Search Results (354)

Background/Objectives: Effective use of health services is essential for universal health coverage, yet many adults in Peru still forgo formal care despite illness. Evidence describing national trends and determinants of non-use of formal health services remains limited. This study aimed to estimate national trends from 2015 to 2024 and identify factors associated with non-use among Peruvian adults. Methods: We conducted a repeated cross-sectional analysis of annual secondary microdata from the Peruvian National Household Survey (ENAHO, 2015–2024). Adults aged ≥ 18 years who reported a health problem in the last four weeks were included. Non-use was defined as not seeking care at any public or private provider (IPRESS). Survey-weighted descriptive analyses and modified Poisson regression models estimated prevalence ratios (PRs) with 95% confidence intervals, adjusting for sex, age, education, marital status, health insurance, chronic illness, disability, area, and region. Results: Among 330,165 adults, 41.5% did not use formal health services. Non-use declined until 2019, rose sharply during 2020–2021, and partially recovered thereafter. In adjusted models, non-use was lower among women (PR = 0.92; 95% CI 0.91–0.93), those with higher education (PR = 0.88; 0.86–0.90), and participants insured by EsSalud (PR = 0.65) or SIS (PR = 0.76). It was higher in the Highlands (PR = 1.07) and lower in Metropolitan Lima (PR = 0.88). Conclusions: Non-use of formal health services in Peru remains high and unequal. Expanding effective coverage, strengthening primary care, and improving health literacy are essential to achieve equitable access. Full article

This report describes the development and deployment of the Public Health Quality Tool (PHQTool), an online resource designed to help mobile health clinics (MHCs) assess and improve the quality of their public health services. MHCs provide essential clinical and public health services to underserved populations but have historically lacked tools to assess and improve the quality of their work. To address this gap, the PHQTool was developed as an online, evidence-based, self-assessment resource for MHCs, hosted on the Mobile Health Map (MHMap) platform. This report documents the collaborative development process of the PHQTool and presents preliminary evaluation findings related to usability and relevance among mobile health clinics. Drawing from national public health frameworks and Honore et al.’s established public health quality aims, the PHQTool focuses on six aims most relevant to mobile care: Equitable, Health Promoting, Proactive, Transparent, Effective, and Efficient. Selection of the six quality aims was guided by explicit criteria developed through pilot testing and stakeholder feedback. The six aims were those that could be directly implemented through mobile clinic practices and were feasible to assess within diverse mobile clinic contexts. The remaining three aims (“population-centered,” “risk-reducing,” and “vigilant”) were determined to be less directly actionable at the program level or required system-wide or data infrastructure beyond the scope of individual mobile clinics. Development included expert consultation, pilot testing, and iterative refinement informed by user feedback. The tool allows clinics to evaluate practices, identify improvement goals, and track progress over time. Since implementation, 82 MHCs representing diverse organizational types have used the PHQTool, reporting high usability and identifying common improvement areas such as outreach, efficiency, and equity-driven service delivery. Across pilot and post-pilot implementation phases, a majority of respondents agreed or strongly agreed that the tool was user-friendly, relevant to their work, and appropriately scoped for mobile clinic practice. Usability and acceptance were assessed using descriptive statistics, including percentage agreement across Likert-scale items as well as qualitative feedback collected during structured debriefs. Reported findings reflect self-reported perceptions of feasibility, clarity, and relevance rather than inferential statistical comparisons. The PHQTool facilitates systematic quality assessment within the mobile clinic sector and supports consistent documentation of public health efforts. By providing a standardized, accessible framework for evaluation, it contributes to broader efforts to strengthen evidence-based quality improvement and promote accountability in MHCs. Full article

Background/Objectives: This study investigates the potential association between the sharp increase in syphilis cases in Japan and the growing popularity of dating apps, with a specific focus on the dynamics during the COVID-19 pandemic. Syphilis, a sexually transmitted infection (STIs) caused by Treponema pallidum, presents a significant global public health challenge despite being curable with antibiotics. In Japan, the incidence of syphilis has risen dramatically since 2013, surpassing 10,000 reported cases annually by 2022. Methods: To examine this trend, we analyzed the quarterly reported syphilis cases alongside active user data from three major dating apps (App1, App2, and App3) and conducted a stratified linear correlation analysis by gender and age group. Results: The results reveal that syphilis cases showed accelerated growth starting in the first quarter of 2021, and App 3 demonstrated the strongest positive correlation with new syphilis cases. The association was particularly significant among males aged 20–29 (R² = 0.70, p = 0.0007) and 30–39 (R² = 0.82, p < 0.0001). Conclusions: These findings suggest that the widespread use of dating apps may contribute to the rise in sexually transmitted infections, including syphilis, by facilitating extensive new sexual contacts. Notably, this trend became increasingly evident during the COVID-19 pandemic. Future STI prevention strategies should consider integrating dating apps as a potential medium for public health interventions. Additionally, strengthening sexual health services is essential to ensure that responses to global crises do not inadvertently undermine STI prevention and control efforts. Full article

School-based health centers (SBHCs) provide accessible, comprehensive healthcare to students, particularly in underserved communities, and play a critical role in addressing reproductive health needs. Despite their benefits, the availability of SBHCs remains limited across the U.S., with ongoing debates regarding their role in educational settings, especially concerning reproductive health services. This study assessed public opinion regarding reproductive health services in SBHCs within middle and high schools in Duval County, Florida. A representative sample of 605 adults was surveyed using a Random-Digit-Dialing approach, and data were weighted for analysis. Overall, support for reproductive health services was high, with 68–74% of respondents in high school and 49–57% in middle school favoring services such as STI testing and treatment, pregnancy testing, and providing condoms. Significant differences in support levels are noted across demographic groups, particularly by age and race. The findings indicate strong community support for implementing reproductive health services in SBHCs, highlighting their potential to improve access to essential health services for adolescents. This research provides valuable insights for policymakers to advocate for the expansion of SBHCs to include comprehensive reproductive health services, addressing health disparities among youth. Full article

Background: Black and racialized immigrants with disabilities in Canada face overlapping systems of exclusion rooted in racism, ableism, and migration status. Yet, their experiences within health and rehabilitation services during the COVID-19 pandemic remain largely undocumented. This study explores how structural inequities shaped access to healthcare, rehabilitation, information, and community supports in the Greater Toronto and Hamilton Area (GTHA). Methods: Using narrative inquiry, ten in-depth interviews were conducted with participants who identified as Black or racialized, disabled, and having immigrated to Canada within the last 10 years. Narratives were analyzed through reflexive thematic analysis to identify how systems, relationships, and policies interacted to shape daily life, health and rehabilitation navigation during the pandemic. Results: Participants described systemic barriers in health and rehabilitation systems, experiences of “othering” and conditional belonging, and the critical role of informal and faith-based networks in navigating inaccessible services. Pandemic policies often intensified existing inequities. Conclusions: Findings underscore the need for intersectional health and rehabilitation planning that centers the voices of Black and racialized disabled immigrants. Addressing systemic racism and ableism is essential for equitable preparedness in future public health emergencies. Full article

Background/Objectives: Healthy ageing, focused on maintaining daily autonomy and cognitive function despite chronic comorbidities, poses a challenge for public health systems, especially for those aged ≥80, given the expected increase in this population. Promoting a healthy lifestyle in this group is essential to achieving this goal, with primary care services playing a key role in this effort. Therefore, our objective was to profile the participants based on these characteristics. Methods: The study included 222 non-institutionalized, dementia-free individuals (mean age 84.58 ± 3.72 years, 56.3% women) recruited from a primary healthcare service. Data were collected from medical records and interviews, including the cognitive Pfeiffer test, the functional Barthel index (BI), and ad hoc questionnaires (for lifestyle variables). Latent profiling analysis (LPA) was used to classify the participants. Results: The participants reported social support (97.7%), low-risk alcohol consumption (94.6%), adherence to the Mediterranean diet (85.1%), physical activity (74.8%), and never smoking (72.5%). Hypertension (86.5%), cataracts (74.3%), and osteoarticular diseases (68.5%) were the most frequent chronic conditions. Women showed a significantly different distribution of certain variables and a higher number of comorbidities (6.34 ± 2.38) than men (5.58 ± 2.44) (p = 0.019). After LPA, we found that 38.29% of individuals met characteristics compatible with healthy ageing, predominantly male (60%); the association of a high probability of cognitive impairment with a high degree (severe or total), exhibited by the profiles likely >85% women (18.5% of individuals); physical activity, smoking, osteoporosis, anxiety, COPD, chronic kidney disease (CKD), and creatinine blood levels exhibited statistical differences between profiles; and the probability of dependence severity was associated with an increase in age, although cognitive status conservation was associated being male. Conclusions: The studied +80 group seems to follow a healthy lifestyle, as self-reported. Women fare worse than men in resilient ageing. While common factors related to dysfunctionality did not differentiate between profiles, CKD, an increasingly common age-related condition, did. Full article

Background: Integrating palliative care (PC) into primary health care (PHC) is essential for achieving Universal Health Coverage and reducing avoidable suffering. Despite global progress in PC development, the extent to which PC is effectively embedded within PHC systems remains unclear, particularly in low- and middle-income countries. Colombia illustrates this gap, with an advanced legal framework but persistent territorial inequities. This study explored how national experts conceptualize PC integration into PHC to inform the development of context-sensitive indicators. Methods: A directed thematic analysis was conducted using qualitative comments from a modified Delphi process (pre-Delphi, Round 1, Round 2). Coding was guided by the WHO model for PC development and the WHO–UNICEF Operational Framework for PHC, combining deductive and inductive approaches to identify recurrent themes. Results: A total of 230 qualitative comments from experts in PC, PHC, and public health were analyzed. Experts described integration as the alignment of policy, education, service delivery, and community participation within PHC structures. They emphasized that laws and training programs alone are insufficient; integration depends on implementation capacity, equitable access, and locally responsive systems. Rural areas were identified as facing the greatest barriers, including limited trained staff, restricted medicine availability, and weak referral pathways. Conclusions: Experts understood PC integration into PHC as a dynamic and ethical process linking system design with human experience. Strengthening equity, workforce preparation, and community engagement is essential to translate policy into practice and to develop meaningful indicators for health system improvement. Full article

In the face of rapid aging, depression in later life has become a prominent issue in urban public health and environmental research. As potential places for social activities and emotional healing, the social stayability of shaded community spaces is an essential environmental factor influencing the mental well-being of the elderly. In order to overcome the challenge of depression relief in later life, it is important to investigate what attributes of social stayability in shaded spaces influence the mental well-being of the elderly, as well as their gap structures. This study innovatively develops a fuzzy multi-criteria decision-making method and builds an analytical framework combining Fuzzy-BWM and VIKOR to comprehensively evaluate three dimensions of physical accessibility, facilities, and spatial conditions, and environmental comfort and safety of shaded spaces. Using the Pioneer community in Panyu, Guangzhou, and the Yuehan community in Macau as empirical cases, this study integrates expert judgment and residents’ perception data to identify the key attributes and gap structure of shaded space stayability in mitigating depression-related psychological risk and promoting emotional restoration and psychological well-being among older adults. The results show that facilities and spatial conditions have the greatest impact on social stayability. The two attributes of sitting comfort and public service facilities are the dominant factors that affect stay intention and emotional recovery. Environmental comfort and safety have a secondary but stable supporting effect on psychological security. This study reveals the coupling relationship between functional configuration and perceptual experience and advocates for the transformation of urban renewal thinking from spatial optimization to psychological health promotion. This study’s results offer theoretical support and policy implications for building restorative, inclusive, and age-friendly cities. The findings provide a quantitative basis for decision making regarding sustainable community space governance and intervention prioritization. Full article

First Nations children remain dramatically over-represented in Australia’s Out-of-Home Care (OOHC) system, particularly in New South Wales (NSW), which continues to report the highest numbers nationally. This narrative review, grounded in a relational First Nations Standpoint Theory and decolonising research paradigms, to critically examine the systemic, structural, and historical factors contributing to these disproportionalities. Drawing on interdisciplinary evidence across law, criminology, education, health, governance studies, and public policy, the analysis centres Indigenous-authored scholarship and contemporary empirical literature, including grey literature, inquiries, and community-led reports. Findings reveal that the OOHC system reproduces the colonial logics that historically drove the Stolen Generations. Macro-level structural drivers—including systemic racism, Indigenous data injustice, entrenched poverty and deprivation, intergenerational trauma, and Westernised governance frameworks—continue to shape child protection policies and practices. Micro-level drivers such as parental supports, mental health distress, substance misuse, family violence, and the criminalisation of children in care (“crossover children”) must be understood as direct consequences of structural inequality rather than as isolated individual risk factors. Current placement and permanency orders in NSW further compound cultural disconnection, with ongoing failures to implement the Aboriginal and Torres Strait Islander Child Placement Principle (ATSICPP). Contemporary cultural rights and Indigenous Cultural and Intellectual Property (ICIP) frameworks highlight the urgency of restoring Indigenous authority in decision-making processes. The literature consistently demonstrates that cultural continuity, kinship networks, and ACCO-led models are sort to produce stronger long-term outcomes for children. The review concludes that genuine transformation requires a systemic shift toward Indigenous-led governance, community-controlled service delivery, data sovereignty, and legislative reform that embeds cultural rights and self-determination. Without acknowledging the structural drivers and redistributing genuine power and authority, the state risks perpetuating a cycle of removal that mirrors earlier assimilationist policies. Strengthening First Peoples governance and cultural authority is therefore essential to creating pathways for First Nations children to live safely, remain connected to family and kin, and thrive in culture. Full article

In the context of China’s accelerated urbanization process, the increasing number of rural-to-urban migrants has become an integral part of urban economic development. Ensuring stable housing for the floating population is essential to facilitating their integration into urban society and promoting the realization of their health rights. Drawing on data from a large-scale survey of Chinese internal migrants, this study empirically analyzes how homeownership influences health services accessibility in rural-to-urban migrants. The findings indicated that homeowners exhibited approximately 18.4% higher odds ratio of accessing public health services compared to renters. This result remained robust after addressing potential reverse causality using instrumental variable approaches and correcting for self-selection bias through propensity score weighting methods. Meanwhile, the mediating effect decomposition showed that migrants’ perception of acculturation and community participation played parallel mediating roles in the relationship between homeownership and health services accessibility. Furthermore, the heterogeneity analysis revealed that the positive impact of homeownership on health services accessibility was more pronounced among individuals with lower household income and shorter migration duration. Our research underscores the importance of securing stable housing for rural-to-urban migrants as a key determinant in advancing the equitable development of urban health systems. Full article

Smart cities generate vast multimodal data from IoT devices, surveillance systems, health monitors, and environmental monitoring infrastructure. The seamless integration and interpretation of such multimodal data is essential for intelligent decision-making and adaptive urban services. Multimodal machine learning (MML) provides a unified framework to fuse and analyze diverse sources, surpassing conventional unimodal and rule-based approaches. This review surveys the role of MML in smart city sensing across mobility, public safety, healthcare, and environmental domains, outlining key data modalities, enabling technologies and state-of-the-art fusion architectures. We analyze major methodological and deployment challenges, including data alignment, scalability, modality-specific noise, infrastructure limitations, privacy, and ethics, and identify future directions toward scalable, interpretable, and responsible MML for urban systems. This survey serves as a reference for AI researchers, urban planners, and policymakers seeking to understand, design, and deploy multimodal learning solutions for intelligent urban sensing frameworks. Full article

Background: Optimal nutritional care is essential to improving outcomes in hemodialysis, yet translation of evidence into routine practice remains uneven across settings. To inform health system planning and implementation priorities, we mapped global research on hemodialysis-related nutrition. Methods: We searched the Web of Science Core Collection for English-language original articles on nutrition and hemodialysis from 1 January 2006 to 13 October 2025. Publication trends, productivity by country and institution, influential journals and authors, citation impact, and conceptual structure via Keyword Plus co-occurrence, trend, and thematic evolution analyses were assessed using the bibliometrix package (version 5.0) in R. Results: A total of 332 articles from 115 journals were identified, with substantial growth and multidisciplinary authorship, though international collaboration remains limited. The United States contributed 21.4% of publications and achieved the highest citation impact, while China, Japan, Iran, and Brazil formed the next tier of contributors. The Journal of Renal Nutrition accounted for 16.6% of papers. Highly cited studies established links between dietary intake, mineral and electrolyte management, and survival, while supporting the use of intradialytic oral nutritional supplements. Thematic evolution showed a shift from biochemical markers toward patient-centered priorities, including diet quality, adherence, body composition, mental health, and quality of life. Emerging directions point to whole-diet approaches and microbiome-modulating strategies. Conclusions: Global research on diet and hemodialysis has progressed from foundational nutrient studies to multidimensional, patient-focused approaches. Our findings suggest opportunities for health systems to strengthen dietitian-led models of care, integrate patient-reported outcomes, and prioritize scalable nutrition interventions within routine dialysis services. Full article

This study aimed to identify scientific evidence that addresses women’s experiences in the process of illness and care during tuberculosis treatment. A systematic review of qualitative studies was conducted based on the Joanna Briggs Institute’s Manual for Evidence Synthesis and the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Searches were performed in the Web of Science, MEDLINE, Embase, SciVerse Scopus, and LILACS databases. The following descriptors were used: “Women,” “Tuberculosis,” “Gender Perspective,” and “Qualitative Approach.” Studies reporting the experiences of women with active tuberculosis, published in any language, without time restrictions, were included. Of the 16,029 studies initially identified, 7079 duplicates were removed and 8895 were excluded after title and abstract screening. A total of 55 studies were read in full, of which 41 did not meet the eligibility criteria, resulting in a final inclusion of 14 studies. Most selected studies were conducted in high-tuberculosis-burden, low- and middle-income countries between 2000 and 2024. All studies focused on pulmonary tuberculosis, with one addressing drug-resistant tuberculosis. The results revealed that women’s experiences with tuberculosis are shaped by the following four thematic categories: (1) stigma and social vulnerability of women with tuberculosis; (2) gender factors in access to health services and in the interruption of tuberculosis treatment among women; (3) intersectionality and social determinants of health; and (4) the importance of social, family, and healthcare support in the experience of tuberculosis illness. The experience of illness due to tuberculosis among women is profoundly shaped by vulnerabilities related to gender, stigma, and social class, which intensify social exclusion, hinder access to diagnosis and treatment, and deepen physical and emotional suffering. Stigma reinforces isolation and weakens support networks, while the burden of domestic labor, caregiving responsibilities, and economic dependence makes it difficult for women to prioritize their own health. In this context, family support and gender-sensitive, humanized healthcare are essential. Therefore, the implementation of public policies that address these specificities and confront structural inequalities is urgent to ensure comprehensive care and a dignified, effective recovery for women with tuberculosis. Full article

Background: This study examines how national innovation performance shapes the diffusion of advanced diagnostic technologies across European healthcare systems. Strengthening technological capacity through innovation is increasingly essential for resilient and efficient health services. The analysis quantifies the influence of innovation capacity on the availability of medical imaging technologies in 26 EU Member States between 2018 and 2024. Methods: A balanced panel dataset was assembled from Eurostat, the European Innovation Scoreboard, and World Bank indicators. Dynamic relationships between innovation performance and the adoption of CT, MRI, gamma cameras, and PET scanners were estimated using a two-step approach combining General-to-Specific (GETS) outlier detection with Robust Least Squares regression to address heterogeneity and specification uncertainty. Results: Higher innovation scores significantly increase the diffusion of R&D-intensive technologies such as MRI and PET, while CT availability shows limited responsiveness due to market maturity. Public health expenditure supports frontier technologies when strategically targeted, whereas GDP growth has no significant effect. Population size consistently enhances technological capacity through scale and system-integration effects. Conclusions: The findings show that innovation ecosystems, rather than economic growth alone, drive the modernization of diagnostic infrastructure in the EU. Integrating innovation metrics into health-technology assessments offers a more accurate basis for designing innovation-oriented investment policies in European healthcare. Full article

Background: Non-communicable diseases (NCDs) such as cardiovascular diseases, diabetes, obesity, and cancer are the leading cause of mortality globally and in Saudi Arabia, accounting for more than 70% of all deaths. Despite national initiatives offering free preventive services, screening uptake remains low. This study aimed to describe the demographic and clinical characteristics of individuals participating in community-based NCD screening campaigns in the Eastern Province of Saudi Arabia and to evaluate screening uptake, compliance, and diagnostic outcomes. Methods: A retrospective cross-sectional analysis was conducted among 3106 adults screened at volunteer-driven community campaigns held between January 2023 and December 2024. Screening included anthropometric measurements, blood pressure assessment, and glucose testing, followed by eligibility evaluation for osteoporosis and cancer screening. Uptake and compliance were verified using electronic health records. Descriptive and inferential statistical analyses were applied. Results: Participants were 64% male and 36% female, with a mean age of 41.4 ± SD years. Obesity, hypertension, and diabetes were identified in 32%, 31%, and 12% of participants overall. Gender-stratified prevalence showed higher obesity among females at 36% (95% CI 32.3 to 38.1) and higher hypertension and diabetes among males at 36% (95% CI 34.0 to 38.2) and 14% (95% CI 12.1 to 15.2), respectively. Uptake among eligible individuals was 51% for dual-energy X-ray absorptiometry (DEXA), 47% for fecal immunochemical testing (FIT), 43% for Pap smear, and 39% for mammography. Diagnostic findings demonstrated substantial undetected disease burden, including osteoporosis in 41% (95% CI 26.0 to 56.8) of DEXA scans, a FIT positivity rate of 5% (95% CI 1.5 to 10.3), abnormal Pap cytology in 3% (95% CI 1.1 to 7.5), and BI-RADS 0 mammograms in 19% (95% CI 11.9 to 29.5), reflecting incomplete assessments requiring further evaluation. Conclusions: Community-based campaigns can effectively resolve limited engagement in health promotional activities and detect substantial burdens of undiagnosed NCDs. However, improvements in referral tracking, follow-up systems, and culturally tailored health education are essential to enhance screening compliance and early detection outcomes. These results can be utilized to inform public policies by extending screening services to additional areas, increasing investment in preventive health campaigns, and enhancing the capacity of the health system. Full article