Search Results (12,392)

Adolescent tobacco use remains a critical public health challenge, requiring innovative early prevention strategies. This study participatively evaluated a medium-fidelity prototype of the No le entres app, designed to prevent tobacco use among adolescents. The prototype was developed based on user-centered design and gamification frameworks, with the aim of ensuring cultural relevance and active user engagement. Qualitative design with content analysis was employed. Four focus groups were conducted in Xalapa, Veracruz: two with health professionals from Medical Specialty Units—Community Mental Health and Addiction Centers (UNEME CECOSAMA), and two with secondary school students. Nineteen professionals and twenty-two adolescents participated. Data were analyzed using MAXQDA 2022, applying both a priori and emergent categories. Professionals valued the app’s innovative approach but recommended improvements in navigation speed, visual design, message clarity, and cultural validation. Adolescents emphasized the need for more engaging features, such as music, rewards, team competitions, and updated graphics. Both groups highlighted the importance of interactivity, personalization, and contextualized content. Findings underscore the value of participatory methods in designing digital health interventions and confirm that involving end users enhances usability and acceptability. The app demonstrates potential for integration into school settings as a preventive tool, with implications for influencing adolescent knowledge, attitudes, and behaviors regarding tobacco use. Full article

This review introduces and elaborates a novel temporal paradigm, the “Gout Inflammation Time Programming” model, conceptualized through the Gout-STAT™ framework. This model redefines gout inflammation as a dynamic continuum progressing through three precisely timed phases: an acute Perception phase (0–24 h) initiated by monosodium urate (MSU) crystal recognition, triggering the NOD-like receptor thermal protein domain associated protein 3 (NLRP3) inflammasome and neutrophil-driven burst; a critical Adaptation phase (24–72 h) where outcomes are determined by immunometabolic reprogramming of macrophages and synovial fibroblasts; and a chronic Tissue Injury phase (>72 h) driven by epigenetic memory, leading to irreversible osteoarticular destruction. Deciphering this programmed timeline reveals distinct therapeutic windows. We propose a shift towards stage-specific precision interventions, targeting upstream triggers (e.g., mitochondrial reactive oxygen species(ROS), neutrophil extracellular trap formation (NETosis)) in the acute phase, correcting metabolic checkpoints (e.g., succinate accumulation, impaired autophagy) during adaptation, and employing tissue-protective strategies (e.g., epigenetic modulators) in the chronic phase. Furthermore, we highlight the pivotal role of cutting-edge translational technologies, such as intelligent drug delivery systems and digital twin joint models, in achieving spatiotemporal precision. Understanding this intrinsic molecular clock is fundamental for advancing gout management from reactive treatment to a predictive, preventive, and personalized 4P medicine approach. Full article

Background/Objectives: Unequal access to cervical cancer screening and treatment remains a significant contributor to preventable morbidity and mortality for women in the Amazon Basin, compounded by geographic, social and infrastructural barriers. Given the fragmented nature of the existing evidence, this systematic review aims to synthesize available findings on barriers to cervical cancer screening and treatment for this region. The implications of these findings are examined to inform the development of actionable strategies to improve equity in prevention and care. Methods: This systematic review was conducted in accordance with PRISMA 2020. Searches were conducted on November 7, 2025, in PubMed/MEDLINE, Web of Science, and SciELO, utilizing combinations of MeSH terms, keywords, and free-text expressions. Studies were considered eligible if they addressed barriers to cervical cancer screening or treatment among women living in the Amazon Region. Two reviewers independently screened the studies and extracted the relevant data. The risk of bias was assessed using the JBI checklists, the Newcastle–Ottawa Scale, and the MMAT. A narrative synthesis summarized the results. Results: Of 57 studies identified, 11 were included. Organizational and health-system barriers were reported most frequently, including scheduling difficulties, long wait times, a shortage of professionals, and equipment unavailability. Socioeconomic barriers were most often related to younger age, low income, limited schooling, and care related expenses. Cultural factors were frequently linked to fear of the procedure and insufficient knowledge about cervical cancer. Geographic barriers included rural residence and travel difficulties. Conclusions: This systematic review indicates that disparities in cervical cancer screening in the Amazon region are primarily associated with organizational and health-system-related barriers, together with socioeconomic, cultural, and geographic factors. These findings highlight the need for equitable, multisectoral interventions to strengthen service organization, improve health literacy, and expand timely access to screening and treatment for underserved women. Full article

Background: Severe lower urinary tract dysfunction (LUTD) in neurologically and anatomically normal children is uncommon and frequently underdiagnosed. When severe, functional voiding disorders may closely mimic obstructive or reflux pathology, leading to diagnostic errors, unnecessary invasive procedures, and potential risk to the upper urinary tract. Case presentation: We present three pediatric cases (aged 3–10 years) referred for recurrent febrile urinary tract infections, incontinence, or acute urinary retention in the absence of neurological or structural abnormalities. Urodynamic evaluation identified three distinct severe functional phenotypes: detrusor overactivity with reduced bladder capacity, poor compliance with detrusor–sphincter dyssynergia and secondary high-grade vesicoureteral reflux (Hinman syndrome), and detrusor underactivity with significant post-void residual volumes. All patients demonstrated marked bladder wall remodeling on cystoscopy, including trabeculation and pseudopolypoid mucosal changes. Case discussion: Despite similar clinical severity, the cases illustrated substantial functional heterogeneity and differing risks of upper urinary tract involvement. Urodynamic phenotyping proved central to diagnosis, differentiation from structural disease, and treatment planning. Multimodal conservative management—including urotherapy, pelvic floor biofeedback, targeted pharmacologic therapy, and, when indicated, clean intermittent catheterization or antibiotic prophylaxis—led to resolution of recurrent infections and meaningful improvement in bladder function during medium-term follow-up, although symptom recurrence occurred in one patient after treatment withdrawal. Conclusions: These cases highlight the heterogeneity and potential reversibility of severe functional LUTD in otherwise healthy children. Early functional recognition based on urodynamic assessment is essential to avoid misdiagnosis, prevent unnecessary surgical intervention, and protect renal function. Conservative, function-oriented management remains the cornerstone of effective treatment. The findings are discussed in the context of the existing literature on severe non-neurogenic LUTD and Hinman syndrome. Full article

Maintaining sustainable mental health is an increasing societal challenge in Japan, where psychological distress and sleep problems have become major public health concerns. This study examined how three culturally grounded dimensions of self-construal—Subjective Self (SS), Objective Self (OS), and Autonomous Self (AS)—relate to both positive and negative indicators of psychological adjustment among Japanese adults. This study aimed to examine whether internally guided forms of self-regulation (SS and AS) function as psychological resources, whereas externally guided self-regulation (OS) operates as a potential vulnerability factor in a culturally tight social context. By simultaneously examining multiple indicators of adjustment, this research clarifies how culturally shared self-regulatory patterns are linked to distress and sleep difficulties that affect large segments of the population. From a public health perspective, the findings highlight socially reinforced risk and protective patterns that can inform population-level prevention and mental health promotion in settings such as schools, workplaces, and communities, rather than relying solely on individual clinical intervention. These results underscore the importance of integrating cultural psychology into public health frameworks aimed at promoting sustainable mental health in contemporary and increasingly diverse social environments. Full article

Background: Cardiac rehabilitation (CR) is a key component of secondary prevention after acute coronary events, coronary and valve interventions, and device implantation, yet participation and long-term adherence remain suboptimal. Digital technologies offer the potential to extend CR beyond the centre-based model and to support more flexible, patient-centred care. Methods: This narrative “review on a systematic backbone” synthesizes original clinical studies published between 2005 and 2025 that evaluated the use of digital technologies as an integral part of CR in adults after myocardial infarction, revascularization, valve procedures or implantation of cardiac devices. Interventions were grouped into four categories: mobile health (mHealth) and tele-rehabilitation, virtual reality (VR) and exergaming, virtual education platforms, and other multi-component digital CR solutions. Only original studies with clinical, functional, or patient-reported outcomes were included. Results: Twenty-one studies on the categories mentioned above met the eligibility criteria. mHealth-enabled home-based or hybrid CR programs consistently achieved improvements in functional capacity and physical activity that were broadly comparable to centre-based CR, with generally high adherence. VR and exergaming interventions were feasible and safe, produced at least similar functional gains, and showed more consistent benefits as far as anxiety levels and engagement levels. Virtual education platforms delivered knowledge and produced behaviour change similar to traditional education and, in some studies, supported better control of blood pressure and lipids. Comprehensive digital CR platforms improved risk-factor profiles and quality of life to a degree comparable with face-to-face CR. Conclusions: Digital technologies can credibly support core objectives of CR in high-risk patients and expand access, but must be implemented as a complement to, rather than a replacement for, multidisciplinary, patient-centred rehabilitation. Full article

Background: The emergence of artificial intelligence (AI) has triggered a global transformation, with the healthcare sector experiencing significant disruption and innovation. In current public health practice, AI is being deployed to power various aspects of public functions, including the assessment and monitoring of health, surveillance and disease control, health promotion and education, policy development and planning, health protection and regulation, prevention services, workforce development, community engagement and partnerships, emergency preparedness and response, and evaluation and research. Nevertheless, its use in leadership and management, such as in change management, process development and integration, problem solving, and decision-making, is still evolving. Aim: This study proposes the adoption of the Public Health AI Framework to ensure that inclusive data are used in AI development, the right policies are deployed, and appropriate partnerships are developed, with human-relevant resources trained to maximize AI potential. Implications: AI holds immense potential to reshape public health by enabling personalized interventions, democratizing access to actionable data, supporting rapid and effective crisis response, advancing equity in health outcomes, promoting ethical and participatory public health practices, and strengthening environmental health and climate resilience. Achieving this goal will require a deliberate and proactive leadership vision, where public health leaders move beyond passive adoption to collaborate with AI specialists to co-create, co-design, co-develop, and co-deploy tools and resources tailored to the unique needs of public health practice. Call to action: Public health professionals can co-innovate in shaping AI evolution to ensure equitable, ethical, and value-based public health. Full article

Background/Objectives: The gut microbiota is increasingly recognized as a key determinant of human health, playing a vital role in metabolism, immunity, and disease susceptibility. Dysbiosis, or microbial imbalance, is associated with gastrointestinal disorders such as irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), and Clostridioides difficile infection (CDI), as well as extraintestinal conditions, including obesity, cardiovascular disease, and neuropsychiatric disorders. This review aims to provide an updated overview of emerging therapeutic strategies to modulate the gut microbiota to restore eubiosis and improve health outcomes. Methods: A narrative review of recent literature was conducted, focusing on preclinical and clinical studies investigating microbiota-targeted therapies. The review primarily covers innovative interventional approaches, including fecal microbiota transplantation (FMT), bacterial consortium transplantation (BCT), bacteriophage therapy and outer membrane vesicles (OMVs). Results: Evidence supports the role of probiotics, prebiotics, and synbiotics in remodeling microbial communities and improving host health, although their effects may be strain- and context-dependent. FMT has demonstrated high efficacy in the treatment of recurrent Clostridium difficile infections and is being studied for IBD, IBS and extraintestinal diseases, following the recent Food and Drug Administration approval of the first commercial FMT products. BCT offers a standardized alternative to donor-derived material, with early clinical successes such as FDA-approved SER-109. Phage therapy and OMVs represent promising frontiers, offering targeted microbial modulation and interactions with the immune system, although clinical data remain limited. Conclusions: Emerging gut microbiota modulation strategies offer new perspectives for precision medicine and could transform the prevention and treatment of many diseases, but further studies are needed to ensure their safety, standardization, and clinical application. Full article

Background/Objectives: Health Promotion Centres (HPCs) in Slovenia represent a European best practice for integrated prevention and health promotion. This study explores the feasibility of adapting the Slovenian HPC model to Bergamo Province, Lombardy, considering local population needs and health system characteristics. Methods: We conducted a qualitative feasibility and policy analysis based primarily on documentary review, complemented by a webinar, a study visit to Slovenia, and expert consultations (conducted in two group discussions) with professionals from ATS (Agenzia Tutela della Salute) Bergamo and local ASST (Azienda Socio-Sanitaria Territoriale) providers. Data were analysed using the PIET-T framework (Population–Intervention–Environment–Transfer). Results: Eight key elements define the Slovenian model: (1) governance and stewardship; (2) structural financing; (3) standardized service portfolio; (4) systematic preventive referrals; (5) integration with primary care and screening; (6) multidisciplinary teams with codified training; (7) community outreach and equity orientation; and (8) information systems and reporting. While Bergamo shares similar demographic and epidemiological profiles, differences in behavioral risk factors, project-based financing, fragmented initiatives, and limited digital integration necessitate adaptation. The comparative assessment highlighted key areas requiring contextual adaptation, including financing mechanisms, organisational coordination, workforce capacity, digital interoperability, and approaches to equity. Conclusions: The Slovenian HPC experience demonstrates the potential of integrated, community-based health promotion. Its adaptation to Lombardy appears feasible if core components are preserved and tailored to local governance, population, and health system conditions. These organisational features may be particularly relevant for time-dependent conditions, such as acute cardiovascular and cerebrovascular events, by potentially supporting more timely risk-factor management and coordination across diagnostic and emergency pathways. Rather than a blueprint for reform, this experience offers useful insights to reinforce prevention and health promotion within the ongoing territorial care reform in Lombardy. Full article

Social acceleration and recurrent structural shocks increase habitus–field mismatch, yet similar exposure does not produce uniform trajectories of daily well-being or suicidal distress. This paper asks how comparable structural strain can generate divergent, path-dependent outcomes and why suicidal vulnerability may persist after objective conditions improve. We develop a theory-building, concept-driven framework that integrates Bourdieu’s practice theory with social and behavioural scholarship on stress, anomie, and despair, and conceptualises these dynamics as social hysteresis. The regime-based model specifies two ideal-typical response orientations through which mismatch can stabilise: an anomic regime marked by shame, withdrawal, and inwardly directed harm, and a radicalising regime marked by grievance framing, moral indignation, and organised participation, without implying violent extremism. Represented through hysteresis loops, the framework implies multistability, asymmetric switching thresholds, and scarring, providing a mechanism for persistence and non-linearity in distress trajectories. The model derives testable expectations for longitudinal panel and experience-sampling designs and suggests that prevention and intervention design should combine reductions in mismatch with relational and institutional infrastructures that facilitate regime shifts and reopen the space of possibles. Full article

Background: Mammary ductal hyperplasia represents a spectrum of benign proliferative breast lesions, some of which pose elevated risks for malignant transformation into ductal carcinoma in situ and invasive breast cancer. This narrative review explores why only specific types, particularly those with atypia, exhibit higher progression potential, synthesizing epidemiologic, histopathologic, molecular, and environmental insights. Methods: We reviewed key literature from databases, including PubMed, focusing on classification, risk stratification, genetic/epigenetic mechanisms, tumor microenvironment dynamics, and modifiable factors influencing progression. Results: Benign breast lesions are categorized into non-proliferative, proliferative without atypia, and proliferative with atypia, such as atypical ductal hyperplasia and atypical lobular hyperplasia. Atypia represents a morphologic continuum toward low-grade ductal carcinoma in situ, driven by genetic alterations, epigenetic reprogramming, and changes in the tumor microenvironment, including stromal remodeling, immune infiltration, hypoxia-induced angiogenesis, and extracellular matrix degradation. Dietary factors, such as high-fat intake and obesity, exacerbate progression through inflammation, insulin resistance, and adipokine imbalance, while environmental toxins, including endocrine disruptors, pesticides, and ionizing radiation, amplify genomic instability. Conclusions: Understanding differential risks and mechanisms underscores the need for stratified surveillance, biomarker-driven interventions, and lifestyle modifications to mitigate progression. Future research should prioritize molecular profiling for personalized prevention in high-risk hyperplasia. Full article

Snakebite envenoming is classified as a Neglected Tropical Disease and causes mortality, morbidity, and economic impacts for hundreds of thousands of people per year, particularly in tropical, low- and middle-income countries. Most research on snakebite interventions focuses on improving clinical management rather than bite prevention. However, prevention may provide a better mechanism to minimise snakebite impacts, particularly in rural areas where access to effective medical treatment is limited. This study reports on the preliminary testing phase of a participatory workshop intervention run in rural Uganda in 2022–23, which used a community engagement approach designed to reduce snakebites through discussing snake behaviour and biology. A mixed methods survey and semi-structured interviews were conducted, both with workshop attendees and non-attendees, after the delivery of the workshops. We found that a fearful attitude toward snakes often led to human–snake conflict, with snake killings occurring commonly, and some bites occurring during attempted killings. Workshops appeared to challenge negative attitudes, as understanding snake behaviour seemed to build compassion toward snakes and therefore has the potential to reduce human–snake conflict. Those who attended workshops were more likely to suggest ‘giving snakes space,’ rather than attempting to kill them, and were more likely to suggest hospital treatment if bitten. We also found that many effective methods for snakebite prevention are already known to the community, but those who attended the workshop were aware of a wider range of prevention methods and were more likely to implement less ecologically damaging and more effective strategies. This emphasises that appropriate knowledge resides within the community to prevent snakebites, and so community engagement approaches can improve prevention practices while recognising that the ownership and knowledge for such changes is generated by the local people themselves. Full article

Background: Metabolic syndrome (MetS) is a pathological condition characterized by the co-occurrence of multiple metabolic abnormalities. The affected population is increasingly shifting toward younger age groups. Emerging digital health technologies, arising from advances in digital society, offer novel methodological tools for lifestyle-based interventions targeting metabolic risk. This systematic review aims to evaluate the effectiveness of emerging digital health technologies based on dietary and physical activity regulation in improving MetS-related outcomes among adolescents, including school-aged children. Methods: This review followed the PRISMA guidelines, systematically searched PubMed, Web of Science, Embase, MEDLINE, and Scopus, and screened eligible studies based on the PICO framework. Results: A total of 12 randomized controlled trials published between 2012 and 2025 were included in the analysis. Single device interventions (5/12) and dual device combinations (5/12) were the predominant approaches used in current digital health technology applications. Intervention content primarily focused on either physical activity alone (5/12) or combined exercise and nutrition interventions (7/12), with most programs lasting 3–6 months (7/12). Across the included digital health interventions, 13 MetS-related measures were assessed, including anthropometric/body composition measures (BMI, BMI z-score, WC, WHR, WHtR, and VFA), blood pressure measures (SBP/DBP), and biochemical markers (BG, HOMA-IR, TG, TC, HDL-C, and LDL-C). Conclusions: The available evidence supports the potential of digital health technologies to improve MetS-related outcomes. Although the selection of biochemical markers varied across studies, the findings highlight the importance of combined exercise and nutrition interventions or physical activity of moderate to high intensity in improving MetS. These results underscore the value of digital health technologies in elucidating the complex interactions among diet, physical activity, and metabolic responses. Overall, these findings support integrating digital health technologies into adolescent lifestyle interventions to facilitate more personalized monitoring and behavior support, and to potentially improve MetS-related outcomes. By promoting timely improvements in these outcome measures, such digital health interventions may have potential longer term implications for chronic disease prevention. Full article

Wildland firefighting involves prolonged, high-intensity physical work performed under hot, variable, and operationally demanding conditions, placing firefighters at substantial risk of heat-related illness. This paper synthesizes current evidence on the mechanisms, contributing factors, and management of heat stress in wildland firefighting, with a specific focus on physiologically and operationally relevant considerations aligned with NIOSH, NFPA, and USFS guidelines. Heat stress is conceptualized as a cumulative process resulting from the interaction of metabolic heat production, environmental heat load, protective clothing, and individual susceptibility. Key environmental contributors include high ambient temperatures, humidity, and solar and fire-related radiant heat, while occupational demands such as sustained heavy work, extended shift durations, limited recovery, and the thermal burden of personal protective equipment further exacerbate risk. Individual factors—including fitness, hydration status, acclimatization, fatigue, and underlying health conditions—modify heat tolerance and vulnerability. This review highlights evidence-based exposure management strategies tailored to wildland fire operations, including work–rest cycles, heat acclimatization protocols, and practical cooling interventions, and addresses the operational constraints that shape their implementation. This paper further emphasizes the role of standardized training programs in prevention, early symptom recognition, and rapid response. Together, these integrated approaches provide a focused framework for reducing heat-related morbidity and enhancing wildland firefighter safety. Full article

Background/Objectives: Although cyberbullying among adolescents has been widely studied, relatively little attention has been paid to the overlapping roles through which cyberbullying is experienced. This study reconceptualizes cyberbullying involvement by classifying perpetration, victimization, and witnessing into eight mutually exclusive involvement types, enabling systematic and non-overlapping comparison of adolescents’ experiences. The study further examines how engagement in individual-level cyber-risk indicators is associated with different patterns of cyberbullying involvement. Methods: The study analyzed nationally representative data from the 2022 Cyberbullying Survey conducted by the Korea National Information Society Agency, including 9693 students from elementary, middle, and high schools across South Korea. Individual-level cyber-risk indicators were assessed through multiple dimensions, including risky online behaviors, intensity of digital activity, peer environments, and awareness of harmful online behaviors. Multinomial logistic regression analyses were conducted to examine associations between individual-level cyber-risk indicators and the eight types of cyberbullying involvement. Results: Engagement in individual-level cyber-risk indicators was associated with increased odds of involvement in at least one cyberbullying type. Risky online behaviors and exposure to peers engaging in cyberbullying were linked to higher likelihood of both single and overlapping involvement patterns, whereas greater acceptance of harmful online behaviors was consistently associated with lower odds of victimization. Conclusions: These findings underscore cyberbullying as a relational and context-dependent phenomenon shaped by everyday digital practices and peer norms rather than isolated individual behavior. From a school social work perspective, the results support preventive, environment-focused interventions, including school-based media literacy education and institutionalized cyberbullying response systems, as promising strategies for reducing cyberbullying involvement among adolescents. Full article