Search Results (2,676)

The incidence of tuberculosis disease (TBD) in New Brunswick (NB) is low but has been rising over the past decade. Analyzing these trends can help identify specific risk factors and transmission patterns to guide targeted public health strategies. This study aimed to provide a comprehensive and detailed characterization of TBD in NB by examining data from 1 January 2002, to 31 December 2024. All TB patients with Mycobacterium tuberculosis complex (MTBC) clinical isolates identified in NB healthcare facilities were eligible for inclusion in the study. We analyzed demographic, drug susceptibility, and 24-locus Mycobacterial Interspersed Repetitive Unit-Variable Number Tandem Repeat (MIRU-VNTR) data from 166 patients. Most MTBC isolates were pan-susceptible to first-line anti-tuberculosis drugs (90.9–98.1%), with 2.4% showing multidrug resistance. The MIRU-VNTR demonstrated a high discriminatory power of 0.9982 and a low clustering rate of 20.4%. Two samples from the same patient, collected seven years apart, showed different genetic profiles, suggesting that the second episode was a new infection. The most prevalent MTBC lineage was East African Indian (n = 23, 13%). This study provides early insights into TB trends in NB, including what may be the first recorded case of TB reinfection in NB. Our findings will help guide future TB research, policies, and public health interventions in the region. Full article

One of the challenges post-COVID-19 is reducing the negative impacts on quality of life, performance, and independence in activities of daily living. Assessing functional dependence in adults one year after acute infection can help to understand the long-term consequences, evaluate the impact on quality of life, plan rehabilitation and healthcare, identify the most vulnerable groups, measure the socioeconomic impact, and support public policies and clinical decisions. Objectives: The objectives of this study are as follows: (a) to assess the prevalence of functional dependence in Brazilian adults with COVID-19; (b) to analyze the association between the study variables; and (c) to determine the factors associated with functional dependence. Methods: This was an observational, cross-sectional study with 987 adults (18 to 59 years old) living in the State of Paraná (Brazil) hospitalized for COVID-19 between March and December 2020. Data were collected by telephone 12 months after the acute infection using an instrument to retrieve sociodemographic and health information, and a functional dependence scale to assess dependence before COVID-19 retrospectively (using participant recall information) and at the time of the interview. Data were analyzed using penalized logistic regression after imputing missing data. Data were analyzed using penalized logistic regression after imputing missing data. Results: Functional dependence after COVID-19 was 5.0% and was associated with low levels of education, not having a partner, living with someone, not owning a home, experiencing job changes, requiring care, obesity, smoking, multimorbidity, ICU admission in the acute phase, use of invasive ventilation, or having Long COVID. Individuals who required care or used invasive ventilation support were, respectively, 9.3 and 6.5 times more likely to develop dependence after COVID-19. Despite adjustment for multiple factors, the magnitude of the observed effects warrants cautious interpretation, as unmeasured or residual confounding effects may still be present. Sample recall bias due to collection after 12 months and the presence of the alpha variant without COVID-19 vaccination coverage may limit data generalization. Conclusions: The results highlight the need to emphasize the public health implications of identifying functional dependence. In this vein, it is necessary to implement preventive measures, identify and monitor more vulnerable groups, plan rehabilitation programs, and develop public health policies. Full article

Background and Objectives: Quality of life (QoL) among healthcare professionals (HCPs) is a critical determinant of workforce performance and patient care. Therefore, the present study aimed to assess QoL and its determinants among HCPs in the Hail region, Saudi Arabia. Methods: In this cross-sectional study, data were collected from 388 HCPs from multiple healthcare facilities using the WHOQOL-BREF questionnaire. The survey was conducted from August 2025 to October 2025. Convenience sampling was used, and QoL domain scores were calculated according to WHO guidelines. We applied Spearman’s correlation test to assess correlations across domains and logistic regression to identify factors associated with individual and overall QoL. Results: Among the HCPs studied, overall QoL had a median score of 80, while the physical, psychological, social, and environmental domains showed moderate scores with considerable variability. We found a significant positive correlation between the various QoL domains (p = 0.001). Non-Saudi nationals (p = 0.010) and participants with chronic diseases (p = 0.032) reported significantly lower overall QoL. Furthermore, age group, work experience, HCPs category, work setting, nationality, and the presence of chronic disease were significant predictors across multiple QoL domains. Conclusions: The findings highlight the need for targeted workplace and health support interventions to manage the mental and physical health of HCPs, particularly for non-Saudi HCPs and those with chronic conditions, through tailored training, education, and lifestyle-based support programs. Full article

There is an established association between neurodivergence and gender variance, with growing documentation of the challenges and inequities faced by those who exist at this intersection. This paper contributes a critical analysis of interviews with 24 autistic adults in the U.S. about their gender experience; yielding three themes: “gender divergence?”, “gender socialization on crip time”, and “either/or: whose intolerance for ambiguity?”. Results suggest that gender variance—if it is best understood as such—among those on the spectrum emerges through a complex set of relationships between participants’ bodyminds (e.g., sensory and cognitive styles); dominant cultural concepts of gender; and ableist and heterocissexist social relations. Neuronormative ways of knowing gender, institutionalized through biomedical research, healthcare, and social policy, emerge as a normalizing discourse contributing to the oppression and marginalization of participants as neurodivergent people. Justice implications of accounting for the epistemology of the neurodivergent bodymind and decentering neuronormative ways of knowing are discussed. Full article

The growing economic pressures on healthcare systems have heightened the need for effective and sustainable cost management strategies. This study presents a PRISMA-based systematic review of 210 peer-reviewed articles published between 1974 and 2024, retrieved from the Scopus and Web of Science databases. Following a structured selection and screening process, the articles were analysed to identify dominant cost control tools, contextual applications, and methodological trends across diverse health systems. The findings highlight a strong prevalence of Activity-Based Costing (ABC), Diagnosis-Related Groups (DRG), and benchmarking practices, predominantly in public hospital settings. However, significant thematic gaps remain, particularly concerning low-income countries, interdisciplinary integration, and the evaluation of digital technologies for financial optimisation. This review provides a comprehensive thematic synthesis of international research, consolidating knowledge in healthcare cost management and offering evidence-based recommendations to guide future empirical research, policy design, and strategic planning in health finance. Full article

Background: Workplace violence (WPV) is a pervasive occupational hazard in healthcare that undermines staff safety and quality of care. In Bulgaria, WPV remains widespread and underreported, despite recent legislative initiatives. This study assessed healthcare professionals’ perceptions of the effectiveness of WPV prevention strategies and examined how prior exposure shapes these perceptions. Methods: A nationwide cross-sectional online survey was conducted in December 2024 with 944 healthcare professionals from multiple sectors. Participants rated the perceived effectiveness of 11 prevention strategies, including environmental/security measures, organizational, and national-level interventions, on a three-point scale. Friedman ANOVA with Kendall’s W assessed overall strategy rankings, while Mann–Whitney U tests with rank-biserial correlations compared specific effectiveness ratings between subgroups defined by WPV exposure (experienced or witnessed vs. not exposed in the previous 12 months). Results: In the previous 12 months, 34.7% of respondents reported direct WPV, and 43.4% had either experienced or witnessed incidents. Friedman ANOVA indicated significant differences in perceived effectiveness across strategies (Kendall’s W = 0.13), with stronger differentiation among violence-exposed respondents (W = 0.37) than among non-exposed respondents (W = 0.09). National-level interventions and security/response measures were consistently ranked the highest. Mann–Whitney tests showed significantly higher endorsement of most strategies among violence-exposed professionals, with large effect sizes for security measures and enforcement of sanctions. Conclusions: Bulgarian healthcare professionals view WPV prevention as requiring a multicomponent approach that integrates robust national policy with organizational and environmental measures. Direct exposure to violence is associated with stronger support for security-focused and national interventions. These findings inform context-specific, evidence-based WPV prevention programs for Bulgarian healthcare facilities. Full article

The incorporation of Artificial Intelligence (AI) into medical services in Saudi Arabia offers a substantial opportunity. Despite the increasing integration of AI techniques such as machine learning, natural language processing, and predictive analytics, there persists an issue in the thorough comprehension of their applications, advantages, and issues within the Saudi healthcare framework. This study aims to perform a thorough systematic literature review (SLR) to assess the current status of AI in Saudi healthcare, determine its alignment with Vision 2030, and suggest practical recommendations for future research and policy. In accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) methodology, 699 studies were initially obtained from electronic databases, with 24 studies selected after the application of established inclusion and exclusion criteria. The results indicated that AI has been effectively utilised in disease prediction, diagnosis, therapy optimisation, patient monitoring, and resource allocation, resulting in notable advancements in diagnostic accuracy, operational efficiency, and patient outcomes. Nonetheless, limitations to adoption, such as ethical issues, legislative complexities, data protection issues, and shortages in worker skills, were also recognised. This review emphasises the necessity for strong ethical frameworks, regulatory control, and capacity-building efforts to guarantee the responsible and fair implementation of AI in healthcare. Recommendations encompass the creation of national AI ethics and governance frameworks, investment in AI education and training initiatives, and the formulation of modular AI solutions to guarantee scalability and cost-effectiveness. This breakthrough enables Saudi Arabia to realise its Vision 2030 objectives, establishing the Kingdom as a global leader in AI-driven healthcare innovation. Full article

Even though environmental health and climate change are rapidly intensifying the severity of determinants of disease and inequity, training for health professionals in these areas remains fragmented across Europe. To address this gap, the European Medical Association (EMA), in collaboration with the European Network on Climate and Health Education (ENCHE), the International Network on Public Health and Environment Tracking (INPHET) and University College London, convened a one-day hybrid roundtable in London on 17 September 2025, focused on “Preparing Health Professionals for Environmental Health and Climate Change: A Challenge for Europe”. The programme combined keynote presentations on global and European policy, health economics and curriculum design with three disease-focused roundtables (respiratory, cardiovascular and neurological conditions), each examining the following topics: (A) climate and environment as preventable causes of disease; (B) healthcare as a source of environmental harm; and (C) capacity building through education and training. Contributors highlighted how environmental epidemiology, community-based prevention programmes and sustainable clinical practice can be integrated into teaching, illustrating models from respiratory, cardiovascular, surgical and neurological care. EU-level speakers outlined the policy framework (European Green Deal, Zero Pollution Action Plan and forthcoming global health programme) and tools through which professional and scientific societies can both inform and benefit from European action on environment and health. Discussions converged on persistent obstacles, including patchy national commitments to decarbonising healthcare, isolated innovations that are not scaled and curricula that do not yet embed sustainability in examinable clinical competencies. The conference concluded with proposals to develop an operational education package on environmental and climate health; map and harmonise core competencies across undergraduate, postgraduate and Continuing -professional-development pathways; and establish a permanent EMA-led working group to co-produce a broader position paper with professional and scientific societies. This conference report summarises the main messages and is intended as a bridge between practice-based experience and a formal EMA position on environmental-health training in Europe. Full article

Background: Black and racialized immigrants with disabilities in Canada face overlapping systems of exclusion rooted in racism, ableism, and migration status. Yet, their experiences within health and rehabilitation services during the COVID-19 pandemic remain largely undocumented. This study explores how structural inequities shaped access to healthcare, rehabilitation, information, and community supports in the Greater Toronto and Hamilton Area (GTHA). Methods: Using narrative inquiry, ten in-depth interviews were conducted with participants who identified as Black or racialized, disabled, and having immigrated to Canada within the last 10 years. Narratives were analyzed through reflexive thematic analysis to identify how systems, relationships, and policies interacted to shape daily life, health and rehabilitation navigation during the pandemic. Results: Participants described systemic barriers in health and rehabilitation systems, experiences of “othering” and conditional belonging, and the critical role of informal and faith-based networks in navigating inaccessible services. Pandemic policies often intensified existing inequities. Conclusions: Findings underscore the need for intersectional health and rehabilitation planning that centers the voices of Black and racialized disabled immigrants. Addressing systemic racism and ableism is essential for equitable preparedness in future public health emergencies. Full article

Background/Objectives: Digital transformation is increasingly essential for healthcare organizations to improve operational efficiency and service quality. However, in developing countries such as Indonesia, many lower-middle-class hospitals lag due to limited financial, human, and infrastructural resources. This study examines how environmental dynamism—comprising regulatory changes, market pressures, and technological shifts—affects the digital capabilities of these hospitals. Methods: A quantitative, cross-sectional survey was conducted in Class C and D hospitals across Indonesia. Respondents included hospital directors, deputy directors, and IT heads. Data were collected through structured questionnaires measuring environmental dynamism and digital capability using a six-point Likert scale. Reliability testing yielded Cronbach’s alpha values above 0.96 for both constructs. Correlation analysis was performed to examine the relationship between environmental dynamism and digital capability. Results: Findings reveal a weak positive correlation (r = 0.1816) between environmental dynamism and digital capability. Although external factors such as policy regulations and technological competition encourage digital adoption, hospitals with limited internal resources struggle to translate these pressures into sustainable transformation. Key challenges include low ICT budgets, inconsistent staff training, and insufficient infrastructure. Conclusions: The results suggest that environmental change alone cannot drive digital readiness without internal capacity development. To foster resilient digital healthcare ecosystems, policy interventions should integrate regulatory frameworks with practical support programs that strengthen resources, leadership, and human capital in lower-middle-class hospitals. Full article

The COVID-19 pandemic highlighted critical issues in health services and public policy, particularly in long-term care facilities across Canada. Failures in these facilities revolving around chronic underfunding, staffing shortages, inadequate infection control, and inconsistent regulatory oversight, underscore the need to rethink health service interventions, especially considering varying implementation contexts among provinces. The Ontario Long-Term Care COVID-19 Commission Final Report pointed to long-standing systemic issues as the primary causes of the sector’s failures. To explore this issue, a narrative review was conducted with findings indicating that the long-term care crisis in Canada cannot be solved by more privatization, regulation or efficiency measures, as these have contributed to the problem’s root causes. Ontario’s long-term care crisis stems from systemic misalignments in policy, structure and stakeholder dynamics, requiring a shift toward systems thinking and resident-centered care to build an equitable and sustainable long-term care sector. Ultimately, governments must lead a policy redesign that reflects shared responsibility, stakeholder interdependence, and public involvement, offering a model for broader healthcare reform. Full article

Health equity and financial inclusion (FI) are at the core of the Sustainable Development Goals, yet their intersection remains critically under-studied. This bibliometric study maps this emergent and fragmented field by analyzing 24,140 publications from Scopus, PubMed, Web of Science, and Lens.org over five decades. Employing co-citation and co-word analysis via VOSviewer, chart research trends, governance frameworks, and policy linkages were systematically presented. The analysis reveals that less than 0.3% of the identified literature explicitly bridges financial inclusion with health outcomes, and direct investigations into health equity are virtually absent. Despite recent growth, fundamental gaps persist, including a lack of empirical studies on digital financial tools in low- and middle-income countries (LMIC) health contexts and insufficient focus on disadvantaged populations. As the first comprehensive empirical mapping of this nexus, this study underscores the urgency for scholarly and policy action to strategically leverage financial instruments for equitable healthcare access. The findings provide a foundational map and a structured agenda to consolidate this nascent field. Full article

Background: Maternal mortality in Brazil remains a critical indicator of social and racial inequalities, reflecting structural failures in access to and quality of obstetric care. Black women, particularly those categorized as black or brown, are at a higher risk of dying during pregnancy, childbirth, or the postpartum period. This is the result of the intersection of institutional racism, poverty, and social vulnerabilities. This study aimed to analyze trends and associated factors of maternal mortality among black women in Brazil from 2000 to 2020. Methods: This is a retrospective cohort analytical study using data from the Brazilian Mortality Information System. The sample included women aged 10 to 49 years whose underlying cause of death was classified under ICD-10 codes O00–O99. Descriptive and bivariate analyses were conducted, as well as Poisson and multinomial logistic regressions to estimate adjusted risk ratios according to skin color, education, region, type, and place of death. Results: A total of 40,907 maternal deaths were identified, with 59.2% occurring among black women. The maternal mortality ratio was 39% higher among black women compared to white women and more than double among Indigenous women. Low education, residence in the North and Northeast regions, deaths outside hospital settings, and lack of formal investigation were independently associated with increased risk. Direct obstetric causes accounted for most deaths, with hypertensive disorders and puerperal complications being the leading conditions. Conclusions: Maternal mortality among black women in Brazil reveals deep structural inequalities. Urgent public policies that incorporate an intersectional perspective, addressing race, gender, and class, are necessary to reduce disparities and ensure equitable and dignified maternal healthcare. Full article

Objective: The aim of this study was to systematically map evidence to inform best practices for sexual and reproductive healthcare delivered via telehealth (TeleSRH) in United States-based Title X-funded clinics. Methods: We searched three databases (2017–2025) for studies evaluating effectiveness, harms, patient and provider experiences, barriers/facilitators, and engagement strategies encompassing TeleSRH for sexually transmitted infections (STIs), contraceptive care/family planning (CC/FP), and sexual wellness, in countries with a human development index of ≥0.8. Results: From 5963 references and 436 articles, we included 142 eligible publications. TeleSRH use declined since the COVID-19 pandemic’s peak but remains higher than pre-pandemic. Evidence comes mostly from poor-quality studies. TeleSRH increases access and adherence to STI prevention (e.g., pre-exposure prophylaxis for HIV). Tele-follow-up may safely facilitate HIV care continuity. For CC/FP, TeleSRH is comparable to in-person care for patient satisfaction and uptake; patients are less likely to select long-acting reversible contraception but post-initiation tele-follow-up may increase its continuation rates. Vasectomy completion rates may be similar between pre-procedural counseling via telehealth versus in-person. TeleSRH’s potential benefits might include reduced travel time, wait times, no-show rates, and clinic human resource burden (via tele-triaging) and increased preventative screening rates for STIs and non-communicable diseases, prescription refill rates, ability to receive confidential care in preferred settings, and rural/marginalized community outreach. Implementation challenges span technological and capital constraints, provider availability, staff capability building, restrictive policies, language incompatibility, and patient mistrust. Supplementing synchronous TeleSRH with asynchronous communication (e.g., mobile application) may improve continued patient engagement. Conclusions: Preventive, diagnostic, and therapeutic TeleSRH can be effective, with high patient acceptability; however, effectiveness and adoption hinge on contextual factors outlined in this review. Full article

Background/Objectives: Antimicrobial resistance (AMR) among Enterobacterales poses a major threat to public health in Southern Africa and has led to limited treatment options and increased mortality. Despite Africa bearing the brunt, there is limited data on the epidemiology and molecular epidemiology of the genetic determinants of β-lactam and/or carbapenem resistance. This narrative literature review summarizes the epidemiology and molecular characteristics of extended-spectrum β-lactamase-producing Enterobacterales (ESBL-PE), carbapenem-resistant Enterobacterales (CRE), and carbapenemase-producing Enterobacterales (CPE) in Southern Africa, while identifying data gaps and surveillance challenges. Methods: A comprehensive literature review was conducted using peer-reviewed articles from ten Southern African countries, including South Africa, Lesotho, Eswatini, Botswana, Namibia, Angola, Zambia, Zimbabwe, Mozambique, and Malawi, reporting the epidemiology and/or molecular characterization of ESBL-PE, CRE, and CPE. Results: ESBL-PE, CRE, and CPE pose an increasing healthcare threat in Southern Africa, with prevalence varying widely by source. Klebsiella pneumoniae and E. coli are the predominant ESBL-PE, CRE, and CPE species. The most frequent resistance genes are bla_CTX-M among ESBLs and bla_NDM and bla_OXA among carbapenemases, reflecting global patterns. However, molecular characterization across the region remains limited, with countries such as Botswana, Lesotho, Eswatini, Zambia, and Zimbabwe lacking sufficient data on the prevalence and diversity of these resistance determinants. Conclusions: Despite the paucity of genomic and epidemiological data, Southern Africa faces an urgent AMR challenge. Strengthening laboratory infrastructure, genomic surveillance, and regional coordination is crucial to mitigate AMR and guide antibiotic stewardship policies. Full article