Search Results (355)

Problem Statement: Two global trends, including aging populations and the acceleration of global warming, are increasing the risk of heat-related illness, challenging the health of populations, and the sustainability of healthcare systems. Global warming refers to the increase in the Earth’s average surface temperature, generally attributed to the greenhouse effect, which is occurring at three times the rate of the pre-industrial era. The global population of older adults, defined here as individuals aged 60 and over, is expected to reach over 2 billion by mid-century. This population is particularly vulnerable to heat-related illness, specifically disruption of thermoregulation from excessive exposure to environmental heat due to metabolic and cognitive changes associated with aging. Objectives: This review examines heat-related illness and its impact on older adults within a socio-ecological framework, considering both drivers and mitigation strategies related to global warming, the built environment, social determinants of health, healthcare system responses, and the individual. The authors were motivated to create a conceptual model within this framework drawing on their lived experiences as healthcare providers interacting with older adults in a large urban area of the southwestern US, known for its extreme heat and extensive heat island effects. Based on this framework, the authors suggest actionable strategies supported by the literature to reduce the risks of morbidity and mortality. Methods: The literature search utilized a wide lens to identify evidence supporting various aspects of the hypothesized framework. In this sense, this review differs from systematic and scoping reviews, which seek a complete synthesis of the available literature or a mapping of the evidence. The first author conducted the literature search and synthesis, while the second and third authors reviewed and added publications to the initial search and conceptualized the socio-ecological framework. Discussion: This study is unique in its focus on a global trend that threatens the well-being of a growing population. The population health focus underscores social determinants of health and limitations of existing healthcare systems to guide healthcare providers in reducing older adults’ vulnerability to heat-related illness. This includes patient education regarding age-related declines in extreme heat tolerance, safe and unsafe physical activity habits, the impact of prescription drugs on heat tolerance, and, importantly, identifying the symptoms of heatstroke, which is a medical emergency. Additional strategies for improving survivability and quality of life for this vulnerable population include improved emergency response systems, better social support, and closer attention to evidence-based treatment for heat-related health conditions. Full article

The global population aged 65 and older is expected to double from 761 million in 2021 to 1.6 billion by 2050. Despite often being treated separately in clinical practice and policy, oral health and mental health are fundamentally interconnected in older adulthood, forming a bidirectional relationship that exacerbates disability, social inequity, and systemic healthcare challenges. This narrative review aims to summarize the two-way relationship between mental and oral health and emphasize their combined impact on systemic health, social engagement, and independence among ageing populations. The bidirectional relationship has profound clinical significance. Untreated oral diseases induce chronic pain and cause social embarrassment, aggravating pre-existing depression and anxiety. Periodontal disease can worsen systemic conditions such as diabetes, cardiovascular disease, and dementia via a shared inflammatory pathway. Conversely, mental health issues—including depression, anxiety, cognitive decline, and the use of psychotropic medications—reduce motivation for oral care, prompt dental neglect, and affect salivary function, deteriorating oral health. Despite clear connections, systemic gaps persist, including fragmented healthcare systems, financial barriers, stigma, lack of awareness, and caregiver burnout. To address these challenges, strategies such as developing integrated care models to unify dental and mental health services, reforming policies to prioritize oral and mental health parity, advocating anti-stigma campaigns to clear the misconceptions, and implementing community-based healthcare programmes to reach underserved older adults are essential. By recognizing oral health as a vital component of mental resilience, societies can transform ageing into an era of empowered well-being, where the mouth–mind connection promotes holistic health rather than functional decline. Full article

The impact of physical health conditions on coronavirus disease of 2019 (COVID-19) severity in World Trade Center disaster-exposed populations remains understudied. We examined the association of type, number and diagnosis time of pre-existing health conditions with COVID-19 severity, using the WTC Health Registry (WTCHR). We analyzed 3568 WTCHR enrollees with self-reported severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in a 2021 follow-up survey. COVID-19 severity was measured by self-reported symptom duration (<2, 2–4, and >4 weeks) and hospitalization (hospitalized versus not). Pre-existing gastroesophageal reflux disease (GERD), respiratory conditions, cardiovascular conditions, and diabetes were self-reported and categorized into four groups (no diagnosis, post-9/11, pre-9/11, and undefinable). We used multinomial logistic regression and binary logistic regression to analyze the association of comorbidities with COVID-19 symptom duration and hospitalization, respectively, adjusting for post-traumatic stress disorder and demographic factors. Analysis was also conducted separately by enrollee type: rescue and recovery workers (RRW) vs. community members (non-RRW). Having all four health conditions post-9/11 was associated with longer symptom duration after SARS-CoV-2 infection (>4 weeks) among RRW (AOR: 2.66, 95% CI: 1.03–6.87). Reporting a post-9/11 respiratory condition was associated with an increased risk of being hospitalized among RRW and an increased risk of longer symptom duration (>4 weeks) among non-RRW. While post-9/11 diabetes was associated with an increased risk of longer symptom duration among RRW, post-9/11 GERD and pre-9/11 cardiovascular conditions were associated with an increased risk of longer symptom duration and being hospitalized among non-RRW, respectively. The impact of certain health conditions on COVID-19 severity varied across enrollee types and time of diagnosis. Given the lasting health impacts of 9/11-related exposures, targeted medical surveillance and proactive healthcare interventions are critical for mitigating the risk of severe COVID-19 illness in this population. Full article

Urban Heat Islands (UHIs) are urbanized areas that experience significantly higher temperatures than their surroundings, contributing to thermal discomfort, increased air pollution, heightened public health risks, and greater energy demand. In Bhutan, where urban expansion is concentrated within narrow valley systems, the formation and intensification of UHIs present emerging challenges for climate-resilient urban development. Thimphu, in particular, is experiencing rapid urban growth and densification, making it highly susceptible to UHI effects. Therefore, the aim of this study was to evaluate and simulate UHI conditions for Thimphu Thromde. We carried out the simulation using a GIS, multi-temporal Landsat imagery, and an Artificial Neural Network model. Land use and land cover classes were mapped through supervised classification in the GIS, and surface temperatures associated with each class were derived from thermal bands of Landsat data. These temperature values were normalized to identify existing UHI patterns. An Artificial Neural Network (ANN) model was then applied to simulate future UHI distribution under expected land use change scenarios. The results indicate that, by 2031, built-up areas in Thimphu Thromde are expected to increase to 72.82%, while vegetation cover is projected to decline to 23.52%. Correspondingly, both UHI and extreme UHI zones are projected to expand, accounting for approximately 14.26% and 6.08% of the total area, respectively. Existing hotspots, particularly dense residential areas, commercial centers, and major institutional or public spaces, are expected to intensify. In addition, new UHI zones are likely to develop along the urban fringe, where expansion is occurring around the current hotspots. These study findings will be useful for Thimphu Thromde authorities in deciding the mitigation measures and pre-emptive strategies required to reduce UHI effects. Full article

The COVID-19 pandemic has demonstrated that its effects go far beyond the initial respiratory illness, with many survivors experiencing lasting neurological problems. Some patients develop a condition known as Long COVID, or post-acute sequelae of SARS-CoV-2 infection (PASC), which includes current issues such as reduced cognitive function, chronic headaches, depression, neuropathic pain, and sensory disturbances. These symptoms can severely disrupt daily life and overall well-being. In this narrative review, we provide an overview of current understanding regarding the neurological effects of COVID-19, with a focus on Long COVID. We discuss possible underlying mechanisms, including direct viral invasion of the nervous system, immune-related damage, and vascular complications. We also summarize findings from cohort studies and meta-analyses that explore the causes, symptom patterns, and frequency of these neurological issues. Approximately one-third of people who have had COVID-19 report neurological symptoms, especially those who experienced severe illness or were infected with pre-Omicron variants. Emerging research has identified potential biomarkers such as neurofilament light chain (NFL) and glial fibrillary acidic protein (GFAP) that may help in diagnosis. Treatment approaches under investigation include antiviral medications, nutraceuticals, and comprehensive rehabilitation programs. Factors like older age, existing health conditions, and genetic differences in ACE2 and TMPRSS2 genes may affect an individual’s risk. To effectively address these challenges, current research is essential to improve diagnostic methods, develop targeted treatments, and enhance rehabilitation strategies. Ultimately, a coordinated, multidisciplinary effort is crucial to reduce the neurological impact of Long COVID and support better recovery for patients. Full article

Background: Persistent postpartum pain (PPP) is a common condition after cesarean section (CS) that affects multiple domains of quality of life. PPP was defined as pain of any cause (not only related to surgery) appearing after CS and persisting for at least the three following months. The objective of this study was to calculate the incidence of PPP in women after elective CS and to analyze the associated risk factors. Methods: It was a retrospective cross-sectional study. An electronic patient-reported outcome tool (ePRO) was used to assess patients’ perception of their own health and to assess the presence and severity of pain. Results: Pain during pregnancy was reported by 66.14% of the study group. The most frequently reported localizations of pain were the lumbar spine, pubic symphysis, lower limbs, and sacrococcygeal region. The mean postoperative pain (day 0) defined by a Numeric Rating Scale was 5.44 (2.78 SD), and on the day of discharge (usually the third day after CS), it was 3.6 (2.29 SD). PPP occurred in 32.37% of women, was usually mild in nature, and had a little to moderate impact on function. Previous surgery raises the odds of PPP by 48.7% (OR = 1.487), pain during pregnancy raises the odds of PPP by 48.1% (OR = 1.481), and each additional point of the NRS on day 0 raises the odds of PPP by 16.6% (OR = 1.166). Conclusions: A higher risk of PPP could be found in women with pre-existing pain conditions, previous surgery, and severe postoperative pain. Persistent postpartum pain is not limited only to the area of surgery. Persistent back pain was reported by every second woman with PPP. Full article

Since its discovery in 2001, Human Metapneumovirus (hMPV) has been identified globally, exhibiting predictable seasonal outbreaks primarily affecting young children, the elderly, and individuals with preexisting health conditions. The virus is transmitted through airborne droplets and is responsible for a notable percentage of respiratory illnesses, particularly in children under five years of age, with hospitalization rates peaking in the first year of life. The complex immune response elicited by hMPV, characterized by a Th17-like profile and excessive mucus production, contributes to respiratory complications, emphasizing the need for effective management strategies. This review discusses various diagnostic methods, emphasizing the potential of combining serology with RT-PCR to enhance diagnostic accuracy during outbreaks. Furthermore, it addresses the therapeutic approaches, including the promise of recombinant interferons and ongoing research on the use of passive immunity through neutralizing antibodies. A comprehensive overview of hMPV, emphasizing the importance of continued research to improve diagnostic and therapeutic options for this significant respiratory pathogen, offers promising strategies for manipulating responses through targeted interventions. Full article

Background: Health disparities research increasingly relies on complex survey data to understand survival differences between population subgroups. While Peters–Belson decomposition provides a principled framework for distinguishing disparities explained by measured covariates from unexplained residual differences, traditional approaches face challenges with complex data patterns and model validation for counterfactual estimation. Objective: To develop validated Peters–Belson decomposition methods for survival analysis that integrate ensemble machine learning with transfer learning while ensuring logical validity of counterfactual estimates through comprehensive model validation. Methods: We extend the traditional Peters–Belson framework through ensemble machine learning that combines Cox proportional hazards models, cross-validated random survival forests, and regularized gradient boosting approaches. Our framework incorporates a transfer learning component via principal component analysis (PCA) to discover shared latent factors between majority and minority groups. We note that this “transfer learning” differs from the standard machine learning definition (pre-trained models or domain adaptation); here, we use the term in its statistical sense to describe the transfer of covariate structure information from the pooled population to identify group-level latent factors. We develop a comprehensive validation framework that ensures Peters–Belson logical bounds compliance, preventing mathematical violations in counterfactual estimates. The approach is evaluated through simulation studies across five realistic health disparity scenarios using stratified complex survey designs. Results: Simulation studies demonstrate that validated ensemble methods achieve superior performance compared to individual models (proportion explained: 0.352 vs. 0.310 for individual Cox, 0.325 for individual random forests), with validation framework reducing logical violations from 34.7% to 2.1% of cases. Transfer learning provides additional 16.1% average improvement in explanation of unexplained disparity when significant unmeasured confounding exists, with 90.1% overall validation success rate. The validation framework ensures explanation proportions remain within realistic bounds while maintaining computational efficiency with 31% overhead for validation procedures. Conclusions: Validated ensemble machine learning provides substantial advantages for Peters–Belson decomposition when combined with proper model validation. Transfer learning offers conditional benefits for capturing unmeasured group-level factors while preventing mathematical violations common in standard approaches. The framework demonstrates that realistic health disparity patterns show 25–35% of differences explained by measured factors, providing actionable targets for reducing health inequities. Full article

Background/Objectives: It is often assumed that patients with pre-existing psychiatric conditions are more prone to severe burn injuries due to impaired judgment or risky behaviors. However, the relationship between psychiatric illnesses and the incidence and severity of burn injuries remains unclear. This study aims to examine the prevalence of psychiatric illnesses among severely burned patients and compare it to the general population. Methods: We analyzed the data of all patients admitted to our burn intensive care unit with severe burn injuries between 2014 and 2024. Data collection focused on the prevalence of psychiatric illnesses and substance abuse. The prevalence rates in our study cohort were compared to available data provided by the Federal Ministry of Social Affairs, Health, Care and Consumer Protection of Austria, representing the general population as well as data from long-term population studies. The severity and outcome of burn injuries were compared between patients with and without psychiatric conditions. Results: A total of 644 patients were included in this study. The analysis revealed that 176 (27.4%) patients had a documented psychiatric comorbidity, which is comparable to the prevalence of psychiatric conditions in the general population, estimated at 25–30%. However, the prevalence of alcohol abuse among burn patients was notably higher, with 64 patients (9.9%), compared to approximately 3% in the general population. Despite the higher prevalence of alcohol abuse, the severity and extent of burn injuries were similar between patients with and without pre-existing psychiatric conditions. Conclusions: Our findings challenge the common belief that pre-existing psychiatric conditions increase the risk or severity of severe burn injuries. While alcohol abuse is indeed more prevalent among burn patients, the overall distribution of psychiatric illnesses is similar to that in the general population. This suggests that psychiatric conditions may not directly influence the incidence or severity of burn injuries. Full article

Background/Objectives: Motorcycle accidents have grown to become a significant public health thread worldwide. Most of the victims are described to be males of young age, some of lower socioeconomic status. Throughout the literature, head and spinal injuries are described as the most common injuries, while chest injuries and lower extremity fractures are also frequently described. Moreover, driving under the influence of alcohol has been widely described as a major predisposing factor. We conducted a retrospective cohort study to categorize risk factors, including demographic information and alcohol/psychoactive substance consumption, as well as pre-existing medical conditions. Correspondingly, we identified the most common injury patterns and attempted to establish a connection between time to hospital and survival rates. Methods: Cases of motorcycle-related road traffic accidents (RTAs) examined by the authors during 2021–2023 were included in the study sample (94 cases in total). This retrospective cohort study assessed survival time (in days) from accident to death. Kaplan–Meier curves, stratified by key categorical variables, were used to analyze survival probabilities over time. Univariate Cox regression was used to assess each variable’s effect on survival. The association between exposure and mortality was analyzed using hazard ratios (HRs) and 95% confidence intervals (CIs). Results: Head injuries were associated with poorer outcomes. Chest injuries reduced median survival to 1.68 h compared to 5.85 days in cases that had not sustained chest injuries. Abdominal injuries also shortened survival (1.632 h vs. 1.896 h), as did multiple-site injuries (1.584 h vs. 0.2 days for single/double-site). Positive toxicology for psychoactive substances lowered survival to 1.32 h compared to 1.752 h in cases with negative toxicological findings. Multiple-site injuries and head, chest and abdominal injuries appeared to significantly affect the survival of victims. Positive toxicological examination results for psychoactive substances also appeared to heavily impact survival. Full article

Racialised minority populations were disproportionately affected by COVID-19 and saw the highest rate of COVID-19 infections and mortality. Low socioeconomic status, working as frontline workers, temporary employment, precarious immigration status and pre-existing medical conditions were factors that contributed to disadvantaged experiences. This systematic review looked at the impact of COVID-19 on racialised minority populations globally, recognising their experiences, perspectives and the effects on their physical and mental health. Eight electronic databases were searched (MEDLINE, PsycINFO, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Social Sciences Citation Index (SSCI), Social Policy and Practice (SPP), Applied Social Sciences Index and Abstracts (ASSIA), MedRxiv and Research Square) for English language qualitative studies. Reference lists of relevant literature reviews and reference lists of articles were hand-searched for additional potentially relevant articles. Duplicates were removed, and articles were screened for titles and abstracts, followed by full-text screening. The Mixed Methods Appraisal Tool (MMAT) was used to assess the quality of the included studies (n = 70). Data were synthesised using thematic synthesis. Seven major and three minor themes were identified. The major themes related to (i) children and young people’s experiences of COVID-19; (ii) exacerbated pre-existing disparities relating to income, employment and housing security, health insurance and immigration status; (iii) lack of knowledge and information about COVID-19 and COVID-19 misinformation; (iv) racial history of medicine and treatment of racialised populations; (v) contemporary experiences of racism; (vi) impact on physical and mental health and wellbeing; (vii) concerns about safety at work. Minor themes related to (a) experiences of intercommunity mutual aid; (b) adherence to preventative guidance/COVID-19 restrictions; (c) the role of faith. Research needs to focus on developing and testing interventions that support transformation of social, cultural and economic systems towards equity of access to healthcare and healthcare knowledge. Research should be cognisant of interventions that have worked in shifting the equity dial in the past, implement these and use them to inform new approaches. Policy and practice should be mechanisms for enabling the implementation of interventions. Full article

Background/Objective: The SARS-CoV-2 pandemic, emerging in late 2019, led to a global health crisis, with many patients developing prolonged symptoms after infection known as sequelae of COVID-19. This condition is theorized to be driven by systemic inflammation and immune dysregulation and presents with diverse symptoms from cardiovascular, pulmonary, and neurological systems. This study investigates the prevalence, risk factors, and long-term impacts of sequelae of COVID-19. Method: Using Denmark’s healthcare databases, this population-based cohort study included 1,034,093 individuals over 40 years who tested positive for COVID-19 between 1 March 2020 and 28 February 2022. Participants were divided into two age groups: 40–59 years and 60 years or older. Part A examined the risk of sequelae of COVID-19 diagnoses (ICD-10 code B94.8A) based on the Charlson Comorbidity Index (CCI). Part B assessed two-year outcomes for patients diagnosed with sequelae of COVID-19. Results: Results showed a 0.55% prevalence of sequelae of COVID-19 in both age groups. Higher CCI scores correlated with an increased risk of sequelae of COVID-19. During the two-year follow-up, patients with sequelae of COVID-19 faced significantly elevated risks of thromboembolic events, chronic lung diseases, and infections. Adjusted hazard ratios were notably high: 14.50 (7.54–27.86) and 12.50 (6.95–22.49) for thromboembolic events in adults and older adults, respectively; 33.81 (13.30–85.96) and 9.83 (6.09–15.87) for chronic lung disease; and 8.40 (4.49–15.70) and 15.44 (10.47–22.78) for infections. Conclusions: While the overall prevalence of sequelae of COVID-19 was low among individuals over 40, those with higher comorbidity burdens were at greater risk of severe sequelae and subsequent health complications. These findings underscore the need for clinical monitoring, especially for patients with pre-existing comorbidities, to mitigate long-term health risks associated with COVID-19 sequelae. Full article

Background/objectives: Overweight and obesity in adolescents is a significant public health concern, yet limited interventions exist in Australia to promote healthy behavior change in families and young people. This retrospective, real-world evaluation aimed to describe the impact of an 8-week e-Health program (Think, Eat And Move, [TEAM]) on anthropometric, behavioral and wellbeing outcomes in adolescents. Methods: Eligible TEAM program participants were aged 13–17 years, resided in Central or Eastern Sydney, Australia, had overweight/obesity, were at risk of or had a chronic health condition and/or required healthy lifestyle support. Retrospective program data were used to assess the impact of TEAM on weight, height and BMI z-score, dietary intake, physical activity and wellbeing indices. Results: Of 567 registered participants, 313 completed the TEAM program and were included in the analysis (median age 14.4 years, 56.2% female). The median (interquartile range) BMI z-score reduced from 1.8 (1.4–2.2) pre-program to 1.6 (1.1–2.1) post-program (p < 0.001, n = 262). Significant improvements in health behaviors following the program were observed, including increased consumption of fruit, vegetables and water; reduced consumption of confectionery and take-away foods; increased days of physical activity; and reduced sedentary time. Significant positive changes were also observed in knowledge and wellbeing measures. Conclusions: Adolescents completing the TEAM program demonstrated clinically important changes in anthropometry and improved nutrition and physical activity behaviors. E-Health modalities for promoting behavior change should be considered in public health strategies for adolescents. Full article

Background/Objectives: Healthcare and social workers were at increased risk of infection during the COVID-19 pandemic, and were therefore also at increased risk of long-term physical and mental health consequences due to infection. This study aimed to investigate the course of health-related quality of life (HRQoL) and mental health, in terms of depression and anxiety. Methods: A longitudinal study surveyed employees in health and social services diagnosed with SARS-CoV-2 in 2020 over a period of three years. Results: A total of 834 individuals participated in all four surveys. The mean age was 50.2 years (SD 5.8), with 82.3% of the participants being female. Mixed-model analyses were performed to examine the development over time. The results showed significant impairments in physical and mental HRQoL, as well as in mental health. Factors influencing physical HRQoL were gender, age, and pre-existing conditions. Pre-existing mental health conditions and self-reported health prior to infection were found to be predictors of mental HRQoL and symptoms of depression and anxiety. Those with persistent symptoms reported a significantly lower quality of life than those who had recovered. The mean physical HRQoL among participants with ongoing symptoms was 38.6, compared with 50.0 for those without symptoms, and the mean mental HRQoL was 40.4 versus 50.1 (p < 0.001). Conclusions: These findings suggest that health-related quality of life and mental health should continue to be monitored to prevent long-term psychological distress. Full article

Background: Refugees often face major health challenges owing to displacement, poor living conditions, limited access to healthcare, and the psychological toll of forced migration. Access to healthcare has been a major concern because of disrupted medical services, pre-existing health conditions, and integration challenges in host countries. This study aimed to evaluate the effect of infectious diseases on refugees in the context of the war in Ukraine by analyzing data from patients who accessed health services from a county hospital. Methods: We analyzed the data of Ukrainian refugees who presented for an infectious disease between February 2022 and March 2025 in the largest hospital unit in Romania located immediately near the border with Ukraine. Results: A total of 2052 refugee patients of Ukrainian nationality presented to the Emergency Reception Unit of “St. Ioan cel Nou Suceava” for consultations; 672 patients required an evaluation by an infectious disease specialist and 48 were hospitalized in the Department of Infectious Diseases. The most common disease encountered in children was influenza, whereas the most common disease in adults was SARS-CoV-2 infection. The most frequently encountered comorbidities in pediatric patients were anemia (26.9%) and dehydration syndrome (46.2%). In adults, comorbidities included chronic obstructive pulmonary disease (18.2%), hypertension (13.6%), chronic coronary disease (4.5%), diabetes (9.1%), and chronic hepatitis (4.5%). Patients were treated with antivirals, rehydration solutions or only symptomatic treatment. Conclusions: Romania is implementing public health measures to address these challenges, focusing on vaccination and disease screening, and ensuring access to essential healthcare services. These services include access to primary care physicians, specialist consultations, hospitalization, and essential medications. Full article