Search Results (4,898)

Air pollution represents one of the foremost environmental and public health challenges of the twenty-first century, with differentiated impacts according to the socio-economic and urban conditions of affected populations. It therefore remains necessary to integrate social and spatial factors into air quality assessment, going beyond purely physicochemical approaches. This study aims to develop a socio-environmental index to assess air quality (SAQI) based on particulate matter (PM) concentrations in two urban areas of Bogota (Colombia). The methodology is structured in three phases: (i) a global review of reported socio-environmental indices over the past decade, (ii) construction of the index via integration of environmental and socio-economic variables collected in the locality of Kennedy, and (iii) comparative validation of the index in the locality of Barrios Unidos to assess robustness and transferability. The structure of the proposed SAQI assigns 45% weight to the socio-economic dimension and 55% to environmental exposure (PM_2.5 and PM₁₀ concentrations). During the development phase in Kennedy, annual PM_2.5 concentrations were systematically found to exceed World Health Organization guidelines by factors ranging between 4.0 and 5.7 (24.5 ± 2.89 µg/m³). The comparative application in Barrios Unidos (SAQI = 12, “good”) and Kennedy (SAQI = 21.8, “acceptable”) revealed an 81.5% socio-environmental gap driven by PM concentrations up to 49.8% higher and greater social vulnerability in Kennedy. The methodological divergence compared to the local technical index—IBOCA (45.2 in Kennedy)—underscores the added value of the SAQI developed to capture effective socio-environmental risk. The SAQI developed in this work is a potential decision-making tool that guides public policies toward fairer and more equitable air quality management in urban areas of developing countries. Full article

Background: The acceptance of new vaccines under uncertainty—such as during the COVID-19 pandemic—poses a major public health challenge because efficacy and safety information is still evolving. Methods: We propose an integrative analytical framework that combines a theory-based model of vaccine acceptance—the cognitive–affective–normative (CAN) model—with machine-learning techniques (decision tree regression, random forest, and Extreme Gradient Boosting) and SHapley Additive exPlanations (SHAP) integrated into an importance–performance map (IPM) to prioritize determinants of vaccination intention. Using survey data collected in Spain in September 2020 (N = 600), when the AstraZeneca vaccine had not yet been approved, we examine the roles of perceived efficacy (EF), fear of COVID-19 (FC), fear of the vaccine (FV), and social influence (SI). Results: EF and SI consistently emerged as the most influential determinants across modelling approaches. Ensemble learners (random forest and Extreme Gradient Boosting) achieved stronger out-of-sample predictive performance than the single decision tree, while decision tree regression provided an interpretable, rule-based representation of the main decision pathways. Exploiting the local nature of SHAP values, we also constructed SHAP-based IPMs for the full sample and for the low-acceptance segment, enhancing the policy relevance of the prioritization exercise. Conclusions: By combining theory-driven structural modelling with predictive and explainable machine learning, the proposed framework offers a transparent and replicable tool to support the design of vaccination communication strategies and can be transferred to other settings involving emerging health technologies. Full article

Public health restrictions during COVID-19 disproportionately affected older adults, especially those in long-term care (LTC) and their families. Family caregivers (FCs) are essential care partners in LTC settings, yet pandemic policies largely excluded them, creating emotional and systemic consequences. This study explored FCs’ experiences of visitation restrictions in British Columbia, Canada, using an arts-based qualitative approach within a larger mixed-methods project. Eight FCs participated in completing a total of twelve artworks, including photographs, collages, and creative writing that reflected their experiences. Virtual talking circles were used to facilitate the sharing and description of their experiences. Findings revealed three interconnected theme categories with eleven sub-themes. These themes suggest a plausible pathway: infection-control rules may lead to caregiver exclusion, disrupting relational continuity and oversight and contributing to distress and task-centered care. While context-specific and exploratory, results underscore the need for trauma-informed, family-inclusive policies and cultural safety in LTC. Arts-based research methods provided a powerful lens for capturing emotional realities often missed by conventional research. Full article

The incidence of tuberculosis disease (TBD) in New Brunswick (NB) is low but has been rising over the past decade. Analyzing these trends can help identify specific risk factors and transmission patterns to guide targeted public health strategies. This study aimed to provide a comprehensive and detailed characterization of TBD in NB by examining data from 1 January 2002, to 31 December 2024. All TB patients with Mycobacterium tuberculosis complex (MTBC) clinical isolates identified in NB healthcare facilities were eligible for inclusion in the study. We analyzed demographic, drug susceptibility, and 24-locus Mycobacterial Interspersed Repetitive Unit-Variable Number Tandem Repeat (MIRU-VNTR) data from 166 patients. Most MTBC isolates were pan-susceptible to first-line anti-tuberculosis drugs (90.9–98.1%), with 2.4% showing multidrug resistance. The MIRU-VNTR demonstrated a high discriminatory power of 0.9982 and a low clustering rate of 20.4%. Two samples from the same patient, collected seven years apart, showed different genetic profiles, suggesting that the second episode was a new infection. The most prevalent MTBC lineage was East African Indian (n = 23, 13%). This study provides early insights into TB trends in NB, including what may be the first recorded case of TB reinfection in NB. Our findings will help guide future TB research, policies, and public health interventions in the region. Full article

One of the challenges post-COVID-19 is reducing the negative impacts on quality of life, performance, and independence in activities of daily living. Assessing functional dependence in adults one year after acute infection can help to understand the long-term consequences, evaluate the impact on quality of life, plan rehabilitation and healthcare, identify the most vulnerable groups, measure the socioeconomic impact, and support public policies and clinical decisions. Objectives: The objectives of this study are as follows: (a) to assess the prevalence of functional dependence in Brazilian adults with COVID-19; (b) to analyze the association between the study variables; and (c) to determine the factors associated with functional dependence. Methods: This was an observational, cross-sectional study with 987 adults (18 to 59 years old) living in the State of Paraná (Brazil) hospitalized for COVID-19 between March and December 2020. Data were collected by telephone 12 months after the acute infection using an instrument to retrieve sociodemographic and health information, and a functional dependence scale to assess dependence before COVID-19 retrospectively (using participant recall information) and at the time of the interview. Data were analyzed using penalized logistic regression after imputing missing data. Data were analyzed using penalized logistic regression after imputing missing data. Results: Functional dependence after COVID-19 was 5.0% and was associated with low levels of education, not having a partner, living with someone, not owning a home, experiencing job changes, requiring care, obesity, smoking, multimorbidity, ICU admission in the acute phase, use of invasive ventilation, or having Long COVID. Individuals who required care or used invasive ventilation support were, respectively, 9.3 and 6.5 times more likely to develop dependence after COVID-19. Despite adjustment for multiple factors, the magnitude of the observed effects warrants cautious interpretation, as unmeasured or residual confounding effects may still be present. Sample recall bias due to collection after 12 months and the presence of the alpha variant without COVID-19 vaccination coverage may limit data generalization. Conclusions: The results highlight the need to emphasize the public health implications of identifying functional dependence. In this vein, it is necessary to implement preventive measures, identify and monitor more vulnerable groups, plan rehabilitation programs, and develop public health policies. Full article

Background: Dementia is an increasing public health challenge in Mexico, yet recent national data on mortality patterns remain limited. This study examines temporal trends in dementia-related mortality and its sociodemographic and ecological characteristics among adults aged ≥65 years from 2017 to 2023. Methods: National mortality records from the General Directorate of Health Information were analyzed. Annual dementia-related mortality rates were calculated based on mid-year population estimates from CONAPO. Trends were assessed with regression analysis, including population offsets, and individual- and state-level characteristics were evaluated. Results: Between 2017 and 2023, dementia-related deaths increased from 761 to 1425, corresponding to an observed rise from 7.9 to 14.6 deaths per 100,000 inhabitants aged ≥65 years. Period trend indicated an average annual expected increase of 18.6% in dementia related mortality. A transient decline occurred in 2020–2021, coinciding with the COVID-19 pandemic. At the individual level, higher education was associated with greater odds of dementia certification, whereas Indigenous ethnicity appeared protective, which may reflect patterns consistent with diagnostic and reporting disparities. Higher state-level life expectancy correlated with higher dementia mortality, while greater population aging was inversely associated. Conclusions: Dementia-related mortality in Mexico shows a sustained upward trend with regional heterogeneity and apparent inequities in diagnosis and reporting. Strengthening mortality surveillance, improving certification quality, and integrating dementia indicators into national non-communicable disease registries are essential to guide equitable policy responses. Full article

Ageing is a dynamic biological process involving interconnected physiological, psychological, and social changes, making the promotion of healthy ageing a global public health priority. The World Health Organization (WHO) defines healthy ageing as the process of developing and maintaining functional ability that enables well-being in older age. The WHO’s Decade of Healthy Aging (2021–2030) outlines four key action areas: changing attitudes toward ageing, creating age-friendly environments, delivering integrated and person-centred care, and ensuring access to long-term care. This Perspective examines yoga, a holistic mind–body practice integrating physical postures, breath regulation, and mindfulness, as a potentially safe, adaptable, and scalable intervention for older adults. Evidence suggests that yoga may improve flexibility, balance, mobility, and cardiovascular function, reduce pain, and support the management of chronic conditions commonly associated with ageing. Psychological and cognitive research further indicates reductions in stress, anxiety, and depressive symptoms, alongside potential benefits for attention, memory, and executive function. Improvements in health-related quality of life (HRQoL) have been reported across physical, psychological, and social domains, with benefits sustained through regular practice. Adaptations such as chair-based practices, restorative postures, and the use of props enhance accessibility and safety, allowing participation across diverse functional levels. Mindfulness and breath-focused components of yoga may additionally support emotional regulation, resilience, and psychological well-being, particularly among older adults experiencing stress or limited mobility. Yoga interventions are generally well tolerated, demonstrate high adherence, and can be delivered through in-person and digital formats, addressing common access barriers. Despite this growing evidence base, yoga remains underintegrated within health policy and care systems in the US, UK, and India. Strengthening its role may require coordinated efforts across research, policy, and implementation to support healthy ageing outcomes. Full article

Following World Health Organization (WHO) validation of lymphatic filariasis (LF) elimination as a public health problem, countries are required to implement post-validation surveillance (PVS) to detect potential resurgence and ensure sustained elimination. WHO’s guidelines released in 2025 recommend implementation of at least two of four PVS strategies—targeted surveys, integration into standardised surveys, health facility-based screening, and molecular xenomonitoring (MX) of mosquitoes. This review synthesised global evidence on PVS activities from 2007 to 2025 in the 23 countries and territories validated as having eliminated LF. Studies were identified through PubMed, Scopus, Embase, Web of Science, and the WHO Institutional Repository for Information Sharing (IRIS). Data on publication information, surveillance strategies, priority populations, and operational challenges and enablers were extracted. Narrative synthesis using deductive content analysis was applied. Thirty documents from 17 countries were included. Targeted surveillance and integration of PVS with other health programmes were the most common approaches noted (reported in ten and nine countries, respectively), followed by MX (seven countries) and health facility-based screening (four countries). Surveillance often focused on migrants and previous hotspots, with operational challenges linked to limited funding, workforce, and supply chains. Documents indicated that Sri Lanka, Thailand, China, and South Korea developed sustained PVS through national policies and domestic funding. Findings highlight the need for clear, contextualised guidance to operationalise sustainable PVS in different settings. Full article

The objective of this study was to analyze social perception, trust, and vaccine hesitancy through a combined approach of bibliometric analysis and qualitative synthesis, based on the most cited articles in the recent scientific literature. A systematic search was conducted in indexed databases, identifying patterns of production, collaboration, citation, thematic networks, and conceptual trends associated with the study of public trust in vaccines. The results reveal a marked geographic concentration of scientific production, dominated by the United States and the United Kingdom, as well as a strong articulation of thematic clusters linked to digital disinformation, health communication, risk perception, and psychosocial determinants of vaccine acceptance. The qualitative synthesis of the most influential studies reveals that vaccine hesitancy is a multidimensional phenomenon, determined by sociocultural, cognitive, emotional, and structural factors that interact dynamically according to each context. Disinformation, institutional trust, community narratives, and the credibility of sources emerge as central components in individual decision-making. Together, the integrated results enable a deeper understanding of vaccine hesitancy beyond traditional cognitive models, highlighting the need for contextualized communication strategies, intercultural approaches, and health policies based on trust and social participation. This study provides an integral view of the scientific landscape and establishes priority lines for future research and the design of effective public health interventions. Full article

Eight Pacific Island Countries and Territories (PICTs) have been validated by the World Health Organization (WHO) as having eliminated lymphatic filariasis (LF) as a public health problem. WHO recommends that these countries implement post-validation surveillance (PVS) to ensure resurgence has not occurred. Some PICTs proactively conducted LF PVS even in the absence of specific recommendations or best-practice guidelines at the time of implementation. We aimed to explore the barriers and facilitators to implementing LF PVS in PICTs, with a view to informing context-specific strategies and regional guidelines. Key informant interviews were held between March and September 2024 with 15 participants involved in LF and/or neglected tropical disease surveillance. Transcripts were analysed thematically using a generalised deductive approach. A conceptual framework was developed to summarise themes with two main streams of barriers identified. Stream One Barriers included limited awareness of, and guidelines for, PVS requirements and competing national health priorities. Stream Two Barriers included cost, resource, and logistical barriers to conducting PVS. Participants called for clearer, contextually tailored guidelines, improved communication from WHO, and integration within existing systems. This study highlights the urgent need for operational guidance, policy advocacy, and capacity strengthening to ensure sustainable LF PVS in PICTs. Incorporating local context and leveraging existing health structures will be essential to prevent disease resurgence and maintain gains achieved through elimination programmes. Full article

Background: Hand, foot, and mouth disease (HFMD) remains a major public-health concern in China. While the monovalent EV-A71 vaccine has effectively reduced EV-A71–associated cases, it offers no protection against CV-A16. The introduction of a bivalent EV-A71/CV-A16 vaccine may offer broader protection, but its economic viability under different immunization strategies remains uncertain. Methods: We developed a dynamic transmission model integrated with cost-effectiveness analysis to assess the epidemiological and economic impact of a hypothetical bivalent EV-A71/CV-A16 vaccine in China. Based on the immunization program policy, seven vaccination strategies, vaccine effectiveness (VE) levels ranging from 50–95% against EV-A71/CV-A16, and coverage levels from 0–95% were evaluated. The threshold vaccine price (TVP) was derived based on incremental cost-effectiveness ratio (ICER) calculations. Cost-effectiveness was assessed using willingness-to-pay (WTP) thresholds defined as 1–3 times the gross domestic product (GDP) per capita. Results: The mean cost of two doses of the monovalent EV-A71 vaccine was USD133.0 (95% CI: 126.9–139.1). Strategy 2, which targeted individuals unvaccinated with the monovalent EV-A71 vaccine, demonstrated the most favorable cost-effectiveness. At 45% coverage and 85% vaccine effectiveness, the estimated threshold price per dose was USD 107.7 (95% CI: 103.4–112.0), with threshold vaccine prices increasing as coverage declined. When vaccination coverage exceeded 80%, the threshold vaccine price decreased substantially, falling below USD 45.9 (95% CI: 43.5–48.3) per dose. Conclusions: Large-scale inclusion in the national immunization program may not be economically justified at current cost levels. Targeted voluntary vaccination of unvaccinated, susceptible populations represents a more cost-effective and practical strategy during the early stage of vaccine introduction. Full article

Current approaches to gaming disorder prevention remain comparatively narrow, and prevention efforts are frequently underdeveloped and fragmented. Using the socio-ecological model (SEM), this qualitative study mapped frontline practitioners’ perceived obstacles and opportunities to develop a multi-level, practice-grounded framework for policy and implementation. Semi-structured interviews were conducted with 18 prevention professionals in Flanders (Dutch-speaking Belgium), recruited via purposive and snowball sampling. A hybrid inductive–deductive analysis—iterative coding guided by Layder’s adaptive theory—organized findings across SEM levels. At the public policy level, participants highlighted insufficient sustainable funding but saw potential in coordinated frameworks moving prevention beyond substance-focused agendas. At the community level, a clear knowledge gap emerged, with opportunities in integrating gaming within broader digital well-being efforts. Institutionally, the absence of practical tools and clear referral pathways was noted, in addition to high participation barriers, whereas accessible programs with targeted outreach were viewed as promising. Interpersonally, parental disengagement was common, but early involvement and pedagogical guidance were seen as key levers. At the intrapersonal level, limited self-insight and emotion regulation impeded change, while resilience, self-confidence, and offline activities were protective. This first empirical application of the SEM to gaming disorder prevention highlights the need for a multi-level, context-sensitive framework that bridges public health and digital media perspectives. Full article

Background: Cannabis excise tax structures vary widely across the states in the United States. Standardizing taxes may improve cross-state comparisons and strengthen evaluations of how taxes and prices influence public health outcomes. This study developed category-specific standardized tax metrics for flower, vaping, and edible products by incorporating price and tax structure variations using retail scanner data. Methods: We analyzed cannabis retail scanner data from dispensary point-of-sale systems for flower, vaping, and edible products in 12 states with legal recreational markets from Q1 2020 to Q4 2024. Using retail prices and excise tax policies, we converted taxes in different forms across the supply chain into standardized measures and estimated tax incidence (ratio of standardized taxes to retail prices) for each category. We also evaluated the association between standardized taxes and retail prices. Results: Mean standardized excise taxes were USD 32.58/ounce for flower, USD 180.21/ounce for vaping, and USD 0.024/milligram THC for edible products. Corresponding tax incidences were 13.03%, 13.59%, and 13.09%. Standardized taxes and tax incidences varied considerably across states. Category-specific standardized taxes strongly predicted retail prices, supporting their use as an instrumental variable candidate. Conclusions: Category-specific standardized measures of cannabis excise taxes derived from retail scanner data may support cross-state comparisons and pricing policy evaluation. Full article

Dental caries remains a major global public health problem characterized by pronounced social inequalities. This study aimed to identify, critically appraise, and synthesize the most recent evidence on the relationship between socioeconomic indicators and dental caries among adults aged 19–60 years, providing an updated systematic review that builds upon our previous reviews from 2012 and 2018. Reported following the PRISMA 2020 guidelines, we conducted a systematic search of eight electronic databases for observational studies published between March 2017 and April 2024 (PROSPERO: CRD42017074434). Two independent reviewers performed study selection, data extraction, and risk of bias assessment using the Newcastle–Ottawa Scale. Due to substantial methodological heterogeneity across the 22 included studies, a narrative synthesis was undertaken. The findings demonstrated a strong inverse association between socioeconomic position and caries experience. Lower income, lower educational attainment, and unemployment or employment in manual/unskilled occupations were associated with a higher overall caries experience. Advanced analytical approaches in recent studies, including life-course, reinforced that education and income are key contributors of these oral health inequalities, with persistent social disadvantage conferring the greatest risk. In conclusion, dental caries in adults aged 19–60 years is a social condition reflecting the cumulative effects of socioeconomic inequality across the life course. Addressing adult dental caries requires integrated approaches that combine clinical prevention with social and public policies aimed at reducing structural inequalities. Full article

Background/Objectives: Dementia represents a growing public health challenge. The WHO Global Action Plan on the Public Health Response to Dementia emphasizes early detection, risk reduction, and innovation as key priorities. Mild Behavioral Impairment (MBI), defined as the emergence of persistent neuropsychiatric symptoms in older individuals, represents a potential marker of early neurodegeneration and possible window for early intervention. This review explores the role of MBI in dementia prevention, mapping current evidence within the WHO Global Action Plan framework. Methods: A comprehensive search was performed in PubMed, Scopus, and the official WHO website, during 1 September 2025–10 November 2025, without time restrictions. Eligible sources included original clinical studies, reviews, and policy documents addressing MBI, dementia prevention, and public health. Data were thematically synthesized according to the seven objectives of WHO: (1) dementia as a public health priority, (2) dementia awareness and friendliness, (3) dementia risk reduction, (4) dementia diagnosis, treatment, care and support, (5) support for dementia carers, (6) information systems for dementia, and (7) dementia research and innovation. Results: Accumulating evidence indicates that MBI assessment can capture early behavioral manifestations of neurodegenerative and other forms of dementia, correlating with fluid, neuroimaging and genetic biomarkers. Integrating MBI screening through the easy-to-administer MBI Checklist (MBI-C) into clinical and community-based care, including telemedicine pathways and research, may enhance early identification and personalized interventions, enrich the pool for clinical trials, and facilitate research in biomarker and therapy. MBI-related research further supports its integration in remote digital monitoring and population-based prevention. Conclusions: Embedding MBI-informed screening and interventions into national dementia strategies aligns with WHO objectives for early, equitable and scalable prevention and brain health. Full article