Search Results (2,512)

This study aims to explore the effectiveness of a problem-solving method, grounded in Pólya’s methodological proposal and complemented by a STEM electronic educational kit, in strengthening the research competences of newly admitted nursing students at a public university in Peru. The research followed a quantitative approach using a quasi-experimental design with pre- and post-test measurements applied to a group of students who addressed real community health issues in their local context. The intervention was structured into four phases: understanding the problem, planning activities, execution, and reviewing the solution. The results showed significant improvements across all phases, particularly in problem analysis, autonomous planning, technological application, and critical thinking. The Wilcoxon test yielded p-values < 0.05 in all evaluated dimensions, allowing the rejection of the null hypothesis and confirming the effectiveness of the intervention. It is concluded that the problem-solving method, when integrated with relevant technological tools, is an effective strategy to promote formative research in vulnerable educational contexts. Moreover, it aligns with the Sustainable Development Goals—specifically SDG 4 (Quality Education) and SDG 10 (Reduced Inequalities)—by fostering inclusive, equitable, and contextually relevant education through socially and technologically meaningful innovation. Full article

This study investigates the impact of the COVID-19 pandemic on clinically diagnosed depression in South Korea, focusing on gender disparities and structural risk factors such as job loss and childcare burden. Although mental health inequalities have received growing attention during the pandemic, most existing research relies on self-reported survey data with inherent limitations. To address this gap, we utilized administrative health data from a 2% stratified random sample of the total population (N = 297,368) in the National Health Insurance Database, focusing on employed individuals without a prior history of depression. Multivariable Cox proportional hazard regression revealed that women had significantly higher risks of depression than men, particularly among those in their 20s to 40s, those who experienced job loss, those who had children aged 7–9, and those who belonged to high-income groups. These findings suggest that the intersection of employment instability and caregiving responsibilities disproportionately affected women’s mental health during the pandemic. The results underscore the urgent need for gender-sensitive public health policies that expand childcare support, institutionalize flexible work arrangements such as telecommuting, and enhance access to targeted mental health services to reduce pandemic-induced gender disparities in mental health. Full article

In response to contemporary challenges such as the COVID-19 pandemic, climate change, armed conflicts, and economic instability, healthcare systems worldwide are increasingly confronted with multifaceted and overlapping crises—collectively referred to as polycrisis. These interconnected threats amplify one another, placing unprecedented strain on healthcare infrastructure, governance, and equity. The COVID-19 pandemic alone led to an estimated 16.3 million missed hospitalizations in 2020 and 14.7 million in 2021, revealing systemic vulnerabilities and deepening social inequalities. Armed conflicts, such as in Syria and Gaza, have devastated healthcare access. In Gaza, by mid-2024, 85% of the population had been forcibly displaced, with only 17 of 36 hospitals partially functioning and over 885 healthcare workers killed. Climate change further exacerbates health burdens, with over 86% of urban residents globally exposed to harmful air pollution, contributing to 1.8 million deaths annually. This study introduces a novel perspective by applying social epidemiology to the analysis of polycrisis. While the existing literature often emphasizes political or economic dimensions, our approach highlights how overlapping crises affect population health, social vulnerability, and systemic resilience. By integrating sociodemographic and environmental data, social epidemiology supports crisis-resilient care models, targeted interventions, and equitable health policies. We argue for a stronger mandate to invest in data infrastructure, enhance surveillance, and embed social determinants into health system responses. Full article

Background: The COVID-19 pandemic magnified long-standing health disparities in the United States, particularly among rural, disadvantaged populations. These communities experience greater barriers to healthcare access, a higher prevalence of chronic illness, and increased vaccine hesitancy factors that collectively contribute to poorer health outcomes. Methods: This narrative review examines rural–urban disparities in COVID-19 vaccine uptake and their impact on mortality, with a focus on cardiovascular disease (CVD) outcomes. We synthesized the peer-reviewed literature, CDC data, and U.S. Census reports to assess factors contributing to vaccine hesitancy, vaccination coverage, COVID-19-related mortality, and CVD mortality trends. Results: Rural residents were less likely to initiate COVID-19 vaccination, showed greater vaccine hesitancy, and experienced higher rates of both COVID-19 and CVD mortality. These disparities were further driven by safety concerns surrounding mRNA technology, misinformation, infrastructural barriers, and sociodemographic factors including political affiliation, education, poverty, and religion. Notably, pre-existing CVD increased vulnerability to severe COVID-19 outcomes in rural communities. Conclusions: Expanding vaccination efforts and improving healthcare infrastructure are essential for addressing these widening health inequities. Future public health strategies should prioritize culturally tailored interventions and rural-specific outreach to reduce vaccine hesitancy and improve mortality outcomes in underserved populations. Full article

Tuberculosis (TB) remains a critical public health issue in Johannesburg, South Africa, driven by a complex interplay of individual, social, and structural factors. This study assessed the syndemic relationship between these determinants to understand their collective impact on TB burden and treatment outcomes. A cross-sectional survey was conducted among TB patients attending selected clinics, examining behavioural risks (e.g., smoking, alcohol use, HIV co-infection), social conditions (poverty, overcrowding, stigma), and structural challenges (access to healthcare, migration status). The results revealed a significant co-occurrence of TB and HIV (56.1%), alongside high rates of smoking (33.1%) and alcohol use (45.2%). Unemployment (50.2%), inadequate housing, and limited healthcare access, particularly for undocumented migrants (26.2%), were also prominent. Factor analysis demonstrated a syndemic interaction between behavioural and social determinants, underscoring the compounded vulnerability of affected populations. The findings highlight the necessity of integrating medical interventions with social and structural reforms. Recommendations include TB-HIV co-management, substance abuse programmes, improved housing, and inclusive healthcare access. A multisectoral approach addressing both health and socioeconomic inequalities is critical for comprehensive TB control in urban South African contexts. Full article

Preterm birth is a leading cause of perinatal morbidity and mortality and is particularly prevalent among socially disadvantaged female populations. This quantitative, cross-sectional study aimed to explore the prevalence of preterm birth in three segregated Roma communities in Hungary and to identify health behavior and care factors associated with its occurrence. In our study, preterm birth was defined as delivery before 37 completed weeks of gestation (i.e., <259 days). Data were collected from 231 Roma women living in three municipalities of Szabolcs-Szatmár-Bereg County, one of Hungary’s most disadvantaged regions, using a structured interview questionnaire. The participants were women aged 18–65 years. Of these, 209 had been pregnant at least once in their lifetime. The questionnaire covered socio-demographic characteristics (age, level of education, employment status, housing conditions, marital status), health behaviors (smoking, alcohol consumption, drug use, vitamin supplementation, other substance use), antenatal care attendance, and birth outcomes (preterm birth, gestational age, low birth weight, newborn status). Statistical analyses included descriptive statistics, chi-square tests, and binary logistic regression with significance set at p < 0.05. Preterm birth was significantly more common among women who smoked, consumed alcohol or drugs during pregnancy, or had vaginal infections. Drug use showed the strongest association with a 22-fold increase in risk, followed by alcohol (nearly fivefold), smoking (over threefold), and infections (threefold). Although non-attendance at antenatal care was associated with increased risk, this relationship was not statistically significant. In the multivariate logistic regression model, alcohol consumption (OR = 1.744, p < 0.01), smoking (OR = 2.495, p < 0.01), drug use (OR = 25.500, p < 0.001), and vaginal infections (OR = 4.014, p < 0.01) during pregnancy were independently associated with an increased risk of preterm birth, whereas folic acid supplementation (OR = 0.448, p < 0.05) showed a significant protective effect. These findings highlight that preterm birth is intricately linked to socioeconomic disadvantage and adverse health behaviors. Culture-specific, community-based prevention strategies are essential to reduce perinatal risks in marginalized populations. Full article

Background: While Asian American individuals are well represented in medical schools in the United States, their advancement to senior positions within the field of orthopaedic surgery is disproportionately low. This underrepresentation not only limits diversity in leadership but also constrains the development of people-centred systems that reflect the needs of an increasingly diverse patient population. Objectives: This study systematically examines Asian American representation across the orthopaedic surgery professional pipeline, focusing on disparities between training-level representation and advancement into both faculty and leadership positions., and framing these gaps as a health equity concern. Methods: A comprehensive literature search for peer-reviewed original research articles was conducted via PubMed, EBSCO Open Research, Wiley Online Library, Google Scholar, and ScienceDirect. The potential articles were screened against prespecified eligibility criteria, and risk of bias was assessed using the Newcastle–Ottawa Scale (NOS). Data were then systematically extracted and analysed. Results: This analysis included 20 research articles investigating Asian American representation in orthopaedic surgery. The results demonstrated an underrepresentation of Asian Americans in orthopaedic leadership positions despite improvements in training programme representation with subspecialty clustering in adult reconstruction and spine. Asian American surgeons were less likely to occupy academic and leadership roles than their non-Asian American peers. Across studies, underrepresentation was consistently observed, with effect size estimates indicating a substantial disparity (e.g., pooled risk difference = 0.19; 95% CI [0.12, 0.28]) in those studies reporting comparative outcomes. Similarly, while Asian Americans in residency programmes increased, this growth did not translate proportionally to faculty advancement. In contrast, Asian women face compounded barriers, particularly in subspecialties like spine surgery. These inequities undermine workforce inclusivity and may reduce cultural and linguistic concordance with patients. Conclusions: Despite having strong representation in orthopaedic training programmes, Asian Americans are disproportionately absent from leadership positions. This poses a challenge to equity in surgical education and patient-centred care. To promote equity in leadership, focused mentorship, clear promotion processes, and institutional reform are necessary to address structural barriers to career advancement, this will reflect the diversity of both the workforce and populations served. Full article

This study examines whether and how community schools’ integrated student support services (academic, socioemotional, health, and family support) contributed to improving whole-child/youth development and reducing systemic inequalities of students’ learning/wellness outcomes across New York State under the Every Student Succeeds Act (ESSA). Applying a quasi-experimental method with propensity score matching to the state’s 2018–2023 school survey and report card databases, it provides new evidence on the efficacy of community school programs on average and by subgroups (race/ethnicity, poverty, disability, English language learner, and housing status). The results of matched comparisons between community schools and non-community schools are mixed, after considering their differences in terms of student demographics and baseline conditions. Overall, community schools showed policy implementation fidelity with more state funding, policy-aligned practices, and school-based health centers/clinics. However, community schools had no discernable impacts on academic achievement and chronic absenteeism overall, except that the operation of school-based health centers was associated with a reduction in absenteeism. In contrast, community schools had more positive impacts on high school graduation rates, particularly among disadvantaged minority students; the impacts are attributable to policy-aligned practices, set-aside funding, and school-based health center dental programs. Educational policy and research implications are discussed. Full article

Work–life balance (WLB) in academia remains a challenge as a result of increasing workloads, precarious employment, and expectations of constant availability. The COVID-19 pandemic exposed these structural barriers to work–life balance in academia and also clearly showed the inequities related to hybrid and remote work for women, caregivers, and underrepresented minorities. This paper highlights the key factors that pose challenges to WLB in academia, how these challenges have been worsened by COVID-19, and what we can learn from pandemic times solutions to devise inclusive practices for long-term structural change. The methodology used in this paper is a critical review of 298 published articles. This review is structured as follows: The structural barriers, inequities, and workplace policies that impact academic WLB are first inventoried. Then, the lessons learned from the pandemic are studied by dividing the short-term disruptions from the permanent shifts. Finally, inclusive solutions, focusing on institutional boundary-setting, workload redistribution, hybrid work policies, and mental health support are presented. This paper makes three key contributions: (1) it provides an intersectional understanding of WLB, accounting for gender, caregiving, ethnicity, migration, and social class; (2) it frames COVID-19 as a driver for structural reform, rather than an anomaly; (3) it bridges WLB research and policy design, proposing actionable strategies for universities and policymakers. By placing equity and inclusion at the core of the analysis, this work advocates for systemic solutions that promote a sustainable academic environment aligned with principles of social justice. Full article

Background: The Amazon biome exhibits complex arboviral transmission dynamics influenced by accelerating deforestation, climate change, and socioeconomic inequities. Objectives/Methods: This study integrates official epidemiological records with socioeconomic, environmental, and climate variables by applying advanced geostatistical methods (Moran’s I, SaTScan, kernel density estimation) combined with principal component analysis and negative binomial regression to assess the spatiotemporal dynamics of dengue incidence and its association with socio-environmental determinants across municipalities in Pará state (eastern Brazilian Amazon) from 2010 to 2024. Results: Dengue incidence showed an overall decline but with marked epidemic peaks in 2010–2012, 2016, and 2024. The spatial analysis revealed significant clustering (Moran’s I = 0.221, p < 0.01), with persistent high-risk hotspots across most of Pará. Of 144 municipalities, 104 exhibited significant dengue risk, while 58 maintained sustained transmission. Negative binomial regression model identified key determinants: illiteracy, low urbanization, reduced GDP, and climate variables. Conclusions: Dengue transmission in the Amazon is driven by synergistic socio-environmental disruptions, necessitating intersectoral policies that bridge public health surveillance, sustainable land-use governance, and poverty alleviation. Priority actions include targeted vector control in high-risk clusters, coupled with integrated deforestation and climate monitoring to predict outbreak risks. The findings emphasize the urgency of implementing multisectoral interventions tailored to the territorial and socio-environmental complexities of vulnerable Amazonian regions for effective dengue control. Full article

Purpose: This systematic review aims to evaluate the utility of mobile health (mHealth) applications in uro-oncology, hereafter referred to as mHealth apps, specifically examining their potential to improve patient care, symptom management, and communication in genitourinary cancer treatment. Methods: Adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a comprehensive systematic review was conducted focusing on mHealth applications for patients with genitourinary cancers. Results: The review analyzed 29 studies, which revealed that mHealth apps demonstrated potential in uro-oncology patient care. Key findings included effective symptom monitoring, enhanced decision support, and improved patient education. The applications were found to be feasible and well-accepted by patients. However, implementation challenges were identified, including technical barriers, variations in app quality, and unequal access to digital healthcare technologies. This review systematically categorized mHealth interventions into three functional domains—symptom management, decision support, and personalized care—and identified critical implementation barriers including digital inequity, high risk of bias, and app quality variability. Conclusions: Mobile health applications demonstrate promise in revolutionizing uro-oncology care. Future research should prioritize developing comprehensive applications that address a broader range of urological cancers, enhance patient–clinician communication, and undergo rigorous evaluation. Collaborative efforts among researchers, clinicians, and app developers are crucial to overcome existing limitations and maximize the potential of these innovative healthcare tools. Full article

This study aimed to understand, through the voices of patients, the factors that contribute to inequality and inequity in oral healthcare and their implications for patient safety. A qualitative study was performed using a Grounded Theory approach (GT) through 13 in-depth interviews with a flexible design, recorded and transcribed verbatim for study purposes. Open and axial coding and analysis categories were generated, and a conceptual and explicative framework was established. Ethical approval was obtained. The main findings highlighted how individual, social, and contextual factors significantly influence the materialization of risks and failures in oral healthcare, ultimately affecting patient safety in dental practice. These factors include individual factors, the relationship between professionals and patients, and failures in healthcare service provision. Participants’ discourses showed examples of inequities, such as gender, socioeconomic gradient, educative level, type of healthcare system, discrimination, stigmatization, and othering-otherness, and their effect on dental care and dentistry safety. Health inequities should be tackled in a preventive and proactive manner through the effective integration of intersectoral policies and strategies. This approach would enhance oral health, make patient safety a fundamental pillar of dental care, uphold human dignity, and strengthen trust in the healthcare system. Full article

Period poverty is a broad and complex issue that intersects with various areas, including health, education, infrastructure, and human rights, among others, affecting countless women and girls around the world. Despite remarkable technological, social, and economic advances this century, menstruation remains a taboo subject, which leads to widespread misinformation and stigma. Prejudice and a lack of access to knowledge and essential sanitation resources, such as clean water, hygiene products, and safe private spaces, heighten the vulnerability of those affected. Integrated and multisectoral approaches that involve legislature, health, education, and sanitation are necessary to face this public health issue effectively. These efforts involve developing and implementing comprehensive plans that unite government, society, and the private sector. Some examples of these actions include making information about menstruation and menstrual health available in schools, cutting taxes on feminine hygiene products, improving basic sanitation, building decent public restrooms, and providing free sanitary pads in schools and workplaces. These initiatives have the potential to promote menstrual health and dignity, ensuring that people who menstruate can manage their periods in healthy, safe, and supportive environments. This review aims to shed light on menstrual poverty in Brazil as a global issue and a human rights violation, especially when it comes to the rights to health, education, and dignity. It stresses that efforts to end this social stigma and align with the 2030 Agenda, which seeks to eliminate poverty and inequality worldwide, and provides a plan of action to tackle this stigma. Full article

Climate change has magnified health disparities across the Southern African Development Community (SADC) region by destabilizing the critical natural systems, which include water security, food production, and disease ecology. The IPCC (2007) underscores the disproportionate impact on low-income populations characterized by limited adaptive capacity, exacerbating existing vulnerabilities. Rising temperatures, erratic precipitation patterns, and increased frequency of extreme weather events ranging from prolonged droughts to catastrophic floods have created favourable conditions for the spread of waterborne diseases such as cholera, dysentery, and typhoid, as well as the expansion of vector-borne diseases zone also characterized by warmer and wetter conditions where diseases like malaria thrives. This study employed a comparative analysis of climate and health data across Malawi, Zimbabwe, Mozambique, and South Africa examining the interplay between climatic shifts and disease patterns. Through reviews of national surveillance reports, adaptation policies, and outbreak records, the analysis reveals the existence of critical gaps in preparedness and response. Zimbabwe’s Matabeleland region experienced a doubling of diarrheal diseases in 2019 due to drought-driven water shortages, forcing communities to rely on unsafe alternatives. Mozambique faced a similar crisis following Cyclone Idai in 2019, where floodwaters precipitated a threefold surge in cholera cases, predominantly affecting children under five. In Malawi, Cyclone Ana’s catastrophic flooding in 2022 contaminated water sources, leading to a devastating cholera outbreak that claimed over 1200 lives. Meanwhile, in South Africa, inadequate sanitation in KwaZulu-Natal’s informal settlements amplified cholera transmission during the 2023 rainy season. Malaria incidence has also risen in these regions, with warmer temperatures extending the geographic range of Anopheles mosquitoes and lengthening the transmission seasons. The findings underscore an urgent need for integrated, multisectoral interventions. Strengthening disease surveillance systems to incorporate climate data could enhance early warning capabilities, while national adaptation plans must prioritize health resilience by bridging gaps between water, agriculture, and infrastructure policies. Community-level interventions, such as water purification programs and targeted vector control, are essential to reduce outbreaks in high-risk areas. Beyond these findings, there is a critical need to invest in longitudinal research so as to elucidate the causal pathways between climate change and disease burden, particularly for understudied linkages like malaria expansion and urbanization. Without coordinated action, climate-related health inequalities will continue to widen, leaving marginalized populations increasingly vulnerable to preventable diseases. The SADC region must adopt evidence-based, equity-centred strategies to mitigate these growing threats and safeguard public health in a warming world. Full article

The COVID-19 pandemic exacerbated mental illness, accelerated cognitive decline, and deepened social inequalities. In low and middle-income countries (LMIC) such as Panama, it is unclear as to whether, and to what extent, the pandemic lockdowns affected cognitive, mental, and physical health of older adults. This study investigated changes in cognitive function, mental health, and physical health in a sample of Panamanian older adults assessed before and during the pandemic, and examined whether sociodemographic variables were associated with cognition and mental health. Participants completed in-person interviews between 2018 and early 2020 and a follow-up telephone interview between February and May 2021. Repeated measures analyses showed no significant changes in cognitive function or depression; however, participants reported fewer chronic illnesses. Linear regression analysis indicated that higher cognitive function during the pandemic was associated with younger age, higher education, and having sufficient income. An attrition analysis compared participants who completed both interviews to those who were lost to follow-up, revealing that participants who dropped out of the study had lower socioeconomic status and greater impairment at baseline. These findings highlight the need for targeted support for vulnerable older adults during public health crises. Full article