Search Results (579)

This article presents a modular and replicable framework to assess spatial accessibility to essential public services in the Lazio Region (Italy). Current policies, framed within the EU Urban Agenda and the UN Sustainable Development Goals, emphasize improving accessibility rather than mobility, integrating land-use and transport planning, and supporting sustainable modes. The study adopts urban centres, densely populated sub-municipal units, as the main spatial unit to capture intra-municipal variability. Accessibility is measured as distance and travel time to the nearest education and healthcare facilities, for both private car and public transport, considering traffic conditions. Distances and times are computed using routing APIs and aggregated into service-specific indicators at urban-centre and municipal levels. Due to GTFS availability, the public transport analysis is restricted to the Province of Rome. Indicators are published as Linked Open Data following DCAT-AP, exposed via a SPARQL endpoint, and visualized through an interactive web map viewer. Results highlight pronounced disparities: car accessibility is relatively uniform, while public transport shows critical gaps in peripheral and mountainous areas. The framework enables transparent benchmarking and supports evidence-based, place-sensitive planning across different European contexts. Full article

The psychosocial well-being of employees is crucial to health and productivity, and it forms the basis for organisational sustainability. Unfortunately, most studies rely on narrow indicators or small samples and thus are not generalisable. The present study aims to identify psychosocial and health-related factors that distinguish employees with high and low SWB and determine whether these effects are universal or sector-specific. A total of 1628 employees with organisations in Latvia’s public administration, healthcare, pharmaceutical and energy sectors participated by completing the Multidimensional Psychosocial Well-Being Scale for Employed Persons (MPSWEP). This instrument assesses five key work environment factors: social inclusion, professional development, work intensity, health risks and autonomy. Subjective well-being (SWB) was measured as a separate outcome variable, and additional self-reported health problems were included as an independent variable in the analysis. Higher odds of high SWB were observed with greater social inclusion (OR = 5.11; p < 0.001), whereas higher work intensity (OR = 0.51; p < 0.001) and health problems (OR = 0.25; p < 0.001) were associated with lower odds of high SWB. Model accuracy was high (AUC = 0.85–0.87), with significant differences between sectors. The results suggest that some resources universally facilitate well-being across sectors, while others exert more sector-specific effects. Full article

Family caregivers provide up to 90% of care in Alberta’s communities and play an essential role in sustaining the province’s health and social care systems, yet they remain under-recognized and insufficiently supported. To address this gap, we co-designed the Alberta Family Caregiver Strategy and Action Plan (2024–2025), a provincial framework developed through participatory research and collective impact methods. Guided by principles of co-production, equity, and lived experience, the project engaged over 500 stakeholders, including caregivers, healthcare providers, educators, employers, and policymakers, through Phase 1 interviews (health/community leaders, n = 44; Family and Community Support Services (FCSS), n = 47; navigation experts, n = 9), Phase 2 co-design team consultations, and Phase 3 sector roundtables (n = 52). Using reflexive thematic analysis, we identified four foundational caregiver strategies, Recognition, Partnership, Needs Assessment, and Navigation, and four enabling conditions: Education, Workplace Supports, Policy and Research and Data Infrastructure. These elements were synthesized into an eight-priority Alberta Caregiver Strategy and Action Plan Framework, a practical way to connect validated priorities with coordinated, measurable implementation across settings. Participants emphasized four key enablers essential to making caregiver inclusion more feasible and sustainable: education, workplace supports, policy infrastructure, and research and evaluation. Findings highlight strong cross-sector consensus that caregiver inclusion must be embedded into routine practice, supported by consistent policy, and reinforced through provincial coordination with local adaptation. The Alberta Family Caregiver Strategy provides a practical, evidence-informed plan for transforming fragmented supports into a coherent, caregiver-inclusive ecosystem that strengthens both caregiver well-being and system sustainability. Full article

Background/Objectives: The COVID-19 pandemic severely impacted healthcare systems globally, with Italian healthcare professionals experiencing heightened stress, organizational challenges, and a significant psychological burden. This study investigates the frequency of depressive symptoms and health-related quality of life (H-QoL) among outpatient healthcare workers in Italy, comparing pre-pandemic (2017) and post-pandemic (2025) periods. Methods: A cross-sectional study was conducted in 2025, including 97 healthcare professionals from five outpatient departments at the University Hospital of Cagliari. Participants completed demographic surveys, the Short Form Health Survey (SF-12), and the Patient Health Questionnaire (PHQ-9) to assess H-QoL and depressive symptoms. Data were compared with previously published data from the same facility collected in 2017 and with pre-pandemic Italian community surveys. Results: Compared to 2017, there was a statistically significant increase in depressive episodes (38.1% vs. 33.2%, p = 0.01) and a higher proportion of individuals with low H-QoL (62.9% vs. 43.5%, p < 0.0001) in 2025. After age- and sex-standardization, both depressive symptoms and low H-QoL were significantly more prevalent among healthcare professionals in 2025 compared with the general population before the pandemic. Within the 2025 sample, non-medical healthcare workers showed a significantly higher prevalence of depressive symptoms than medical doctors, while female healthcare workers were more likely to report low H-QoL. Conclusions: Despite the pandemic’s end, healthcare workers, especially those in outpatient settings, continue to face elevated psychological distress. Specific professional and gender-related vulnerabilities persist, and structural challenges, such as staff shortages and organizational issues, may exacerbate this burden. Sustained mental health support and targeted systemic interventions remain crucial to mitigate the long-term impact on the healthcare workforce. Full article

Background/Objectives: Diabetic Foot Ulceration (DFU) is one of the most debilitating and costly complications of diabetes mellitus, representing a significant cause of morbidity, disability, and healthcare burden worldwide. Refractory non-healing ulcers that fail to respond to conventional therapies require novel adjuvant treatment modalities. This clinical audit aimed to evaluate the long-term clinical outcomes of an autologous, bioactive platelet-rich fibrin (PRF) matrix combined with topical gentamicin in patients with chronic, non-healing DFUs. Methods: A retrospective observational audit was conducted, involving eleven patients with refractory DFUs who underwent adjunctive treatment with a PRF matrix (Arthrozheal^®) and co-applied gentamicin. Patients were followed at three-week intervals using standardised wound imaging (Silhouette^® 3D) to assess healing parameters. Long-term follow-up data, evaluating healing durability and complications, is presented. Results: All patients completed the treatment protocol, with significant reductions in mean wound area (87.9%), perimeter, depth, and volume (all p < 0.05). Epithelialised tissue increased from 24.7% to 82.8%. At 12 months, 81.8% of patients maintained complete ulcer healing. Two patients experienced complications: one ulcer recurrence requiring surgical debridement and one unrelated amputation due to osteomyelitis. Conclusions: The combination of autologous PRF matrix and gentamicin demonstrated promising results in promoting sustained healing of refractory DFUs with minimal complications. These findings support further investigation in larger, controlled studies to validate this biologic-antimicrobial approach as a safe, effective, and durable therapy for complex diabetic wounds. Full article

Artificial intelligence (AI) is now embedded across many aspects of healthcare, yet most implementations remain fragmented, task-specific, and layered onto legacy workflows. This paper does not review AI applications in healthcare per se; instead, it examines what an AI-first healthcare system would look like, one in which AI functions as a foundational organizing principle of care delivery rather than an adjunct technology. We synthesize evidence across ambulatory, inpatient, diagnostic, post-acute, and population health settings to assess where AI capabilities are sufficiently mature to support system-level integration and where critical gaps remain. Across domains, the literature demonstrates strong performance for narrowly defined tasks such as imaging interpretation, documentation support, predictive surveillance, and remote monitoring. However, evidence for longitudinal orchestration, cross-setting integration, and sustained impact on outcomes, costs, and equity remains limited. Key barriers include data fragmentation, workflow misalignment, algorithmic bias, insufficient governance, and lack of prospective, multi-site evaluations. We argue that advancing toward AI-first healthcare requires shifting evaluation from accuracy-centric metrics to system-level outcomes, emphasizing human-enabled AI, interoperability, continuous learning, and equity-aware design. Using hypertension management and patient journey exemplars, we illustrate how AI-first systems can enable proactive risk stratification, coordinated intervention, and continuous support across the care continuum. We further outline architectural and governance requirements, including cloud-enabled infrastructure, interoperability, operational machine learning practices, and accountability frameworks—necessary to operationalize AI-first care safely and at scale, subject to prospective validation, regulatory oversight, and post-deployment surveillance. This review contributes a system-level framework for understanding AI-first healthcare, identifies priority research and implementation gaps, and offers practical considerations for clinicians, health systems, researchers, and policymakers. By reframing AI as infrastructure rather than isolated tools, the AI-first approach provides a pathway toward more proactive, coordinated, and equitable healthcare delivery while preserving the central role of human judgment and trust. Full article

Background: Healthcare is a large contributor to greenhouse gas (GHG) emissions, contributing to climate change and health impairments. However, the magnitude of health and climate benefits of local and regional GHG mitigation strategies has not been well quantified. Few studies have demonstrated the use of public tools for this purpose in healthcare facilities. Methods: We evaluated several renewable energy and energy efficiency scenarios focused on one academic medical center in New York State. We used the Environmental Protection Agency’s (EPA) publicly available AVoided Emissions and geneRation Tool to estimate avoided GHG and health-harmful air pollutant emissions. The economic value of the resulting avoided health and climate damages was quantified using EPA’s CO-Benefits Risk Assessment screening tool. Results: Transitioning one healthcare institution to 100% solar energy and improving energy efficiency by 25% could yield approximately $807,000 to $1.5 million in annual health savings, with an additional $2.3 million benefits in avoided climate damages. There is an approximate $108.5–$196.6 million in annual climate and health benefits when extrapolating these energy solutions to hospitals across the same state. Conclusions: There are significant health savings from healthcare GHG mitigation strategies. This application of publicly available and accessible tools demonstrates ways to integrate climate and health benefits into local decision-making around climate change mitigation and sustainability efforts. Full article

Background/Objectives: Neonatal Intensive Care Units (NICUs) constitute a highly complex clinical environment characterized by patient fragility and frequent ethically sensitive decisions. To date, systematic studies investigating how Italian NICUs address these challenges and what forms of ethics support are effectively available are lacking. The aim of this study is therefore to assess how ethical issues are managed in Italian NICUs, with particular attention to the availability, use, and perceived usefulness of clinical ethics support in everyday practice. Methods: A 25-item questionnaire was developed by adapting an existing tool for investigating clinical ethics activities to the neonatal context. Following expert review by the GIBCE (Gruppo Interdisciplinare di Bioetica Clinica e Consulenza Etica in ambito sanitario), the final instrument covered four areas (general data, experience with ethical dilemmas, tools and procedures, opinions and training needs). A manual web search identified all Italian NICUs and their clinical directors, who were asked to disseminate the survey among staff. Participation was voluntary and anonymous. Data collection was conducted via Google Forms and analyzed through qualitative thematic analysis. Results: A total of 217 questionnaires were collected. The most frequent ethical dilemmas concern quality of life with anticipated multiple or severe disabilities (72.4%) and decisions to withdraw or withhold life-sustaining treatments (64.5%). Major challenges include fear of medico-legal repercussions (57.6%) and communication divergences between physicians and nurses (49.8%). More than half of respondents (52.1%) reported no formal training in clinical ethics, and 68.7% had never developed a Shared Care Plan (Shared Document for healthcare ethics planning) as defined by the Italian Law 219/2017. Conclusions: Findings highlight marked fragmentation in ethical practices across Italian NICUs. On this basis, establishing structured and accessible CEC services could help promote consistency, reinforce shared ethical standards, and support transparent and equitable decision-making in critical neonatal care. Full article

Background: The COVID-19 pandemic has put other infectious diseases, especially in children, into a new perspective. Our study focuses on two important viral infections: COVID-19 and influenza, which often present with similar clinical symptoms. Taking into consideration that the pathophysiology and systemic impact of the two viruses are distinct, which can lead to measurable differences in laboratory values, this study aimed to analyze laboratory features that differentiate between COVID-19 and influenza virus infections in pediatric patients. Methods: We statistically analyzed the routinely available laboratory data of 98 patients with influenza virus and 78 patients with COVID-19. Afterwards, the classification and regression tree (CART) method was performed to identify specific clinical scenarios, based on multilevel interactions of different features that could assist clinicians in evidence-based differentiation. Results: Significant differences between the two groups were observed in ALT, eosinophils, hemoglobin, and creatinine. Influenza-infected infants presented significantly higher leukocyte, neutrophil, and basophil counts compared to infants infected with COVID-19. Regarding children (over 12 months), significantly lower levels of ALT and eosinophil counts were observed in those with influenza compared to those with COVID-19. Furthermore, the CART decision tree model identified distinct profiles based on a combination of features such as age, leukocytes, lymphocytes, platelets, and neutrophils. Conclusions: After further refinement and application, such machine learning-based, evidence-driven models, considering the large scale of clinical and laboratory variables, might help to improve, support, and sustain healthcare practices. The differential decision tree may contribute to enhanced clinical risk assessment and decision making. Full article

Real-time emotion monitoring is increasingly relevant in healthcare, automotive, and workplace applications, where adaptive systems can enhance user experience and well-being. This study investigates the feasibility of classifying emotions along the valence–arousal dimensions of the Circumplex Model of Affect using EEG signals acquired from a single mastoid channel positioned near the ear. Twenty-four participants viewed emotion-eliciting videos and self-reported their affective states using the Self-Assessment Manikin. EEG data were recorded with an OpenBCI Cyton board and both spectral and temporal features (including power in multiple frequency bands and entropy-based complexity measures) were extracted from the single ear-channel. A dual analytical framework was adopted: classical statistical analyses (ANOVA, Mann–Whitney U) and artificial neural networks combined with explainable AI methods (Gradient × Input, Integrated Gradients) were used to identify features associated with valence and arousal. Results confirmed the physiological validity of single-channel ear-EEG, and showed that absolute $\beta$- and $\gamma$-band power, spectral ratios, and entropy-based metrics consistently contributed to emotion classification. Overall, the findings demonstrate that reliable and interpretable affective information can be extracted from minimal EEG configurations, supporting their potential for wearable, real-world emotion monitoring. Nonetheless, practical considerations—such as long-term comfort, stability, and wearability of ear-EEG devices—remain important challenges and motivate future research on sustained use in naturalistic environments. Full article

Healthcare-associated infections (HCAIs) remain a significant global challenge, as pathogenic microorganisms can persist on hospital surfaces and medical equipment, contributing to severe infections and epidemic outbreaks. Conventional preventive measures, including disinfection procedures and personal protective equipment, are often insufficient to ensure complete microbial control, prompting interest in innovative antimicrobial surface technologies. This study reports the design, preparation, and comprehensive characterization of chitosan- and poly(ε-caprolactone)-based antibacterial coatings incorporating chlorhexidine-loaded zirconium phosphate (ZrPCHX) nanoparticles. Coatings were deposited by optimized spray and brush techniques to obtain uniform, adherent, and well-defined films. Their morphological, physicochemical, mechanical, and cytocompatibility properties were systematically evaluated, and antibacterial efficacy was assessed against clinically relevant pathogens following ISO 22196:2011 and additional protocols simulating realistic hospital conditions. Both coating systems demonstrated pronounced antibacterial activity, with the PCL-based formulation exhibiting a faster and broader bactericidal effect while maintaining good cytocompatibility. These findings support the potential of the developed nanostructured coatings as sustainable and scalable materials for the active decontamination of high-touch hospital surfaces, offering continuous antimicrobial protection and contributing to a reduction in HCAI incidence. Full article

Background/Objectives: Home care plays a crucial role in contemporary healthcare systems, particularly in the long-term care of people with chronic and progressive illnesses. Family caregivers often experience substantial physical, emotional, and organizational burden. Telemedicine and digital health applications have the potential to support home care by improving health monitoring, communication, and care coordination. However, their use among family caregivers remains inconsistent, and little is known about how organizational support structures such as telemedicine centers influence acceptance and everyday use. This study aims to examine the benefits of telemedicine in home care and to evaluate the role of telemedicine centers as supportive infrastructures for family caregivers. Methods: A mixed-methods design was applied. Quantitative data were collected through an online survey of 58 family caregivers to assess the use of telemedicine and digital health applications, perceived benefits, barriers, and support needs. This was complemented by an in-depth qualitative case study exploring everyday caregiving experiences with telemedicine technologies and telemedicine center support. A systematic literature review informed the theoretical framework and the development of the empirical instruments. Results: Most respondents reported not using telemedicine or digital health applications in home care. Among users, telemedicine was associated with perceived improvements in quality of care, particularly through enhanced health monitoring, improved communication with healthcare professionals, and increased feelings of safety and control. Key barriers to adoption included technical complexity, data protection concerns, and limited digital literacy. Both quantitative findings and the qualitative case study highlighted the importance of structured support. Telemedicine centers were perceived as highly beneficial, providing technical assistance, training, coordination, and ongoing guidance that facilitated technology acceptance and sustained use. Conclusions: Telemedicine and digital health applications can meaningfully support home care and reduce caregiver burden when they are embedded in supportive socio-technical structures. Telemedicine centers can function as central points of contact that enhance usability, trust, and continuity of care. The findings suggest that successful implementation of telemedicine in home care requires not only technological solutions but also accessible organizational support and targeted training for family caregivers. Full article

Smallholder rice farmers in sub-Saharan Africa face persistent livelihood challenges due to declining returns from monocropping, limited diversification opportunities, and vulnerability to climate and market shocks. This study integrated the Drivers–Pressures–State–Impact–Response (DPSIR) framework with the sustainable livelihood approach to evaluate how the transition from rice monocropping to integrated rice–fish farming influences productivity, profitability, and household welfare in Nigeria’s leading rice-producing region. Using a mixed-methods, three-year panel (2021–2023) of 228 households across three communities in Kebbi State, descriptive statistics, regression models, and thematic analyses were combined to assess changes in livelihood capitals, system pressures, and response mechanisms. Adoption of rice–fish systems was associated with substantial improvements: 96.1% of farmers reported increased income, 56.3% improved food security, and 30.6% greater dietary diversity. Regression analyses confirmed that access to more land (p < 0.001 for healthcare and education; p = 0.011 for social status), labor affordability (p < 0.001), and farm size (p < 0.05) were consistent predictors of gains in healthcare, education, and social status, while pesticide and herbicide use negatively affected food access and wellbeing (p < 0.05). The DPSIR assessment revealed that rice–fish integration altered the state of rice production systems through reductions in input-related pressures and generated positive livelihood impacts. The results align with Sustainable Development Goals (SDGs) related to poverty reduction, food and nutrition security, sustainable production, and biodiversity conservation, and provide the first large-scale, longitudinal evidence from West Africa that integrated rice–fish systems support food security, income diversification, and sustainable resource management. Full article

Millions of healthcare workers experience percutaneous exposure to bloodborne communicable infectious disease pathogens annually, with the risk of contracting occupationally acquired infections. In this study, we aimed to assess the status of occupational safety and outbreak preparedness in Congolese nurses and laboratory technicians in Kongo central and the Katanga area, amidst multiple ongoing public health emergencies in the Democratic Republic of the Congo (DRC). This was a multicenter analytical cross-sectional study conducted in five referral hospitals located in Kongo central province and the Katanga area between 2019 and 2020 amidst Ebola, Yellow fever, Cholera and Chikungunya outbreaks. Participants were adult A0 grade nurses, A1 nurses, A2 nurses and medical laboratory technicians (N = 493). They answered a structured, self-administered questionnaire related to hospital hygiene and standard precautions for occupational infection prevention. The majority of the respondents were females (53.6%), and 30.1% of them have never participated in a training session on hospital infection prevention during their career. The proportions of those who have been immunized against hepatitis B virus (HBV) was markedly low, at 16.5%. Of the respondents, 75.3% have been using safety-engineered medical devices (SEDs), whereas 93.5% consistently disinfected medical devices after use. Moreover, 78% of the respondents used gloves during medical procedures and 92.2% wore masks consistently. A large majority of the respondents, 82.9%, have been recapping the needles after use. Regarding participation in outbreak response, 24.5% and 12.2% of the respondents were Chikungunya and Cholera epidemic responders, respectively; 1.8% have served in Ebola outbreak sites. The proportion of the respondents who sustained at least one percutaneous injury by needlestick or sharp device, blood/body fluid splash or both in the previous 12-month period was high, 89.3% (41.8% for injury, 59.2% for BBF event), and most of them (73%) reported over 11 events. Compared to laboratory technicians, nurses had higher odds for sustaining percutaneous injury and BBF events [OR = 1.38 (0.16); p < 0.01], whereas respondents with longer working experience were less likely to sustain those events [OR = 0.47 (0.11); p < 0.001]. Findings from this study suggest that Congolese nurses and laboratory technicians experience a high frequency of injury and BBF events at work, and remain at high risk for occupationally acquired infection. There is a need for periodic capacity-building training for the healthcare workforce to improve infection prevention in health settings, the provision of sufficient and appropriate PPE and SEDs, post-exposure follow-up and keeping records of occupational injuries in hospitals in Congolese healthcare settings. Full article

Photocatalytic water sterilization has emerged as a promising sustainable technology for addressing microbial contamination across diverse sectors including healthcare, food production, and environmental management. This review examines the fundamental mechanisms and recent advances in photocatalytic water sterilization, with a particular emphasis on the differential bactericidal pathways against Gram-negative and Gram-positive bacteria. Gram-negative bacteria undergo a two-step inactivation process involving initial outer membrane lipopolysaccharide (LPS) degradation followed by inner membrane disruption, whereas Gram-positive bacteria exhibit simpler kinetics due to direct oxidative attacks on their thick peptidoglycan layer. Escherichia coli has long been used as the gold standard in photocatalytic sterilization studies owing to its aerobic nature and suitability for the colony-counting method. In contrast, Lactobacillus casei, a facultative anaerobe, can be cultured statically and evaluated rapidly using turbidity-based optical density measurements. Therefore, both organisms serve complementary roles depending on the experimental objectives—E. coli for precise quantification and L. casei for rapid, practical assessments of Gram-positive bacterial inactivation under laboratory conditions. We also describe sterilization using light alone while comparing it to photocatalytic sterilization and then discuss two innovative suspension-based photocatalyst systems: polystyrene bead-supported TiO₂/SiO₂ composites offering balanced reactivity and separability and magnetic TiO₂-SiO₂/Fe₃O₄ nanoparticles enabling rapid magnetic recovery. Future research directions should prioritize enhancing visible-light efficiency using metal-doped TiO₂ such as Cu-doped systems; improving catalyst durability; developing new applications of photocatalysts, such as protecting RO membranes; and validating scalability across diverse industrial and medical water treatment applications. Full article