Search Results (834)

Background: Access to safe and reliable water and sanitation remains a critical public health and development challenge, with rural and low-income communities being disproportionately affected by inadequate services and heightened exposure to waterborne diseases. Despite global efforts and infrastructure-based progress indicators, significant disparities persist, and these often overlook users’ perceptions of water quality, reliability, and safety. This study explores the determinants of household satisfaction with drinking water in rural areas, comparing subjective user feedback with official access data to reveal gaps in current monitoring approaches and support more equitable, user-centered water governance. Methods: This study was conducted in Kazakhstan’s Atyrau Region, where 1361 residents from 86 rural villages participated in a structured survey assessing household access to drinking water and perceptions of its quality. Data were analyzed using descriptive statistics and multinomial logistic regression to identify key predictors of user satisfaction, with results compared against official records to evaluate discrepancies between reported experiences and administrative data. Results: The field survey results revealed substantial discrepancies between official statistics and residents’ reports, with only 58.1% of respondents having in-house tap water access despite claims of universal coverage. Multinomial logistic regression analysis identified key predictors of user satisfaction, showing that uninterrupted supply and the absence of complaints about turbidity, odor, or taste significantly increased the likelihood of higher satisfaction levels with drinking water quality. Conclusions: This study underscores the critical need to align official water access statistics with household-level experiences, revealing that user satisfaction—strongly influenced by supply reliability and sensory water quality—is essential for achieving equitable and effective rural water governance. Full article

The COVID-19 pandemic precipitated unprecedented social isolation measures, profoundly disrupting daily life, educational routines, and mental health worldwide. University students, already susceptible to psychological distress, encountered intensified challenges under remote learning and prolonged confinement. This longitudinal study examined fluctuations in anxiety and mood among 102 Brazilian university students during the pandemic, distinguishing between those solely engaged in academic pursuits and those simultaneously balancing work and study. Data collected via the Brunel Mood Scale and State-Trait Anxiety Inventory in April and July 2021 revealed that students exclusively focused on studies exhibited significant increases in depressive symptoms, anger, confusion, and anxiety, alongside diminished vigor. Conversely, participants who combined work and study reported reduced tension, fatigue, confusion, and overall mood disturbance, coupled with heightened vigor across the same period. Notably, women demonstrated greater vulnerability to anxiety and mood fluctuations, with socioeconomic disparities particularly pronounced among females managing dual roles, who reported lower family income. These findings suggest that occupational engagement may serve as a protective factor against psychological distress during crises, underscoring the urgent need for tailored mental health interventions and institutional support to mitigate the enduring impacts of pandemic-related adversities on the student population. Full article

Cancer disparities in low- and middle-income countries (LMICs) arise from multifaceted interactions between environmental exposures, infectious agents, and systemic inequities, such as limited access to care. The exposome, a framework encompassing the totality of non-genetic exposures throughout life, offers a powerful lens for understanding these disparities. In LMICs, populations are disproportionately affected by air and water pollution, occupational hazards, and oncogenic infections, including human papillomavirus (HPV), hepatitis B virus (HBV), Helicobacter pylori (H. pylori), human immunodeficiency virus (HIV), and neglected tropical diseases, such as schistosomiasis. These infectious agents contribute to increased cancer susceptibility and poor outcomes, particularly in immunocompromised individuals. Moreover, climate change, food insecurity, and barriers to healthcare access exacerbate these risks. This review adopts a population-level exposome approach to explore how environmental and infectious exposures intersect with genetic, epigenetic, and immune mechanisms to influence cancer incidence and progression in LMICs. We highlight the critical pathways linking chronic exposure and inflammation to tumor development and evaluate strategies such as HPV and HBV vaccination, antiretroviral therapy, and environmental regulation. Special attention is given to tools such as exposome-wide association studies (ExWASs), which offer promise for exposure surveillance, early detection, and public health policy. By integrating exposomic insights into national health systems, especially in regions such as sub-Saharan Africa (SSA) and South Asia, LMICs can advance equitable cancer prevention and control strategies. A holistic, exposome-informed strategy is essential for reducing global cancer disparities and improving outcomes in vulnerable populations. Full article

Background: Prematurity and low birth weight (LBW) drive infant morbidity and mortality, requiring nutritional interventions, especially in food-insecure settings. In Indonesia, regional disparities in food security hinder adequate nutrition for premature and LBW infants, exacerbating health challenges. The aim of study is to investigate and determine factors associated with prematurity and LBW in children from food-insecure and food-secure households. Methods: This research employed a cross-sectional study with 657 mothers of children aged 36–59 months, conducted using random sampling. Data was collected via standardized questionnaires and analyzed using Chi-square tests and logistic regression. Results: The adjusted model showed that children of food-insecure households had a higher risk of LBW (AOR = 0.54; 95% CI: 0.29–0.99; p < 0.05). LBWs were found to significantly less occur in food-insecure households. Low maternal education was associated with an increased risk of preterm birth (AOR = 3.23; 95% CI:1.78–5.84; p < 0.001). Furthermore, prematurity correlated with house ownership (p < 0.01), indicating the household’s wealth condition. Maternal education and house ownership were linked to prematurity, indicating the risk to child health outcomes. In summary, maternal education, employment status, and household income were linked to food insecurity, indicating the risk to child health outcomes. Conclusion: Strategies to improve child health outcomes are essential, including enhancing maternal nutrition knowledge to improve child feeding practices, promoting gender equality in career development, and reducing food insecurity in households. Full article

Society’s adaptation to shared mobility services is a growing topic that requires detailed understanding of the local circumstances of potential and current users. This paper focuses on analyzing barriers to the adoption of urban bike-sharing systems in post-industrial cities, using a case study of the Silesian agglomeration in Poland. Methodologically, the article integrates quantitative survey methods with multivariate statistical analysis to analyze the demographic, socioeconomic, and motivational factors that underline the adoption of shared micromobility. The study highlights a detailed segmentation of users by income, age, professional status, and gender, as well as the observation of profound disparities in access and perceived usefulness. Of note is the study’s identification of a highly concentrated segment of young, low-income users (mostly students), which largely accounts for the general perception of economic and infrastructural barriers. These include the use of factor analysis and regression to plot the interaction patterns between individual user characteristics and certain system-level constraints, such as cost, infrastructure coverage, weather, and health. The study’s findings prioritize problem-specific interventions in urban mobility planning: bridging equity gaps between user groups. This research contributes to the current literature by providing detailed insights into the heterogeneity of user mobility behavior, offering evidence-based recommendations for inclusive and adaptive options for shared transportation infrastructure in a changing urban context. Full article

More than 50 years ago, children were viewed as naturally resilient and often labeled invulnerable or invincible. Resilience is now understood to be the result of dynamic interactions between individual, familial, social, and environmental systems, decentralizing the focus from the individual to the global society. Experiences with adversity may emanate from the youth’s family environment, their community, the school system, and larger structural challenges related to poverty, discrimination, health disparities, and educational inequities. Youth experiences with adversity, trauma, and tragedy have the potential to negatively impact youth well-being, with consequences manifesting across the lifespan. Children and adolescents generally hold limited power to change their circumstances and are often ill-equipped to resolve the adverse or traumatic experiences occurring within their ecosystem. The value of social supports in the young person’s ability to be resilient has been affirmed. This understanding is particularly important for children growing up in poverty or in Low- and Middle-Income Countries (LMICs) where significant challenges occur as a result of economic and social disadvantage. Resilience at the individual level is unlikely to eliminate macrolevel issues. Developing and deploying strategies to enhance the ability of youth to rebound from adversity represents a positive step at the micro level, but the larger issues of economic and social disadvantage are unlikely to change without macro-level interventions. Glancing toward the future, traumatized youth may grow into traumatized adults without appropriate interventions and changes in social policies, programs, and protections. Full article

Background/Objectives: Syphilis, a re-emerging global public health issue, has shown increasing incidence over the past decade, particularly among key populations such as men who have sex with men (MSM), people living with HIV, and pregnant women. This narrative review aimed to synthesize global epidemiological trends of syphilis from 2015 to 2025, with a focus on surveillance gaps, regional disparities, and structural determinants. Methods: A broad narrative approach was used to collect and analyze epidemiological data from 2015 to 2025. The literature was retrieved from databases (PubMed, Scopus) and official reports from the WHO, CDC, and ECDC. Included materials span observational studies, surveillance reports, and modeling data relevant to global trends and public health responses. Results: Globally, syphilis incidence has increased, with notable surges in North America, Europe, and Asia. MSM remain disproportionately affected, while congenital syphilis is resurging even in high-income countries. Low- and middle-income countries report persistent burdens, especially among women of reproductive age, often exacerbated by limited screening and surveillance infrastructure. The COVID-19 pandemic disrupted syphilis-related services and further exacerbated underreporting, hindering timely detection and response efforts. Surveillance systems vary widely in their completeness and quality, which significantly hinders global data comparability and coordinated public health responses. Conclusions: Despite its curability, syphilis continues to spread due to fragmented prevention strategies, inequities in access to care, and insufficient surveillance. Strengthening diagnostic access, integrating prevention efforts into broader health systems, and addressing social determinants are essential. Improved surveillance, equitable access, and innovation—including diagnostics and potential vaccine research—are critical to controlling the global syphilis epidemic. Full article

Background/Objectives: This quantitative cross-sectional study examined the relationships between self-efficacy, compassion fatigue, and the quality of nursing work life (QNWL) in primary care nurses from the Dammam and Riyadh regions of Saudi Arabia. This study examined how these factors varied according to gender, education, income, and years of experience. Methods: A total of 158 primary care nurses completed validated survey instruments, including the General Self-Efficacy Scale, Professional Quality of Life Scale—Version 5, and Work-Related Quality of Life Scale-2. Descriptive statistics were used for data analysis. Results: The results indicated that participants experienced elevated self-efficacy (M = 29.53, SD = 0.52), moderate compassion fatigue (M = 54.62, SD = 10.16), and moderate overall quality of work life (QWL) (M = 3.26, SD = 0.52). Positive correlations were identified between self-efficacy and QWL (r = 0.250, p < 0.05) and compassion satisfaction (r = 0.533, p < 0.05). By contrast, compassion fatigue was negatively correlated with QWL (r = −0.259, p < 0.05). Notable disparities in QWL were identified according to education level and years of experience, with nurses possessing advanced degrees and those with less experience having elevated QNWL scores. Conclusions: This study highlights the significance of promoting self-efficacy and mitigating compassion fatigue to improve the quality of nursing. Administrators and nurse leaders should consider strategies such as continuous professional development, psychological support, and effective workload management to enhance the well-being and retention of primary care nurses. Full article

Background/Objectives: Antimicrobial consumption (AMC) surveillance and antimicrobial stewardship (AMS) constitute effective strategies to combat the increasing antimicrobial resistance rates worldwide. Post-Soviet countries (Armenia, Azerbaijan, Belarus, Estonia, Georgia, Kazakhstan, Kyrgyzstan, Latvia, Lithuania, Moldova, the Russian Federation, Tajikistan, Turkmenistan, Ukraine, and Uzbekistan) implemented various elements of AMC surveillance and AMS to different extents. The limited quantity and quality of data from post-Soviet countries make it difficult to assess health system performance; therefore, this region is a blind spot in global AMR monitoring. This systematic review assesses and characterises AMC surveillance and AMS implementation in post-Soviet countries. Methods: Evidence was compiled via a search in PubMed, Google Scholar, Embase, CyberLeninka, and Scopus. The eligibility criteria included AMC surveillance- and AMS-related papers in human health within defined regions and timelines. Some literature from the official websites of international and national health organisations was included in the search. Results: As a result of the searches, screening, and critical appraisal, three peer-reviewed publications and 31 documents were selected for analysis. Eleven out of fifteen countries with updated national action plans for combating antimicrobial resistance have defined AMC surveillance and AMS as strategic objectives. All 15 examined countries submitted antimicrobial consumption data to international networks and reported the existence of approved laws and regulations on antibiotic sales. However, disparities exist in the complexity of monitoring systems and AMS implementation between high-income and low-income countries in the region. Conclusions: This review provides key insights into the existing AMC surveillance and AMS implementation in former Soviet countries. Although the approach of this review lacks quantitative comparability, it provides a comprehensive qualitative framework for national-level AMC surveillance and AMS system assessment. Full article

Background/Objectives: With the rising trend of out-of-home dining in China, the use of iodized salt (IS) in eating-out venues plays a key role in preventing iodine deficiency disorders (IDDs). However, the coverage rate of iodized salt (CRIS) and the utilization rate of adequately iodized salt (URAIS) in these venues in China remain underexplored, potentially undermining IDD prevention strategies. This study aims to assess the CRIS and URAIS in such venues across China and identify the factors influencing their prevalence. Methods: From 2021 to 2024, a nationwide cross-sectional study was conducted in China, involving 19,346 venues. A 50 g sample of cooking salt was collected from each venue, and the iodine content was measured. The CRIS and URAIS were calculated, and associations with various factors were assessed using Chi-square tests, the Cochran–Armitage trend test, and multivariate logistic regression. Results: Of the 19,346 samples, 18,519 tested positive for IS, and 17,588 contained adequately iodized salt (AIS), resulting in a CRIS of 95.7% and a URAIS of 90.9%. Significant regional differences were found, with coastal areas showing a lower CRIS and URAIS than inland areas (87.0% vs. 97.8%; 81.0% vs. 93.2%) and urbanized areas having lower rates compared to less urbanized areas (94.1% vs. 97.3%; 88.9% vs. 92.9%). Higher per capita income was associated with a lower CRIS and URAIS (Z = −19.72, p < 0.0001; Z = −13.85, p < 0.0001). Lower per capita income (OR = 3.24, OR = 1.36, p < 0.0001), inland areas (OR = 4.14, OR = 2.68, p < 0.0001), and mountainous areas (OR = 2.48, OR = 1.27, p < 0.0001) were associated with a higher likelihood of IS and AIS use. Conclusions: While the CRIS and URAIS in dining venues meet national standards, regional disparities persist, particularly in coastal, plain, and economically advanced areas. Strengthening regulatory oversight and public education on iodized salt’s health benefits is essential. Full article

This study developed an Energy Quadrilemma Index (EQI) for Latin American countries, analyzing data from six countries from 2014 to 2020. Using the Principal Component Analysis method, this work reduced the dimensionality of 20 indicators grouped into four dimensions: energy security, energy equity, sustainable development, and a new social context axis. The results reveal significant disparities among the countries in the study. For example, Uruguay shows robust indicators, Paraguay exhibits low utilization of the energy it produces, and Chile displays the poorest results in the sustainable development axis. Many countries’ widespread dependence on hydroelectricity makes them vulnerable to water crises. The results show that social, economic, and structural inequalities represent the main barriers to the energy transition, often marginalizing low-income populations. Ensuring a fair and inclusive transition requires implementing targeted policies and solutions adapted to each country’s specific context. Although Costa Rica leads in performance, it faces significant challenges in the field of sustainability. In contrast, Honduras has made some progress with sustainable development but still demonstrates weaknesses in other areas. These results highlight that standardized solutions can exacerbate regional inequalities, demanding approaches more tailored to local needs. This work’s novelty lies in the use of the social context dimension as a feature to assess energy poverty in selected countries. Full article

Health literacy is a critical determinant of health outcomes, yet it is often overlooked, particularly among marginalized groups. This paper explores the significance of health literacy, with a particular focus on low-income African American and Black (AA/B) men, a population that faces unique challenges due to intersecting factors such as race, gender, socioeconomic status, and educational disparities. We examine how these factors contribute to health literacy gaps, highlighting adverse effects on health outcomes for AA/B men compared to the general population. Additionally, we stress the growing importance of digital literacy in an increasingly technology-driven world. Not actively addressing digital health literacy, especially within chronic disease self-management programs (CDSMPs), further exacerbates health disparities within this group. Recommendations are provided for improving health literacy, with specific strategies to also enhance general literacy and digital literacy, among low-income AA/B men. The paper also advocates for a systematic review of the existing literature on health literacy among this group, emphasizing the need for tailored interventions that account for the unique challenges faced by low-income AA/B men. In conclusion, the paper underscores the critical need for targeted research and practical approaches to improve health literacy and ultimately health outcomes for AA/B men in the digital age, particularly through CDSMPs. Full article

The 100-Day Mission, coordinated by the Coalition for Epidemic Preparedness Innovations (CEPI) and endorsed by significant international stakeholders, aims to shorten the timeframe for developing and implementing vaccines to 100 days after the report of a new pathogen. This ambitious goal is outlined as an essential first step in improving pandemic preparedness worldwide. This review highlights the mission’s implementation potential and challenges by examining it through the lens of low- and middle-income countries (LMICs), which often face barriers to equitable vaccine access. This article explores the scientific, economic, political, and social aspects that could influence the mission’s success, relying on lessons learned from previous pandemics, such as the Spanish flu, H1N1, and COVID-19. We also examined important cornerstones like prototype vaccine libraries, accelerated clinical trial preparedness, early biomarkers identification, scalable manufacturing capabilities, and rapid pathogen characterization. The review also explores the World Health Organization (WHO) Pandemic Agreement and the significance of Phase 4 surveillance in ensuring vaccine safety. We additionally evaluate societal issues that disproportionately impact LMICs, like vaccine reluctance, health literacy gaps, and digital access limitations. Without intentional attempts to incorporate under-resourced regions into global preparedness frameworks, we argue that the 100-Day Mission carries the risk of exacerbating already-existing disparities. Ultimately, our analysis emphasizes that success will not only rely on a scientific innovation but also on sustained international collaboration, transparent governance, and equitable funding that prioritizes inclusion from the beginning. Full article

This study explores the spatial and social implications of urban food systems in Quito, Ecuador, focusing on how food access inequalities reflect and reinforce broader urban disparities. The research addresses a critical problem in contemporary urbanization: the disconnection between food provisioning and spatial equity in rapidly growing cities. The objective is to assess and map disparities in food accessibility using a mixed-methods approach that includes field observation, participatory mapping, value chain analysis, and statistical modeling. Five traditional and emerging food markets were studied in diverse districts across the city. A synthetic accessibility function F(x) was constructed to model food access levels, integrating variables such as income, infrastructure, transport availability, and travel time. These variables were subjected to Principal Component Analysis (PCA) and hierarchical clustering to generate three typologies of territorial vulnerability. The results reveal that peripheral areas exhibit lower F(x) values and weaker integration with the formal food system, leading to higher consumer costs and limited fresh food options. In contrast, central districts benefit from multimodal infrastructure and greater diversity of supply. This study concludes that food systems should be treated as critical urban infrastructure. Integrating food equity into land use and mobility planning is essential to promote inclusive, sustainable, and resilient urban development. Full article

Property crime is a pressing issue in maintaining social order and urban sustainability, particularly in regions marked by pronounced socioeconomic disparity. While the link between socioeconomic stress and crime is well established, regional variations in Thailand have not been fully examined. Therefore, the purpose of this research was to examine spatial patterns of property crime and identify the potential associations between property crime and socioeconomic environment across Thailand. Using nationally compiled property-crime data from official sources across all provinces of Thailand, we employed geographic information system (GIS) tools to conduct a spatial cluster analysis at the sub-national level across 76 provinces. Both global and local statistical techniques were applied to identify spatial associations between property-crime rates and neighborhood-level socioeconomic conditions. The results revealed that property-crime clusters are primarily concentrated in the south, while low-crime areas dominate parts of the north and northeast regions. To analyze the spatial dynamics of property crime, we used geospatial statistical models to investigate the influence of socioeconomic variables across provinces. We found that property-crime rates were significantly associated with monthly income, areas experiencing high levels of household debt, migrant populations, working-age populations, an uneducated labor force, and population density. Identifying associated factors and mapping geographic regions with significant spatial clusters is an effective approach for determining where issues concentrate and for deepening understanding of the underlying patterns and drivers of property crime. This study offers actionable insights for enhancing safety, resilience, and urban sustainability in Thailand’s diverse regional contexts by highlighting geographies of vulnerability. Full article