Search Results (1,390)

After delivering my Keynote address to the young scientists at the International Gap Junction meeting, “International Colloquium on Gap Junctions and Cancer: Discussing how cellular communication modifies carcinogenesis and cancer treatment outcomes” (San Paulo, Brazil, 10–14 July 2023), I was asked to condense the talk into a manuscript covering the 50+ years of my scientific journey of basic biomedical research. While this journey had to omit so many important experiences, people and external events, I have tried to illustrate how my initial motivation, personal perspective of my abilities, and naïve goal as a young scientist did not prepare me for the non-linear path to where I ended. That path had many twists, turns, barriers, disappointments, surprises and wrong directions, as well as associations with co-workers, students and collaborators who afforded me with great wisdom, support and technical advice. In the history of science, few individuals have left their footprints in a straight path; however, my early education in human evolutionary genetics provided me a strong background framework, on which multiple other acquired disciplines, forced by circumstances along my uneven journey, allowed me to grow intellectually, as well as making me aware of my limitations. As my late mentor, Dr. Van Rensselaer Potter said: “… humility with responsibility”. At the completion of my experimental journey, I continued to reflect on the implied meanings of my and others’ results to view the current state of collected knowledge on global health issues as one of all scientists’ obligations, namely, to weigh the value and bioethical implications of our work to global society. “ Full article

Despite growing global momentum to reduce the number of children who never received a dose of any vaccine, i.e., zero-dose (ZD) children, persistent geographic and social inequities continue to undermine progress toward universal immunization coverage. In Madagascar, where routine vaccination coverage remains below 50% in most regions, the non-governmental organization Doctors for Madagascar and public sector partners are implementing the SOAMEVA program: a targeted community-based initiative to identify and reach ZD children in sixteen underserved districts in the country’s south. This paper outlines the equity-sensitive evaluation design developed to assess the implementation and impact of SOAMEVA. It presents a forward-looking evaluation framework that integrates both quantitative program monitoring and qualitative community insights. By focusing at the fokontany level—the smallest administrative unit in Madagascar—the evaluation captures small-scale variation in ZD prevalence and program reach, allowing for a detailed analysis of disparities often masked in aggregated data. Importantly, the evaluation includes structured feedback loops with community health workers and caregivers, surfacing local knowledge on barriers to immunization access and program adoption. It also tracks real-time adaptations to implementation strategy across diverse contexts, offering insight into how routine immunization programs can be made more responsive, sustainable, and equitable. We propose eight design principles for conducting equity-sensitive evaluation of immunization programs in similar fragile settings. Full article

The European Union Council’s zero vision aims to eliminate workplace fatalities, while Industry 4.0 presents new challenges for occupational safety. Despite HR professionals assessing managers’ and employees’ competencies, no system currently exists to evaluate the competencies of workers’ representatives in occupational safety and health (OSH). It is crucial to establish the necessary competencies for these representatives to avoid their selection based on personal bias, ambition, or coercion. The main objective of the study is to identify the competencies and their components required for workers’ representatives in the field of occupational safety and health by following the steps of the DACUM method with the assistance of OSH professionals. First, tasks were identified through semi-structured interviews conducted with eight occupational safety experts. In the second step, a focus group consisting of 34 OSH professionals (2 invited guests and 32 volunteers) determined the competencies and their components necessary to perform those tasks. Finally, the results were validated through an online questionnaire sent to the 32 volunteer participants of the focus group, from which 11 responses (34%) were received. The research categorized the competencies into the following three groups: core competencies (occupational safety and professional knowledge) and distinguishing competencies (personal attributes). Within occupational safety knowledge, 10 components were defined; for professional expertise, 7 components; and for personal attributes, 16 components. Based on the results, it was confirmed that all participants of the tripartite system have an important role in the training and development of workers’ representatives in the field of occupational safety and health. The results indicate that although OSH representation is not yet a priority in Hungary, there is a willingness to collaborate with competent, well-prepared representatives. The study emphasizes the importance of clearly defining and assessing the required competencies. Full article

There is little qualitative research on the support needed by workers with type 1 diabetes to effectively self-manage at work and maintain work ability. In this UK study, 21 workers with type 1 diabetes participated in semi-structured interviews. The interviews were transcribed and analysed using interpretive phenomenological analysis and then characterised under the Psychosocial Flags Framework. Findings highlighted several obstacles to maintaining self-management, including systemic workplace issues (black flags), individual attitudes and beliefs (yellow flags), and workplace issues (blue flags). Participants generally lacked confidence in voicing their needs, emphasising a requirement for a more supportive, inclusive workplace culture. This indicates a need for employers to foster an environment where workers with T1D feel comfortable seeking support without penalty. Addressing unhelpful perceptions of T1D seems key to this, making increased knowledge and awareness crucial for the harmonious integration of T1D with work. But delivering effective interventions may be challenging, since they must account for the complex biopsychosocial interplay of obstacles to work ability that this qualitative investigation emphasises. Full article

Coyaima is a town in the department of Tolima, Colombia, that was prioritized in a pilot program under Colombia’s National Plan for the Control of the Taeniasis/Cysticercosis Complex, focusing on this neglected health issue. The project engaged local indigenous communities, promoting education and outreach within the One Health framework. The study included 444 randomly selected volunteers, who filled a Knowledge, Attitudes, and Practices (KAP) survey on the taeniasis/cysticercosis complex. The baseline study found no Taenia spp. eggs via microscopy on 383 stool samples examined, and no T. solium DNA was detected on human stool and soil samples by Copro-qPCR. However, seroprevalence was 8.5% for human cysticercosis and 14% for porcine cysticercosis, as detected by in-house ELISA testing for T. solium. Moreover, 57.9% of participants who provided a stool sample were positive for at least one parasite. Following the sampling and characterization activities, local health workers implemented mass treatment with Niclosamide, based on evidence of ongoing transmission, high porcine seroprevalence, poor basic sanitation, and the presence of free-roaming pigs reported in the KAP survey. These findings provide scientific evidence to apply national public health policies for controlling taeniasis/cysticercosis complex in Coyaima. Full article

Background: Since the election of Hamas in 2006, Gaza has endured eight major military conflicts, culminating in the ongoing 2023–2025 war, now surpassing 520 days. This protracted violence, compounded by a 17-year blockade, has resulted in the near-total collapse of Gaza’s health system. Over 49,000 deaths, widespread displacement, and the destruction of more than 60% of health infrastructure have overwhelmed both local capacity and international humanitarian response. Objectives: This narrative review aims to examine and synthesize the current literature (October 2023–April 2025) on the health crisis in Gaza, with a specific focus on identifying key themes and knowledge gaps relevant to rebuilding a sustainable health system. The review also seeks to outline strategic pathways for recovery in the context of ongoing conflict and systemic deprivation. Methods: Given the urgency and limitations of empirical data from conflict zones, a narrative review approach was adopted. Fifty-two sources—including peer-reviewed articles, editorials, reports, and correspondence—were selected through targeted searches using Medline and Google Scholar. The analysis was framed within a public health and political economy perspective, also taking health system building blocks into consideration. Results: The reviewed literature emphasizes emergency needs: trauma care, infectious disease control, and supply chain restoration. Innovations such as mobile clinics and telemedicine offer interim solutions. Gaps include limited attention to mental health (including that of health workers), local governance, and sustainable planning frameworks. Conclusions: Sustainable reconstruction requires a durable ceasefire; international stewardship aligned with local ownership; and a phased, equity-driven strategy emphasizing primary care, mental health, trauma management, and community engagement. Full article

Introduction: Despite the key role of healthcare workers (HCWs) in tuberculosis (TB) prevention and control, there is a lack of regional data on their knowledge, attitudes, and practices (KAPs) regarding the disease in Atlantic Canada. Objectives: To assess the KAPs of HCWs and identify targets for educational interventions to enhance TB care and control. Methods: A cross-sectional study was conducted among HCWs in Atlantic Canada aged $\ge$19 years from October 2023 to February 2024. Participants were recruited via multiple channels such as social media, collegiate email lists, and snowball sampling. Survey data were collected using an online platform and analyzed using IBM SPSS Statistics v29. KAPs were assessed using Likert-type scales and internal consistency was evaluated using Cronbach’s alpha. Results: A total of 157 HCWs participated in this study (age range: 19 to 69 years); most were women (n = 145, 92%), born in Canada (n = 134, 85.4%), with nearly three-quarters (n = 115, 73.2%) who had never lived outside of Canada. Study participants demonstrated moderately high knowledge (M = 29.32, SD = 3.25) and positive attitudes (M = 3.87, SD = 0.37) towards TB and strong practices (M = 4.24, SD = 0.69) in TB care; however, gaps were identified in HCW abilities to recognize less common TB symptoms (e.g., rash and nausea), as well as inconsistent practices in ventilation and pre-treatment initiation. Internal consistency analysis indicated suboptimal reliability across all three KAP domains, with Cronbach’s alpha values falling below 0.7, thwarting further planned analyses. Conclusions: This study found overall moderate-to-strong TB-related KAPs among HCWs in Atlantic Canada; however, critical gaps in knowledge and practice were noted. This new information can now guide future educational initiatives and targeted training to enhance TB preparedness and ensure equitable care for patients in the region. Full article

There has been a widely held view for some time that school teachers and principals need to possess a level of knowledge and understanding of the legal regulation of schools and that of their workers. This study explores the level of understanding of legal matters pertaining to the school environment that independent school teachers hold in Queensland. This level of ‘legal literacy’ is investigated in a qualitative research study that explains the various areas of education law that are known and those that are less understood by such educators. Data was analysed using content analysis methodology, using a coding scale that was created specifically for the purposes of coding the participants’ scenario responses. Overall, it was discovered that the level of legal literacy held by Queensland independent school teachers was alarmingly low. This varied across the myriad topics, but essentially, the educators surveyed did not demonstrate an adequate legal understanding to successfully complete their roles. More education in this area should be made available for educators to better equip them with such an understanding to ensure they know when and how to more capably protect themselves and the children entrusted to their care. Full article

High-rise construction presents heightened safety risks due to vertical complexity, spatial constraints, and workforce variability. Conventional safety management often proves insufficient, especially in rapidly urbanizing or resource-limited settings. This study proposes a hybrid methodological framework to systematically identify and prioritize the critical factors influencing occupational safety in Vietnamese high-rise construction projects. Based on 181 valid survey responses from construction professionals, 23 observed variables were developed through extensive literature review and expert consultation. Exploratory Factor Analysis (EFA) was employed to empirically group 23 validated indicators into five key latent dimensions: (1) Safety Training and Inspection, (2) Employer’s Knowledge and Responsibility, (3) Worker’s Competence and Compliance, (4) Working Conditions and Environment, and (5) Safety Equipment and Signage. These dimensions were then structured into an Analytic Hierarchy Process (AHP) model, with pairwise comparisons conducted by industry experts to calculate consistency ratios and derive factor weights across three high-rise project case studies. The findings provide actionable insights for construction managers, safety professionals, and policymakers in developing and underdeveloped countries, supporting data-driven decision-making for safer and more sustainable urban development. Full article

The gastrointestinal tract mediates the absorption of nutrients from the diet, which is increasingly contaminated with toxic metal(loid) species (TMs) and thus threatens food safety. Evidence in support of the influx of TMs into the bloodstream of the general and vulnerable populations (babies, children, pregnant women, and industrial workers) has been obtained by accurately quantifying their blood concentrations. The interpretation of these TM blood concentrations, however, is problematic, as we cannot distinguish between those that are tolerable from those that may cause the onset of environmental diseases. Since TMs that have invaded the bloodstream may perturb biochemical processes therein that will eventually cause organ damage it is crucial to better understand their bioinorganic chemistry as these processes collectively determine their organ availability. Thus, bioinorganic processes of TMs in the bloodstream represent selectivity filters which protect organs from their influx and ultimately determine the corresponding exposure-response relationships. The need to better understand selectivity filters prompted us to mechanistically disentangle them into the major bioinorganic chemistry processes. It is argued that the detoxification of TMs in the bloodstream and the biomolecular mechanisms, which mediate their uptake into target organs, represent critical knowledge gaps to revise regulatory frameworks to reduce the disease burden. Full article

In the last two decades, the prevalence of South Asian migrant workers has significantly increased in the UAE’s construction sector, and they are under huge debt. Although researchers heavily stress the role of employers in migrant workers’ debt, the role of debt before departure has not been investigated. Thus, this study bridges this gap in the literature in the context of South Asian construction migrant workers. The objective of this study is to investigate how informal recruitment fees and debt arrangements contribute to bonded labor and dependency among migrant workers. A qualitative approach was used to conduct in-depth interviews with 30 South Asian migrants employed in the construction sector. This article highlights how pre-migration debt—which is often accrued through informal loans and exploitative recruitment fees—has been underexplored in migration studies. Drawing on interviews with 30 South Asian laborers, this study identifies five interconnected themes: pre-migration debt bondage, exploitative lending practices, lack of legal recourse, emotional manipulation, and a cycle of dependency. While UAE labor policies have improved, the real vulnerabilities lie in the informal recruitment systems and weak oversight in migrant workers’ countries of origin. Consequently, five themes were generated from the analysis: pre-migration debt bondage, exploitative lending practices, no legal recourse, emotional manipulation, and cycles of dependency. This study contributes to our existing knowledge by revealing the experiences of migrant construction workers from South Asia in the UAE. While the UAE has established one of the region’s most progressive legal frameworks to protect migrant workers and set clear labor standards, many exploitative practices occur outside its jurisdiction, particularly in the workers’ countries of origin. This study underscores that the root of the problem lies in weak enforcement and informal recruitment networks in sending countries, not in UAE policy itself. Addressing these challenges requires coordinated international action to ensure that migrant protection begins well before arrival. Full article

Task-oriented medical dialogue systems face two fundamental challenges: the explosion of state-action space caused by numerous diseases and symptoms and the sparsity of informative signals during interactive diagnosis. These issues significantly hinder the accuracy and efficiency of automated clinical reasoning. To address these problems, we propose MA-HRL, a multi-agent hierarchical reinforcement learning framework that decomposes the diagnostic task into specialized agents. A high-level controller coordinates symptom inquiry via multiple worker agents, each targeting a specific disease group, while a two-tier disease classifier refines diagnostic decisions through hierarchical probability reasoning. To combat sparse rewards, we design an information entropy-based reward function that encourages agents to acquire maximally informative symptoms. Additionally, medical knowledge graphs are integrated to guide decision-making and improve dialogue coherence. Experiments on the SymCat-derived SD dataset demonstrate that MA-HRL achieves substantial improvements over state-of-the-art baselines, including +7.2% diagnosis accuracy, +0.91% symptom hit rate, and +15.94% symptom recognition rate. Ablation studies further verify the effectiveness of each module. This work highlights the potential of hierarchical, knowledge-aware multi-agent systems for interpretable and scalable medical diagnosis. Full article

Background: This study examined risk factors for syndrome novel coronavirus 2 virus (SARS-CoV-2) infection and self-reported adherence to infection prevention and control (IPC) measures among healthcare workers (HCWs) at a hospital in Thailand near the Myanmar border. Methods: From March to July 2022, HCWs aged ≥ 18 with COVID-19 exposure at Mae Sot General Hospital completed a questionnaire on IPC adherence, training, and COVID-19 knowledge. Nasopharyngeal samples were collected bi-weekly for SARS-CoV-2 testing. A mobile application was used for real-time monitoring of daily symptoms and exposure risks. Chi-square, Fisher’s exact tests, and log-binomial regression were performed to investigate association. Results: Out of 289 (96.3%) participants, 27 (9.9%) tested positive for SARS-CoV-2, with cough reported by 85.2% of cases. Nurse assistants (NAs) had a higher risk of infection (adjusted relative risk [aRR] 3.87; 95% CI: 0.96–15.6). Working in inpatient departments (aRR 2.37; 95% CI: 1.09–5.15) and COVID-19 wards (aRR 5.97; 95% CI: 1.32–26.9) was also associated with increased risk. While 81.7% reported consistent hand hygiene, 37% indicated inadequate IPC knowledge. Conclusions: HCWs, especially NAs and those in high-risk departments, should receive enhanced IPC training. Real-time digital monitoring tools can enhance data collection and HCW safety and are likely to be useful tools for supporting surveillance and data collection efforts. Full article

Federated learning (FL) enables collaborative model building among a large number of participants without sharing sensitive data to the central server. Because of its distributed nature, FL has limited control over local data and the corresponding training process. Therefore, it is susceptible to data poisoning attacks where malicious workers use malicious training data to train the model. Furthermore, attackers on the worker side can easily manipulate local data by swapping the labels of training instances, adding noise to training instances, and adding out-of-distribution training instances in the local data to initiate data poisoning attacks. And local workers under such attacks carry incorrect information to the server, poison the global model, and cause misclassifications. So, the prevention and detection of such data poisoning attacks is crucial to build a robust federated training framework. To address this, we propose a prevention strategy in federated learning, namely confident federated learning, to protect workers from such data poisoning attacks. Our proposed prevention strategy at first validates the label quality of local training samples by characterizing and identifying label errors in the local training data, and then excludes the detected mislabeled samples from the local training. To this aim, we experiment with our proposed approach on both the image and audio domains, and our experimental results validated the robustness of our proposed confident federated learning in preventing the data poisoning attacks. Our proposed method can successfully detect the mislabeled training samples with above 85% accuracy and exclude those detected samples from the training set to prevent data poisoning attacks on the local workers. However, our prevention strategy can successfully prevent the attack locally in the presence of a certain percentage of poisonous samples. Beyond that percentage, the prevention strategy may not be effective in preventing attacks. In such cases, detection of the attacked workers is needed. So, in addition to the prevention strategy, we propose a novel detection strategy in the federated learning framework to detect the malicious workers under attack. We propose to create a class-wise cluster representation for every participating worker by utilizing the neuron activation maps of local models and analyze the resulting clusters to filter out the workers under attack before model aggregation. We experimentally demonstrated the efficacy of our proposed detection strategy in detecting workers affected by data poisoning attacks, along with the attack types, e.g., label-flipping or dirty labeling. In addition, our experimental results suggest that the global model could not converge even after a large number of training rounds in the presence of malicious workers, whereas after detecting the malicious workers with our proposed detection method and discarding them from model aggregation, we ensured that the global model achieved convergence within very few training rounds. Furthermore, our proposed approach stays robust under different data distributions and model sizes and does not require prior knowledge about the number of attackers in the system. Full article

The preparedness of healthcare workers for disaster situations depends on their technical skills, disaster knowledge, and psychosocial strength, including teamwork and emotional regulation. This study aims to assess disaster preparedness among healthcare professionals in primary healthcare centers (PHCs) in Alqurayat, Saudi Arabia, with a specific focus on evaluating technical competencies, psychosocial readiness, and predictive modeling of preparedness levels. A mixed-methods approach was employed, incorporating structured questionnaires, semi-structured interviews, and observational data from disaster drills to evaluate the preparedness levels of 400 healthcare workers, including doctors, nurses, and administrative staff. The results showed that while knowledge (mean: 3.9) and skills (mean: 4.0) were generally moderate to high, notable gaps in overall preparedness remained. Importantly, 69.5% of participants reported enhanced readiness following simulation drills. Machine learning models, including Random Forest and Artificial Neural Networks, were used to predict preparedness outcomes based on psychosocial variables such as emotional intelligence, teamwork, and stress management. Sentiment analysis and topic modeling of qualitative responses revealed key themes including communication barriers, psychological safety, and the need for ongoing training. The findings highlight the importance of integrating both technical competencies and psychosocial resilience into disaster management programs. This study contributes an innovative framework for evaluating preparedness and offers practical insights for policymakers, disaster planners, and health training institutions aiming to strengthen the sustainability and responsiveness of primary healthcare systems. Full article