Search Results (60)

While most prison healthcare litigation seeks individual relief, some cases lead to broader structural reform via consent decrees—court-approved “legally binding performance improvement plans” designed to improve conditions. This study systematically analyzes 121 such settlements from 1970 to 2022 to assess their policy goals and implementation strategies. We identify the substantive areas targeted—general medical care, mental health, dental services, and treatment for specialized conditions like HIV, Hepatitis C, and COVID-19—and trace trends across time and geography. These agreements span 39 states and the federal system, with most states subject to multiple cases. They frequently mandate changes to budgets, staffing, facility infrastructure, training, and patient rights, alongside monitoring for quality improvement. Our findings suggest that consent decrees function not only as judicial remedies but as tools of policy development and institutional reform, shedding light on the role of courts in shaping correctional healthcare delivery. These findings also show how institutional responses to healthcare failures in prisons shape the conditions under which serious harm—and in some cases, preventable death—occur behind bars. Full article

With the acceleration of urbanization, the impact of built community environments on residents’ health has emerged as a research focus in urban geography and public health. This study examines 25 representative communities in Wuhan, China, employing a combination of questionnaire surveys and multi-source geospatial data. It systematically analyzes the influence patterns of built environment characteristics on residents’ self-rated health from dual perspectives: subjective perception and objective measurement. The XGBoost model was employed to achieve nonlinear fitting and prediction of residents’ self-rated health, while the SHAP method was introduced to interpret model outputs, identifying key environmental factors and their complex effect patterns. The results show that the built environment and health exhibit significant nonlinear relationships, with XGBoost outperforming other models. Residents’ health perception is jointly influenced by subjective and objective factors, with satisfaction with commercial services contributing most. Key environmental elements display threshold effects, indicating that excessive mixing may not further improve health. Furthermore, complex local interactions exist, where good transport accessibility enhances the health benefits of medical facilities and green spaces. This study demonstrates the applicability of interpretable machine learning in health geography, thus providing scientific guidance for health-oriented community planning. Full article

ST-segment elevation myocardial infarction (STEMI) represents a time-critical medical emergency where complete coronary artery occlusion initiates progressive myocardial necrosis. The fundamental principle of modern STEMI care—“Time is Muscle”—establishes that ischemic duration directly determines infarct size and clinical outcomes. Each minute of delay correlates with increased mortality, larger infarcts, and a higher risk of heart failure development. Total ischemic time encompasses both patient-mediated delays (often the largest component) and system-related delays, each influenced by distinct factors requiring targeted interventions. This comprehensive review analyzes the components of total ischemic time, quantifies the clinical consequences of delay, and evaluates evidence-based mitigation strategies. We examine the evolution from fibrinolysis to primary percutaneous coronary intervention and the resulting logistical challenges. System-level interventions—including public awareness campaigns, regionalized STEMI networks, pre-hospital ECG acquisition, and standardized hospital protocols—have dramatically reduced treatment times. However, persistent disparities based on geography, presentation timing, sex, race, and age remain problematic. Emerging technologies, particularly artificial intelligence for ECG interpretation, offer promise for further time reduction. Full article

Background and objective: Typical endpoints in cancer clinical trials focus on standardized efficacy endpoints, such as overall survival. Pain is not always assessed, although it is a highly prevalent and distressing aspect of patients’ cancer experience and plays a critical role in health-related quality of life. To inform future pain measurement strategies in oncology, this targeted literature review of pain-related qualitative publications in oncology aimed to characterize and explore the patient experience of pain, and its impact on how patients feel and function. Methods: A review of publications in MEDLINE, Embase and PsycINFO from 2018 to 2023 was conducted. Patient quotes or author descriptions/interpretations were extracted and analyzed with directed content analysis techniques, using ATLAS.ti v9. Data were synthesized to inform the development of a conceptual model. Results: Twenty-eight publications, with data from 534 patients across different oncology indications and geographies, were reviewed. Pain was triggered by disease symptoms and treatment, including surgical procedures, chemotherapy, and radiation. Pain was most often daily, severe, and chronic in nature. Characterizations of pain varied, but most often “sharp”/“stabbing”/“shooting” pain was described across different treatment stages. Pain had an extensive impact on emotional wellbeing, activities of daily living, physical, physiological and social functioning, sleep and work. Unmet needs included difficulty communicating pain needs to healthcare practitioners and fear/distrust of opioid pain medication. Conclusions: This research provides a patient-centric model conceptualizing the patient experience of cancer-related pain. The findings highlight the burden and all-encompassing impact of cancer-related pain, demonstrating the importance of assessing pain in oncology clinical trials. Full article

Mental health disorders are increasingly being recognized as a major global challenge. In the Arabic-speaking Middle East and North Africa (MENA) region, this challenge is compounded by sociocultural stigma, political instability, and limited mental health infrastructure, all of which restrict access to effective care. While neurostimulation modalities such as electroconvulsive therapy (ECT) and repetitive transcranial magnetic stimulation (rTMS) have proven effective and are gaining traction, their use in the MENA region remains limited and underexplored. This narrative review aims to bridge critical gaps by examining knowledge levels, attitudes, perceptions, and the clinical application and accessibility of ECT and rTMS across Arabic-speaking countries. We searched multiple databases using keywords related to neurostimulation and psychiatry, covering all 22 Arabic-speaking MENA countries. Studies were included if they were published in English and were related to psychiatric applications of ECT or rTMS. Findings were categorized by geography and grouped into four thematic domains: knowledge, perception, availability, and clinical use. The findings revealed an uneven distribution of neurostimulation research and services across the region; ECT is more established than rTMS. Additionally, public awareness remains low, and high levels of stigma persist. Among clinicians, psychiatrists tend to support neurostimulation, while general medical staff show mixed opinions. rTMS is gaining clinical interest but remains limited in accessibility due to high costs and limited infrastructure. Although neurostimulation should be more widely implemented in psychiatry in the MENA region, it is still underrecognized and underused. Region-specific strategies addressing stigma, training gaps, and policy standardization are essential to optimize neurostimulation use and its public acceptance. Full article

Purpose: Standard automated perimetry (SAP) remains the gold standard functional test in glaucoma, used primarily for evaluating peripheral vision loss. Central contrast sensitivity (CCS) has emerged as a potential early functional marker of glaucomatous damage. This systematic review aimed to describe the different methods used to measure CCS in randomized controlled trials (RCT) involving glaucoma patients. Methods: We searched the MEDLINE, Embase, CINAHL, Cochrane Central Register of Controlled Trials, Epistemonikos, and ClinicalTrials.gov databases on 25 January 2023, and updated the search on 12 February 2025. Eligible studies comprised RCTs that reported CCS as an outcome in patients with glaucoma, suspected glaucoma, or ocular hypertension. No restrictions were placed on age, sex, ethnicity, geography, intervention, or publication year. Abstracts and full texts were screened independently by two reviewers. Descriptive statistics were used. No formal risk of bias assessment was performed, due to the descriptive nature of the review. Results: Of 1066 records screened, 31 studies met the eligibility criteria. The study sample size ranged from 7 to 207 (median: 23), with most studies involving primary open-angle glaucoma. Interventions were diverse, mainly involving topical medications, with timolol being the most frequent. Eleven CCS test methods were identified. Five studies did not report the method used. The CSV-1000 was the most commonly used test, being applied in 11 studies. Conclusions: CCS has been measured using a wide range of methods in glaucoma RCTs, with limited standardization. Most of the included studies were small, variably reported, and conducted over 10 years ago, suggesting a decreasing interest in CCS as an outcome measure in glaucoma RCTs. Funding: This review was funded by Oslo University Hospital and the Research Council of Norway. Registration: This review was registered on the OSF. Full article

Crowdsourcing has become increasingly relevant in academic research due to its role in the evolving digital landscape, where information is a key driver of organizational performance. In a context dominated by emerging technologies and digital platforms, organizations are turning to external sources for data and idea generation. This paper offers a comprehensive review of the literature on crowdsourcing and digital information, using bibliometric techniques and qualitative analysis to identify major trends. The findings reveal several shifts in focus: from conceptual frameworks to practical applications; from customer participation to broader stakeholder involvement; and from general technological and managerial approaches to specific technologies and emerging perspectives in entrepreneurship and finance. The primary contributing disciplines are Computer Science, Engineering, and Information Science. Recent research (post 2023) emphasizes constructs such as “crowdfunding”, “digital platforms”, and “machine learning”, moving beyond earlier focuses like “citizen science” and “social media.” This review also reveals growing interest in managerial, medical, and cultural heritage applications, alongside a decline in research related to geography and crisis management over the past two years. This study enhances our understanding of current research directions and practical implications in crowdsourcing and digital information, offering valuable insights for both academics and practitioners. Full article

Residential mobility within cities reflects the spatio-temporal patterns of individual or household relocation behaviors and serves as an effective tool for interpreting urban socio-spatial differentiation from a micro-level perspective. Newly employed college graduates (NECGs) have become the second-largest migrating population in China. This study selects Guangzhou, a megacity, as the study area and utilizes data from the “Guangzhou New Citizens’ Residential Mobility Survey” conducted in 2023. It applies spatio-temporal systems and the spatio-temporal path method based on time geography to explore the residential mobility trajectories of NECGs in Guangzhou. In addition, the study uses a logistic regression model to explore the influencing factors. The findings indicate that NECGs frequently move across districts, showing no significant patterns of concentration or dispersion. However, residential location choices vary considerably across educational levels and household registration natures (Hukou), and as the duration of residence in Guangzhou increases, the probability of residential mobility among NECGs across all educational levels shows a declining trend. Specifically, marital status (life course attributes), housing prices and medical facilities (housing attributes), and job type (socioeconomic attributes) emerge as critical factors influencing residential mobility. By providing a foundation for urban planning policies, this study aims to support the settlement and well-being of NECGs while promoting high-quality urban development in Guangzhou. Full article

Bovine respiratory disease (BRD) is a major economic and animal welfare issue in the beef industry. Mycoplasma bovis is one of the main causal organisms, particularly in chronic cases. Due to the difficulty of isolating M. bovis from clinical isolates, there is a lack of information on the genetic diversity of this pathogen in the Texas panhandle region of the United States. Therefore, our objective was to provide genome-level characterization of M. bovis isolated from the lung lesions of beef and dairy cattle in the Texas panhandle. Fifty-four isolates displaying mycoplasma-like growth were recovered from bovine lung lesions by the Texas Veterinary Medical Diagnostic Laboratory in 2021 and 2022. Of these isolates, 32 were determined to be M. bovis via species-specific qPCR using the uvrC gene. Long-read whole-genome sequencing was used to identify key virulence factors, antimicrobial resistance genes, and to assess the genetic diversity of these isolates. Fisher’s exact tests were used to identify associations between isolate characteristics and host metadata, including the state of origin, type of operation, animal age, and animal sex. Our results indicate that there is considerable genetic diversity among the M. bovis isolates, despite their shared geography in the Texas panhandle, though significant clustering based on host metadata was observed. Analysis of the pangenome showed that the M. bovis isolates in this study also harbor a diverse array of virulence genes, but no antimicrobial resistance genes were identified in this study. Full article

Travel to and from distant cancer treatment facilities can place a significant burden on cancer patients, particularly rural and minority survivors. Thus, the purpose of our investigation was to examine the association between patient travel distance and delays in types of treatment for breast cancer (surgery, radiation, chemotherapy, and hormonal therapy) and treatment delays. Using a novel linkage between the state cancer registry and administrative data from Medicaid and a private insurance plan, 2155 BC patients were successfully linked to create the cohort. ArcGIS was used to geocode all case residences and treatment facility addresses and calculate network distance between the residence and each facility. Logistic regression models were used to calculate the adjusted odds of being delayed versus timely by street distance. Odds of late surgery were increased by 1% (95% CI: 1.00, 1.01) for each one-mile increase from the patient’s residence to the treatment facility. In race-stratified models, the odds of late treatment for Black patients increased by 3% per mile (95% CI 1.01, 1.06) for radiation. Increased travel distance appears to significantly increase treatment delays for surgical, radiation, and chemotherapeutic treatments for women with BC, especially among Black women. Full article

Aim: This article aims to explore the role of the human gut microbiota (GM) in the pathogenesis of neurological, psychiatric, and neurodevelopmental disorders, highlighting its influence on health and disease, and investigating potential therapeutic strategies targeting GM modulation. Materials and Methods: A comprehensive analysis of the gut microbiota’s composition and its interaction with the human body, particularly, its role in neurological and psychiatric conditions, is provided. The review discusses factors influencing GM composition, including birth mode, breastfeeding, diet, medications, and geography. Additionally, it examines the GM’s functions, such as nutrient absorption, immune regulation, and pathogen defense, alongside its interactions with the nervous system through the gut–brain axis, neurotransmitters, and short-chain fatty acids (SCFAs). Results: Alterations in the GM are linked to various disorders, including Parkinson’s disease, multiple sclerosis, depression, schizophrenia, ADHD, and autism. The GM influences cognitive functions, stress responses, and mood regulation. Antibiotic use disrupts GM diversity, increasing the risk of metabolic disorders, obesity, and allergic diseases. Emerging therapies such as probiotics, prebiotics, and microbiota transplantation show promise in modulating the GM and alleviating symptoms of neurological and psychiatric conditions. Conclusions. The modulation of the GM represents a promising approach for personalized treatment strategies. Further research is needed to better understand the underlying mechanisms and to develop targeted therapies aimed at restoring GM balance for improved clinical outcomes. Full article

Background: The World Health Organization (WHO) recommends hepatitis D virus (HDV) screening among hepatitis B virus (HBV) infected individuals, with a focus on priority populations in resource-limited settings like Nigeria. HDV infection is a growing public health challenge, particularly among individuals with chronic hepatitis B virus (HBV) infection. HDV accelerates liver disease progression and significantly increases the risk of cirrhosis and hepatocellular carcinoma. Despite this, the epidemiology of HDV in Nigeria remains inadequately documented. This scoping review critically evaluates the prevalence, risk factors, and clinical outcomes of HDV co-infection among HBV patients in Nigeria. Method: We conducted a systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. The review included observational cross-sectional studies published between 2009 and 2024. We focused on studies that used Immunoglobulin G (IgG) antibody testing or RNA-based diagnostics to assess HDV prevalence. We included PubMed, Google Scholar, and Dimensions databases due to their broad indexing and coverage of peer-reviewed articles and accessibility. We screened the studies for their relevance to HDV prevalence, risk factors, and clinical outcomes, while excluding those that only tested for IgM or HDV antigen. Eleven studies, with a combined sample size of 2308 participants, were included in the final analysis. We performed a narrative synthesis of the findings, considering geographic, gender, and age-based variations in HDV prevalence and clinical impact. Results: HDV prevalence among HBV-infected individuals in Nigeria ranged from 2.0% to 31.6%. The highest prevalence was reported in the Southwest (31.6%) among malaria patients, while lower rates were observed in the Southeast (2.8%). Prevalence was higher in males, particularly those aged 21–30 years in the Southwest and 31–40 years in other regions. RNA-based testing provided more accurate data on active viremia, with viremic HDV prevalence rates ranging from 3.2% to 16%. Triple infection with HIV/HBV/HDV was associated with significantly lower CD4+ cell counts and worse clinical outcomes, including elevated liver enzymes and rapid progression to liver cancer. Key risk factors for HDV co-infection included multiple sexual partners, sharing of needles, and unsafe medical practices. Co-infected patients demonstrated worse clinical outcomes, such as elevated liver enzymes, decompensated cirrhosis, and higher rates of hepatocellular carcinoma. Conclusions: Our review underscores the urgent need for routine HDV screening among HBV patients in Nigeria, especially given the severe clinical consequences of co-infection. The recent WHO guidelines recommending HDV screening align with our findings, which emphasize the importance of RNA-based HDV testing among HBV-positive patients to improve diagnostic accuracy. Public health efforts should prioritize tailored interventions based on geographic, age, and gender disparities in HDV prevalence. Triple infection with HIV/HBV/HDV requires integrated care models to address both immune suppressions as indicated by diminished CD4 cell count and liver disease progression, as these patients face worse outcomes. Targeted HDV screening in mostly affected demographics and geographies and improved Nigeria capacity for cheaper HDV RNA/PCR diagnostics can reduce liver-related morbidity and mortality caused by HBV, which can be worsened and accelerated by HDV coinfection. Full article

Despite consensus guidelines, most patients with early-stage triple-negative (TN) and HER2-positive (HER2+) breast cancer do not see a medical oncologist prior to surgery and do not receive neoadjuvant chemotherapy (NAC). To understand barriers to care, we aimed to characterize the relationship between geography (region of residence and cancer centre proximity) and receipt of a pre-treatment medical oncology consultation and NAC for patients with TN and HER2+ breast cancer. Using linked administrative datasets in Ontario, Canada, we performed a retrospective population-based analysis of women diagnosed with stage I–III TN or HER2+ breast cancer from 2012 to 2020. The outcomes were a pre-treatment medical oncology consultation and the initiation of NAC. We created choropleth maps to assess the distribution of the outcomes and cancer centres across census divisions. To assess the relationship between distance to the nearest cancer centre and outcomes, we performed multivariable regression analyses adjusted for relevant factors, including tumour extent and nodal status. Of 14,647 patients, 29.9% received a pre-treatment medical oncology consultation and 77.7% received NAC. Mapping demonstrated high interregional variability, ranging across census divisions from 12.5% to 64.3% for medical oncology consultation and from 8.8% to 64.3% for NAC. In the full cohort, compared to a distance of ≤5 km from the nearest cancer centre, only 10–25 km was significantly associated with lower odds of NAC (OR 0.83, 95% CI 0.70–0.99). Greater distances were not associated with pre-treatment medical oncology consultation. The interregional variability in medical oncology consultation and NAC for patients with TN and HER2+ breast cancer suggests that regional and/or provider practice patterns underlie discrepancies in the referral for and receipt of NAC. These findings can inform interventions to improve equitable access to NAC for eligible patients. Full article

Lyme disease, a multisystemic infectious disorder caused by pathogenic spirochetes of the genus Borrelia transmitted by the bite of ticks, typically from the family Ixodidae, pose a significant public health issue worldwide. The Borrelia burgdorferi sensu lato (s.l.) group encompasses the Borrelia Lyme Group (LG), Borrelia Echidna-Reptile Group (REPG), and Borrelia Relapsing Fever Group (RFG), with some species remaining unclassified due to culturing challenges. Research into B. burgdorferi s.l. infection (Lyme Group) has intensified, focusing on its epidemiology, diagnosis, and treatment. Originally identified in North America and Europe, Lyme disease has now become a global concern, with Latin American countries reporting the microorganism, the disease, and/or its vectors. In Argentina, the presence of B. burgdorferi and Lyme disease has sparked significant scientific and medical debate. Ecological changes due to climate and habitat shifts have expanded the geographical distribution of these ticks. Argentina, with its diverse geography and climate, hosts various tick species that could potentially act as Lyme disease vectors, raising important public health questions. The confirmed presence of B. burgdorferi s.l. and Lyme disease in Argentina remains contentious but relevant, necessitating thorough scientific and medical examination. This work aims to enhance understanding and discussion of Lyme disease in Argentina by presenting clinical cases and their laboratory analyses, highlighting the disease’s presence and implications in the country. Through documenting suspected clinical cases and analyzing available data on B. burgdorferi and Lyme disease in Argentina, this study seeks to contribute to the understanding of the disease’s current status and inform future research, prevention, and control strategies in the region. The goal is to provide a basis for addressing Lyme disease’s public health impact in Argentina and promote further investigation into this evolving issue. Full article

Antibiotic resistance is a persistent and growing concern. Our objective was to analyze antibiotic prescribing in the United States (US) in the Medical Expenditure Panel System (MEPS) and to Medicaid patients. We obtained MEPS prescriptions for eight antibiotics from 2013 to 2020. We extracted prescribing rates per 1000 Medicaid enrollees for two years, 2018 and 2019, for four broad-spectrum (azithromycin, ciprofloxacin, levofloxacin, and moxifloxacin) and four narrow-spectrum (amoxicillin, cephalexin, doxycycline, and trimethoprim-sulfamethoxazole) antibiotics. Antibiotic prescriptions in MEPS decreased from 2013 to 2020 by 38.7%, with a larger decline for the broad (−53.7%) than narrow (−23.5%) spectrum antibiotics. Antibiotic prescriptions in Medicaid decreased by 6.7%. Amoxicillin was the predominant antibiotic, followed by azithromycin, cephalexin, trimethoprim-sulfamethoxazole, doxycycline, ciprofloxacin, levofloxacin, and moxifloxacin. Substantial geographic variation in prescribing existed, with a 2.8-fold difference between the highest (Kentucky = 855/1000) and lowest (Oregon = 299) states. The South prescribed 52.2% more antibiotics (580/1000) than the West (381/1000). There were significant correlations across states (r = 0.81 for azithromycin and amoxicillin). This study identified sizable disparities by geography in the prescribing rates of eight antibiotics with over three-fold state-level differences. Areas with high prescribing rates, particularly for outpatients, may benefit from stewardship programs to reduce potentially unnecessary prescribing. Full article