Search Results (658)

Background: The quality of decision-making processes is increasingly recognized as critical to public trust and policy sustainability. Objectives: This narrative review aims to identify and describe process-focused decision support models (DSMs) applied in pharmaceutical policy, and to examine their potential contributions to improving procedural quality in decisions related to pricing, reimbursement, and access to medicines. Methods: Relevant peer-reviewed and gray literature published between 2000 and 2025 was considered, drawing from key databases (e.g., PubMed and Scopus) and international policy reports (e.g., WHO, ISPOR, and HTA agencies). Studies were included if they provided insights into DSMs addressing at least one dimension of decision process quality. Results: Findings are synthesized narratively and organized by tool type, application context, and key quality dimensions. Frequently referenced tools included the Quality of Decision-Making Orientation Scheme (QoDoS), WHO-INTEGRATE, and AGREE II. QoDoS emerged as the only tool applied across regulatory, HTA, and industry settings, evaluating both individual- and organizational-level practices. WHO-INTEGRATE highlighted equity and legitimacy considerations but lacked a structured format. Overall, most tools demonstrated benefits in promoting internal consistency, transparency, and stakeholder engagement; however, their adoption remains limited, especially in low- and middle-income countries. Conclusions: Process-focused DSMs offer promising avenues for enhancing transparency, consistency, and legitimacy in pharmaceutical policy. Further exploration is needed to standardize evaluation approaches and expand the use of DSMs in diverse health systems. Full article

Background/Objectives: Respectful maternity care involves privacy, dignity, and informed choice within the process of delivery as stipulated by the World Health Organization (WHO). Informed consent is a cornerstone of patient-centered care, representing not just a formal document, but an ongoing ethical and clinical process through which women are offered objective, understandable information to support autonomous, informed decision-making. Methods: This narrative review critically examines the literature on informed consent in maternity care, with particular attention to both obstetric-led and midwifery-led models of care. In addition to identifying institutional, cultural, and systemic obstacles to its successful implementation, the review examines the definition and application of informed consent in perinatal settings and evaluates its effects on women’s autonomy and satisfaction with care. Results: Important conclusions emphasize that improving women’s experiences and minimizing needless interventions require active decision-making participation, a positive provider–patient relationship, and ongoing support from medical professionals. However, significant gaps persist between legal mandates and actual practice due to provider attitudes, systemic constraints, and sociocultural influences. Women’s experiences of consent can be more effectively understood through the use of instruments such as the Mothers’ Respect (MOR) Index and the Mothers’ Autonomy in Decision Making (MADM) Scale. Conclusions: To promote genuinely informed and considerate maternity care, this review emphasizes the necessity of legislative reform and improved provider education in order to close the gap between policy and practice. Full article

Background: Electronic waste (e-waste) recycling in informal settings like Agbogbloshie in Accra, Ghana, releases toxic metals into the environment, posing serious health risks to nearby residents, particularly children. This study assessed the body burdens of lead (Pb), manganese (Mn), cadmium (Cd), chromium (Cr), nickel (Ni), and arsenic (As) and their association with cognitive function in schoolchildren living within 1 km of the Agbogbloshie site. Method: A cross-sectional study involving 56 pupils collected demographic data and blood and urine samples and administered the Wechsler Intelligence Scale for Children—Fourth Edition (WISC-IV). Blood was tested for Pb and Mn and urine for Cd, Cr, Ni, and As. Associations between metal levels and cognitive outcomes were examined using regression analyses, adjusting for confounders. Result: Children showed elevated metal levels, with mean blood Pb of 60.43 µg/L and urinary s of 21.50 µg/L. Symptoms of cognitive dysfunction were common: 75% reported confusion, 67.9% poor memory, and 66% poor concentration. Urinary Cr levels were significantly associated with lower Full-Scale IQ (β = −18.42, p < 0.05) and increased difficulty in decision-making (OR = 0.1, p < 0.05). Conclusion: These findings underscore the neurodevelopmental risks of heavy metal exposure from e-waste in low- and middle-income countries and call for urgent public health interventions and policy actions. Full article

This study investigates the critical determinants of customer retention in casual dining restaurants within the context of the post-pandemic “new normal.” Anchored in service quality and consumer behavior theories, the research examines the influences of food quality, health measures, perceived price, brand image, ambiance, and location on customer decision making. Using Partial Least Squares Structural Equation Modeling (PLS-SEM), data from 336 respondents in the National Capital Region, Philippines were analyzed to assess the relationships among these variables and their effects on restaurant selection and customer retention. The results reveal that food quality (β = 0.698, p < 0.05) exerts the strongest influence on restaurant selection, followed by health measures (β = 0.477, p = 0.001), perceived price (β = 0.378, p < 0.02), and brand image (β = 0.341, p < 0.035). Furthermore, health measures (β = 0.436, p = 0.002) and restaurant selection (β = 0.475, p < 0.05) significantly enhance customer retention, while ambiance and location were not found to be significant predictors. These findings offer theoretical contributions to the service quality and consumer trust literature and provide practical and policy-relevant insights for food establishments adapting to health-driven consumer expectations. The study highlights the need for the strategic integration of safety protocols, pricing value, and brand positioning to foster long-term loyalty and resilience in the evolving food service market. Full article

T1D and CD commonly occur together. This association has received increasing attention from researchers and is considered in detail in this review. Since CD is over-represented in T1D, it may cause ill health with attendant complications, but because there is an effective dietary treatment, screening has been recommended in children and adults. However, there are many unknowns regarding this association, and understanding the why, when, and how with regard to screening and managing those with dual diagnoses requires thorough consideration when introducing the concept of screening to patients. It is important that patients and, where appropriate, carers are put at the heart of the decision-making process with careful discussion of the issues involved before undertaking screening that might uncover a second life-changing diagnosis, for which, without preparatory preparation and support, individuals may be ill-prepared, causing mental health issues. For some patients, an initial policy of monitoring rather than moving to immediate small bowel biopsy and exposure to a gluten-free diet (GFD) will be appropriate. The correct management of patients will ultimately improve their quality of life medically and socially. Full article

Hepatitis C is an infectious liver disease which contributes to an estimated 400,000 deaths each year. The disease is caused by the hepatitis C virus (HCV) and is spread by direct blood contact between infected and susceptible individuals. While the magnitude of its impact on human populations has prompted a growing body of scientific work, the current epidemiological models of HCV transmission among injecting drug users treat risk behaviors as fixed parameters rather than as outcomes of a dynamic, decision-making process. Our study addresses this gap by constructing a game-theoretic model to investigate the implications of voluntary participation in clean needle exchange programs on the spread of HCV among this high-risk population. Individual drug users weigh the (perceived) cost of clean equipment usage relative to the (perceived) cost of infection, as well as the strategies adopted by the rest of the population, and look for a selfishly optimal level of protection. We find that the spread of HCV in this population can theoretically be eliminated if individuals use sterile equipment approximately two-thirds of the time. Achieving this level of compliance, however, requires that the real and perceived costs of obtaining sterile equipment are essentially zero. Our study demonstrates a robust method for integrating game theory with epidemiological models to analyze voluntary health interventions. It provides a quantitative justification for public health policies that eliminate all barriers—both monetary and social—to comprehensive harm-reduction services. Full article

This study presents a novel game-theoretical framework designed to support epidemic management, with a specific focus on the allocation of limited resources across competing public health objectives and intervention strategies. Recognizing the varied roles and capacities of participatory agents, we model their involvement as occurring at multiple levels, reflecting the complex decision-making processes encountered in real-world situations. To account for the unequal influence or priority of different agents and strategies, we further propose a suite of weighted allocation measures grounded in well-established theoretical principles. In response to ongoing concerns over the arbitrariness of externally assigned weights, we also construct a refined metric based on endogenous marginal intervention effects, offering a more organically derived representation of participator impact. A series of illustrative examples demonstrates the practical relevance of these models, revealing how they can capture key dynamics such as behavioral diversity, the coexistence of overlapping policies, and logical independence under distinct weighting perspectives. Collectively, these contributions aim to provide epidemic response teams with a set of interpretable and adaptable tools tailored to the complexity of real-world public health crises. Full article

Introduction: The health emergency caused by the pandemic led to severe health issues in populations across many countries worldwide, including widespread morbidity and significant mortality. Nevertheless, several countries succeeded in keeping infection rates remarkably low before the approval of vaccines and the initiation of vaccinations in early 2021. We aim to identify the success factors of health policies in managing the impact of the health emergency across a selection of countries, focusing on how they protected their populations. Our study presents outcomes of sustainable health policy measures, along with health and social system challenges, and economic responses during the global health emergency. We sometimes found it difficult to define what counted as a success factor in some countries. Method: Our study draws upon a selection of reports and documents published by various ministries and economic, social, and health authorities, which we collected online. We structured our study into three phases to frame and contextualize the impact of health policy measures and countermeasures as follows: (i) observations and content analysis; (ii) empirical support through illustrative examples; and (iii) development of a health emergency toolkit of assessment. The documents were not always easy to compare because they differed in format and detail. Results: Our study outlines ten success factors for sustainable health policy measures and countermeasures: (i) preparedness; (ii) control; (iii) precaution; (iv) proactive decision-making; (v) synchronization; (vi) adequate legislation; (vii) goal fulfillment; (viii) digital health technology; (ix) empirical evidence; (x) ethical and moral virtues. Sometimes we struggled to separate what was ethical guidance from what was simply practical advice. Conclusion: We argue that the relevance of the health emergency toolkit of assessment outlined in our study demonstrates clearly that the success factors related to sustainable health policy measures and countermeasures can be applied and adapted to the societal conditions of individual countries. These factors may form a foundation for the development of a health emergency toolkit of assessment for future health emergencies. We also maintain that these factors may serve as a platform for establishing sustainable plans across health, social, and economic domains, with clear guidelines for implementation, management, and control. It is our hope that future health systems will make use of these findings before the next crisis emerges. Full article

Background: Human papillomavirus (HPV) is the most common sexually transmitted infection in the United States (U.S.) and a major contributor to several cancers, including cervical, anal, penile, and oropharyngeal cancers. Although a safe and effective vaccine is available, HPV vaccination rates remain suboptimal, particularly among racial, ethnic, and immigrant minority groups. This study explored multiple factors, such as cultural, social, and structural influences, influencing HPV vaccine decision-making among Cape Verdean immigrant parents in the U.S., a population currently underrepresented in HPV research. Methods: Qualitative study using individual, in-depth interviews with Cape Verdean immigrant parents of children aged 11 to 17 years living in the U.S. Interviews were transcribed verbatim and analyzed thematically using the social ecological model (SEM) to identify barriers and facilitators at the intrapersonal, interpersonal, organizational, community, and policy levels. Results: Forty-five Cape Verdean parents (27 mothers, 18 fathers) participated. Fathers were significantly older than mothers (50.0 vs. 41.1 years, p = 0.05). Most were married or partnered (60%), had at least a high school education (84.4%), and reported annual household incomes of US$50,000 or more (66.7%), with no significant gender differences. Nearly all spoke Creole at home (95.6%). Fathers had lower acculturation than mothers (p = 0.05), reflecting less adaptation to U.S. norms and language use. Most parents had limited knowledge of HPV and the vaccine, with gendered beliefs and misconceptions about risk. Only seven mothers (25.9%) reported receiving a provider recommendation; all indicated that their children had initiated vaccination (1 dose or more). Mothers were the primary decision-makers, though joint decision-making was common. Trust in providers was high, but poor communication and the lack of culturally and linguistically appropriate materials limited informed decision-making. Stigma, misinformation, and cultural taboos restricted open dialogue. Trusted sources of information included schools, churches, and Cape Verdean organizations. While parents valued the U.S. healthcare system, they noted gaps in public health messaging and provider engagement. Conclusions: Findings revealed that HPV vaccine uptake and hesitancy among Cape Verdean immigrant parents in the U.S. were influenced by individual beliefs, family dynamics, healthcare provider interactions, cultural norms, and structural barriers. These findings highlight the need for multilevel strategies such as culturally tailored education, community engagement, and improved provider communication to support informed vaccination decisions in this population. Full article

Water resources have become a critical factor limiting agricultural development and ecological health in arid regions. The ecological efficiency of agricultural water use (EEAWU) serves as an indicator of the sustainable utilization of agricultural water resources, taking into account both economic output and environmental impact. This paper, grounded in the social–ecological system (SES) framework, integrates multidimensional variables related to social behavior, economic decision-making, and ecological constraints to construct an analytical system that examines the impact mechanism of farmers’ part-time employment on the EEAWU. Utilizing survey data from 448 farmers in the western Tarim River Basin, and employing the super-efficiency SBM model alongside Tobit regression for empirical analysis, the study reveals the following findings: (1) the degree of farmers’ part-time employment is significantly negatively correlated with EEAWU (β = −0.041, p < 0.05); (2) as the extent of part-time employment increases, farmers adversely affect EEAWU by altering agricultural labor allocation, adjusting crop structures, and inadequately adopting water-saving measures; (3) farm size plays a negative moderating role in the relationship between farmers’ part-time engagement and the EEAWU, where scale expansion can alleviate the EEAWU losses associated with part-time employment through cost-sharing and factor substitution mechanisms. Based on these findings, it is recommended to enhance the land transfer mechanism, promote agricultural social services, implement tiered water pricing and water-saving subsidy policies, optimize crop structures, and strengthen environmental regulations to improve EEAWU in arid regions. Full article

The reduction of environmental pollutant emissions—including greenhouse gases, particulate matter, and other harmful substances—represents one of the foremost challenges in climate policy, economics, and industrial management today. Excessive emissions of CO₂, NO_X, and suspended particulates exert significant impacts on climate change as well as human health and welfare. Consequently, numerous studies and regulatory and technological initiatives are underway to mitigate these emissions. One critical area is intra-plant transport within manufacturing facilities, which, despite its localized scope, can substantially contribute to a company’s total emissions. This paper aims to assess the potential of computer simulation using FlexSim software as a decision-support tool for planning inter-operational transport, with a particular focus on environmental aspects. The study analyzes real operational data from a selected production plant (case study), concentrating on the optimization of the number of transport units, their routing, and the layout of workstations. It is hypothesized that reducing the number of trips, shortening transport routes, and efficiently utilizing transport resources can lead to lower emissions of carbon dioxide (CO₂) and nitrogen oxides (NO_X). The findings provide a basis for a broader adoption of digital tools in sustainable production planning, emphasizing the integration of environmental criteria into decision-making processes. Furthermore, the results offer a foundation for future analyses that consider the development of green transport technologies—such as electric and hydrogen-powered vehicles—in the context of their implementation in the internal logistics of manufacturing enterprises. Full article

Placenta accreta spectrum (PAS) refers to a group of abnormal placental attachments in which the placenta adheres too deeply to the uterine wall, with varying degrees of invasion classified as accreta, increta, or percreta. Increased rates of uterine surgeries, advanced maternal age, and cesarean deliveries have all contributed to an increase in the incidence of PAS. Complications associated with PAS can lead to severe intrapartum or postpartum hemorrhage, hysterectomy, and significant maternal morbidity, making early diagnosis and management crucial for improving outcomes. Understanding the epidemiology and risk factors of PAS is crucial for developing early detection protocols and preventive strategies. Localized data, particularly from Bahrain, can inform targeted care approaches and optimize resource allocation, ultimately leading to improved clinical guidelines, enhanced patient education, and better healthcare outcomes for affected women. There are growing concerns about the impact of PAS on maternal health and healthcare resources in Bahrain, similar to trends observed in other regions. To improve patient education and management strategies, it is essential to comprehend the regional patterns, characteristics, and outcomes associated with PAS. However, the absence of comprehensive data specific to Bahrain hinders effective clinical decision-making and policy development. Addressing this gap is imperative for advancing maternal healthcare in the region. Full article

The study analyses at the information level the impact of the main economic indicators on migration and access to services in the European Union, using methods specific to intelligent information systems. The research is based on the correlations between gross value added (GVA), gross fixed capital formation (GFCF), greenhouse gas emissions (GHGE), health expenditure (SHA11), and migration rates (MIGR). The applied methodology includes attribute distribution analysis, identification of hidden patterns through clustering algorithms (K-Means and Expectation-Maximisation) and training of classifiers using regression decision trees with linear leaf models (M5P) corresponding to interdependent data processing and integration modules, exploratory analysis module, machine learning and decision-making modules, oriented to support public policies through explainable scenarios and predictive-evaluative structures. The results highlight the superiority of the EM model in detecting relevant clusters and the usefulness of M5P trees in highlighting complex economic influences on population mobility. The study proposes the integration of these methods into an intelligent analysis framework aimed at reducing disparities and optimising socio-economic sustainability. The EM model demonstrated a superior ability to detect subgroups within the dataset, revealing four distinct clusters with specific characteristics. Furthermore, the M5P tree analysis allowed the extraction of significant non-linear relationships between economic variables and the migration phenomenon. The study emphasises the importance of public policies aimed at reducing regional economic disparities and increasing social and economic sustainability. By integrating these results into a well-structured information system, it provides a robust analytical framework that supports policy makers and researchers in designing effective public policies on population mobility and its related economic impact in the EU Member States. Full article

Against the backdrop of health inequality among rural residents, focusing on the impact of cultural institutions during the transitional period on villagers’ health contributes to ensuring healthy lives for rural populations (SDG-3). Drawing on institutional theory, this study explores how rural banquet culture shapes residents’ health outcomes and the mechanisms through which this influence operates. Utilizing data from the 2021 China Land Economy Survey (CLES), we employ both mediation effect models and machine learning techniques. The findings indicate that a stronger presence of banquet culture within villages is significantly associated with poorer health outcomes among rural residents. Further analysis reveals that banquet culture is also correlated with increased adult and infant mortality rates and reduced life expectancy. Mechanism analysis shows that time crowding caused by social obligations and suboptimal health decision-making serve as important mediating pathways through which banquet culture influences health. Moreover, heterogeneity analysis suggests that higher levels of village autonomy and greater provision of public health goods can mitigate the negative health impacts of banquet culture. By uncovering the micro-level behavioral mechanisms through which cultural norms influence individual health, this research advances the understanding of informal institutions. It innovatively links ritualized social practices to measurable health outcomes, addresses a critical gap in public health research on rural populations, and provides policy-relevant insights for the development of targeted rural health interventions. Full article

Air pollution, particularly PM₁₀ particulate matter, poses significant health risks related to respiratory and cardiovascular diseases as well as cancer. Accurate identification of PM₁₀ reduction factors is therefore essential for developing effective sustainable development strategies. According to the current state of knowledge, machine learning methods are most frequently employed for this purpose due to their superior performance compared to classical statistical approaches. This study evaluated the performance of three machine learning algorithms—Decision Tree (CART), Random Forest, and Cubist Rule—in predicting PM₁₀ concentrations and estimating long-term trends following meteorological normalisation. The research focused on Tarnów, Poland (2010–2022), with comprehensive consideration of meteorological variability. The results demonstrated superior accuracy for the Random Forest and Cubist models (R² ~0.88–0.89, RMSE ~14 μg/m³) compared to CART (RMSE 19.96 μg/m³). Air temperature and boundary layer height emerged as the most significant predictive variables across all algorithms. The Cubist algorithm proved particularly effective in detecting the impact of policy interventions, making it valuable for air quality trend analysis. While the study confirmed a statistically significant annual decrease in PM₁₀ concentrations (0.83–1.03 μg/m³), pollution levels still exceeded both the updated EU air quality standards from 2024 (Directive (EU) 2024/2881), which will come into force in 2030, and the more stringent WHO guidelines from 2021. Full article