Search Results (9,179)

Cardiometabolic disease and age-related health complications are significant clinical and public health concerns that impact an individual’s overall quality of life and longevity. Chronic low-grade and immune-mediated inflammation underlies the pathophysiology of metabolic and systemic tissue dysfunction associated with cardiometabolic disease development and accelerated aging, whereas therapeutic and preventative strategies to reduce inflammation and promote immune function yield beneficial health outcomes. Evidence from cell and animal studies demonstrates that consumption of grapes, grape-based extracts and preparations, and grape-derived bioactive compounds exert beneficial anti-inflammatory and immunomodulatory effects, which are associated with improvements in metabolic profiles. However, results from human intervention trials investigating grape effects on inflammatory and immune markers are more limited and report varied effects on improvements in clinical and experimental biomarkers indicative of cardiometabolic disease risk and healthy aging, such as serum lipids, blood pressure, insulin resistance, oxidative stress, gut dysbiosis, and cognitive function. Variability in responses to grape products in human trials may be attributable to differences in grape product preparation in addition to variability in the health status of the study population. In this review, we present an overview of mechanistic studies evaluating the effects of grapes and grape-derived products on inflammatory and immune pathways within the context of cardiometabolic disease and aging, and provide an update on recent intervention trials in this area. Full article

Background: Artificial Light at Night (ALAN) is a growing public health concern, associated with circadian disruption, sleep disturbances, mental health issues, and increased risk for chronic conditions such as cancer and cardiovascular diseases. Despite a rapidly expanding epidemiological literature on ALAN-related health outcomes, there is limited consensus on standardized and comparable tools for assessing both how individuals perceive ALAN and their objective exposure at the individual and population levels. Methods: A scoping review was conducted using Scopus, PubMed, and Web of Science to identify studies published between 2010 and 2025. The aim was to systematically map the methods, tools, and frameworks used to evaluate both the perception of ALAN and objective ALAN exposure, and to examine their implications for public health. Eligibility was restricted to studies explicitly describing approaches to assess ALAN perception or exposure applied to human health research. Results: Most studies adopted cross-sectional designs and focused on urban contexts. Satellite-derived nighttime light data (62%) and GIS-based indicators (46%) were the most frequently used exposure proxies, while surveys and self-reported measures were commonly used to capture individual behaviors, health impacts and perceptions. Only 23% of studies employed wearable sensors or mobile applications, and architectural or building-level data were included in a single study (8%), highlighting a substantial gap in indoor exposure characterization. Conclusions: By critically reviewing current methods, tools, and frameworks, this work highlights the urgent need for harmonized, validated approaches that integrate objective environmental light measurements with human-centered data on how ALAN is perceived and experienced, thereby strengthening the evidence base for public health research and policy. Full article

Background/Objectives: Dental caries is the most prevalent chronic disease of childhood, and untreated caries in the primary dentition affects an estimated 514 million children worldwide. Children are the principal target of oral health outreach through school dental screening, community camps, and charitable events for children with special healthcare needs, yet these programmes are evaluated largely by what is most visible: the number of children examined and the photographs disseminated. This measurement substitution dissociates activity from impact, so that children are screened but not treated, counted but not cared for. The objective was to determine what works, for whom, in what contexts, and through what mechanisms in converting children’s oral health screening contacts into sustained care, with primary applicability to low- and middle-income, community-outreach-oriented health systems and, in particular, to India and South Asia, while the configurational logic is offered as transferable rather than universal. Methods: A realist synthesis was conducted and reported in accordance with the RAMESES publication standards. An initial programme theory was developed and refined through purposive iterative searching, appraisal of relevance and rigour, and the extraction of Context, Mechanism, and Outcome (CMO) configurations across the diverse literature. Searching ran from initiation to theoretical saturation; complete strategies, dates, and a document-selection flow diagram are provided. Results: Eight configurations were derived, six enabling and two antagonistic, organised around three thematic constellations, Prevent, Promote, and Promulgate, and navigated by a compass of competency-based education. Thirty-six documents were retained as the principal contributors to the final synthesis. The refined theory holds that the intervention is not the camp but the configuration of conditions that allows it to convert into care for the child. Conclusions: Children’s oral health outreach should be evaluated as a multi-level health-systems configuration rather than a discrete event; competency-based education is the generative lever that reorients practice from optics to outcomes. The eight configurations are theoretical propositions that require prospective empirical testing through realist evaluation before they are treated as confirmed causal claims. Full article

Background: Adequate patient self-care is fundamental to effective heart failure (HF) management and is endorsed by international guidelines to improve clinical outcomes. Despite a growing body of evidence, the global research landscape, including publication trends, collaborative networks, and research hotspots, remains poorly characterized. Methods: Publications on HF self-care were extracted from the Web of Science Core Collection from database inception to 29 June 2026, restricted to the categories of “Nursing” or “Cardiac & Cardiovascular Systems” and to English-language articles and reviews. Bibliometric analyses were performed using VOSviewer and CiteSpace for specific characteristics such as publication year, countries, institutions, authors, journals, keywords, and co-cited references. Results: A total of 2867 publications were included, revealing a sustained increase in annual output and citations, with a marked acceleration since 2008. The United States dominated global production (1362 publications, 47.51%) and academic impact. The University of Pennsylvania was the most prolific institution, and Riegel B was the leading author. Keyword and co-citation analyses identified four interconnected thematic domains: barriers to self-care and their prognostic impact, psychosocial factors and patient-reported outcomes, intervention strategies and healthcare delivery, and caregiver burden and dyadic interaction. Digital health, particularly telemedicine and mobile health, has emerged as a rapidly evolving frontier. Conclusions: HF self-care research continues to grow rapidly, with future efforts focused on caregiver burden and dyadic dynamics, equitable digital health, and personalized management for older adults with multimorbidity and cognitive impairment to ultimately improve clinical outcomes and quality of life for patients with HF. Full article

Makkah faces substantial heat-stress challenges associated with extreme temperatures, dense urban form, and the large numbers of pilgrims present during Hajj and Umrah, creating important public health concerns. Recent heat-related fatalities highlight the need for complementary strategies that address outdoor as well as indoor heat exposure, alongside conventional cooling approaches such as air conditioning. This article examines the potential role of nature-based and complementary engineered interventions in mitigating urban heat stress in Makkah, focusing on afforestation, urban greening, and the possible use of artificial water bodies, contingent on sustainable water management. Drawing on case studies and published evidence from arid and heat-prone regions, including China, Pakistan, Saudi Arabia, and the wider Middle East, we summarize reported cooling effects, implementation experience, and feasibility considerations and assess their potential relevance to Makkah. The perspective highlights critical challenges related to water scarcity, spatial constraints, ecological impacts, and governance, while proposing phased implementation pathways that could be evaluated incrementally. If carefully designed and integrated with urban planning and climate-adaptation strategies, nature-based and complementary interventions could potentially reduce human heat stress, reduce cooling demand, and strengthen climate resilience in Makkah. However, their effectiveness, water requirements, environmental impacts, and scalability require evaluation under Makkah-specific environmental and operational conditions. Full article

Brucella canis is a recognized zoonotic pathogen associated with human infection in a variety of epidemiological settings; however, the magnitude of its impact on human health remains uncertain because of its nonspecific clinical presentation, limited availability of species-specific diagnostic methods, and insufficient awareness among physicians, veterinarians, microbiologists, and public health professionals. Unlike classical human brucellosis caused by smooth Brucella species, B. canis infection may be overlooked, potentially leading to delayed diagnosis and incomplete case detection. This narrative review summarizes current evidence on the epidemiology, transmission pathways, occupational and non-occupational risk factors, clinical manifestations, diagnostic approaches, treatment, and public health implications of human B. canis infection. Particular emphasis is placed on published human cases, laboratory-acquired infections, household clusters, cases reported in different age and immune-status groups, and the biological and epidemiological characteristics of canine infection that facilitate zoonotic transmission. The review further examines the limitations of currently available microbiological, serological, and molecular diagnostic methods, the lack of harmonized surveillance systems, and the consequences of inadequate recognition from a One Health perspective. Collectively, the available evidence confirms the zoonotic potential of B. canis but remains insufficient to define the true burden of human infection. Improving clinical awareness, strengthening collaboration between veterinary and human health sectors, expanding access to standardized diagnostic tools, and implementing integrated One Health surveillance may improve recognition and reduce zoonotic risk. Full article

Climate change perception among youth has gained increasing scholarly attention; however, immigrant youth remain underrepresented in empirical research despite navigating climate change impacts across multiple sociocultural and geopolitical contexts. This study investigates (1) immigrant youths’ beliefs about climate change, (2) how climate risks are perceived across space and time, and (3) how they construct their climate change beliefs and associated risks. Drawing on Social Constructivism, and Risk Perception Theory, the study employs a qualitative descriptive design using eight focus group discussions with 41 immigrant youth aged 14–18 in Calgary, Canada. Reflexive thematic analysis reveals that immigrant youth widely recognise climate change as real and intensifying, with beliefs shaped through lived and observed environmental experiences, social interaction, family narratives, and transnational comparisons rather than abstract scientific reasoning alone. Climate risk perception emerges as complex and relational. Participants associated climate change with impacts on health, wellbeing, food security, and everyday life; however, they often perceived its most severe consequences as temporally and spatially distant. This produces a notable “belief–risk gap,” where acceptance of climate change does not translate into a strong sense of personal vulnerability or urgency. Risk perceptions are mediated by everyday experiences, institutional trust in the host country, and comparisons with other global crises. The findings highlight the critical role of transnational experiences in shaping climate understanding and advance an integrated interpretation linking socially constructed climate knowledge with perceptions of risk and psychological distance, with implications for climate communication and public health communication strategies for immigrant youth. Full article

Community-based digital transformation (DX) initiatives are increasingly used to promote healthy aging, although their effects are often evaluated using subjective self-reported measures. This study aimed to quantitatively evaluate a community DX health promotion initiative with Takashimadaira as its primary target area in Japan using wearable sensor data. A total of 500 community-dwelling older adults participated in the initiative, and wearable sensor data were obtained from 355 participants during the five-month observational period. The initiative combined wearable device distribution with event-information dissemination via the messaging platform. Daily step count and heart-rate indices were analyzed. Within-participant analyses showed significant increases in daily step counts in the information-provision groups, whereas the primary linear mixed-effects model showed no significant information-provision × time interaction for daily step count. Information provision was associated with differences in mean and minimum daily heart rate in cross-sectional analyses. Adherence and dropout also varied by residential area. Age, BMI, and exercise frequency were associated with several health-related indices, but these associations were not interpreted as evidence of wearable measurement validity. These findings demonstrate the potential utility of using wearable sensor data to evaluate longitudinal changes in health-related behavior and physiological signals in community-based DX initiatives, while also revealing important feasibility limitations, including substantial attrition (only 222 of 355 participants met the 14-day criterion; 90-day dropout 58.3%) and indicating that observed within-participant changes should not be interpreted as demonstrated intervention effects. Community context may also be relevant to sustained participation in such programs. Full article

Mycotoxin contamination in food and feed remains a major public health concern because of its potential toxicological impact and its global economic implications. Aflatoxins and ochratoxin A are of particular concern due to their carcinogenic, hepatotoxic, and nephrotoxic effects, highlighting the need for effective surveillance systems to reduce dietary exposure in the population. This study analyzes 2479 mycotoxin-related notifications concerning both food and feed reported through the iRASFF system during the period 2020–2024, with the aim of characterizing temporal notification trends, identifying the most affected food products and geographical regions, and evaluating the evolution of control strategies implemented by competent authorities. The results did not show a statistically significant long-term increasing trend in the number of mycotoxin notifications, although interannual fluctuations may reflect both changes in contamination patterns and improvements in detection and reporting systems. Products originating outside the European Union accounted for 90.44% of notifications and showed a significantly higher mean number of notifications than products originating within the European Union. Turkey (24%) and the United States (14%) were the most frequently reported countries of origin at a global level. Aflatoxins were the most frequently detected mycotoxins in food (84%), followed by ochratoxin A (15%), mainly affecting nuts, cereals, fruits, vegetables and herbs and spices. These findings demonstrate that mycotoxins continue to represent a persistent challenge for European food safety. Strengthening surveillance systems, enhancing international cooperation, and adapting control strategies to emerging environmental and trade-related factors are essential to minimize consumer exposure, particularly to compounds with genotoxic and carcinogenic potential, and to improve risk management within the food supply chain. Full article

This research examines the structural evolution of environmental assessment in Spain over a 35-year period (1991–2025), serving as a longitudinal case study for the transition of mid-sized developed economies from industrial-age infrastructure to a decarbonized energy model. The study introduces a novel approach by utilizing Environmental Assessment records to evaluate national strategic directions and quantify developmental intent via administrative proxies. The analysis utilizes a comparative quantitative study of Strategic Environmental Assessments and Environmental Impact Assessments of national and supranational projects. Administrative trends were contextualized within major socio-economic and geopolitical events, including global financial crises, public health emergencies, and energy security developments, to identify potential external influences. The data reveals a paradigm shift. While the period 1991–2010 was dominated by grey infrastructure (transport and civil engineering), the post-2018 era shows an unprecedented increase in renewable energy dossiers. Between 2021 and 2025, energy projects dominated the regulatory workload, accounting for 73.86% of total processed dossiers, and reaching a single-year peak of 84.56% in 2022. National and international legal, economic, and social events, such as European Green Deal mandates and the NextGenerationEU recovery funds, have an apparent alignment with a country’s development strategy. We highlight the challenges and risks of such an exponential change in the energy model. For mid-sized developed economies, these findings suggest that Environmental Assessment data is an essential tool for navigating the complexities of rapid decarbonization and identifying systemic gaps in strategic planning. Full article

Long COVID, defined by the National Academies of Sciences as an infection-associated chronic condition persisting at least three months following SARS-CoV-2 infection, presents a growing public health challenge. Despite national prevalence estimates of 11 to 15 percent among U.S. adults who have had COVID-19, the general population estimates of approximately 5 to 7 percent population-level symptom burden in diverse metropolitan areas remain insufficiently characterized. A cross-sectional survey was administered to adults residing in Houston and Harris County. Participants self-reported infection history, persistent symptoms lasting at least 90 days, health status, access to care, and functional impacts. Descriptive statistics summarize infected and affected, symptom frequency, and functional limitations. Of 264 eligible respondents who tested positive for COVID and rated the worst symptoms, 92 (34.85 percent) met the operational definition of Long COVID, representing an estimated sample-based prevalence of 16.91 percent across all 544 survey respondents. Given the use of convenience sampling, this figure should be interpreted as descriptive of this sample rather than as a generalized population-level estimate. Fatigue was the most reported persistent symptom (69.32 percent), followed by brain fog (62.5 percent), shortness of breath (48.84 percent), headache or migraine (43.02 percent), and joint or muscle pain (41.38 percent). Cognitive and functional symptoms predominate over respiratory symptoms. These findings demonstrate a substantial burden of persistent, multisystem symptoms in a sample of community-dwelling urban adults, highlighting the need for longitudinal research and targeted public health strategies to address long-term consequences of SARS-CoV-2 infection in diverse metropolitan settings. Full article

Traditional benefit–cost analysis (BCA) summarizes the average net social benefit of a policy but often obscures how benefits and costs are distributed across groups. This is a major limitation in health policy settings, where decision-makers must assess both efficiency and equity. This article develops an integrated equity-weighted causal benefit–cost analysis (IEW-BCA) framework for equity-conscious policy evaluation. The framework links subgroup-specific causal effect estimates, explicit valuation functions, and equity weights within a single evaluation pipeline suitable for applied policy appraisal. It makes three contributions: first, it provides an implementable structure for combining causal heterogeneity with welfare-consistent valuation; second, it introduces a compound equity vector and associated weighting functions that extend income-based schemes and can be interpreted, under standard conditions, as a first-order approximation to a broad class of social welfare functions; and third, it develops equity-oriented summary tools, including a causal equity gradient and related dominance criteria, to improve transparency about distributional impacts. A stylized example illustrates implementation, and the discussion outlines implications for uncertainty, sensitivity analysis, and potential application in health economics, public health policy, and regulatory evaluation. Full article

Enterotoxigenic Escherichia coli (ETEC) is a leading cause of bacterial diarrheal illness in low- and middle-income countries and among travelers to endemic regions, impacting morbidity and mortality and impairing childhood development. Despite its significant importance in public health, the propensity of ETEC diarrhea in endemic settings is influenced by complex interactions among epidemiological, immunological, environmental, and pathogen-related factors. This review aims to provide a comprehensive understanding of ETEC diarrhea in endemic regions by examining epidemiological trends, host immune responses, environmental determinants, and progress in current ETEC vaccine development. We discuss disease burden, seasonality, age-specific susceptibility, toxin and colonization factor diversity, and their relation to diarrheal disease severity at the community level and in hospitalized patients. In addition, we summarize current knowledge on natural immunity, including mucosal and systemic immune responses induced in ETEC-infected diarrheal patients. The review further highlights advances in ETEC vaccine development, focusing on candidate vaccines, safety, immunogenicity, protective efficacy, and challenges associated with implementation in resource-limited settings. By integrating clinical, microbiological, immunological, environmental, and public health perspectives, this review provides a multisectoral framework to better understand ETEC pathogenesis and prevention. It also highlights future research priorities, vaccine strategies, and policy interventions to reduce the burden of ETEC-associated diarrhea in endemic settings. Full article

Objectives: To establish a global academic ranking of Schools of Public Health based on bibliometric data. Methods: Data were extracted and analyzed using InCites Benchmarking and Analytics™ and the Web of Science™ Core Collection database. Bibliometric data were collected on a selection of 145 Schools of Public Health from all continents between June and September 2025. Ten research indicators were included for the period 2019–2023. Both global and continental rankings were established. Results: The leading institutions were the Harvard T.H. Chan School of Public Health in North America, also ranked first globally; the London School of Hygiene & Tropical Medicine in Europe; the Department of Public Health at the National Autonomous University of Mexico in Latin America; the Saw Swee Hock School of Public Health in Asia; the School of Public Health at the University of Cape Town in Africa; and the School of Public Health and Preventive Medicine at Monash University in Oceania. Conclusions: PHAR 2025 provides the first global bibliometric ranking of a selection of 145 Schools of Public Health. It is a measure of research activity and bibliometric impact, rather than an assessment of the overall quality or public health contribution of each school. Full article