Search Results (219)

Background: The COVID-19 pandemic triggered unprecedented mobility disruptions worldwide as governments imposed strict lockdowns to contain the spread of the virus. In India, prolonged restrictions severely affected economic activity, particularly for migrant workers, leading to a large-scale and unplanned exodus from urban employment centres to native places. This sudden population movement undermined containment efforts and contributed to the spatial diffusion of infections. Understanding evacuees’ behavioural responses during such crises is therefore critical for effective emergency logistics and evacuation planning. Methods: This study examines the determinants of transport mode and shelter choice decisions made by migrants during the COVID-19-induced evacuation in India. Using primary survey data, a multinomial logistic regression model is developed to analyze how socio-economic characteristics influence evacuees’ choices of travel mode and shelter type. Results: The results reveal significant heterogeneity in decision-making, highlighting the role of economic vulnerability and accessibility constraints in shaping evacuation behaviour. Conclusions: The findings offer actionable insights for policymakers and emergency planners to design inclusive evacuation strategies, improve crisis-responsive transportation planning, and enhance shelter provisioning in future pandemics or large-scale disruptions. The study contributes to the logistics and humanitarian operations literature by providing empirical evidence on evacuation behaviour under public health emergencies. Full article

Background/Objectives: The American Heart Association Life’s Essential 8 (LE8) is a tool proposed to categorize overall cardiovascular health (CVH), ranging from 0 to 100 and classifies CVH as low (<50), moderate (50–79) or high (≥80), based on the following health behaviors (diet, physical activity, nicotine exposure and sleep) and health factors (body mass index—BMI, lipid levels, glycemic profile and blood pressure). Although used in the general population, it is not part of the health assessment routine in the workplace. We assessed CVH of healthcare workers using an LE8-based score through a mobile application. Methods: Cross-sectional pilot study with adults working at a tertiary hospital in Brazil. We used an app for self-reporting LE8 metrics. Additionally, data on age, sex, and mental health (10-item Perceived Stress Scale, PSS-10) were collected. Results: Sixty-five adults (58.5% female; mean age 36 ± 9.01 years) were included. The mean LE8 overall score was 69.39 ± 12.63. The proportion of participants in the low, moderate and high cardiovascular health categories were 6.2%, 69.2% and 24.6%, respectively. Diet quality (34.76 ± 24.3) and physical activity (45.38 ± 40.58) were in the “low cardiovascular health” category. “Health behaviors” had a significantly lower mean score than “health factors” (58.90 ± 20.53 vs. 79.88 ± 15.55, p < 0.001). The mean PSS-10 score was 19.01 ± 7.49, indicating moderate perceived stress. Overall LE8 and PSS-10 scores were not significantly correlated (r_s = −0,0.17; p = 0.161). There was no significant difference in the mean overall LE8 score in the linear regression model adjusting for age, sex and perceived stress. Conclusions: Among employees of a Brazilian tertiary hospital, the adapted LE8 score indicated overall moderate CVH. Health behaviors—particularly diet quality and physical activity—were the main vulnerable areas. Implementation of an LE8-based assessment in the workplace may be useful for targeted prevention strategies in Brazil. Future larger and longitudinal studies are warranted to confirm these findings. Full article

Background: Migraine in older adults represents an increasingly relevant yet underrecognized clinical challenge in aging societies, where multimorbidity, frailty, and polypharmacy complicate both diagnosis and management. Although traditionally considered a disorder of younger individuals, migraine frequently persists or presents after the age of 60 with atypical features, contributing to diagnostic uncertainty. Methods: This narrative review, conducted in accordance with the SANRA principles, aims to provide a comprehensive overview of the epidemiology, clinical presentation, pathophysiology, and management of migraine in older adults, with particular emphasis on age-related complexities, therapeutic challenges, and unmet clinical needs. Results: Migraine in this population often presents with atypical or misleading features, such as aura without headache, vestibular symptoms, or overlap with cerebrovascular conditions, leading to delayed or incorrect diagnoses. The burden of disease is substantial, affecting physical function, mobility, cognition, emotional well-being, and social participation, and is further amplified by comorbid conditions including cardiovascular and metabolic disorders, mood disturbances, and chronic pain syndromes. Aging-related neurobiological changes, such as impaired pain modulation, endothelial dysfunction, and neuroinflammation, may influence disease expression and treatment response. Therapeutic management is challenged by contraindications, increased susceptibility to adverse drug effects, and the complexity of polypharmacy, highlighting the importance of individualized and non-pharmacological approaches. Conclusions: Migraine in older adults is a significant but often overlooked contributor to disability and reduced quality of life. Improved recognition of its unique clinical features and age-specific vulnerabilities is essential to optimize patient-centered care. Future research should prioritize the inclusion of older populations and the development of tailored, safe, and effective management strategies. Full article

Casablanca, Morocco’s most populous and economically dynamic metropolis, is undergoing rapid and unregulated expansion, leading to accelerated agricultural land artificialization, landscape fragmentation, and growing socio-environmental vulnerability in peri-urban territories. This study investigates the spatio-temporal dynamics of urban expansion within a 40 km buffer around the city, using multi-temporal Landsat imagery (2015–2025), a GIS-based framework, and supervised classification. Four land-cover classes were extracted (urban, vegetation, forest and water) enabling a diachronic comparison of land transformation processes. Two spatial indicators were mobilized to quantify urban dynamics: the Average Urban Expansion Rate (AUER) and the Urban Expansion Intensity Index (UEII). Results reveal that urban areas expanded by up to 387.9% in some communes, with 15 exceeding an AUER of 25% and 17 falling within the “very high development” category based on UEII thresholds. Land artificialization was most intense along southern and southeastern peripheries, notably Deroua, Tit Mellil, Had Soualem, and Sidi Moussa Ben Ali, resulting in severe fragmentation of agricultural land. The classification of communes into four profiles (fast, slow, consolidated, and stable) highlights varying degrees of territorial vulnerability. By integrating demographic trends (2014–2024), the study exposes mismatches between population growth and land consumption, underscoring the urgent need for integrated spatial diagnostics and governance reforms toward sustainable peri-urban land management. Full article

Background: Breast cancer-related lymphedema (BCRL) is one of the most debilitating long-term morbidities after axillary lymph node dissection (ALND), severely impairing quality of life through reduced mobility, independence, and chronic burden, especially in older women. Axillary reverse mapping (ARM) aims to preserve upper extremity lymphatics while maintaining oncologic safety. Evidence in older adult populations with long-term follow-up remains limited. Methods: This retrospective cohort study included 138 female patients (median age 72.5 years) undergoing ALND for invasive breast cancer between January 2018 and January 2024. Patients were divided into ARM (n = 72) and non-ARM (n = 66) groups. BCRL was graded 0–3 according to adapted International Society of Lymphology (ISL) criteria (2013 consensus document). Assessments were performed preoperatively and at 3, 6, 12, 24, 36, 48, and 60 months using blinded circumference measurements and bioimpedance spectroscopy. Results: Baseline characteristics were comparable. Mean follow-up was 46.5 ± 8.8 months. Clinically relevant BCRL (Grades 2–3) was dramatically lower in the ARM group (18.1% vs. 60.6%, p < 0.0001), while subclinical changes (Grade 1) were similar (31.9% vs. 27.3%, p = 0.55). Kaplan–Meier analysis showed significantly better clinically relevant lymphedema-free survival with ARM (log-rank p = 0.00019), with curve separation after 30–40 months—indicating a sustained long-term benefit for quality of life in this frail population. Recurrence rates were comparable (8.3% vs. 10.6%, p = 0.776). Multivariable Cox regression confirmed ARM as an independent protective factor (adjusted HR 0.22, 95% CI 0.11–0.44, p < 0.0001). Conclusions: In older women with breast cancer, ARM significantly reduces clinically relevant lymphedema—a major determinant of long-term quality of life—without compromising oncologic safety. These findings support the routine consideration of ARM during ALND to preserve upper-extremity function, mobility, and independence in this vulnerable population, thereby balancing aggressive oncologic treatment with enhanced long-term quality of life and reduced treatment-related morbidity. Full article

Mental health inequities affecting migrant populations stem from structural determinants that hierarchize access to resources, recognition, and social protection. Among these determinants, structural racism plays a central role in the experiences of racialised Brazilian immigrant women in Portugal, producing vulnerabilities at the intersection of race, gender, nationality, and migration status. Grounded in intersectional feminist and decolonial epistemology, this study analyses how structural racism operates as a health determinant through specific mechanisms traversing material conditions of life, distress trajectories, and experiences of psychological care, and it examines how these women navigate the limitations of mental health services, identifying conditions for a practice committed to racial equity. Fifteen semi-structured interviews were conducted with racialised Brazilian immigrant women and analyzed through Reflexive Thematic Analysis. The findings indicate that racism is manifested through professional devaluation, labour precarity, documentation instability, and linguistic racialisation, impacting access to rights and the production of psychological distress. Mental health inequities are not limited to barriers to access, as institutional and clinical dynamics tend to individualize distress and disregard its historical and social bases, operating as epistemic violence. The community-based strategies mobilized by participants challenge models centred on individual intervention. This study underscores the need for structurally competent approaches and for institutional reforms oriented toward equity and racial justice within mental health systems. Full article

Mobile health units (MHUs) can reach populations facing barriers to traditional primary care, but information about factors associated with their utilization is limited. The objective of this ecological study was to evaluate whether MHU encounter density is increased in census tracts designated as Primary Care Health Professional Shortage Areas (HPSAs) and explore whether associations varied by socioeconomic vulnerability. We analyzed Wayne State University/Wayne Health MHU encounters with adult patients from July 2021 to September 2025. Negative binomial regression models with a log link and log(population) offset tested the a priori hypothesis that encounter density was increased in designated versus undesignated HPSA census tracts. Sensitivity analyses assessed variation by social vulnerability index score quartiles established by the US Centers for Disease Control and Prevention. One quarter of the five-county metropolitan Detroit, Michigan, catchment area census tracts were designated healthcare shortage areas. Overall, 13,852 encounters with 10,924 unique patients occurred across 924 of 1305 census tracts. Encounter rate per adult population was significantly increased by severalfold comparing designated versus undesignated shortage areas, with stronger associations at lower socioeconomic vulnerability index score quartiles (interaction p = 0.0006). These findings support continued efforts to scale and evaluate MHUs to address projected healthcare shortages, particularly in socioeconomically vulnerable areas. Full article

Flooding is one of the most persistent and destructive natural hazards in West Virginia. However, community-scale assessments that connect social vulnerability with physical flood vulnerability are still limited. Existing floodplain management plans often focus on infrastructure and hydrology, overlooking how socioeconomic disparities shape resilience. This study assesses flood resilience in West Virginia communities by connecting socioeconomic vulnerability with physical flood vulnerability. Using data from the American Community Survey (ACS) and state floodplain maps, we developed a Socioeconomic Vulnerability Index (SEVI) and combined it with physical indicators, such as the percentage of residential buildings in the 100-year floodplain, the share of mobile homes in flood-prone areas, the presence of essential facilities and community assets within flood zones, and the proportion of roads submerged by at least one foot of water. Incorporated and unincorporated communities were analyzed separately to reflect differences in governance and service capacity. The results reveal that high flood vulnerability areas often coincide with high socioeconomic vulnerability, especially in the southern and southeastern counties, where long-term economic decline has increased risks. Communities like McDowell and Mingo face a combined challenge of social and physical vulnerability, adding pressure to populations already dealing with limited resources. These findings emphasize the importance of integrated resilience planning that combines physical protection with social support. Considering the increasing intensity of extreme precipitation events associated with climate change, these findings also highlight the importance of incorporating long-term climate considerations into flood resilience planning. Policy suggestions include expanding targeted flood insurance subsidies for low-income households, prioritizing the relocation or retrofitting of mobile homes and essential facilities, investing in green and open spaces, and encouraging community-based mitigation strategies. Together, these actions can lower long-term flood risks while addressing structural inequalities that make certain populations more vulnerable. Full article

Background: Nursing homes are congregate settings for elderly individuals where infectious diseases can easily spread. The elderly are at high risk of contracting and dying from influenza, and the most effective way to prevent this is to receive the influenza vaccine. Methods: This study conducted a cross-sectional survey of elderly people in nursing homes to investigate the occurrence of influenza symptoms during the 2024–2025 flu season, as well as vaccination status and reasons for receiving or not receiving the vaccine. Bivariate logistic regression was used to determine the factors influencing the vaccination rate. Results: Of the 1024 elderly people who participated in the survey, 25.39% reported experiencing flu-related symptoms in the previous flu season. While 16.21% of the elderly expressed willingness to receive vaccination, only 5.57% actually received it. Influenza vaccination was positively correlated with educational attainment (aOR 3.800, 95% CI 1.480–9.758 for middle school; aOR 5.138, 95% CI 1.738–15.191 for high school), monthly household income (aOR 0.216, 95% CI 0.072–0.644 for >8000), ability for self-care (aOR 0.269, 95% CI 0.123–0.591), and the scale of the nursing home (aOR 9.033, 95% CI 1.531–53.305 for 151–299; aOR 2.629, 95% CI 1.359–5.084 for ≥300). Willingness to receive the influenza vaccination was positively correlated with an unhealthy health status (aOR 0.398, 95% CI 0.204–0.779), symptoms of influenza (aOR 2.730, 95% CI 1.861–4.007), nursing home location (aOR 1.537, 95% CI 1.099–2.941 for outer suburbs), and the scale of the nursing home (aOR 1.991, 95% CI 1.154–3.435 for 151–299; aOR 2.158, 95% CI 1.374–3.390 for ≥300). Most elderly people who received the vaccine believed that vaccination could effectively prevent flu and that it could reduce the risk of complications, the rest were not vaccinated due to concerns about adverse reactions, mobility issues, or the distance to vaccination sites. Conclusions: Low awareness of flu vaccines and physical inability to travel to vaccination sites may be potential barriers to receiving the flu vaccine. It is worrying that the influenza vaccination rate is low among the elderly in nursing homes in Shanghai. As a result, it is crucial to prioritize targeted monitoring and intervention strategies for vulnerable populations living in collective institutions. Full article

Background: The impact of screen time is having serious adverse effects on people’s lives. Unfortunately, early childhood is the most vulnerable stage in the lifespan, and most children are using television, computers, parents’ and mothers’ mobile phones, or tablets, for longer than recommended. For this reason, the interest of the education community in proposing programs for reducing screen time has grown, which could be of interest for families and professionals in early childhood development and care for children adhering to a healthy lifestyle. For this reason, the objective of this study is to compile programs including families that have tried to reduce preschool-aged children’s time in front of screens. Method: The search strategy is designed based on the PICOS framework. A review was conducted in three databases (PubMed, Web of Science, and ProQuest Central) on 11 October 2024, following the PRISMA guidelines. The systematic review is registered in PROSPERO. Results: A total of 287 articles were initially found, and 15 met all inclusion criteria. Conclusions: The results reveal that programs based on training parents in addition to performing games with children have positive effects for reducing screen time in children up to six years old, even in a specific population. Full article

Background: Motor decline associated with ageing compromises mobility, postural control and the ability, thereby increasing risk among older adults. Biomechanical characterization of movement, particularly using non-linear methods, offers a process-oriented approach capable of detecting subtle changes in motor coordination. The MIND&GAIT programme has previously demonstrated benefits in physical function in frail older individuals; however, its potential to improve motor coordination parameters that underpin fall risk remains insufficiently explored. Objectives: To analyse the impact of the MIND&GAIT program on motor coordination during sit-to-stand (STS) and walking tasks, two daily activities strongly associated with fall risk, using advanced non-linear and biomechanical metrics in institutionalized older adults. Methods: Fourteen institutionalized older adults (82.21 ± 7.14 years) participated. Three-dimensional acceleration and angular velocity were recorded using inertial sensors. Motor variability and predictability were quantified using the multivariate Lyapunov exponent (LyEM) and multivariate incremental entropy (MIE). STS (30 s) and walking-in-place (2 min) tasks were assessed pre- and post-intervention following a three-month, thrice-weekly programme. Results: Although no statistically significant differences emerged (ps > 0.05), trends were observed suggesting increases in LyEM during STS and in both MIE and LyEM during walking were found post-intervention. These exploratory findings may indicate enhanced motor complexity, stability and adaptability, features associated with reduced fall vulnerability. Conclusions: Despite the absence of statistical significance, the biomechanical trends observed suggest improvements in motor coordination patterns relevant to fall risk reduction in institutionalized older adults following the MIND&GAIT programme. These findings highlight the potential of structured exercise-based interventions for promoting safer movement behaviors in frail populations. Full article

Against the backdrop of rapid development in megacities, urban park green spaces serve as essential public resources whose accessibility and equity directly affect residents’ quality of life and broader social justice. This study addresses the imbalance between the spatial distribution of green space resources and the socio-demographic characteristics of different population groups in megacities. It takes the six central districts of Beijing as the study area and integrates data from 457 urban parks. The research applies the Gaussian two-step floating catchment area (G2SFCA) method and bivariate spatial autocorrelation analysis (Moran’s I) to systematically evaluate the equity of urban park green space provision across multiple social dimensions, including economic status, educational attainment, and vulnerable groups. The results indicate that urban park green spaces in Beijing’s six central districts exhibit a pronounced central and northern advantage, with significant deficits in southern and peripheral areas. High accessibility and greater per capita green space are concentrated in core and high-housing-price districts, overlapping with high-income and highly educated populations. In contrast, vulnerable groups and migrant workers are more likely to reside in green-space-deficient areas, facing a structural “high population density–low green space provision” disadvantage, reflecting clear social inequities. In addition, inequity is more pronounced at the walking scale than at the cycling scale. The study reveals a dual mismatch in green space provision across both spatial and social dimensions within a megacity context. The findings suggest that future urban planning should shift from quantitative expansion to the optimization of existing green space resources. Planning strategies should prioritize vulnerable groups and adopt a people-oriented approach. Policymakers should allocate greater support to southern and peripheral areas, increase the provision of pocket parks, and improve slow-mobility systems. These measures can more precisely safeguard equitable access to green space for disadvantaged populations and promote the realization of spatial justice. Full article

The convergence of climate change, migration, and health represents a critical global challenge, with the Middle East and North Africa (MENA) region illustrating acute vulnerabilities while offering insight relevant beyond the region. Increasing exposure to extreme heat, droughts, and floods drives displacement, constrained mobility, and adaptive migration, placing additional pressure on already stretched health systems. This paper proposes an integrated Nexus Action Framework for Climate Change, Migration, and Health (NAF-CMH) to address these interlinked dynamics and move beyond fragmented, sector-specific responses. The framework conceptualizes human mobility both as a potential resilience strategy and as a determinant of health, encompassing climate-affected migrants, displaced populations, and those experiencing involuntary immobility across diverse pathways and settings. It promotes systematic integration of health considerations into climate adaptation and migration governance and situates these interventions within the broader agenda of climate-resilient health systems. Drawing on a non-systematic narrative review of peer-reviewed and grey literature, complemented by the authors’ expertise, the paper identifies seven interrelated pillars for coordinated policy and operational action. While grounded in MENA-specific vulnerabilities, the framework is flexible and adaptable to other regions facing climate-driven mobility challenges. By providing an operational architecture for multisector collaboration, the NAF-CMH supports policymakers, public health authorities, and migration actors in strengthening resilience, reducing vulnerability and safeguarding health amid accelerating climate impacts and evolving mobility patterns. Full article

Geographical exclaves face distinctive development challenges as spatial separation creates cross-border dependencies and institutional vulnerabilities. Musandam Governorate, Oman’s exclave separated from the mainland by United Arab Emirates (UAE) territory, exemplifies how exclave status shapes development trajectories, cross-border interactions, and population resilience. This study examines Musandam’s socio-economic dynamics, development patterns, and cross-border relationships, addressing gaps in understanding how exclave residents navigate spatial discontinuity while maintaining mainland and cross-border connections. Mixed methods combined quantitative assessment using the adapted Vera Carstairs Index (VCI) across seven domains (education, skills, employment, housing, living environment, household facilities, health) with qualitative fieldwork spanning four campaigns (2019–2023). Semi-structured interviews with 47 residents across all four wilayaat (provinces), complemented by citizen science approaches engaging twelve community participants, documented mobility patterns and cross-border transactions. Secondary data from the 2010 Population Census and national statistics provided contextual depth. Findings reveal two of four Musandam wilayaat (Daba and Khasab) ranking in the lower half nationally, with low health scores (ranks 1 and 9) and education institution deficits reflecting structural integration into transnational economic and services systems. COVID-19 border closures amplified pre-existing dependencies, converting eight-month isolation into a humanitarian crisis with food shortages, medicine unavailability, and social fragmentation. Residents maintain stronger functional connections with UAE cities than with mainland Oman despite preserving national identity. Policy implications emphasize six strategic priorities: higher education institutions, transportation infrastructure, marine fisheries development, tourism enhancement, small-medium enterprise facilitation, and residential land provision. Full article

In August 2023, a large forest fire burned more than 60% of the Dadia–Lefkimi–Soufli Forest National Park in northeastern Greece, following another large fire in 2022. To quantify the effects of these fires on local herpetofauna, we analyzed community composition, abundance, and diversity before and after the 2023 event. Standardized visual encounter surveys were conducted across 29 sites between 2015 and 2024, spanning burned and unburned areas. Species richness, abundance, and diversity metrics, together with Bray–Curtis community dissimilarities, were compared across sampling periods and fire-severity classes. Amphibian assemblages showed high postfire persistence, with 82% of regional species still detected and no significant changes in diversity indices, likely reflecting the buffering role of perennial streams and other hydrologically stable refugia. In contrast, reptile communities showed clear compositional shifts and experienced severe declines: overall reptile species richness decreased to 30% of prefire levels and diversity indices dropped significantly. Tortoises (i.e., Testudo graeca, T. hermanni) declined by nearly 90% relative to prefire estimates, indicating high vulnerability of low-mobility, long-lived species. Snakes were not detected in any burned sites, whereas only a few small-bodied lizards and the freshwater turtle Mauremys rivulata persisted locally. These findings demonstrate that extreme, landscape-scale fires can restructure reptile communities in Mediterranean forests, particularly where long-term habitat change and drought had already reduced population resilience. The study underscores the need for targeted postfire restoration, conservation planning for slow-dispersing taxa, and long-term biodiversity monitoring under increasingly frequent fire regimes. Full article