Search Results (4,411)

Background/Objectives: Immunization coverage in the Democratic Republic of the Congo (DRC) consistently falls short of global standards, placing the country among those with the highest prevalence of unvaccinated or “zero-dose” children. This study aimed to generate high-resolution (1 km × 1 km) geospatial estimates of coverage for the first to third doses of diphtheria–tetanus–pertussis vaccine (DTP1–3) and the first dose of measles-containing vaccine (MCV1), along with estimates of zero-dose and under-vaccinated children to support vaccination programming in DRC. Methods: We used Bayesian geostatistical modelling to integrate data from the 2023 Enquête de Couverture Vaccinale (ECV) survey with geospatial covariates and harmonized population datasets. The model generated vaccine coverage and dropout rates at 1 × 1 km resolution while accounting for spatial dependence and prediction uncertainty. Grid-level estimates were aggregated to health areas, health zones, and provinces using population-weighted averages, and combined with under-one population estimates to quantify zero-dose and DTP-under-vaccinated children. Results: The grid-level unconstrained coverage estimates (estimation over all land grid squares) showed substantial variability across the country (DTP1: 13.3 to 99.7%; DTP2: 12.3 to 96.8%; DTP3: 3.1 to 93.6%; and MCV1: 7.5 to 93.6%). In total, 56.4% of mapped health areas achieved DTP1 coverage above 80%, but this declined to 32% for DTP2, 15% for DTP3, and 8.3% for MCV1. Around 60.5% of the health zones achieved DTP1 coverage ≥ 80%, while only 2.7% fell below 40%, indicating that substantial disparities persist across these zones. Nationally, based on constrained coverage estimates (only areas with identified built settlements) applied to an estimated 4.2 million children under 1 year in 2024, 18.4% had not received DTP1, 20.7% were DTP-under-vaccinated (received DTP1 but not DTP3), and 46.8% remained unvaccinated for MCV1. Conclusions: The prevalence of large numbers of zero-dose children, together with increased dropout rates, underscores systemic issues in access and follow-up initiatives. These findings are critical for microplanning and targeted outreach to achieve equitable immunization coverage in line with the Immunization Agenda 2030’s goal of leaving no child behind. Full article

Background: Transparent measurement is essential when organizational capacity is compared across public health institutions. The supplied analytic dataset did not contain repeated annual scores or indicator-level evidence for the previously proposed five-domain maturity model. We therefore conducted a reproducible cross-sectional analysis limited to the variables available in the dataset. Methods: Twenty Romanian public health directorates (PHDs)—10 in counties with a university medical center (CU) and 10 in counties without one (FU)—were compared using structural indicators, eight binary COVID-19 re-sponse measures, and a composite capacity–response index. The index was the equally weighted arithmetic mean of four sample-normalized components: employees per 100,000 inhabitants, budget per capita, previous-crisis experience, and the number of documented COVID-19 measures. Results are presented as medians and interquartile ranges. Mann–Whitney U and Fisher exact tests were used, with Holm correction within comparison families. Results: The composite index was higher in CU than FU institutions (55.0 [38.0–66.3] vs. 22.0 [19.3–31.3]; U = 93.0; p = 0.0013; Holm-adjusted p = 0.0077; rank-biserial r = 0.86). CU institutions also had larger populations, more employees, larger total budgets, higher per capita budgets, more previous-crisis experience, and more documented response measures. Employees per 100,000 inhabitants did not differ significantly. After multiplicity correction, vaccination-center involvement and communication/education were more frequently documented in the CU group. Digital platforms were recorded for only two institutions and cannot be interpreted as a digital-maturity domain. Conclusions: The available data support descriptive evidence of institutional disparities associated with the university-center context, but they do not support causal inference or validation of a maturity model. The composite index should be treated as an exploratory, sample-dependent benchmarking measure pending prospective instrument development, documented scoring rules, independent assessment, and external criterion validation. Its group difference largely reflects the four constituent components, which should remain the primary basis for interpretation. Full article

This review examines how smart city technologies have influenced health equity in urban settings between 2019 and 2026, guided by a dual-lens framework that assesses both equity-related outcomes and the systemic factors enabling or constraining their realization. As cities increasingly turn to digital tools to strengthen healthcare delivery, it remains unclear whether these interventions narrow or widen existing health disparities. Drawing on interdisciplinary literature spanning public health, urban informatics, and digital governance, this synthesis finds that smart health initiatives have improved healthcare access for some underserved populations, but their overall effect on health equity remains modest, inconsistent, and highly dependent on local context. Persistent structural obstacles, including digital divides, socio-economic inequality, and fragmented governance, continue to limit equitable implementation, while institutional barriers emerge as the most widespread challenge. Conversely, people-centered design, participatory governance, inclusive digital infrastructure, and equity-sensitive policy frameworks stand out as critical enablers of more just outcomes. The review further identifies an underexplored link between environmental sustainability and smart city technology, showing that AI-driven tools addressing emissions and urban environmental quality can indirectly support more equitable health systems. Overall, the findings underscore that technological innovation alone is insufficient; realizing the equity potential of smart cities requires deliberate integration of social justice, environmental sustainability, and collaborative governance into digital health strategy and practice. Full article

This study conceptualizes the youth observatory as an analytical and governance-oriented framework for examining social change, inequality, and youth development in urban contexts characterized by persistent structural disparities, using Cartagena, Colombia, as an empirical case study. Rather than conceptualizing the observatory solely as a technical mechanism for data collection and monitoring, the article argues that it should be understood as a platform for knowledge production capable of identifying emerging patterns in youth trajectories, institutional fragmentation, and evolving forms of civic engagement. The research employed a qualitative, descriptive, and interpretive design based on documentary analysis and a focus group comprising institutional stakeholders involved in youth-related initiatives. Findings indicate that the principal challenge in Cartagena is not the absence of youth-related information but the fragmentation, discontinuity, and weak articulation of existing institutional and knowledge-production systems. As a result, valuable evidence remains underutilized in policy formulation and institutional decision-making processes. The findings further demonstrate that education, labour-market integration, political participation, cultural access, mental health, and digital vulnerability should not be treated as discrete dimensions but rather as interconnected and mutually reinforcing components of contemporary youth experience. Ultimately, this article contributes to current debates by proposing the youth observatory as an analytical, interpretive, and governance mechanism that links evidence generation, public deliberation, and policy development. The study provides both empirical and conceptual foundations for the establishment of youth observatories in contexts marked by urban inequality, institutional fragmentation, and accelerated social transformation. Full article

Telemedicine is increasingly transforming pediatric cardiology by expanding access to specialized care, supporting early diagnosis, and improving longitudinal monitoring of children with cardiovascular disease. This narrative review summarizes current applications of digital health in pediatric cardiology, with emphasis on congenital heart disease, pediatric hypertension, and arrhythmia management. Tele-echocardiography represents one of the most established telehealth tools, enabling remote interpretation of fetal, neonatal, and pediatric echocardiographic images and improving referral appropriateness, particularly in peripheral or resource-limited settings. In infants with complex congenital heart disease, especially those with single-ventricle physiology during the interstage period, home monitoring programs using mobile applications, pulse oximeters, digital scales, and structured caregiver reporting may facilitate early recognition of clinical deterioration and reduce avoidable transfers. In non-congenital cardiovascular disease, home blood pressure monitoring can improve diagnostic accuracy by reducing white-coat effects and supporting repeated measurements in real-life settings. Smartphone-enabled electrocardiographic devices and wearable technologies may enhance detection of intermittent arrhythmias and strengthen outpatient management. Despite these advantages, challenges remain, including data fragmentation, limited pediatric validation of consumer devices, interoperability issues, privacy concerns, and socioeconomic disparities in technology access. Properly integrated telemedicine may promote more timely, equitable, and patient-centered pediatric cardiovascular care. Full article

Background: Population-level patterns in the real-world use of initial treatment combinations for glioblastoma (GBM) remain poorly characterized. Materials and Methods: We assessed temporal trends in treatment and survival among patients with GBM in the SEER registry. Guideline-concordant multimodal therapy was defined as cancer-directed surgery combined with radiotherapy and chemotherapy. Outcomes were further stratified by extent of resection, including gross total resection (GTR) versus subtotal resection. Results: Among 46,186 patients, 43.5% underwent GTR, 32.0% subtotal resection, and 24.5% no surgery; 71.8% received radiotherapy and 61.3% received chemotherapy. From 2000 to 2020, utilization increased for any surgery (OR/year 1.03, 95% CI 1.028–1.036), radiotherapy (1.01, 1.010–1.017), and chemotherapy (1.08, 1.081–1.088), whereas the likelihood of GTR vs. subtotal resection declined (0.92, 0.915–0.922). Triple therapy increased modestly (1.01, 1.005–1.012) but plateaued at 30%. Older age, non-lobar tumors, unmarried status, and lower income predicted lower odds of triple therapy; after adjustment, calendar year showed a marginal decline in the odds of receiving triple therapy (aOR/year 0.99, 0.99–1.00). Median overall survival improved from 6.0 to 10.0 months, with gains in fixed-time survival. Patients receiving multimodal therapy demonstrated the longest survival overall; within this group, GTR-based multimodal therapy was associated with longer survival than subtotal resection-based multimodal therapy across age strata. Conclusions: Guideline-concordant multimodal therapy was associated with the longest survival. GTR rates did not rise in recent years, and substantial disparities in the deployment of GTR-based multimodal therapy persisted. Efforts to expand equitable access and prioritize maximal safe resection are essential to achieve greater population-level survival gains. These differences should be interpreted cautiously, as SEER cannot distinguish appropriate clinical treatment selection from limited access to care or treatment ineligibility. Full article

Background: Long-acting monoclonal antibodies have become an important strategy for preventing respiratory syncytial virus (RSV) disease in infants. Nirsevimab is the first product for which substantial post-licensure implementation data are available, whereas real-world evidence on clesrovimab remains limited. Although nirsevimab has demonstrated high efficacy, its uptake varies considerably across countries, healthcare systems, delivery settings, and population subgroups. This World Association for Infectious Diseases and Immunological Disorders (WAidid) consensus document examines the policy, organizational, economic, and equity-related determinants that shape real-world implementation of long-acting monoclonal antibodies for infant RSV prevention. Methods: This study was conducted as a structured narrative review and WAidid expert consensus document. A structured literature search was performed in PubMed and Embase for English-language publications relevant to nirsevimab uptake and implementation, complemented by targeted review of surveillance reports, policy documents, and public health guidance from the ECDC, UKHSA, and CDC, as well as reference lists of selected publications. Eligible sources included observational and real-world implementation studies, systematic reviews and meta-analyses, economic evaluations, guidelines, policy statements, surveillance reports, and relevant narrative reviews. Evidence was synthesized qualitatively according to policy frameworks, financing and reimbursement, delivery pathways, demographic and socioeconomic determinants, and healthcare-system factors influencing uptake. No statistical software was used because no quantitative re-analysis or meta-analysis was performed. Results: Nirsevimab uptake was strongly influenced by national RSV prevention policies, particularly whether countries adopted universal infant monoclonal antibody programs, maternal RSV vaccination strategies, dual maternal–infant approaches, or targeted risk-based models. Universal, publicly funded programs integrated into neonatal care achieved the highest and most homogeneous coverage, especially when administration occurred before hospital discharge and was supported by registry-based recall systems for infants born outside the RSV season. In contrast, fragmented, outpatient-only, insurance-dependent, or partially reimbursed models were associated with lower, delayed, or more variable uptake. Additional determinants included product cost, reimbursement pathways, provider practices, caregiver awareness and health literacy, insurance status, income, race and ethnicity, geographic deprivation, and access to primary pediatric care. Most available evidence comes from high-income countries, limiting generalizability to low- and middle-income settings, where RSV burden is greatest and implementation constraints may differ. Conclusions: Successful implementation of long-acting monoclonal antibodies for infant RSV prevention requires more than regulatory approval and demonstrated efficacy. Equitable uptake depends on clear national recommendations, sustainable public financing, reliable product supply, integration into neonatal and primary pediatric care, proactive identification and recall of eligible infants, and targeted strategies to reduce socioeconomic and geographic disparities. Although many determinants identified in high-income settings are likely relevant globally, their feasibility, relative importance, and impact require dedicated evaluation in low- and middle-income countries. Full article

Psychological resilience is a key protective factor for mental health. Reducing inequalities in access to childhood experiential activities may foster resilience across socioeconomic backgrounds. However, Japan limits policies ensuring equitable access to such activities before entering elementary school. This cross-sectional study examined the association between exposure to experiential activities before entering elementary school and psychological resilience in Japanese individuals aged 15–39 years (n = 8000). Experiential activities were classified into nature-related, social, and cultural domains and by number and combination (none, any single, any two, and all three types). Psychological resilience was assessed using the 14-item Resilience Scale (Japanese version). Multivariable linear regression models were adjusted for demographic and socioeconomic covariates with Benjamini–Hochberg (BH) correction. Exposure to one or two activity domains was significantly associated with higher psychological resilience, except for the nature-related plus social activities combination. Exposure to all three domains showed the strongest association (β = 8.06, 95% confidence interval [6.73, 9.38], BH-adjusted p < 0.001). Therefore, early childhood experiential activities may promote psychological resilience, with persistent long-term effects. Implementing social policies to reduce the disparity in access may be a key strategy for promoting psychological resilience among Japanese individuals aged 15–39 years. Full article

The equitable allocation of health resources is fundamental to building healthy cities and advancing sustainable regional development. Using panel data for 122 county-level units in Hunan Province, China, from 2011 to 2022, this study constructs an evaluation index system for healthcare resource allocation and applies trend surface analysis, spatial autocorrelation, the Dagum Gini coefficient, and geographically and temporally weighted regression (GTWR) to examine the spatiotemporal evolution, equity, and driving factors of health resource allocation. The results show the following. (1) The level of health resource allocation in Hunan Province rose steadily, with the composite score increasing by 74%, yet a persistent spatial pattern of higher allocation in the east and north than in the west and south remained; hot spots clustered in Changsha, while cold spots concentrated in parts of Southern Hunan and Western Hunan. (2) Regional disparities narrowed gradually, and the Dagum decomposition identified transvariation density as the dominant source of inequality, with an average contribution of 53.58%, exceeding intra-group and inter-group differences. (3) The effects of the drivers exhibited marked spatiotemporal heterogeneity. Per capita GDP promoted health resource allocation mainly in developed regions, while urbanization exerted stronger positive effects in less-developed regions. The positive effect of per capita disposable income gradually shifted from less-developed to developed regions over time, and population density generally showed a positive effect, with stronger influences concentrated in the Greater Western Hunan region. This study contributes to a deeper understanding of how regional disparities and heterogeneous driving mechanisms shape health resource allocation, providing evidence for more adaptive and equitable healthcare governance. Full article

Background/Objectives: Diet is a key modifiable determinant of mental health; however, the prospective association between dietary patterns and new-onset suicidal ideation remains poorly elucidated. Methods: We enrolled 7480 participants from demolition resettlement communities in Jining, Zoucheng, and Weifang in Shandong Province, China, during 2021–2023. Data were used from two waves (baseline and 1-year follow-up) in this study. Dietary patterns were determined using principal component analysis based on food frequency questionnaire data. Incident suicidal ideation was assessed using the ninth item of the Patient Health Questionnaire-9. Multivariable logistic regression, stratified analysis, and sensitivity analysis were used to examine associations of different dietary patterns with the risk of incident suicidal ideation. Results: Among participants, 193 (2.58%) reported incident suicidal ideation. After full multivariable adjustment, the livestock–poultry–seafood dietary pattern was significantly inversely associated with incident suicidal ideation (Q3 vs. Q1; odds ratio = 0.67; 95% confidence interval: 0.45–0.97), whereas no significant association was identified when the pattern score was modelled continuously (OR = 0.92; 95% CI: 0.79–1.06; p = 0.239). Stratified analyses revealed stronger inverse associations among men, older adults, overweight individuals, and participants who did not use dietary supplements, but all interaction p-values exceeded 0.05, with no statistically confirmed subgroup disparities. After excluding participants with baseline depression, participants with baseline anxiety, and individuals with missing covariates in sensitivity analysis, the inverse association remained statistically stable. Conclusions: Our findings suggested a modest inverse association between higher adherence to the livestock–poultry–seafood dietary pattern and new-onset suicidal ideation in this observational cohort. Full article

Globally, physical activity is increasingly acknowledged as an effective strategy for combating non-communicable diseases (NCDs). However, there is a significant global disparity in the integration of sport sciences graduates (SSGs) into national health systems. This study assessed the professional roles of SSGs within healthcare systems and their association with NCD mortality across (n = 34) countries that met the selection criteria, using a cross-national, ecological, and cross-sectional design. Principal component analysis was conducted to reduce the dimensions of the correlated structural indicators. A pre-specified generalized linear model (Gamma family, log link) with HC3 robust standard errors estimated the association between SSG integration and age-standardized NCD mortality, alongside a descriptive analysis of public funding (national or subnational) for SSG services. The findings indicate that integrating SSGs into primary care was associated with approximately 23% lower age-standardized NCD mortality (rate ratio 0.77, 95% CI 0.63–0.94, p = 0.011; approximately 16% to 23% across model specifications) after adjusting for demographic and economic factors, with near-universal public funding (100% of integrated versus 24% of other countries; Fisher’s exact p < 0.001). To our knowledge, this is the first cross-national analysis to link the functional integration of SSGs into primary care with population NCD mortality, and this relationship remained consistent across multiple robustness checks. The implications suggest that functional integration and its public funding may represent promising policy approaches for strengthening preventive health services. Given the ecological, cross-sectional design, longitudinal studies are warranted to establish causality. Full article

Background/Objectives: Social determinants of health, including income, age, education, and gender, have been proposed to shape diabetes self-care capacity, yet their joint associations within Saudi Arabian primary healthcare populations remain poorly delineated. Anchored within the World Health Organization’s Commission on Social Determinants of Health framework and the Social Ecological Model, this study examined both the unadjusted and, via multivariable regression, adjusted associations of four sociodemographic factors with diabetes self-care management and health literacy among adults in southern Riyadh. Methods: A cross-sectional correlational design was employed with 92 adults with type 2 diabetes recruited from primary healthcare centers in southern Riyadh. Data were collected using the Arabic HLS-Q12 (health literacy) and SDSCA-Arabic (self-care management). Non-parametric Spearman rank-order correlations were conducted to examine bivariate associations. Multivariable linear regression was subsequently performed to estimate adjusted associations for each sociodemographic variable. Bivariate analyses were conducted using IBM SPSS Statistics for Windows, Version 25.0 (IBM Corp., Armonk, NY, USA), while multivariable linear regression analyses were performed using Python version 3.12 with the statsmodels package. Results: Income level showed significant, moderate positive unadjusted correlations with both self-care management (rs = 0.40, 95% CI [0.21, 0.56], p < 0.01) and health literacy (rs = 0.41, 95% CI [0.22, 0.57], p < 0.01). Age showed the strongest negative unadjusted correlation with self-care management (rs = −0.49, 95% CI [−0.63, −0.31], p < 0.01) and a significant negative correlation with health literacy (rs = −0.36, 95% CI [−0.53, −0.17], p < 0.01). Educational attainment was significantly associated with both self-care management (rs = 0.29, 95% CI [0.09, 0.47], p < 0.01) and health literacy (rs = 0.26, 95% CI [0.06, 0.44], p < 0.05). Gender did not reach statistical significance for either outcome. A multivariable model adjusting for all four sociodemographic variables confirmed that income and age remained independently associated with both outcomes, whereas education and gender did not. These findings do not establish independent or causal effects from the bivariate correlations alone; the adjusted results are reported separately below. Conclusions: Income and age were independently associated with both diabetes self-care and health literacy after multivariable adjustment, whereas education and gender were not. Findings support equity-focused nursing interventions and age-responsive diabetes education attentive to the social patterning of self-care disparities in southern Riyadh. Full article

Sex differences in intensive care unit (ICU) admission and treatment are reflected in the underrepresentation of women, poorer outcomes, and higher mortality risk. Historical exclusion from clinical trials has limited evidence for providing sex-specific care. This study aims to examine demographic and admission data from MIMIC-IV electronic health records to understand sex differences in ICU admissions, treatments, and outcomes, addressing critical gaps in care. Using the MIMIC-IV database of de-identified electronic health records, multiple correspondence analysis (MCA) was applied as an exploratory method to identify patterns and associations across categorical variables, including ICU type and demographic factors, for both heart failure (HF) and myocardial infarction (MI) patients. The study aimed to determine whether demographic or socioeconomic factors influenced assignment to specialty cardiac ICUs, and to evaluate differences in critical care delivery among patients with HF and MI. We observed that women were associated with admission to non-specialty ICUs, whereas men were admitted to specialty cardiac ICUs. MCA uncovered subgroup patterns showing that admission to cardiac ICUs is not uniform across sex, race, insurance, age, or marital status. There were also racial discrepancies noted in assignments to specialty ICUs, with minority groups being underrepresented in specialty ICUs. Marital status was a factor in admissions: widowed and single people were more frequently admitted to non-specialty ICUs. Length of stay (LOS) was comparable between HF and MI patients; however, chi-square analysis showed LOS being significantly associated with sex, age and marital status in HF, and with insurance status in the MI cohort. This data exploration illustrates systemic inequities in ICU allocation based on sex, race, and socioeconomic factors. Evidence of sex-based bias in the medical community highlights the need to address these inequalities in treatments and critical care to achieve better outcomes in the future. Full article

Rural men in Australia experience poorer health outcomes compared to their urban counterparts, often due to barriers such as limited access to services, cultural norms around masculinity, and geographic isolation. This study explored the motivations underlying rural men’s participation in a student-led health promotion activity conducted by first-year paramedicine students at a large agricultural event. Using semi-structured verbal surveys with 60 participants, qualitative data were collected and analysed through an inductive content analysis approach. Three key themes were created to represent the reasons men engaged in the activity and the impact it had: factors that encouraged engagement and built trust, meeting multiple needs, and giving to student learning for the future. Participants were drawn to the activity by a welcoming environment, peer encouragement, and the consistent presence of health promotion at the event. Health promotion provided an opportunity for men to access basic health assessments, reflect on their wellbeing, and engage in conversations about physical and mental health in a supportive setting. Many participants also expressed a strong motivation to contribute to student learning, particularly through experiential interactions that allowed students to develop technical and interpersonal skills. The findings highlight the value of embedding health promotion activities in familiar, community-based settings and demonstrate the multitude of benefits for rural men. This research contributes to the growing evidence supporting innovative, community-engaged models of work-integrated learning that address health disparities while enhancing student education and rural workforce development. Full article

Chronic illness burden is unevenly distributed across US counties, with some counties experiencing overlapping challenges related to healthcare access, socioeconomic disadvantage, environmental exposure, and chronic disease burden. Several multidimensional frameworks, including the Social Vulnerability Index, Environmental Justice Index, and Pandemic Vulnerability Index, have highlighted the importance of integrating multiple determinants of vulnerability. This study presents an interpretable machine learning-based multi-model framework for constructing and characterizing a county-level chronic illness vulnerability index. The framework integrates five domains: health burden, social conditions, environmental exposure, behavioral factors, and COVID-19-related measures. Four publicly available 2023 datasets were merged into a 12-feature dataset covering 2911 US counties, and a weighted domain score was used to classify counties into low-, medium-, and high-vulnerability categories. Because the class labels were constructed directly from these variables, the resulting categories should be interpreted as an author-defined composite index rather than an independent health outcome. Four machine-learning models, including Random Forest, XGBoost, MLP (Multilayer Perceptron), and TabNet, were evaluated individually and as a majority-vote ensemble. SHAP and LIME were independently applied to interpret model behavior, and the explainability analyses were restricted to model interpretation rather than causal inference. The ensemble reproduced the three-tier classification with an accuracy of 94.68% and an ROC-AUC (Receiver Operating Characteristic–Area Under the Curve) of 0.9974 on 583 held-out counties. Because the class label is a deterministic function of the same 12 features, these results should be interpreted as measures of index reconstruction rather than prediction of an independent outcome; a penalized multinomial logistic regression achieved 98.97% reconstruction accuracy, further indicating the largely linear structure of the index. COPD prevalence ranked first according to both SHAP and LIME across all four models, reflecting the weighting structure of the index rather than an independent causal effect. Six of the twelve features received identical rankings from both methods, and no feature moved more than three positions. The framework relies entirely on publicly available data and provides a reproducible approach for county-level characterization of chronic illness vulnerability. Full article