Search Results (1,638)

Background: Rural and resource-constrained settings face major barriers to timely cancer screening, diagnosis, and treatment due to limited specialist availability and centralised service-delivery models. In the Eastern Cape, a largely rural province with a constrained oncology workforce, a decentralised–centralised hybrid model was introduced to improve access to cancer care. Nelson Mandela Academic Hospital serves as the central referral hub within this model. This study evaluates the implementation process and impact of this decentralised cancer care model on service utilisation, access, and continuity of care. Methods: A quantitative quasi-experimental pre–post implementation and quality improvement evaluation was conducted using retrospectively collected routine service utilisation and programme data from April 2023 to February 2025. The study assessed the impact of a decentralised oncology care model on access, service integration, and utilisation outcomes. Data from facility registers and district health information systems were managed using Microsoft Excel and analysed using Stata and IBM SPSS Statistics. Descriptive statistics, correlation analysis, and linear regression were used to compare pre- and post-implementation changes in patient volumes, screening coverage, referral completion, workforce capacity, gender distribution, and service uptake. The intervention decentralised screening, diagnosis, follow-up, and patient navigation services to district and satellite facilities while centralising specialised oncology care at referral centres to improve accessibility, efficiency, and continuity of care. Results: Cancer patient attendance increased substantially over the study period, from 355 patients in April 2023 to a peak of 1039 in April 2024, with a sustained upward trend (B = 18.03, p = 0.005), reflecting an average monthly increase of 18 patients. Female patients accounted for most visits, while male attendance showed a significant increasing trend (B = 8.03, p < 0.001). Service integration improved, with strong positive correlations between new patient registrations, follow-up care, palliative services, and inpatient admissions, indicating an expanding continuum of care. Breast and cervical cancers contributed the highest service burden, while cervical and lung cancers showed significant upward trends. Seasonal variation in attendance was observed, particularly during festive periods. From an implementation perspective, screening coverage for priority cancers increased by 18%, while 732,349 individuals were reached through community awareness initiatives. Access improved substantially, evidenced by a reduction of 56,400 km in cumulative patient travel distance over one year. Workforce capacity was strengthened through the training of 517 healthcare workers, and 1943 patients received structured navigation support. Referral efficiency and continuity of care improved, although persistent bottlenecks were observed in diagnostic and referral pathways. Conclusions: The decentralised–centralised oncology care model demonstrated improved cancer service utilisation, access, and continuity of care in a rural, resource-limited setting. However, increasing patient volumes and interconnected service demands place additional pressure on health system capacity. Sustained investment in workforce development, screening—particularly for cervical cancer—and system efficiency is required. This model provides a scalable and context-appropriate framework for strengthening oncology services in similar low-resource settings. Full article

Risk assessment is critical for managing health threats at the human–animal–environment interface, yet sector-specific approaches can result in fragmented actions. To address this gap, the Joint Risk Assessment Operational Tool (JRA OT), an operational tool of the Tripartite Zoonoses Guide, was developed by the Food and Agriculture Organization of the United Nations, the World Health Organization, and the World Organization for Animal Health. The JRA OT provides a structured framework for joint qualitative risk assessments that integrate multisectoral expertise to identify risk pathways, assess likelihood and impact, and develop consensus-based risk management and communication options. Surveillance systems play a critical role in this process by providing the multisectoral data needed to inform risk assessments, while the JRA process helps identify information gaps and guide the strengthening of integrated One Health surveillance. Implemented in at least 52 countries, the JRA OT has informed national mandates in Indonesia, Viet Nam, and Tanzania, regional strategies in West Africa, and adaptations in Canada. Cascade training has been used to build subnational capacity to facilitate roll out. Sustained leadership commitment, multisectoral coordination, routine applications, local adaptation, and capacity building remain essential for global implementation. Full article

Background: Mental health issues among university students are a growing global concern, including in Malaysia. This exploratory study aims to examine mental health support systems in Malaysian universities using a dyadic perspective, capturing both students’ and counsellors’ experiences. This addresses a key gap in the literature, which has largely relied on single-perspective accounts. Methods: A qualitative exploratory design was employed using purposive sampling. Semi-structured interviews were conducted with 15 students receiving mental health support and 10 university counsellors. The data were analysed using hybrid deductive–inductive thematic analysis. Results: Three themes emerged from the findings. The first theme showed that students sought support once distress affected their daily functioning, valuing trust, safety, and emotional guidance, while counsellors described a parallel process of assessing student needs and facilitating longer term recovery. The second theme identified barriers shared by both groups, namely limited awareness of services and stigma, alongside additional constraints reported only by counsellors, including staffing shortages, unclear referral pathways, and limited institutional support. The third theme centred on strategies for improvement, including early assessment, awareness campaigns, digital accessibility, resilience building, and stronger collaboration among students, counsellors, and university stakeholders. Conclusions: This study contributes to the literature by integrating three complementary theoretical perspectives to explain university students’ mental health support experiences, support networks, and help-seeking behaviour. The findings also provide practical guidance for university administrators, counsellors, and policymakers seeking to develop more accessible, proactive, and student-centred mental health support systems. As the study is based on qualitative, cross-sectional data, the findings should be interpreted as indicative rather than causal. Nonetheless, they suggest that strengthening such initiatives may contribute to more supportive and responsive mental health provision within higher education institutions. Full article

In regulated cross-institution electronic health record (EHR) sharing, access control may need to respect patient consent while also providing issuance accountability and revocation correctness. Existing multi-authority ciphertext-policy attribute-based encryption (MA-CP-ABE) schemes provide decentralized attribute management but generally do not bind key issuance and ciphertext use to explicit patient-authorized sharing episodes, nor do they provide proactive verification that accepted key packages are consistent with authenticated user requests and the current revocation state. In this paper, we propose a verifiable, consent-bound MA-CP-ABE scheme for cloud-assisted EHR sharing. The scheme binds ciphertexts and attribute key packages issued to a patient-signed consent identifier, supports request-consistent and verifiable key issuance, integrates revocation freshness and stale-key detection, and provides a two-layer accountability framework consisting of proactive issuance verification together with reactive tracing and audit. In addition, each issued package is bound to the enrolled user public key and to a user-originated commitment, supporting restricted designated-user delivery. Theoretical and experimental evaluations indicate that, under the stated trust and non-collusion assumptions, the proposed design strengthens consent-scoped access control and accountability while maintaining competitive computational efficiency for cloud-based EHR systems. Full article

Future climate projections suggest an increase in heat-related mortality and a decrease in cold-related deaths under warming scenarios. Understanding the health impacts of extreme heat, and their implications for healthcare demand is essential for assessing the future burden of climate-related illnesses. In this study, we examined the relationship between extreme heat events and Emergency Department Visits (EDV) for heat-related illnesses (HRIs) across the United States from 2018 to 2025. Using data from the Centers for Disease Control and Prevention (CDC) Heat and Health Tracker and other relevant sources, we analyzed EDV rates standardized to 100,000 population. We aggregated daily into the 10 U.S. Health and Human Services (HHS) Regions. We used 0.5° × 0.5° gridded maximum daily temperature data (aggregated to HHS regions with proportional area weighting) and daily maximum heat index extracted from the CDC data portal (estimated using the US National Weather Service methodology and aggregated to HHS regions using total population weighting) to characterize seasonal patterns and regional variability. The association between peak heat events and EDV time series was explored using log-linear mixed-effects models, which accounted for seasonal trends, climate variables, and their regional variability. Random effects were used to capture regional heterogeneity in predictor-response relationships, accommodating variation in associations across regions. Model performance was evaluated using prediction error metrics and goodness-of-fit assessments. Maximum temperature and heat index were both significant predictors, with the heat index offering a slightly better fit. Associations were largely contemporaneous, with peak correlations at lag zero, underscoring the need for real-time response. EDV increased several days before peak environmental conditions, consistent with early exposure effects. While temperature-EDV relationships varied regionally, heat index associations were more stable. This work underscores the urgent need for regionally adaptive public health strategies in the face of intensifying climate extremes and outlines future directions for research and policy to strengthen health systems’ preparedness in a warming world. Full article

Optimal sensor placement (OSP) is critical to building a full-lifecycle health monitoring network for high-aspect-ratio unmanned aerial vehicle wings, as it directly affects the deformation sensing of the wing shape. To address this challenge, this paper proposes a novel sensor placement method for wings based on a chaotic strengthened aquila optimizer (CSAO) that integrates chaotic mapping and a nonlinear search strategy. Specifically, the proposed method introduces a uniform initialization strategy based on the piecewise chaotic map and a nonlinear criterion for switching between exploration and exploitation in the basic aquila optimizer (AO). These enhancements increase the diversity of the initial population and raise the probability of global search in later iterations, thereby accelerating convergence and strengthening global optimization capability. First, the performance of the CSAO is compared with that of other popular intelligent algorithms on 10 benchmark functions. The results show that the proposed method exhibits superior convergence speed, higher-quality solutions, stronger global search ability, and better robustness, making it suitable for OSP problems involving tens of thousands of candidate points. Next, the CSAO is applied to sensor placement on a wing-shaped plate. Compared with other OSP methods, the proposed method offers significant advantages in terms of sensor distribution, computational time, and hardware cost. Finally, experimental validation is conducted using a wing test platform equipped with fiber Bragg grating (FBG) strain sensors. The measurement results demonstrate that the reconstructed shape is in excellent agreement with the measured shape. Therefore, the proposed CSAO-based OSP method, combined with the FBG-based structural monitoring system, offers a promising solution for health monitoring of deformable structures in extreme environments. Full article

Digital transformation is reshaping the mining industry by improving resource efficiency and environmental performance. However, empirical evidence explaining how, why, and under which organizational and institutional conditions digitalisation enhances sustainable operational performance (SOP) in Sub-Saharan African mining remains limited, despite the region’s strategic role in global mineral supply. This study examines the effect of digitalisation on sustainable operational performance using longitudinal panel data from 48 mining companies operating in Sub-Saharan Africa between 2013 and 2022. Digitalisation is conceptualized as a multidimensional organizational capability and measured through a Digitalisation Index. The index was systematically derived from corporate annual environmental, social and governance reports using transparent coding procedures and Principal Component Analysis, enhancing measurement transparency and reproducibility. SOP is measured using a composite index encompassing operational efficiency, equipment utilization and maintenance effectiveness, resource utilization and environmental sustainability, and occupational health and safety. Fixed effects panel regression serves as the primary estimator, while the two-step System Generalized Method of Moments addresses endogeneity and dynamic persistence, with robustness analyses confirming result stability. The findings show that digitalisation significantly enhances sustainable operational performance by transforming digital resources into organizational capabilities that strengthen operational resilience, optimize resource allocation, and improve sustainability outcomes. By integrating the Resource-Based View, Dynamic Capabilities Theory, the TOE framework, and the Natural Resource-Based View into a unified explanatory framework, this study advances theory while providing practical guidance for digital capability development and Industry 4.0 investment and informing policies that strengthen digital infrastructure, institutional readiness, and regulatory support for sustainable mining in Sub-Saharan Africa. Full article

Background: Upper airway tract infections (UATIs) are among the most common infectious diseases worldwide, accounting for an estimated 12.8 billion episodes annually and more than 8 million disability-adjusted life years (DALYs). Despite their generally self-limiting nature, their cumulative clinical, socioeconomic, and public health burden remains substantial, particularly in children, older adults, and low- and middle-income countries (LMICs). Methods: We performed a structured narrative review of the peer-reviewed literature and reports from major international health organizations to summarize the current evidence on the epidemiology, etiology, clinical impact, socioeconomic burden, prevention strategies, and future challenges associated with UATIs. Particular attention was given to the influence of antimicrobial resistance, vaccination policies, and lessons learned from the COVID-19 pandemic. Results: UATIs remain one of the leading causes of healthcare utilization worldwide. Children experience the highest incidence, averaging 6–8 episodes annually, whereas vulnerable populations are at increased risk of complications and hospitalization. Marked geographical disparities persist, with LMICs experiencing a disproportionate burden due to limited healthcare access, lower vaccination coverage, and higher complication rates. Inappropriate antibiotic prescribing continues to accelerate antimicrobial resistance, while the COVID-19 pandemic profoundly altered the epidemiology of respiratory infections and demonstrated the effectiveness of non-pharmaceutical interventions. Advances in vaccination, antimicrobial stewardship, rapid diagnostics, and novel therapeutic strategies offer promising opportunities to reduce disease burden. Conclusions: Reducing the global burden of UATIs requires integrated public health strategies combining equitable vaccine access, effective antimicrobial stewardship, strengthened healthcare systems, and sustained surveillance. Lessons learned from the COVID-19 pandemic provide a unique opportunity to improve preparedness for future respiratory outbreaks while addressing persistent regional inequalities in prevention and care. 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

Educators are working within increasingly complex environments characterized by rapid change and uncertainty, where future conditions, expectations, and appropriate responses are often ambiguous or difficult to anticipate. Technological innovation, political and social polarization, climate-related concerns, shifting policy landscapes, workforce pressures, and the lasting effects of public health disruptions each introduce distinct yet interconnected forms of uncertainty. While these domains of uncertainty have generated substantial bodies of scholarship, less attention has been paid to how multiple forms of uncertainty converge within educators’ professional lives. This essay introduces the concept of stacked uncertainties as a lens for understanding how overlapping uncertainties accumulate, interact, and amplify across interconnected technological, socio-political, ecological, organizational, and policy systems. From this perspective, multiple uncertainties compete for the same personal, relational, organizational, and material resources that support educator well-being and resilience. Resilience is understood as a dynamic process shaped by access to adaptive resources across ecological systems. Applying the concept of stacked uncertainties has practical implications for educational leadership, policy, professional learning, and initiatives aimed at strengthening conditions that support educator well-being and resilience amid ongoing complexity and change. Full article

Carbapenem-resistant Enterobacterales (CRE) represent one of the most important antimicrobial resistance threats in Europe, particularly in healthcare settings. Their increasing epidemiological significance is driven by the dissemination of carbapenem-resistant Klebsiella pneumoniae, the emergence of high-risk clones, horizontal transfer of mobile genetic elements, and the convergence of antimicrobial resistance and hypervirulence. Despite the growing epidemiological importance of CRE, surveillance and preparedness remain heterogeneous across European countries, creating a need for a continent-wide assessment of existing surveillance systems, implementation gaps, and emerging challenges. This narrative review summarizes the current epidemiology of CRE in Europe and critically discusses the role of European and global surveillance systems in monitoring their spread. Particular attention is given to the European Antimicrobial Resistance Surveillance Network (EARS-Net), European Antimicrobial Resistance Genes Surveillance Network (EURGen-Net), Healthcare-Associated Infections Surveillance Network (HAI-Net), European Surveillance of Antimicrobial Consumption Network (ESAC-Net), Point Prevalence Survey (PPS), EpiPulse/TESSy, the Central Asian and European Surveillance of Antimicrobial Resistance (CAESAR) programme, and the World Health Organization Global Antimicrobial Resistance and Use Surveillance System (WHO GLASS). Although Europe has well-established surveillance infrastructures, substantial heterogeneity persists among countries with respect to microbiological and genomic diagnostic capacity, reporting practices, infection prevention and control (IPC), antimicrobial stewardship, healthcare infrastructure, and implementation of national policies. These differences limit data comparability and may delay the detection of colonization, outbreaks, and cross-border transmission. The available evidence indicates that effective CRE control requires integrated surveillance combining microbiological, genomic, epidemiological, and antimicrobial consumption data within a coordinated One Health framework. Further expansion of genomic surveillance, harmonization of surveillance indicators, strengthening of healthcare system preparedness, and wider implementation of antimicrobial stewardship programmes are identified as priority areas for improve CRE prevention and control across Europe. By integrating evidence across surveillance, diagnostics, infection prevention and control, and antimicrobial stewardship, this review highlights key gaps in current European approaches and provides a framework for prioritizing future surveillance and preparedness efforts. Full article

Background/Objectives: Timely identification of autism spectrum disorder (ASD) is essential for access to early intervention; however, diagnostic delay remains a persistent challenge. Methods: This scoping review synthesized evidence from eight studies (>24,000 participants), most conducted in the Southeast region, on diagnostic pathways, screening practices, and barriers to ASD identification in Brazil, following PRISMA-ScR guidelines. Results: Across studies, mean age at diagnosis frequently exceeded 48–60 months, while the interval between first caregiver concern and diagnosis ranged from 24 to 36 months, with tertiary-care samples reporting diagnostic ages approaching 79 months. Diagnosis was predominantly specialist-driven, with limited involvement of primary care providers (PCPs). Later identification was associated with reliance on the public health system in a multinational analysis that included Brazil, while geographic concentration of specialized services and socioeconomic inequalities were identified as reported barriers across the included studies. Race/ethnicity was rarely reported. Delays emerged from interacting multilevel barriers, including limited caregiver awareness, dismissal of parental concerns, inconsistent developmental surveillance, fragmented referral pathways, and shortages of specialists. Structural inequities, particularly geographic disparities and urban concentration of services, compounded these challenges. Conclusions: The evidence suggests delayed ASD diagnosis in Brazil reflects systemic gaps in care organization rather than isolated clinical factors. Strengthening PCP-based developmental surveillance and improving referral coordination are key strategies to reduce preventable delays and promote earlier access to intervention. 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

Urban soils are central to ecological functioning and urban resilience and have value not only for the services they provide to people but also for their intrinsic ecological worth. However, this ecocentric dimension remains underrepresented in urban sustainability research and practice. This study examines how urban soil management can be transformed to incorporate ecocentric values of nature by analysing both the practices through which this transformation can be achieved and the barriers that stand in the way. Based on a survey of 80 urban practitioners conducted in 2023, the study explores stakeholder roles, value orientations, soil indicators, regenerative practices, and perceived barriers to implementation. The results show that nearly all respondents recognised at least one explicit value of urban soil (95%), and a majority (60%) attributed several values at once, with future and intrinsic values each recognised by a substantial share of practitioners (65% and 50%, respectively), suggesting that ecocentric framings are present among a substantial share of practitioners. Whether this recognition translates into practice is more limited: about half of the respondents (51%) consider soil properties in their professional practices. Soil assessment is predominantly based on physical and chemical indicators, with biological indicators receiving comparatively little attention. The central empirical finding of this study is a pronounced awareness–action gap specific to soil regeneration: 96% of respondents recognise the importance of soil regeneration, yet only 40% report implementing regenerative practices. Regeneration, understood here as the restoration of biological activity and natural soil processes, is conceptually located towards the ecocentric pole of an anthropocentric–ecocentric continuum, since it engages with soil as a living system with intrinsic value rather than as a substrate for human use. Respondents identify knowledge gaps, fragmented governance, and financial constraints as key barriers to wider adoption, which indicates that the principal barriers are structural and institutional in nature; a lack of practitioner commitment does not appear to be the issue. Embedding ecocentric values in everyday practice will require integrating biological indicators into standard soil assessments, strengthening knowledge exchange through living labs and practitioner-oriented tools, and extending soil health targets across the policy, procurement, and funding mechanisms that govern urban development. Full article

Background/Objectives: Perinatal care is essential for the health and well-being of women and adolescent girls from conception through the first year postpartum. The World Health Organization (WHO) provides evidence-based recommendations aimed at improving the quality of antenatal, intrapartum, and postnatal care. This study mapped 51 WHO perinatal care recommendations against Zambian guidelines to identify areas of alignment, as well as gaps and challenges related to their implementation. Methods: The review was conducted following Joanna Briggs Institute (JBI) guidance. Published recommendations and relevant documents issued from 2016 onwards were included. National guidelines, policy documents, professional standards, and literature related to perinatal care in Zambia were identified through searches of PubMed, Google Scholar, WHO resources, and relevant institutional websites. WHO recommendations were mapped against Zambian guidelines and classified according to their level of alignment. Results: The findings demonstrated significant alignment between WHO recommendations and Zambian guidelines in perinatal healthcare. However, important implementation gaps remain; for example, only 4.7% of pregnant women attended all eight recommended antenatal care visits. Intrapartum care largely aligns with WHO standards, though there are differences in pain-relief choices. Furthermore, difficulties in adopting WHO recommendations are mostly due to health system constraints. Conclusions: Most of the Zambian guidelines align with the WHO recommendations. However, ten were classified as partly aligned, and one did not align. This small proportion of non-alignment may reflect adaptation for a national context and require further evidence-based evaluation. In addition, consolidating existing recommendations, strengthening health-system capacity, and addressing implementation gaps may support the delivery of standardized, high-quality perinatal care and contribute to improved maternal and newborn health outcomes. Full article