Search Results (1,300)

Objectives: The adoption of telemedicine, which is the delivery of healthcare services through digital platforms, exploded during the COVID-19 pandemic as a means to ensure the continuity of care while minimizing infection risks. While this modality improved access and convenience for many, disparities in adoption have emerged, particularly in rural and underserved populations. This study aims to evaluate the impact of telemedicine on patient satisfaction before and during the pandemic, with a focus on chronic disease management—notably hypertension—and to identify factors influencing the equitable adoption of telehealth. Methods and Procedures: This study used a mixed method approach, combining quantitative survey data and causal loop modeling to analyze patient satisfaction levels and the interplay between telehealth adoption, healthcare access, and demographic disparities. Patient-reported satisfaction data were collected in two time periods—before and during the pandemic. Causal modeling was used to explore systemic relationships between provider support, technology access, patient engagement, and health equity. Results: The findings revealed that telemedicine significantly enhanced healthcare access during the pandemic, with a notable increase in patient satisfaction scores. Patients with chronic conditions, especially those diagnosed with hypertension, reported the improved continuity of care and reduced geographic barriers. However, disparities in telehealth access were more pronounced in non-metropolitan areas and among older adults and minority populations. Causal analysis highlighted key enablers of telehealth success, i.e., provider support, digital literacy, and access to reliable internet and devices. Conclusions: Telemedicine presents a transformative solution for equitable healthcare delivery, especially in chronic disease management. Strategic efforts are needed to address adoption disparities and ensure the sustained and inclusive integration of telehealth after the pandemic. Full article

Background: Hepatitis presents a major health and economic challenge in Saudi Arabia, necessitating insight into its epidemiology, risk factors, and control measures. This review aims to synthesize current evidence on the epidemiology, risk factors, and prevention strategies for viral hepatitis in Saudi Arabia. It evaluates the effectiveness of existing interventions and proposes data-driven approaches to advance national hepatitis elimination goals. Methods: This study reviewed data from 2016 to 2024, sourced from PubMed, Google Scholar, ResearchGate, and ScienceDirect, focusing on hepatitis epidemiology and prevention in Saudi Arabia. Studies relevant to Saudi-specific trends and prevention strategies were included. Results: Saudi Arabia has achieved significant reductions in viral hepatitis prevalence, notably HBV (1.3%) due to universal infant vaccination (98% coverage), and HCV (0.124%) through the Saudi National Hepatitis Program (SNHP), which provides free DAAs (95% cure rate) and has screened 5 million people. However, challenges persist: HAV susceptibility is rising in adults (seroprevalence 33.1%), HDV affects 7.7% of HBV patients, and key risk factors include socioeconomic disparities (higher HAV/HEV in rural/low-income areas), intravenous drug use (30–50% of HCV cases), unsafe medical/cultural practices (e.g., Hijama), and limited healthcare access for migrants/rural populations. While interventions like water sanitation initiatives (58% HAV decline) and prenatal screening are effective, advancing elimination goals requires addressing gaps in HDV/HEV surveillance, outdated seroprevalence data, equitable treatment access (35% lower in rural areas), stigma reduction, and targeted strategies for high-risk groups to meet WHO 2030 targets. Conclusions: Saudi Arabia has made significant progress in hepatitis control through vaccination and public health efforts, but challenges persist. Strengthening healthcare systems, improving community engagement, and ensuring equitable access are key to sustaining elimination efforts. Full article

Introduction: The organization of mental health care is undergoing a transformation from an institutionalized model to a community-centered model. Due to the critical specialist workforce shortage, insufficient funding, and the large number of children in crisis, its implementation presents a challenge. The aim of this study is to analyze the current situation regarding access to system-based care under contracts with the National Health Fund in various provinces in Poland. Materials and Methods: Based on an analysis of data, resources available to patients were assessed—specifically, information was obtained from the National Health Fund website entitled “NFZ Treatment Waiting Times.” From this, the waiting times for appointments in child and adolescent mental health care facilities, the availability of mental health care facilities under contracts with the National Health Fund in Poland, legal acts, and data from the Central Statistical Office were extracted. Then, an analysis of the current accessibility to child and adolescent mental health services was conducted. The inclusion criteria for data sources were as follows: accessibility—the data had to be openly available to researchers without restrictions; credibility—the data had to be verified by individual health care facilities; usefulness—the data had to accurately reflect the actual availability of services and the needs within the child and adolescent psychiatric care system. Results: There are significant differences and deviations from the average number of facilities and waiting times when comparing the 16 provinces. Notably, some of the analyzed facilities are already operating within the framework of Child and Adolescent Mental Health Centers, where the mean waiting period for inpatient care is 105 days, the mean waiting period for day-care units is 61 days, and the mean waiting period for outpatient clinics is 257 days. The number of facilities is increasing under the reform, with new level I reference centers being opened, which ensures prevention and early support is provided by a pedagogue, psychologist, and non-medical staff, providing enhanced accessibility to care without the need for a visit to a child and adolescent psychiatrist, of whom there are only 579 for the entire child population in Poland. This metric primarily refers to first-time appointments in public institutions, with notable disparities between urban and rural areas. Conclusions: The development of the reform offers hope for quicker access to mental health support for children and adolescents. With the consistent implementation of the reform and further support from non-governmental organizations, there is a high chance of building an effective community-based model with a short waiting time for help and reducing ineffective hospitalizations, among other things, in terms of costs. Full article

Disparities in primary care access among Medicaid enrollees may be driven by differences in provider acceptance of Medicaid, yet the extent to which primary care provider (PCP) panels reflect the racial and ethnic diversity of local Medicaid populations is unknown. Objectives: To quantify the alignment between the racial/ethnic composition of PCP Medicaid panels and the underlying Medicaid population in their service areas. Methods: We conducted a cross-sectional analysis of 2019 Transformed Medicaid Statistical Information System Analytic Files from 44 states focusing on non-Hispanic White (NHW), non-Hispanic Black (NHB), and Hispanic enrollees. We calculated a panel representation ratio (PRR) for each PCP (physicians, nurse practitioners, and physician associates) as the proportion of a racial/ethnic group in their panel divided by that group’s proportion in the county Medicaid population. PRRs > 1 indicate overrepresentation; PRRs < 1, underrepresentation. Analyses were stratified by provider specialty, rurality, and Health Professional Shortage Area (HPSA) status. Results: The study sample included 372,320 PCPs from the following professions: nurse practitioners (NPs) and physician associates (PAs), along with physicians from the following specialties: family physicians (FPs), internal medicine physicians (IM), obstetrician gynecologists (ObGyn), and pediatricians (Peds). In the full sample, PRR was 1.28 for NHW enrollees, but less than one for NHB (0.98) and Hispanic (0.82) enrollees. Across provider specialties and professions, NHW enrollees were overrepresented in both rural and urban areas. In rural areas, NHB enrollees were overrepresented, but Hispanic enrollees remained underrepresented regardless of Health Professional Shortage Area (HPSA) status. In urban areas, both NHB and Hispanic enrollees were underrepresented in provider panels. Conclusions: Medicaid PCP panels do not reflect the racial/ethnic diversity of local Medicaid populations, particularly for NHB and Hispanic enrollees in urban settings. Efforts to improve equitable access to primary care must address these disparities in provider panel composition. Full article

Helicobacter pylori (H. pylori) and intestinal helminthes are common in low- and middle-income countries, where co-infection is endemic due to similar modes of transmission and poor sanitation. Whereas H. pylori are recognized gastric pathogens that induce gastritis, ulcers, and gastric carcinoma, helminths possess systemic immunomodulatory functions. The immunological, epidemiological, and clinical features of H. pylori and helminth co-infections will be discussed in this review. Key findings include that helminths induce a Th2-biased and regulatory immune response, potentially counteracting the Th1/Th17 H. pylori-induced inflammation and therefore limiting gastric tissue damage and cancer risk. Certain human studies and animal models concluded that co-infection would be protective against extreme gastric pathology by modulating immunity, altering gut microbiota, and by helminth-secreted extracellular vesicles. Epidemiologic data show large regional heterogeneity in co-infection prevalence with higher rates in children and rural socioeconomically disadvantaged populations. Much of the research mechanisms, however, are limited to models in the lab, and few human studies exist. Lastly, helminth co-infection is also potentially immunoprotective against H. pylori-associated illnesses, but greater translational research and human clinical trials are necessary. Public health policy in endemic regions must consider the complex relationships between co-infecting parasites when developing control. Full article

Telemedicine has transformed obstetrics and gynecology (OB/GYN), accelerated by the COVID-19 pandemic. This study aims to synthesize evidence on the adoption, effectiveness, barriers, and technological innovations of telemedicine in OB/GYN across diverse healthcare settings. This scoping review synthesized 63 peer-reviewed studies (2010–2023) using PRISMA-ScR guidelines to map global applications, outcomes, and challenges. Key modalities included synchronous consultations, remote monitoring, AI-assisted triage, tele-supervision, and asynchronous communication. Results demonstrated improved access to routine care and mental health support, with outcomes for low-risk pregnancies comparable to in-person services. Adoption surged >500% during pandemic peaks, stabilizing at 9–12% of services in high-income countries. However, significant disparities persisted: 43% of rural Sub-Saharan clinics lacked stable internet, while socioeconomic, linguistic, and cultural barriers disproportionately affected vulnerable populations (e.g., non-English-speaking, transgender, and refugee patients). Providers reported utility but also screen fatigue (41–68%) and diagnostic uncertainty. Critical barriers included fragmented policies, reimbursement variability, data privacy concerns, and limited evidence from conflict-affected regions. Sustainable integration requires equity-centered design, robust policy frameworks, rigorous longitudinal evaluation, and ethically validated AI to address clinical complexity and systemic gaps. Full article

Globally, the accelerating aging of the rural labor force is profoundly impacting the economic resilience of the labor-intensive forestry sector. However, the intrinsic connection between the two has not been fully understood and requires further exploration. As the most populous nation globally and a top producer, trader, and consumer of forest products, China stands out as a perfect case study for this issue. Based on this, this study utilizes panel data from 30 provinces in China from 2012 to 2022 and employs a dual machine learning model to empirically examine the impact and mechanisms of rural labor force aging on forestry economic resilience from the perspective of production factors. The findings indicate: (1) overall, the increase in rural labor force aging significantly inhibits forestry economic resilience; (2) rural labor force aging enhances forestry economic resilience by promoting large-scale forest land management, driving forestry technological innovation, and increasing government capital investment; it also inhibits forestry economic resilience by reducing educational human capital and health human capital; (3) the rural force aging exerts a marked adverse effect on the resilience of the forestry economy in the eastern and central regions, major grain-producing areas, and major grain-consuming areas. Based on this, this study proposes policy recommendations in three areas: building a flexible and diversified labor supply and replacement system, exploring a “scale and technology” integration path suited to national conditions, and implementing differentiated regional strategies. The aim is to provide a reference for government departments in formulating strategies to enhance the resilience of the forestry economy in the era of aging. Full article

Background: Outdoor and household PM_2.5 are established risk factors for chronic disease and early mortality. In China, high levels of outdoor PM_2.5 and solid fuel use for cooking and heating, especially in winter, pose large health risks to the country’s aging population. Hand grip strength is a validated biomarker of functional aging and strong predictor of disability and mortality in older adults. We investigated the effects of wintertime household and outdoor PM_2.5 on maximum grip strength in a rural cohort in Beijing. Methods: We analyzed data from 877 adults (mean age: 62 y) residing in 50 rural villages over three winter seasons (2018–2019, 2019–2020, and 2021–2022). Outdoor PM_2.5 was continuously measured in all villages, and household (indoor) PM_2.5 was monitored for at least two months in a randomly selected ~30% subsample of homes. Missing data were handled using multiple imputation. We applied multivariable mixed effects regression models to estimate within- and between-individual effects of PM_2.5 on grip strength, adjusting for demographic, behavioral, and health-related covariates. Results: Wintertime household and outdoor PM_2.5 concentrations ranged from 3 to 431 μg/m³ (mean = 80 μg/m³) and 8 to 100 μg/m³ (mean = 49 μg/m³), respectively. The effect of a 10 μg/m³ within-individual increase in household and outdoor PM_2.5 on maximum grip strength was 0.06 kg (95%CI: −0.01, 0.12 kg) and 1.51 kg (95%CI: 1.35, 1.68 kg), respectively. The household PM_2.5 effect attenuated after adjusting for outdoor PM_2.5, while outdoor PM_2.5 effects remained robust across sensitivity analyses. We found little evidence of between-individual effects. Conclusions: We did not find strong evidence of an adverse effect of household PM_2.5 on grip strength. The unexpected positive effects of outdoor PM_2.5 on grip strength may reflect transient physiological changes following short-term exposure. However, these findings should not be interpreted as evidence of protective effects of air pollution on aging. Rather, they highlight the complexity of air pollution’s health impacts and the value of longitudinal data in capturing time-sensitive effects. Further research is needed to better understand these patterns and their implications in high-exposure settings. Full article

Technological innovation in immersive virtual reality is fostering the development of novel psychotherapeutic interventions in mental health, particularly benefiting populations with limited access to specialized services. This pilot study explores the feasibility, tolerability, and therapeutic potential of an immersive virtual reality-based psychotherapeutic intervention for adolescents and young people with eating disorders in a rural setting. A quasi-experimental pre-test/post-test design was used, with a control group (n = 5) and an experimental group (n = 5), applying weekly immersive virtual reality sessions focused on body perception and food exposure. Preliminary results showed good acceptance and a low incidence of cybersickness. However, a reduction in anxiety levels was observed in the experimental group after immersive virtual reality exposure, particularly in trait anxiety, suggesting a potential effect of the intervention on emotional regulation. While these changes were not statistically significant, the direction and magnitude of the effect warrant further investigation. Changes in body mass index were also noted during the intervention. The remotely guided sessions, conducted via fifth-generation mobile network connectivity, demonstrated technical feasibility and encouraging clinical outcomes, even in geographically isolated or underserved areas. These findings support the use of immersive VR as a complementary tool in the early stages of treatment for eating disorders, contributing to improved body perception and emotional self-regulation. This work not only reinforces the applicability of immersive technology in real-world clinical practice but also opens new avenues for the development of personalized, accessible, and emotionally meaningful interventions in child and adolescent mental health. 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

This study advances the understanding of atmospheric microplastic (MPs) exposure across urban (US), suburban (SS), and rural (RS) areas of Madrid, Spain, for the first time. Air pollution from MPs remains an understudied issue with broad implications for environmental and human health. Recent evidence highlights the need for multipoint studies to accurately establish atmospheric exposure to MPs, especially during winter seasons in the city. To address this issue, this work conducted active sampling of ≤10 μm aerosol particles, following EN 12341:2014 standards, during the 2024–2025 winter season. A quantitative innovative method using UV-assisted optical microscopy was applied to assess daily MPs exposure. To trace the potential sources and transport pathways, air mass back trajectories were modelled using the Hybrid Single-Particle Lagrangian Integrated Trajectory (HYSPLIT) software. The results showed an average exposure (n = 4) of 80 ± 20; 55 ± 9 and 46 ± 20 MPs·m⁻³·day⁻¹ during the sampling period in US, SS, and RS, respectively; and an average exposure (n = 4) of 61 ± 11 MPs·m⁻³·day⁻¹ throughout the winter period between November and December 2024 and January and February 2025. The polymers detected as constituents of MPs were polystyrene, polyethylene, polymethyl methacrylate, and polyethylene terephthalate, achieving a correct identification ratio of 100% for the detected microplastic particles. The HYSPLIT results showed diffuse sources of MPs, especially local, regional, and oceanic sources, in the US. In contrast, microplastic contributions in SS and RS areas originated from local or regional sources, highlighting the need for advanced studies to identify the sources of emissions and transport routes that converge in the occurrence of microplastics in the areas studied. These results demonstrate the atmospheric exposure to microplastics in the city, justifying the need for specialized studies to define the health impacts associated with the inhalation of these emerging pollutants. The findings of this research provide clear evidence of exposure to atmospheric microplastics in urban, suburban, and rural environments in Madrid, suggesting the need for further specialized research to rigorously assess the potential risks to human health associated with microplastic inhalation by the city’s population. Full article

The global expansion of shale oil and gas extraction has generated widespread attention for its environmental, economic, and political implications. However, its social consequences remain less systematically assessed. This review synthesizes interdisciplinary research on how shale energy development affects communities, particularly in rural and resource-dependent regions. While extraction activities may generate economic opportunities and strengthen national energy security, they are also associated with population influx, pressure on infrastructure, housing shortages, public health risks, and increased political polarization. These impacts can alter social relationships, institutional trust, and access to essential services. By organizing and analyzing key themes in the social science literature, this review offers a structured overview of how shale energy development shapes local experiences and social systems. The goal of the present paper is to support researchers, policymakers, and community stakeholders in understanding the civic, communal, and public dimensions of energy transitions and in developing more equitable and sustainable policy responses. Full article

Background/Objectives: Antihypertensive treatment is crucial for preventing major adverse cardiovascular events, but suboptimal adherence remains a challenge. Methods: This is a secondary analysis of routine care data from a large pragmatic trial comparing two thiazide diuretics: chlorthalidone (CTD) and hydrochlorothiazide (HCTZ). In the trial, 13,523 older hypertensive patients were randomized from 72 Veterans Affairs medical centers. Medication possession ratio (MPR), reflecting adherence to either study medication (CTD or HCTZ), was used and compared across all randomized patients. Results: The overall median MPR was 95% for all randomized patients and 80% for 6656 individuals who reached 2.4 years for the average follow-up. Lower MPR was observed in Black, separated, urban-living, and comorbid patients. About 30% of the participants (n = 4022) were categorized as non-adherent using a definition of MPR < 80%. Those with baseline systolic blood pressure ≥ 136, recent smoking history, and prior heart failure and Black participants had decreased odds of having an MPR ≥ 80%, while increased odds of reaching that threshold were observed in those who had an eGFR ≥ 60, received ≥3 antihypertensive medications, were married, or resided in rural areas. Conclusions: This analysis provided assessment of real-world medication adherence in a sizable older hypertensive cohort. The proportion of non-adherence found in our analysis was comparable to national trends for US older adults taking blood pressure medications. Identifying sociodemographic characteristics and health conditions associated with non-adherence can help clinicians design targeted interventions for improved adherence to clinically prescribed medications. This is important as hypertension and the older adult population are both expected to grow significantly in the future. Full article

Background: Prostate cancer (PCa) is one of the most common malignancies among men in Saudi Arabia and contributes significantly to cancer-related morbidity and mortality. The objective of this survey was to evaluate community awareness and screening practices related to PCa among men in the Asir region of Saudi Arabia. Method: A cross-sectional study was conducted from 5 October to 25 December 2024 among men aged 40 and above in the Asir region, excluding those with a prior PCa diagnosis. Using convenience sampling, 399 participants were recruited via social media and community outreach. Data were collected through a self-administered online questionnaire covering demographics, medical history, PCa knowledge, information sources, prevention, screening awareness, and barriers. Informed consent was obtained from all participants. Results: The study comprised 399 male participants, with 37.09% aged 40–50, 36.34% aged 51–60, and 26.56% over 60. Most participants (363; 90.97%) were married, 245 (61.4%) had a university education, 282 (70.67%) lived in urban areas, and 180 (45.11%) were employed. Over half of the participants, 222 (55.63%), had a personal history of prostate problems. Additionally, 272 (68.17%) had health insurance, and 153 (38.34%) reported a monthly income between 10,000 and 14,999 SAR. The study found that 329 (82.5%) participants had good knowledge of PCa but only 197 (49.4%) had good awareness of screening methods. Key predictors of good awareness of PCa screening included a personal history of prostate problems (odds ratio—OR = 4.791, p = 0.000, confidence interval—CI 2.727–8.418) and health insurance (OR = 0.359, p = 0.000, CI 0.203–0.636). Common barriers to screening were affordability, n = 116 (29.07%), and perceived good health, n = 201 (50.37%). Additionally, 154 participants (38.59%) found screening uncomfortable, while 156 (39.59%) believed the Digital Rectal Exam (DRE) was harmful or embarrassing. Significant differences in perceived barriers were found based on age (F = 11.449, p < 0.001), education (F = 2.608, p = 0.051), occupation (F = 3.668, p = 0.026), family history (F = 17.407, p < 0.001), and income (F = 5.148, p = 0.006). Conclusions: The study highlights a significant gap between general knowledge and specific awareness of prostate cancer (PCa) screening among men in the Asir region. Although 82.5% demonstrated good overall knowledge, only 49.4% were aware of screening methods, and just 44.36% had undergone PSA testing. Common barriers included perceived good health, fear of diagnosis, embarrassment, and financial concerns. However, due to the use of convenience sampling, online distribution, and geographic restriction to the Asir region, the findings may not be generalizable to the broader male population in Saudi Arabia, particularly older men and those in rural areas. Addressing these gaps requires targeted education, empowerment of healthcare providers, and coordinated public health strategies to enhance early detection and reduce the PCa burden. Full article

Self-care is a critical component of chronic disease management and is linked to better health outcomes. The Hypertension Self-Care Profile (HBP SCP) is one of the few validated instruments designed to assess not only behaviors but also self-efficacy and motivation in HBP self-care. This scoping review synthesized published research using the HBP SCP to examine its scope and utility across diverse populations. A total of 48 studies were reviewed—34 non-validation studies and 14 validation studies—spanning regions including Asia, the Middle East, and the Americas. The HBP SCP showed strong psychometric performance across multiple cultural adaptations, with Cronbach’s alpha values ranging from 0.73 to 0.99. Several correlates of HBP self-care emerged, including self-efficacy, social support, health literacy, and education. Findings also revealed that HBP self-care remains suboptimal, particularly among rural populations and low- and middle-income countries. The HBP SCP has proven to be a versatile and culturally adaptable instrument for evaluating HBP self-care behaviors, self-efficacy, and motivation. Its consistently demonstrated validity and reliability across diverse contexts, combined with its responsiveness in randomized controlled trials, affirm its value as both a clinical assessment tool and a research outcome measure in interventions aimed at improving cardiovascular health. Full article