Search Results (1,386)

Sex-based immunological differences significantly influence the outcome of vaccination, yet the molecular mediators underpinning these differences remain largely elusive. MicroRNAs (miRNAs), key post-transcriptional regulators of gene expression, have emerged as critical modulators of innate and adaptive immune responses. In this study, we investigated the expression profile of selected circulating miRNAs as potential biomarkers of sex-specific humoral responses to the mRNA COVID-19 vaccine in a cohort of health care workers. Plasma samples were collected longitudinally at a defined time point (average 71 days) post-vaccination and analyzed using RT-qPCR to quantify a panel of immune-relevant miRNAs. Anti-spike (anti-S) IgG titers were measured by chemiluminescent immunoassays. Our results revealed sex-dependent differences in miRNA expression dynamics, with miR-221-3p and miR-148a-3p significantly overexpressed in vaccinated female HCWs and miR-155-5p overexpressed in vaccinated males. MiR-148a-3p showed a significant association with anti-S/RBD (RBD: receptor binding domain) IgG levels in a sex-specific manner. Bioinformatic analysis for miRNA targets indicated distinct regulatory networks and pathways involved in innate and adaptive immune responses, potentially underlying the differential immune activation observed between males and females. These findings support the utility of circulating miRNAs as minimally invasive biomarkers for monitoring and predicting sex-specific vaccine-induced immune responses and provide mechanistic insights that may inform tailored vaccination strategies. Full article

Heart failure (HF) is a major global health challenge, characterized by high morbidity, mortality, and frequent hospital readmissions. Despite the advent of guideline-directed medical therapies (GDMTs), the burden of HF continues to grow, necessitating a shift toward comprehensive, multidisciplinary care models. Heart Failure Disease Management Programs (HF-DMPs) have emerged as structured frameworks that integrate evidence-based medical therapy, patient education, telemonitoring, and support for social determinants of health to optimize outcomes and reduce healthcare costs. This review outlines the key components of HF-DMPs, including patient identification and risk stratification, pharmacologic optimization, team-based care, transitional follow-up, remote monitoring, performance metrics, and social support systems. Incorporating tools such as artificial intelligence, pharmacist-led titration, and community health worker support, HF-DMPs represent a scalable approach to improving care delivery. The success of these programs depends on tailored interventions, interdisciplinary collaboration, and health equity-driven strategies. Full article

Workplace violence (WV) is a ubiquitous risk in healthcare settings where it has been associated with physical and mental health problems. We aimed to investigate the relationship between the violence experienced by healthcare workers (HCWs) and the presence of eating disorders (EDs). During routine health surveillance, 1215 HCWs were questioned about their experience of WV and the short version of the Eating Disorder Examination Questionnaire (EDE-QS) was used to assess their eating behaviors. Sleep quality, stress, and the presence of common mental illnesses and metabolic disorders were also evaluated. HCWs who had experienced one or more assaults in the previous year had a significantly higher EDE score than their colleagues. In a multivariate model, WV doubled the risk of EDs (odds ratio 2.33, confidence intervals 95% 1.30; 4.18, p < 0.01). A very significant association was observed between common mental disorders and EDs (OR 1.13, CI 95% 1.04; 1.23, p < 0.01), while low sleep quality almost reached a significant level (OR 1.09, CI 95% 0.99; 1.20). The higher frequency of EDs among workers subjected to violence may result from maladaptive coping mechanisms used when stress and mental health problems caused by WV lead to compensatory overeating. However, reverse causation, where WV is induced by stigmatization, cannot be ruled out. Because of the considerable impact EDs have on physical and mental health, productivity, and patient care, healthcare organizations should adopt programs designed to prevent these disorders in HCWs. Full article

Background: Health equity can only be achieved when every individual has access to quality healthcare without fear of being discriminated against. This study analyzed the sociodemographic characteristics associated with self-reported racial discrimination when receiving medical care in the United States. Methods: This quantitative cross-sectional study utilized the 2022 National Trends Survey 6. We performed a logistic regression analysis using 6102 survey responses from study participants who answered the question about perceived discrimination. Results: Older adults aged 75 years and above had significantly lower odds of reporting perceived discrimination when receiving medical care compared to those aged 18–34 years (AOR = 0.24; 95% CI: 0.10–0.58). The odds of reporting perceived discrimination were significantly higher among non-Hispanic Blacks (AOR = 7.30; 95% CI: 4.48–11.88), Hispanics (AOR = 3.56; 95% CI: 2.45–5.17), non-Hispanic Asians (AOR = 5.95; 95% CI: 2.25–15.73), and individuals identifying as non-Hispanic Other (AOR = 10.91; 95% CI: 5.42–21.98), compared to non-Hispanic Whites. Compared to individuals from households earning less than USD 20,000, the odds of reporting perceived discrimination when receiving medical care were significantly lower among individuals from households earning between USD 50,000 and <USD 75,000 (AOR = 0.42; 95% CI: 0.23–0.78) and those earning USD 75,000 or more (AOR = 0.43; 95% CI: 0.22–0.83). Conclusions: Despite having a multicultural and ethnically diverse population, racial discrimination persists in the United States and has become a barrier to achieving health equity. Health organizations should implement policies that ensure health workers attend mandatory anti-racism training. Full article

Tuberculosis (TB) remains a leading cause of death in Bangladesh, disproportionately affecting low socio-economic status (SES) populations. This review, guided by the WHO Social Determinants of Health framework and Rockefeller-Lancet Planetary Health Report, examined how social, economic, and ecological factors link SES to TB burden. The first literature search identified 28 articles focused on SES-TB relationships in Bangladesh. A second search through snowballing and conceptual mapping yielded 55 more papers of diverse source types and disciplines. Low-SES groups face elevated TB risk due to smoking, biomass fuel use, malnutrition, limited education, stigma, financial barriers, and hazardous housing or workplaces. These factors delay care-seeking, worsen outcomes, and fuel transmission, especially among women. High-SES groups more often face comorbidities like diabetes, which increase TB risk. Broader contextual drivers include urbanisation, weak labour protections, cultural norms, and poor governance. Recommendations include housing and labour reform, gender parity in education, and integrating private providers into TB programmes. These align with the WHO End TB Strategy, UN SDGs and Planetary Health Quadruple Aims, which expand the traditional Triple Aim for health system design by integrating environmental sustainability alongside improved patient outcomes, population health, and cost efficiency. Future research should explore trust in frontline workers, reasons for consulting informal carers, links between makeshift housing and TB, and integrating ecological determinants into existing frameworks. Full article

Background/Objectives: Improving health outcomes for Indigenous people by strengthening the cultural safety of care is a vital challenge for the health sector. University Departments of Rural Health (UDRH), academic centres based in regional, rural, and remote (RRR) locations across Australia, are uniquely positioned to foster a culturally safe rural health workforce through training, education, and engagement with Indigenous communities. This narrative review examines the contributions of UDRHs to health workforce issues through analysis of their publications focused on Indigenous health. Methods: Research articles relating to workforce were identified from an established database of UDRH Indigenous health-related publications published 2010–2021. Results: Of 46 articles identified across the 12 years, 19 focused on developing the understanding and cultural safety skills of university students studying in a health field, including campus-based Indigenous health education and support for students undertaking rural clinical placements. Twelve articles investigated cultural safety skills and recruitment and retention of the rural health workforce. Fifteen articles focused on Indigenous people in the health workforce, examining clinical training and resources, and the enablers and barriers to retaining Indigenous students and workers. Conclusions: This analysis highlights the sustained efforts of UDRHs to improve Indigenous health through multiple areas within their influence, including curriculum design, health student training on campus, and rural placement opportunities to transform understanding of Indigenous strengths and disadvantages and rural health workforce development. A continuing effort is needed on ways UDRHs can support Indigenous health students during their studies and while on placement, how to improve cultural safety in the health workforce, and ways to better support Indigenous health professionals. Full article

Background: The consumption of ultra-processed foods (UPFs) represents an important public health challenge, especially among education workers, whose intense routine can negatively impact eating habits. This study aimed to analyze the factors associated with the regular consumption of UPF among employees of the Federal Network of Professional, Scientific and Technological Education (RFEPCT) in Brazil. Methods: This was a cross-sectional study, with a quantitative approach, carried out with 1563 education workers. Validated instruments on eating habits (PeNSE), mental health (DASS-21) and quality of life (WHOQOL-bref) were used. The regular consumption of UPF was defined as intake on ≥5 days in the last seven days. The association between the regular consumption of UPF and sociodemographic, occupational, behavioral, mental health and quality of life variables was assessed by Poisson regression with robust variance, generating adjusted prevalence ratios (PRadj) and respective 95% confidence intervals. Results: The regular consumption of UPF was associated mainly with female gender, a lower age group, Southeast and Midwest regions, dissatisfaction with sleep and the body, physical inactivity and poor sleep quality. In addition, the findings suggested a significant relationship between the worst stress scores and soft drinks (PRadj: 2.11; CI: 1.43–3.13), anxiety and soft drinks (PRadj: 1.83; CI: 1.24–2.70) and depression and industrialized/ultra-processed salty foods (PRadj: 2.43; CI: 1.82–3.26). The same was observed in the scores for the worst perception of quality of life, where there was a prevalence of up to 2.32 in the psychological domain and the consumption of industrialized/ultra-processed salty foods. Conclusions: The findings indicate that multiple interrelated factors—individual, psychosocial and occupational—are associated with the consumption of UPF among education workers. These results reinforce the importance of institutional policies that integrate actions to promote dietary health, mental health care and improved working conditions in the education sector. Full article

Background: Since the election of Hamas in 2006, Gaza has endured eight major military conflicts, culminating in the ongoing 2023–2025 war, now surpassing 520 days. This protracted violence, compounded by a 17-year blockade, has resulted in the near-total collapse of Gaza’s health system. Over 49,000 deaths, widespread displacement, and the destruction of more than 60% of health infrastructure have overwhelmed both local capacity and international humanitarian response. Objectives: This narrative review aims to examine and synthesize the current literature (October 2023–April 2025) on the health crisis in Gaza, with a specific focus on identifying key themes and knowledge gaps relevant to rebuilding a sustainable health system. The review also seeks to outline strategic pathways for recovery in the context of ongoing conflict and systemic deprivation. Methods: Given the urgency and limitations of empirical data from conflict zones, a narrative review approach was adopted. Fifty-two sources—including peer-reviewed articles, editorials, reports, and correspondence—were selected through targeted searches using Medline and Google Scholar. The analysis was framed within a public health and political economy perspective, also taking health system building blocks into consideration. Results: The reviewed literature emphasizes emergency needs: trauma care, infectious disease control, and supply chain restoration. Innovations such as mobile clinics and telemedicine offer interim solutions. Gaps include limited attention to mental health (including that of health workers), local governance, and sustainable planning frameworks. Conclusions: Sustainable reconstruction requires a durable ceasefire; international stewardship aligned with local ownership; and a phased, equity-driven strategy emphasizing primary care, mental health, trauma management, and community engagement. Full article

Background: Overtime adversely affects physical and mental health, contributing to irritability, anxiety, reduced sleep, and even cardiovascular issues, ultimately lowering care quality and increasing turnover intentions. This study aimed to investigate whether prolonged overtime increases the risk of occupational burnout over time among healthcare workers. Methods: We conducted a four-year longitudinal observational study using secondary data from annual surveys (2021–2024) of healthcare workers at a medical university hospital in Taichung, Taiwan. Burnout was assessed using the personal burnout (PB) scale from the Copenhagen Burnout Inventory (CBI), with high PB levels (HPBL) defined as scores in the upper quartile of the 2021 baseline. Survival analysis utilizing the Kaplan–Meier method and Cox regression investigated burnout progression and the effects of overtime. Results: HPBL was defined as PB scores ≥45.83 (upper quartile in 2021). The proportions of HPBL were 30.28% (2021), 33.29% (2022), 36.75% (2023), and 32.51% (2024). Survival analysis confirmed that the risk of burnout increased over time, with the survival time estimated at 2.50 ± 0.03 years and lower survival probabilities observed among participants working overtime (Log-rank test, p < 0.0001). Multivariate logistics revealed overtime work, female gender, being a physician/nurse, and reduced sleep as independent risk factors for HPBL (OR = 3.14 for overtime, p < 0.001). These findings support the hypotheses on burnout progression and the impact of overtime. Conclusions: Overtime significantly heightens the risk of burnout, which worsens over time. Female sex, healthcare roles, obesity, and insufficient sleep are additional risk factors. Limiting overtime and proactive interventions are crucial to preventing burnout in healthcare workers. Full article

Introduction: Nurses are the largest group of healthcare workers, and healthcare managers should pay attention to the quality of work life and the health and working capacity of nurses in order to ensure a sufficient number of nurses and a stable workforce. Aim: The present study aimed to determine nurses’ quality of work life, work ability index and intention to leave the nursing profession and to examine the associations between nurses’ quality of work life, work ability index and intention to leave the nursing profession. Methods: An online cross-sectional study was conducted. A total of 498 nurses completed the instrument, consisting of demographic data, Brooks’ Quality of Nursing Work Life Survey (BQNWL), Work Ability Index Questionnaire (WAIQ) and questions on their intention to leave their current job or the nursing profession. Results: Most nurses had a moderate quality of work life (QWL) (73.7%) and a good work ability index (WAI) (43.78%). Men (p = 0.047), nurses who study (p = 0.021), nurses who do not have children (p = 0.000) and nurses who do not take care of their parents (p = 0.000) have a statistically significantly higher total WAIQ score. Most nurses (61.1%) had considered changing jobs in the last 12 months, and 36.9% had considered leaving the nursing profession. A statistically significant positive correlation was found between the total BQNWL and the total WAI. The study found no correlation between QWL, WAI and intention to change jobs or leave the profession, which was unexpected. Conclusions: To ensure the provision of necessary nursing care and a healthy working environment for nurses, it is necessary to regularly monitor QWL and WAI and take measures to ensure the highest quality of working life. Further longitudinal and mixed-methods research is needed to understand the relationship between QWL, WAI and intention to leave. Full article

Background: Adolescents in Ethiopia, particularly in rural areas, face significant barriers to accessing comprehensive sexual and reproductive health (SRH) services, resulting in poor health outcomes. The youth-friendly health services (YFHS) initiative addresses these challenges by training Health Extension Workers (HEWs) to deliver tailored, age-appropriate care at the primary care level. This study evaluates the cost-effectiveness of YFHS implementation in rural health posts in the Jimma Zone, Ethiopia. Methods: Using an ingredient-based costing approach, costs were analyzed across six health posts, three implementing YFHS and three offering routine services. Health outcomes were modeled using disability-adjusted life years (DALYs) averted, and incremental cost-effectiveness ratios (ICERs) were calculated. Results: Results showed that YFHS reached 9854 adolescents annually at a cost of USD 29,680, compared to 2012.5 adolescents and USD 7519 in control sites. The study showed the ICER of USD 25.50 per DALY averted. The intervention improved health outcomes, including a 27% increase in antenatal care uptake, a 34% rise in contraceptive use, and a 0.065% reduction in abortion-related mortality, averting 52.11 DALYs versus 26.42 in controls. Conclusions: The ICER was USD 25.50 per DALY averted, well below Ethiopia’s GDP per capita, making it highly cost-effective by WHO standards. Scaling YFHS through HEWs offers a transformative, cost-effective strategy to advance adolescent SRH equity and achieve universal health coverage in Ethiopia. Full article

Background: The longitudinal RisCoin study investigated risk factors for COVID-19 vaccination failure among healthcare workers (HCWs) and patients with inflammatory bowel disease (IBD) at a University Hospital in Germany. Since the hospital served as the study sponsor and employer of the HCW, we implemented a custom mobile application. We aimed to evaluate the implementation, adherence, benefits, and limitations of this study’s app. Methods: The app allowed secure data collection through questionnaires, disseminated serological results, and managed bidirectional communication. Access was double-pseudonymized and irreversibly anonymized six months after enrollment. Download frequency, login events, and questionnaire submissions between October 2021 and December 2022 were analyzed. Multivariable logistic regression identified factors associated with app adherence. Results: Of the 3979 participants with app access, 3622 (91%) used the app; out of these, 1016 (28%) were “adherent users” (≥12 submitted questionnaires). App adherence significantly increased with age. Among HCW, adherent users were more likely to be non-smokers (p < 0.001), working as administrators or nursing staff vs. physicians (p < 0.001), vaccinated against influenza (p < 0.001), and had not travelled abroad in the past year (p < 0.001). IBD patients exposed to SARS-CoV-2 (p = 0.0133) and those with adverse events following the second COVID-19 vaccination (p = 0.0171) were more likely adherent app users. Despite technical issues causing dropout or non-adherence, the app served as a secure solution for cohort management and longitudinal data collection. Discussion: App-based cohort management enabled continuous data acquisition and individualized care while providing flexibility and anonymity for the study team and participants. App usability, technical issues, and cohort characteristics need to be thoroughly considered prior to implementation to optimize usage and adherence in clinical research. Full article

Background/Objectives: Coercive measures remain a common practice in mental health, despite ethical concerns, potential risks, and uncertain efficacy. Mental healthcare workers’ (MHCWs) attitudes toward coercion can influence their use. However, research in Italy is limited. This study aimed to investigate Italian MHCWs’ attitudes toward coercion and their associations with sociodemographic and professional characteristics. Methods: A cross-sectional study was conducted on 356 MHCWs from a mental health department in Southern Italy. Participants completed the Staff Attitude to Coercion Scale (SACS), which assesses negative, pragmatic, and positive attitudes toward coercion. Descriptive statistics (i.e., frequencies, percentages, means) and bivariate analyses (i.e., one-way ANOVA) were used to explore the associations between variables. Results: The majority of participants were male (56.7%), nurses (50.3%), and worked in acute psychiatric settings (52%), with a mean age of 51.08 years (±10.59) and 13.74 years (±12.14) of experience in mental health. Attitudes differed significantly according to age, sex, professional role, and work setting. More negative attitudes were found among staff in residential settings and non-caring roles (p < 0.001). Pragmatic attitudes were lower among older staff (p = 0.012) and among those in residential settings and non-caring roles (p < 0.001). Positive attitudes were higher among males (p = 0.001), nursing staff (p < 0.001), and staff in acute settings (p = 0.049). Conclusions: Italian MHCWs reported different attitudes toward coercion, which was influenced by personal and professional factors. These findings highlight the need for targeted interventions and policy strategies to promote attitudinal change, particularly in settings where positive attitudes are prevalent. Full article

Background/Objectives: The COVID-19 pandemic has caused sickness and death among many health care workers. However, the apparent resistance of health care workers to SARS-CoV-2 infection despite their high-risk work environment remains unclear. To investigate if inflammation and circadian disruption contribute to resistance or diminished susceptibility to the SARS-CoV-2 virus, we retrospectively evaluated a cohort of volunteer hospital nurses (VHNs). Methods: A total of 246 apparently healthy VHNs (mean age 37.4 ± 5.9 years) who had received the BNT162b2 mRNA vaccine were asked to report their sleep quality, according to the Pittsburgh Sleep Quality Index, and number of SARS-CoV-2 infections during the observational study period (from the end of December 2020 to April 2025). The expression of inflammation-associated mediators and circadian transcription factors in peripheral blood mononuclear cells, as well as sleep quality, were examined. Results: Our findings revealed no anthropometric, biochemical, or inflammation-associated parameters but demonstrated significantly greater levels of NFE2L2, also known as nuclear factor erythroid-derived 2-like 2 (NFR2), gene expression in peripheral blood mononuclear cells among VHNs who had never been infected with SARS-CoV-2 (n = 97) than in VHNs with only one (n = 119) or with two or more (n = 35) prior SARS-CoV-2 infections (p < 0.01). This result was confirmed through one-to-one propensity score matching (p < 0.01). Moreover, NRF2 gene expression was not associated with the number of COVID-19 vaccinations (p = 0.598). Finally, NRF2 gene expression was higher among participants who reported better sleep quality (p < 0.01). Conclusions: Our findings suggest possible interactions among NRF2 gene expression, protection against SARS-CoV-2 infection, and the modulation of COVID-19 vaccination efficacy. Full article

Background/Objectives: The beneficial effects of physical activity on mental health and well-being are well established. The integration of physical activity into psychotherapeutic treatment for mental health difficulty holds promise as an avenue to reduce symptoms and support well-being. Mental health clinicians have previously indicated an interest in the use of physical activity in treatment, but it is unclear to what extent physical activity interventions are implemented in clinical mental health care. The present study aimed to understand mental health clinicians’ practices related to physical activity, as well as to investigate their related training and knowledge. Methods: Semi-structured interviews were conducted with mental health clinicians, including registered psychologists, psychotherapists, and social workers. Inductive content analysis was performed to identify key themes related to practices, training experiences, and training interests. Results: Clinicians reported making recommendations for physical activity and using a range of in-session strategies to include physical activity in mental health treatment. Clinicians reported that their knowledge and training about physical activity was obtained primarily from informal sources. Clinicians indicated an interest in further training, with an emphasis on practical strategies. Conclusions: Mental health clinicians demonstrated an interest in the use of physical activity as part of psychotherapeutic treatment. Some clinicians routinely integrate physical activity into treatment, while others express a need for further training in this area. Full article