Search Results (1,580)

A variety of measurement systems are available for monitoring existing concrete bridges with deficiencies in shear capacity. In addition to established systems, fiber optic sensors (FOS) offer significant potential for structural health monitoring. However, FOSs are often installed in the tension zone, where crack formation may occur even under service loads, increasing the risk of sensor failure and potentially resulting in a loss of measurement capability. A promising approach to significantly reduce this risk is the installation of FOSs in the compression zone. However, it remains unclear whether measurements obtained from FOSs in the compression zone can be used to assess the load-bearing and deformation behavior of reinforced concrete beams and how they relate to measurements obtained in the tension zone. To address this question, shear tests were carried out on reinforced concrete beams with shear reinforcement ratios commonly used in practice. The experimental results demonstrate close agreement between measurements obtained from FOSs installed in the compression and tension zones under service loads. Furthermore, the findings and the characteristic strain profiles associated with shear and flexural failure provide a basis for assessing existing structures monitored using FOSs. Full article

Access to clean drinking water is one of the main factors influencing public health during humanitarian crises. In the northern districts of the Gaza Strip, long-term warfare and mass migration caused serious damage to the water supply system, cutting off access to drinking water, limiting the availability of fuel and chemicals used for water chlorination, and increasing reliance on intermittent networks and water transportation services. The present study is a descriptive cross-sectional study of water quality and health risks in 11 emergency camps. Water samples were collected from supply points, communal tanks, and household storage containers and analyzed for key physicochemical indicators (pH, turbidity, electrical conductivity/total dissolved solids, residual free chlorine) and microbiological contamination (E. coli and fecal coliforms). Household surveys documented transport and storage practices, perceived service adequacy, and recent gastrointestinal illness. Overall, 35% of samples exceeded WHO microbiological limits; E. coli was detected in 28% of household containers and 24% of distribution tanks. Residual chlorine was <0.5 mg/L in 40% of samples and turbidity exceeded guidance in 18%. Forty-five percent of households reported transferring water using open/uncovered containers, and 42% reported gastrointestinal illness in the previous month, with higher reporting in sites showing microbial contamination. The results suggest that there are significant weaknesses in the source-to-point-of-use system during emergencies. The priority actions we recommend are, restoring residual disinfection; strengthening monitoring at important control points; improving hygienic transport and covered storage; and providing backup fuel and treatment supplies to minimize the risk of waterborne diseases in shelters in North Gaza. Full article

Background and Objectives: This study investigated the association between periodontal procedure intensity, serving as an indirect proxy for periodontal disease burden, and incident tinnitus in Korean adults. Materials and Methods: Using the Korean National Health Insurance Service–National Health Screening Cohort (2002–2019), we included adults aged ≥40 years who had a diagnosis of periodontal disease (International Classification of Diseases, 10th Revision [ICD-10] code K05), had undergone relevant periodontal treatment, and had available health-screening data. Because direct clinical periodontal measures were unavailable, participants were classified according to treatment intensity into: a mild procedure group (scaling or root planing only) and a moderate-to-severe procedure group (subgingival curettage, extraction, periodontal flap surgery, bone grafting, or guided tissue regeneration). Incident tinnitus was defined as an ICD-10 H93.1 diagnosis recorded during two or more outpatient visits to a neurology or otolaryngology department to improve diagnostic specificity. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox proportional hazards models adjusted for demographic, socioeconomic, cardiometabolic, and behavioral factors. Results: Among 132,808 participants (76,844 mild; 55,964 moderate-to-severe), the incidence rate of tinnitus was higher in the moderate-to-severe group than in the mild group (4.38 vs. 3.87 per 1000 person-years). After adjustment, the moderate-to-severe group showed a significantly higher risk of tinnitus (HR 1.24, 95% CI 1.17–1.30). These associations were consistent across sex- and age-stratified analyses and in sensitivity analyses using stricter tinnitus definitions. Conclusions: Greater periodontal procedure intensity was associated with a modestly higher incidence of tinnitus in this nationwide cohort. Because procedure intensity serves only as an indirect surrogate for periodontal disease burden, and because auditory confounders and short-term procedure-related factors were unavailable, causality and a specific inflammatory mechanism cannot be established. Further studies incorporating direct periodontal measurements, audiological data, and prespecified lag-time analyses are warranted to confirm these findings. Full article

Background: Public health in Greece has undergone substantial changes since the COVID-19 pandemic, while challenges related to governance, workforce distribution, regional inequalities and service organization remain. This study aimed to map the current public health landscape in Greece by examining its institutional frameworks, stakeholder roles, policy implementation and public health data systems. Methods: A structured situation analysis combining a review of peer-reviewed and gray literature, policy analysis, and stakeholder mapping was conducted. PubMed, EMBASE, and CINAHL were searched for English- and Greek-language publications issued between 2005 and 2026, supplemented by reports, legislation, and policy documents from the Greek Ministry of Health, the World Health Organization, the Organisation for Economic Co-operation and Development, the European Commission, and other relevant institutions. Results: Public health responsibilities were distributed across multiple national, regional, and local institutions, creating challenges concerning coordination and accountability. Regional and socioeconomic inequalities continued to affect access to services, while workforce shortages and skill-mix imbalances constrained public health capacity. Public health information was dispersed across different institutions and data systems, with limitations concerning standardization, accessibility, and interoperability. Recent legislation, prevention programs, and digital-health initiatives indicated increased policy attention to prevention and population health, although publicly available evidence regarding their implementation and outcomes remained limited. Conclusions: Strengthening public health in Greece requires clearer institutional responsibilities, improved coordination across governance levels, sustainable workforce planning and interoperable data systems that support routine monitoring of program coverage, equity, and population-level outcomes. Full article

Background: Genetic diseases pose a significant public health issue in Saudi Arabia, driven by relatively high prevalence and factors such as consanguineous marriage. Increasing public awareness and understanding are crucial to improving prevention, early detection, and the use of genetic healthcare services. This study aimed to evaluate residents’ knowledge, attitudes, and awareness of genetic diseases in the Qassim region. Methods: A web-based cross-sectional survey was conducted from March to May 2024 among Qassim residents, using an online questionnaire shared via multiple social media platforms. The survey assessed knowledge of genetic diseases, awareness of preventive measures and screening programs, and familiarity with genetic healthcare services. Descriptive statistics summarised the results, and binary logistic regression was conducted to identify factors independently associated with good awareness of genetic testing. Results: Of the 398 participants, about 66% knew about common genetic diseases in Saudi Arabia, while 92% recognised consanguineous marriage as a key cause of genetic disorders. Most respondents correctly identified that genetic diseases are not transmitted through infection (93%). Support for expanding premarital, prenatal, and newborn screening programs was high at 93%, 88.9%, and 90.7%, respectively. Nonetheless, only 38.7% were aware of specialised genetic laboratories and counselling services, and just 4.4% had consulted a genetic counsellor. Social media was the primary source of genetic information (36%). Despite limited awareness of available services, 94% supported establishing a regional genetic testing lab, and 71% were willing to participate in future genetic research. Multivariate analysis identified that marital status is the only variable significantly associated with genetics testing awareness status [aOR = 2.34; 95% CI (1.08–5.08); p = 0.030]. Conclusions: Participants demonstrated generally good knowledge of genetic diseases and positive attitudes towards preventive genetic screening programmes. However, awareness of and utilisation of specialised genetic healthcare services, including genetic counselling and genetic testing laboratories, remained limited. These findings underscore the need to enhance public education, expand genetic counselling, and improve access to specialised services to advance genomic medicine in Saudi Arabia. However, the predominance of younger participants and students may limit the generalisability of the findings to the broader Qassim population. Full article

Background/Objectives: Obesity is associated with respiratory infection risk, but its relationship with post-discharge healthcare burden remains unclear. This study examined the associations of body mass index (BMI) and waist circumference (WC), evaluated separately, with hospitalization and post-discharge outcomes in analyses stratified by sex among South Korean adults with claims-defined hospitalizations involving influenza or pneumonia. Methods: This retrospective cohort study used the 2018 National Health Insurance Service (NHIS) Customized Research Database linked to health-screening data. Adults aged 20–89 years with claims-defined hospitalizations involving influenza or pneumonia were included if BMI and WC measurements were available from the most recent NHIS health-screening examination conducted within two years before the index admission. Length of stay and index hospitalization costs were summarized descriptively. Cox proportional hazards models were used to estimate hazard ratios (HRs) for all-cause and pneumonia-related readmission within two years after discharge, and two-part models were used to estimate readmission-related costs, expressed in US dollars (USD). Results: The cohort included 175,774 patients, of whom 80,257 (45.7%) were male. Category-specific associations varied according to the anthropometric measure, outcome, and sex stratum. In female patients, the highest WC category had the largest estimated all-cause readmission HR (HR 1.195, 95% confidence interval 1.157–1.235), and the highest model-based mean cost of the first all-cause readmission was also observed in this category (USD 1407.4). In male patients, several higher BMI categories had lower estimated readmission HRs than the reference category; however, these estimates should not be interpreted as protective effects because competing mortality was not accounted for using competing-risk methods. Patterns for pneumonia-related readmission and costs were less consistent. Conclusions: BMI and WC showed category-specific associations with readmission, while model-based mean readmission costs varied across anthropometric categories and sex strata. Higher WC categories were associated with higher all-cause readmission HRs in the female stratum; however, the independent or incremental prognostic value of BMI and WC was not evaluated. Full article

Gout is one of the most common inflammatory arthritides worldwide, and its burden is rising in Southeast Asia alongside rapid demographic and socioeconomic transitions. This region, characterized by diverse healthcare systems, cultural practices, and levels of economic development, presents a unique context in which the epidemiology and management of gout are evolving. Despite the availability of effective urate-lowering therapy (ULT) and well-established treat-to-target (T2T) strategies, real-world outcomes remain suboptimal. Barriers to optimal gout care operate at multiple levels. Physician-related factors include clinical inertia and limited awareness of evidence-based recommendations. Patient-related factors include limited understanding of gout and its treatment, compounded by socioeconomic disadvantages. System-level challenges include inequitable access to healthcare services, limited health insurance coverage, and resource-strained health systems. The current evidence base in Southeast Asia remains limited and heterogeneous, raising uncertainty regarding the applicability of global data to local populations. Nevertheless, emerging studies suggest that multidisciplinary, context-oriented approaches can improve gout outcomes. The objective of this review is to explore the evolving epidemiological landscape and barriers to gout management in Southeast Asia. Full article

Many law enforcement agencies operate crisis service models that utilize the expertise of mental health professionals in assisting law enforcement officers (LEOs) when interacting with people experiencing a mental health crisis. This study examines three agencies with two different types of established crisis service models in the same geographical area to answer three research questions: (1) Does the type of crisis service model affect facilitators of success for the model? (2) Does the type of crisis service model affect how practitioners personally measure the success of the model they use? (3) What patterns exist in involuntary psychiatric examination rates before and after the implementation of the crisis service models? Sixteen practitioners representing two crisis service models responded to a survey investigating the first two questions. Participants were recruited through email. The analysis used inferential and descriptive statistics to examine their responses. A before-and-after design using descriptive statistics of publicly available data about involuntary psychiatric examinations was employed to investigate the third research question. Results showed variation across the model participants’ choices of facilitators important for model success and metrics, but only differences between the responses from members of two models in choosing the facilitator of clear policies and procedures (e.g., clearly written protocols) and the metric of use of force were at statistically significant levels. The practitioners of the models are the experts. Understanding how they judge the success of their work and what facilitates that success is vital for allocating resources effectively and adjusting policies as needed. The study determined that involuntary psychiatric examinations decreased concurrently with the use of crisis service models, but it is not possible to establish causation. More investigation is needed. Full article

Background/Objectives: Endometriosis is a chronic gynecological condition affecting approximately 10% of women of reproductive age and is associated with chronic pain, fatigue, infertility, and reduced quality of life. Beyond its physical burden, delayed diagnosis, healthcare dismissal, and inadequate support may contribute substantially to psychological distress. In line with growing efforts to promote mental health and wellbeing within healthcare settings, this study explored women’s experiences of healthcare services and the psychological impact of living with endometriosis. Methods: A qualitative study was conducted using thematic analysis of 2500 publicly available Twitter/X posts shared by accounts self-presenting as women discussing experiences of endometriosis. Results: Three overarching themes were identified: (1) Institutional Invalidation of Women’s Endometriosis Experiences, (2) Living with the Multidimensional Burden of Endometriosis, and (3) Reimagining Endometriosis Care. Participants described chronic pain, reproductive uncertainty, and significant emotional distress that were frequently intensified by delayed diagnosis and experiences of not being believed or taken seriously within healthcare settings. Accounts suggested that suffering was shaped not only by disease symptoms but also by interactions with healthcare systems that undermined the legitimacy of women’s experiences. Conversely, validation, empathy, and collaborative communication were associated with improved wellbeing and engagement with care. Participants advocated for greater awareness of endometriosis, earlier diagnosis, and more integrated models of support. Conclusions: Endometriosis should be understood as a biopsychosocial condition whose impact extends beyond physical symptoms alone. The narratives analyzed highlight how psychological distress may be amplified by experiences of invalidation, delayed recognition, and fragmented care. Improving outcomes requires timely diagnosis, patient-centered healthcare interactions, and the integration of psychological support within multidisciplinary endometriosis services. Full article

Antiretroviral therapy (ART) is essential for preventing HIV transmission and improving the health outcomes of people living with HIV (PLHIV). However, many barriers limit PLHIV from starting and adhering to ART, which explains why HIV responses in many settings, including Indonesia, have produced limited gains. This qualitative phenomenological study explored multilevel barriers to ART adherence in urban Yogyakarta (locally known as Jogja) and rural Belu, Indonesia, from the perspectives of PLHIV and healthcare professionals (HCPs). Data were collected through one-on-one in-depth interviews with 92 PLHIV and 20 HCPs. Participants were recruited using the snowball sampling technique. Data were analysed using framework analysis informed by the Access to Healthcare Framework. The findings showed that PLHIV in Belu and Jogja had different experiences in terms of the provision of and ability to access and adhere to ART or HIV treatment. In rural Belu, ART was less available and visible, harder to approach, often unaffordable, less aligned with patients’ needs, and strongly influenced by the widespread use of traditional medicine. PLHIV in Belu also reported a more limited ability to perceive the need for ART, reach services, pay costs, engage in care, and seek ART than those in urban Jogja. Personal, psychological, and social barriers were also reported to hinder PLHIV’s ART adherence in both settings. These findings highlight the need for HIV policies that promote the equitable distribution of ART services and targeted interventions to improve understanding and acceptance of HIV care among PLHIV and the wider community. Full article

Background/Objectives: Telehealth (TH) and Telemedicine (TM) can significantly benefit individuals who live far from healthcare institutions and those with limited financial resources by improving access to essential health services. This review explores the attitudes and determinants affecting the use of TH and TM, focusing on the MENA region with insights from the global context. Methods: A narrative review was created using a compilation of scientific articles published between 2020 and 2025 from PubMed and Scopus. Studies were screened to be relevant with the determinants, attitudes or use of TH and TM. Forty one sources met the eligibility criteria and covered evidence from the MENA region with supporting background from global developments. Results: In the MENA region, although high perceived effectiveness is recorded, the use of TH and TM remains below optimal levels. The majority of the studies reviewed suggested that participants have positive attitudes towards TH and TM. Nevertheless, some studies suggest low awareness and limited utilization of available TH and TM services. Determinants affecting TH and TM included pandemic-based, socioeconomic, cultural, financial, health literacy, and infrastructure-based factors, and those relating to physician implementation. Disparities in utilization of these services were evident among individuals with low digital literacy, older individuals and low-income workers. Conclusions: TH and TM are observed to increase the availability and accessibility of preventative and treatment-based health services, especially in regions facing geographic limitations. The findings exhibit the disparities in institution and uptake of these services due to socioeconomic, geographic and cultural aspects. Interventions at the system level, supported by evidence such as multilingual digital platforms, investments in digital infrastructure and coverage in insurance, need to be implemented to ensure equitable utilization of these services in the MENA region. Full article

Background: Adolescents in low- and middle-income countries (LMICs) continue to face substantial challenges related to sexual and reproductive health (SRH), including high rates of unintended pregnancy, sexually transmitted infections (STIs), and limited access to accurate reproductive health information and services. Rural provinces of South Africa, such as Limpopo, are no exception, with notably higher pregnancy rates. Aim: This study aimed to explore adolescent girls’ perceptions and experiences associated with school-based comprehensive sexuality education (CSE) programs and their perceived role in pregnancy prevention in Bolobedu, Limpopo province, South Africa. Methods: A qualitative, descriptive, and contextual design was employed. Data were collected through individual interviews and field notes from adolescent girls aged 14–19 years who were accessing contraceptives or had given birth. Content analysis was conducted using Tesch’s method. Findings: Results suggest that the quality and contents of CSE programs varied widely, leading to CSE intervention programs not being successfully implemented, leading to poor uptake and no behavior change. Implications: While research on CES programs shows that the CSE programming varies and can be vital to reducing adolescent pregnancy, its success depends on the quality of the implementation, which leads to behavior change. The research finds that the adoption of Comprehensive Sexual Education in schools and communities is vital to tackling the high incidence of adolescent pregnancy. However, its success depends on the quality of implementation, facilitator training, and resource availability. Full article

Background: Dementia is a global health priority affecting more than 55 million people worldwide, with projections indicating this figure will rise to 139 million by 2050. People living with dementia (PLWD) face profound difficulties accessing primary care services—the critical gateway to dementia diagnosis, ongoing management, and coordinated specialist referral. Despite growing evidence on individual barriers, a comprehensive synthesis integrating patient, caregiver, and system-level perspectives is lacking. Objectives: This systematic review and meta-synthesis aimed to identify, appraise, and synthesize evidence on the barriers and facilitators experienced by PLWD and their caregivers when accessing primary care services, and to propose evidence-based recommendations to address inequities. Methods: A systematic search was conducted to identify relevant articles in six electronic databases: PubMed, MEDLINE, EMBASE, PsycINFO, CINAHL, Cochrane Library, and Web of Science from January 2000 to December 2024, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. Qualitative, quantitative, and mixed-methods studies reporting barriers or facilitators to primary care access for PLWD were included. A convergent integrated synthesis and thematic meta-synthesis approach was applied. Quality was assessed using the Mixed Methods Appraisal Tool (MMAT). Results: Forty-three studies from 18 countries met inclusion criteria. Barriers were categorized across five domains: (1) patient-level factors (stigma, denial, symptom normalization, and limited health literacy); (2) caregiver-level factors (burden, late symptom recognition, and cultural barriers); (3) provider-level factors (insufficient training, therapeutic nihilism, and time constraints); (4) system-level factors (fragmented care pathways, long waiting times, and poor care coordination); and (5) structural and societal factors (rurality, poverty, and ethnic minority status). Facilitators included caregiver advocacy, strong patient–GP relationships, dementia literacy campaigns, availability of memory clinics, and integrated care models. Disparities were consistently greater for ethnic minority groups, rural populations, and those with lower socioeconomic status. Conclusions: Barriers to primary care access in dementia are complex, overlapping, and mutually reinforcing. Effective strategies require multi-level interventions addressing individual, relational, provider, and system dimensions simultaneously. Full article

Background/Objectives: In Italy, Ministerial Decree 77/2022 provides the regulatory framework for reorganizing community-based care around community health centers and hub-and-spoke territorial networks. However, translating territorial allocation into specialist working-hour requirements remains a key operational challenge, particularly in low-density and mountainous areas. This study developed an activity-based workload model to translate observed outpatient cardiology activity into estimated specialist working-hour requirements within the hub-and-spoke community health center network of local health authority (ASL 1) Avezzano-Sulmona-L’Aquila, Abruzzo, Italy. Methods: A second-stage workforce planning analysis was conducted using the baseline 30 min territorial configuration from a previously defined allocation framework. Municipal-level outpatient cardiology administrative data for 2019 were linked to standardized procedure scheduling durations and aggregated across the catchments of three hub centers and eight spoke centers according to predefined municipality-to-node assignments. Procedure volumes were converted into annual and weekly workload hours and then into nominal 36 h weekly specialist-schedule equivalents. The resulting estimates represent a pre-pandemic, utilization-based workload scenario derived from observed activity; they should not be interpreted as direct measures of underlying population demand, epidemiological need, or unmet need, nor as validated staffing requirements. Results: The reference network covered 286,832 residents and included 44,039 outpatient cardiology procedures, corresponding to 12,719.8 annual workload hours. These volumes generated 244.6 weekly workload hours, equivalent to 6.79 nominal 36 h weekly specialist-schedule equivalents. Workload was unevenly distributed across the network: the L’Aquila and Sulmona hubs accounted for the largest annual workloads, with 3014.9 and 2894.3 h, respectively, whereas Trasacco was the spoke center with the highest observed workload, with 1775.5 h. Population-standardized indicators showed substantial variation in workload intensity across the catchments, indicating that catchment population size alone did not adequately capture the observed workload differences. Conclusions: Activity-based workload estimation adds an operational workforce layer to hub-and-spoke territorial planning. By translating observed outpatient service-use volumes into specialist working-hour requirements, the model provides a transparent and potentially transferable framework to support the operational planning of community health centers in geographically complex settings. The approach is adaptable to other specialties, territories, and service configurations where comparable activity data, standardized scheduling durations, and territorial assignment inputs are available. Full article

The increasing number of new battery electric vehicle (BEV) registrations worldwide and the development of advanced batteries with higher energy density and pack capacity have contributed to large volumes of batteries approaching the end of their first service life. The retired batteries may be repurposed in second-life applications or recycled. The degradation profile of BEVs is a critical determinant in second-life potential of the retired batteries. This study presents a comprehensive analysis of calendar and cycle mechanisms in lithium iron phosphate (LFP) and nickel manganese cobalt oxide (NMC) batteries across 37 commercially available BEV models in the European Union (EU) market. Three scenarios are considered, based on the operational temperature—Scenario I with a 273.15 K, Scenario II with a 298.15 K, and Scenario III with a 318.15 K operational temperature—and two degradation metrics are determined for each analyzed BEV: state-of-health (SoH) and remaining capacity at end-of-life (EoL). The results show that the SoH of both chemistries is highly dependent on the state-of-charge (SoC), temperature, depth of discharge (DoD), and real usable capacity. Moreover, the Tesla Model 3–Premium RWD, Volkswagen ID.3, ID.4, and ID5–GTX, and the Tesla Model Y–Premium AWD all exhibit a remaining capacity between 40 and 77 kWh at EoL, depending on degradation profile, making them a viable option for second-life applications. Full article