Search Results (23,503)

In August 2024, the Africa Centres for Disease Control and Prevention (Africa CDC) declared mpox a Public Health Emergency of Continental Security (PHECS), and the World Health Organization (WHO) followed with a second Public Health Emergency of International Concern (PHEIC), in response to the rapid expansion of clade Ib monkeypox virus (MPXV) across eastern Democratic Republic of the Congo (DRC) and neighboring countries. Both declarations have since been lifted (September 2025 and January 2026), yet clade Ib transmission and severe outcomes in pregnant women and children persist. We argue that closing these emergency mechanisms marks not the end of the epidemic but the start of a harder phase: sustaining surveillance, care, and research amid shrinking donor support, including the dissolution of the United States Agency for International Development (USAID). We contend that integrating mpox into existing HIV, sexually transmitted infection (STI), and reproductive health platforms is the most realistic route to durable routine care, while pregnancy, paediatric disease, severe cases, and zoonotic spillover still need dedicated pathways. Sustainable management ultimately depends on domesticated financing, stronger institutions, genuine community engagement, and action on the ecological drivers of spillover. Full article

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

Our first objective was to quantify the associations between health-related events (HRE) before insemination, the relative increase in estrus intensity (REI) at insemination, and the probability of cow-level pregnancy per artificial insemination (P/AI) in organic Holstein dairy cows. Quantifying these associations may aid on-farm decision-making, such as setting the voluntary waiting period, choice of type of semen, do-not-breed and culling decisions. A second objective was to develop predictive models to estimate P/AI based on readily available data, and present common goodness-of-fit results also used in the machine learning community. All data were collected from a certified organic dairy farm in the western USA from 2019 to 2021. Health-related and reproduction data were obtained through Dairy Records Management Systems (DRMS; Raleigh, NC, USA). Activity data were collected using pedometers (IceRobotics, Stirling, UK) mounted on the rear legs. The REI, defined as walking steps per hour before insemination divided by the cow’s baseline steps per hour, was available for 17,238 inseminations from 4759 cows. The REI was categorized as ≤200%, >200–400%, >400–600%, or >600%. The HRE were available for 65,684 inseminations from 13,365 cows. The HRE were categorized as mastitis, metabolic disease (i.e., hypocalcemia, ketosis, displaced abomasum, digestive problems), reproductive disease (i.e, metritis, endometritis, pyometra, retained fetal membranes), lameness, 2 different diseases, ≥3 different diseases, or as healthy (none of these diseases prior to insemination). Combinations (COMBO) between REI categories and 0, 1, or ≥2 HRE were also created. Data were split into training and test sets. The training data were used to fit three logistic regression models that included either HRE, or REI, or COMBO. Each of the three models also included the covariates of 3-mo herd-average P/AI prior to insemination, days in milk, and the fixed effects of parity, insemination season, days after the previous insemination or days to 1st insemination. A random effect accounted for repeated inseminations within cow. Parameter estimates, odds ratios, and the estimated marginal means of the estimated P/AI of the fixed effects were obtained from the logistic regression models. The models’ estimates were applied to the test datasets, and discrimination and calibration statistics were calculated to judge goodness-of-fit. Unadjusted mean P/AI were 0.31, 0.28 and 0.28 for the HRE, REI and COMBO training datasets. For the HRE model, estimated P/AI ranged from 0.20 (≥3 different HRE) to 0.30 (healthy). The estimated P/AI associated with four REI categories were not different from 0.27 in the REI model. The estimated P/AI associated with the combinations of HRE and REI in the COMBO model varied from 0.18 after ≥2 HRE and >200–400% REI, to 0.30 when inseminations were in healthy cows with REI >600%. Inseminations in older cows, in the spring, and outside 18–24 d after the previous insemination were also associated with lower estimated P/AI. The area underneath the Receiver Operating Characteristic curve ranged from 0.57 (COMBO) to 0.60 (HRE) for the test data, indicating fair discrimination ability of the models. Calibration plots showed that the prediction models produced unbiased predicted P/AI. In conclusion, the results showed no conclusive evidence of greater estimated P/AI related to greater REI as a measure of estrus activity. More HRE were associated with lower estimated P/AI. Combinations of low REI and more HRE were associated with notably decreased estimated P/AI. The logistic regression models produced unbiased predicted P/AI. We found no evidence that the strength of the relationship between REI and P/AI depended on the HRE category. The applications of the results are as follows. First, these predictive models may help inform insemination decisions in organic dairy cows, although further external validation is recommended, and the discriminatory performance is weak. Second, a variety of goodness-of-fit statistics were calculated to allow comparisons of the current logistic regression analyses with future analyses made by other machine learning techniques. Full article

In the context of public health emergencies (PHEs), conventional static indicators are insufficient for capturing the dynamic supply–demand relationship of emergency medical care. Grounded in adaptive cycle theory, this study proposes a integrated analytical framework that sequentially integrates supply baseline identification, disturbance impact simulation, mismatch diagnosis, and zoning-based response optimization. Taking 475 communities and 18 major designated hospitals in the Changsha metropolitan area as the empirical case, we integrate AHP-CRITIC evaluation, the SEIQRDP-SG model, and the 3SFCA-SMI method to identify the spatial mismatch of emergency-bed supply and demand and to delineate planning response zones. The results show that: (1) emergency-bed supply exhibits marked agglomeration and quasi-Pareto polarization, with the top three districts accounting for 75.83% of effective emergency beds; (2) under the core scenario of R₀ = 5 with moderate intervention, peak bed demand in the metropolitan area reaches approximately 7835 beds around day 21, with high-demand communities emerging in high-density and high-mobility areas; and (3) although the overall supply–demand ratio is 1.34, 78% of communities cannot reach any designated hospital within 15 min, and the supply–demand pattern forms a compound spatial structure characterized by “central carrying, transitional mismatch, and peripheral weakness”. These findings indicate that the primary constraint on emergency medical resilience lies not in aggregate bed shortages alone, but in structural spatial mismatch jointly shaped by effective supply, dynamic demand, and transfer-time constraints. This study extends emergency medical facility evaluation from static assessment to dynamic matching and provides evidence for the layout of resilient “dual-use” medical facilities for routine and emergency conditions. Full article

Monitoring poultry microbiota and antimicrobial resistance genes is important, as they can reflect flock health, farm conditions, and the level of antimicrobial resistance. Although shotgun metagenomics has been widely applied worldwide to investigate poultry microbiota and antimicrobial resistance, comparable baseline datasets describing the cloacal microbiota and resistome of poultry in Kazakhstan are scarce. In this study, taxonomic and resistome profiles were characterized in pooled metagenomes of the cloacal microbiota of chickens sampled from household and industrial poultry farms in Kazakhstan. Cloacal swabs were collected from laying hens, pooled at the house level, and analyzed using high-throughput metagenomic sequencing. Taxonomic profiles were generated at the genus level, and antimicrobial resistance gene signals were summarized by drug class. Compositional patterns were assessed using CLR/Aitchison ordination, the Mantel test, and Procrustes analysis. The pooled samples exhibited heterogeneous microbiota profiles at the genus level and included taxa of veterinary interest, such as Chlamydia, Avibacterium, and Gallibacterium spp. Resistome profiling revealed a broad but uneven distribution of antimicrobial resistance signals, including those associated with tetracyclines, fluoroquinolones, aminoglycosides, and beta-lactams. Taxonomic and resistome profiles showed preliminary alignment at the matrix level, indicating that resistome variations are partially linked to microbial community structure. Full article

Background: Individuals with intellectual and/or developmental disabilities (IDDs) experience persistent health inequities, exacerbated by the systemic lack of education of health care professionals about their care. In response to a 2020 call from the Administration for Community Living in the United States, five institutions formed the IDD Health Equity Consortium to develop a suite of educational materials and practice experiences to improve the education of health care professionals in the health and health care of individuals with IDDs. Methods: The Collective Impact Model, designed to align organizations and stakeholders around a shared agenda for system change, was used to organize IDD Health Equity Consortium programs. Backbone infrastructure included a cross-sector steering committee, an Advocate Advisory Committee, and three Consortium Action Networks focused on communication, measurement, and education, practice, and policy. A scoping review of the literature was conducted, and a Participatory Planning and Decision-Making process engaged individuals with IDDs, family members, students, faculty, and professionals in identifying important themes for developed materials. Results: Learning modules, case studies, service-learning experiences, and simulation experiences were developed across Consortium institutions and were disseminated across multiple other institutions, with beginning alignment with interprofessional and disability competencies. Mixed-methods evaluation strategies assessed learner outcomes, including knowledge checks and pre and post evaluations using established measures of skills, comfort levels, and approach; and interprofessional socialization, valuing, and collaborative practice behaviors. Conclusions: By involving individuals with IDDs in curriculum development and building multi-institution and cross-sector infrastructure, the Consortium developed scalable materials that address longstanding gaps in health care professional education. The developed suite of educational materials and practice experiences and early evaluation findings provided a foundation for further program refinement and future empirical studies examining long-term effects on practice and clinical outcomes. Full article

Dengue and other arboviruses are a rising public health concern, worsened by climate change, globalization, and weak vector control. This study assessed the preparedness of local institutions and general practitioners (GPs)/paediatricians in ASL Roma 5 (Lazio, Italy) for potential arboviral outbreaks. A cross-sectional survey (April–May 2024) conducted 99 interviews: 57 with mayors and 42 with general GPs/paediatricians. A Health Belief Model (HBM)-based questionnaire assessed knowledge, attitudes, and practices regarding arbovirus transmission and management. Data were analyzed using descriptive statistics and chi-square tests. Dengue transmission awareness was low. Most mayors (85.96%) and GPs/paediatricians (88.1%) rated community knowledge as poor; 12.8% of mayors and 4.76% of GPs/paediatricians believed residents recognized local transmission risks. Environmental prevention programs were reported by 57.89% of mayors and 26.19% of GPs/paediatricians. Staff resource adequacy perceptions differed significantly (73.33% GPs/paediatricians vs. 21.82% mayors; p = 0.0005). In emergencies, 84.62% of GPs/paediatricians and 66.07% of mayors felt ready to act within 24 h. Local administrations face organizational and staffing limitations that hinder effective dengue prevention. While GPs/paediatricians showed greater confidence, they stressed the need for further training. Enhancing risk communication, environmental management, and intersectoral collaboration is crucial to improve preparedness for dengue and emerging arboviruses. Full article

Background: Rural older women in China face intersecting disadvantages including eroded family support, limited pension coverage, and high social isolation that elevate depressive symptoms. Although Long-Term Care Insurance (LTCI) has expanded rapidly since 2016 to provide both financial protection and formal care services for older adults, whether it can compensate for depleted informal support and protect mental health among this vulnerable population remains unknown. Methods: We used five waves of CHARLS (2011–2020) with 2193 rural women aged ≥60. We employed a staggered difference-in-differences design, complemented by moderation analysis, heterogeneity tests, and time-dependent survival analysis. Robustness checks included Callaway-Sant’Anna DID, placebo permutation and baseline exclusion sensitivity. Results: LTCI reduced depression scores by 0.45 points (β = −0.447, p = 0.028) and depression onset hazard by 36.1% (HR = 0.639, p = 0.009). Benefits were compensatory, concentrated among women lacking regular emotional and financial support from children and those with high social isolation. Heterogeneity analyses demonstrated a pronounced age gradient and a significant education gradient, while care-need and disability subgroups showed directionally consistent but underpowered effects. These findings were robust to supplementary sensitivity checks, including Callaway-Sant’Anna DID, placebo permutation, and baseline-depressed exclusion. Conclusions: LTCI confers meaningful mental health protection for rural older women through compensatory pathways that substitute for depleted informal support. However, benefits are concentrated among younger-old and more-educated women, raising equity concerns. Gender-sensitive implementation with mental health screening, targeted outreach for less-educated women, and community-based enrollment assistance is essential to ensure policy equity. Full article

Background: Population ageing has increased the importance of maintaining the quality of life (QOL) of community-dwelling older adults. Resilience and social participation are considered important determinants of well-being in later life. However, little is known about how social participation involving mutual support relates to subjective QOL in Japanese community settings. This study examined associations between resilience and social participation, including mutual support and subjective QOL, among community-dwelling older adults. Methods: This cross-sectional survey was conducted in December 2021 among community-dwelling older adults in Japan. The study sample mainly comprised socially active older adults recruited through senior citizen clubs. Anonymous self-administered questionnaires were distributed to 434 individuals aged 65 years and older, and 258 valid responses were analysed. Subjective QOL was assessed using the Subjective QOL Scale, resilience using the Resilience Scale for Older Adults, and social participation, including mutual support, using a composite score based on neighbourhood relationships and participation in community activities. Results: Subjective QOL was positively correlated with resilience (ρ = 0.475, p < 0.001) and social participation including mutual support (r = 0.163, p = 0.009). After adjustment for self-rated health, the number of outpatient visits per month, and the number of daily medications, the association between subjective QOL and social participation including mutual support was no longer significant (pr = 0.104, p = 0.096), while resilience remained significantly associated with subjective QOL (pr = 0.417, p < 0.001). Participants with higher levels of social participation had significantly higher subjective QOL and resilience scores than those with lower levels of participation. Conclusions: In this study sample, resilience was more strongly associated with subjective QOL than social participation including mutual support. These findings highlight the importance of individualised community-based approaches that address both psychological resilience and opportunities for social participation when promoting well-being among older adults. Full article

This empirical study positions hotel-based sport wellness programs as structured physical activity offerings embedded in co-created guest experiences in luxury hotels in Saudi Arabia. It examines how the quality of wellness sports programs relates to guests’ satisfaction with the program, loyalty intentions toward the hotel, and self-reported physical activity orientation and intention. The construct is operationalized as guests’ perceived increase in activity during the stay and their stated intention to maintain or increase activity afterward. The study also tests the mediating roles of perceived health benefits and enjoyment, as well as the moderating role of staff health communication. Drawing on service quality and expectancy disconfirmation perspectives, together with health belief and motor learning insights, a cross-sectional survey was conducted with 412 guests who had participated in structured sport-based wellness sessions during their stay in Saudi Arabian luxury hotels. Data were analyzed using partial least squares structural equation modeling (PLS SEM). Wellness sport program quality was positively associated with perceived health benefits, enjoyment, and program satisfaction, and both perceived health benefits and enjoyment partially mediated the quality satisfaction relationship, indicating parallel cognitive and affective pathways in the guest experience. Program satisfaction, in turn, was positively associated with guests’ loyalty intentions and their self-reported orientation toward maintaining healthier physical activity routines after their stay, while staff health communication significantly strengthened the association between program quality and perceived health benefits. These results contribute to wellness tourism and hospitality research by integrating sport pedagogy and health communication into an experience-centric framework and by clarifying how hotel-based sport wellness offerings can support satisfaction, loyalty, and self-reported physical activity orientation in an emerging tourism destination. Practical implications are offered for hotel managers seeking to design human-centered, health-oriented wellness services aligned with Vision 2030 and global physical activity promotion agendas, recognizing that the findings represent perception-based associations that are a promising foundation for future longitudinal and behavioral research. Full article

Poor indoor air quality is linked to respiratory symptoms and disease, but interactions between indoor pollutants and microbial communities remain unclear. Evidence suggests microorganisms can interact with polycyclic aromatic hydrocarbons (PAHs) through degradation or attachment, potentially shaping indoor microbiomes. In the COPSACsevere cohort, we analyzed bed dust from 84 children (58 asthma, 26 controls). PAHs were measured by HPLC-FLD and microbiota profiled by 16S rRNA and ITS2 sequencing. Questionnaires captured sociodemographic and lifestyle factors. Associations were tested using PERMANOVA, Spearman correlations, and MaAsLin2. Bacterial community composition varied with the host factors age, sex, and parental education, but showed no association with PAH concentrations. Fungal diversity and composition were significantly associated with PAHs, especially pyrene and fluoranthene, which explained 6.1–6.3% variance (p < 0.05) and were positively correlated with Shannon diversity and evenness. Several fungal taxa including Lecanoraceae, Helotiales, and Circinaria correlated positively with PAHs. Asthma status was not associated with bacterial or fungal alpha and beta diversity metrics. PAHs selectively influenced fungal but not bacterial communities in bed dust. Although no asthma associations were detected and no mechanisms can be inferred, these findings highlight potential chemical–fungal interactions in indoor environments and their relevance for future respiratory health research. These results suggest that chemical exposures may shape specific components of indoor microbiomes independent of host disease status, emphasizing the need to integrate chemical–biological interactions in indoor exposure assessments in future environmental health studies and interventions. Full article

In Brazil, Community Restaurants (CRs) are regarded as an essential public initiative to expand food access for groups experiencing severe social vulnerability. This cross-sectional study analyzed the strategic effect of CRs as an indirect mechanism to ensure food availability in municipalities with more than 100,000 inhabitants, located in the North and Northeast regions of the country, using the CR evaluation matrix system of structural and process indicators as proxies to classify units as “not very effective,” “effective,” or “very effective,” rather than direct outcome impacts. Of the 94 CRs assessed (North: n = 23; Northeast: n = 71), most were rated as effective or very effective (95.6% in the North, 95.8% in the Northeast), with only one CR in Pará and three in the northeast (two in Bahia and one in Sergipe) classified as not very effective. The North region showed strong performance in financial resources, monitoring, location, physical structure, menu planning, incorporation of regional foods, volume of meals served to the attending public, and intersectoral actions. The Northeast excelled in financial resources, food security, physical structure, menu planning, and integration of regional foods, though it scored lower in education and volume of meals served to the attending public. This study represents the first structured application of the Oliveira matrix in the North and Northeast, providing new evidence on regional disparities and management challenges. These findings underscore CR’s strategic effectiveness in supporting regional efforts to improve food access and mitigate food and nutritional insecurity in historically vulnerable regions. However, outcome indicators such as dietary diversity, nutritional adequacy, and user health outcomes were not assessed. Future studies should incorporate these measures, alongside longitudinal designs and onsite evaluations, to better understand the broader impact of CRs on food and nutrition security. Full article

The rapid emergence and dissemination of antimicrobial resistance (AMR) among bacterial pathogens, particularly the ESKAPE group (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter spp.), represents one of the most pressing global public health challenges, contributing to increased morbidity, mortality, and healthcare costs. The limited development of new antibiotic classes over the past two decades has intensified the search for structurally novel antimicrobial agents and adjuvants capable of overcoming multidrug resistance. Natural products continue to serve as an invaluable source of anti-infective drug leads owing to their remarkable structural diversity and broad spectrum of biological activities. Mangrove ecosystems, located at the interface of terrestrial and marine environments, harbor highly diverse microbial communities, including fungi that have evolved under extreme environmental conditions and produce a wide range of unique secondary metabolites. Beyond their ecological significance, mangrove-associated fungi have emerged as prolific producers of bioactive compounds with promising antibacterial activity against multidrug-resistant pathogens. This review comprehensively summarizes recent advances (2018–2026) in the discovery of antibacterial metabolites from mangrove-associated fungi active against ESKAPE pathogens, which discusses their structural diversity, reported antimicrobial activities, and emerging strategies for accelerating natural product discovery, including genome mining, metabolomics, OSMAC, adaptive laboratory evolution, and artificial intelligence-assisted approaches. A total of 139 chemically distinct metabolites (Compounds 1–139) isolated from mangrove-associated fungi are critically reviewed, highlighting their potential as promising leads for the development of next-generation antimicrobial agents against ESKAPE pathogens. Full article

Toxocara spp. infection is a neglected zoonotic disease associated with exposure to companion animals and contaminated environments. However, information regarding its seroprevalence and associated risk factors among cat owners in Thailand, particularly in remote island communities, remains limited. This cross-sectional study aimed to determine anti-Toxocara spp. IgG seropositivity and identify associated risk factors among cat owners in Koh Yao District, Phang Nga Province, Thailand. A total of 291 cat owners participated in the study. Sociodemographic characteristics, health-related behaviors, serum anti-Toxocara spp. IgG antibodies, and hematological parameters were collected. Univariate and multivariable logistic regression analyses were performed to identify factors associated with seropositivity. The overall prevalence of anti-Toxocara spp. IgG seropositivity was 34.36%. In the univariate analysis, failure to wash hands after cat contact was significantly associated with higher odds of seropositivity (odds ratio [OR] = 1.96, 95% confidence interval [CI]: 1.16–3.33; p = 0.011). This association remained significant in the multivariable logistic regression model. These findings indicate substantial exposure to Toxocara spp. among cat owners in this island community and highlight the importance of personal hygiene, particularly handwashing after cat contact, in reducing exposure to infective Toxocara eggs. Targeted health education programs and preventive interventions should be strengthened to reduce the risk of Toxocara spp. exposure in endemic communities. Full article

Background: Nursing education has evolved in response to changing social, cultural, political, and healthcare contexts. Although Cultural–Historical Activity Theory (CHAT) has increasingly been applied in medical education research, its application to the historical development of nursing education remains limited. This study examined the historical evolution of Mongolian nursing education through the lens of CHAT to identify patterns of activity system transformation and their implications for contemporary nursing education. Methods: A historical documentary review was conducted using CHAT as the primary analytical framework. Historical evidence was interpreted through Engeström’s activity system model, and transformations across successive historical periods were analyzed by examining changes in the object, mediating tools, institutional rules, community, division of labour, and outcomes of nursing education. Results: The findings demonstrate that the development of Mongolian nursing education was shaped by four complementary analytical dimensions: the Social Determinants of Health (SDOH), Diversity, Equity and Inclusion (DEI), political ideology, and paradigm shifts. These factors collectively influenced the transformation of nursing education activity systems from traditional caregiving practices to a modern, research-oriented, and internationally connected educational system. The analysis further revealed how social reforms, ideological transitions, and educational restructuring generated successive transformations in the organization, objectives, and professional identity of nursing education. Conclusions: This study provides a theoretically grounded historical interpretation of Mongolian nursing education through the lens of CHAT. The findings demonstrate that nursing education evolves through dynamic interactions among social, political, cultural, and educational factors, offering valuable insights for curriculum development, educational reform, and the advancement of nursing education in rapidly changing societies. Full article