Search Results (7,543)

Since the COVID-19 pandemic, wastewater monitoring has become an additional tool in the surveillance of infectious diseases. Many EU countries put wastewater surveillance systems (WSS) in place to track SARS-CoV-2 and its variants and other pathogens, such as the influenza virus or Respiratory syncytial virus (RSV). In Germany, several research and pilot projects funded by the EU, the Federal Ministry of Education and Research, the Federal Ministry of Health, and projects at Federal State level have been launched in the last four years. In Germany, wastewater monitoring was not implemented as a public health tool before the COVID-19 pandemic, but in September 2022, it has been legally determined in the German infection protection act (Infektionsschutzgesetz, IfSG). As Germany is a federal state, competencies in epidemic management partly belong to the 16 federal states (“Länder”). In the federal states, the local health authorities at the county (“Kreise”) level also have specific risk management and communication competencies. Furthermore, WSS has been incorporated into the revised Urban Wastewater Treatment Directive (EU) 2024/3019. For this reason, the federal states and local health authorities play a pivotal role in successfully implementing wastewater monitoring as a supplementary component of disease surveillance in Germany. Between November 2021 and August 2022, the federal state of Thuringia, Germany, supported a pilot study to implement a surveillance system for SARS-CoV-2-RNA in wastewater of 23 wastewater treatment plants in 17 counties in Thuringia. Here, we describe the study design and the system behind the logistics and the planning, and we provide an overview of the options for involving the public health service. Furthermore, the possibilities for IT concepts and approaches to innovative AI solutions are shown. We also aim to explore the feasibility and potential barriers to further implementing wastewater surveillance as a supplementary public health tool in Thuringia. Full article

The subject of this research is the exploration of the potential of remote sensing and Geographic Information Systems (GIS) for basin-scale spatio-temporal monitoring of drought and its impacts in the Ukrina River Basin, Bosnia and Herzegovina (BH), during the last decade (2015–2024). The aim is to integrate meteorological, hydrological, agricultural, and socio-economic drought signals and to delineate areas of long-term drought exposure. Meteorological drought was evaluated using CHIRPS precipitation and the Standardized Precipitation Index (SPI) calculated at 1-, 3-, 6-, and 12- month accumulation scales using Gamma fitting and a fixed long term reference period; hydrological drought was examined using available water-level records complemented by the Standardized Water Level Index (SWLI) and supported by correspondence with standardized ERA5-Land runoff anomalies; agricultural drought was mapped using remote sensing indices—the Temperature Condition Index (TCI), Vegetation Condition Index (VCI), and Vegetation Health Index (VHI)—calculated from MODIS satellite data; and socio-economic effects were assessed using municipal crop-production statistics (2015–2019). The results indicate that drought conditions were most pronounced in 2015, 2017, 2021, and especially 2022, showing consistent agreement between precipitation deficits, hydrological responses, and vegetation stress, while 2016, 2018–2020, 2023, and 2024 were generally more favorable. As a key novelty, a persistent drought-prone zone was delineated by intersecting drought-affected areas across major episodes, providing a basin-scale identification of chronic drought hotspots for a river basin in BH. The persistent zone covers 40.02% of the basin and spans nine cities and municipalities, with >93% located in Prnjavor, Derventa, Stanari, and Teslić. Hotspots are concentrated mainly in lowlands below 400 m a.s.l., with a statistically significant concentration across lower elevation classes, indicating higher long-term exposure in the central and northern valley sectors, and land use overlay further highlights high relative exposure of productive land. Overall, the integrated remote sensing and GIS framework strengthens drought monitoring by providing spatially explicit and repeatable evidence to support targeted adaptation planning and drought-risk management. Full article

Background: Food insecurity among college students is a multidimensional challenge shaped by individual, interpersonal, institutional, community, and policy factors. Although many campuses require or provide meal plans, students may experience food insecurity when barriers related to agency (choice and autonomy), utilization (nutrition security), and availability persist. This study explored how undergraduate students at a private, urban U.S. university experience and navigate the multiple dimensions of food insecurity. Methods: We conducted in-depth, semi-structured interviews via Zoom between December 2024 and January 2025 with n = 22 undergraduate students recruited based on food security status, determined by a Fall 2024 longitudinal survey using the USDA Six-Item Short Form. Transcripts were double-coded by trained research assistants in ATLAS.ti using an inductive codebook. Thematic analyses followed a phronetic, iterative approach, organizing findings within a socio-ecological determinants framework and comparing themes by food security status. Results: We identified nine themes across four domains (individual, interpersonal, institutional and community, and political). At the individual level, constrained personal resources for groceries and cooking, time scarcity leading to skipped meals, and health impacts that detracted from academics emerged as key themes. Interpersonally, reliable family financial support was protective and informal support from peers/coaches filled gaps sporadically for some. At the institutional and community level, dining hall hours misaligned with student schedules, perceived limited variety and nutrition quality reduced food agency and utilization, and transportation impeded use of the sole grocery partner accepting university meal plan benefits. Notably, meal plans including unlimited meal swipes provided stable access but did not guarantee food security when food agency and utilization barriers persisted. Many students relied on campus events for free food; formal assistance (e.g., food pantry) was largely underused. At the policy level, Supplemental Nutrition Assistance Program (SNAP) awareness and enrollment was limited among our sample. Conclusions: Meal plan access alone is insufficient to ensure food security. Campus strategies should extend beyond access to prioritize flexibility, variety, and alignment with students’ schedules and preferences, while strengthening communication and eligibility support for external benefits. Future work should design and evaluate interventions that integrate all dimensions of food security and address institutional policies affecting students’ basic needs. Full article

Background/Objectives: The growing number of older adults with complex healthcare needs increases demand for homecare services, while a shrinking workforce often lacks skills for advanced tasks. Digital health is seen as a promising tool to address these challenges. This study explored Swedish homecare professionals’ perceptions of the potential use of digital twins in daily work. Methods: Four focus group discussions were conducted with 31 homecare professionals; two groups each in one urban/rural and one rural municipality. Data were analyzed using inductive content analysis. Results: Three main themes emerged: (i) Perceptions of digital twins as support for older adults, including needs-based, individualized care and proactive support enabling preventive measures; (ii) Perceptions of digital twins as support for professionals, including a better work environment through streamlined tasks and flows and enhanced planning and assessment; and (iii) Concerns about digital twins, focusing on ethical and social issues and limited understanding, which were related to monitoring aspects, the importance of physical visits, and how the technology works. Conclusions: Digital twins are perceived by professionals to have the potential to improve homecare services by supporting both older adults and professionals; however, further research is needed to address concerns and practical implications. Full article

Urban heat islands are among the most intense and unequal climate impacts in Mediterranean cities, with direct effects on health, thermal comfort, and habitability. This reality calls for the incorporation of binding and verifiable climate criteria into spatial planning and urban planning law. This article examines the extent to which the Spanish legal framework—at national, regional, and municipal levels—incorporates measurable standards to mitigate urban heat islands and how it might evolve towards operational climate-responsive urbanism. A legal–analytical and comparative methodology is applied, based on multilevel normative content analysis and a comparison of four autonomous communities, four Spanish cities, and four international reference cases with consolidated metrics. The results show that, despite progress in recognising adaptation, territorial asymmetries persist, enforceable parameters remain scarce, and there is a prevailing reliance on strategic or voluntary instruments. In response to these gaps, the study proposes a coherent set of urban climate standards (urban vegetation, functional soil permeability, roof albedo/cool roofs, green roofs and façades, plot-scale performance indices, urban ventilation, and thermal diagnostics) and a multilevel integration model aimed at guiding legislative reforms and strengthening cities’ adaptive capacity and thermal equity. Full article

Flooding is a recurrent problem in many Brazilian cities, resulting in significant losses that affect health, assets, finance, and the environment. The uncertainty regarding extreme rainfall events due to climate change makes this challenge even more severe, compounded by inadequate urban planning and the occupation of risk areas, particularly for the municipality of Catu, in the state of Bahia, which also suffers from recurrent floods. Critical hotspots include the Santa Rita neighborhood and its surroundings, the main supply center, and the city center—the municipality’s commercial hub. The focus of this research is the unprecedented quantification of the socioeconomic impact of these floods on the low-income population and the region’s informal sector (street vendors). This research focused on analyzing and modeling the destructive potential of intense rainfall in the Santa Rita region (Supply Center) of Catu, Bahia, and its effects on the local economy across different recurrence intervals. A hydrological simulation software suite based on computational and geoprocessing technologies—specifically HEC-RAS 6.4, HEC-HMS 4.11, and QGIS— 3.16 was utilized. Two-dimensional (2D) modeling was applied to assess the flood-prone areas. For the socioeconomic impact assessment, a loss procedure based on linear regression was developed, which correlated the different return periods of extreme events with the potential losses. This methodology, which utilizes validated, indirect data, establishes a replicable framework adaptable to other regions facing similar socioeconomic and drainage challenges. The results revealed that the area becomes impassable during flood events, preventing commercial activities and causing significant economic losses, particularly for local market vendors. The total financial damage for the 100-year extreme event is approximately US $30,000, with the loss model achieving an R² of 0.98. The research concludes that urgent measures are necessary to mitigate flood impacts, particularly as climate change reduces the return period of extreme events. The implementation of adequate infrastructure, informed by the presented risk modeling, and public awareness are essential for reducing vulnerability. Full article

Family caregivers provide up to 90% of care in Alberta’s communities and play an essential role in sustaining the province’s health and social care systems, yet they remain under-recognized and insufficiently supported. To address this gap, we co-designed the Alberta Family Caregiver Strategy and Action Plan (2024–2025), a provincial framework developed through participatory research and collective impact methods. Guided by principles of co-production, equity, and lived experience, the project engaged over 500 stakeholders, including caregivers, healthcare providers, educators, employers, and policymakers, through Phase 1 interviews (health/community leaders, n = 44; Family and Community Support Services (FCSS), n = 47; navigation experts, n = 9), Phase 2 co-design team consultations, and Phase 3 sector roundtables (n = 52). Using reflexive thematic analysis, we identified four foundational caregiver strategies, Recognition, Partnership, Needs Assessment, and Navigation, and four enabling conditions: Education, Workplace Supports, Policy and Research and Data Infrastructure. These elements were synthesized into an eight-priority Alberta Caregiver Strategy and Action Plan Framework, a practical way to connect validated priorities with coordinated, measurable implementation across settings. Participants emphasized four key enablers essential to making caregiver inclusion more feasible and sustainable: education, workplace supports, policy infrastructure, and research and evaluation. Findings highlight strong cross-sector consensus that caregiver inclusion must be embedded into routine practice, supported by consistent policy, and reinforced through provincial coordination with local adaptation. The Alberta Family Caregiver Strategy provides a practical, evidence-informed plan for transforming fragmented supports into a coherent, caregiver-inclusive ecosystem that strengthens both caregiver well-being and system sustainability. Full article

Background/Objectives: This study aimed to describe changes in physical performance and nutritional status among frail adults at risk of falls receiving muscle-targeted oral nutritional supplementation (MT-ONS) as part of routine clinical care. Methods: A prospective, open-label, single-centre, uncontrolled, descriptive study was conducted in a real-world clinical setting. Patients ≥ 70 years attending an outpatient fall clinic were consecutively recruited and assessed at baseline and after at least 90 days of MT-ONS (100% whey protein enriched with leucine and vitamin D), provided as part of a comprehensive care plan including exercise recommendations, medication review, and home adaptation advice. Sociodemographic, physical performance [Short Physical Performance Battery (SPPB)], nutritional status [Mini Nutritional Assessment-Short Form, (MNA^®-SF)], walking ability [Functional Ambulation Categories (FACs)], number of falls, muscle strength (dynamometry), body composition (Tanita), health-related quality-of-life (SF-12), functional capacity (Barthel Index), and adherence data were collected. Statistics analyses were descriptive and exploratory. Results: Twenty-six participants were assessed (58% women, age: 82.1 ± 5.4 years). Mean SPPB score increased from 7.3 (±3.6) to 8.0 (±4.0) (p = 0.3). At baseline, 35% were malnourished, 42% at risk of malnutrition, and 23% well-nourished. After ≥90 days of MT-ONS, 4% were malnourished, 54% at risk, and 42% well-nourished. The number of falls decreased from 1.2 falls/month (±0.9) to 0.2 falls/month (±0.3, p < 0.0001). Favourable changes in physical performance were positively correlated with improvements in nutritional status (p = 0.03). Adherence was high (92%), largely attributed to pleasant taste (71%) and smell (58%) and positive health perceptions (58%). Conclusions: In routine clinical practice, frail adults at risk of falls who received MT-ONS, 100% whey protein enriched with leucine and vitamin D for ≥90 days, as part of a comprehensive care plan improved their physical performance and nutritional status and reduced the number of falls. These findings should be interpreted as preliminary. Full article

Background: Medication adherence and persistence in treating chronic diseases present as a continuous challenge for healthcare providers in long-term management. The most frequent reasons that several diseases are poorly controlled in the population include suboptimal drug adherence and discontinuation of therapies. One main issue why physicians cannot detect patients with poor adherence is that they have relatively limited time and tools to do so. Aim: To review the critical role of medication adherence in the management of chronic diseases by addressing the following: what medication adherence is; its critical role; factors and strategies influencing it; challenges and consequences of poor adherence; patients at risk; present and future strategies in place to detect and improve adherence; implications for public health and health value creation for patients; key analytical frameworks for understanding it; determinants; how adherence improves health; the role of healthcare professionals and technological innovations; implications of medication adherence; adherence as a key area for exploring the psychological mechanisms underlying patient behavior; and patient adherence as a major social and public health challenge. Finally, this review considers strengths, limitations, recommendations, and future value. Methodology: The following databases were used to carry out the review: PubMed, Scopus, Google Scholar, and ScienceDirect. The following themes were combined in the search: what adherence is, why it is critical, why adherence occurs, and how to improve adherence. The following search terms were used: what adherence is and critical, why and adherence and occurs, and how and to improve adherence. Results: Under the theme of why adherence is critical, five sub-themes were reviewed; four sub-themes were reviewed under the theme of why adherence occurs; and five sub-themes were reviewed under the theme of how to improve adherence. Conclusions: Strategies to enhance medication adherence involve a comprehensive approach that includes patient education, streamlined treatment plans, digital tools, and effective communication from healthcare professionals. Full article

As people spend more time indoors, the impact of the built environment on psychological health has attracted growing attention. Yet existing studies often have difficulty capturing decision-makers’ reference dependence and loss aversion under uncertainty. To bridge this gap, we propose an evaluation framework comprising three first-level criteria—Outdoor Environment, Physical Comfort (including thermal, lighting, and color environments), and Acoustic Comfort—and determine combined weights by integrating subjective analytic hierarchy process (AHP) judgments with objective entropy weighting based on triangular fuzzy numbers (TFNs). We further incorporate prospect–regret theory to represent loss aversion, expectation-based reference points, and counterfactual regret/rejoicing, and couple it with the VIKOR compromise ranking method, forming an integrated “TFN + Prospect–Regret + VIKOR” approach. The proposed method is applied to four retrofit alternatives for an open-plan office floor (approximately 1200 m²), each emphasizing outdoor environment, physical comfort, acoustic comfort, or no single priority. Experts assessed the schemes using fuzzy linguistic variables. The results show that lighting conditions, thermal comfort, color scheme, and internal noise control receive the highest comprehensive weights. Extensive sensitivity analyses across value/weighting functions and regret-aversion parameters indicate that the ranking of alternatives remains stable while exhibiting clearer separation. Comparative analyses further suggest that, although the overall ordering is consistent with baseline methods, the proposed model increases score dispersion and improves discriminative power. Overall, by explicitly accounting for decision-makers’ psychological behavior and information uncertainty, the framework enables robust and interpretable selection of retrofit schemes for existing office spaces. Full article

Advances in veterinary medicine have contributed to increased life expectancy in companion animals, leading to a higher incidence of chronic and neoplastic diseases in cats. Epidemiological studies correlating demographic and clinical factors with lymphoma in cats are needed, particularly in South America. Data from 662 cats diagnosed with lymphoma were collected from veterinary centers located in all five Brazilian geographical regions and the Federal District. This study represents one of the largest epidemiological assessments of feline lymphoma in Brazil and highlights the broad distribution of the disease across diverse regions and age groups. The predominance of mixed-breed animals and the frequent association with retroviral infections underscore the need for early diagnostic protocols and targeted health strategies to address this issue. These findings contribute to a better understanding of feline lymphoma in Brazil and may support future efforts in disease prevention, early detection, and therapeutic planning for this disease. Full article

Background/Objectives: Geographic Information Systems (GIS) offer essential capabilities for identifying spatial concentrations of vulnerability and strengthening context-aware prevention strategies. This manuscript describes a geospatial architecture designed to generate anticipatory, place-based risk identification applicable across diverse community and institutional environments. Interpersonal Violence (IPV), one of several preventable harms that benefit from this spatially informed analysis, remains a critical public health challenge shaped by structural, ecological, and situational factors. Methods: The conceptual framework presented integrates de-identified surveillance data, ecological indicators, environmental and temporal dynamics into a unified spatial epidemiological model. Multilevel data layers are geocoded, spatially matched, and analyzed using clustering (e.g., Getis-Ord Gi*), spatial dependence metrics (e.g., Moran’s I), and contextual modeling to support anticipatory identification of elevated vulnerability. Framework Outputs: The model is designed to identify spatial clustering, mobility-linked risk patterns, and emerging escalation zones using neighborhood disadvantage, built-environment factors, and situational markers. Outputs are intended to support both clinical decision-making (e.g., geocoded trauma screening, and context-aware discharge planning), and community-level prevention (e.g., targeted environmental interventions and cross-sector resource coordination). Conclusions: This framework synthesizes behavioral theory, spatial epidemiology, and prevention science into an integrative architecture for coordinated public health response. As a conceptual foundation for future empirical research, it advances the development of more dynamic, spatially informed, and equity-focused prevention systems. Full article

Background/Objectives: Antimicrobial resistance (AMR) surveillance is a cornerstone of national AMR strategies but requires sustained, cross-sectoral financing. While the need for such financing is well recognized, its quantification remains scarce in low- and middle-income countries. This study aimed to estimate the full costs of AMR surveillance across the human health, animal health, and food sectors (2021–2030) in selected facilities in Nepal and generate evidence to inform sustainable financing. Methods: A bottom-up micro-costing approach was used to analyze data from five sites. Costs were adjusted for inflation using projected gross domestic product deflators, and probabilistic sensitivity analyses were conducted to assess uncertainty in laboratory sample volumes under four scenarios. Results: The total cost of AMR surveillance in Nepal was $6.7 million: $3.4 million for human health (50.3% out of the aggregated costs), $2.7 million for animal health (39.8%), and $0.7 million for the food sector (9.9%). Laboratories accounted for >90% of total costs, with consumables and personnel as the main cost drivers. Average cost per sample was $150 (animal), $64 (food), and $6 (human). Conclusions: This study offers the first robust, multi-sectoral 10-year cost estimates of AMR surveillance in Nepal. The findings highlight that sustaining AMR surveillance requires predictable domestic financing, particularly to cover recurrent laboratory operations as donor support declines. These results provide cost evidence to support future budgeting and policy planning toward sustainable, nationally financed AMR surveillance in Nepal. Full article

Urban parks are central to public health and equity, yet less is known about how park travel distance, park “attractor” types, and time-of-day visitation rhythms co-evolved through and after the COVID-19 pandemic. Using anonymized smartphone mobility traces for public parks in Las Vegas, USA (2018–2022), we construct weekly origin–destination flows between census block groups (CBGs) and parks and link origins to socio-economic indicators. We first estimate visitor-weighted mean travel distance with a segmented time-series model that allows pandemic-related breakpoints. Results show that average park-trip distance (≈8.4 km pre-pandemic), including a substantial share of long-distance trips (≈52% of visits), contracted sharply at the onset of COVID-19, and that both travel radii and seasonal excursion peaks only partially rebounded by 2022. Next, cross-sectional OLS/WLS models (R² ≈ 0.08–0.14) indicate persistent socio-spatial disparities: CBGs with higher educational attainment and larger shares of Black and Hispanic residents are consistently associated with shorter park-trip distances, suggesting constrained recreational mobility for socially disadvantaged groups. We then identify a stable two-type park typology—local versus regional attractors—using clustering on origin diversity and long-distance share (silhouette ≈ 0.46–0.52); this typology is strongly related to visitation volume and temporal usage profiles. Finally, mixed-effects models of evening and late-night visit shares show that regional attractors sustain higher nighttime activity than local parks, even as citywide evening/late-night visitation dipped during the mid-pandemic period and only partly recovered thereafter. Overall, our findings reveal a durable post-pandemic re-scaling of park use toward more proximate, CBG-embedded patterns layered on enduring inequities in access to distant, destination-oriented parks. These insights offer actionable evidence for equitable park planning, targeted investment in high-need areas, and time-sensitive management strategies that account for daytime versus nighttime use. Full article

Background/Objectives: Lower limb amputation (LLA) negatively affects the physical and psychological health of individuals, leading to a lower quality of life and sedentary lifestyle. The objective of this scoping review is to search for evidence regarding physical activity interventions in individuals with LLA, investigating improvements in specific outcomes related to quality of life and performance. Methods: PRISMA guidelines—extension for scoping reviews—were used to structure the study. The research was conducted between 26 July 2023 and 30 September 2023; it was structured by defining two PICO questions (P = amputation, I = physical exercise, O1 = quality of life, and O2 = performance) through Pubmed, Cochrane, and Pedro databases. The study included subjects with LLA of any etiology, in prosthetic or pre-prosthetic phase, practicing non-competitive physical activity. The results were then subjected to both qualitative and quantitative analysis. Results: Of the 615 studies identified, 18 were included in the review. They consisted of 6 systematic reviews (SR), 5 RCTs, 4 case–control studies, 1 case report (CR), and 2 cross-sectional (CS). Physical activity (PA) interventions were extremely heterogeneous and were, therefore, categorized into 6 modalities: surveys were the most reported strategies (57%), followed by personalized training (23%), strength training (13%), endurance training (13%), combined training (2%), and gait training (5%). Due to the heterogeneity of the studies, the variety of interventions proposed and the different outcomes registered, there is no evidence that one approach is more effective than another, while each group showed benefits on different specific outcomes. In total, five outcome categories were identified: quality of life was the most frequently analysed (42%), followed by cardiovascular fitness (20%), muscular fitness (14%), gait parameters (13%), functionality and disability (11%). Conclusions: PA represents a valuable strategy for improving performance and quality of life in individuals with LLA, offering a variety of interventions. Although there is no evidence that one strategy is better than the others, each activity has proven to be effective on specific outcomes, therefore, the choice must depend on the patient’s necessities. The preferred option should be the personalization of the training according to individual needs, coupled with long-term planning and remote monitoring. Creating meeting places and supporting occasions for sports activities could be a valid option. Further research could help to clarify the benefits of such interventions and enhance the understanding of how to optimize the management of LLA patients. Full article