Search Results (4,185)

Background: Black communities in England experience health inequalities rooted in structural racism, socioeconomic deprivation, and systemic exclusion from health systems that fail to address their specific needs. Digital health technologies offer potential for reducing these disparities, yet the existing evidence reveals an absence of culturally appropriate digital interventions designed with and for Black communities in England. Objective: To synthesise evidence on the structural and cultural determinants of health inequality affecting Black people in England and examine the potential of health apps for delivering culturally appropriate health promotion. Methods: This is a purposive, critical narrative literature review, not a systematic review; it does not aim for exhaustive or fully reproducible search coverage but for a structured, purposive synthesis of the evidence base relevant to four thematic domains. Purposive sampling was used to identify literature across the PubMed/MEDLINE, PsycINFO, Google Scholar, and policy databases. Findings were thematically synthesised around four domains: structural determinants of health inequality; cultural diversity and representation within Black communities; digital inclusion and health app access; and theoretical frameworks for culturally appropriate intervention design. Findings: Three intertwined problems underpin the absence of culturally appropriate digital health tools for Black communities: structural exclusion from health systems; methodological shortcomings of aggregating heterogeneous populations under broad ethnic labels such as BAME; and the systematic exclusion of Black people from digital health design processes. We propose a multi-layered theoretical framework combining the Health Belief Model, Beattie’s community development paradigm, and McCurdie’s user-centred design principles to guide the co-design of a culturally appropriate health promotion app. Conclusions: A culturally appropriate health promotion app for Black communities in England appears to be a promising and potentially feasible direction, provided it is developed through authentic community partnership and grounded in theories that account for structural determinants of health; this conclusion is conceptual, and no user research, prototype testing, or feasibility study has yet been undertaken to confirm it. These are identified as necessary next steps rather than results already achieved. Full article

Purpose: To characterize ophthalmology research output relative to disease burden and national economic capacity after accounting for population size. Methods: We analyzed Scopus publications, Global Burden of Disease disability-adjusted life years (DALYs), and World Bank economic and population data from 2011 to 2021. Negative binomial and Gamma models evaluated publication volume and positive citation-weighted impact, adjusting for DALYs, gross domestic product (GDP) per capita, population, disease category, and publication year. Results: Refractive disorders accounted for 45.4% of DALYs and 23.2% of publication volume; cataract, 44.7% and 29.8%; glaucoma, 5.2% and 30.6%; and age-related macular degeneration, 3.8% and 15.2%. High-income countries accounted for 11.8% of burden, 67.2% of publication volume, and 74.2% of citation-weighted impact; lower-middle-income countries accounted for 49.1%, 7.9%, and 6.8%, respectively. DALYs were not independently associated with publication volume (adjusted count ratio [aCR], 0.99; 95% confidence interval [CI], 0.98–1.01; p = 0.278), whereas GDP per capita (aCR, 4.47) and population (aCR, 13.99) were strongly associated (both p < 0.001). For positive citation-weighted impact, DALYs had a small association (adjusted ratio of means [aRM], 1.05), whereas GDP per capita (aRM, 2.86) and population (aRM, 4.96) were strongly associated (all p < 0.001). Conclusions: After accounting for population size, absolute disease burden was not independently associated with publication volume, whereas national economic capacity remained strongly associated with both outcomes. These patterns should inform research and service-delivery priorities. Full article

The global dissemination of antimicrobial resistance (AMR) poses a serious threat to public health, with wastewater increasingly recognized as an important reservoir and a dissemination interface for antibiotic-resistant bacteria (ARB), antibiotic resistance genes (ARGs), and mobile genetic elements (MGEs). Within the One Health framework, wastewater integrates human, animal, industrial, and environmental inputs, creating conditions that promote the selection, persistence, and dissemination of resistance determinants across interconnected ecosystems. Current advances in understanding the global wastewater resistome are reviewed, with particular emphasis on the ecological and anthropogenic drivers shaping its composition and dynamics, including antibiotic residues, co-selective contaminants, microbial community interactions, horizontal gene transfer (HGT), and wastewater treatment processes. The integration of wastewater-based genomic surveillance with epidemiological data and treatment processes is further examined to characterize resistance transmission across environmental, animal, and human interfaces. In addition, recent developments in molecular surveillance, including metagenomics and high-throughput sequencing, are critically assessed with emphasis on methodological harmonization, global monitoring disparities, and the need for standardized benchmarking frameworks to facilitate meaningful comparisons across regions. The review highlights current limitations in linking wastewater resistome profiles with clinical infection trends and discusses strategies for integrating environmental, genomic, and epidemiological data to improve and strengthen risk assessment and support the development of early-warning systems. Particular attention is given to the challenges of translating wastewater resistome data into actionable public health indicators and outlining future priorities for standardized surveillance, quantitative risk assessment, and integrated One Health mitigation strategies. Full article

Background: Dry eye disease (DED) and meibomian gland dysfunction (MGD) impose a significant global burden, yet clinical practice varies substantially between regions. This study investigated international trends in DED diagnosis and management among eye care practitioners (ECPs), with regional focus on South Africa (SA), the United Kingdom (UK) and the rest of the world (RoW; heterogeneous international respondents). Methods: An anonymised cross-sectional online survey was distributed to ECPs globally (May 2023–September 2024). In total, 383 participants from 31 countries were included in the analysis (SA n = 137; UK n = 112; RoW n = 134). Mann–Whitney U tests with Benjamini–Hochberg false discovery rate correction, chi-square tests and Kendall’s tau concordance were applied. Results: SA practitioners reported significantly lower confidence across all four DED domains than their UK and RoW counterparts (all q < 0.05; Cliff’s delta small-to-medium). Core diagnostic practices—case history (88.7%), fluorescein staining (79.4%) and tear break-up time (77.3%)—were globally consistent. UK practitioners showed greater recognition of blepharitis and higher uptake of lid massage, dietary modification and intense pulsed light. Advanced diagnostics received low reported importance globally. Conclusions: Significant regional disparities exist in practitioner confidence, diagnostic emphasis and therapeutic access. A tiered diagnostic framework is proposed to support equitable care, applying a universal core of assessments supplemented by advanced tools where resources permit. Full article

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