Search Results (14,865)

Care transition comprises integrated actions that ensure individualized, multidimensional care and became especially relevant after COVID-19 due to complications, readmissions, and fragmented healthcare delivery. The aim this study was to assess care transition care quality for post-COVID-19 patients using the Care Transition Measure (CTM-15) and its association with sociodemographic and clinical variables. This cross-sectional quantitative study included 176 post-COVID-19 patients or caregivers from a Brazilian public hospital (2020–2021). Data were collected by telephone within 30 days after discharge using a sociodemographic/clinical questionnaire and the CTM-15. The results demonstrated that care transition quality was rated as satisfactory. The highest scores were observed in health management preparation and the lowest in understanding medications. Better evaluations were associated with younger age, higher income, influenza diagnosis, and non-smoking status, whereas diabetes and chronic obstructive pulmonary disease negatively influenced care plan scores. In conclusion, care transition quality was satisfactory and influenced by sociodemographic and clinical factors, highlighting the importance of individualized discharge planning. Full article

Chronic kidney disease (CKD) is a major public health challenge associated with substantial physical, psychological, social, and economic consequences. Although its clinical outcomes have been extensively investigated, less is known about how individuals progressively reconstruct their lives while living with an irreversible condition requiring long-term dialysis, particularly in contexts characterized by health inequities. This study aimed to develop a substantive theory explaining how adults reconstruct their lives while living with CKD on dialysis. A qualitative study was conducted using Strauss and Corbin’s Grounded Theory methodology. Eighteen adults receiving hemodialysis or peritoneal dialysis in Chile participated in semi-structured interviews. Data collection and analysis were conducted concurrently using theoretical sampling, the constant comparative method, memo writing, and theoretical saturation. The findings identified “Reconstructing Life While Living with Chronic Kidney Disease” as the central phenomenon. Life reconstruction emerged as a dynamic and ongoing process sustained by the interaction between resignation and survival and facilitated by three interrelated conditions: understanding the disease, social support networks, and nursing care. Through this process, participants progressively reorganized their identities, everyday lives, interpersonal relationships, and future life projects while living with an irreversible chronic condition. The resulting substantive theory provides a contextually grounded explanation of life reconstruction that integrates individual, relational, and social dimensions of living with CKD. By demonstrating that opportunities for life reconstruction are shaped not only by individual agency but also by supportive social and healthcare conditions, the findings contribute to nursing knowledge and provide a conceptual foundation for person-centered care, health equity, and future research on chronic illness. Full article

Background/Objectives: Early detection of pancreatic cancer (PC) remains challenging due to the lack of effective screening tools. We aimed to develop a clinically applicable model to identify individuals at high risk of PC using routine health check-up data. Methods: In a 1:4 matched case–control study (111 cases and 439 controls) using data collected between 2010 and 2018, PC cases were defined as individuals diagnosed with PC within 2 years of a health check-up. A model was developed using conditional logistic regression and validated in an independent cohort of 52,043 individuals (40 PC cases; 2019–2021). Results: Five risk factors were identified: carbohydrate antigen 19-9 ≥ 39 U/mL, hemoglobin A1c ≥ 6.5%, alkaline phosphatase > 110 IU/L, weight loss ≥ 5%, and dyspepsia. A 12-point risk scoring system was constructed, with an area under the curve of 0.784 in the development and 0.841 in the validation cohort. At a threshold of ≥5, the high-risk group had a significantly higher 2-year incidence of PC than the low-risk group (2.56% vs. 0.047%; p < 0.001), a 54.76-fold risk enrichment, with a negative predictive value of 99.95% and a number-needed-to-follow of 39. Conclusions: This simple, validated model effectively stratifies short-term PC risk using routine data, potentially facilitating targeted surveillance in the general population. Full article

Cutaneous graft-versus-host disease (GVHD) is a common complication of allogeneic haematopoietic stem cell transplantation (allo-HSCT). Despite established guidelines, discrepancies persist between clinical trial evidence and real-world practice, particularly for newer agents such as ruxolitinib. To characterize the phenotypic spectrum of cutaneous GVHD, evaluate real-world treatment strategies—with a specific focus on systemic and topical ruxolitinib—and assess adherence to national and international guidelines, we conducted a retrospective observational study of patients undergoing allo-HSCT between 2015 and 2025 who were referred to a dedicated dermato-haematology clinic. Clinical, histological, and therapeutic data were collected. Cutaneous manifestations were classified according to National Institutes of Health (NIH) and Italian Group for Blood and Marrow Transplantation (GITMO) criteria. Of 62 transplanted patients, 44 (71%) developed GVHD, with the skin as the most frequently involved organ. Acute GVHD predominantly presented with maculopapular eruptions, whereas chronic GVHD showed heterogeneous phenotypes, including sclerotic variants. First-line management was largely guideline-concordant. Systemic ruxolitinib was administered to 3% of patients in the aGVHD group and 3% in the cGVHD group. Steroid-refractory and steroid-dependent status was not systematically recorded; therefore, treatment eligibility could not be reliably determined, and the observed frequencies should not be interpreted as evidence of underuse. Topical ruxolitinib was not used and remains investigational for cutaneous GVHD. Interpretation should also consider that the study period encompassed changes in regulatory approval, reimbursement, and access to targeted therapies. Structured multidisciplinary assessment may support the management of complex cutaneous GVHD, although its effects on treatment decisions and patient outcomes require prospective evaluation. Full article

Urban environments concentrate spatially distributed stressors, including heat, noise, pollution, and biodiversity loss, that are increasingly recognized as determinants of population mental health. However, current approaches rarely integrate environmental structure, lived exposure, and climate-related emotional responses within a unified spatial framework applicable to public health. This article introduces Eco-Affective Health Mapping (EAHM) as a conceptual, spatially explicit framework, grounded in the recently formalized Eco-Affective Health theoretical model, for understanding how environmental conditions may shape climate-related emotional responses, including eco-anxiety, solastalgia, and ecological grief, across urban socio-ecological systems. Drawing on evidence from spatial epidemiology, landscape ecology, environmental mental health, and digital phenotyping, I argue that affective responses to environmental stressors are not randomly distributed but are hypothesized to exhibit spatial clustering in relation to environmental exposures, landscape configuration, and mobility-based interactions. I propose the Eco-Affective Health Mapping (EAHM) framework, which integrates four spatial layers: environmental exposures, landscape configuration, person–place interaction, and affective indicators, together with a companion composite metric, the Eco-Affective Load Index (EALI), for which I provide a formal multi-domain specification and a purely illustrative, non-empirical worked example. EAHM is presented here as a theoretical and methodological proposal rather than as a validated instrument: no primary environmental, mobility, or affective data were collected or analyzed for this article, and the framework’s constituent relationships require prospective empirical testing, for which I outline a companion measurement strategy grounded in the Eco-Affective Health Assessment Protocol (EAHAP). By conceptualizing climate-related emotional responses as candidate measurable public health signals, EAHM is intended to support a future shift toward prevention-oriented, population-level mental health strategies aligned with planetary health and sustainable development agendas. Full article

Background/Objectives: Multimorbidity among older adults is increasing globally and places significant pressure on primary healthcare systems, particularly in low-resource settings. Health literacy is recognized as an important determinant of chronic disease management; however, evidence regarding its association with chronic disease self-efficacy remains limited. This study examined the association between health literacy and chronic disease self-efficacy among older adults with multimorbidity receiving primary healthcare services in Albania. Methods: A cross-sectional study was conducted among 464 adults aged ≥65 years with at least two chronic conditions attending primary healthcare centres in Vlora Municipality. Stratified random sampling was used. Data were collected using a sociodemographic questionnaire, the European Health Literacy Questionnaire (HLS-EU-Q16), and the Stanford Chronic Disease Self-Efficacy Scale (CDSES-33). Health literacy was classified into three categories: inadequate, problematic, or adequate. Pearson’s correlation and hierarchical multiple linear regression analyses were performed after adjustment for relevant sociodemographic and clinical characteristics. Results: Participants were predominantly women (54.3%), with a mean age of 69.9 ± 4.7 years. Hypertension (72.6%) and diabetes mellitus (70.3%) were the most prevalent chronic conditions. Health literacy demonstrated a moderate positive correlation with chronic disease self-efficacy (r = 0.407, p < 0.001). In the fully adjusted regression model, health literacy remained an independent predictor of chronic disease self-efficacy. Higher educational attainment and better self-rated health were also significantly associated with greater chronic disease self-efficacy. Conclusions: Older adults with multimorbidity demonstrated varying levels of health literacy and chronic disease self-efficacy. Higher health literacy was independently associated with greater confidence in managing chronic conditions. These findings support the integration of health-literacy-responsive interventions into primary healthcare to strengthen chronic disease self-management and improve person-centred care among older adults with multimorbidity. Full article

Background/Objectives: While there is an existing body of quantitative data on the psychological and mental burden of suicide-bereaved parents, further qualitative research is needed to explore suicide-bereaved mothers’ living experiences in specific sociocultural contexts, especially in Southern Europe and the Eastern Mediterranean. Given the persistent stigma surrounding suicide in these societies, and the fact that previous research has often overlooked mothers’ perspectives in favor of broader samples of bereaved parents, we explored the psychosocial needs of Greek-speaking suicide-bereaved mothers in the Republic of Cyprus, and their experiences in accessing formal mental healthcare support. Methods: An inductive, secondary content analysis of qualitative data collected through personal semi-structured interviews with ten suicide-bereaved mothers was employed. Results: Participants’ psychosocial needs centered around a “persistent orientation towards protection,” encompassing three interconnected domains: (1) self-protection and the need for acceptance by shielding themselves from stigma, social judgment, and emotional disintegration, (2) ensuring a safe and protective environment for the surviving family by safeguarding the psychological well-being and cohesion of surviving family members, and (3) protecting the posthumous dignity and memory of the deceased child. Rather than seeking formal support, participants overwhelmingly avoided mental health services, citing a lack of empathy, cultural misunderstanding, and fear of further stigmatization. Mental health professionals were often perceived as inadequate or even harmful, undermining participants’ need for protective attitudes, self-reliance and self-respect during bereavement. These responses reflected how stigma and gendered social expectations surrounding suicide shaped participating bereaved mothers’ disengagement from the healthcare system, despite their intense psychological needs. Conclusions: These findings underscored how gendered social expectations, combined with the stigma surrounding suicide, created significant psychosocial barriers to mental health care for women navigating traumatic grief, particularly in sociocultural contexts where suicide remains highly stigmatized. Full article

Background/Objectives: Although companion animals are recognized as reservoirs of antimicrobial resistant enterococci, it remains unclear whether antimicrobial resistance differs between clinical and commensal isolates, particularly for antimicrobials reserved for human medicine. This study compared antimicrobial susceptibility profiles of clinical and commensal E. faecalis and E. faecium isolates from dogs and cats, focusing on antimicrobials reserved for human medicine under European regulation and EMA/AMEG classification. Methods: A total of 99 isolates (49 E. faecalis and 50 E. faecium) collected between 2022 and 2025 were analysed by broth microdilution, gradient diffusion, and disk diffusion methods. Antimicrobial resistance patterns were compared according to bacterial species and isolate origin. Results:E. faecium exhibited significantly higher resistance rates than E. faecalis, particularly to ampicillin, fluoroquinolones, erythromycin, nitrofurantoin, and vancomycin. Multidrug resistance was widespread, affecting all clinical E. faecium isolates and 72.2% of commensal E. faecium, whereas corresponding proportions in E. faecalis were 64.1% and 40.0%, respectively. Clinical E. faecium isolates showed significantly higher resistance than commensal isolates to antimicrobials commonly used in veterinary medicine, including ampicillin, fluoroquinolones, erythromycin, gentamicin, streptomycin, and tetracycline. Conversely, no significant differences were observed for antimicrobials reserved for human medicine, including linezolid, vancomycin, teicoplanin, tigecycline, daptomycin, rifampicin, and quinupristin/dalfopristin. Conclusions: The higher resistance observed in clinical isolates to veterinary antimicrobials is consistent with the selective pressure exerted by antimicrobial use in veterinary clinical settings, whereas resistance to human-reserved agents may reflect epidemiological processes that are independent of antimicrobial exposure in veterinary clinical settings. Continuous integrated One Health surveillance is essential to monitor the emergence and dissemination of these resistance phenotypes. The AMR profiles observed in companion animals further support the need for integrated One Health surveillance, combining veterinary, human, and environmental data to better understand the emergence and dissemination of resistant enterococci. Full article

Background: Emergency medical services (EMS) personnel experience high rates of psychological distress yet demonstrate low utilization of mental health services. Factors associated with actual service use—rather than intentions or attitudes—are not well understood. Methods: Using secondary data from 36,697 licensed Florida EMTs and paramedics collected during the 2022 licensure renewal process, logistic regression models evaluated the relative contributions of workplace factors, attitudinal variables, trauma exposure, and mental health symptoms in their association with service utilization. Results: Psychological symptoms, particularly anxiety and depression, were the strongest factors associated with help-seeking. Peer support emerged as one of the few system-level factors associated with increased service use, even after accounting for symptom presence. Stigma-related variables showed weaker and, in some cases, counterintuitive associations. Suicidality and substance use were modestly associated with help-seeking beyond core symptom variables. Findings were consistent among trauma-exposed personnel. Discussion: Results are consistent with the potential value of early identification, routine symptom screening, and integrated, system-level supports such as peer support and access to confidential, occupationally competent care. Full article

Gastrointestinal (GI) parasitic infections are still a major concern for cattle health and productivity in tropical and subtropical regions. However, epidemiological data on GI parasitism in cattle from western Thailand remain limited, particularly in border areas with frequent animal movement. This study focuses on establishing the prevalence of gastrointestinal parasitic infections and identifies its related risk factors among the cattle in Kanchanaburi province, western Thailand. Cross-sectional study was performed from December 2022 to January 2023 involving 153 cattle from the following three study populations: local cattle from Thong Pha Phum district, Sangkhlaburi district, and cross-border cattle imported from Myanmar. Fecal samples were examined using both simple flotation and formalin-ethyl acetate sedimentation techniques, and data on animal and management factors were collected through questionnaire surveys. Overall, 35.9% (55/153) of the cattle had at least one GI parasite species positive. Six parasite taxa were identified, with Strongyle-type nematodes being the most frequently detected (26.1%), followed by other helminth parasites. The prevalence of infection and parasite diversity increased progressively in cattle populations located closer to the Thai–Myanmar border, suggesting that this region may represent a potential hotspot for GI parasite transmission. From a One Health perspective, these findings highlight the potential for some helminths to circulate across animal, human, and environmental interfaces. The presence of 1.3% for both Capillaria spp., Trichuris spp. and 0.7% of Fasciola spp. suggests possible zoonotic transmission pathways, particularly via the fecal-oral route. Although 93.5% of cattle had reportedly received anthelmintic treatment, no apparent protective effect was observed. These findings highlight that the Thai–Myanmar border acts as a hotspot for parasite transmission and the need for improved parasite control strategies in this region, alongside integrated One Health surveillance linking animal, human, and environmental health in this cross-border region. Full article

Background/Objectives: Excess mortality (EM) is a key indicator for assessing the population-level impact of large-scale health crises, particularly when cause-of-death ascertainment is incomplete or delayed. However, EM estimates are sensitive to methodological decisions, highlighting the need for operationally feasible approaches suitable for routine public health surveillance. Methods: We conducted time series analyses of routinely collected mortality data from a subnational setting in northern Mexico. Deaths recorded between 2015 and 2022 were grouped into 28 cause-of-death categories. Expected deaths during the COVID-19 pandemic period (March 2020–July 2022) were estimated using negative binomial regression models fitted to pre-pandemic data (2015–2019), incorporating a linear trend and monthly indicators to account for long-term trends and seasonality. Newey–West standard errors were used to address serial correlation and heteroskedasticity. EM was defined as the difference between observed and expected deaths. Results: An estimated 14,482 excess deaths were observed during the pandemic period, corresponding to a 30.9% increase relative to expected mortality. Time-series models identified four distinct peaks of excess mortality coinciding with major pandemic waves. Although COVID-19 accounted for most excess deaths, among non-COVID causes, only ischemic heart disease and diabetes showed statistically significant excess mortality among major non-communicable diseases after baseline adjustment. However, additional categories—including non-transport-related accidents, ill-defined causes, and other endocrine, metabolic, hematological, and immunological diseases—also exhibited statistically significant excess mortality. For several causes, increases in crude mortality did not translate into statistically significant excess mortality. Conclusions: Negative binomial time series regression provides an implementable framework for estimating EM, underscoring the importance of expected mortality estimation for understanding population-level mortality dynamics during health emergencies. Full article

Background and Objectives: Individuals with heroin-related opioid use disorder are at high risk of poor oral health and impaired oral health-related quality of life (OHRQoL). However, data on the determinants of OHRQoL in this population remain limited. This study aimed to assess oral health status and OHRQoL and to identify key predictors of OHRQoL among hospitalized patients with heroin-related opioid use disorder. Materials and Methods: A cross-sectional study was conducted among 97 hospitalized patients with heroin-related opioid use disorder. Data were collected through structured interviews and clinical oral examinations, including the Decayed, Missing, and Filled Teeth (DMFT) index and the Simplified Oral Hygiene Index (OHI-S). OHRQoL was assessed using the Oral Health Impact Profile-14 (OHIP-14). Spearman correlation and multiple linear regression analyses were performed to examine associations and identify predictors of OHRQoL. Results: Participants had poor oral health, with high DMFT (19.1 ± 6.1) and OHI-S (2.0 ± 1.2) scores. OHRQoL was markedly impaired, with a mean OHIP-14 score of 29.6 ± 7.0, particularly in the psychological and social domains. OHIP-14 scores were strongly correlated with DMFT (r = 0.754, p < 0.001) and OHI-S (r = 0.552, p < 0.001). Longer duration of heroin use was associated with higher DMFT scores, poorer oral hygiene, and greater OHRQoL impairment. Multiple linear regression analysis identified unstable housing/homelessness (β = 0.166, p = 0.012), DMFT (β = 0.624, p < 0.001), and OHI-S (β = 0.272, p = 0.007) as significant predictors of poorer OHRQoL. Conclusions: Individuals with heroin-related opioid use disorder experienced substantial oral health burden and impaired OHRQoL, strongly associated with caries experience, poor oral hygiene, and housing instability. These findings highlight the need to integrate prevention-oriented dental care into addiction treatment services and to address the broader social determinants of oral health. Full article

To assess the environmental impact of uranium mining operations in southern Kazakhstan, the elemental and radionuclide composition of soil samples collected from settlements in the Kyzylorda Region was investigated. The analysis was carried out using X-ray fluorescence (XRF) and gamma-ray spectrometry. Mean concentrations and variation ranges were determined for 28 chemical elements, including uranium, lead, antimony, and gamma-emitting radionuclides such as ¹³⁷Cs, ⁴⁰K, ²³²Th, ²³⁸U, ²²⁶Ra, ²¹⁰Pb, and ²⁴¹Am. The analysis of the specific activities of the artificial radionuclides¹³⁷Cs and²⁴¹Am was carried out in order to assess the influence of the Semipalatinsk Test Site on the soils of the study area. Based on the obtained data, heavy metal pollution indices, ecological risk indices, and radiological parameters were calculated to evaluate the potential environmental and human health impacts. Most elements were present at levels below average crustal abundances, suggesting limited anthropogenic influence. Slight exceedances for uranium, lead, and antimony are likely associated with regional geochemical features. Radiological assessment indicated that the radiation environment remains within internationally accepted limits. The lifetime cancer risk values for exposure of humans to natural radionuclides²²⁶Ra, ²³²Th, ⁴⁰K and ¹³⁷Cs from soil at 1 m above ground level ranged from0.19 × 10⁻³ to0.30 × 10⁻³, with an average of0.24 × 10⁻³. Nearly all sampling points remained below the risk threshold of 0.29 × 10⁻³, indicating minimal radiological hazard. The carcinogenic risk remained within the acceptable regulatory range for both adults (2.0 × 10⁻⁵) and children (4.4 × 10⁻⁵), whereas the non-carcinogenic hazard index for children (1.3) slightly exceeded the screening threshold of 1. This finding identifies children as the most sensitive receptor group under the conservative assumptions of the applied screening methodology. The study demonstrates the applicability of combined chemical and radiometric methods for comprehensive environmental assessments in uranium mining regions. The results are of interest both in terms of methodology and in understanding the local geochemical and radiological landscape. Full article

The current study aims to assess the effects of coated sodium butyrate (CSB) on the weaning transition of White King pigeons. A total of 336 1-month-old White King pigeons were assigned randomly to four groups, including the Control group fed basal health sandand without CSB and test groups fed the basal health sand with 0.1%, 0.2%, and 0.4% CSB, respectively. The results showed that, compared with the Control group, the average daily feed intake (ADFI) was significantly increased in the 0.1% and 0.2% CSB groups (p < 0.05). The 0.1% CSB group exhibited a higher immune organ index (IOI) than the Control group (p < 0.05). The total protein (TP) and albumin (ALB) levels in the 0.1% CSB and 0.4% CSB groups significantly increased compared with the Control group (p < 0.05). In contrast, the 0.2% CSB group exhibited lower serum ALB, TP, and total cholesterol (TC) levels; TNF-α and IL-6 concentrations were reduced compared with the other groups (p < 0.05), and the 0.4% CSB group showed significantly increased serum TNF-α, IL-6, and D-lactic acid levels (p < 0.05). The ratio of villus height to crypt depth (VH/CD) of the jejunum (p < 0.05) was significantly increased in the 0.2% CSB group. In addition, the CD and VH/CD of the ileum were significantly increased in the 0.1% CSB group (p < 0.05). Firmicutes was the predominant phylum across all treatment groups, while Bacteroidota showed a more sensitive response to CSB supplementation. The 0.1% CSB group showed a significant enrichment of Oscillospiraceae and Muribaculaceae, fiber-fermenting, SCFA-producing taxa, Enterobacterales and Klebsiella, suggesting CSB-mediated alterations in luminal oxygen tension that favor the coexistence of facultative and obligate anaerobic taxa. Collectively, these data revealed that CSB supplementation efficiently improves growth performance and intestinal health of weaning pigeons by ameliorating the intestinal environment. Full article

Over the past few decades, South Africa has experienced recurrent drought events of varying intensity. The Musina Local Municipality is particularly vulnerable due to a semi-arid climate, erratic rainfall, and rising temperatures which collectively contribute to heightened environmental stress. This study analyzed drought spatiotemporal patterns, livelihood impacts, and associated coping strategies in Musina from 1991 to 2023. Adopting a mixed-method approach, the research integrated quantitative climate data from the Copernicus Climate Data Store with qualitative insights gathered through semi-structured questionnaires administered to local community members. Drought frequency and distribution were examined using rainfall anomalies, temperature trends, and the Standardized Precipitation Evapotranspiration Index (SPEI). With more than 15 drought events recorded between 1991 and 2023, the findings indicate that Musina experiences recurrent drought episodes including major drought events in 1991–1992 and 2015–2016, characterized by rising temperatures that intensify evapotranspiration and exacerbate water scarcity. SPEI results highlight repeated drought conditions over the study period, with over 14 identified episodes and variable recovery periods, while notably negative values during major events (1991–1992 and 2015–2016) reflect severe moisture deficits associated with elevated temperatures. These climatic shifts have significantly undermined agricultural productivity, livestock health, and household water security, thereby threatening overall livelihood stability. More than 50% of the households experienced water shortages, with 17% reporting crop losses and 17% livestock mortality. While the study identified various coping mechanisms—such as reliance on boreholes, government water aid, conservation agriculture, and livelihood diversification—community vulnerability remains high due to limited water infrastructure and ongoing climate variability. These results contribute to efforts to reduce localized drought risk by providing a detailed understanding of drought dynamics and the effectiveness of community-based adaptation strategies in Musina. Full article