Search Results (686)

Storm Kristin affected central Portugal on 28 January 2026, producing exceptional wind gusts and widespread disruption across the natural, infrastructural and built environments. This paper presents the results of a post-disaster reconnaissance mission carried out in the municipalities of Leiria and Marinha Grande, two of the most affected areas. The methodology combined ground-based visual inspection, photographic records, unmanned aerial vehicle surveys, terrestrial laser scanning, and information provided by local authorities and infrastructure managers. The results show that the spatial distribution and severity of the damage were consistent with the occurrence of very intense localised gusts associated with a sting jet mechanism. Extensive damage was observed in vegetation, transport networks, electrical and telecommunications infrastructure, public spaces and different building typologies. Across the building stock, roofing systems were the most vulnerable components, particularly lightweight panels, ceramic tiles, ridge elements and poorly anchored envelope systems. Industrial and public buildings showed the most severe failures, including extensive roof loss, deformation of structural and envelope components, and local collapse, while residential buildings generally presented minor-to-moderate damage. Heritage buildings showed specific vulnerabilities related to cumulative degradation, exposed architectural elements and the consequences of local damage for historic fabric. The findings highlight the need for improved wind-risk preparedness, systematic post-event documentation, enhanced roof and cladding anchorage, preventive maintenance, and further investigation of the relationship between recorded wind speeds, observed damage patterns and current wind-design assumptions. Full article

The Guangdong–Hong Kong–Macao Greater Bay Area (GBA) is a densely populated, highly connected coastal urban region that is exposed to typhoons, extreme rainfall, flooding, storm surges, heat-related risks, and public health emergencies. Existing studies have clarified many aspects of hazard exposure and spatial vulnerability, but evidence on how residents receive warnings, interpret risks, prepare, evacuate, and contribute to community resilience remains dispersed across disciplines and jurisdictions. This study maps the intellectual structure and thematic evolution of research on residents’ responses to urban disaster risks in the GBA. Following a PRISMA 2020-aligned identification and screening process, 144 records from the Web of Science Core Collection were manually screened. Bibliometric analysis, keyword co-occurrence analysis, a region–hazard matrix, and a BERTopic-inspired topic modelling procedure were then used to identify publication trends, disciplinary sources, spatial hazard patterns, and latent themes. The results show accelerated growth after 2020 and identify six interrelated themes: risk perception and preparedness; evacuation and shelter accessibility; urban flooding vulnerability; typhoon, storm surge, and coastal community risk; community resilience and climate adaptation governance; and health emergency response and psychosocial resilience. The review synthesises these findings into a heuristic framework linking risk information, cognitive appraisal, response action, and community resilience. The GBA is treated as an analytically informative, rather than statistically representative, case of a high-density, coastal, and multi-jurisdictional urban region. The findings suggest that resident-centred resilience planning should connect trusted and actionable warnings with inclusive digital communication, accessible protective resources, and cross-boundary coordination for compound hazards. Full article

Long-term and large-scale power outages (blackouts) pose a significant threat to the functioning of modern cities, exposing the level of their preparedness for crisis situations. A blackout is a systemic phenomenon whose cascading impacts extend far beyond the energy sector, affecting multiple interdependent domains of urban operations. Therefore, this study aims to evaluate the resilience of urban systems to electricity supply disruptions across infrastructural, institutional, social, and functional dimensions, based on blackout case studies from selected cities in Poland, Spain, and Portugal. Utilising data spanning the period 2008–2025, a qualitative cross-case comparison was conducted based on indicator coding and the identification of recurrent patterns. The results indicate that a blackout simultaneously impacts all four dimensions of urban resilience. The highest vulnerability was observed within the social and functional dimensions, manifested by the limited preparedness of residents for prolonged power deprivation, as well as disruptions in information flow and municipal service delivery. Furthermore, the findings reveal that a high level of infrastructural resilience does not guarantee effective crisis response without adequate institutional and social support. Based on these insights, it is recommended to develop a European Union-level framework to secure financial resources aimed not only at mitigating the consequences of blackouts—which frequently exhibit cross-border characteristics—but primarily at funding proactive prevention and preparedness measures against power grid failures. Full article

Japan is one of the most earthquake-prone countries in the world. The 2011 Great East Japan Earthquake alone caused nearly 20,000 deaths and missing persons. International visitors and newly arrived foreign residents in Japan may face heightened risk during earthquakes, as limited prior experience with earthquakes and limited Japanese-language proficiency can restrict access to essential safety information. In addition, because disaster-preparedness education is often insufficient in countries with low disaster risk, they may be especially vulnerable in emergencies. This study designed, developed, and evaluated an augmented reality (AR) application intended to provide earthquake-preparedness and survival guidance in the Japanese context. The application was evaluated using a pre-test/post-test design with 40 participants from 10 countries, who completed a 14-item multiple-choice disaster-preparedness knowledge test and a user satisfaction survey. Participants’ knowledge scores improved significantly from the pre-test to the post-test (t(39) = 8.20, p < 0.001), with a large effect size (Cohen’s d = 1.30), and participants reported high satisfaction (4.55/5, SD = 0.61). These results suggest the potential of AR as an accessible educational approach for enhancing earthquake-preparedness knowledge among international visitors and newly arrived foreign residents in earthquake-prone regions. Full article

Background/Objectives: Disaster preparedness is central to public health resilience. This study examined the association between disaster-related digital technology engagement and Health Belief Model-based preparedness beliefs among adults attending a primary care clinic in Türkiye. Methods: In this cross-sectional study, 538 participants completed a sociodemographic form, a researcher-developed 10-item Disaster and Technology Use Questionnaire, and the 31-item General Disaster Preparedness Belief Scale. The technology questionnaire used five-point Likert-type response categories and was treated as a multidomain questionnaire; its prespecified equal-weighted sum formed an operational composite index rather than a unidimensional scale score. Supplementary internal-structure analyses described item covariance and clustering. Spearman correlations, false-discovery-rate correction, and hierarchical multiple linear regression with HC3 robust standard errors were used, adjusting for age, gender, education, income, marital status, and occupation. Results: The technology composite showed α = 0.793 and ω = 0.799, and exploratory and confirmatory analyses identified two correlated empirical item domains with adequate model fit (CFI = 0.952, TLI = 0.936, RMSEA = 0.055). Technology engagement was independently associated with total preparedness beliefs (B = 0.888, 95% CI 0.672–1.103; standardized β = 0.397; p < 0.001) and increased explained variance by 13.3% beyond sociodemographic factors. Adjusted associations remained significant for perceived susceptibility, perceived benefits, perceived low barriers, cues to action, and self-efficacy, but not for perceived severity. Conclusions: Greater disaster-related digital technology engagement was associated with stronger preparedness beliefs, but causal direction cannot be inferred. Primary care initiatives may promote official alert tools, practical application use, and digital-information literacy while maintaining non-digital alternatives for people with limited digital access. Full article

This study aims to assess the impact of the October 2023 Gaza War on water and sanitation systems and propose actionable solutions for effective management. The study adopted a mixed-methods approach (quantitative and qualitative). Primary data were collected through semi-structured interviews, targeted questionnaires, and direct field observations. Secondary data were gathered from reports by international organizations (UNRWA, OCHA, WHO), Palestinian authorities, academic research, in addition to satellite imagery and Geographic Information System (GIS) data for damage assessment. The results showed that the institutional level of emergency preparedness before the war varied significantly. Despite the existence of pre-developed emergency plans (mean score 3.26, relative weight 65.28%, p = 0.0355), there were significant shortcomings in practical staff training (mean score 2.64, relative weight 52.83%, p = 0.006), logistical readiness, and the activation of international partnerships. The study also revealed major challenges faced in providing water and sanitation services during the war, including fuel and resource shortages, safety risks for field teams, weak coordination with security agencies, lack of materials and equipment, insufficient emergency funding, coordination gaps, staff displacement, communication breakdowns, difficulty accessing water sources, area division and blockade, and loss of personnel. Specifically, the inability to access water sources was a critical challenge (mean score 4.30, relative weight 86.04%, p < 0.0001), as was indiscriminate shelling impacting field team safety (mean score 4.19, relative weight 83.77%, p < 0.0001) and lack of materials and equipment (mean score 4.15, relative weight 83.02%, p < 0.0001). Residents reported water availability only every 10–15 days, and over 70% of water and sanitation systems were damaged. While funding proposals were being prepared (mean score 3.26, relative weight 65.28%, p = 0.02), weaknesses in reporting systems and coordination of roles were observed (mean score 2.55, relative weight 50.94%, p < 0.0001). The research contributes to guiding local and international efforts towards reconstruction, enhancing resilience, and ensuring the provision of safe drinking water and adequate sanitation for the affected population, thereby reducing the risks of waterborne diseases and improving public health. Full article

Background/Objectives: Local anaesthetic systemic toxicity (LAST) is a rare but potentially fatal complication of dental and oral and maxillofacial surgical local anaesthesia (LA). Three amide agents are commonly used in the UK: lignocaine (lidocaine) 2% with adrenaline 1:80,000; articaine 4% with adrenaline 1:100,000 (2.2 mL cartridges); and bupivacaine 0.5%. Clinically significant discrepancies between guideline sources for maximum recommended dosages (MRDs) persist, and the additive toxicity of combined amide agents remains underappreciated. The objectives are: to provide clear, evidence-appraised MRD guidance for dental practitioners; to explain safe combination dosing using the fractional dose rule with acknowledgement of its pharmacokinetic limitations; and to outline recognition and management of LAST, including intravenous lipid emulsion (ILE) therapy, setting-stratified response, and differential diagnosis. Methods: These include the following: narrative review of MEDLINE (via PubMed), the Cochrane Library, and Embase (inception to May 2026), supplemented by key regulatory documents (British National Formulary (BNF) 91; US Food and Drug Administration (FDA) prescribing information; UK Summaries of Product Characteristics (SmPCs)); major guideline documents (American Society of Regional Anesthesia and Pain Medicine (ASRA) 2018; Association of Anaesthetists 2021; Resuscitation Council UK 2021); systematic reviews; and peer-reviewed literature, ranked by a jurisdiction-specific UK prescribing and regulatory source hierarchy. Results: BNF 91 and the FDA both support a 7 mg/kg (500 mg) MRD for lignocaine with adrenaline; in practice, the adrenaline ceiling limits administration to 6–7 cartridges (2.2 mL) regardless of the guideline followed. The principal reasons for caution when combining amide agents are; additive systemic toxicity, more complex dose calculation, absence of proven clinical benefit for concurrent mixing, unnecessary drug exposure, and incremental hypersensitivity risk—not metabolic pathway differences. The fractional dose rule is a pharmacologically justified safety heuristic with acknowledged pharmacokinetic limitations. ILE is a specific rescue therapy for severe or cardiovascular LAST; airway support and oxygenation remain the primary interventions. Patient-specific factors substantially lower the effective toxic threshold. Conclusions: Safe LA administration in oral surgery requires systematic MRD calculation, application of the fractional dose rule for combined-agent appointments, attention to patient-specific risk factors, setting-appropriate emergency preparedness, and structured differential diagnosis to distinguish LAST from more common dental emergencies. Full article

Background/Objective: Research has indicated that providing care during the COVID-19 pandemic negatively impacted healthcare providers’ wellbeing and burnout. Much of the literature has focused on emergency department (ED) physicians and nurses, including the distinct challenges they faced caring for persons experiencing homelessness (PEH), including addressing unmet basic needs, limited discharge options, and disruptions to community-based health and social services during the pandemic. Comparatively little research has examined the experiences of other multidisciplinary team members caring for PEH. This study explored the shared experiences of multidisciplinary ED staff caring for PEH during the COVID-19 pandemic to inform workforce planning and future pandemic preparedness. Methods: Using inductive qualitative analysis, we examined self-reported experience, mental health impacts and solutions for workforce planning and pandemic preparedness of multidisciplinary ED staff caring for PEH. Three virtual focus group discussions involving 12 multidisciplinary ED staff (registered nurses, clerical staff, security staff, community support workers, and a clinical assistant) were conducted during the first two years of the COVID-19 pandemic, a period characterized by evolving public health restrictions, uncertainty, and disruptions to health and social services. Results: Inductive qualitative analysis identified four key themes: (1) emotional experiences of care provision (including gratitude, compassion fatigue, and moral distress), (2) hospital- and community-led adaptations to support care delivery, (3) strategies for wellness and resilience building among staff, and (4) recommendations for future workforce planning and pandemic preparedness. Conclusions: Caring for PEH during the intense pandemic period intensified staff distress by exposing them to unmet social needs and system-level resource gaps, while also fostering interprofessional collaboration and resilience. Staff collaborated to facilitate organizational adaptations that enabled continuity-of-care. Future pandemic preparedness should include targeted mental health supports for staff, flexible institutional contingency planning, and formalized hospital–community partnerships to sustain care for PEH and other socially vulnerable populations. Full article

Background/Objectives: Individuals with marginalized sexual and gender identities experience mental health disparities arising from chronic minority stress and systemic barriers within healthcare settings. Mental health professionals occupy a central role in addressing these inequities; however, persistent deficits in professional preparation and cultural knowledge continue to undermine affirming, identity-inclusive care. This study explored the cultural knowledge of Italian mental health professionals regarding LGBTQIA+ health needs, focusing on how such knowledge is conceptualized, enacted, and constrained in clinical practice, using the Culturally Competent Compassion Model as a theoretical framework. Methods: A qualitative study was conducted using semi-structured interviews with 14 Italian mental health professionals (psychologists, psychotherapists, and psychiatrists), purposively selected from a broader qualitative dataset of 33 professionals based on clinical specialization in mental health. Data were analyzed using reflexive thematic analysis. Results: Four themes were identified: (1) training as absent structure; (2) knowing without knowing; (3) the paralysis of partial competence; and (4) stigma as institutional climate. Findings showed that professionals often rely on partial and informal knowledge, experience uncertainty in clinical interactions, and encounter difficulties in translating knowledge into practice. Participants demonstrated awareness of explicit and subtle forms of stigma affecting LGBTQIA+ individuals within healthcare settings. Conclusions: The findings highlight a gap between declarative awareness and self-reported preparedness for clinical practice, underscoring the need for structured training programs integrating theoretical knowledge and clinical skill development. Cultivating cultural knowledge and cultural humility among mental health professionals represents a systemic investment in reducing mental health inequities and improving affirming care for LGBTQIA+ populations. Full article

The ongoing 2026 Bundibugyo ebolavirus outbreak in eastern Democratic Republic of the Congo highlights the continued vulnerability of Central Africa to recurrent Ebola emergence. This outbreak emerged less than six months after the previous one ended, appears to represent one of the shortest documented inter-epidemic intervals in the Democratic Republic of the Congo based on currently available outbreak reports. Current surveillance systems remain largely reactive, focusing on the detection of human cases after zoonotic spillover has occurred. While strengthening health systems, diagnostic capacity, and early case detection remains the cornerstone of Ebola preparedness, growing research suggests that environmental and climatic information may eventually contribute to a broader understanding of spillover risk within a One Health framework. However, current evidence remains insufficient to identify validated environmental indicators or operational thresholds capable of predicting Ebola spillover events. Recent modeling studies have demonstrated that environmental drivers of Ebola emergence remain highly context-dependent and cannot yet support operational early warning systems. This commentary argues that continued research integrating environmental monitoring, remote sensing, ecological observations, and epidemiological data may improve understanding of Ebola emergence and eventually contribute to future preparedness strategies. Rather than proposing climate-informed preparedness approaches as an operational prediction tool, we emphasize its potential as a complementary research priority requiring further validation before any operational implementation. Full article

Background: Vaccine hesitancy has traditionally been understood as a multifactorial phenomenon shaped by individual beliefs, risk perceptions, and access barriers. However, the COVID-19 pandemic has fundamentally transformed the relationship between citizens, science, and public institutions, raising the question of whether vaccine hesitancy has evolved into a broader form of institutional distrust. Objective: This narrative review synthesizes evidence on vaccine confidence, trust dynamics, misinformation, and post-pandemic attitudes to propose a new conceptual framework, i.e., institutional hesitancy, that reframes vaccine acceptance within the wider context of institutional credibility, transparency, and legitimacy. Methods: We conducted a narrative synthesis of peer-reviewed literature, surveillance reports, and cross-national surveys published between 2015 and 2026, focusing on trust in science, governments, public health agencies, healthcare systems, and regulatory authorities as determinants of vaccination behavior. Results: The evidence consistently demonstrates that institutional trust is among the strongest predictors of vaccine acceptance, often surpassing traditional demographic and knowledge-based variables. The pandemic exposed and amplified pre-existing fractures in the relationship between citizens and institutions, creating a legacy of institutional skepticism that extends beyond COVID-19 vaccines to routine immunization programs, seasonal vaccination campaigns, and future pandemic preparedness. Traditional information-based approaches, which assume that knowledge deficits drive hesitancy, have proven insufficient when trust is compromised. Instead, rebuilding vaccine confidence requires sustained investment in institutional transparency, community engagement, and accountable governance. Conclusions: The post-pandemic era calls for a fundamental reconceptualization of vaccine hesitancy. We propose the institutional hesitancy framework as a complementary lens that shifts the analytical focus from individual knowledge deficits to relational dynamics between citizens and institutions. Addressing this challenge requires moving beyond communication campaigns toward long-term strategies that restore institutional trust and strengthen the resilience of public health systems. Full article

Background/Objectives: West Nile virus (WNV) is a persistent mosquito-borne threat in Greece. This study examined whether online information-seeking patterns reflected official WNV surveillance during 2024–2025, with Crete providing descriptive field-level One Health preparedness context. Methods: Official national surveillance data were compared with country-level Google Trends relative search volume and Greek-language Wikipedia pageviews, focusing on weekly locally acquired West Nile neuroinvasive disease/central nervous system (WNND/CNS) cases. The Crete component separately summarized regional One Health preparedness. Results: Greece reported 220 locally acquired WNV cases (157 WNND/CNS) in 2024 and 96 (76 WNND/CNS) in 2025. Wikipedia pageviews showed the strongest full-year associations with WNND/CNS activity when pageviews followed cases by one week (2024: Spearman rho = 0.802; 2025: rho = 0.763; both p < 0.001). Google Trends showed weaker associations at the same lag (2024: rho = 0.402, p = 0.003; 2025: rho = 0.452, p < 0.001). Transmission-period sensitivity analyses attenuated several associations: the 2025 Wikipedia associations and the Google Trends associations in both years were not statistically significant. The first-difference lag analysis identified no leading digital signal. Conclusions: Wikipedia showed more stable language-specific temporal concordance with national surveillance than Google Trends. However, the digital indicators reflected concurrent or lagging public attention and did not demonstrate predictive capacity. The Crete component separately illustrates how regional One Health preparedness complements national surveillance and risk communication. Full article

Mpox remains an important public health threat in several African countries, with recurrent outbreaks highlighting the need for decentralized and scalable diagnostic systems. During the 2024–2025 Mpox outbreak in Burundi, reliance on a single National Reference Laboratory limited timely diagnosis, reduced surveillance efficiency, and delayed outbreak response activities. This study describes and evaluates the implementation of a national strategy for decentralizing and expanding Mpox diagnostic capacity across Burundi. A descriptive implementation study was conducted between August 2024 and July 2025. Burundi implemented a four-phase diagnostic scale-up strategy that expanded Mpox testing services from one centralized laboratory to 56 decentralized GeneXpert-equipped laboratories, including mobile laboratory units. The implementation phases comprised strategic planning and risk mapping, pilot deployment at the national level, regional expansion, and extension to peripheral district laboratories. Key interventions included healthcare workforce training, strengthening laboratory supply chains, deployment of mobile diagnostic units, and integration of laboratory information into the national surveillance system. Program performance was assessed using indicators of laboratory network expansion, testing coverage, diagnostic turnaround time, and confirmed case detection. Following implementation, the number of operational Mpox diagnostic sites increased from 1 to 56, representing a 5500% expansion in testing capacity. National testing coverage approached 100%, substantially improving geographical access to diagnostic services. Weekly confirmed Mpox case detection increased by 496%, reflecting enhanced surveillance sensitivity and improved case identification. Diagnostic turnaround time decreased from 24–72 h under the centralized model to 2–4 h following decentralization. The expanded diagnostic network facilitated earlier case confirmation, more rapid isolation of infected individuals, strengthened surveillance activities, and accelerated implementation of outbreak control measures. The phased decentralization of Mpox diagnostics using existing GeneXpert infrastructure and mobile laboratories substantially improved testing access, reduced diagnostic delays, and strengthened outbreak response capacity in Burundi. This approach demonstrates a practical, scalable, and cost-effective model for enhancing epidemic preparedness and building resilient diagnostic systems in resource-constrained settings. Similar strategies could support improved detection and control of Mpox and other emerging infectious diseases across Africa and comparable low-resource environments. Full article

Background/Objectives: Secondary victimization (SV) following sexual assault (SA) is known to compound negative health outcomes for survivors seeking help within formal systems, such as healthcare. While there have been advances in preventing SV and support for SA survivors seeking help within healthcare, experiences of SV persist alongside worsening health disparities, particularly among disenfranchised populations of women. This literature review aims to examine the literature on HCP approaches to practices that may contribute to the SV of SA survivors. Methods: Following the PRISMA 2020 guidelines, the literature from three databases (PubMed, CINAHL Plus, and PsycINFO) was collected, followed by the screening of the titles, abstracts, and full texts of primary data sources available in full text and published in English between 2009 and 2022. The articles included for synthesis were appraised using the Johns Hopkins Nursing Evidence-Based Practice Model (JHNEBP), and the data extracted were analyzed using thematic analysis. Results: Four HCP approaches to practice were found to potentially contribute to the SV of SA survivors: (1) incomprehensive care in clinical practice; (2) a lack of collaboration between inter-agencies, healthcare organizations, interdisciplinary teams, and HCPs with SA survivors; (3) barriers to HCP training and preparedness to respond to SA; and (4) failures to implement trauma-informed care (TIC) frameworks. Conclusions: Based on these findings, we provide recommendations for the prevention and mitigation of the SV of SA survivors by integrating philosophical frameworks to guide healthcare practice, including person-centered care, trauma- and violence-informed care (TVIC), and cultural safety. We reflect on the current gaps identified from this systematic review and the need for future research to operationalize and measure SV after SA in healthcare. Full article

Kazakhstan ruminant genomics is expanding through targeted diagnostic testing, SNP-array studies, whole-genome sequencing, runs of homozygosity, candidate-gene analyses, transcriptomic studies and pathogen molecular diagnostics. However, these evidence types differ substantially in their relevance for breeding decisions. This structured narrative review evaluates molecular evidence for inherited disorders, deleterious alleles, disease-resistance loci, reproductive genes and genomic-health indicators in Kazakhstan cattle, sheep and goats. We define actionable evidence as evidence that can directly inform breeding management because it involves a validated pathogenic variant, risk variant or fertility haplotype detected or excluded in breeding-relevant animals or germplasm. Under this definition, cattle currently provide the strongest immediately actionable evidence, mainly because targeted studies have screened validated defects and fertility-related loci in artificial-insemination bulls, imported germplasm or breed-relevant populations. Evidence includes Kazakhstan-associated screening for BLAD (Bovine leukocyte adhesion deficiency), DUMPS (Deficiency of uridine monophosphate synthase), hypotrichosis, OH1-associated achromatopsia, fertility haplotypes and several beef- or dairy-breed recessive defects. In sheep, evidence is broader but less directly actionable, consisting mainly of prion protein gene preparedness, MHC (Major histocompatibility complex)-related immune hypotheses, reproductive candidate loci, runs of homozygosity, genome wide associated data and pathogen-exposure context. In goats, current evidence is mostly population-genomic and adaptation-oriented, while hereditary-disease surveillance and phenotype-linked resistance studies remain sparse. We propose an author-defined staged genomic-health framework that separates validated carrier-screening evidence from candidate genomic signals and international evidence requiring local validation. Priority actions include carrier-aware management of high-impact cattle germplasm, representative prion protein gene and runs of homozygosity baselines in small ruminants, phenotype-first surveillance, biobanking and national genotype–phenotype databases. Full article