Search Results (3,693)

Cervical cancer is one of the most preventable malignancies, yet disparities in survival remain a significant public health burden across Eastern Europe and the Balkans. Bulgaria illustrates this paradox: HPV vaccination coverage is very low, and prevention continues to rely substantially on opportunistic screening, although recent national initiatives have introduced HPV-based testing and self-sampling. This article argues that the primary barrier to cervical cancer control in Bulgaria is not the lack of medical technology, but the absence of a structured, organized screening system. A modern national cervical cancer screening program should be recognized as a structured clinical and organizational pathway rather than a single diagnostic test. Such a programme requires population identification, active invitation and recall, reg-istry-based tracking, standardized referral and follow-up pathways, and continuous quality assurance. Primary high-risk HPV (hrHPV) testing provides high sensitivity and excellent negative predictive value, supporting longer screening intervals; however, screening for HPV positivity alone is insufficient as a sole referral criterion because many infections are transient and clinically insignificant. We propose a rational framework for cervical cancer screening in Bulgaria and comparable health systems: invitation-based screening for women aged 25–65 years built on primary hrHPV testing with genotyping, reflex cytology, and selective use of p16/Ki-67 dual staining. Drawing on a regional comparison of HPV vaccination and screening programs and on Bulgarian cost-of-illness data, we argue that transitioning from opportunistic testing to an integrated, registry-based screening cascade is essential for effective and equitable cervical cancer prevention in the region. Full article

Parenting programs in Aotearoa New Zealand are typically designed by and for non-Indigenous parents of non-disabled children, yet are routinely promoted to all families, including Māori (the Indigenous people of Aotearoa) and families of disabled children, despite limited cultural relevance. This paper describes and discusses the co-creation of a culturally responsive program for whānau (families) of a disabled child, undertaken over three years using a participatory, culturally informed approach. Drawing on key practices from te Ao Māori (the Māori worldview)—including whakawhanaungatanga (relationship building), tuakana-teina (peer-to-peer support), and koha atu koha mai (reciprocity)—the team developed and iteratively tested a wānanga-style program across three stages of development (foundation building, program drafting, and program testing). Evaluation data was collected from participants (n = 16), facilitators (n = 3), and authors, using anonymous online surveys (participants, facilitators), in-person discussion (facilitators), and reflective observation (authors). Data analysis was pragmatic and participatory in design, prioritizing collective sense-making. Findings indicate that whānau highly valued dedicated time for wellbeing reflection, culturally grounded content (particularly the Whiti Te Rā wellbeing model), peer connection, and practical supports such as on-site childcare. The paper reflects on the intentionality required for working together, including the need to center Māori knowledge, flatten power dynamics, and slow down program development to prioritize relationship over output. This work contributes to community psychology and public health scholarship as an example of decolonial, anti-racist practice in community health program design. This paper offers a template for how culturally responsive, co-created program design and delivery can work in practice. Full article

Background/Objectives: Population aging represents a major social and public health challenge in Latin America. Mexico has made significant advances in regulatory and policy frameworks. Notable progress includes accession to the Inter-American Convention on Protecting the Human Rights of Older Persons (IACPHROP). It also includes the enactment of the Law on the Rights of Older Persons, and institutional reforms for social and cultural inclusion. This review evaluates Mexico’s alignment of aging policies with IACPHROP standards using an integrated framework of social determinants, policies, and legal obligations. This approach has not been previously reported for Mexico. Methods: Searches were conducted in electronic databases and official repositories. These included the World Health Organization, the Organization of American States, the Inter-American Human Rights System, and Mexican government regulations. Additional searches were performed in PubMed, Redalyc, SciELO, and Google Scholar. Results: Advances include universal non-contributory pensions, the expansion of healthcare coverage, and social inclusion programs. Important policy areas remain to be addressed, including the establishment of a national long-term care system, and the reduction of regional disparities in health coverage. In addition, the evidence linking specific policies to improve health outcomes remains heterogeneous. Conclusions: Mexico has built a solid foundation for the protection of older adults’ rights. The development of a long-term care system and the adoption of place-based approaches are also essential. Regional cooperation and community traditions play a pivotal role in achieving dignified, inclusive, and sustainable aging. Full article

Depression is a common mental health issue among migrant workers. This study was designed to investigate the effectiveness of a LINE-application-based PASS program on depression scores among Myanmar migrant factory workers in Samut Prakan, Thailand. This randomized controlled trial was conducted in nine factories in Samut Prakan, Thailand. One hundred and forty-four factory workers were randomly allocated between the intervention and control groups (72 participants in each group). The PASS program was implemented in the intervention group. A self-administered method was used at three time points—baseline, immediately after the intervention, and at the three-month follow-up. The generalized linear mixed model was used for statistical analysis. There were no statistically significant between-group differences in sociodemographic characteristics or depression at baseline. According to the generalized linear mixed model, the intervention group demonstrated a significantly greater reduction in depression scores than the control group (p < 0.001). The PASS program intervention significantly reduced depression scores, with sustained effects at three months. It also provides a suggestion for stakeholders, particularly public health organizations, that they need to implement measures to reduce depression and to prevent more serious psychological health issues among Myanmar migrant factory workers in the future. Full article

Despite widespread vaccination programs, pertussis continues to pose a major public health challenge, primarily due to waning immunity, persistent transmission, and treatment delays. This study introduces an SVEITR model to explore the transmission dynamics and control strategies for pertussis. Unlike many existing pertussis models, this framework explicitly incorporates a treatment compartment alongside vaccination and recovery, allowing for a more thorough evaluation of disease control measures. The fundamental mathematical properties of the model are established, equilibrium points are derived, and the basic reproduction number ${\mathcal{R}}_0$ is calculated. Theoretical conditions for local and global stability of the equilibrium points are rigorously analyzed using eigenvalue theory, the Routh–Hurwitz criterion, the Castillo-Chavez methodology, and Lyapunov theory. Bifurcation analysis, conducted via center manifold theory, reveals a forward transcritical bifurcation at ${\mathcal{R}}_0=1$, confirming that disease eradication is possible when ${\mathcal{R}}_0<1$. Local and global sensitivity analyses identify the most influential epidemiological parameters affecting disease dynamics (i.e., transmission, vaccination, and treatment rates). Numerical simulations illustrate the effects of vaccination, transmission, and treatment rates on disease progression and delineate stable and unstable endemic regions. The findings indicate that increased vaccination coverage and prompt treatment significantly reduce disease prevalence, whereas higher transmission rates intensify outbreaks. The proposed model offers new insights into the combined effects of vaccination and treatment in controlling pertussis and provides a quantitative framework for designing effective public health intervention strategies. Full article

Background: Equitable access to kidney replacement therapy (KRT) remains a major challenge for patients living in geographically isolated, rural, and underserved settings. Organizational approaches, including tele-nephrology, remote patient monitoring, decentralized dialysis services, home dialysis support, rural outreach programs, and emergency preparedness strategies, have been increasingly used to address geographic and organizational barriers to KRT delivery. This review summarizes the available evidence on organizational approaches supporting remote and decentralized KRT delivery and examines their reported implications for healthcare accessibility, continuity of care, and service delivery. Methods: A structured literature search was conducted in PubMed/MEDLINE, Scopus, Web of Science Core Collection, and the Cochrane Library for studies published between January 2016 and January 2026. Publications considered relevant addressed organizational, healthcare delivery, implementation, or health-system approaches supporting KRT accessibility, continuity, or delivery in geographically isolated, rural, underserved, disaster-affected, humanitarian, or resource-limited settings. Studies describing conventional facility-based dialysis without an organizational or healthcare delivery component were excluded. Relevant information on study characteristics, KRT modality, organizational approaches, implementation components, healthcare accessibility, continuity of care, and reported barriers and outcomes was extracted and narratively synthesized. Results: A total of 749 records were identified, and 12 publications were retained for detailed synthesis. The publications addressed tele-nephrology, remote monitoring, home dialysis support, rural outreach, decentralized and community-based dialysis, and emergency preparedness. Study designs, settings, organizational models, and outcomes varied substantially. Reported findings concerned specialist access, home and decentralized dialysis pathways, dialysis continuity, healthcare utilization, and implementation feasibility. Most publications were observational, pilot, implementation-based, or qualitative, limiting causal inference and direct comparison across settings. Conclusions: The literature describes organizational approaches that may address specific barriers to KRT access and continuity. However, heterogeneous and predominantly non-comparative evidence is insufficient to establish causal effectiveness or superiority of any specific model. Multicenter comparative studies with standardized organizational, patient-centered, and economic outcomes are needed to assess effectiveness, scalability, and sustainability. Full article

Clinical adoption of large language models (LLMs) in public healthcare faces a structural impasse: the capital expenditure of centralised high-performance computing on one side and the privacy risk of routing patient data through third-party cloud interfaces on the other. Italian local health authorities (Aziende Sanitarie Locali, ASL) operate large fleets of clinical workstations that remain idle outside peak administrative hours. We present OmniMed Federated, a browser-native architecture using the WebGPU application programming interface (API) and the WebLLM framework to distribute LLM inference tasks across these existing workstations. The system federates task allocation rather than model training or partitioned inference: each query executes in full on one node, selected under a data residency constraint. A five-tier escalation model, coordinated by a metadata-only PHP back end, ranks tiers by data exposure rather than capability, with commercial cloud fallback disabled by default. In a pilot three-node testbed (50 queries), federated throughput reached 19.5 versus 8.2 tokens/second standalone, peak per-node memory fell 62%, and node discovery took 140 ms; query content remained within the institutional perimeter throughout. These figures establish infrastructural feasibility at pilot scale. Clinical output quality, security hardening, and scalability remain unevaluated. Full article

Philanthropic hospitals are key providers within Brazil’s public healthcare system and benefit from the Certification of Beneficent Social Assistance Entities in Health (CEBAS-Saúde), a tax relief program designed to incentivize service provision in underserved areas. We analyze a balanced panel of 1641 philanthropic general hospitals from 2005 to 2019, employing a conditional Difference-in-Differences (DiD) model with heterogeneous treatment exposure and entropy balancing to ensure comparability between certified and non-certified hospitals. The results show that certification significantly improved geographic access, mainly by reducing macro-regional patient evasion—the outflow of patients seeking care outside their designated health regions. This effect, most pronounced after ten years of certification, translated into an average annual reduction of approximately 8700 avoided hospitalizations between 2015 and 2019. The reduction was particularly concentrated in small hospitals and in the Northeast region, where access barriers are historically greater. These findings suggest that CEBAS-Saúde is an effective policy instrument for strengthening the regionalization of healthcare provision, reducing geographic inequities, and addressing service gaps in areas with limited healthcare supply. Full article

Background/Objectives: Human papillomavirus (HPV) genotype distribution is an important epidemiologic indicator for guiding public health surveillance, yet large-scale, laboratory-based data among Korean females remain limited, particularly following the incorporation of HPV vaccination into the National Immunization Program in 2016. This study evaluated HPV positivity and genotype distribution among clinically tested Korean females using a large-scale laboratory-based dataset. Methods: A retrospective analysis was conducted on 530,808 HPV genotyping results from Korean females tested between 2014 and 2022 using the Anyplex™ II HPV 28 Detection system (Seegene, Seoul, Republic of Korea). Specimens were classified as high-risk (HR), low-risk (LR), or multiple-type infections, and the proportion of specimens containing at least one HR genotype not included in the 9-valent vaccine was determined. Results: The overall HPV positivity rate was 44.4%, with a U-shaped age distribution. HPV 52 was the most frequently detected genotype (7.2%), followed by HPV 53 (6.3%) and HPV 58 (5.1%). Multiple-type infections were identified in 45.4% of HPV-positive specimens, and 24.4% of specimens harbored at least one HR genotype not included in the 9-valent vaccine. Conclusions: This large-scale laboratory-based analysis provides updated epidemiologic data on HPV positivity and genotype distribution among clinically tested Korean females. As this cohort reflects clinically tested rather than population-based specimens, these findings should be interpreted as descriptive observations that support continued surveillance of circulating HPV genotypes. Full article

Occupational exposure to blood and body fluids (OEBBF) continues to represent an important public health problem due to the associated medical, social and economic consequences. Young healthcare workers are at high risk of OEBBF because of their lack of experience, hesitation before performing a task and the nature of the task performed. This study aims to comparatively evaluate the knowledge, attitudes and perceptions on OEBBF among students from the Faculty of Medicine and the Faculty of Dental Medicine at Carol Davila University of Medicine and Pharmacy, Bucharest, Romania, during the 2021–2022 academic year in order to facilitate the adaptation of educational materials used in training programs. Out of the 911 students who completed the questionnaire, 55% (502) correctly identified hepatitis B virus (HBV) as having the highest risk of transmission after an OEBBF, with statistically significantly higher percentages among Dental Medicine students (152; 60% vs. 350; 53%; p = 0.003). However, lower percentages of Dental Medicine students recognized the protective concentration of antibodies against HBV (173; 68% vs. 536; 82%; p < 0.001) or reported knowing to be vaccinated against hepatitis B (110; 43% vs. 459; 70%; p < 0.001). Additionally, higher percentages of Dental Medicine students reported not having an antibodies concentration measurement since they started their clinical practice (206; 81% vs. 439; 67%; p < 0.001). If an OEBBF were to occur, 43% (391) reported that they would induce bleeding, either instinctively (210; 23%) or because they considered it necessary (181; 20%). Ninety-three students (10%) reported at least one past OEBBF; 59 (63%) reported it to their supervisors. Statistically significantly higher percentages of Dental Medicine students reported a high perceived risk of exposure compared to Medicine students (117; 46% vs. 202; 31%; p < 0.001), with the finding supported by univariable and multivariable analyses. In conclusion, the reporting frequency of past OEBBF in our study population was low. However, enhanced efforts are required to improve knowledge and awareness regarding OEBBF risk and preventive measures. Additionally, efforts should focus on assessing the level of protection against hepatitis B among Dental Medicine students and on promoting timely reporting to ensure appropriate post-exposure management. Full article

Background/Objectives: Pertussis has resurged worldwide despite long-standing vaccination programs. Whole-cell (wP) and acellular (aP) pertussis vaccines differ in immunobiology, durability, reactogenicity, and programmatic use. Poland is the only European Union/European Economic Area (EU/EEA) country that routinely primes infants with wP while using aP products for boosters, pregnancy, and selected indications, providing an informative programmatic context. This review compares both platforms across biological, clinical, safety, epidemiological, and supply domains. Methods: We conducted a narrative review of PubMed/MEDLINE literature and documents from the World Health Organization, European Centre for Disease Prevention and Control, national public health institutes, and regulatory authorities through July 2026. No protocol was registered and no quantitative synthesis was performed. Results: wP priming induces a persistent T-helper 1/T-helper 17-oriented response and an immunoglobulin G1-dominant profile, whereas aP vaccination produces higher, higher-avidity antibody concentrations, an increasing immunoglobulin G4 fraction, and substantially lower reactogenicity. Historical trials demonstrated marked product-level heterogeneity: efficacy ranged from 36–48% for poorly performing wP vaccines to 84–85% for multicomponent aP vaccines, while one United Kingdom wP product performed comparably to a five-component aP vaccine. Protection after aP schedules wanes within several years, no validated correlate of protection exists, and neither intramuscular platform reliably prevents colonization or transmission. In 2024, eight aP-using EU/EEA countries had higher pertussis notification rates than Poland despite stable Polish infant coverage. Conclusions: Neither platform is uniformly superior across products, schedules, and clinically relevant outcomes. Program performance depends primarily on timely infant vaccination, maternal vaccination, appropriate boosters, product-specific effectiveness evidence, and secure vaccine supply. Full article

Accurate forecasting of nitrogen dioxide (${\mathrm{NO}}_2$) in high-traffic urban environments is a critical challenge for public health management and environmental policy. This study presents a hybrid physics-informed machine learning pipeline for ${\mathrm{NO}}_2$ dispersion modeling and short-term forecasting along Viale Regione Siciliana in Palermo, Italy, one of the highest traffic-density corridors in Europe, over six full years (2020–2025) of hourly data resolved at approximately 11 m. Station measurements and weather data are harmonized hourly over the OpenStreetMap road network, converted into emissions with COPERT-Italy (COmputer Program to calculate Emissions from Road Transport) factors, and dispersed with the SIRANE street-network model; the chain is also inverted to recover corridor traffic from the observed ${\mathrm{NO}}_2$. The resulting field is joined with the measured predictors in the machine learning stage, and the output is mapped in GIS Geographic Information System. The hourly scatter between observations and the SIRANE model built on 44,752 h is centered on the 1:1 line, with a Pearson correlation of $\mathit{r}=0.83$. Of two “memory-less” ensembles on an identical predictor set, XGBoost (eXtreme Gradient Boosting) returns the better $R^2$, mean absolute error, and RMSE Root Mean Square Error at all twelve recursive lead times, declining from $R^2=0.79$ at $t+1$ h to a plateau of 0.66 at $t+12$ h, compared to 0.76 to 0.59 for random forest; both reproduce the mean field almost exactly ($r\ge 0.97$), with the XGBoost residual staying between 1.0 and 1.7 $\mathsf{\mu }$g m⁻³ at every horizon and that of random forest growing to 4.3 $\mathsf{\mu }$g m⁻³ by $t+12$ h. The proposed pipeline offers a transferable methodology for urban air quality management in traffic-dominated environments. Full article

Background/Objectives: Antimicrobial resistance threatens public health globally, and critical access hospitals (CAHs) serving rural communities face structural barriers to implementing antibiotic stewardship programs (ASPs). This study evaluated whether a regional educational intervention could improve antimicrobial stewardship knowledge and implementation among rural healthcare professionals. Methods: A quantitative, quasi-experimental repeated cross-sectional evaluation was conducted following Antibiotic Stewardship conferences in 2023 and 2024. Participants from 38 rural and critical access hospitals completed pre-conference, post-conference, 6-month follow-up, and implementation surveys. Quantitative data were analyzed using descriptive statistics and unpaired chi-square tests, with Fisher’s exact test substituted where expected cell counts were below 5, with significance set at p < 0.05. Results: Seventy healthcare professionals participated across both years. Correct identification of the use of an antibiogram to guide empiric (rather than definitive) therapy improved from 27% pre-conference to 58% post-conference (p = 0.029). Confidence in antibiogram interpretation increased from 67% to 100% post-intervention (p = 0.004, Fisher’s exact) but declined to 50% (5 of 10) at 6-month follow-up. Knowledge of the minimum isolate threshold required to construct an antibiogram improved from 23% (7 of 30) pre-conference to 64% (7 of 11) at 6-month follow-up (p = 0.026, Fisher’s exact). Despite this, prescribing intent for conditions where antibiotics are typically unnecessary showed minimal improvement: recommendations for antibiotic use in middle ear infections decreased from 50% to 36.84%, and for mpox from 20% to 15.79%. All participants reported intent to modify clinical practice; however, time constraints, technology limitations, and lack of resources were consistently cited as primary barriers for implementation across both survey years. Conclusions: A regional educational intervention improved short-term antimicrobial stewardship knowledge and confidence among rural healthcare professionals, but knowledge retention declined over time and structural barriers persisted. Education alone is insufficient; sustained reinforcement and rural-adapted ASP models incorporating protected ASP time, decision-support tools and external partnerships are needed to translate knowledge gains into consistent stewardship practice. Full article

Intestinal parasitic infections, particularly soil-transmitted helminths (STHs), remain a major public health concern in low- and middle-income countries. As control programs reduce infection intensity, accurate diagnosis becomes increasingly challenging. The McMaster technique has been proposed as an alternative diagnostic method for detecting human intestinal parasites; however, its diagnostic performance in human populations remains unclear. This study aimed to evaluate the diagnostic sensitivity of the McMaster technique for detecting intestinal parasites, particularly STHs. A systematic review and meta-analysis were conducted in accordance with the PRISMA guidelines and registered in PROSPERO (CRD420261298952). Electronic databases (PubMed, Scopus, Web of Science, Ovid, Nursing & Allied Health Premium, and Google Scholar) were searched up to January 2026. Studies assessing the McMaster technique in human populations and reporting sufficient data to calculate sensitivity were included. A random-effects model was used to estimate pooled sensitivity, with subgroup analyses by parasite species, geographic region, and population characteristics. Risk of bias was assessed using the the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. Among the 1514 records identified through database searching, 10 studies were included in the final analysis. The pooled sensitivity of the McMaster technique was 73% (95% confidence interval [CI]: 67–78%; I² = 91.0%) for detecting any intestinal parasites and 72% (95% CI: 65–78%; I² = 93.5%) for STHs. Species-specific sensitivities were 67% (95% CI: 61–72%; I² = 80.7%) for Ascaris lumbricoides, 79% (95% CI: 57–91%; I² = 96.9%) for Trichuris trichiura, and 71% (95% CI: 61–80%; I² = 89.9%) for hookworms. The McMaster technique demonstrates moderate sensitivity for detecting intestinal parasites in humans. While it offers practical advantages for field applications, its reduced sensitivity in low-intensity infections limits its utility as a standalone diagnostic tool in control and elimination settings. Further research should focus on methodological standardization and integration with more sensitive diagnostic approaches. Full article

Microplastic contamination has become a major environmental health concern because of its widespread occurrence and potential risks to human health. Although environmental health literacy (EHL) is recognized as an important determinant of health-related decision-making, evidence regarding its influence on behaviors that reduce potential microplastic exposure remains limited, particularly in riverine communities of developing countries. This study assessed EHL, environmental health behaviors associated with potential microplastic exposure, and factors associated with these behaviors among urban residents living along the Mekong River in Thailand. A community-based cross-sectional study was conducted among 420 adults in Mueang Nakhon Phanom District, Thailand, between October and December 2024 using multistage random sampling. Face-to-face interviews were performed using a content-validated questionnaire assessing six EHL domains and environmental health behaviors related to microplastic exposure. Multivariable logistic regression was used to examine factors associated with poor environmental health behaviors. Overall, 41.7% of participants demonstrated good environmental health behaviors, whereas 58.3% exhibited poor behaviors. Participants had a moderate level of EHL (mean score, 2.30 ± 0.46), with decision-making representing the weakest domain. Insufficient EHL was strongly associated with poor environmental health behaviors (AOR = 8.06, 95% CI: 2.86–10.04; p < 0.001). Additional factors associated with poor environmental health behaviors included consumption of untreated river or other water sources, no physician visit during the previous month, age older than 60 years, and obtaining aquatic foods through self-capture, whereas trade occupation was associated with lower odds of poor behaviors. These findings support community-based EHL programs led by local authorities and public health practitioners that strengthen critical appraisal and decision-making skills, provide accessible and evidence-based information on microplastic risks, and promote practical actions such as reducing single-use plastics and improving household waste management. Full article