Search Results (2,909)

Background/Objectives: Regional disparities in neonatal care capacity may have a disproportionate impact on the smallest and most vulnerable infants. In South Korea, where specialized perinatal resources are concentrated in the Seoul Capital Area (Seoul, Gyeonggi, and Incheon), it remains unclear how these disparities vary by birth weight and time since birth. Methods: We conducted a nationwide, population-based cohort study of preterm infants (<37 weeks gestation) born between 2002 and 2021 using the Korean National Health Insurance Service database. Residential address at birth classified infants into Seoul Capital Area or regions outside the Seoul Capital Area. We examined 28-day and one-year all-cause mortality using multivariable logistic regression, adjusting for sex, birth weight category, early transfer, medical aid status, maternal age, and antenatal visits. Birth weight-stratified analyses assessed effect modification. Major morbidities were evaluated with multivariable Cox models. Results: Among 204,245 preterm infants, those residing outside the Seoul Capital Area had higher adjusted odds of mortality at both 28 days (odds ratio 1.46; 95% confidence interval [CI], 1.30–1.64) and one year (odds ratio 1.25; 95% CI, 1.17–1.34) than those residing in the Seoul Capital Area. Disparities were minimal in infants ≥2500 g but increased progressively in lower birth weight strata, peaking among extremely low birth weight infants (<1000 g) (28-day odds ratio 1.67; 95% CI, 1.40–1.97; one-year odds ratio 1.54; 95% CI, 1.37–1.73). Conclusions: Regional survival disparities among preterm infants in South Korea widen with decreasing birth weight, underscoring the need for targeted neonatal care and post-discharge support in underserved regions. Full article

Background: South Africa faces the world’s highest HIV burden, disproportionately affecting women, alongside rising Type 2 Diabetes (T2D). Weight gain associated with preferred dolutegravir (DTG)-based antiretroviral therapy may worsen obesity and T2D risk. This process evaluation explored the implementation of a 12-month time-restricted eating (TRE) intervention for weight management in women with HIV and overweight/obesity in Khayelitsha, Cape Town. Methods: Using the RE-AIM framework, the study investigated the implementation journey. Data were collected from three groups: RCT participants, healthcare workers (n = 21), and fieldworkers (n = 3). Methods included structured informal interviews with TRE participants throughout the intervention and semi-structured in-depth interviews (IDIs) with a subset (n = 19) at 12 months. IDIs and focus group discussions were conducted with healthcare staff. Results: Implementation faced significant contextual challenges, including high food insecurity, economic constraints, and high crime levels. Cultural norms around food hospitality also posed barriers. Despite this, TRE was highly feasible and acceptable. Participants reported positive behavioural changes, establishing eating routines and consuming healthier foods. Perceived health benefits included improved appetite control, wellbeing, sleep, and weight management. Key facilitators were the intervention’s flexibility and, importantly, the non-judgmental, empathetic support from fieldworkers, which drove engagement and retention. Healthcare workers expressed willingness to integrate TRE into existing HIV counsellor-led services, and nearly all participants desired to continue TRE post-intervention. Conclusions: This process evaluation demonstrates that TRE is a contextually suitable and acceptable intervention from an implementation perspective. Its success in practice, however, depends on mitigating complex multi-level barriers through a flexible program design and high-quality, relationship-focused support integrated into existing healthcare infrastructure. Trial registration: PACTR202302484999720, 8 February 2023. Full article

Digital mental health resources have expanded rapidly in the wake of the COVID-19 pandemic, offering new opportunities to improve access to mental healthcare through technologies such as AI chatbots, mobile apps, and online platforms. Despite this growth, significant challenges persist, including low user retention, limited digital literacy, unclear privacy regulations, and insufficient evidence of clinical effectiveness and safety. AI chatbots, which act as virtual therapists or companions, provide counseling and personalized support, but raise concerns about user dependence, emotional outcomes, privacy, ethical risks, and bias. User experiences are mixed: while some report enhanced social health and reduced loneliness, others question the safety, crisis response, and overall reliability of these tools, particularly in unregulated settings. Vulnerable and underserved populations may face heightened risks, highlighting the need for engagement with individuals with lived experience to define safe and supportive interactions. This review critically examines the empirical and grey literature on AI chatbot use in mental healthcare, evaluating their benefits and limitations in terms of access, user engagement, risk management, and clinical integration. Key findings indicate that AI chatbots can complement traditional care and bridge service gaps. However, current evidence is constrained by short-term studies and a lack of diverse, long-term outcome data. The review underscores the importance of transparent operations, ethical governance, and hybrid care models combining technological and human oversight. Recommendations include stakeholder-driven deployment approaches, rigorous evaluation standards, and ongoing real-world validation to ensure equitable, safe, and effective use of AI chatbots in mental healthcare. Full article

Ongoing conflicts in sub-Saharan Africa negatively affect the population’s mental health and weaken health care systems. Collaboration among stakeholders is recommended to strengthen mental health services in post-conflict settings, despite limited evidence on context-specific strategies. This paper aimed to identify strategies for collaboration between traditional and biomedical services to improve mental health care. An adapted nominal group technique was employed during a one-day stakeholder workshop. Fourteen participants representing traditional and biomedical mental health services discussed and prioritised strategies based on importance and feasibility to reach consensus. Five collaborative care strategies were prioritised based on stakeholder consensus regarding importance and feasibility: (1) collaborative learning, (2) formalising coordination, (3) capacity building, (4) joint intervention programs, and (5) regulatory support. Key mechanisms for implementing these strategies were also identified, including piloting integrated interventions, appointing a dedicated focal person to coordinate, providing basic psychosocial counselling skills, reducing harmful practices, and strengthening supportive supervision. Mutual learning was identified as a crucial cross-cutting component of all approaches. The conclusion was that implementing these prioritised strategies could improve mental health care. Further research is needed to evaluate the effectiveness of these strategies in enhancing collaborative care and improving mental health outcomes for individuals. Full article

Food supply veterinarians, those who service the dairy, swine, poultry, small ruminant, and beef cattle industries, benefit society by protecting animal and public health and ensuring a safe, wholesome food supply. However, there are not enough entering the workforce to meet current and future demands. Non-formal learning environments can be used as a recruitment tool to provide participants with positive interactions and hands-on experiences. To build awareness of food supply veterinary medicine (FSVM) in youth, we developed an immersion program designed to provide high school students with hands-on experiences with food animal species. Day camps were held during the summers of 2022 and 2023, each coordinated with multiple partners at different locations in central Ohio. Year One camp utilized registration and post-test surveys and Year Two utilized matching pre- and post-test for analysis. Over the two programs, 110 participants engaged in hands-on experiences, including: outbreak investigations, measuring clinical parameters, performing diagnostics, and basic veterinarian procedures. Pre- and post-test evaluations were performed to measure changes in participants’ attitudes and perceptions, and a McNemars test was used to evaluate Year Two data. In Year One, we saw positive shifts in those interested in FSVM careers. In Year Two, we saw positive shifts in knowledge of FVSM careers, with biosecurity knowledge increasing. Outreach activities like day camps can be replicated in other locations to increase interest in FSVM careers. Full article

Background/Objectives: Family Integrated Care (FICare) is a model of care for preterm or critically ill infants in which families are considered equal partners with clinical teams and are fully integrated into all aspects of care and decision-making. In this study, we conducted a health economics study of FICare implementation in the UK, as part of the EU-funded international, interdisciplinary, and intersectoral project RISEinFamily. Methods: An economic evaluation of healthcare services and an audit of clinical outcomes for infants admitted to the Royal Sussex County Hospital and the Princess Royal Hospital neonatal units in 2021 (at the start of FICare) and 2024 (when FICare was fully integrated into clinical practice) were conducted. Anonymized data on hospital admissions were downloaded from the hospital database. Infants with a duration of stay in the NICU of more than 20 days were included in the analysis. The cost of NICU stay was estimated using the Health Resource Group codes. Results: The average duration of infants’ stay in NICU was similar before and after the implementation of FICare (47 days (SD 29) in 2021 and 47 days (SD 31) in 2024). However, the infants who received FICare spent fewer days in high-dependency care; on average, 10 days in 2024 and 13 days in 2021. The duration of invasive ventilation fell by 12% and the duration of CPAP by 26% after introducing FICare. The total cost per baby stay in NICU was GBP 63,279 (USD 87,021) in 2021 and GBP 59,284 (USD 75,777) in 2024. Conclusions: Although the changes did not reach statistical significance, the study suggests that FICare may be resource- and cost-saving due to reducing infants’ stays in high-dependency care. Full article

Background/Objectives: The incorporation of peer support within mental health services has shown benefits for service users’ recovery and engagement, yet implementation is often hindered by role ambiguity and limited institutional recognition. The aim of this study is to explore the experiences of workers in a programme that provides peer support within a personal assistance model. The focus is on how they perceive the shaping of their professional role and their integration within care teams, rather than on evaluating service outcomes or effectiveness. Methods: An interpretive qualitative methodology with an exploratory approach was used. The study was conducted in a single organisational setting and focused on the self-reported experiences of personal assistants. Fieldwork was conducted in 2025 with ten personal assistants. Data were obtained through individual semi-structured interviews and one focus group with the same participants. A thematic content analysis combining inductive and deductive coding strategies was conducted using MAXQDA (version 24.11). Results: Findings indicate that the Personal Assistant role was perceived as reducing some of the ambiguity commonly associated with peer support, due to a clearer contractual framework and a more explicit delineation of functions. However, tensions persisted in relation to its hybrid professional identity, experiences of task overload, and ongoing gaps in coordination with traditional professional roles. Key facilitators included institutional support, accessible coordination, a supportive culture of care, and informal peer networks. Perceived benefits were reported for service users, including increased trust, hope, and autonomy, as well as for assistants, who described enhanced professional purpose and progress in their own recovery, alongside risks of emotional strain. Conclusions: Analysing the perspective of participants, the personal assistance model may represent a promising framework for the professionalisation of peer support through functional clarity, continuous supervision, and recognition of experiential knowledge. Further progress requires strengthening internal communication, expanding training opportunities, and enhancing the structural participation of personal assistants in decision-making. The study contributes an exploratory qualitative perspective to the growing literature on integrating lived-experience professionals into mental health services. Full article

Tackling poor mental health and wellbeing among healthcare workers remains a high priority for the National Health Service (NHS). This study evaluated the social value of the Coming to Our Senses mindfulness-based programme, designed to support the mental health of workers in high-stress medical environments, for NHS healthcare workers in Wales. Respondents (N = 39) to an online survey were assessed for mental health social value at baseline and one-month follow-up using the Short Warwick–Edinburgh Mental Wellbeing Scale (SWEMWBS) and the Social Value Bank (SVB). Social return on investment (SROI) ratios were calculated by dividing the change in mental health social value, health resource service use, and productivity costs by the programme delivery costs. Social value generated per respondent was £1890.05 using SWEMSWBS and £5775.97 using SVB. Cost savings in health resource and productivity were £9.41 and £79.10 per respondent, respectively. The programme delivery cost was £463.63 per respondent. Overall, including sensitivity analysis, the programme yielded a positive SROI of £2.35–£4.27:£1 using SWEMWBS or £6.82–£12.65:£1 using SVB. These findings suggest that the Coming to Our Senses programme may be effective in generating positive social value by improving self-reported mental health and wellbeing among NHS healthcare workers in Wales. Full article

With the increasing detection of micro- and nanoplastics (MNPs) in marine environments and the expanding body of related research, their environmental behavior and ecological effects have become central topics in marine environmental science. This review addresses the growing concern over MNP pollution in the marine realm, encompassing their primary sources, spatial accumulation and distribution, environmental transport and transformation dynamics, and ecotoxicological effects on marine organisms and ecosystems, as well as the ecological risks they pose within key habitats such as seagrass beds and coral reefs. We synthesize evidence on the biological impacts of MNPs, including oxidative stress, tissue accumulation, metabolic disturbances, and immune impairment, as well as the heightened risk of pathogen transmission facilitated by the so-called “Plastisphere”. Moreover, we explore the potential implications of MNP exposure on oceanic carbon cycling and net primary productivity. The reviewed literature suggests that MNPs are capable of long-range transport and progressive fragmentation into ultrafine particles, which are readily ingested and retained by a wide array of marine organisms, subsequently inducing toxicological effects and compromising both organismal health and ecological integrity. Such disturbances may undermine critical ecosystem services, including carbon sequestration capacity and food web stability. Finally, based on the current research landscape, we outline future research priorities: improving environmental detection and toxicological evaluation of MNPs, elucidating their long-term effects at the ecosystem scale, and investigating their interactions with co-occurring pollutants under complex, multi-stressor scenarios. These efforts are essential to support science-based assessment and effective management strategies for marine MNP pollution. Full article

Heavy metal pollution in forest and agroforestry soils represents a persistent environmental challenge with direct implications for ecosystem functioning, food security, and human health. In tropical and subtropical regions, intense weathering, rapid organic matter turnover, and dynamic redox conditions strongly modulate metal mobility, bioavailability, and long-term soil vulnerability. This review synthesizes current knowledge on the sources, biogeochemical mechanisms, ecological impacts, monitoring approaches, and restoration strategies associated with heavy metal contamination in forest and agroforestry systems, with particular emphasis on tropical landscapes. We examine natural and anthropogenic metal inputs, highlighting how atmospheric deposition, legacy contamination, land-use practices, and soil management interact with mineralogy, organic matter, and hydrology to control metal fate. Key processes governing metal behavior include sorption and complexation, Fe–Mn redox cycling, pH-dependent solubility, microbial mediation, and rhizosphere dynamics. The ecological consequences of contamination are discussed in terms of soil health degradation, plant physiological stress, disruption of ecosystem services, and risks of metal transfer to food chains in managed systems. The review also evaluates integrated monitoring frameworks that combine field-based soil analyses, biomonitoring, and geospatial technologies, while acknowledging methodological limitations and scale-dependent uncertainties. Finally, restoration and remediation strategies—ranging from phytotechnologies and soil amendments to engineered Technosols—are assessed in relation to their effectiveness, scalability, and relevance for long-term functional recovery. By linking mechanistic understanding with management and policy considerations, this review provides a process-oriented framework to support sustainable management and restoration of contaminated forest and agroforestry soils in tropical and subtropical regions. Full article

Objectives: Mindfulness has been proposed as an important health outcome and an indicator of mental well-being. This study aimed to evaluate the psychometric properties of the Five Facet Mindfulness Questionnaire (FFMQ-15) in two samples of mental health service users with diverse cultural and linguistic backgrounds (English- and Chinese-speaking). The study addresses the conceptual gap regarding the limited validation of the FFMQ-15 in Chinese-speaking clinical populations and examines the implications of measurement invariance. This study aimed at (1) confirming the reliability and validity of the FFMQ-15 in mental health service users; (2) assessing the validity of the FFMQ-15 in Chinese-speaking populations, where evidence is limited; and (3) examining measurement invariance across English- and Chinese-speaking groups to ensure cross-cultural applicability and comparable score interpretation. Methods: Participants were recruited using snowball sampling and social media advertising, targeting adults aged 18 or older who could read and write English or Chinese and had received mental health services. The English-speaking sample comprised 115 adults, and the Chinese-speaking sample included 118 adults. Exploratory factor analysis was used to identify structural dimensions, while confirmatory factor analysis was conducted for both samples to evaluate the five-factor structure of the FFMQ-15. Results: The EFA showed literature-aligned results supporting the 5-factor structure model, while the CFA model demonstrated acceptable fit: χ²/df = 159.50/80 = 1.99, p < 0.001; CFI = 0.927; TLI = 0.904; RMSEA = 0.065 (90% CI [0.050, 0.080]); SRMR = 0.060, BIC = 10,843.067, meeting established thresholds, and the non-significant measurement variance indicated the measurement model’s consistency among clinical patients and across different cultural contexts. Conclusions: The FFMQ-15 shows strong psychometric properties for measuring mindfulness in English- and Chinese-speaking mental health service users, supporting its value in clinical research and practice. Full article

Background: Patients with catastrophic health conditions have continuously faced substantial out-of-pocket (OOP) costs for non-covered services despite universal health coverage in South Korea. In 2013, the National Health Insurance Service (NHIS) expanded coverage for four major catastrophic conditions—cancers, cardiovascular diseases, cerebrovascular diseases, and rare illnesses—aiming to strengthen financial protection for patients with catastrophic conditions. However, concerns remain that providers may respond by inducing more use of non-covered services, potentially offsetting reductions in patients’ financial burden. Methods: We evaluated the impact of the 2013 catastrophic coverage expansion on patients’ OOP spending for non-covered services using a quasi-experimental difference-in-differences design. Using nationally representative longitudinal healthcare expenditure data, the Korean Health Panel Survey (KHPS), from 2011 to 2016, we compared patients with the four targeted conditions to a control group with clinically comparable conditions. A two-part model was applied to separately estimate changes in the probability of incurring any non-covered OOP spending and changes in spending levels conditional on positive expenditures. We further examined whether effects differed by supplemental private health insurance (PHI) status. Results: We found that 7.3-, 5.2-, and 7.7-percentage-point decreases in annual probability of incurring any non-covered OOP spending for total, inpatient, and outpatient services, respectively, after policy implementation. Among patients with positive spending, OOP spending for total and inpatient non-covered services decreased by approximately 164 USD and 254 USD per year, while outpatient spending showed no statistically significant change. No statistically significant differential effects were also observed by PHI status. Conclusion: The catastrophic coverage expansion reduced patients’ exposure to and burden of non-covered OOP spending, indicating improved financial protection without evidence of compensatory increases in non-covered service use. These findings suggest that targeted benefit expansions for high-cost conditions can enhance financial equity within universal health systems. Full article

Chinese local governments have long financed public services through land-sale revenues. The shift from selling undeveloped land to redeveloping existing urban areas has disrupted this traditional financing model, exposing a critical tension between the pursuit of immediate revenue and the assurance of long-term fiscal health. The continued dependence on land-based finance has led many local governments to overlook long-term public service obligations and the long-term operating deficits associated with intensive urban development. Thus, by examining the relationship between the development rights allocation and the sustainable fiscal capacity of the government, the study evaluates both short-term revenue generation and long-term expenditure commitments in urban redevelopment contexts. However, existing research has yet to provide actionable tools to reconcile this structural mismatch between short-term revenues and long-term liabilities. We employ a comprehensive analytical framework that integrates fiscal impact modeling with the optimization of development rights allocation. Based on this framework, we construct a quantitative, dual-period fiscal balance model using mathematical programming to analyze various combinations of land development rights supply strategies for achieving fiscal equilibrium. Our results identify multiple feasible supply combinations that can maintain fiscal balance while supporting sustainable urban development. The findings demonstrate that strategic development rights allocation functions as an effective tool for balancing short-term revenue needs with long-term obligations in local land finance systems. Our study contributes to establishing a sustainable land finance framework, particularly for jurisdictions lacking comprehensive land value capture mechanisms. The proposed approach offers an alternative to traditional land rights transfer models and provides guidance for avoiding long-term fiscal distress caused by excessive land transfer. The framework supports more sustainable urban redevelopment financing while maintaining fiscal responsibility across temporal horizons. Full article

Background/Objectives: Primary health care (PHC) is the cornerstone of any high-quality healthcare system. For PHC to work well, healthcare professionals need to be skilled in critical thinking, self-reflection, and patient-centered care. However, few studies have explored the potential interplays between these factors. Therefore, this cross-sectional study evaluated the critical thinking disposition and training needs of PHC professionals, alongside patient experiences and satisfaction with PHC services. Methods: The study involved 54 PHC professionals and 100 patients from sixteen PHC facilities in Crete, Greece. Professionals completed the Critical Thinking Disposition Scale (CTDS) and Training Needs Assessment (TNA) questionnaires, while patients filled out the Quality-of-Life Instrument of Chronic Conditions in Primary Health Care (QUALICOPC) questionnaire. Results: Our findings indicated that PHC professionals exhibited high critical thinking levels (CTDS, mean score of 46.46 ± 4.24). However, TNA scores suggested moderate training needs, particularly in relationships/investigations [median: 0.50 (0, 1.50)], communication/patient-centered [median: 0.30 (0, 1.1)], and flexibility and application of knowledge [median: 0.40 (0, 1.0)]. Nevertheless, no significant correlation was found between CTDS and TNA (ρ = 0.08, p > 0.05). Patients mostly rated their health as poor (40%), and 26% lacked a family physician. Although patients were highly satisfied with communication and patient-centered care (>95% reporting positive experiences), continuity and empowerment had room for improvement. Only 37% felt their GP knew their living conditions, and 26% lacked a personal physician. Patients with chronic conditions reported significantly different experiences. Specifically, patients with chronic conditions had better continuity of care (84% vs. 59%, p = 0.01) and more comprehensive care (70% vs. 43%, p = 0.01) compared to controls. Conclusions: Our findings suggest that targeted training is needed for PHC professionals to address skill gaps. These initial findings could guide the creation of customized professional development initiatives and point to areas where PHC services could be structurally improved. Additional studies, including longitudinal ones, are required to further validate these associations. Full article

Background/Objectives: Emerging evidence suggests that multiple micronutrient supplements (MMS) provide additional benefits for maternal and neonatal health compared with iron and folic acid (IFA) supplements. To achieve effective coverage, acceptability, and adherence—and to inform a nationwide rollout of MMS—it is essential to understand the context-specific factors that shape implementation. This study evaluated the pilot implementation of MMS in Rwanda to identify key enablers, areas for improvement, and challenges related to antenatal care (ANC) attendance and MMS use. Methods: Data were collected through a survey of 3257 women who attended ANC services, seven focus group discussions with 35 ANC attendees, and key informant interviews with 20 ANC nurses and 21 community health workers. Results: Pregnant women reported high ANC attendance (74%) and MMS consumption (79%), largely driven by strong motivation and awareness of MMS benefits. Strategies to remember daily intake and to manage side effects supported adherence, as did reminders, motivation, and information from family members and healthcare providers. Limited patient-centered counselling, financial constraints, barriers to accessing ANC services, and product stock-outs were key areas for strengthening service delivery in Rwanda. Conclusions: Sustaining high ANC attendance and MMS adherence as the program transitions from the pilot phase to national scale-up is essential. Improving counseling quality and strengthening supply chains may reinforce ANC services and support sustained MMS adherence, with benefits for maternal and child health. Full article