Search Results (1,601)

From the perspective of educational inclusion proposed by Booth and Ainscow, the transformation of school systems revolves around three key dimensions: presence, participation and learning. These dimensions constitute the axes of the so-called Inclusion Index and allow for a holistic analysis of the barriers that limit equity and inclusion in school contexts. Based on this theoretical framework, this study aims to systematically map the barriers documented in recent academic literature (2000–2025) that affect these dimensions at the primary and compulsory secondary education levels, with a special focus on intersectional variables that amplify inequalities (gender, migration, disability, mental health, among others). Full article

Background/Objectives: Inclusive nutrition services and data on children with disabilities living in low- and middle-income countries remain limited. We estimated the prevalence of undernutrition and described feeding practices and difficulties among children with disabilities ages birth to 10 years at a rehabilitation hospital in Uganda and identified barriers and opportunities for inclusive nutrition. Methods: This cross-sectional study enrolled 428 children. Data included demographics, weight, height, mid–upper arm circumference (MUAC), hemoglobin levels, risk for feeding difficulties, caregiver-reported feeding practices, and functional difficulties complemented by 32 caregiver and stakeholder interviews. Undernutrition was defined using WHO z-scores, MUAC, and anemia cutoffs. Associations were examined using Pearson’s chi-squared tests and adjusted odds ratios from logistic regression. Results: Over half of participants were boys (56.1%) and 65.9% were <24 months old. Common conditions included cleft lip/palate (55.4%) and cerebral palsy (38.6%). Undernutrition was prevalent: 45.2% were underweight, 38.3% stunted, 16.1% wasted (by MUAC), and 39.5% anemic. Being at risk for feeding difficulties (67.2% of children) increased the odds of underweight [AOR = 2.28 (1.23–4.24)], stunting [2.46 (1.26–4.79)], and wasting [2.43 (1.10–5.35)] after adjusting for covariates. Bottle-feeding increased the odds of stunting [3.09 (1.24–7.70)] in infants with cleft lip/palate <12 months old. Poor access to services, food insecurity, and feeding challenges were key barriers to optimal nutrition. Most caregivers reported using practices that support responsive feeding. Conclusions: Reported barriers to services and high levels of undernutrition, strongly linked to feeding difficulties, underscore the need for targeted feeding interventions and better access to inclusive nutrition services in Uganda. Full article

Background/Objectives: Family members are the principal providers of home-based care for migrant older adults. Linguistic, cultural, and structural barriers within health systems exacerbate the caregiver burden across emotional, physical and financial domains. Although home healthcare services may alleviate this burden, variability in access, cultural safety, and care coordination can also intensify it. This scoping review maps the evidence on the burden experienced by family caregivers who deliver home-based healthcare to migrant older adults and examines how these arrangements affect caregivers’ health and well-being. It synthesizes the literature on facilitators and barriers—including access, cultural-linguistic fit, coordination with formal services, and legal/immigration constraints—and distills implications for policy and practice to strengthen equitable, culturally responsive home care. Method: The Joanna Briggs Institute (JBI) scoping review framework was used to conduct the review. A comprehensive search was performed across six databases (CINAHL, Scopus, Web of Science, PsycINFO, MEDLINE and Sociological Abstracts) for articles published between 2000 and 2025. Studies were selected based on predefined inclusion criteria focusing on the family caregiver burden in providing home healthcare for migrant older adults. Data extraction and thematic analysis were conducted to identify key themes. Results: The review identified 20 studies across various geographical regions, highlighting four key themes: (1) Multidimensional Caregiver Burden, (2) The Influence of Gender, Family Hierarchy, and Migratory Trajectories on Caregiving, (3) Limited Access to Formal and Culturally Appropriate Support, and (4) Health Outcomes, Coping, and the Need for Community-Based Solutions. Conclusions: System-level reforms are required to advance equity in home healthcare for aging migrants. Priorities include establishing accountable cultural-safety training for providers; expanding multilingual access across intake, assessment, and follow-up; and formally recognizing and resourcing family caregivers (e.g., navigation support, respite, training, and financial relief). Investment in community-driven programs, frameworks and targeted outreach—co-designed with migrant communities—can mitigate isolation and improve uptake. While home healthcare is pivotal, structural inequities and cultural barriers continue to constrain equitable access. Addressing these gaps demands coordinated policy action, enhanced provider preparation, and culturally responsive care models. Future research should evaluate innovative frameworks that integrate community partnerships and culturally responsive practices to reduce the caregiver burden and improve outcomes for migrant families. Full article

The concept of intersectionality examines how multiple and interdependent forms of oppression manifest among marginalized social groups, considering their social markers. This study aims to analyze intersectionality in the labor market, with a critical focus on the interactions between race, gender, and class as structuring axes of inequality. An integrative literature review was conducted, encompassing an in-depth analysis of 140 articles addressing intersectionality in the labor context. The findings reveal a persistent conceptual fragmentation of intersectionality and a dilution of critical debates within labor market research. Empirical evidence consistently shows that women and racialized groups face enduring structural barriers, including wage gaps, occupational segregation, and limited access to leadership positions. Moreover, these inequalities are often obscured or reduced to superficial diversity and inclusion initiatives rather than being addressed as systemic issues. The study emphasizes the importance of committed and critical intersectional approaches to understanding and addressing systemic inequalities in the labor market, highlighting theoretical and epistemological gaps that must be addressed to advance emancipatory practices and policies that directly confront structural racism, patriarchy, and class-based exploitation. The study contributes theoretically by deepening the application of intersectionality in the labor market and by identifying conceptual and epistemological gaps in the literature. Empirically, it provides practical guidance for organizations to transform diversity initiatives into strategic and inclusive actions, integrating multiple social identities into management policies and practices. Full article

Background and Objectives: Radiomics and artificial intelligence (AI) offer emerging quantitative tools for enhancing the diagnostic evaluation of testicular cancer. Conventional imaging—ultrasound (US), magnetic resonance imaging (MRI), and computed tomography (CT)—remains central to management but has limited ability to characterize tumor subtypes, detect occult nodal disease, or differentiate necrosis, teratoma, and viable tumor in post-chemotherapy residual masses. This systematic review summarizes current advances in radiomics and AI for both primary tumors and retroperitoneal disease. Materials and Methods: A systematic search of PubMed, Scopus, and Web of Science identified studies applying radiomics or AI to testicular tumors, retroperitoneal lymph nodes and post-chemotherapy residual masses. Eligible studies included quantitative imaging analyses performed on ultrasound, MRI, and CT, with optional integration of clinical or molecular biomarkers. Eighteen studies met inclusion criteria and were evaluated with respect to methodological design, diagnostic performance, and translational readiness. Results: Across modalities, radiomics demonstrated encouraging discriminatory capacity, with accuracies of 74–82% for ultrasound, 80.7–97.9% for MRI, and 71.7–85.3% for CT. CT-based radiomics for post-chemotherapy residual masses showed moderate ability to distinguish necrosis/fibrosis, teratoma, and viable germ-cell tumor, though heterogeneous methodologies and limited external validation constrained generalizability. The strongest performance was observed in multimodal approaches: integrating radiomics with clinical variables or circulating microRNAs improved accuracy by up to 12% and 15%, respectively, mirroring gains reported in other oncologic radiomics applications. Persisting variability in segmentation practices, acquisition protocols, feature extraction, and machine-learning methods highlights ongoing barriers to reproducibility. Conclusions: Radiomics and AI-enhanced frameworks represent promising adjuncts for improving the noninvasive evaluation of testicular cancer, particularly when combined with clinical or molecular biomarkers. Future progress will depend on standardized imaging protocols, harmonized radiomics pipelines, and multicenter prospective validation. With continued methodological refinement and clinical integration, radiomics may support more precise risk stratification and reduce unnecessary interventions in testicular cancer. Full article

Although DNS has been continuously extended to improve usability and security, its centralized, server-based architecture leaves fundamental limitations unresolved, including single points of failure (SPOF), susceptibility to censorship, and exposure to DDoS. This study examines blockchain-based DNS (BDNS) as an alternative proposed to mitigate these structural issues. We first synthesize prior research and systems on BDNS, and then conduct a comparative analysis using practical deployability as the primary criterion. Specifically, we selected seven representative BDNS projects, including Namecoin, Handshake, and Ethereum Name Service (ENS), and evaluated them under a common set of criteria: (i) the record model, finality, and TTL semantics; (ii) friction along real resolution paths involving resolvers, browsers, and gateways; and (iii) interoperability with the legacy DNS, including DNSSEC and DNS over TLS(DoT)/DNS over HTTPS(DoH), together with migration scenarios. The analysis indicates that many systems rely on gateways and client-side extensions, limiting native resolution paths. It further finds that finality latency, dependence on off-chain indexing and availability, and the interplay of key management and tokenomics design increase operational complexity and raise barriers to adoption. Building on these findings, the paper derives operational requirements and proposes a coexistence-first, five-layer migration framework that incrementally integrates BDNS while retaining the legacy DNS. This provides an incremental path toward a more resilient, inclusive, and secure global naming infrastructure. Full article

The present paper examines the degree of acceptance of eco-schemes by farmers. Specifically, eco-schemes, the new form of direct subsidies under the current Common Agricultural Policy (CAP) 2023–2027, are the focus of investigation regarding the motivations for participation, barriers to inclusion and advisory requirements for their successful implementation. This study was conducted at the regional unit (RU) of Serres (Central Macedonia, Greece) and combines both qualitative and quantitative research on the participation of local producers in eco-schemes during the years 2023 and 2024. Taking into account both statistical data on participation in eco-schemes in the Serres regional unit, as well as the members of the Agricultural Cooperative and the results of a survey conducted through a questionnaire, a variety of motivations and barriers for participation emerge. These include factors related to the personal characteristics of the producers, the structural features of their agricultural enterprises, as well as the type of commitments associated with eco-schemes. Finally, specific training/advice needs have been identified for their successful implementation. Full article

Background: People with multiple sclerosis (PwMS) face a wide range of social barriers, including stigma, limited support, and inaccessible environments, that restrict participation in physical activity (PA). Although PA is known to improve physical and psychological outcomes, its role in reducing social barriers has not been clearly synthesized. Methods: Following PRISMA 2020 guidelines, we conducted a systematic search of PubMed, Scopus, and Web of Science (January 1997–October 2025). Qualitative, quantitative, and mixed-methods studies examining how PA relates to social barriers, facilitators, or social outcomes for PwMS were included. Data were synthesized using a thematic analysis approach due to heterogeneity in study designs and outcomes. Risk of bias was assessed using JBI, NIH, RoB 2.0, and MMAT tools. Results: Twenty-nine studies met the inclusion criteria. The thematic synthesis identified three overarching mechanisms through which PA contributes to reducing social barriers: (1) peer support and shared experience, whereby group-based PA reduced isolation and normalized fluctuating symptoms; (2) guidance from knowledgeable professionals, which fostered trust, confidence, and perceived safety; and (3) changes in social identity, with participants shifting from a “sick role” toward identities such as “exerciser” or “athlete.” These mechanisms were supported by high-quality qualitative studies and by quantitative evidence showing small-to-moderate effect sizes for improvements in self-efficacy, social participation, and perceived social support. Conclusions: PA functions as a socially transformative practice for PwMS when delivered in group-based, supervised, and accessible formats. Programs designed to intentionally cultivate peer connection, professional support, and identity-building processes may be especially effective in overcoming social barriers and promoting social inclusion. Full article

Climate change is one of the greatest challenges of our time, with direct implications for sustainable development, the physical and mental health of populations, and the functioning of health systems. Strengthening the resilience and sustainability of health systems through mitigation and adaptation strategies requires the active involvement of health professionals. This scoping review explores health professionals’ perceptions of climate change and its impacts on public health and health systems, as well as their operational preparedness and the barriers to adaptation. The literature review was conducted in three phases (20 December 2024, 20 January 2025, and 20 March 2025) using the Web of Science, Scopus, and PubMed databases, covering the period 2016–2025 and following PRISMA guidelines. Of the 1888 studies initially identified, 36 met the predefined inclusion and exclusion criteria. The findings showed that while health professionals recognize climate change as a current threat to public health and health systems, they are not adequately prepared to address its impacts. The main barriers to addressing climate change are related to a lack of information and awareness, inadequate training, limited time, lack of supportive leadership, failure to integrate sustainable practices into daily clinical practice and, above all, inadequate funding. Based on these findings, there is an urgent need to develop policies that promote the active participation of health professionals in the design and implementation of climate change mitigation and adaptation strategies. At the same time, there is a need to strengthen research activity through both synchronous and diachronic studies in order to gather information on the sustainability and resilience of health systems. Full article

Sierra Leone’s water sector faces a “paradox of scarcity in abundance”: despite plentiful natural water resources, access to safe, reliable, and affordable supply remains limited, particularly for vulnerable populations. This paper investigates the governance dynamics and stakeholder relationships that underpin these challenges, drawing on a mixed-methods approach combining desktop research, surveys, and 37 semi-structured interviews. Using stakeholder and social network analysis, the study identifies key actors and their roles, interests, influence, and interdependencies, while also examining systemic barriers across social, technical, economic, environmental, and political dimensions. The findings reveal a highly fragmented governance landscape, characterised by overlapping mandates, donor dependency, weak enforcement, and the marginalisation of community voices. Although recent reforms—including new regulatory institutions, donor-funded infrastructure projects, and community-based initiatives—represent progress, they remain largely piecemeal, reactive, and insufficient to address entrenched structural deficiencies. The paper concludes that Sierra Leone’s water crisis is less a problem of resource scarcity than one of governance. Achieving sustainable water security requires integrated, system-wide reforms that strengthen institutional capacity, enhance coordination, enforce accountability, and embed inclusive stakeholder participation. Full article

The growing demand for effective skincare products that can effectively target specific dermatological concerns has accelerated the development of advanced delivery technologies. Among them, nanocarrier-based topical delivery systems have gained significant attention for their ability to enhance the performance of skincare formulations. Acting as versatile delivery tools, nanocarriers not only stabilize and protect sensitive cosmetic ingredients but also improve their penetration through the skin barrier and enable controlled, sustained, or targeted release. Therefore, this review focuses on the recent achievements of nanocarrier-based topical delivery technology for skincare applications, which systematically summarizes the design principles, mechanisms and functional characteristics of diverse nano-based delivery platforms, including vesicular nanocarriers, lipid-based nanocarriers, emulsion-based nanocarriers, polymeric nanocarriers, inorganic nanoparticles, and inclusion complexes. Meanwhile, these nanocarriers are discussed according to their relevance to the pathogenesis of prevalent skin disorders, highlighting how tailored nanocarriers can address specific therapeutic or cosmetic needs. Overall, this review emphasizes the emerging trends and future perspectives of nanotechnology-based topical delivery systems in modern cosmetology, offering more opportunities for precise, effective and science-driven cosmetic solutions. Full article

Migrant populations drive Canada’s demographic expansion, making their successful integration a national priority. However, research has consistently shown that refugees and immigrants experience declining mental health and encounter significant barriers to accessing culturally appropriate mental health support. This scoping review examined the breadth of evidence on culturally adapted mental health education (MHE) programs for migrant populations, including those that integrate traditional and complementary healing practices, and their effectiveness. Systematic searches across six databases (Medline, EMBASE, PsycINFO, Global Health, CINAHL, and Scopus) identified 4075 peer-reviewed articles, with 28 studies meeting inclusion criteria. These included mental health education and awareness programs that integrate psychoeducation and skill-building. Inclusion criteria required cultural adaptation of programs through one or more approaches such as language modification, culturally adapted content, community-based delivery, or integration of traditional and complementary healing practices. Thematic analysis of the programs revealed seven key themes characterizing effective MHE programs: cultural adaptation and sensitivity, addressing unique migration-related stressors, integration of traditional and Western approaches, use of theoretical frameworks and evidence-based practices, rigorous evaluation methodologies, application of holistic frameworks, and community-based peer support models. Programs predominantly utilized psychoeducation and culturally adapted interventions, with common theoretical frameworks including cognitive–behavioral therapy and the PRECEDE–PROCEED model. Across the reviewed studies, program evaluations reported positive outcomes including increased mental health literacy, reduced stigma, enhanced coping skills, and decreased depression, anxiety, and PTSD symptoms, suggesting that culturally adapted MHE programs are acceptable and feasible interventions for migrant populations. Full article

This study examines how societal heteronormative norms influence interactions involving transgender individuals, offering insights into identity formation and mental health. Understanding how societal heteronormative norms shape interactions involving transgender individuals is crucial to the attainment of public health goals related to addressing societal barriers, such as stigma, and promoting mental health. Interviews were conducted at a university in the Southwest United States with 11 self-identified transgender individuals, focusing on three main questions: How do you feel when you interact with someone who does not conform to heteronormative gender roles? When you meet somebody who doesn’t conform to heteronormative gender roles does that cause you to question your own gender identity. Does your body have to match your gender identity? Directed content analysis revealed a divided phenomenon. While some participants experienced discomfort due to societal scrutiny, safety issues concerns, and heightened visibility, others found empowerment and validation in these interactions, affirming their identities and fostering a sense of belonging. Yet another finding pointed to the role of embodiment and lived experiences, highlighting contrasting views on body harmony congruence: some participants prioritized physical alignment for societal acceptance, while others valued internal authenticity over external validation. This underscores the tension between personal agency and societal expectations in shaping gender identity. The study contributes to transidentity-theoretical literature by addressing the diverse outcomes resulting from the copresence of discomfort versus empowerment, internalized stigma, and the interplay of self-perception with societal norms. Clinical implications point to the need for inclusive spaces, supportive interventions, and mental health resources to assist trans individuals in navigating these challenges. Full article

The current study explores the social experiences of adolescent and transition-age youths with intellectual disabilities (IDs) and the support mechanisms available to these groups in Saudi Arabia. This study adopts a qualitative methodology with a semi-structured interview constituting the data collection method involving 13 parents with children aged between 11 and 19 years, a critical adolescent period and transition to early adulthood. The results suggest that family, caregivers, community, friendships, and healthcare providers play important roles that impact the quality of life for these groups. The main challenges identified include health-related issues, employment challenges, educational barriers, insufficient services, inadequate community participation, and limited social relationships, with special emphasis on obstacles linked to transition during the 18 to 19-year period when youths must navigate transfers from pediatric to adult services and changes associated with legal rights. This study highlights several reasons it is important to increase awareness and education, while also continuing to improve support systems aimed at dealing with both transition challenges and adolescent needs. The results further illustrate that although support from family provides the foundation for care, systemic changes are needed to promote social inclusion and reduce stigma during critical development periods. The current study contributes to the limited research related to IDs in the context of the Middle East, with special reference to Saudi Arabia. Finally, the discussion highlights several insights that are culturally specific for the development of policy and provision of services associated with the transition from adolescence to early adulthood. Full article

The number of students living with disabilities entering post-secondary education, including health professional programs (HPPs), is increasing. However, disabled students continue to experience challenges in both the on-campus and fieldwork components of these programs. The purpose of this study is to understand the experiences and perspectives of fieldwork educators to determine how they can be supported by HPPs when supervising students living with disabilities. An online survey was developed and circulated to fieldwork educators who supervise students in nine HPPs at McMaster University in Canada. Descriptive statistics and content analysis were used to analyze survey responses. The survey was completed by 42 respondents, 10 of whom reported living with a disability and demonstrated a nuanced understanding of accommodation issues. More than half of the total respondents reported they had supervised disabled students in fieldwork; however, only 12 received accommodation plans and evaluation occurred informally, if at all. Respondents requested training on how to accommodate specific student needs. Efficient processes are needed for educator training, and the involvement of educators is needed in accommodation development. Accommodations must be evaluated to ensure students have equitable opportunities for learning and assessment. Educators living with disabilities provide valuable insights on dismantling systemic barriers to inclusion. Full article