Search Results (176)

Background and Clinical Significance: Brugada syndrome (BrS) is a rare inherited cardiac channelopathy, often associated with SCN5A loss-of-function mutations. Clinical presentations range from asymptomatic to malignant arrhythmias and sudden cardiac death. Physiological and pharmacological stressors affecting sodium channel function—such as pyrexia, certain medications, and possibly pregnancy—may unmask or exacerbate arrhythmic risk. However, there is limited information regarding pregnancy and obstetric outcomes. Obstetric management remains largely informed by isolated case reports and small case series. A literature review was conducted using OVID Medline and Embase, identifying case reports, case series, and one retrospective cohort study reporting clinical presentation, obstetric management, and outcomes in maternal BrS. A case is presented detailing coordinated multidisciplinary input, antenatal surveillance, and intrapartum and postpartum care to contribute to the growing evidence base guiding obstetric care in this complex setting. Case Presentation: A 30-year-old G2P0 woman with asymptomatic BrS (SCN5A-positive) was referred at 31 + 5 weeks’ gestation for multidisciplinary antenatal care. Regular review and collaborative planning involving cardiology, anaesthetics, maternal–fetal medicine, and obstetrics guided a plan for vaginal delivery with continuous cardiac and fetal monitoring. At 38 + 0 weeks, the woman presented with spontaneous rupture of membranes and underwent induction of labour. A normal vaginal delivery was achieved without arrhythmic events. Epidural block with ropivacaine and local anaesthesia with lignocaine were well tolerated, and 24 h postpartum monitoring revealed no abnormalities. Conclusions: This case adds to the limited but growing literature suggesting that with individualised planning and multidisciplinary care, pregnancies in women with BrS can proceed safely and without complication. Ongoing case reporting is essential to inform future guidelines and optimise maternal and fetal outcomes. Full article

Tuberculosis (TB) remains a leading cause of death in Bangladesh, disproportionately affecting low socio-economic status (SES) populations. This review, guided by the WHO Social Determinants of Health framework and Rockefeller-Lancet Planetary Health Report, examined how social, economic, and ecological factors link SES to TB burden. The first literature search identified 28 articles focused on SES-TB relationships in Bangladesh. A second search through snowballing and conceptual mapping yielded 55 more papers of diverse source types and disciplines. Low-SES groups face elevated TB risk due to smoking, biomass fuel use, malnutrition, limited education, stigma, financial barriers, and hazardous housing or workplaces. These factors delay care-seeking, worsen outcomes, and fuel transmission, especially among women. High-SES groups more often face comorbidities like diabetes, which increase TB risk. Broader contextual drivers include urbanisation, weak labour protections, cultural norms, and poor governance. Recommendations include housing and labour reform, gender parity in education, and integrating private providers into TB programmes. These align with the WHO End TB Strategy, UN SDGs and Planetary Health Quadruple Aims, which expand the traditional Triple Aim for health system design by integrating environmental sustainability alongside improved patient outcomes, population health, and cost efficiency. Future research should explore trust in frontline workers, reasons for consulting informal carers, links between makeshift housing and TB, and integrating ecological determinants into existing frameworks. Full article

Background/Objectives: Agricultural workers in Spain with a migratory background face challenging working and living conditions that significantly affect their health. This study aimed to explore how professionals in healthcare, social services, civil society organisations, and labour institutions perceive that the working conditions affect the physical health of this population. Methods: A qualitative descriptive study was conducted through 92 semi-structured interviews with professionals from six provinces in Spain. Data were analysed using thematic analysis following Braun and Clarke’s six-phase framework. Rigour was ensured through triangulation, independent coding, and interdisciplinary consensus. Results: Two overarching themes were identified: (1) the health consequences of workplace demands and environmental hazards, and (2) navigating health services such as sick leave and disability permits. These findings highlight how the impact of precarious working conditions and limited access to healthcare affect the physical health of migrant agricultural workers. Conclusions: The professionals interviewed described and relate precarious working conditions with adverse health outcomes among migrant agricultural workers. Their insights reveal the need for systemic reforms to enforce labour rights, ensure access to health services, and address the structural factors that contribute to exclusion and vulnerability. Full article

This article examines the relationship between human capital accumulation, household income, and shared prosperity using 2005–2018 household surveys in Cameroon, Ethiopia, Kenya, Nigeria, and Uganda. Human capital is found to be positively and significantly correlated with household wellbeing in all five nations. Health’s indirect benefits in Cameroon, Ethiopia, and Kenya augment its direct benefits. Education has monotonic welfare benefits from primary to tertiary levels in all countries. Human capital and labour market participation are strongly associated with household wellbeing. The equalization of human capital endowments increases income for the 40% of the least well-off groups in three of the sample countries. All countries except Uganda record a decrease in human capital deprivation over the period studied. Redistribution is associated with a reduction in human capital deprivation, although less systematically than in the growth scenario. These results suggest that sizeable reductions in human capital deprivation are more likely to be accomplished by interventions that focus on boosting general human capital outcomes than those that redistribute the human capital formation inputs. In countries with declining human capital deprivation, the within-sector interventions seem to account for this success. Substantial heterogeneity in human capital poverty exists within and across countries and between rural and urban areas. Full article

Micro, Small, and Medium Enterprises (MSMEs) are vital drivers of economic growth in Kenya, yet they face persistent barriers, including limited capacity, financial exclusion, and weak market integration. This study assessed the potential of universities as strategic hubs for MSME capacity building through a collaborative initiative between Egerton University and the KCB Foundation. Using the International Labour Organization’s Start and Improve Your Business (SIYB) methodology, 481 entrepreneurs from Egerton, Njoro, and Gilgil were trained in a business development bootcamp. This study evaluated the training effectiveness, participant demographics, confidence in skill application, networking outcomes, and satisfaction levels. The results showed high participant confidence (over 95% across all regions), strong financial management uptake (85%), and mobile banking adoption (70%). Gilgil led in inclusivity and peer engagement, while Njoro showed stronger gender representation. However, logistical challenges caused 25% absenteeism in rural areas, and only 23% accessed post-training mentorship. These findings underscore the transformative role of HEIs in fostering sustainable entrepreneurship through localized, inclusive, and industry-aligned training. Policy recommendations include hybrid delivery models, tiered curricula for diverse skill levels, and institutionalized mentorship through public–private partnerships. This case demonstrates the value of embedding entrepreneurship support within university mandates to advance national MSME development agendas. Full article

Amid growing concern about labour market resilience in an era of digital and green transitions, this study carries out an investigation on how academic innovation and industrial transformation jointly shape sustainable employment outcomes across EU-27 member states. We frame this inquiry within the emerging concept of the “employment trilemma”, which posits inherent tension between competitiveness, innovation, and social inclusiveness in modern economies. Drawing on a dynamic panel dataset (2005–2023) and employing System SMM estimations, we test the hypothesis that the alignment of academic innovation systems and industrial transformation strategies enhances long-term employment sustainability. Our results reveal a nuanced relationship: academic innovation significantly supports employment in countries with high knowledge absorption capacity, whereas industrial transformation contributes positively only when embedded in cohesive, inclusive economic frameworks. Thus, these findings provide valuable insights for international business due to their emphasis on the importance of cross-sectoral collaboration, policy synchronisation, and investment in human capital for firms navigating increasingly volatile labour markets. Likewise, the study offers actionable insights for business leaders, policymakers, and universities striving to balance innovation with equitable labour market outcomes in an integrated European economy. Full article

Many vocational education and training (VET) students in the Netherlands struggle with the transition from education to the labour market, resulting in high dropout rates. VET institutions are actively seeking effective mechanisms to support their students during this transition. This research explored valuable strategies identified by education professionals to facilitate a sustainable transition from education to the labour market. This study employed a realistic evaluation framework using CIMO-logic (which focuses on the Context, Intervention, Mechanism, Outcome) for analysis in order to gain insight into the processes of change. In total, four cases were studied at two Dutch educational institutions. The research followed an inductive approach using within-case and cross-case analyses. Five key elements were identified: skills and competencies, Self-insight, Self-efficacy, Building a professional network, and bridging education and practice. In school-to-work guidance for VET students, these elements are relevant to consider in guidance programs. Full article

This study explores the regional disparities in the tourism sector in Portugal between 2012 and 2022 with the aim of understanding how the spatial distribution, typology, and scale of tourism enterprises relate to regional wage dynamics. Using a quantitative approach, the analysis draws on secondary data from the Ministry of Labour and the Bank of Portugal, incorporating information on business characteristics and average employee remuneration across NUT II or regions. A combination of descriptive statistics, linear mixed-effects regression models, time series analysis, and ANOVA tests were employed to capture both temporal and territorial variations. The findings reveal a notable concentration of larger tourism enterprises in Lisbon, the North, and the Algarve, coupled with persistent wage disparities that tend to favour these same regions. Although average wages have increased, they remain insufficient in areas with high living costs, raising concerns about tourism’s redistributive potential. The study provides empirical evidence that tourism may exacerbate rather than reduce regional inequalities. By highlighting the territorial dimension of economic outcomes, this research offers valuable insights for policymakers and contributes to a more nuanced theoretical understanding of tourism-led development. Full article

We investigate the impact of significant life events on two critical health outcomes: insomnia and obesity. Using data from the Household, Income, and Labour Dynamics in Australia (HILDA) survey, we focus on significant life events experienced in the preceding 12 months. To model these health outcomes jointly, we employ a bivariate random effects probit panel data model and a longitudinal random effects panel data model whose outcomes can be a combination of discrete/categorical and continuous variables. Estimating these random effects panel data models is challenging because the likelihood is an integral over the latent individual random effects. In addition, the models often have a large number of predictors. In this paper, Bayesian inference is carried out using a particle Metropolis within a Gibbs sampler, which is particularly well suited for statistical models with latent variables. Additionally, within this inference framework, we integrate a Hamiltonian Monte Carlo (HMC) step to sample the high-dimensional vector of regression coefficients efficiently. The HMC step enables faster convergence and improved mixing of the Markov chain. Our article contributes to a better understanding of how stress-related life events shape health outcomes and demonstrates the advantages of combining particle Metropolis within Gibbs and HMC in the estimation of complex panel data models. Full article

Perineal injuries are a common complication of vaginal delivery, affecting 75–85% of women. This review examines current knowledge on risk factors, classification, treatment, and quality of life impacts. Risk factors are divided into maternal, foetal, and labour-related categories. Treatment depends on injury severity. First-degree tears can be managed conservatively, with skin glue or suturing—preferably with synthetic absorbable sutures to reduce pain and infection risk. Second-degree tears and episiotomies respond best to continuous non-locking sutures, improving healing, and minimizing postpartum pain. Severe third- and fourth-degree tears require specialised surgical techniques, such as the overlay method for anal sphincter repair, which improves faecal continence. Proper preoperative care, including antibiotics and anaesthesia, enhances outcomes. Episiotomy is controversial; selective use based on clinical indications is recommended over routine practice. Research shows no significant long-term benefits compared to spontaneous tears, and links episiotomy to psychological distress and negative body image. Preventative strategies, like perineal massage and warm compresses during labour, may reduce the risk of severe trauma, particularly in first-time mothers. Perineal trauma can have lasting physical and psychological effects, impacting sexual function, continence, and mental health. Proper diagnosis, treatment, and postpartum care are essential. Future studies should aim to standardise care protocols and explore long-term outcomes to enhance patient quality of life. Full article

Background: Over recent years, several pain management techniques have been proposed to control labour pain, including pharmacological and non-pharmacological interventions. Transcutaneous electrical nerve stimulation (TENS) is considered a safe, non-invasive, easily applicable, and inexpensive pain relief method. This study aimed to investigate the impact of TENS on consecutive labour stages and on maternal and neonatal outcomes. Methods: This retrospective, single-centre cohort study covered a two-year period (1 January 2022–31 December 2023). A total of 1451 women met the inclusion criteria. TENS was applied in 203 of them. In 54.67% of cases, TENS was combined with water immersion and, in 42.85%, with water immersion and Entonox (N₂O and O₂ mixture). Two groups of patients that either made use of TENS, or not, to reduce labour pain, were compared to assess the effect of TENS on the course of labour and the condition of the newborn. Results: The women in the TENS group experienced a significantly longer first stage of labour. There was no statistically significant difference between the groups in terms of oxytocin usage, perineal tearing, episiotomy, and umbilical cord blood pH. The simultaneous application of TENS and water immersion contributed to prolonging the first stage of labour relative to their independent effects. Conclusions: The application of TENS may prolong the first stage of labour, without increasing the rate of perineal tearing and episiotomy and without any adverse effects on the condition of the newborn. Full article

Educational achievement plays a significant role in the labour market, benefiting individuals and society. Graduating from high school is a key step towards better employment opportunities and a prerequisite for higher education attainment. In 2023, only 22.5% of the Romanian population graduated tertiary education, while 16.6% left education or training early. The Romanian public high school network comprises 1558 units, mostly located in urban areas. The high school enrolment rate is 83.5% in urban areas, and it drops to less than 60% in rural areas, with the country registering the highest out-of-school rate in the EU for the 15-year-old population. Spatial accessibility may influence enrolment in high schools, particularly for students living in rural or remote areas, who often face financial challenges fuelled by long distances and limited transportation options. Hence, travel distance may represent a potential barrier to completing the educational process or may determine inequalities in educational opportunities and outcomes. This paper aims to assess the spatial accessibility of the public high school network in Romania by using distance data provided by the Open Street Map API (Application Programming Interface). We examine variations in spatial accessibility based on the distribution of high school units and road network characteristics considering three variables: travel distance to the nearest high school, the average distance to three different categories of high schools, and the number of high schools located within a 20 km buffer zone. The results highlight a significant urban–rural divide in the availability of public high school facilities, with 84.1% (n = 1311) located in urban areas while 49.1% of the high school-aged population lives in rural areas. Many rural communities lack adequate educational facilities, often having limited options for high school education. The findings also show that 32% of the high school-aged population has to travel more than 10 km to the nearest high school, and 7% has no high school options within a 20 km buffer zone. This study provides insights into the educational landscape in Romania, pointing out areas with limited access to high schools, which contributes to further inequalities in educational attainment. The findings may serve as a basis for developing policies and practices to bridge the urban–rural divide in educational opportunities and foster a more equitable and inclusive education system. Full article

Construction is a long-hours industry in which people often work a six-day week. This research examined the extent to which shifting to a five-day week schedule impacts labour productivity in construction projects. Five construction projects in Australia implemented a five-day weekly schedule. Interviews were conducted with 89 workers across five projects to explore workers’ subjective productivity and reasons for any perceived changes in productivity associated with the modified schedule. Thematic analysis of interview data revealed that, while some workers perceived the five-day week to be less productive, the majority of participants perceived their productivity to be enhanced, due to a variety of health- and work-related factors. In particular, people experiencing a two-day break from work each week indicated they were better rested and more energetic and engaged in their work. Participants also suggested work was better planned in order to manage the five- compared to the six-day week, and quality improvements also reduced re-work. The research concludes that perceived negative impacts on production associated with not working on Saturdays are offset by an increase in productivity arising from improved health and positive work outcomes associated with the five-day schedule. Full article

Background: Presentations of preterm labour at <25 weeks of gestational age (GA) require timely evidence-based counselling and management to optimise outcomes and facilitate informed decisions. In non-tertiary centres, this counselling is often especially challenging. Objectives: (1) To develop a tool to support counselling for preterm births at <25 weeks of GA, and (2) to refine and facilitate the utilisation of this tool and develop targeted supports through an understanding of challenges to providing counselling in non-tertiary centres. Methods: Perinatal risk factors and local outcome data were incorporated into a counselling tool. Semi-structured virtual interviews were conducted with participants with experience in counselling or receiving care at <25 weeks of GA in non-tertiary centres. Interviewees included transport team members, paediatricians, obstetricians, one family physician, and one parent. Analysis using interpretive description methodology was performed to identify themes in participant practice and experience. Results: A risk-based counselling tool was developed, including guidance for counselling discussions. Twenty-one interviews were completed. Practice challenges that were identified included a lack of updated knowledge on practices in tertiary centres, discomfort in providing counselling, variability in counselling content, and a variation in health care provider teams involved in counselling. All providers expressed a desire for further education in this area. Conclusions: Support for providers in non-tertiary centres in the counselling of periviable preterm families is much needed. The development of our practice tool targeted for non-tertiary centres provides an important step in this process. The next steps include responding to the expressed need from providers for education and training in the counselling and management of periviable preterm pregnancies. Full article

Background: The optimal application of medical nutrition therapy (MNT) in treating gestational diabetes remains uncertain. MNT involves individualised nutrition assessment and counselling, which is labour-intensive and is not the sole type of intervention offered by clinical dietitians. Objective: To determine whether pregnancy outcomes differed for individuals with gestational diabetes who were offered MNT on a risk-prioritised (RP) versus universal basis. Methods: Observational data from two cohorts of individuals who were offered MNT only if they met the high-risk criteria following general group-based dietary education (RP1, n = 369; RP2, n = 446) were compared with a baseline cohort who were universally offered at least one MNT consultation (UM, n = 649). The RP1 cohort were seen during community-wide COVID-19 restrictions in 2021, while RP2 were seen after restrictions had lifted in 2022. Furthermore, the RP approach primarily utilised telemedicine, while the UM approach was delivered in person. Results: MNT consultations halved under the RP approach (59 vs. 119 sessions per 100 diagnoses for RP2 vs. UM) and saved more than 20 h of dietitian time per 100 diagnoses (95 vs. 73 h for RP2 vs. UM). No significant increases were observed (p < 0.05) for any pregnancy outcomes in the RP cohorts compared with the UM cohort, including usage of diabetes medications, maternal weight gain below and above target, early deliveries, induced deliveries, emergency caesarean sections, large- and small-for-gestational-age (SGA) infants, infant macrosomia, neonatal hypoglycaemia and neonatal intensive care admissions. The use of both basal insulin (27% vs. 33%, OR 0.62, 95% CI 0.46 to 0.84) and metformin (6% vs. 10%, OR 0.52, 95% CI 0.31 to 0.88) was lower in the RP1 cohort during pandemic restrictions compared with the UM cohort; however, these differences were not retained in the RP2 cohort. Additionally, there were fewer SGA infants under the RP approach, particularly for the RP2 cohort (6% vs. 11% for RP2 vs. UM, OR 0.55, 95% CI 0.34 to 0.89). Conclusions: Risk-prioritised MNT was a more efficient dietetic service approach to gestational diabetes than the universal MNT model, with comparable pregnancy outcomes. Similar approaches may represent a strategic way to address sustainable health service planning amidst the rising global prevalence of this condition. However, further research is needed to investigate consumer perspectives, wider service impacts and post-partum maternal and child health outcomes. Full article