66) at baseline to 10.78 pg/mL (IQR, 0.65–33.64) after the intervention (Z = −3.764, p = 0.001). Greater reductions were observed among residents with greater functional dependence, whereas limited communication ability or oral care refusal was associated with minimal improvement. Conclusions: A care worker-centered oral healthcare program significantly reduced salivary IL-1β concentrations among older adults residing in LTCFs. Findings support care worker training and highlight the use of salivary IL-1β as an objective biomarker for evaluating oral healthcare interventions. Full article

Background: Rural and resource-constrained settings face major barriers to timely cancer screening, diagnosis, and treatment due to limited specialist availability and centralised service-delivery models. In the Eastern Cape, a largely rural province with a constrained oncology workforce, a decentralised–centralised hybrid model was introduced to improve access to cancer care. Nelson Mandela Academic Hospital serves as the central referral hub within this model. This study evaluates the implementation process and impact of this decentralised cancer care model on service utilisation, access, and continuity of care. Methods: A quantitative quasi-experimental pre–post implementation and quality improvement evaluation was conducted using retrospectively collected routine service utilisation and programme data from April 2023 to February 2025. The study assessed the impact of a decentralised oncology care model on access, service integration, and utilisation outcomes. Data from facility registers and district health information systems were managed using Microsoft Excel and analysed using Stata and IBM SPSS Statistics. Descriptive statistics, correlation analysis, and linear regression were used to compare pre- and post-implementation changes in patient volumes, screening coverage, referral completion, workforce capacity, gender distribution, and service uptake. The intervention decentralised screening, diagnosis, follow-up, and patient navigation services to district and satellite facilities while centralising specialised oncology care at referral centres to improve accessibility, efficiency, and continuity of care. Results: Cancer patient attendance increased substantially over the study period, from 355 patients in April 2023 to a peak of 1039 in April 2024, with a sustained upward trend (B = 18.03, p = 0.005), reflecting an average monthly increase of 18 patients. Female patients accounted for most visits, while male attendance showed a significant increasing trend (B = 8.03, p < 0.001). Service integration improved, with strong positive correlations between new patient registrations, follow-up care, palliative services, and inpatient admissions, indicating an expanding continuum of care. Breast and cervical cancers contributed the highest service burden, while cervical and lung cancers showed significant upward trends. Seasonal variation in attendance was observed, particularly during festive periods. From an implementation perspective, screening coverage for priority cancers increased by 18%, while 732,349 individuals were reached through community awareness initiatives. Access improved substantially, evidenced by a reduction of 56,400 km in cumulative patient travel distance over one year. Workforce capacity was strengthened through the training of 517 healthcare workers, and 1943 patients received structured navigation support. Referral efficiency and continuity of care improved, although persistent bottlenecks were observed in diagnostic and referral pathways. Conclusions: The decentralised–centralised oncology care model demonstrated improved cancer service utilisation, access, and continuity of care in a rural, resource-limited setting. However, increasing patient volumes and interconnected service demands place additional pressure on health system capacity. Sustained investment in workforce development, screening—particularly for cervical cancer—and system efficiency is required. This model provides a scalable and context-appropriate framework for strengthening oncology services in similar low-resource settings. Full article

Introduction: Tuberculosis [TB] and diabetes mellitus (DM) remain major public health concerns worldwide. TB negatively affects an individual’s glucose tolerance, increasing the risk of developing DM. Similarly, DM reduces the host’s ability to fight TB infection and increases the likelihood of developing TB and poor response to TB medication. This study analysed stigma and health-seeking behaviour in a sub-district of Accra Metropolis. Methods: We used a mixed-methods research approach involving a cross-sectional survey and in-depth interviews to explore community knowledge, stigma, and health-seeking behaviour related to TB and DM. A total of 437 individuals were selected for a survey using a simple random sampling technique, while 22 participants, including three TB patients, four nurses, one medical doctor, four students from a nursing and midwifery school, five students from a school of hygiene, and five community members, were involved in the study. Healthcare providers and patients were purposively selected, while students and community members were recruited through convenience sampling. Descriptive and logistic regression analyses were performed on the quantitative data using STATA, while the qualitative data were thematically analysed using the MAXQDA software. Results: Participants’ age, sex, and educational levels were significantly associated with their knowledge of TB and DM. Males were 0.600 times as likely as females to be knowledgeable about DM (95% CI: 0.386–0.934, p = 0.024). Social determinants of health, such as poverty, local beliefs, stigma, and negative attitudes from healthcare workers, may influence TB patients’ preference for traditional remedies over biomedical treatment. Conclusion: Therefore, we observed that addressing cultural barriers, stigma, and financial costs related to TB and diabetes care will help increase patients’ willingness for biomedical treatment. Full article

People living with HIV (PLHIV) are at an increased risk of progressing from Mycobacterium tuberculosis (TB) infection to TB disease. Tuberculosis preventive treatment (TPT) is recommended for PLHIV; however, its uptake remains suboptimal. In Zimbabwe, three months of weekly rifapentine and isoniazid (3HP) and six months of daily isoniazid (6H) are the most commonly prescribed TPT regimens. We explored barriers to TPT uptake among PLHIV from the perspective of healthcare workers (HCWs) in Zimbabwe. Facility nurses who had been implementing TPT for at least six months were invited to participate in in-depth interviews and/or focus group discussions conducted in March 2023. Audio recordings were transcribed into English, coded using NVivo 12 (QSR International), and analyzed thematically. Eleven HCWs participated in in-depth interviews and 15 in focus group discussions. Barriers were categorized as person- and health system-related. Person-related barriers included misconceptions about TPT, fear of adverse events, and pill burden. Health system barriers included stock-outs of TPT medications, limited HCW knowledge and skills to promote TPT, limited expertise in initiating TPT among children under five years of age, and limited access to chest radiography. Barriers to TPT uptake and completion remain in Zimbabwe and contribute to missed opportunities for TB prevention among PLHIV. TPT implementation could be strengthened through an uninterrupted supply of TPT medications, continuous training and mentorship of HCWs, and community engagement to improve awareness of the benefits and risks of TPT. Full article

The rapid global expansion of data center infrastructure has prompted substantial clean technology research on energy, water, and carbon impacts, while the acoustic health dimension of these facilities remains virtually unstudied. Existing occupational and environmental noise assessments rely on A-weighted (dBA) metrics, which apply more than 26 decibels (dB) of attenuation at 63 hertz (Hz) and exceed 50 dB at infrasound frequencies, sharply discounting their sensitivity to infrasound and low-frequency noise (ILFN) generated by data center cooling fans, heating, ventilation, and air conditioning (HVAC) systems, backup generators, and power transformers. This narrative review synthesizes evidence from established ILFN health research alongside the emerging data center acoustics literature, identifying a consequential gap: no published study has measured the ILFN spectrum of an operational data center, nor examined health outcomes in workers or surrounding communities with respect to sub-audible acoustic exposure. Evidence from wind turbine, industrial, and laboratory contexts documents non-auditory ILFN pathways, including sleep disturbance, cardiovascular stress responses, cognitive impairment, and audiovestibular symptoms—effects that operate below the auditory threshold and are substantially undercounted by standard dBA monitoring. A prioritized research agenda is proposed, beginning with G-weighted and flat-response ILFN characterization of operational data centers across at least 1–200 Hz—a prerequisite for evidence-based acoustic design standards and health-protective infrastructure development consistent with clean technology principles. Full article

Long-term sickness absence is a growing public health issue, reducing workforce participation and widening health inequalities. Effective interventions must address both health and workplace factors to enable not only return-to-work but sustained employment. This study evaluated the feasibility of a multi-level workplace intervention to support sustainable RTW in large organizations. A two-arm cluster randomised feasibility trial was conducted in nine UK organizations (≥600 employees). Participants included senior leaders and HR professionals (n = 91), workers on long-term sick leave (n = 112), and line managers (n = 83). The IGLOo intervention combined e-learning for leaders/HR with structured toolkits for workers and managers to support RTW before and after return. Feasibility outcomes included recruitment, retention, engagement, acceptability, and usability. Secondary outcomes included RTW timing, sustained participation, mental health, and workplace factors. A mixed methods process evaluation explored implementation and context. Retention, acceptability, and usability met targets, but recruitment and engagement were lower than expected. Potential mechanisms included improved confidence, communication, and self-management. Organizational systems and pressures affected delivery. Exploratory analyses suggested different patterns of return-to-work trajectories across trial arms. Overall, the intervention was acceptable to participants who engaged with it, but recruitment barriers and organizational constraints require substantial modification before any future efficacy trial. Full article

Background: Palliative care is a clinically, relationally and emotionally demanding field. Continuous exposure to suffering and death exposes professionals to compassion fatigue, vicarious trauma and grief, and burnout, while also offering opportunities for compassion satisfaction and meaning-making. How professionals cope is central to sustaining the supporting role in diseases with a poor prognosis. Objectives: To explore the emotional and experiential dimensions of palliative care work and the coping strategies, individual and team-based, that professionals deploy when accompanying patients and families at the end of life. Methods: Reflexive thematic analysis of 16 semi-structured interviews with palliative care professionals (5 physicians, 7 nurses, 3 psychologists, and 1 social-health worker; 14 women and 2 men) recruited from hospices, hospital wards and home-based services in Northern Italy. Sample size was guided by an information power model. Reporting follows the COREQ checklist. Results: Four themes were constructed: (1) the unsustainability of the workload; (2) the pleasure of care between empathic relationship, listening and welcoming; (3) the holistic role of the professional; and (4) the awareness of death. Across themes, participants mobilised a layered repertoire of problem-, emotion- and meaning-focused coping. Narratives fitting a structured moral-distress pattern were comparatively limited in participants’ accounts. Conclusions: Sustaining supporting roles in poor-prognosis care may require more than individual resilience; it depends on organisational support—structured supervision, reflective spaces, and communication and emotional training—that makes professionals’ largely informal coping work a shared and sustainable resource. Full article

Community pharmacies are increasingly providing health care services like tobacco treatment and disease-related management but need sustainable models for implementation. As several state Medicaid programs reimburse for community health worker (CHW) services, one promising model is to have pharmacy technicians engage with patients as designated CHWs. This qualitative study interviewed staff in seven California pharmacies about their experience with and perspectives on implementing community pharmacy technicians as CHWs. Guided by implementation science frameworks, data were hand-coded and analyzed iteratively using thematic analysis. Relative advantage and compatibility of CHWs was high across all pharmacies. Pharmacy culture aligned with CHW values, and CHW integration helped formalize the work that pharmacy staff were already doing. Challenges included the complexity of billing and obtaining payment for services provided. Despite these barriers, pharmacies successfully integrated and expanded their CHW services, ranging from social service connections to tobacco treatment or disease-related management education. Pharmacy peer networks, health plan champions and patient outcome improvements accelerated diffusion. Community pharmacies provide a trusted setting for delivering both CHW education and extending health care services, but broad implementation will need health plans to improve policy and procedure with guidance specifically for the pharmacy context that helps overcome administrative barriers. Full article

The adversity-activated development reflection tool (AART) has been used therapeutically to capture personal growth arising during adversity. Our mixed-methods study used this tool to assess adversity-activated growth in 854 mental and community healthcare workers during the COVID-19 pandemic. Participants used the tool to describe the positive and negative effects of the COVID-19 pandemic in different life domains (self, family, work, and community). Through an ideal-type analysis of 133 purposively subsampled AARTs, we derived three levels of adversity-activated development (AAD): none, minimal, and deep. Higher levels of AAD were associated with spending more time connecting with friends and family (OR = 1.83, 95% CI 1.23 to 2.75, p < 0.01) and skill development in mental health care (OR = 1.63, 95% CI 1.16 to 2.28, p < 0.01). Deep development was characterised by changes in life priorities, changes in coping, realising strengths and capabilities, and making stronger connections with others. The AART can usefully assess both positive and negative growth, enabling respondents to convey the complexities of their experiences in their own words, whilst allowing the levels of overall self-development to be distilled. Our findings reinforce the value of promoting social connectedness and skill development to facilitate employee growth during collective occupational stress. Full article

Collective intergenerational trauma is a complex phenomenon affecting descendants and families exposed to the enduring effects of collective traumatic events, such as forced displacement, genocide and war. This systematic review aimed to explore the mechanisms through which collective trauma is transmitted across generations, examine its consequences for children and families, and critically analyse interventions employed by health professionals and social workers. A systematic review was conducted using ScienceDirect, Wiley Online Library and PubMed. Studies published between 2016 and 2026 were screened for eligibility, resulting in the inclusion of 22 studies. The indexing terms “collective intergenerational trauma”, “collective transgenerational trauma”, “trauma transmission”, “transmission mechanisms”, “consequences”, “intergenerational trauma interventions”, “Social Care”, and “Health Professionals”, were used, along with the Boolean operators AND and OR. The included studies were synthesised using thematic analysis. The findings indicate that collective intergenerational trauma is transmitted through interacting family, communicative, sociocultural and biological mechanisms. Its consequences include psychological and psychosocial difficulties among descendants, disruptions in family relationships and adverse effects on family functioning. Existing interventions primarily focus on individual trauma, with limited attention to its collective and intergenerational dimensions. The findings highlight the need for culturally responsive, trauma-informed and family-centred interventions addressing collective intergenerational trauma within a systemic framework. Health professionals and social workers can play an important role in promoting mental health, strengthening resilience, mitigating the long-term effects of trauma and supporting affected children, families and communities. Full article

NM averages 450 new cases of melanoma annually. Promotoras are community health workers in NM that provide health education and resources to the community. The project aims to determine if promotora education can improve the recognition of suspicious lesions, encouraging community members to seek care. Current literature focuses on the self-reported confidence of CHWs in recognizing skin cancer. A total of 54 promotoras were sampled through a Qualtrics quiz asking whether skin lesion photos are suspicious. Participants were also asked to rate their confidence in recognizing a suspicious skin lesion and comfort in addressing it from 1 to 5. Participants then read an educational flyer about the “ABCDEs” of melanoma before repeating the quiz/ratings. Wilcoxon signed-rank testing revealed significant increases in quiz scores (W = 220.5, p = 0.045), confidence (W = 44.0, p < 0.001), and comfort (W = 8.5, p < 0.001). Promotoras could be an additional line of defense against melanoma, helping save lives. Healthcare personnel with limited skin lesion knowledge could be an ideal future population for education. Full article

Tuberculosis (TB) remains a leading cause of infectious disease-related mortality worldwide despite major advances in diagnostics, treatment, and programmatic control. Achieving the goals of the World Health Organization End TB Strategy requires a greater emphasis on prevention alongside improvements in diagnosis and treatment. This viewpoint examines evolving priorities in TB prevention and highlights key insights from studies included in the Special Issue ‘New Perspectives in Tuberculosis Prevention and Control’. The articles published in the Special Issue highlight the importance of identifying populations at increased risk of infection, disease transmission, and disease progression; strengthening the implementation of tuberculosis preventive treatment among household contacts and people living with HIV; and addressing the behavioral, social, and structural determinants that influence access to TB prevention and care. They also demonstrate persistent challenges related to medicine availability, healthcare worker capacity, patient initiation and follow-up, program monitoring, and the implementation of preventive interventions in resource-constrained settings. Emerging developments in diagnostics, biomarkers, vaccines, and digital health may contribute to the longer-term TB prevention agenda but require further evaluation of their feasibility, affordability, and programmatic relevance. Collectively, the evidence indicates that effective TB prevention extends beyond individual biomedical interventions and requires coordinated approaches involving healthcare systems, communities, surveillance systems, and social support mechanisms. Continued investment in implementation research, health-system strengthening, program management, economic evaluation, and multisectoral action will be critical to translate existing evidence into sustainable, equitable, and context-specific strategies for reducing the global burden of TB. Full article

Background: Missed and zero-dose children remain major barriers to polio eradication in settings affected by insecurity, poverty, weak health systems, and social exclusion. This narrative review synthesized evidence on how gender norms and related social determinants influence childhood polio vaccination in Afghanistan, Nigeria, Pakistan, and Sudan. Afghanistan and Pakistan remain the only countries with endemic wild poliovirus transmission, while northern Nigeria, especially areas affected by insurgency, and war-affected Sudan continue to report substantial numbers of polio zero-dose and under-immunized children, together with occasional reports of circulating vaccine-derived poliovirus. Methods: A comprehensive search of peer-reviewed and institutional literature was conducted in major databases and relevant grey literature sources. Eligible studies examined childhood immunization or polio vaccination among children under five and reported gender-related determinants of vaccination uptake. Findings were synthesized thematically. Results: Forty-one studies were included. Five interconnected domains emerged: women’s empowerment, autonomy, and household decision-making; male involvement, household gender norms, and family power relations; socioeconomic and structural gender-related barriers; education, information access, community perceptions, and health system responsiveness; and war, insurgency and their gendered impact on childhood polio immunization. Across countries, limited maternal autonomy, restricted mobility, dependence on male decision-makers, poverty, conflict, displacement, misinformation, and weak health services reduced access to vaccination. Supportive male engagement, female health workers, trusted community leadership, and culturally responsive outreach facilitated vaccine acceptance. Conclusions: Gender influences childhood polio vaccination through intersecting household, community, structural, and health-system pathways. Family power extends beyond male decision-making, with women’s education and influence within households shaping vaccination decisions. Strengthening women’s agency, constructively engaging men (e.g., through husband schools), and delivering culturally responsive services are essential for reaching missed and zero-dose children and accelerating polio eradication. Full article

Community-based organisations (CBOs) play a critical role in implementing HIV programmes, many of which have historically relied on United States (U.S.) donor funding. Recent U.S. funding cuts have disrupted community-based HIV programmes, underscoring the need to understand implementers’ experiences to support sustainable service delivery. This study explored how funding instability affected community-based HIV programmes in rural KwaZulu-Natal, South Africa. A qualitative, exploratory design was employed using interviews and focus group discussions with purposively selected youth frontline workers and programme managers (n = 26). The Health Systems Building Blocks framework guided thematic analysis. Participants described disruptions in outreach and prevention services, contract terminations and reduced working hours among frontline personnel, weakened data and follow-up systems, shortages or reduced local availability of HIV prevention commodities, lack of transition planning, and abrupt program closure without sustainability measures. U.S. funding cuts disrupted essential community-based HIV services in rural KwaZulu-Natal, exposing vulnerabilities in prevention, outreach, workforce, and monitoring systems. Sustainable financing and stronger integration of community organisations into health systems are needed to protect HIV service continuity. Full article