Search Results (797)

Vehicular emissions are a major contributor to air pollution and respiratory morbidity in Ecuador’s urban centers. Despite increasing evidence of traffic-related health impacts, national research remains fragmented and unevenly distributed. This narrative review synthesizes 26 peer-reviewed studies published between 2000 and 2024 to characterize vehicular air pollution sources, pollutants, and respiratory health effects in Ecuador. The evidence shows a strong geographic concentration, with more than half of the studies conducted in Quito, followed by Guayaquil and Cuenca. National inventories indicate that the transport sector accounts for approximately 41.7% of Ecuador’s CO₂ emissions. Across cities, PM_2.5, PM₁₀, NO₂, CO, and SO₂ were the most frequently assessed pollutants and were repeatedly reported to approach or exceed international guideline values, particularly during traffic peaks and under low-dispersion conditions. Health-related studies documented substantial impacts, including up to 19,966 respiratory hospitalizations in Quito, with short-term PM_2.5 exposure associated with increased hospitalization risk in children. Among schoolchildren attending high-traffic schools, carboxyhemoglobin levels above 2.5% were linked to a threefold increase in the risk of acute respiratory infections. Occupationally exposed adults, such as drivers, traffic police officers, and outdoor workers with regular exposure to traffic-related air pollution, also showed a higher prevalence of chronic respiratory symptoms. Environmental evidence further highlighted the accumulation of traffic-related heavy metals (Zn, Cu, Pb, Cr) and pronounced spatial inequalities affecting low-income neighborhoods. Overall, the review identifies aging vehicle fleets and diesel-based transport as dominant contributors to observed pollution and health patterns, while underscoring methodological limitations such as the scarcity of longitudinal studies and uneven monitoring coverage. These findings provide integrated and policy-relevant evidence to support sustainable urban planning, cleaner transport strategies, and targeted respiratory health policies in Ecuador. Full article

This article examines how Ecuadorian digital media have portrayed the phenomenon of vacunas—an extortion practice targeting small businesses—between January and July 2025. Through qualitative content analysis and semiotic analysis, this study reviews news items, reports, interviews, editorials and chronicles published in eight major national outlets (Expreso, El Universo, El Comercio, El Mercurio, La Hora, GK, Primicias and Extra). Findings reveal that the media frame vacunas not only as a criminal act but also as a structural threat that deepens unemployment, territorial disputes, economic decline, business closures and migration. Symbolic representations of fear, power and vulnerability permeate both textual and visual narratives, reinforcing imaginaries of crisis and uncertainty. The article concludes that media coverage does more than inform; it constructs interpretative frameworks that shape how citizens, institutions and policymakers perceive insecurity, linking everyday extortion with broader debates on governance, economic fragility and social cohesion in Ecuador. Full article

Background: Nutrition during the perinatal period, including pregnancy, childbirth, postpartum, and lactation, is a critical determinant of maternal and neonatal health. While the importance of balanced nutrition is well established, the integration of nutritional counseling into midwifery care remains inconsistent across settings. Evidence suggests that midwives are uniquely positioned to deliver nutrition-related support, yet gaps persist in their formal training and in the availability of structured guidance. These gaps are particularly evident in certain regions, such as Greece, where dedicated national guidelines for perinatal nutrition are lacking. Methods: This systematized narrative review synthesises evidence from studies published between 2010 and 2025, retrieved through PubMed, CINAHL, Scopus, and relevant national guidelines. Although the synthesis draws on diverse study designs to provide contextual depth, randomized controlled trials (RCTs) were prioritized and synthesized separately to evaluate the effectiveness of midwife-led interventions. In total, ten randomized controlled trials were included in the evidence synthesis, alongside additional observational and qualitative studies that informed the narrative analysis. Both international and Greek literature were examined to capture current practices, challenges, and knowledge gaps in the nutritional dimension of midwifery care. Results: Findings indicate that adequate intake of macronutrients and micronutrients, including iron, folic acid, vitamin D, iodine, calcium, and omega-3 fatty acids, is essential for optimal maternal and neonatal outcomes. Despite this, studies consistently report insufficient nutritional knowledge among midwives, limited confidence in providing counseling, and variability in clinical practice. Socio-cultural factors, such as dietary traditions and migration-related challenges, further influence nutritional behaviors and access to guidance. Emerging approaches, including e-health tools, group counseling models, and continuity-of-care frameworks, show promise in enhancing midwives’ capacity to integrate nutrition into perinatal care. Conclusion: Nutrition is a cornerstone of perinatal health, and midwives are strategically placed to address it. However, gaps in training, inconsistent guidelines, and cultural barriers limit the effectiveness of current practices. Strengthening midwifery education in nutrition, developing context-specific tools, and fostering interdisciplinary collaboration are essential steps toward more comprehensive and culturally sensitive perinatal care. Future research should focus on longitudinal and intervention studies that assess the impact of midwife-led nutritional counseling on maternal and neonatal outcomes. Full article

The Atlantic slave trade was one of the most significant and violent processes in global history, and the Iberian empires played a central role in its development. Yet in Spain and Portugal, the historical and public memory of slavery remains fragmented, producing silences that contrast with its historical magnitude. This study examines these silences through two complementary lenses: the academic preparation of future history teachers and the heritage narratives presented in Iberian museums, adopting a mixed-methods design. A total of 138 pre-service teachers from eight Spanish and Portuguese universities completed a questionnaire providing quantitative data to assess how the Atlantic slave trade was addressed in their university training and which didactic and heritage resources they consider most appropriate for teaching it. In parallel, exhibitions and institutional discourses were analysed in seven national and regional museums related to America, colonisation or maritime expansion, drawing on qualitative data from written interviews with museum professionals. The findings reveal limited curricular attention to the Atlantic slave trade, uneven valuation of heritage resources, and highly variable museum narratives. These results highlight the need for coordinated educational and heritage strategies that strengthen historical understanding, support democratic and intercultural competencies, and contribute to a more inclusive and critically informed public memory. Full article

Diagnostic errors have been a critical concern in healthcare, leading to substantial financial burdens and serious threats to patient safety. The Improving Diagnosis in Health Care report by the National Academies of Sciences, Engineering, and Medicine (NASEM) defines diagnostic errors, focusing on accuracy, timeliness, and communication, which are influenced by clinical knowledge and the broader healthcare system. This review aims to integrate existing literature on diagnostic error from a systems-based perspective and examine the factors across various domains to present a comprehensive picture of the topic. A narrative literature review was structured upon the Systems Engineering Initiative for Patient Safety (SEIPS) model that focuses on six domains central to the diagnostic process: Diagnostic Team Members, Tasks, Technologies and Tools, Organization, Physical Environment, and External Environment. Studies on contributing factors for diagnostic error in these domains were identified and integrated. The findings reveal that the effectiveness of diagnostics is influenced by complex, interconnected factors spanning all six SEIPS domains. In particular, socio-behavioral factors, such as team communication, cognitive bias, and workload, and environmental pressures, stand out as significant but difficult-to-capture contributors in traditional and commonly used data resources like electronic health records (EHRs), which limits the scope of many studies on diagnostic errors. Factors associated with diagnostic errors are often interconnected across healthcare system stakeholders and organizations. Future research should address both technical and behavioral elements within the diagnostic ecosystem to reduce errors and enhance patient outcomes. Full article

This article explores urban ‘societal resilience’ during the global pandemic of 2020–2021. This health crisis involved a complex interweaving of social, cultural, political, and economic processes which involved both top-down measures undertaken by nation-state governments and bottom-up actions by local residents. In a research study undertaken in two European cities—Stuttgart and London—we focussed on two migrant minorities and the involvement by ‘experts’ and ‘non-experts’ in the meso-level where these top-down measures and bottom-up actions met. Our study provided a grounded understanding of ‘layered resilience’ where resiliency develops through the disjunctive order of communication patterns, public service delivery, institutionalized dialogue, narratives, and values. Through distinguishing between resiliency and resilience, we seek to illustrate the ‘elastic’ character of urban modes of integration. Our study suggests the need for more empirically grounded investigations into the continuity and difference between adaptation and adjustment, normality and normalcy, and resilience and resiliency. It also highlights the importance of context-specific and path-dependent notions of resilience and resiliency. Full article

Interest in plant-based diets has grown expressively in different regions of the world. However, the missing regulation for meat analogs may mislead consumers by suggesting that these products are the same as the meat they are replacing. Therefore, this study aims to analyze the current global scenario of meat analogs, discuss consumption changes and their regulation, as well as pointing out future perspectives for the sector. A narrative literature review was performed using scientific papers from the Virtual Health Library (BVS), LILACS, PubMed (NIH), Embase, Web of Science, Scopus, and official documents. Included studies were aligned with the research theme, concentrating on countries with regulations for plant-based analog products and those lacking or pursuing such regulations. Additionally, studies were selected based on the following criteria: original or review studies from different countries, papers discussing meat analogs in terms of consumption, sensory attributes, market dynamics, sustainability, regulation, food safety; availability of full text; and publication dates ranging from 2015 to 2025. The data reveals that most of the assessed nations still lack specific regulations for meat analog products, adopting general labeling and naming standards that range from flexible approaches to strict restrictions. To conclude, the article highlights that meat substitutes are emerging as promising and sustainable options; however, their true consolidation is conditioned on the existence of more defined regulatory frameworks, increased consumer confidence, and market conditions that favor their large-scale adoption. Full article

Lymph node evaluation is a central determinant of oncologic quality in the surgical management of non-small-cell lung cancer (NSCLC). Accurate assessment of hilar and mediastinal lymph nodes underpins pathologic staging, informs postoperative treatment decisions, and remains essential for prognostic stratification and assessment of resection completeness. Although international guidelines provide clear recommendations, real-world data consistently demonstrate substantial variability in lymph node staging practices, with inadequate evaluation frequently observed across institutions and surgical settings. Insufficient nodal assessment, manifested as the omission of mediastinal staging, limited station sampling, or low lymph node yield, is associated with reduced nodal upstaging, inappropriate omission of adjuvant therapy, higher recurrence rates, and inferior long-term survival. Contemporary guidance from major societies, including the National Comprehensive Cancer Network, European Society of Thoracic Surgeons, International Association for the Study of Lung Cancer, and the Commission on Cancer, has increasingly converged on a station-based definition of adequacy, emphasizing systematic evaluation of both N1 and N2 nodal stations rather than reliance on absolute node counts alone. In parallel, preoperative mediastinal staging algorithms have evolved toward routine use of endobronchial and esophageal ultrasound as first-line invasive modalities, reserving surgical mediastinoscopy for selected high-risk or inconclusive cases. Evidence from randomized trials, population-level databases, and meta-analyses indicates that thorough nodal assessment improves staging accuracy and survival, while recent data support the selective use of lobe-specific or tailored lymphadenectomy in carefully staged, low-risk early disease. Finally, emerging quality improvement interventions, including standardized specimen handling, operative checklists, and multidisciplinary feedback mechanisms, have demonstrated measurable improvements in guideline adherence and patient outcomes. This narrative review integrates contemporary evidence and guideline recommendations to outline a practical framework for implementing reliable, high-quality lymph node staging in modern lung cancer surgery. Full article

Background: Narrative Medicine (NM) has emerged as a strategy to support reflective clinical practice and emotional resilience among nurses. This study examined relationships between NM practices and well-being among registered nurses (RNs) and nurse practitioners (NPs). Methods: A national sample of RNs and NPs was recruited using snowball sampling. Participants completed a NM practice survey and the Mayo Clinic Well-Being Index (WBI) survey. Data were analyzed using descriptive statistics and Pearson correlation coefficients. Results: A total of 3167 responses were analyzed (1934 RNs and 1233 NPs). Among RNs, strong statistically significant correlations were found between NM practices and well-being scores (p < 0.001). Among NPs, moderate correlations appeared in select NM practice dimensions (p < 0.05). Conclusions: Engagement in narrative Medicine practices is associated with improved well-being among nurses and nurse practitioners. NM may present a promising strategy to reduce burnout and strengthen professional resilience. Full article

Following World Health Organization (WHO) validation of lymphatic filariasis (LF) elimination as a public health problem, countries are required to implement post-validation surveillance (PVS) to detect potential resurgence and ensure sustained elimination. WHO’s guidelines released in 2025 recommend implementation of at least two of four PVS strategies—targeted surveys, integration into standardised surveys, health facility-based screening, and molecular xenomonitoring (MX) of mosquitoes. This review synthesised global evidence on PVS activities from 2007 to 2025 in the 23 countries and territories validated as having eliminated LF. Studies were identified through PubMed, Scopus, Embase, Web of Science, and the WHO Institutional Repository for Information Sharing (IRIS). Data on publication information, surveillance strategies, priority populations, and operational challenges and enablers were extracted. Narrative synthesis using deductive content analysis was applied. Thirty documents from 17 countries were included. Targeted surveillance and integration of PVS with other health programmes were the most common approaches noted (reported in ten and nine countries, respectively), followed by MX (seven countries) and health facility-based screening (four countries). Surveillance often focused on migrants and previous hotspots, with operational challenges linked to limited funding, workforce, and supply chains. Documents indicated that Sri Lanka, Thailand, China, and South Korea developed sustained PVS through national policies and domestic funding. Findings highlight the need for clear, contextualised guidance to operationalise sustainable PVS in different settings. Full article

Bacteriophage (phage) therapy, including monophage preparations, phage cocktails, engineered phages, and phage-derived enzymes, has re-emerged as a potential option for difficult-to-treat and biofilm-associated infections in the context of rising antimicrobial resistance. Recent scientific and regulatory developments, such as the 2024 World Health Organization Bacterial Priority Pathogens List and the introduction of the European Pharmacopoeia general chapter 5.31 on phage therapy medicinal products, highlight the growing interest in establishing quality, safety, and governance standards for clinical implementation. This narrative review provides an overview of current clinical applications of phage therapy, drawing on published case reports, case series, early-phase clinical studies, and regulatory experiences across different healthcare settings. Clinical use has been reported in respiratory, urinary tract, musculoskeletal, cardiovascular, and device-associated infections, particularly in cases involving multidrug-resistant pathogens, often in combination with antibiotics. At the same time, the biological characteristics of phages, such as strain specificity, adaptive composition of phage cocktails, and the need for individualized formulations, pose significant regulatory and translational challenges. Access to phage therapy currently relies on heterogeneous regulatory mechanisms, including compassionate use programmes, magistral preparations, named-patient pathways, and other national frameworks. Overall, phage therapy represents a promising strategy for selected infections, but its broader clinical adoption will depend on harmonized regulatory approaches, robust quality standards, and the generation of stronger clinical evidence to support safe and scalable use. Full article

Existing office buildings in Australia contribute to 24% of the nation’s electricity consumption and 10% of greenhouse gas emissions, with energy use projected to rise by 84%. Meeting the 2050 sustainability target and United Nations (UN) 17 Sustainable Development Goals (SDGs) requires improving sustainability within existing office buildings. This systematic review examines net zero energy and climate resilience strategies in these buildings by analysing 74 studies from scholarly literature, government reports, and industry publications. The literature search was conducted across Scopus, Google Scholar, and Web of Science databases, with the final search in early 2025. Studies were selected based on keywords and research parameters. A narrative synthesis identified key technologies, evaluating the integration of net zero principles with climate resilience to enhance energy efficiency through HVAC modifications. Technologies like heat pumps, energy recovery ventilators, thermal energy storage, and phase change materials (PCMs) have been identified as crucial in reducing HVAC energy usage intensity (EUI). Lighting control and plug load management advancements are examined for reducing electricity demand. This review highlights the gap between academic research and practical applications, emphasising the need for comprehensive field studies to provide long-term performance data. Current regulatory frameworks influencing the net zero transition are discussed, with recommendations for policy actions and future research. This study links net zero performance with climate adaptation objectives for existing office buildings and provides recommendations for future research, retrofit planning, and policy development. Full article

This study examines how Association of Southeast Asian Nations (ASEAN) is framed in Chinese, Japanese, and South Korean English-language mainstream media during four high-salience geopolitical events (2023–2025). Methodologically, it employs a qualitative comparative framing and discourse analysis of 28 systematically selected news articles from leading outlets in each media system, coded using Entman’s four framing functions (problem definition, causal attribution, moral evaluation, and treatment recommendation) and supplemented by representational logics and explicitly stated platform-governance indicators. Drawing on framing theory, representation, platform governance, and critical geopolitics, the analysis finds that ASEAN is portrayed not as an autonomous actor but as a flexible signifier within nationally inflected narratives. Chinese media emphasize regional cooperation and developmental connectivity, Japanese outlets foreground liberal-normative order and security alignment, and South Korean coverage prioritizes technocratic and pragmatic partnership. The study argues that ASEAN’s mediated visibility is shaped by recurring editorial framing patterns and, where explicitly invoked, by infrastructural and platform-related cues, revealing ongoing narrative contestation over regional power and legitimacy in East Asia. Full article

The Japanese scholar and art critic Okakura Tenshin traveled to colonial India from January to September 1902 and made three visits to the Buddhist holy site of Bodh Gaya. There, he attempted to purchase a piece of land from the landowner, the Mahant, to build a vihāra (resthouse) for Japanese Buddhist devotees. His purchase request was rejected by the British colonial authority for his foreigner status, despite no legal prohibition against land sales to foreigners under Bodh Gaya’s land management laws at the time. The year after his journey to India, Okakura Tenshin published The Ideals of the East, wherein the renowned declaration that “Asia is one” subsequently evolved to be the intellectual cornerstone of twentieth-century Asianism (or Pan-Asianism). How did Okakura’s Indian journey and his experience of the failed attempt to purchase land in Bodh Gaya catalyze his conception of “Asia is One”? This essay first traces the Buddhist revival movements in late nineteenth-century India and Japan, elucidating how Buddhism helped forge a sense of transnational solidarity between the two nations, which Okakura also embraced. It then examines Okakura’s trip to India and his plan to purchase land at Bodh Gaya, uncovering the underlying geopolitical struggle between the British Empire and the New Asian Power Japan. In this context, the analysis will show that Okakura’s frustrating experience of failed land purchase underscored for him the necessity for the solidarity between Japan and India and the need for a unitary idea of Asia to articulate that solidarity. Finally, a comparative textual analysis between The Ideals of the East (1903) and Okakura’s “History of Japanese Art” lectures given at the Tokyo Fine Arts School before his trip to India explicates how Buddhism, which was being revived by a collective of various groups in and outside its place of origin India, served as a cohesive discursive agent in Okakura’s construction of the narrative of an Asian unity. This Buddhist framework helped Okakura to reconstruct the interlinked cultural histories of India, China, and Japan into a unified notion of Asia within which he crystallized a unique and favored cultural identity for Japan. Full article

Background: Cardiometabolic risk (CMR), including obesity, dyslipidemia, hypertension, and impaired glucose regulation, disproportionately affects Hispanic/Latinx adults in the United States (U.S.). Although plant-forward dietary patterns are established as cardioprotective, less is known about how dietary patterns within Hispanic/Latinx subgroups relate to CMR. Methods: A narrative review was conducted of observational studies among U.S. Hispanic/Latinx adults (≥18 years) examining defined dietary patterns (a priori, a posteriori, or hybrid) in relation to CMR outcomes (e.g., BMI, waist circumference, blood pressure, glucose, lipids). Risk of bias was assessed using an adapted version of the Newcastle–Ottawa Scale. Results: Ten studies met the inclusion criteria, including Seventh-day Adventist Latinx, Puerto Rican adults, Mexican American adults, Hispanic women, and a national Hispanic cohort. Plant-forward dietary patterns were associated with lower BMI and waist circumference, lower triglycerides and fasting glucose, and higher HDL-C. In contrast, energy-dense patterns characterized by refined grains, added sugars, processed meats, fried foods, solid fats, and sugar-sweetened beverages were associated with greater adiposity, poorer lipid profiles, and higher blood pressure. Traditional rice-and-beans–based patterns observed in Puerto Rican and Mexican American groups were associated with central adiposity and higher metabolic syndrome prevalence, despite modestly higher intakes of fruits, vegetables, and fiber. Study quality ranged from good (n = 4) to very good (n = 6). Conclusions: Across Hispanic/Latinx subgroups, plant-forward dietary patterns were associated with favorable cardiometabolic profiles, whereas refined and animal-based patterns aligned with higher CMR. Given the predominance of cross-sectional evidence, these findings should be interpreted as associative rather than causal. Culturally grounded dietary counseling, along with additional longitudinal and intervention studies, is needed to support cardiometabolic health in these populations. Full article