Search Results (8,992)

Background: Rickettsioses are diseases caused by obligate intracellular non-motile coccobacilli transmitted via arthropods. The most common rickettsioses are scrub typhus (ST), typhus group rickettsioses (TGR), and spotted fever group rickettsioses (SFGR). This study aims to provide information and insight into rickettsioses seropositivity among suspected patients in East and Peninsular Malaysia over a six-year period from 2016 to 2021. Methodology/Principal Findings: Data obtained from four state hospitals and one national research institute providing rickettsial serological testing were analyzed using the IBM SPSS (Statistical Package for the Social Sciences) software program. The six-year analysis revealed that ST had the highest number of seropositivity cases, followed by TGR, and SFGR, for both immunoglobulin M (IgM) and immunoglobulin G (IgG) antibodies. Of the 3228 samples, 21.6%, 16.1%, and 13.9% of suspected patients were IgM seropositive for ST, TGR, and SFGR, respectively. IgG seropositivity for ST was 21.9%, followed by TGR at 21.4%, and SFGR at 17.2% among suspected rickettsioses cases. All regions in Malaysia were significantly associated with IgM seropositivity for ST, TGR, and SFGR. IgM seropositivity for SFGR was significantly higher in females. Age group 41–65 years was highly associated with IgG seropositivity for ST, TGR, and SFGR. Conclusions/Significance: Analysis of six-year data on ST, TGR, and SFGR seropositivity in Malaysia revealed variations across regions, age groups, and genders. This seropositivity study underscores ST, TGR, and SFGR as possible causes of acute febrile illness among patients suspected of rickettsial disease in Malaysia. The findings contributed to the awareness of reemerging rickettsioses and warrant public health interventions that may reduce the incidence of rickettsioses in Malaysia. Abstract summary: Scrub typhus (ST), typhus group rickettsioses (TGR), and spotted fever group rickettsioses (SFGR) are significant global public health concerns. Our results showed that the highest number of IgM and IgG seropositivity cases was observed for ST, followed by TGR and SFGR. All regions in Malaysia were significantly associated with IgM seropositivity for ST, TGR, and SFGR. East Malaysia exhibited significantly higher seropositivity for ST, TGR, and SFGR than other regions in Malaysia. IgM seropositivity for SFGR was significantly higher in females. The age group 41–65 years was highly associated with IgG seropositivity for ST, TGR, and SFGR. This study highlights the value of serological data in uncovering the hidden burden of disease in Malaysia. In addition, the findings contributed to bridging knowledge gaps on the limited data from Malaysia spanning extended periods, despite being one of the countries in the endemic Tsutsugamushi Triangle. The findings from this study may direct future research on rickettsioses and warrant public health interventions in Malaysia. Full article

Background/Objectives: Patients with stage IV gastric cancer who develop chronic intestinal failure require home parenteral nutrition (HPN). This study aimed to evaluate the prognostic relevance of nutritional and immune–inflammatory biomarkers and to construct an individualised survival prediction model using machine learning techniques. Methods: A secondary analysis was performed on a cohort of 410 patients with TNM stage IV gastric adenocarcinoma who initiated HPN between 2015 and 2023. Nutritional and inflammatory indices, including the Controlling Nutritional Status (CONUT) score and lymphocyte-to-monocyte ratio (LMR), were assessed. Independent prognostic factors were identified using Cox proportional hazards models. A Random Survival Forest (RSF) model was constructed to estimate survival probabilities and quantify variable importance. Results: Both the CONUT score and LMR were independently associated with overall survival. In multivariate analysis, higher CONUT scores were linked to increased mortality risk (HR = 1.656, 95% CI: 1.306–2.101, p < 0.001), whereas higher LMR values were protective (HR = 0.632, 95% CI: 0.514–0.777, p < 0.001). The RSF model demonstrated strong predictive accuracy (C-index: 0.985–0.986) and effectively stratified patients by survival risk. The CONUT score exerted the greatest prognostic influence, with the LMR providing additional discriminatory value. A gradual decline in survival probability was observed with an increasing CONUT score and a decreasing LMR. Conclusions: The application of machine learning to immune–nutritional data offers a robust tool for predicting survival in patients with advanced gastric cancer requiring HPN. This approach may enhance risk stratification, support individualised clinical decision-making regarding nutritional interventions, and inform treatment intensity adjustment. Full article

Idiopathic pulmonary fibrosis (IPF) is a progressive fibrosing lung disease characterized by chronic inflammation, vascular remodeling, and immune dysregulation. COVID-19, caused by SARS-CoV-2, shares several systemic immunohematologic disturbances with IPF, including cytokine storms, endothelial injury, and prothrombotic states. Unlike general comparisons of viral infections and chronic lung disease, this review offers a focused analysis of the shared hematologic and immunologic mechanisms between COVID-19 and IPF. Our aim is to better understand how SARS-CoV-2 infection may worsen disease progression in IPF and identify converging pathophysiological pathways that may inform clinical management. We conducted a narrative synthesis of the peer-reviewed literature from PubMed, Scopus, and Web of Science, focusing on clinical, experimental, and pathological studies addressing immune and coagulation abnormalities in both COVID-19 and IPF. Both diseases exhibit significant overlap in inflammatory and fibrotic signaling, particularly via the TGF-β, IL-6, and TNF-α pathways. COVID-19 amplifies coagulation disturbances and endothelial dysfunction already present in IPF, promoting microvascular thrombosis and acute exacerbations. Myeloid cell overactivation, impaired lymphocyte responses, and fibroblast proliferation are central to this shared pathophysiology. These synergistic mechanisms may accelerate fibrosis and increase mortality risk in IPF patients infected with SARS-CoV-2. This review proposes an integrative framework for understanding the hematologic and immunologic convergence of COVID-19 and IPF. Such insights are essential for refining therapeutic targets, improving prognostic stratification, and guiding early interventions in this high-risk population. Full article

Background: Behavioural heterogeneity in obesity is increasingly recognised, but how specific dietary patterns, food preferences and physical activity vary between obesity classes remains poorly characterised. Methods: We analysed behavioural, dietary, and lifestyle data from 1366 adults attending a tertiary obesity clinic in Italy. Participants were stratified into five obesity classes defined by BMI. Age-adjusted regression models and chi-square tests with Bonferroni correction were used to examine associations between obesity severity and key behavioural outcomes, including food preferences, eating behaviours, physical activity, and self-reported sleep quality. Results: The prevalence of uncontrolled eating, skipping meals, and fast eating significantly increased with obesity severity after adjusting for age (all p < 0.05). Preference for yoghurt and legumes declined with increasing BMI, whereas preferences for meat and dairy remained stable. Age-adjusted sport participation decreased progressively, with significantly lower odds in Obesity I, II, and IIIA compared to the Overweight group. Sleep quality was highest among overweight participants and declined with obesity severity; night-time awakenings were most frequent in Obesity IIIB. Conclusions: Distinct behavioural and lifestyle traits, including lower sport participation, reduced preference for fibre-rich foods, and greater frequency of uncontrolled, fast, and irregular eating, showed overall trends across obesity classes. While these findings suggest the presence of behavioural phenotypes, their interpretation is limited by the cross-sectional design and the use of self-reported, non-validated measures. Future studies should incorporate objective assessments to inform targeted obesity interventions. Full article

This paper critically examines the persistent limitations of spatial planning reforms in China in addressing urban–rural integration, despite significant and successive legislative and planning reforms. Through a historically grounded and institutionally informed analysis, the study traces the evolution of China’s planning regimes across three key phases—urban planning, urban–rural planning, and territorial spatial planning (TSP)—highlighting shifting policy logics and the enduring structural challenges that shape rural marginalization. Drawing on national planning documents and authors’ empirical insights from planning practice, the paper identifies four interrelated and persistent constraints: (1) cross-scalar and interdepartmental fragmentation in governance, (2) contradictions in the land system that restrict rural development rights, (3) fiscal dependence on land conversion that distorts planning priorities, and (4) technical and conceptual gaps that reduce rural planning to physicalist and exogenous interventions. The paper contributes by offering a periodized account of China’s rural planning reforms, situating these within global debates on rural marginalization, and evaluating the transformative potential of the TSP framework. It argues that achieving meaningful urban–rural integration requires a fundamental rethinking of planning as a developmental, rather than solely regulatory, practice—one that is territorially embedded, socially responsive, and functionally aligned with endogenous rural revitalization. Full article

Background: Electronic waste (e-waste) recycling in informal settings like Agbogbloshie in Accra, Ghana, releases toxic metals into the environment, posing serious health risks to nearby residents, particularly children. This study assessed the body burdens of lead (Pb), manganese (Mn), cadmium (Cd), chromium (Cr), nickel (Ni), and arsenic (As) and their association with cognitive function in schoolchildren living within 1 km of the Agbogbloshie site. Method: A cross-sectional study involving 56 pupils collected demographic data and blood and urine samples and administered the Wechsler Intelligence Scale for Children—Fourth Edition (WISC-IV). Blood was tested for Pb and Mn and urine for Cd, Cr, Ni, and As. Associations between metal levels and cognitive outcomes were examined using regression analyses, adjusting for confounders. Result: Children showed elevated metal levels, with mean blood Pb of 60.43 µg/L and urinary s of 21.50 µg/L. Symptoms of cognitive dysfunction were common: 75% reported confusion, 67.9% poor memory, and 66% poor concentration. Urinary Cr levels were significantly associated with lower Full-Scale IQ (β = −18.42, p < 0.05) and increased difficulty in decision-making (OR = 0.1, p < 0.05). Conclusion: These findings underscore the neurodevelopmental risks of heavy metal exposure from e-waste in low- and middle-income countries and call for urgent public health interventions and policy actions. Full article

This study estimates a willingness-to-pay (WTP) space mixed logit model to evaluate user valuations of travel time, safety, and comfort attributes associated with common access modes in Bangkok, including walking, motorcycle taxis, and localized minibuses. The model accounts for preference heterogeneity by specifying random parameters for travel time. Results indicate that users—exhibiting substantial variation in preferences—place higher value on reducing motorcycle taxi travel time, particularly in time-constrained contexts such as peak-hour commuting, whereas walking is more acceptable in less pressured settings. Safety and comfort attributes—such as helmet availability, smooth pavement, and seating—significantly influence access mode choice. Notably, the WTP for helmet availability is estimated at THB 8.04 per trip, equivalent to approximately 40% of the typical fare for station access, underscoring the importance of safety provision. Women exhibit stronger preferences for motorized access modes, reflecting heightened sensitivity to environmental and social conditions. This study represents one of the first applications of WTP-space modeling for valuing informal station access transport in Southeast Asia, offering context-specific and segment-level estimates. These findings support targeted interventions—including differentiated pricing, safety regulations, and service quality enhancements—to strengthen first-/last-mile connectivity. The results provide policy-relevant evidence to advance equitable and sustainable transport, particularly in rapidly urbanizing contexts aligned with SDG 11.2. Full article

Rabies is a fatal but entirely vaccine-preventable disease, with the highest risk in areas where free-roaming domestic dogs are prevalent. Understanding dog owners’ knowledge, attitudes, and practices (KAP) is crucial for shaping effective rabies control strategies. This scoping review aimed to synthesize global evidence from studies evaluating dog owners’ KAP to identify behavioral factors relevant to rabies prevention and control. A systematic literature search was conducted using PubMed, Web of Science, and Scopus, covering the period from 2012 to 2025. Seventy full-text articles were included based on predefined criteria. The findings reveal substantial gaps in dog owners’ knowledge, beliefs, and behaviors regarding rabies prevention. While general awareness of rabies is high among dog owners, their knowledge about transmission, clinical signs, and the fatal nature of the disease is inconsistent, with significant variability across studies. The vaccination uptake also varied widely across studies, ranging from less than 1% to over 90%, with no study reporting full coverage. Furthermore, a strong positive correlation was found between vaccination practice and the awareness of vaccine benefits (r = 0.69, p = 0.004). Common barriers to vaccination include lack of information, vaccine accessibility, distance to clinics, and personal constraints. These insights underscore the importance of early and targeted communication about vaccination campaigns. Future research should focus on periodically evaluating KAP before and after interventions to better inform rabies control efforts. Full article

Non-pharmacological interventions, such as physical activity and exercise, are essential in managing type 1 diabetes mellitus by improving glycemic control, cardiovascular health and autonomic function. Given the chronic nature and long-term complications associated with type 1 diabetes, strategies beyond pharmacotherapy are essential. This review examines the effects of exercise on heart rate variability, a key indicator of autonomic nervous system activity. A systematic search was conducted in March 2024 across PubMed, Embase, Cochrane and CINAHL databases. Studies evaluating the retrospective or prospective impact of exercise or physical activity on heart rate variability parameters were included. Utilizing best evidence synthesis, the methodological quality of the included studies was evaluated. Seven studies met the inclusion criteria, all of which were rated as methodologically weak. Moderate evidence suggests that exercise may enhance heart rate variability, particularly by increasing parasympathetic activity and improving sympathovagal balance. However, evidence remains limited regarding the optimal type, frequency and intensity of exercise. Exercise appears to support autonomic function in individuals with type 1 diabetes mellitus. Nonetheless, further high-quality research is needed to determine the most effective exercise modalities and to inform evidence-based clinical guidelines. Full article

Background: Tobacco use is disproportionately high in rural areas, contributing to elevated cancer mortality, yet it often goes untreated due to limited access to care, high poverty and uninsured rates, and co-occurring substance use disorders (SUDs). This study explored the utility of using rapid qualitative analysis (RQA) to guide the adaptation of a tobacco-free workplace program (TFWP) in Texas healthcare centers serving adults with SUDs in medically underserved areas. Methods: From September–December 2023 and May–July 2024, we conducted 11 pre-implementation, virtual semi-structured group interviews focused on adapting the TFWP to local contexts (N = 69); 7 with providers (n = 34) and managers (n = 12) and 4 with patients (n = 23) in 6 healthcare centers. Two qualified analysts independently summarized transcripts, using RQA templates of key domains drawn from interview guides to summarize and organize data in matrices, enabling systematic comparison. Results: The main themes identified were minimal organizational tobacco cessation support and practices, and attitudinal barriers, as follows: (1) the need for program materials tailored to local populations; (2) limited tobacco cessation practices and partial policies—staff requested guidance on enhancing tobacco screenings and cessation delivery, and integrating new interventions; (3) contradictory views on treating tobacco use that can inhibit implementation (e.g., wanting to quit yet anxious that quitting would cause SUD relapse); and (4) inadequate environmental supports—staff requested treating tobacco-use training, patients group cessation counseling; both requested nicotine replacement therapy. Conclusions: RQA identified key areas requiring capacity development through participants’ willingness to adopt the following adaptations: program content (e.g., trainings and tailored educational materials), delivery methods/systems (e.g., adopting additional tobacco care interventions) and implementation strategies (e.g., integrating tobacco cessation practices into routine care) critical to optimizing TFWP fit and implementation. The study findings can inform timely formative evaluation processes to design and tailor similar intervention efforts by addressing site-specific needs and implementation barriers to enhance program uptake. Full article

COVID-19 vaccine hesitancy in Pakistan is a barrier to optimal vaccine uptake and has been situated within a context of hesitancy towards other vaccines. A mixed-methods study was conducted during the initial COVID-19 vaccine roll-out in 2021 in four union councils in Peshawar, consisting of a cross-sectional survey, eight focus group discussions (FGDs) with community members and eight in-depth interviews with healthcare workers (HCWs) to assess perceptions toward vaccines. Multivariable logistic regression was used to assess factors associated with COVID-19 vaccine hesitancy. Of 400 survey participants, 57.3% were vaccine acceptant and 42.8% vaccine hesitant. Just over half (56.8%) perceived COVID-19 vaccines to be safe. Most (88%) reported trust in HCWs to provide accurate vaccine information. FGDs revealed that women received less information about the vaccine compared to men and cultural restrictions were barriers even for those willing to be vaccinated. Correlates of vaccine acceptance included male sex (aOR 2.25; 95% CI 1.29–3.91), age 50 years or greater (aOR 1.74; 95% CI 1.19–6.31), social network support (e.g., vaccine acceptance among an individual’s social network) in receiving COVID-19 vaccines (aOR 2.38; 95% CI 1.45–3.89), community concern about COVID-19 spread (aOR 2.84; 95% CI 1.73–4.66), and trust in HCWs to provide vaccine information (aOR 3.47; 95% CI 1.62–7.42). Future vaccine promotion should prioritize engaging community leaders, sharing transparent information, combatting misinformation and rumors, and implementing household-based interventions especially targeting the importance of vaccination among women and young people to increase uptake. Full article

In the context of promoting sustainable mobility, walking and cycling have been widely recognized for their environmental and health benefits. However, a notable gap often exists between residents’ motivation to engage in these modes and their actual behavior. This study focuses on this motivation–behavior discrepancy and explores how heterogeneous information interventions—within the constraints of the existing built environment—can effectively influence residents’ travel psychology and behavior. Drawing on Protection Motivation Theory, this study aims to uncover the psychological mechanisms behind travel-mode choices and quantify the relative impacts of different types of information interventions. A travel survey was conducted in Yangzhou, China, collecting data from 1052 residents. Cluster analysis was performed using travel psychology data to categorize travel motivations and examine their alignment with actual travel behavior. A random forest model was then employed to assess the effects of individual attributes, travel characteristics, and information intervention attributes on the choice of walking and cycling. The results reveal a significant motivation–behavior gap: while 76% of surveyed residents expressed motivation to walk or cycle, only 30% actually adopted these modes. Based on this, further research shows that informational attributes exhibit a stronger effect in terms of promoting walking and cycling behavior compared to individual attributes and travel characteristics. Among these, health-related information demonstrates the maximum efficacy in areas with well-developed infrastructure. Specifically, health-related information has a greater impact on cycling (21.4%), while environmental information exerts a stronger influence on walking (7.31%). These findings suggest that leveraging information to promote walking and cycling should be more targeted. Full article

Nature-based solutions (NbS) are increasingly recognized as strategic alternatives and complements to grey infrastructure for addressing water-related challenges in the context of climate change, urbanization, and biodiversity decline. This article presents a critical, theory-informed review of the state of NbS implementation in European water management, drawing on a structured synthesis of empirical evidence from regional case studies and policy frameworks. The analysis found that while NbS are effective in reducing surface runoff, mitigating floods, and improving water quality under low- to moderate-intensity events, their performance remains uncertain under extreme climate scenarios. Key gaps identified include the lack of long-term monitoring data, limited assessment of NbS under future climate conditions, and weak integration into mainstream planning and financing systems. Existing evaluation frameworks are critiqued for treating NbS as static interventions, overlooking their ecological dynamics and temporal variability. In response, a dynamic, climate-resilient assessment model is proposed—grounded in systems thinking, backcasting, and participatory scenario planning—to evaluate NbS adaptively. Emerging innovations, such as hybrid green–grey infrastructure, adaptive governance models, and novel financing mechanisms, are highlighted as key enablers for scaling NbS. The article contributes to the scientific literature by bridging theoretical and empirical insights, offering region-specific findings and recommendations based on a comparative analysis across diverse European contexts. These findings provide conceptual and methodological tools to better design, evaluate, and scale NbS for transformative, equitable, and climate-resilient water governance. Full article

Aquaculture is a crucial food-producing sector that can supply more essential nutrients to nourish the growing human population. However, it faces challenges, including limited water quality and space competition. These constraints have led to the intensification of culture systems for more efficient resource use while maintaining or increasing production levels. However, intensification introduces stress risks to cultured organisms by, for instance, overcrowding, waste accumulation, and water quality deterioration, which can negatively affect the growth, health, and immunity of animals and cause diseases. Additionally, environmental changes due to climate and anthropogenic activities further intensify the environmental stress for aquaculture organisms, including crustaceans. Shrimp are one of the most widely cultured and consumed farmed crustacea. Relative to aquatic vertebrates such as fish, the physiology of crustaceans has simpler physiological structures, as they lack a spinal cord. Consequently, their stress response mechanisms follow a single pathway, resulting in less complex responses to stress exposure compared to those of fish. While stress is considered a primary factor influencing the growth, health, and immunity of shrimp, comprehensive research on crustacean stress responses remains limited. Understanding the stress response at the organismal and cellular levels is essential to identify sensitive and effective stress biomarkers which can inform the development of targeted intervention strategies to mitigate stress. This review provides a comprehensive overview of the physiological changes that occur in crustaceans under stress, including hormonal, metabolic, hematological, hydromineral, and phenotypic alterations. By synthesizing current knowledge, this article aims to bridge existing gaps and provide insights into the stress response mechanisms, paving the way for advancements in crustacean health management. Full article

Pharmacist-led transitions of care (TOC) services decrease preventable hospital readmission. TOC service implementation assessment can inform translation to real-world settings. The purpose of this study was to evaluate the implementation of a TOC service for patients with multiple admissions at a regional hospital using the RE-AIM framework. In this quasi-experimental, non-randomized study, individuals with ≥2 recent hospitalizations received pharmacist-led discharge medication reconciliation and counseling, management of drug-related problems, post-discharge telephonic visits, and social support. The reach, effectiveness, implementation, and maintenance RE-AIM dimensions were assessed using patient and service records. Outcomes included 30-day readmission rates for individuals completing ≥1 outpatient pharmacist visit (intervention) versus those unreachable in the outpatient setting (comparison), completed interventions, implementation features, and service adaptations. Chi-square and Fisher’s exact tests were used for comparison of categorical variables and the t-test was used for continuous variables. From February 2022 to August 2023, 72.7% of the 66 service participants participated in the intervention (reach). Additionally, 30-day readmission was 22.9% (intervention) versus 55.6% (comparison; p = 0.01). In total, 2279 interventions were documented (effectiveness). The service was adapted (implementation) and expanded to include additional populations (maintenance) to enhance sustainability. Based on RE-AIM evaluation, the pharmacist-led TOC intervention appears to be a sustainable solution for addressing readmission in multivisit patients. Full article