Search Results (5,693)

The supply and demand levels of urban health resources directly impact residents’ quality of life and health. This study employs the Multi-Mode Three-Step Floating Catchment Area (MM3SFCA) method to assess the supply and demand levels of health resources in the main urban area of Harbin under different transportation modes. To address the gap in previous studies that did not consider the impact of the spatial distribution of health resources at varying distances on residents, K-means clustering analysis was applied. The results indicate a significant imbalance between supply and demand for health resources in Harbin’s main urban area. Specifically, approximately 86% of the population met the supply-and-demand standards for health care facilities. However, only 29% and 41% of the population met the supply and demand standards for physical activity facilities and leisure wellness facilities, respectively. From a transportation perspective, the findings reveal that in areas with balanced or abundant supply and demand, residents primarily rely on driving and public transportation. This suggests that health resources are still concentrated in areas far from residential zones, thereby affecting accessibility to resources for some residents. Full article

Background: Despite its crucial role in overall health, oral health is frequently overlooked within healthcare systems, partly due to the misconception that oral diseases are neither life-threatening nor directly disabling. This perception has led to an underestimation of the psychological, social, and economic burden associated with oral diseases. Τhe present study aimed to assess oral health status and oral health-related quality of life among dental patients attending a public Special Care Center in Greece. Methods: A cross-sectional study was conducted among 400 dental patients aged 18 years and older who visited a public Special Care Center for a routine check-up or a dental problem between September and October 2024. Data was collected through personal interviews and clinical examinations after informed consent was obtained. Oral health-related quality of life was evaluated using the Oral Health Impact Profile-14 (OHIP-14) and the Oral Impacts on Daily Performance (OIDP) questionnaires. Categorical variables were presented as absolute and relative frequencies, while quantitative variables were summarized as mean, standard deviation, median, minimum, and maximum. Normality was assessed using the Kolmogorov–Smirnov test. Bivariate analyses and multivariate linear regression models were performed, with statistical significance set at p < 0.05. Statistical analyses were conducted using IBM SPSS 23.0. Results: The majority of participants were female (56.3%) with a mean age of 50.4 years (SD = 14.9). Overall oral health-related quality of life was moderate (OHIP-14: Mean = 21.0, SD = 14.8; OIDP: Mean = 14.0, SD = 12.8). Patients who attended the center due to a dental problem reported significantly poorer oral health outcomes than those attending routine check-ups (p < 0.001). Poorer self-rated oral health, having ≥12 missing teeth, prosthetic restoration, and foreign nationality were significantly associated with worse oral health-related quality of life. Conclusions: Dental patients attending the Special Care Center demonstrated moderate oral health status, which was associated with psychological distress, physical disability, and social limitations. These findings underline the need for targeted public oral health interventions, especially for vulnerable population groups. Full article

Background/Objectives: Healthy ageing, focused on maintaining daily autonomy and cognitive function despite chronic comorbidities, poses a challenge for public health systems, especially for those aged ≥80, given the expected increase in this population. Promoting a healthy lifestyle in this group is essential to achieving this goal, with primary care services playing a key role in this effort. Therefore, our objective was to profile the participants based on these characteristics. Methods: The study included 222 non-institutionalized, dementia-free individuals (mean age 84.58 ± 3.72 years, 56.3% women) recruited from a primary healthcare service. Data were collected from medical records and interviews, including the cognitive Pfeiffer test, the functional Barthel index (BI), and ad hoc questionnaires (for lifestyle variables). Latent profiling analysis (LPA) was used to classify the participants. Results: The participants reported social support (97.7%), low-risk alcohol consumption (94.6%), adherence to the Mediterranean diet (85.1%), physical activity (74.8%), and never smoking (72.5%). Hypertension (86.5%), cataracts (74.3%), and osteoarticular diseases (68.5%) were the most frequent chronic conditions. Women showed a significantly different distribution of certain variables and a higher number of comorbidities (6.34 ± 2.38) than men (5.58 ± 2.44) (p = 0.019). After LPA, we found that 38.29% of individuals met characteristics compatible with healthy ageing, predominantly male (60%); the association of a high probability of cognitive impairment with a high degree (severe or total), exhibited by the profiles likely >85% women (18.5% of individuals); physical activity, smoking, osteoporosis, anxiety, COPD, chronic kidney disease (CKD), and creatinine blood levels exhibited statistical differences between profiles; and the probability of dependence severity was associated with an increase in age, although cognitive status conservation was associated being male. Conclusions: The studied +80 group seems to follow a healthy lifestyle, as self-reported. Women fare worse than men in resilient ageing. While common factors related to dysfunctionality did not differentiate between profiles, CKD, an increasingly common age-related condition, did. Full article

Background and Objectives: Hypertension affects more than 27% of adults in China, and despite ongoing public health efforts, substantial gaps remain in awareness, treatment, and blood pressure control, particularly among older adults and patients with multiple comorbidities. Conventional clinic-based care often provides limited opportunity for frequent monitoring and timely treatment adjustment, which may contribute to persistent poor control in routine practice. The objective of this study was to evaluate changes in blood pressure control and related clinical indicators during implementation of a mobile-enhanced remote patient monitoring (RPM)–supported care model among hypertensive patients with comorbidities, including patterns of medication adjustment, adherence, and selected cardiometabolic parameters. Methods: We conducted a multicenter, pre–post evaluation of a mobile-enhanced remote patient monitoring (RPM) program among 6874 adults with hypertension managed at six hospitals in Chongqing, China. Participants received usual care during the pre-RPM phase (April–September 2024; clinic blood pressure measured using an Omron HEM-7136 device), followed by an RPM-supported phase (October 2024–March 2025; home blood pressure measured twice daily using connected A666G monitors with automated transmission via WeChat, medication reminders, and clinician follow-up). Given the use of different devices and measurement settings, blood pressure comparisons may be influenced by device- and setting-related measurement differences. Monthly blood pressure averages were calculated from all available readings. Subgroup analyses explored patterns by sex, age, baseline BP category, and comorbidity status. Results: The cohort was 48.9% male with a mean age of 66.9 ± 13.7 years. During the RPM-supported care period, the proportion meeting the study’s blood pressure control threshold increased from 62.4% (pre-RPM) to 90.1%. Mean systolic blood pressure decreased from 140 mmHg at baseline to 116–118 mmHg at 6 months during the more frequent monitoring and active treatment adjustment period supported by RPM (p < 0.001), alongside modest reductions in fasting blood glucose and total cholesterol. These achieved SBP levels are below commonly recommended office targets for many older adults (typically <140 mmHg for ages 65–79, with individualized lower targets only if well tolerated; and less stringent targets for adults ≥80 years) and therefore warrant cautious interpretation and safety contextualization. Medication adherence improved, and antihypertensive regimen intensity increased during follow-up, suggesting that more frequent monitoring and active treatment adjustment contributed to the early blood pressure decline. Subgroup patterns were broadly similar across age and baseline BP categories; observed differences by sex and comorbidity groups were exploratory. Conclusions: In this large multicenter pre–post study, implementation of an RPM-supported hypertension care model was associated with substantial improvements in blood pressure control and concurrent intensification of guideline-concordant therapy. Given the absence of a concurrent control group, clinic-to-home measurement differences, and concurrent medication changes, findings should be interpreted as associations observed during an intensified monitoring and treatment period rather than definitive causal effects of RPM technology alone. Pragmatic randomized evaluations with standardized measurement protocols, longer follow-up, and cost-effectiveness analyses are warranted. Full article

Background/Objectives: Telemedicine has emerged as a pivotal approach to improving access to diabetic retinopathy (DR) screening, diagnosis, management, and monitoring. Over the past two decades, rapid advancements in digital imaging, mobile health technologies, and artificial intelligence have substantially expanded the role of teleophthalmology in DR, resulting in a large volume of pertinent publications. This study aimed to provide a scientific overview of telemedicine applied to DR through bibliometric analysis. Methods: A search of the Web of Science Core Collection was conducted on 15 November 2025 to identify English-language original research and review articles regarding telemedicine for DR. Bibliographic data from relevant publications were extracted and underwent quantitative analysis and visualization using the tools Bibliometrix and VOSviewer. Results: A total of 515 articles published between 1998 and 2025 were included in our analysis. During this period, the research field of telemedicine for DR exhibited an annual growth rate of 13.14%, with publication activity markedly increasing after 2010 and peaking in 2020–2021. Based on the number of publications, United States, China, and Australia were the most productive countries, while Telemedicine and e-Health, Journal of Telemedicine and Telecare, and British Journal of Ophthalmology were the most relevant journals in the field. Keyword co-occurrence analysis revealed three major thematic clusters within the broader topic of telemedicine and DR, namely, public health-oriented work, telehealth service models, and applications of artificial intelligence technologies. Conclusions: The role of telemedicine in DR detection and care represents an expanding multidisciplinary field of research supported by contributions from multiple authors and institutions worldwide. As technological capabilities continue to evolve, ongoing innovation and cross-domain collaboration could further advance the applications of teleophthalmology for DR, promoting more accessible, efficient, and equitable identification and management of this condition. Full article

The COVID-19 pandemic highlighted critical issues in health services and public policy, particularly in long-term care facilities across Canada. Failures in these facilities revolving around chronic underfunding, staffing shortages, inadequate infection control, and inconsistent regulatory oversight, underscore the need to rethink health service interventions, especially considering varying implementation contexts among provinces. The Ontario Long-Term Care COVID-19 Commission Final Report pointed to long-standing systemic issues as the primary causes of the sector’s failures. To explore this issue, a narrative review was conducted with findings indicating that the long-term care crisis in Canada cannot be solved by more privatization, regulation or efficiency measures, as these have contributed to the problem’s root causes. Ontario’s long-term care crisis stems from systemic misalignments in policy, structure and stakeholder dynamics, requiring a shift toward systems thinking and resident-centered care to build an equitable and sustainable long-term care sector. Ultimately, governments must lead a policy redesign that reflects shared responsibility, stakeholder interdependence, and public involvement, offering a model for broader healthcare reform. Full article

Hypertension remains one of the most pressing public health challenges worldwide, affecting more than one billion individuals and serving as a principal risk factor for cardiovascular morbidity and mortality. Whilst blood pressure measurement constitutes a routine component of clinical practice, the capacity to predict blood pressure values from readily obtainable patient characteristics could substantially enhance preventive care strategies and facilitate timely intervention. The present study examines whether machine learning methodologies can reliably forecast blood pressure measurements utilizing cardiovascular risk factors in conjunction with demographic and anthropometric data. We have analyzed data from 68,616 individuals following rigorous quality assessment of 70,000 patient records obtained from Kaggle’s cardiovascular disease repository. Beyond the 10 original variables, we engineered additional features encompassing demographic patterns, body composition indices, clinical risk indicators, and their interactions. Nine distinct predictive models were systematically evaluated, spanning from elementary baseline approaches through to sophisticated gradient boosting ensembles. CatBoost demonstrated superior performance, yielding systolic blood pressure predictions with a root mean squared error (RMSE) of 14.37 mmHg and coefficient of determination (R²) of 0.265, alongside diastolic blood pressure predictions with RMSE of 8.57 mmHg and R² of 0.187. These modest explained variance values—substantially below unity—reveal a fundamental limitation: blood pressure proves remarkably resistant to prediction from the demographic, anthropometric, and clinical variables typically available in epidemiological datasets. These findings illuminate a sobering reality regarding blood pressure prediction from routinely collected clinical data. The observation that standard variables account for merely one-quarter of blood pressure variance should temper expectations for machine learning applications within this domain, whilst simultaneously underscoring the necessity for richer data sources or novel biomarkers to achieve clinically meaningful predictive accuracy. Full article

Background: Maternal mortality in Brazil remains a critical indicator of social and racial inequalities, reflecting structural failures in access to and quality of obstetric care. Black women, particularly those categorized as black or brown, are at a higher risk of dying during pregnancy, childbirth, or the postpartum period. This is the result of the intersection of institutional racism, poverty, and social vulnerabilities. This study aimed to analyze trends and associated factors of maternal mortality among black women in Brazil from 2000 to 2020. Methods: This is a retrospective cohort analytical study using data from the Brazilian Mortality Information System. The sample included women aged 10 to 49 years whose underlying cause of death was classified under ICD-10 codes O00–O99. Descriptive and bivariate analyses were conducted, as well as Poisson and multinomial logistic regressions to estimate adjusted risk ratios according to skin color, education, region, type, and place of death. Results: A total of 40,907 maternal deaths were identified, with 59.2% occurring among black women. The maternal mortality ratio was 39% higher among black women compared to white women and more than double among Indigenous women. Low education, residence in the North and Northeast regions, deaths outside hospital settings, and lack of formal investigation were independently associated with increased risk. Direct obstetric causes accounted for most deaths, with hypertensive disorders and puerperal complications being the leading conditions. Conclusions: Maternal mortality among black women in Brazil reveals deep structural inequalities. Urgent public policies that incorporate an intersectional perspective, addressing race, gender, and class, are necessary to reduce disparities and ensure equitable and dignified maternal healthcare. Full article

Background: Integrating palliative care (PC) into primary health care (PHC) is essential for achieving Universal Health Coverage and reducing avoidable suffering. Despite global progress in PC development, the extent to which PC is effectively embedded within PHC systems remains unclear, particularly in low- and middle-income countries. Colombia illustrates this gap, with an advanced legal framework but persistent territorial inequities. This study explored how national experts conceptualize PC integration into PHC to inform the development of context-sensitive indicators. Methods: A directed thematic analysis was conducted using qualitative comments from a modified Delphi process (pre-Delphi, Round 1, Round 2). Coding was guided by the WHO model for PC development and the WHO–UNICEF Operational Framework for PHC, combining deductive and inductive approaches to identify recurrent themes. Results: A total of 230 qualitative comments from experts in PC, PHC, and public health were analyzed. Experts described integration as the alignment of policy, education, service delivery, and community participation within PHC structures. They emphasized that laws and training programs alone are insufficient; integration depends on implementation capacity, equitable access, and locally responsive systems. Rural areas were identified as facing the greatest barriers, including limited trained staff, restricted medicine availability, and weak referral pathways. Conclusions: Experts understood PC integration into PHC as a dynamic and ethical process linking system design with human experience. Strengthening equity, workforce preparation, and community engagement is essential to translate policy into practice and to develop meaningful indicators for health system improvement. Full article

Background: Glioblastoma multiforme (GBM), the most aggressive primary brain malignancy in adults, is associated with poor prognosis and recurrence despite standard of care and newer immunotherapies. This warrants exploration of synergistic approaches such as combination immunotherapy for improved tumor control. Methods: We initiated a systematic review of articles from 2015–2025 in PubMed, Embase, Scopus, Cochrane, and Web of Science if they assessed immunotherapy for GBM. Results: We included 49 studies (n = 3002 patients) with no significant demographic differences across publications. Combination immunotherapy regimens demonstrated higher pooled ORRs in limited comparative analyses, though findings were driven by a small number of studies. Single-arm analysis for overall survival (OS), progression-free survival (PFS), treatment-related adverse events (TRAEs), and ORR showed no significant differences among the groups. However, treatment–control arm analysis showed pooled ORs of 9.51 for combination immunotherapies and 0.44 in the control group. Conclusions: Combining immunotherapeutics across mechanisms may potentiate immune response effectiveness against GBM. Full article

Timely recognition of type 1 diabetes (T1D) in children and adolescents is crucial to prevent acute complications such as diabetic ketoacidosis (DKA). This narrative review examines the pathophysiology, clinical presentation, and diagnostic challenges of childhood T1D, including the young age of onset, clinician training gaps, and overlapping symptomatology between T1D and other common pediatric illnesses. Despite increased awareness, a significant proportion of children still present with DKA at diagnosis due to misinterpretation of symptoms, such as polydipsia, polyuria, and weight loss. This work emphasizes the importance of early recognition, timely intervention, and the use of structured management algorithms for primary care clinicians. Strategies to reduce DKA incidence, based on existing literature, successful real-world examples, and current guidelines, include enhanced screening for high-risk populations, educational initiatives, and improved diagnostic protocols. By implementing systematic approaches and public health campaigns, healthcare providers can improve early T1D detection and prevent severe DKA complications, ultimately enhancing patient outcomes and reducing long-term morbidity. Full article

Objective: The aim of this study was to systematically map evidence to inform best practices for sexual and reproductive healthcare delivered via telehealth (TeleSRH) in United States-based Title X-funded clinics. Methods: We searched three databases (2017–2025) for studies evaluating effectiveness, harms, patient and provider experiences, barriers/facilitators, and engagement strategies encompassing TeleSRH for sexually transmitted infections (STIs), contraceptive care/family planning (CC/FP), and sexual wellness, in countries with a human development index of ≥0.8. Results: From 5963 references and 436 articles, we included 142 eligible publications. TeleSRH use declined since the COVID-19 pandemic’s peak but remains higher than pre-pandemic. Evidence comes mostly from poor-quality studies. TeleSRH increases access and adherence to STI prevention (e.g., pre-exposure prophylaxis for HIV). Tele-follow-up may safely facilitate HIV care continuity. For CC/FP, TeleSRH is comparable to in-person care for patient satisfaction and uptake; patients are less likely to select long-acting reversible contraception but post-initiation tele-follow-up may increase its continuation rates. Vasectomy completion rates may be similar between pre-procedural counseling via telehealth versus in-person. TeleSRH’s potential benefits might include reduced travel time, wait times, no-show rates, and clinic human resource burden (via tele-triaging) and increased preventative screening rates for STIs and non-communicable diseases, prescription refill rates, ability to receive confidential care in preferred settings, and rural/marginalized community outreach. Implementation challenges span technological and capital constraints, provider availability, staff capability building, restrictive policies, language incompatibility, and patient mistrust. Supplementing synchronous TeleSRH with asynchronous communication (e.g., mobile application) may improve continued patient engagement. Conclusions: Preventive, diagnostic, and therapeutic TeleSRH can be effective, with high patient acceptability; however, effectiveness and adoption hinge on contextual factors outlined in this review. Full article

Background/Objectives: Healthcare workers (HCW) in primary care settings play a significant role in recommending vaccines to patients. We aimed to describe COVID-19 vaccination knowledge, attitudes, perception, and practices (KAPP) of HCWs in Tunisia and identify associated factors. Methods: We conducted a national cross-sectional survey (29 January to 3 February 2024) among HCWs in primary public healthcare centers using purposive sampling. Factors associated with good knowledge, positive attitude, and good practice, measured through Likert scales using face-to-face questionnaires, were identified using binary logistic regression. Results: We included 906 HCWs (mean age = 41.87 ± 8.89 years). In total, 37.75% (342/906) of HCWs had good knowledge and perception, 4.30% (39/906) had a positive attitude, and 24.9% (226/906) had good practices related to COVID-19 vaccination. Working in urban compared to rural areas was associated with good knowledge (aOR = 1.57, 95%CI = 1.12–2.21) and positive attitude (aOR = 4.94, 95%CI = 1.19–20.44) to COVID-19 vaccination. Physicians had better KAPP scores than other medical professionals. HCWs working in departments with high-risk patients were more likely to have good knowledge (aOR = 1.28, 95%CI = 1.00–1.72). Positive attitude was also associated with being male (aOR = 2.97, 95%CI = 1.75–5.07) and having at least one non-communicable disease (aOR = 1.92, 95%CI = 1.14–3.23). Being male (aOR = 1.97, 95%CI = 1.35–2.88) and having more years of professional experience (aOR = 1.81, 95%CI = 1.29–2.52) were associated with good practice. Conclusions: Just over a third of HCWs in primary healthcare clinics had good knowledge of COVID-19 vaccination, while positive attitudes and good practices were low. Targeted interventions, particularly for HCWs with less professional experience working in rural settings, are needed to increase good practices and improve COVID-19 vaccination coverage in Tunisia. Full article

Background: The belief that “sugar feeds cancer” is widespread and has strongly influenced public perceptions, patient behavior, and dietary recommendations, despite uncertainty regarding its scientific validity. This belief largely stems from misinterpretation of the Warburg effect, which describes altered glucose metabolism in cancer cells rather than dietary sugar dependence. The objective of this review was to critically evaluate whether dietary sugar intake directly contributes to cancer development or progression by examining the totality of epidemiological, experimental, and mechanistic evidence. Methods: We conducted a narrative review of human epidemiological studies, experimental animal and cell-based models, and mechanistic investigations published between 1980 and July 2025. Evidence was synthesized across cancer types, sugar sources, and biological pathways, with careful consideration of study design, exposure relevance, and key confounders, including obesity, insulin resistance, and overall dietary patterns. Results: Across cancer types, epidemiological evidence showed predominantly null or inconsistent associations between sugar intake and cancer risk or outcomes, with positive findings largely confined to metabolically susceptible subgroups and often attenuated after adjustment for adiposity and energy intake. Experimental studies suggested potential tumor-promoting effects under non-physiological conditions, while mechanistic data indicated that sugar influences cancer risk indirectly through insulin signaling, inflammation, and metabolic dysfunction rather than direct tumor fueling. Conclusions: Current evidence does not support the hypothesis that dietary sugar directly “feeds” cancer in humans. Overemphasis on sugar avoidance risks nutritional and psychological harm, particularly among cancer patients. Evidence-based guidance should prioritize overall dietary quality, metabolic health, and patient well-being rather than isolated sugar restriction. Full article

Severe emotional stress constitutes a significant public-health concern associated with negative health outcomes. Although the clinical effects are well acknowledged, the specific biological mechanisms that translate emotional suffering into systemic disease remain incompletely understood. Psychological stress activates the sympathetic nervous system and hypothalamic–pituitary–adrenal axis, which directly target mitochondria and alter their bioenergetic and redox capacity. For this reason, this narrative review proposes that mitochondria serve as the primary subcellular link in the mind–body connection, as they play a pivotal role in converting neuroendocrine signals into cellular dysfunction. In particular, we focus on the concept of mitochondrial allostatic load (MALT), a framework explaining how the progressive decline in mitochondrial functions, from their initial adaptive roles in energy production, reactive oxygen species signaling, and calcium regulation, to being sources of inflammation and systemic damage, occurs when stress exceeds regulatory limits. We also, discuss how this transition turns mitochondria from adaptive responders into drivers of multi-organ disease. In subsequent sections, we examine diagnostic potentials related to MALT, including the use of biomarkers, such as growth differentiation factor 15, cell-free mitochondrial desoxyribonucleic acid, and functional respirometry. Furthermore, we evaluate mitochondria-targeted therapeutic strategies, encompassing pharmacological compounds, such as mitoquinone mesylate, Skulachev ions, and elamipretide, alongside lifestyle and psychological interventions. Here, we aim to translate MALT biology into clinical applications, positioning mitochondrial health as a target for preventing and treating stress-related disorders. We propose that MALT may serve as a quantifiable bridge between emotional stress and somatic disease, enabling future precision medicine strategies integrating mitochondrial care. Full article