Search Results (644)

Individuals with developmental disabilities often experience physical and mental chronic conditions from early childhood, which can negatively affect their education, employment, and social participation without appropriate interventions. These impairments frequently limit the acquisition of essential daily living skills, including personal hygiene skills. This study examined a multicomponent intervention package—comprising video prompting, step-by-step instruction based on task analysis, systematic error correction, and reinforcement—to support the acquisition of handwashing skills for two adolescents with developmental disabilities (Autism Spectrum Disorder and Intellectual Disability) and toothbrushing skills for one adolescent. A nonconcurrent multiple-baseline design across participants and skills was employed, including baseline, intervention, maintenance, and generalization phases. The intervention was conducted over eight weeks. The results indicated low and stable baseline performance for both participants, followed by a systematic increase in performance after the introduction of the intervention, reaching accuracy levels between 80% and 91%. Participants demonstrated meaningful improvements in hygiene skill performance following intervention. These gains were maintained over time and generalized to new settings, although a few task steps continued to require prompting. Furthermore, teachers and parents rated the intervention as highly feasible, practical, and useful for supporting hygiene skills, while students reported enjoyment, perceived improvement, and willingness to participate again. Overall, the findings suggest that structured, evidence-based instructional approaches may support increased functional participation in essential daily living skills, particularly when complete independence may not be attainable for all individuals. Full article

Musculoskeletal disorders (MSDs) remain one of the most persistent occupational health challenges in the U.S. construction industry, where physically demanding tasks such as heavy lifting, kneeling, and working in awkward postures contribute to elevated injury rates. This study aims to identify significant job-related determinants of MSDs in construction-sector occupations. By integrating publicly available datasets from the Survey of Occupational Injuries and Illnesses (SOII) and the Occupational Information Network (O*NET) datasets, a stepwise multiple regression analysis was conducted on 344 occupation-condition observations representing 86 construction occupations, yielding a final model that explained 49% of the variance. Ten significant predictors of MSD events were identified and classified as either risk amplifiers or mitigators. Amplifiers included factors such as exposure to noise, disease, hazardous conditions, and time pressure, all of which heightened MSD risk, while mitigators—such as reduced cramped-space exposure and regulated work environments—were associated with lower risk. MSDs resulting from sprains, strains, or tears accounted for 62.8% of all cases, frequently leading to days away from work (36.3%) or job restrictions (26.5%). The findings underscore that ergonomic risk in construction extends beyond physical strain to include scheduling, equipment design, and work organization. These results provide actionable insights for employers and safety professionals to redesign tools, optimize task rotation, and implement realistic work pacing strategies, ultimately reducing MSD incidence and improving productivity in this high-risk sector. Full article

Background: The (COVID-19) pandemic profoundly disrupted daily routines and physical activity (PA), especially among university students, due to restrictions and limited access to sports facilities. As this group is particularly vulnerable to sedentary lifestyles and mental health issues, understanding their PA patterns is crucial. This study explores overall and domain-specific PA levels and the influence of sociodemographic factors, offering insights for promoting sustainable PA strategies in higher education during and beyond health crises. Methods: A cross-sectional online survey was conducted among University of Foggia students during the pandemic. The participants completed the validated Italian IPAQ-Long to assess PA across various domains. Associations with demographics and perceived barriers were analyzed via t tests, ANOVA, and nonparametric tests. Results: A total of 301 students completed the survey. Despite barriers such as limited living space, low income, and sports facility closures, 66% of the participants reported high PA levels, mainly through work-related and leisure activities. This remains insufficient. PA varied significantly by gender, income, residence, and employment status: males reported higher leisure PA, whereas females engaged more in active transport and domestic activities. Rural residents and those with moderate incomes demonstrated higher overall PA, whereas employed students presented lower activity levels. These findings underscore the complex socioeconomic and environmental factors shaping PA behavior during an unprecedented global health crisis. Conclusions: The findings reveal that students’ resilience in maintaining PA is a coping mechanism despite socioeconomic and environmental barriers. Tailored, accessible PA initiatives integrated into university curricula can enhance student well-being, academic performance, and long-term health during and after public health emergencies. Universities should adopt accessible, equity-oriented PA initiatives to promote physical and mental health and enhance public-health preparedness during future emergencies. Full article

Background/Objectives: Return to work (RTW) after an industrial accident is crucial for an individual’s well-being and socioeconomic recovery. This study investigated factors influencing RTW among workers who sustained physical or brain lesion-related disabilities following industrial accidents. Methods: Using five-year panel data (2018–2022) from the Panel Study of Workers’ Compensation Insurance of South Korea, we analyzed 340 individuals with physical or brain lesion-related disabilities sustained from industrial accidents. We used logistic regression models to identify factors associated with RTW and return to employed (RTE) status. Results: The RTW and non-RTW groups comprised 160 and 180 participants, respectively. Factors associated with non-RTW included female sex (adjusted odds ratio [aOR], 0.33; 95% confidence interval [CI], 0.13–0.86; p = 0.023), injury caused by disease (aOR, 0.18; 95% CI, 0.05–0.66; p = 0.010), long recovery periods (aOR, 0.27; 95% CI, 0.10–0.72; p = 0.009), low self-confidence (aOR, 0.16; 95% CI, 0.07–0.35; p < 0.001), and older age (aOR, 0.08; 95% CI, 0.02–0.34; p = 0.001). Workers with no blood pressure problems (aOR, 2.21; 95% CI, 1.11–4.38; p = 0.024) and longer employment durations (aOR, 3.84; 95% CI, 1.15–12.81; p = 0.029) had a higher chance of RTW. Similar factors were associated with RTE, with more emphasis on older age, long recovery periods, low self-confidence, and injury caused by disease. Conclusions: Our findings contribute to developing targeted support services and informing policy decisions to improve RTW for workers with physical or brain lesion-related disabilities caused by industrial accidents. Full article

Background: In Canada, 30 percent of the older adult population is foreign-born. Immigrant older adults are more likely to experience significant social isolation due to a variety of factors. However, limited research exists on the influence of specific factors. The objective of this study is to understand the economic factors that contribute to social isolation among older immigrants in the Greater Toronto Area (GTA), Canada. Methods: A qualitative interpretive description method was used. Following research ethics boards’ approval, semi-structured individual interviews were conducted with a total of 47 Arabic, Mandarin, and Punjabi-speaking older immigrants in the GTA. The interviews were conducted in their preferred language, audio-recorded, and translated (when needed) into English and transcribed. Thematic analysis of the data was informed by an ecosystemic framework. Results: Six themes were identified: (1) barriers to finding employment; (2) living a “hand-to-mouth life” due to limited income/pension; (3) housing costs that eliminate choices and options; (4) costs (and availability) of transportation as a barrier to getting around; (5) lack of “essential” healthcare coverage; and (6) costs of community programs that prevent “getting out of the house.” These economic factors at micro, meso, and macro levels of society intersected to create desperate situations that contributed to social isolation among older immigrants in the GTA. Conclusions/Implications: Addressing these economic factors is critical to immigrant older adults’ aging in place. Service providers must advocate for accessible physical and financial resources and services including affordable housing and transportation, old age security, and comprehensive healthcare coverage for older immigrants. Future research should focus on economic challenges faced by older adults across other immigrant communities in the GTA as well as in other cities, provinces, and territories. Full article

Background: This study explored facilitators and barriers to return to work (RTW) after acute cardiovascular events or elective cardiac surgery, integrating clinical, functional, and occupational factors. Methods: A prospective cohort study was conducted at the Occupational Medicine and Cardiac Rehabilitation Units of the Maggiore Hospital in Trieste, Italy. Employed adults (18–67 years) admitted for acute coronary syndrome, valve replacement, or thoracic aortic surgery between January 2024 and July 2025 were enrolled. Sociodemographic, clinical, and occupational data were collected alongside functional and psychosocial assessments, including the Work Ability Index (WAI) and EQ-5D-5L. Predictors of RTW were analyzed with Cox regression models. Results: Among 103 patients (mean age 56.8 years; 92.2% male), 77.7% returned to work after a mean of 58.9 days. Independent predictors of earlier RTW were self-employment (HR 5.08, 95% CI 2.52–10.27), occupational responsibility (HR 2.12, 95% CI 1.01–4.45), and percutaneous coronary intervention (HR 2.72, 95% CI 1.47–5.06). Higher job-related physical demands, arrhythmias, and cardiac rehabilitation participation were associated with delayed RTW. Mean WAI (37.2 ± 5.1) and EQ-5D index (0.92 ± 0.09; EQ-VAS 77.4 ± 12.9) indicated preserved function and quality of life. Conclusions: RTW after cardiovascular events is multifactorial. Integrating occupational medicine into cardiac rehabilitation is key to ensuring safe, sustainable reintegration. Full article

Despite seven decades of international commitment—from the 1948 Universal Declaration of Human Rights through SDG 3.8—universal health coverage remains stubbornly out of reach. Two billion people, predominantly informal sector workers, lack access to sustainable health insurance. This entry explains the underlying cause: sustainable health insurance requires specific behavioral and institutional conditions for collective action—conditions that existing health insurance models systematically fail to satisfy, thereby structurally excluding informal populations. The Trinity Law framework formalizes these conditions as three multiplicatively interacting requirements—Trust (T), Consensus (C), and Dual Benefit (DB)—expressed as S = T × C × DB. Empirical analysis of community-based health insurance schemes across 24 countries identifies a robust trust threshold (τ* ≈ 0.68) operating as a behavioral phase transition: below this level, cooperation collapses; above it, participation becomes self-sustaining. Cross-country evidence from 274 organizations across 155 countries confirms consensus thresholds (C* ≈ 0.59), while analysis of 158,763 observations validates dual benefit mechanisms. The multiplicative structure explains why partial reforms fail: weakness in any single component drives overall sustainability toward zero. Applied to health insurance, this framework distinguishes conventional systems—Bismarckian employment-based, Beveridgean tax-financed, and commercial health insurance from sustainable systems like participatory community-based microinsurance that satisfy all three Trinity Law conditions through participatory design, transparent governance, and aligned incentives. The persistent UHC gap reflects not implementation failures but fundamental design incompatibilities that the Trinity Law makes explicit. This entry has three objectives: first, it states the Trinity Law conditions; second, it summarizes the empirical evidence for each component; third, it applies the framework to classify major health insurance models. Supporting datasets and code are available in the referenced Zenodo repositories. The term ‘law’ follows the tradition of social science regularities like the ‘law of demand’: a robust empirical pattern with strong predictive validity, not a claim to physical certainty. Full article

Background/Objectives: Nursing professionals were among the most affected groups during the COVID-19 pandemic, exposed to simultaneous physical demands and emotional strain. This study examined the interplay between work engagement, compassion fatigue, and musculoskeletal symptoms among frontline nurses in a Brazilian public hospital. Methods: A cross-sectional study (n = 77) was conducted between February and April 2022 using validated instruments (Work Stress Scale, ProQoL-BR, Nordic Musculoskeletal Questionnaire, and UWES-9). Descriptive and inferential analyses were performed (p ≤ 0.05). Results: Most participants did not report occupational stress (84.4%). No profiles of compassion fatigue were identified, although notable rates of burnout (26.0%) and secondary traumatic stress (23.4%) were observed. Engagement scores were very high in vigor and dedication. Musculoskeletal symptoms were prevalent, especially in the lumbar region (chronic: 60.0%). Female sex, statutory employment, and lack of physical activity were associated with a higher prevalence of symptoms and sick leave. Work engagement (vigor and overall score) showed negative correlations with absenteeism. Conclusions: The coexistence of high engagement and emotional vulnerability, in the absence of compassion fatigue, suggests that higher levels of engagement may be associated with lower occupational stress. These findings highlight the importance of integrated strategies, including ergonomic interventions, health promotion, and organizational support, to preserve the physical and mental health of frontline nursing professionals. This study provides new evidence of engagement as a potential protective factor that may mitigate physical and emotional burden among nurses in resource-limited settings. Full article

Background: Transition from paediatric to adult care in congenital heart disease (CHD) represents a pivotal and vulnerable phase that critically influences long-term survival, morbidity, and quality of life. Advances in paediatric cardiology and surgery have generated a rapidly growing population of adults with congenital heart disease who exhibit complex, lifelong, and multidisciplinary needs. However, survival does not equate to cure, and discontinuity of care during adolescence remains a major predictor of adverse outcomes. Despite widespread recognition of their importance, transition programmes are heterogeneous worldwide, and standardised, evidence-based protocols are missing. Objective: This review calls for action acknowledging the urgent need for structured and standardised transition programmes in CHD care, integrating the key elements that should be addressed in any programme to optimise outcomes. Content: Transition should be understood as a multidisciplinary, longitudinal process integrating medical management, patient and family education, psychological preparation, and societal inclusion. Core domains include tailored physical activity, nutritional counselling, cardiovascular risk factor management, infective endocarditis prevention, reproductive health, psychosocial support, and engagement of primary care providers, educators, and employers. Evidence demonstrates that structured transition programmes enhance health literacy, adherence, and self-management, while reducing loss to follow-up. The active involvement of primary care providers, psychologists, educators, and employers is essential to sustain holistic and equitable care. Conclusions: Transition should be reframed as an essential, lifelong component of CHD care. The development and implementation of standardised, multidisciplinary, evidence-based transition protocols are urgently required to ensure continuity, empower patients, and optimise long-term clinical and psychosocial outcomes for adults with CHD. Full article

This study examines the perceived mental health of Ukrainian female forced migrants in Ireland through the lens of the socio-ecological model (SEM). Using binomial logistic regression on a 2023 online survey dataset (N = 656), it explores multi-level predictors across individual, relationship, community, and societal domains. Results indicate that individual-level factors explain the largest proportion of variance in perceived mental health (Nagelkerke R² = 0.399). Employment status, self-rated physical health, and coping strategies were key determinants: part-time employment and good physical health were associated with higher odds of good perceived mental health. In contrast, avoidant coping and worsening health were associated with poorer outcomes. Relationship-level factors (R² = 0.194) also contributed significantly; lack of social support and deteriorating family or friendship ties were linked to poorer mental health, whereas participation in refugee meetings was strongly protective. Community-level factors (R² = 0.123) revealed that unstable housing, living with strangers, and declining neighbourhood relationships were associated with reduced mental well-being. At the societal level (R² = 0.168), insufficient access to psychological support and excessive exposure to Ukrainian news were associated with poorer outcomes, while moderate news engagement was protective. The findings highlight the multifaceted nature of refugees’ perceived mental health, emphasising the interdependence of personal resilience, social connectedness, and systemic support. Full article

Background/Objectives: The purpose of this study was to examine nutrition-related knowledge (NRK) and the implementation of national dietary guidelines (NDGs) as nutrition-related practices (NRPs) among women, identifying profiles and their determinants. Methods: A cross-sectional study including 1294 Polish women (mean age 35.8 ± 14.6 years) was conducted in the period June 2021–December 2022 using the Computer Assisted Web Interview (CAWI) method. K-means cluster analysis was applied to standardized variables (NRK and NRP scores, age, and BMI), with the optimal number of clusters determined using the elbow method, to identify major participant profiles representing knowledge and practices with respect to the NDGs. Results: Three distinct clusters were identified. The “High” cluster showed median NRK and NRP scores of 15 (IQR = 14–17) and 11 points (IQR = 10–13), significantly higher than those of the “Low” (11 (IQR = 9–13) and 8 points (IQR = 7–10); p < 0.001) and “Moderate” cluster (13 (IQR = 11–14) and 7 points (IQR = 6–9); p < 0.001), respectively. There were significant differences between clusters in socio-demographics, lifestyle, and health-related distribution. Cluster “High” (38% of sample) had the best NRK and NRP scores and more advantageous socio-economic and lifestyle profiles (higher education, employment, better financial situation, normal BMI, less smoking and higher levels of physical activity), p < 0.001; “Moderate” (39%) was characterized by average to relatively good NRK but weaker implementation of NRPs, particularly among younger women, representing more advantageous socio-demographic, lifestyle, and health-related characteristics (p < 0.001); and “Low” (23% of sample) comprising middle-aged and older women with lower education, more frequent rural residence, poorer financial status, less favourable lifestyle factors, the lowest NRK and NRP scores, higher prevalence of overweight or obesity, and the lowest level of physical activity (p < 0.001)—thus indicating a marked knowledge–practice gap, with this group constituting a potential high-risk population. Conclusions: Greater awareness of national dietary guidelines among women is observed alongside higher nutrition-related knowledge and healthier dietary practices. A persistent gap between knowledge and practical implementation among women highlights the need for interventions that support behaviour change alongside nutritional education. Targeted public health strategies are required for women with lower levels of nutrition-related knowledge and less favourable lifestyle profiles. Full article

Global fishery resources are under increasing pressure from environmental change and institutional constraints. China’s seasonal fishing moratorium has contributed to resource recovery but has also created income and employment challenges for small-scale fishers. This study examines how livelihood capital structures shape annual livelihood portfolios under predictable closure constraints, using three representative fishing communities in Guangdong Province as case studies. A combination of data augmentation, regression analysis, and agent-based simulation was applied to analyze the relationships between capital endowments and behavioral responses. Results show that environmental and financial capital significantly increase the likelihood of maintaining capture as the primary livelihood, while psychological capital stabilizes decisions under uncertainty. Physical capital and social networks exhibit more variable effects, reflecting differentiated adaptive capacities. Simulations further reveal threshold effects and diminishing marginal returns in capital accumulation, with heterogeneous temporal impacts across capital types. Theoretically, the study extends the Sustainable Livelihoods Approach by incorporating environmental and psychological capital, thereby enriching the understanding of capital mechanisms in fisheries. Overall, the findings advance knowledge of how small-scale fishers adapt under institutional constraints and provide practical insights for policies aimed at aligning livelihood security with the sustainable use of marine resources. Full article

Tourism today represents a strategic engine of economic growth, contributing substantially to GDP, employment, and export revenues. Accounting for approximately 10% of global GDP, the sector plays a significant role in tourism-intensive countries. Tourism has shown remarkable resilience and recovery capacity in the post-COVID era, reaffirming its status not only as an economic sector but also as a spatial phenomenon. Due to its inherent place-based nature, tourism cannot be outsourced: it relies on the unique cultural, environmental, and territorial assets of specific locations. While this makes tourism a powerful driver of local development, it also presents challenges related to environmental stress, cultural commodification, and social tensions, especially in over-visited destinations such as Venice, Barcelona, or Lisbon. This paper introduces the concept of “anti-gravity tourism”, a novel framework inspired by physics, to describe planning strategies aimed at counteracting the gravitational pull exerted by mass tourism hotspots. Using the STESY model, the study applies spatial analysis to four case study areas, identifying Destination Areas (DAs) through clustering techniques and developing spatial design proposals aligned with the principles of the New Urban Agenda (NUA). The results highlight how “anti-gravity” strategies can be operationalized through context-sensitive planning tools to mitigate overtourism, support territorial equity, and maximize positive externalities. Ultimately, the paper argues for a paradigm shift towards tourism policies that ensure long-term sustainability by balancing economic growth with social inclusion and environmental stewardship. Full article

Background: Patients presenting to the Emergency Department (ED) with amphetamine-type stimulant (ATS) use can exhibit a wide range of symptoms, ranging from mild agitation to life-threatening dysrhythmias. Early identification of patients at risk for more severe medical complications after ATS use is a key challenge in emergency care. Objective: To identify clinical and demographic predictors associated with a medical condition among patients presenting to the ED after ATS use. Methods: Retrospective cohort study of patients who presented to the ED with suspected ATS use at a large academic community hospital in Ontario from 1 September 2016 to 31 August 2017. Patients were screened using ICD-10 codes and included if they had a positive drug screen and clinical suspicion for ATS use. Our primary outcome was a composite of recognized complications of ATS toxicity. Predictor variables included age, sex, employment status, mental illness or substance use history, ED administration of benzodiazepines, antipsychotics, or physical restraints. Multivariable logistic regression was used to assess associations. Results: Of 1591 charts reviewed, 128 (8%) met the inclusion criteria. The median age was 29.5 years (interquartile range [IQR]: 23–36), and 50.8% were female. In adjusted analyses, benzodiazepine administration was significantly associated with a medical condition (Odds Ratio [OR] 3.33; 95% CI: 1.31–8.45; p = 0.011) as was employment status (OR 9.30; 95% CI: 1.00–86.03; p = 0.019). Conclusions: Benzodiazepine administration and unemployment were strong predictors of a medical condition among patients presenting to the ED after ATS use. These patients should undergo thorough physical examination and diagnostic testing to identify and manage potentially life-threatening conditions. Full article

This study examines how Israel’s legal and institutional arrangements, including migration policies, health-insurance eligibility rules, and safety enforcement mechanisms, shape health risks for Thai migrant agricultural workers, and identifies policy levers to mitigate preventable harm. Using a legal policy analysis informed by syndemics and labor frameworks, we mapped laws, regulatory oversight, and enforcement chains, and synthesized evidence from worker surveys, affidavits, and civil society reports to link institutional structures with barriers experienced in workplaces and healthcare settings. The findings reveal that health inequalities stem from structural design rather than isolated failures, including exclusion from public insurance, dependence on employer-based plans, employer-tied visas, opaque injury-claim procedures, fragmented oversight, absence of occupational-health surveillance, limited language access, poor housing conditions, and weak inspections. These interlocking features reinforce one another, resulting in under-reporting, delayed medical attention, and cumulative physical and psychological harm. The study concludes that structural legal and administrative reforms—rather than individual adaptation—are required to address these inequities. Policy priorities include integrating migrant workers into public insurance or ensuring equivalent coverage, decoupling residency from single employers, guaranteeing multilingual access, establishing independent health monitoring, and enforcing safety, housing standards and other social determinants of health through transparent inspections, positive incentives and meaningful sanctions. Full article