Search Results (5,179)

Refugee mothers are at heightened risk of developing negative family dynamics due to traumatic experiences and unstable living conditions, often impacting their children in lasting ways. This partially mixed, explanatory mixed-methods pilot study examines the potential of Drama Therapy as a psychosocial intervention to reduce harmful parenting behaviors and strengthen parent–child relationships. The study engaged 20 refugee mothers who participated in a three-session intervention based on Emunah’s five-phase model. Data collection included pre-intervention demographic information, two standardized psychological scales—The Child–Parent Relationship Scale and the Parent Anger Scale—and post-intervention focus group discussions. The findings indicate that the Drama Therapy Intervention (DTI) helped reduce parental anger and improve emotional regulation, leading to more positive interactions with children and decreased conflict within the family. Focus group insights revealed that the mothers’ ongoing and past traumas significantly shaped their emotional responses and parenting styles. This pilot study highlights the importance of addressing maternal mental health in post-displacement contexts. Although one cannot draw causal inferences of efficacy in the absence of a control group, the findings provide preliminary evidence that Drama Therapy can be an effective tool for reducing parental maltreatment and improving family relationships among refugee populations. Full article

Urban greenspace exposure associates with improved health outcomes, particularly chronic disease mitigation. Based on the need to characterize spatial heterogeneity in the health benefits of urban greenspaces, this study quantified the association between greenspace accessibility and chronic disease mortality in London, while examining the modulating effects of urbanization and age. Utilizing nighttime light (NTL) data to define urbanization gradients and road-network analysis to measure greenspace accessibility, we applied geographically weighted regression (GWR) across 983 neighborhoods. Key findings reveal that over 60% of central London residents live within 300 m of greenspace, yet 20% fall short of WHO standards. Greenspace accessibility showed significant negative associations with standardized mortality ratios for both cancer (β = −0.0759) and respiratory diseases (β = −0.0358), and this relationship was more pronounced in highly urbanized areas and neighborhoods with higher working-age populations. Crucially, central urban zones show amplified effects: a 100 m accessibility improvement was associated with a potential reduction in cancer deaths of 1.9% and in respiratory disease deaths of 2.4% in high-sensitivity areas. Urbanization levels and working-age population proportions exert significantly stronger moderating effects on greenspace–respiratory disease relationships than on cancer outcomes. While observational, our findings provide spatially explicit evidence that the greenspace–mortality relationship is context-dependent. This underscores the need for precision in urban health planning, suggesting interventions should prioritize equitable greenspace coverage in highly urbanized cores and tailor functions to local demographics to optimize potential co-benefits. This study reframes understanding of greenspace health benefits, enhances spatial management precision, and offers models for healthy planning in global high-density cities. Full article

Vector-borne parasitic diseases (VBPDs), including malaria, schistosomiasis, leishmaniasis, Chagas disease, African trypanosomiasis, lymphatic filariasis, and onchocerciasis, impose a significant global health burden. This study analyzes the global disease burden of VBPDs from 1990 to 2021 using Global Burden of Disease (GBD) 2021 data and projects trends to 2036. Metrics include prevalence, deaths, disability-adjusted life years (DALYs), and age-standardized rates (ASRs) across regions, sexes, age groups, and Socio-demographic Index (SDI) levels. Key findings reveal persistent disparities: malaria dominated the burden (42% of cases, 96.5% of deaths), disproportionately affecting sub-Saharan Africa. Schistosomiasis ranked second in prevalence (36.5%). While African trypanosomiasis, Chagas disease, lymphatic filariasis, and onchocerciasis declined significantly, leishmaniasis showed rising prevalence (EAPC = 0.713). Low-SDI regions bore the highest burden, linked to environmental, socioeconomic, and healthcare access challenges. Males exhibited greater DALY burdens than females, attributed to occupational exposure. Age disparities were evident: children under five faced high malaria mortality and leishmaniasis DALY peaks, while older adults experienced complications from diseases like Chagas and schistosomiasis. ARIMA modeling forecasts divergent trends: lymphatic filariasis prevalence nears elimination by 2029, but leishmaniasis burden rises across all metrics. Despite overall progress, VBPDs remain critical public health threats, exacerbated by climate change, drug resistance, and uneven resource distribution. Targeted interventions are urgently needed, prioritizing vector control in endemic areas, enhanced surveillance for leishmaniasis, gender- and age-specific strategies, and optimized resource allocation in low-SDI regions. This analysis provides a foundation for evidence-based policy and precision public health efforts to achieve elimination targets and advance global health equity. Full article

Background/Objectives: Vancouver type C periprosthetic femoral fractures (VC-PFFs) predominantly affect frail elderly patients and are associated with high mortality, yet limited evidence exists regarding prognostic factors. The PIPPAS study (Peri-Implant and PeriProsthetic Survival Analysis) sub-analysis aimed to investigate the risk factors for one-year mortality following VC-PFF and identify predictors of medical and surgical complications. Methods: This prospective, multicenter, observational case series was conducted across 59 hospitals in Spain and involved 262 VC-PFF patients between January 2021 and April 2023 with a minimum 1-year follow-up. Demographic, clinical, management, and surgical and outcome data were collected. Logistic regression models were used to identify predictors of one-year mortality and complications. Results: One-year mortality was 30.1%. VC-PFF patients were elderly (median age 85 years, IQR (12.75)), female (77.1%) and frail: median clinical frailty scale 5, IQR (2), mild cognitive impairment (median Pfeiffer score 3, IQR (5)), and multiple comorbidities (median age-adjusted Charlson comorbidity index (a-CCI) 6, IQR (2)). Surgery was performed in 94.7% of cases, primarily with plate osteosynthesis (62.3%) or intramedullary nailing (29.1%). Male sex, higher age, frailty, cognitive impairment, ASA score, and a-CCI were significantly associated with increased mortality. Protective factors included higher hemoglobin levels, surgical treatment, and early postoperative ambulation. No significant difference in mortality was observed between fixation techniques. Conclusions: One-year mortality in VC-PFF patients is high. These findings underscore the need for individualized treatment plans and reinforce the role of early co-management and clinical optimization. Full article

Background: Pan-drug-resistant (PDR) Acinetobacterinfections are an escalating ICU threat, demanding both patient-level triage and facility-wide forecasting. Objective: The aim of this study was to build a dual-scale AI framework that (i) predicts PDR status at infection onset and (ii) forecasts hospital-level PDR burden through 2027. Methods: We retrospectively analyzed 270 Acinetobacter infection episodes (2020–2024) with 65 predictors spanning demographics, timelines, infection type, resistance-class flags, and a 25-drug antibiogram. TabTransformer and XGBoost were trained on 2020–2023 episodes (n = 210), evaluated by stratified 5-fold CV, and externally tested on 2024 episodes (n = 60). Metrics included AUROC, AUPRC, accuracy, and recall at 90% specificity; AUROC was optimism-corrected via 0.632 + bootstrap and DeLong-tested for drift. SHAP values quantified feature impact. Weekly PDR incidence was forecast with an attention–LSTM model retrained monthly (200 weekly origins, 4-week horizon) and benchmarked against seasonal-naïve, Prophet, and SARIMA models (MAPE and RMSE). Quarterly projections (TFT-lite) extended forecasts to 2027. Results: The CV AUROC was 0.924 (optimism-corrected 0.874); an ensemble of TabTransformer + XGBoost reached 0.958. The 2024 AUROC fell to 0.586 (p < 0.001), coinciding with a PDR prevalence drop (75→38%) and three covariates with PSIs > 1.0. Isotonic recalibration improved the Brier score from 0.326 to 0.207 and yielded a net benefit equivalent to 26 unnecessary isolation-days averted per 100 ICU admissions at a 0.20 threshold. SHAP highlighted Ampicillin/Sulbactam resistance, unknown acquisition mode, and device-related infection as dominant drivers. The attention–LSTM achieved a median weekly MAE of 0.10 (IQR: 0.028–0.985) vs. 1.00 for the seasonal-naïve rule, outperforming it on 48.5% of weeks and surpassing Prophet and SARIMA (MAPE = 6.2%, RMSE = 0.032). TFT-lite projected a ≥ 25% PDR tipping point in 2025 Q1 with a sustained rise in 2027. Conclusions: The proposed framework delivers explainable patient-level PDR risk scores and competitive 4-week and multi-year incidence forecasts despite temporal drift, supporting antimicrobial stewardship and ICU capacity planning. Shrinkage and bootstrap correction were applied to address the small sample size (EPV = 2.1), which poses an overfitting risk. Continuous recalibration and multi-center validation remain priorities. Full article

China has entered an era of population decline, yet urbanization continues as rural-to-urban migration persists. This demographic transition has prompted a strategic shift in urban development from extensive spatial expansion toward quality-oriented, intensive growth models. However, evolving human–land supply–demand dynamics in cities historically characterized by population inflows remain insufficiently understood. This study focuses on Xiamen, a prototypical coastal migrant-receiving city, to investigate land use simulation under demographic transition. By integrating the cohort-component method with the Patch-generating Land Use Simulation (PLUS) model, we project Xiamen’s population under three scenarios by 2030: Stable Continuation (SCS), Natural Development (NDS), and National 2030 Population Planning (NPP), with projected increases of 5.56%, 6.76%, and 24.69%, respectively. Results show continued but decelerating population growth, with adequate labor supply and persistent demographic dividend. Notably, the NPP scenario reveals a negative correlation between population growth and construction land expansion. In NPP-High, prioritizing compact development and ecological conservation, population grows by 1.27 million while construction land decreases by 2.85% and forest land increases by 4.09%. This framework provides empirical evidence for compact urban development under the dual constraints of land-use efficiency and ecological protection. Full article

The growing participation of elderly individuals in cruise tourism introduces asymmetry in passenger mobility and perception, posing challenges for onboard emergency evacuation. To address this, an interactive cellular automata model that enables dynamic human–signage interaction, incorporating age-dependent variations in walking speed and visual field. The model simulates passenger behavior during evacuation by integrating a static potential field, signage attraction, and directional guidance mechanisms. A bi-objective optimization framework is proposed to determine the optimal signage layout for symmetrical cruise ship theaters, balancing evacuation effectiveness across age groups with design constraints such as economic considerations. The optimization uses a genetic algorithm through simulation experiments under varying age compositions and smoke concentration levels. Results indicate that age-sensitive and interactive signage design substantially enhances evacuation efficiency, particularly for elderly passengers and under limited visibility conditions. This study offers practical insights into signage layout strategies for enhancing shipboard evacuation safety in diverse demographic and environmentally complex scenarios. Full article

Background: Physical inactivity is a major contributor to increased mortality among aging populations, especially in middle-aged and older adults. Methods: Data were derived from the China Health and Retirement Longitudinal Study (CHARLS, 2011–2020). Participants self-reported their physical activity frequency, categorized as low (≤1 day/week), medium (2–4 days/week), or high (≥5 days/week). All-cause mortality was tracked through verified records. Cox proportional hazards models were used to estimate hazard ratios (HRs), with adjustments for demographics, lifestyle factors, and baseline health conditions. Results: A total of 2092 participants (mean age = 63.7 ± 10.4 years) were included in the final analytic sample. Higher physical activity frequency was significantly associated with lower mortality in unadjusted models. Participants engaging in activity ≥5 days/week had a 67% reduced mortality risk compared to the low-frequency group (HR = 0.33, p < 0.001). However, after adjusting for health-related covariates, the protective effect was attenuated and no longer statistically significant. In the fully adjusted model, advanced age, current smoking, and ADL limitations emerged as the strongest independent risk factors for mortality, while being married and residing in a rural area were significantly protective effects. Conclusions: The association between frequent physical activity and reduced mortality risk among Chinese older adults is profoundly mediated by baseline health status and functional capacity. These findings highlight the importance of integrated, multifactorial public health interventions that address chronic disease management and functional rehabilitation alongside physical activity promotion. Full article

Nutrition plays a pivotal role in preventive health, yet existing digital solutions often lack personalization and accessibility. This study presents an AI-driven framework that integrates machine learning (ML) and natural language processing (NLP) to deliver dynamic, user-centric dietary recommendations. A gradient boosting model, trained on NHANES demographic and anthropometric data, predicts caloric needs with an MAE of 132 kcal, while a locally deployed LLM (Mistral 7B) interprets free-text dietary constraints with 91% accuracy. Rule-based filtering from the USDA database ensures nutritional balance. A pilot usability test (n = 5) confirmed the system’s practicality and satisfaction. The proposed framework addresses key gaps in scalability, privacy, and adaptability, demonstrating the potential of hybrid AI techniques in applied nutrition science. By bridging computational methods with food science, this work offers a reproducible, modular solution for personalized health applications. Full article

Background: The optimal surgical approach for malignant pleural mesothelioma (PM) remains a topic of debate. While extrapleural pneumonectomy (EPP) offers radical resection, it is associated with significant morbidity. Pleurectomy/decortication (P/D) is less extensive but may offer comparable oncologic outcomes with reduced perioperative risk. This study aimed to conduct a comprehensive systematic review and meta-analysis to systematically evaluate and quantitatively compare survival outcomes, 30-day postoperative mortality, and baseline characteristics between patients undergoing P/D and EPP for PM. Methods: A systematic review was conducted in accordance with the PRISMA guidelines. MEDLINE, Embase, and Scopus were searched up to May 2025. Studies comparing EPP and P/D in PM that reported on survival, mortality, or baseline demographics were included. Data from 24 retrospective studies were extracted. Pooled estimates were calculated using random-effects models. Meta-regression and subgroup analyses were performed by geographic region and publication year. Results: P/D was associated with a significantly improved overall survival compared to EPP in the primary analysis (mean difference = 7.01 months; 95% CI: 1.15–12.86; p = 0.018), with substantial heterogeneity (I² = 98.5%). In a sensitivity analysis excluding one statistical outlier, the survival benefit remained significant (mean difference = 4.31 months; 95% CI: 1.69–6.93), and heterogeneity was markedly reduced. The 30-day mortality rate was also significantly lower for P/D (odds ratio = 0.34; 95% CI: 0.13–0.88; p = 0.027). Patients undergoing P/D were, on average, 3.78 years older than those undergoing EPP (p < 0.001), whereas no significant difference was observed in the sex distribution between groups. Subgroup analyses by region and publication year confirmed the robustness of the findings. Meta-regression did not reveal substantial modifiers of survival. Conclusions: P/D demonstrates superior overall survival and reduced perioperative mortality compared to EPP, without evidence of baseline demographic confounding. These findings, derived from retrospective comparative studies, support the preferential use of P/D in eligible patients, particularly in high-volume centers, given its favorable safety profile and superior median survival. However, the absence of randomized trials directly comparing P/D and EPP and the potential influence of patient selection warrant cautious interpretation, and surgical decisions should be tailored to individual patient factors within a multidisciplinary setting. Full article

Predictive models use historical data to predict a future event and can be applied to a wide variety of tasks. A broader evaluation of the cattle literature is required to better understand predictive model performance across various health challenges and to understand data types utilized to train models. This narrative review aims to describe predictive model performance in greater detail across various disease outcomes, input data types, and algorithms with a specific focus on accuracy, sensitivity, specificity, and positive and negative predictive values. A secondary goal is to address important areas for consideration for future work in the beef cattle sector. In total, 19 articles were included. Broad categories of disease were covered, including respiratory disease, bovine tuberculosis, and others. Various input data types were reported, including demographic data, images, and laboratory test results, among others. Several algorithms were utilized, including neural networks, linear models, and others. Accuracy, sensitivity, and specificity values ranged widely across disease outcome and algorithm categories. Negative predictive values were greater than positive predictive values for most disease outcomes. This review highlights the importance of utilizing several performance metrics and concludes that future work should address prevalence of outcomes and class-imbalanced data. Full article

Objectives: The adoption of telemedicine, which is the delivery of healthcare services through digital platforms, exploded during the COVID-19 pandemic as a means to ensure the continuity of care while minimizing infection risks. While this modality improved access and convenience for many, disparities in adoption have emerged, particularly in rural and underserved populations. This study aims to evaluate the impact of telemedicine on patient satisfaction before and during the pandemic, with a focus on chronic disease management—notably hypertension—and to identify factors influencing the equitable adoption of telehealth. Methods and Procedures: This study used a mixed method approach, combining quantitative survey data and causal loop modeling to analyze patient satisfaction levels and the interplay between telehealth adoption, healthcare access, and demographic disparities. Patient-reported satisfaction data were collected in two time periods—before and during the pandemic. Causal modeling was used to explore systemic relationships between provider support, technology access, patient engagement, and health equity. Results: The findings revealed that telemedicine significantly enhanced healthcare access during the pandemic, with a notable increase in patient satisfaction scores. Patients with chronic conditions, especially those diagnosed with hypertension, reported the improved continuity of care and reduced geographic barriers. However, disparities in telehealth access were more pronounced in non-metropolitan areas and among older adults and minority populations. Causal analysis highlighted key enablers of telehealth success, i.e., provider support, digital literacy, and access to reliable internet and devices. Conclusions: Telemedicine presents a transformative solution for equitable healthcare delivery, especially in chronic disease management. Strategic efforts are needed to address adoption disparities and ensure the sustained and inclusive integration of telehealth after the pandemic. Full article

Background: Firearm-related injuries are the leading cause of death among children and adolescents (ages 1 to 19 years) in the United States. Access to and carrying firearms are key risk factors for violence and adolescent firearm use. This study examines the association between family conflict and adolescent gun carrying in Los Angeles County, and the extent to which household and neighborhood contexts contribute to adolescent gun carrying. Methods: We use cross-sectional multilevel data from adolescents ages 12–17 years in the Los Angeles Family and Neighborhood Study, conducted in 2002, to fit a series of generalized linear mixed models to examine the association between family conflict (scale range: 0–2) and adolescent gun carrying. Models include random effects to examine the contributions of household and neighborhood contexts on the outcome measure. Results: After controlling for demographic characteristics, gang involvement, substance use, and household and neighborhood contexts, adolescent experiences of family conflict remain positively associated with adolescent gun carrying behavior (OR = 3.45, p = 0.043). Random effects estimates indicate that a relatively large amount of variation in adolescent gun carrying is explained by household and neighborhood contexts: 23% and 24%, respectively. Conclusions: Multilevel family and community-level interventions, with an emphasis on family violence, are necessary components of prevention strategies to reduce high rates of firearm-related mortality among US adolescents. Full article

The increasing demographic aging of society is a great challenge to the healthcare sector and raises the socio-economic burden. Therefore, elucidating the mechanisms of aging and developing safe effective anti-aging products to prolong people’s healthy lifespan are paramount nowadays. Panax ginseng has been highly regarded since ancient times for its ability to enhance health and prolong life. However, its main active substances of anti-aging and their mechanisms are not fully understood. In this research, Caenorhabditis elegans was used as a model organism to explore and confirm the key active substances from Panax ginseng and the mechanisms that exert anti-aging effects. Various ginsenoside compounds were evaluated based on longevity, anti-stress, physiological function, etc. Ginsenoside Re, which has powerful anti-aging activity, was screened. In the follow-up trials, transcriptomics and RT-qPCR techniques were used to investigate the mechanism of Re in exerting its anti-aging properties. Differential genes were enriched in the Insulin/Insulin-like Growth Factor-1 Signaling (IIS) pathway, the neuropeptide signaling pathway, and lipid metabolism. A significant increase in the expression levels of daf-16, sgk-1, skn-1, hsf-1, hsp-16.2, sod-3, gst-4, fil-2, lips-11, cyp-35A4, and aex-2 genes, and a significant decrease in the expression levels of daf-2, age-1, and akt-2 genes were verified. These suggest that ginsenoside Re exerts its life-extending influence by regulating lipid metabolism and the IIS pathway. Full article

This research examines the factors influencing drop out among adult college students. As the traditional-age student population (ages 19–24) declines, the older, part-time, adult learners have emerged as a critical enrollment demographic for higher education institutions. These learners often pursue higher education for career advancement, re-skilling, or re-employment. However, many encounter difficulties in sustaining their academic engagement due to low motivation, limited basic learning skills, or external constraints. Despite the growing presence of adult learners in Korean universities, limited research has analyzed drop-out factors within this specific context. To address this gap, this study applies Bean and Metzner’s nontraditional undergraduate student attrition model, using data from the Korean Educational Longitudinal Study (KELS). It investigates how background characteristics, academic variables, environmental factors, and academic and psychological outcomes influence the drop out of adult learners. The findings reveal that academic variables significantly impact drop-out intentions, while student engagement and social integration show minimal effects. These results offer valuable theoretical insights and practical implications for enhancing adult learner retention in higher education. Full article