Search Results (190)

Background: Schizophrenia is strongly associated with severe oral health deterioration, driven by cognitive deficits, behavioral dysfunction, and medication-related biological changes. Objective: To examine how neurocognitive dysfunction in schizophrenia, particularly cognitive deficits, is associated with poorer oral hygiene control, motivation, and self-regulation, contributes to oral health decline by disrupting everyday oral hygiene behaviors and dental care engagement, and to discuss the implications of this framework for interdisciplinary prevention strategies. Methods: This manuscript follows a narrative review design aimed at conceptually integrating evidence on neurocognitive mechanisms underlying oral health decline in schizophrenia. To identify relevant literature, a targeted search of PubMed/MEDLINE, Scopus, and Web of Science was conducted, covering publications from 2000 to 2025. The search strategy was used to support thematic exploration and conceptual synthesis, rather than to perform a systematic study selection or quantitative evidence aggregation. This narrative review summarizes findings from 90 peer-reviewed studies selected from the available literature. Results: Executive dysfunction, attentional deficits, and low motivation impair routine oral hygiene and delay dental care-seeking. Antipsychotic-induced xerostomia, metabolic disturbances, oxidative stress, immune dysregulation, and oral microbiome dysbiosis accelerate periodontal breakdown and caries progression. These interacting processes generate a self-reinforcing cycle of inflammation, tissue destruction, and treatment avoidance. Epidemiological data show markedly elevated DMFT/DMFS indices and up to a three-fold higher risk of edentulism compared with the general population. Emerging evidence suggests that integrated psychiatric–dental care models may be associated with improvements in oral health and care engagement, although current findings are largely preliminary and based on small or heterogeneous study populations, including related neurocognitive disorders. Conclusions: Unlike existing epidemiological syntheses, this review highlights oral health deterioration in schizophrenia as a functionally mediated consequence of neurocognitive impairment, underscoring the need for preventive approaches aligned with patients’ cognitive and motivational capacities. Full article

Background/Objective: Hand hygiene is a cornerstone of infection prevention; however, compliance is inconsistent in intensive care units (ICUs), particularly in resource-constrained settings. This study evaluated whether a low-cost, multimodal quality improvement intervention could improve process-level hand hygiene compliance using routine, episode-based audits embedded in the ICU practice. Methods: We conducted a single-cycle Plan-Do-Study-Act quality improvement project in a 12-bed mixed medical–surgical ICU in Pakistan (December 2023–January 2024). Hand hygiene performance was assessed using the unit’s routine weekly episode-based audit protocol, aligned with the WHO Five Moments framework. A targeted multimodal intervention comprising education, point-of-care visual reminders, audit feedback, and leadership engagement was implemented between the pre- and post-intervention phases (four weeks each). Non-applicable moments were scored as “compliant by default” according to the institutional protocol. A sensitivity analysis was performed excluding these moments to calculate pure adherence. Compliance proportions were summarized using exact 95% Clopper–Pearson confidence intervals without inferential testing. Results: A total of 942 audit episodes (471 per phase) generated 4710 moment-level assessments were generated. Composite hand hygiene compliance increased from 63.1% pre-intervention to 82.0% post-intervention [absolute increase: 18.9 percentage points (pp)]. Sensitivity analysis excluding non-applicable moments demonstrated pure adherence improvement from 54.2% to 82.5% (+28.3 pp), confirming a genuine behavioral change rather than a measurement artifact. Compliance improved across all five WHO moments, with the largest gains in awareness-dependent moments targeted by the intervention: before touching the patient (+27.0 pp) and after touching patient surroundings (+40.0 pp). Week-by-week compliance remained stable within both phases, without immediate post-intervention decay. Conclusions: A pragmatic, low-cost multimodal intervention embedded in routine ICU workflows was associated with substantial short-term improvements in hand hygiene compliance over a four-week observation period, particularly for awareness-dependent behaviors. Episode-based audit systems can support directional process monitoring in resource-limited critical care settings without the need for electronic surveillance. However, its long-term sustainability beyond one month and generalizability to other settings remain unknown. Sensitivity analyses are essential when using “compliant by default” scoring to distinguish adherence patterns from measurement artifacts. Full article

Aim: This study compared the effects of standard evening smartphone restriction with an adapted intervention combining progressive restriction, psychoeducational guidance, and pre-sleep relaxation on sleep, psychological state, cognitive performance, and physical performance in physically active physical education students with moderate-to-high nomophobia. Methods: Thirty participants (age 21.9 ± 1.2 years; intermediate chronotype) completed a randomized controlled trial consisting of a 7-day baseline period, a 14-day intervention phase, and post-intervention assessments. The standard group (n = 15) implemented a 2-h pre-bedtime smartphone restriction combined with general sleep hygiene guidance. The adapted group (n = 15) followed a progressive restriction protocol (30→60→120 min) supplemented with psychoeducational guidance targeting smartphone-related anxiety and a nightly slow-paced breathing routine. Objective sleep parameters were quantified using wrist-worn actigraphy. Subjective sleep quality, pre-sleep anxiety, and stress were assessed using visual analog scales. Cognitive performance (psychomotor vigilance task and choice reaction time) and physical performance (vertical jumps and agility) were evaluated at both morning and afternoon time points. Results: The adapted intervention produced significantly greater improvements in sleep efficiency (time × group: F(1,28) = 6.84, p = 0.014, ηp² = 0.20; d = 0.78) and sleep onset latency (F(1,28) = 5.97, p = 0.021, ηp² = 0.18; d = 0.72) compared with standard restriction. Significant reductions were also observed in pre-sleep anxiety (F(1,28) = 7.12, p = 0.012, ηp² = 0.20; d = 0.81) and stress (F(1,28) = 6.45, p = 0.017, ηp² = 0.19; d = 0.74). Cognitive performance showed significant time × group × time-of-day interactions, with improvements during afternoon assessments in psychomotor vigilance (F(1,28) = 7.48, p = 0.011; d = 0.83) and choice reaction time (F(1,28) = 6.89, p = 0.014; d = 0.79) exclusively in the adapted group. Physical performance outcomes remained stable across interventions. Conclusions: Progressive smartphone restriction combined with psychoeducational strategies and pre-sleep relaxation yields clinically meaningful improvements in sleep continuity, psychological arousal, and afternoon cognitive performance, exceeding the benefits achieved through behavioral restriction alone. Full article

Background/Objectives: Institutional catering serves vulnerable populations, including schoolchildren. Surfaces in food preparation environments are key control points for food safety and reservoirs and transmission routes for antimicrobial-resistant (AMR) bacteria. This study characterized the hygienic status of food-contact surfaces (FCS) and non-food-contact surfaces (NFCS) in Hungarian school kitchens, identified contamination hotspots, and examined how routine monitoring can support AMR prevention. Methods: We retrospectively analyzed routine environmental hygiene monitoring records from 96 school kitchens (2019–2024). In total, 8412 swab samples were collected, 8407 had quantifiable counts, 6233 from FCS (e.g., plates, trays, boards, utensils), and 2174 from NFCS (e.g., sinks, fridges, workers’ hands). Total aerobic mesophilic counts were measured with a redox-potential method and expressed as CFU/100 cm²; 250 CFU/100 cm² (2.4 log₁₀) was the hygienic threshold. Results: Overall, 12.4% of surfaces exceeded the threshold. Non-food-contact surfaces were more likely to be non-compliant than food-contact surfaces (OR 2.77, 95% CI 2.43–3.17; p < 0.001). Hotspots included transport-container lids (67.2% non-compliant; OR 43.82), sink basins (32.8%; OR 10.46), and cutting boards (21.6%; OR 5.89). Seasonally, non-compliance was highest in summer (16.5%) and lowest in winter (9.0%; p < 0.001). Conclusions: Multi-year monitoring revealed substantial contamination concentrated in a few hotspots that, within a One Health framework—which recognizes the interconnectedness of human, animal, and environmental health—may represent environmental reservoirs and cross-contamination nodes relevant to AMR prevention. Targeted optimization of cleaning and disinfection for these surfaces, combined with trend analysis of indicator data and periodic AMR-focused environmental sampling, could reduce foodborne and AMR-related risks in public catering. Full article

Objective: The emergence and spread of multi-drug-resistant (MDR) bacteria pose a growing threat in veterinary medicine, particularly in equine hospitals. This study investigated the colonization and infection dynamics of horses undergoing emergency laparotomy with two distinct antibiotic protocols (single-shot versus 5-day protocol) during hospitalization. Methods: Nasal swabs and fecal samples were collected from 67 horses undergoing emergency laparotomy at clinic admission as well as on postoperative days 3 and 10. These were screened for multi-drug-resistant indicator pathogens. As multi-drug-resistant indicator pathogens, methicillin-resistant Staphylococcus aureus (MRSA), extended-spectrum β-lactamase (ESBL)-producing Enterobacterales (ESBL-E), and bacteria belonging to the Acinetobacter baumannii complex were defined. Results: Preoperatively, 6.2% of horses tested positive for MRSA and 13% for ESBL-E. An increase in colonization was observed on day 3 postoperatively, with 62.1% of nasal swabs and 86.4% of fecal samples testing positive for MDR organisms. On day 10, 53.4% of nasal swabs and 62.5% of fecal samples tested positive for indicator pathogens. Surgical site infection developed in five horses, two of which tested positive for MRSA in both nasal and wound samples during hospitalization, supporting the potential role of nasal carriage as a source of infection. Furthermore, all horses tested positive for ESBL-E during at least one time-point during hospitalization, and Enterobacterales (MDR in two surgical site infections (SSI)) were involved in all surgical site infections. No significant differences were observed between the two antibiotic treatment groups regarding colonization rates with indicator pathogens during hospitalization. However, the results indicate that hospitalization itself contributes to increased colonization with resistant bacteria. A clear limitation of the study is the restricted number of sampled horses and the lack of environmental contamination data. Non-sampled hospitalized horses with and without antibiotic treatment may have acted as reservoirs for MDR bacteria. Conclusion: The findings emphasize the need for routine environmental monitoring and strict adherence to hygiene protocols in equine clinics to reduce the risk of nosocomial transmission. Ongoing surveillance and infection control strategies are essential to mitigate the spread of MDR pathogens in veterinary settings. Full article

Campylobacter is a leading foodborne bacterial pathogen, and poultry production is a major reservoir contributing to human exposure. Reducing Campylobacter at farm level is therefore critical to limit downstream contamination. This systematic review and meta-analysis aimed to identify and quantitively summarise the current interventions and control measures applied in poultry farms to control the contamination and bird colonisation by Campylobacter. The Scopus electronic database was accessed to collect primary research articles that focused on observational studies and in vivo experiments, reporting results on Campylobacter concentrations or prevalence in both non-intervened and intervened groups. A total of 4080 studies were reviewed, from which 112 were selected and included in the meta-analysis according to predefined criteria, yielding 1467 observations. Meta-regression models were adjusted to the full data set and by intervention strategy based on the type of outcome measure (i.e., concentration and prevalence). In general terms, the results reveal that the effectiveness to reduce Campylobacter colonisation vary among interventions. A highly significant effect (p < 0.001) was observed in interventions such as organic acids, bacteriophages, plant extracts, probiotics, and organic iron complexes added to feed or drinking water; although drinking water was proven to be a more effective means of administration than feed for extracts and organic acids. In contrast, interventions such as chemical treatments, routine cleaning and disinfection, and vaccination showed both lower and more heterogeneous effects on Campylobacter loads. Vaccination effects were demonstrated to be driven by route and schedule, with intramuscular administration, longer vaccination periods and sufficient time before slaughter linked to greater reduction in Campylobacter colonisation. Probiotics, plant extracts and routine cleaning and disinfection were associated with lower Campylobacter prevalence in flocks. Meta-regression models consistently showed that the interventions were proven more effective when the sample analysed was caecal contents in comparison to faeces (p < 0.001). Overall, the findings of this meta-analysis study emphasise the application of a multi-barrier approach that combines targeted interventions with robust biosecurity and hygiene measures in order to reduce Campylobacter levels in poultry farms. Full article

Pneumonia caused by the facultative intracellular pathogen Rhodococcus equi stands out as one of the most significant infections associated with a notably high mortality rate in foals worldwide. Limited therapeutic options and inadequate control and prevention measures result in substantial economic losses, underscoring the need for enhanced interventions. A cross-sectional, multi-province study was conducted on racehorse-breeding farms in Türkiye to estimate prevalence and index virulence, assess relatedness, and summarize antimicrobial susceptibility within a farm management context. Nasal and fecal swabs and environmental samples (soil and water) were cultured and confirmed; virulence was assessed with vapA-specific PCR, genetic relationship determined with PFGE, and antimicrobial susceptibility using disk diffusion. R. equi was detected in 10% of nasal swabs, 22.9% of fecal swabs, 29.4% of soil samples, and 5.9% of water samples; 46.2% of confirmed isolates were vapA-positive. Susceptibility patterns were favorable overall, with frequent ampicillin resistance, infrequent resistance to macrolides and rifampin, rare multidrug resistance, and no vancomycin resistance was detected. PFGE demonstrated substantial genotypic diversity, with 12 clusters and 29 distinct pulsotypes. Farm-level observations were exploratory. More frequent mechanical paddock cleaning coincided with the absence of foal deaths, and vapA-positive isolates were observed on farms with prior infection. Taken together, these findings support routine paddock hygiene, prompt isolation of clinically affected foals, culture-guided therapy, and continued surveillance, and they indicate a need for longitudinal and genomic studies to evaluate the impact. Full article

Pseudomonas aeruginosa is a key indicator of hygienic and operational deficiencies in swimming pools, particularly in tourist facilities with high and variable user loads. This study reports the results of a four-year regulatory surveillance program (2016–2019) assessing P. aeruginosa contamination in tourist swimming pools in Andalusia, Spain. The program involved 14 hotels and 58 unique installations. A total of 2053 water samples collected from different installation types (outdoor and indoor pools, whirlpools, and cold-plunge pools) were analyzed using standardized ISO methods within the framework of Spanish legislation, and prevalence comparisons were based on proportion tests. The overall prevalence of P. aeruginosa was 5.1%, with marked differences among installation types, reflecting both variation in contamination rates and unequal sampling intensity. Whirlpools consistently showed the highest contamination rates, whereas indoor pools and cold-plunge pools exhibited lower prevalence. No significant differences were observed between chlorine- and bromine-treated pools, and contaminated samples were detected across the full range of disinfectant concentrations, including values within regulatory limits. Temporal analysis revealed that apparent seasonal peaks were installation-dependent rather than reflecting a uniform seasonal trend. Winter detections were confined to indoor pools and whirlpools, which remain operational year-round, while outdoor pools and cold-plunge pools were underrepresented during the low season due to reduced sampling. A marked increase in prevalence was observed in 2019, driven mainly by summer months and high-risk installations; however, this rise was not directly associated with tourist volume and does not support causal inference. These findings highlight the importance of installation-specific and operational factors in shaping P. aeruginosa contamination patterns. The study underscores the need for targeted surveillance strategies focusing on high-risk installations and for cautious interpretation of seasonal patterns in datasets derived from routine regulatory monitoring. Full article

Background and Objectives: The growing number of patients seeking medical care in the internal medicine departments over the past decades has been accompanied by an increase in the bed occupancy rate. This is associated with a heavier work burden among the professional staff members, which may lead to a lower quality of care. Therefore, this study aimed to evaluate the association between the bed occupancy rate and staff compliance with hand hygiene regulations. Materials and Methods: This ecological study included 9 internal medicine departments (~300 beds) in a single medical center between 01/2017 and 12/2019. Routine hand hygiene performance was evaluated randomly, and the association between the bed occupancy rate and the staff’s compliance with the hospital regulations was studied. Univariate and multivariable analyses were performed by the generalized estimating equation model. Results: The study included 12,736 episodes that warranted hand hygiene practices (“opportunities”). The overall hand hygiene performance rate was 78.3% (physicians 76.2%, nurses 80.7%, and healthcare assistants 76.9%). There was an approximately 2% decline in staff compliance for each 10% increase in bed occupancy rate (adjusted IRR 0.98, 95%CI 0.97–0.99, p < 0.001). Stratification by staff members showed a significant decline in routine hand hygiene practices among physicians (adjusted IRR 0.97, 95%CI 0.95–0.99, p < 0.001) and healthcare assistants (adjusted IRR 0.97, 95%CI 0.96–0.99, p < 0.001) but not among nurses (adjusted IRR 0.99, 95%CI 0.98–1.01, p = 0.392). Conclusions: An increase in bed occupancy rate is associated with a decrease in the hospital staff’s compliance with hand hygiene and therefore may lead to a lower quality of care. Full article

Exposure to chemical irritants in laboratory and medical environments poses significant health risks to workers, particularly in relation to asthma-like symptoms. Routine cleaning practices, which often involve the use of strong chemical agents to maintain hygienic settings, have been shown to contribute to respiratory issues. Laboratories, where chemicals such as hydrochloric acid and ammonia are frequently used, represent an underexplored context in the study of occupational asthma. While much of the research on chemical exposure has focused on industrial and high-risk occupations or large cohort populations, less attention has been given to the risks in laboratory and medical environments, particularly for professional cleaning staff. Given the growing reliance on cleaning agents to maintain sterile and safe workspaces in scientific research and healthcare facilities, this gap is concerning. This study developed an exploratory simulation tool, using a simulated cohort based on key demographic and exposure patterns from foundational research, to assess the impact of chemical exposure from cleaning products in laboratory environments. Four supervised machine learning models were applied to evaluate the relationship between chemical exposures and asthma-like symptoms: (1) Decision Trees, (2) Random Forest, (3) Gradient Boosting, and (4) XGBoost. High exposures to hydrochloric acid and ammonia were found to be significantly associated with asthma-like symptoms, and workplace type also played a critical role in determining asthma risk. This research provides a data-driven framework for assessing and predicting asthma-like symptoms in professional cleaning workers exposed to cleaning agents and highlights the potential for integrating predictive modeling into occupational health and safety monitoring. Future work should explore dose–response relationships and the temporal dynamics of chemical exposure to further refine these models and improve understanding of long-term health risks. Full article

Background/Objectives: The USAID STOP Spillover project in Cambodia aimed to reduce the risk of zoonotic virus spillover from bats to humans in bat guano farming communities. Methods: Using participatory tools, such as Outcome Mapping and Trials of Improved Practices, a team of local experts and community members collaboratively designed, tested, and refined biosafety and hygiene practices that are acceptable and sustainable to mitigate the risk of bat-borne disease spillover. We tracked progress and rolled out interventions to promote the adoption of safe behaviors that strengthen the understanding of zoonotic disease and reinforce the adoption of safety practices among bat guano producers and their neighbors. The intervention’s effectiveness was evaluated after three-month trials. Results: An improvement in knowledge, attitudes, and risk reduction practices was observed among participants. The primary motivators for adopting these measures were fear of disease, families’ well-being, cost savings, and experience of the COVID-19 pandemic. Conclusions: The community-driven approach fostered a sense of ownership, enabling participants to find the best solutions for their circumstance for long-term sustainability of the intervention. The findings recommended continued community engagement, improved access to biosafety and hygiene resources, and reinforced routine zoonotic disease surveillance. This model can be applied to mitigate emerging infectious disease spillover risks in similar contexts. Full article

Background: Access to water, sanitation, and hygiene (WASH) services is internationally recognized as a fundamental human right and an essential determinant of health. Yet, many healthcare facilities in sub-Saharan Africa face persistent WASH deficits, undermining safe and effective care delivery. Aim: To explore how water (in)accessibility influences patient healthcare experiences and patient–provider relationships in Yendi Hospital, a major referral facility in northern Ghana. Methods: Using a qualitative design, we gathered data from patients (n = 21), caregivers (n = 11), and nurses (n = 11) through in-depth interviews, participant observation, and a focus group to document their lived experiences and perceptions. We transcribed and inductively coded the data for thematic analysis. Results: Our key findings reveal that water inaccessibility is not solely an infrastructural issue but also a pervasive challenge with profound implications for care delivery. Patients and caregivers often leave the hospital to bathe at home, resulting in missed ward rounds, delayed reviews, and/or refusal of admission. Nurses described how water inaccessibility disrupted clinical routines and strained relationships with patients and caregivers. These dynamics eroded trust, rapport, and professional morale, while exacerbating inequities in healthcare access and outcomes. Conclusions: This study underscores that addressing water challenges in the hospital is imperative not only for infection control but also for fostering equity, patient rights, and institutional resilience. We argue that policy interventions to strengthen WASH systems are urgently required to advance progress toward Sustainable Development Goal 6. Full article

Background: Sustainable sanitation underpins Sustainable Development Goal (SDG) 6.2, which mandates safe, equitable services and the elimination of open defecation by 2030. Rural South African communities continue to face significant Water, Sanitation and Hygiene (WASH) challenges driven by economic, environmental and governance constraints. Methods: An explanatory sequential mixed-methods design was conducted in King Sabata Dalindyebo Local Municipality, Eastern Cape. Quantitative data comprised household surveys (n = 246) and structured observations of VIP latrines (n = 50). Qualitative data were gathered from 20 semi-structured interviews with community representatives and four focus groups (n = 32). Results: While 63% of households owned VIP latrines, only 22% of the inspected facilities were in good working condition and 20% were abandoned; 58% required major maintenance. Major barriers to sustainable sanitation included limited financial capacity, structural damage related to a high-water table, gendered safety risks, and low community engagement in sanitation planning and maintenance. Conclusions: Achieving SDG 6.2 in rural South Africa requires co-productive governance that integrates infrastructure maintenance with community leadership. Recommended actions include delegated WASH committees, targeted subsidies for vulnerable households, routine gender and safety audits, and enforcement of environmental protection measures to secure long-term sanitation sustainability. Full article

Background: Saliva sampling is increasingly used for respiratory virus diagnostics in dentistry and oral medicine due to patient comfort and reduced exposure risk. How routine behaviors—mechanical oral hygiene, rinsing, and food intake—affect short-term SARS-CoV-2 detectability remains insufficiently characterized for clinical workflows. Methods: In this international two-center pilot study, twelve RT-PCR-confirmed COVID-19 patients provided paired mouth-rinse saliva samples and pharyngeal swabs at predefined time points. The study assessed (I) an intensified 3 min mechanical oral hygiene protocol (toothbrushing of teeth, gingiva, tongue, and palate, followed by toothpaste–saliva gargling); (II) repeated short mouth rinses; and (III) postprandial sampling. Viral RNA was quantified by RT-PCR; Ct-trajectories were analyzed intra-individually. Results: Cycle threshold (Ct) values from pharyngeal swabs remained relatively stable over time, whereas mouth-rinse samples exhibited notable fluctuations throughout the 24 h period. An average increase of 3 Ct units was observed three minutes after the final mouth rinse (T24+3). Meal ingestion was associated with increased Ct values, rising by 4–5 units for pharyngeal swabs and 3–11 units for mouth rinses immediately after eating. Conclusions: In clinical dental settings, saliva diagnostics are feasible but acutely modulated by common behaviors. Mechanical oral hygiene, brief rinsing, and food intake can transiently reduce detectable oral SARS-CoV-2 RNA, with potential implications for timing of sampling, chairside triage, and infection-control protocols. This pilot study provides initial evidence supporting the development of standardized pre-analytical instructions (e.g., fasting window, pre-rinse policy, and sampling timing relative to oral hygiene and meals) to enhance the reliability of saliva-based testing in dental care. Full article

Background: Maintaining daily optimal dental hygiene, especially in medically vulnerable patients with periodontitis, remains challenging in dental practice. Mobile apps and other digital tools might offer useful support alongside traditional advice. Objectives: This study aimed to develop a mobile health app, PerioSupportPro, that helps patients improve their daily plaque control habits. It also reports on the pilot testing of the app’s usability and users’ perception in a small patient group. Methods: The app was created by a mixed team including periodontists, psychologists, developers, and data protection specialists. The first version included reminders, gamified elements, video tutorials, and motivational messages. After internal testing, a group of 18 patients tested the app and completed a feedback questionnaire that assessed usability (Q3–Q5), educational impact (Q6–Q8), motivation (Q9–Q11), and overall satisfaction (Q12–Q14). Cronbach’s alpha was used to check internal consistency, and non-parametric tests were applied for basic statistical comparisons. Results: The motivation section of the questionnaire showed acceptable consistency (α = 0.784), while usability and educational impact had lower values (α = 0.418 and 0.438). No clear differences were found between age groups. Satisfaction was positively associated with reminders and motivational items. Most appreciated features included reminders, the simple interface, and short videos. Based on the input provided by the questionnaire, a few improvements were made, and a second version of the app was prepared. Conclusions: Early user responses show that PerioSupportPro may help motivate and guide patients in their oral hygiene routine. While still in an early phase, the app seems well-received and ready for future clinical validation with more users. Full article