Search Results (1,462)

This study aimed at proposing a predictive model for real-time monitoring of epidemic dynamics at the municipal scale in Lombardy region, in northern Italy, leveraging Emergency Medical Services (EMS) dispatch data and Geographic Information Systems (GIS) methodologies. Unlike traditional epidemiological models that rely on official diagnoses and offer limited spatial granularity, our approach uses EMS call data (rapidly collected, geo-referenced, and unbiased by institutional delays) as an early proxy for outbreak detection. The model integrates spatial filtering and machine learning (random forest classifier) to categorize municipalities into five epidemic scenarios: from no diffusion to active spread with increasing trends. Developed in collaboration with the Lombardy EMS agency (AREU), the system is designed for operational applicability, emphasizing simplicity, speed, and interpretability. Despite the complexity of the phenomenon and the use of a five-class output, the model shows promising predictive capacity, particularly for identifying outbreak-free areas. Performance is affected by changing epidemic dynamics, such as those induced by widespread vaccination, yet remains informative for early warning. The framework supports health decision-makers with timely, localized insights, offering a scalable tool for epidemic preparedness and response. Full article

Background: Access to safe and reliable water and sanitation remains a critical public health and development challenge, with rural and low-income communities being disproportionately affected by inadequate services and heightened exposure to waterborne diseases. Despite global efforts and infrastructure-based progress indicators, significant disparities persist, and these often overlook users’ perceptions of water quality, reliability, and safety. This study explores the determinants of household satisfaction with drinking water in rural areas, comparing subjective user feedback with official access data to reveal gaps in current monitoring approaches and support more equitable, user-centered water governance. Methods: This study was conducted in Kazakhstan’s Atyrau Region, where 1361 residents from 86 rural villages participated in a structured survey assessing household access to drinking water and perceptions of its quality. Data were analyzed using descriptive statistics and multinomial logistic regression to identify key predictors of user satisfaction, with results compared against official records to evaluate discrepancies between reported experiences and administrative data. Results: The field survey results revealed substantial discrepancies between official statistics and residents’ reports, with only 58.1% of respondents having in-house tap water access despite claims of universal coverage. Multinomial logistic regression analysis identified key predictors of user satisfaction, showing that uninterrupted supply and the absence of complaints about turbidity, odor, or taste significantly increased the likelihood of higher satisfaction levels with drinking water quality. Conclusions: This study underscores the critical need to align official water access statistics with household-level experiences, revealing that user satisfaction—strongly influenced by supply reliability and sensory water quality—is essential for achieving equitable and effective rural water governance. Full article

Background/Objectives: The two major subtypes of inflammatory bowel disease (IBD)—Crohn’s disease (CD) and ulcerative colitis (UC)—are known to increase the likelihood of developing colorectal cancer (CRC). While this relationship has been well studied in Western populations, evidence from East Asia remains limited and inconsistent. Using nationwide cohort data, this study explored the potential connection between IBD and CRC in a large Korean population. Methods: We conducted a retrospective cohort study using data from the Korean National Health Insurance Service–National Sample Cohort from 2005 to 2019. A total of 9920 CRC patients were matched 1:4 with 39,680 controls using propensity scores based on age, sex, income, and region. Overlap weighting and multivariable logistic regression were used to evaluate the association between IBD and CRC. Subgroup analyses were conducted to assess effect modification by demographic and clinical factors. Results: IBD markedly increased the likelihood of developing CRC (adjusted odds ratio (aOR) = 1.38; 95% confidence interval (CI): 1.20–1.58; p < 0.001), with the association primarily driven by UC (aOR = 1.52; 95% CI: 1.27–1.83). CD appeared unrelated to heightened CRC risk overall, though a significant association was observed among low-income CD patients (aOR = 1.58; 95% CI: 1.15–2.16). The UC–CRC association persisted across all subgroups, including patients without comorbidities. Conclusions: Our findings support an independent association between IBD—particularly UC—and increased CRC risk in Korea. These results underscore the need for personalized CRC surveillance strategies that account for disease subtype, comorbidity burden, and socioeconomic status, especially in vulnerable subpopulations. Full article

Aquatic vegetation plays a crucial role in freshwater ecosystems by providing habitats, regulating water quality, and supporting biodiversity. This study aims to monitor and analyze the dynamics of aquatic vegetation in Chimaditida Shallow Lake, Greece, using Sentinel-2 satellite imagery, with validation from field measurements. Data processing was performed using Google Earth Engine and QGIS. The study focuses on discriminating and mapping two classes of aquatic surface conditions: areas covered with Floating and Emergent Aquatic Vegetation and open water, covering all seasons from 1 March 2024, to 28 February 2025. Spectral bands such as B04 (red), B08 (near infrared), B03 (green), and B11 (shortwave infrared) were used, along with indices like the Modified Normalized Difference Water Index and Normalized Difference Vegetation Index. The classification was enhanced using Otsu’s thresholding technique to distinguish accurately between Floating and Emergent Aquatic Vegetation and open water. Seasonal fluctuations were observed, with significant peaks in vegetation growth during the summer and autumn months, including a peak coverage of 2.08 km² on 9 September 2024 and a low of 0.00068 km² on 28 December 2024. These variations correspond to the seasonal growth patterns of Floating and Emergent Aquatic Vegetation, driven by temperature and nutrient availability. The study achieved a high overall classification accuracy of 89.31%, with producer accuracy for Floating and Emergent Aquatic Vegetation at 97.42% and user accuracy at 95.38%. Validation with Unmanned Aerial Vehicle-based aerial surveys showed a strong correlation (R² = 0.88) between satellite-derived and field data, underscoring the reliability of Sentinel-2 for aquatic vegetation monitoring. Findings highlight the potential of satellite-based remote sensing to monitor vegetation health and dynamics, offering valuable insights for the management and conservation of freshwater ecosystems. The results are particularly useful for governmental authorities and natural park administrations, enabling near-real-time monitoring to mitigate the impacts of overgrowth on water quality, biodiversity, and ecosystem services. This methodology provides a cost-effective alternative for long-term environmental monitoring, especially in regions where traditional methods are impractical or costly. Full article

Background/Objectives: The demand for accessible and reliable digital health services has increased significantly in recent years, particularly in regions facing physician shortages. HomeDOCtor, a conversational AI platform developed in Slovenia, addresses this need with a nationally adapted architecture that combines retrieval-augmented generation (RAG) and a Redis-based vector database of curated medical guidelines. The objective of this study was to assess the performance and impact of HomeDOCtor in providing AI-powered healthcare assistance. Methods: HomeDOCtor is designed for human-centered communication and clinical relevance, supporting multilingual and multimedia citizen inputs while being available 24/7. It was tested using a set of 100 international clinical vignettes and 150 internal medicine exam questions from the University of Ljubljana to validate its clinical performance. Results: During its six-month nationwide deployment, HomeDOCtor received overwhelmingly positive user feedback with minimal criticism, and exceeded initial expectations, especially in light of widespread media narratives warning about the risks of AI. HomeDOCtor autonomously delivered localized, evidence-based guidance, including self-care instructions and referral suggestions, with average response times under three seconds. On international benchmarks, the system achieved ≥95% Top-1 diagnostic accuracy, comparable to leading medical AI platforms, and significantly outperformed stand-alone ChatGPT-4o in the national context (90.7% vs. 80.7%, p = 0.0135). Conclusions: Practically, HomeDOCtor eases the burden on healthcare professionals by providing citizens with 24/7 autonomous, personalized triage and self-care guidance for less complex medical issues, ensuring that these cases are self-managed efficiently. The system also identifies more serious cases that might otherwise be neglected, directing them to professionals for appropriate care. Theoretically, HomeDOCtor demonstrates that domain-specific, nationally adapted large language models can outperform general-purpose models. Methodologically, it offers a framework for integrating GDPR-compliant AI solutions in healthcare. These findings emphasize the value of localization in conversational AI and telemedicine solutions across diverse national contexts. Full article

Background/Objectives: Syphilis, a re-emerging global public health issue, has shown increasing incidence over the past decade, particularly among key populations such as men who have sex with men (MSM), people living with HIV, and pregnant women. This narrative review aimed to synthesize global epidemiological trends of syphilis from 2015 to 2025, with a focus on surveillance gaps, regional disparities, and structural determinants. Methods: A broad narrative approach was used to collect and analyze epidemiological data from 2015 to 2025. The literature was retrieved from databases (PubMed, Scopus) and official reports from the WHO, CDC, and ECDC. Included materials span observational studies, surveillance reports, and modeling data relevant to global trends and public health responses. Results: Globally, syphilis incidence has increased, with notable surges in North America, Europe, and Asia. MSM remain disproportionately affected, while congenital syphilis is resurging even in high-income countries. Low- and middle-income countries report persistent burdens, especially among women of reproductive age, often exacerbated by limited screening and surveillance infrastructure. The COVID-19 pandemic disrupted syphilis-related services and further exacerbated underreporting, hindering timely detection and response efforts. Surveillance systems vary widely in their completeness and quality, which significantly hinders global data comparability and coordinated public health responses. Conclusions: Despite its curability, syphilis continues to spread due to fragmented prevention strategies, inequities in access to care, and insufficient surveillance. Strengthening diagnostic access, integrating prevention efforts into broader health systems, and addressing social determinants are essential. Improved surveillance, equitable access, and innovation—including diagnostics and potential vaccine research—are critical to controlling the global syphilis epidemic. Full article

Agricultural workers—individuals employed for labor in agriculture—are at high risk of various negative health outcomes, with many impacted by both the existence of health disparities and stress. While the issue of farm stress and associated psychosocial health outcomes has been studied in the general agricultural population, research investigating these issues specifically within the agricultural worker population is sparse. This study presents data from the United States Western Region Agricultural Worker Stress Survey (N = 354), which gauged workers’ perceived stress levels, sources of stress, desired stress management topics, and preferred methods of receiving information and support services. Long working hours, working in extreme temperatures, and a lack of time emerged as the top three stressors. On average, workers across the Western region of the U.S. are experiencing a moderate level of stress, with younger workers reporting greater stressor pileup than their older counterparts. Retirement planning was cited as the most preferred stress management topic, regardless of demographic. Lastly, workers chose in-person counseling as the support modality that they would most likely utilize. This research provides a variety of stress management recommendations such as working with farm owners to increase the safety of their operation, investing in face-to-face counseling services, and utilizing community health workers as sources of support. Full article

Background/Objectives: Violence is a significant occupational health issue for paramedics, yet underreporting limits efforts to identify and mitigate risk. Leveraging a novel, point-of-event violence reporting system, we aimed to identify characteristics of 9-1-1 calls associated with an increased risk of violence in a single paramedic service in Ontario, Canada. Methods: We retrospectively analyzed all electronic violence and patient care reports filed by paramedics in Peel Region and used logistic regression to identify call-level predictors of any violence and, more specifically, physical or sexual assault. Results: In total, 374 paramedics filed 974 violence reports, 40% of which documented an assault, corresponding to a rate of 4.18 violent encounters per 1000 9-1-1 calls. In adjusted models, the risk of violence was elevated for calls originating from non-residential locations (e.g., streets, hotels, bars), occurring during afternoon or overnight shifts, and involving young or working-age males. Presenting problems related to intoxication, mental health, or altered mental status were strongly associated with increased risk, with particularly high adjusted odds ratios for assault. Conclusions: These findings support the utility of near-miss and violence surveillance systems and highlight the need for multidisciplinary crisis response to high-risk calls, especially those involving mental health or substance use. Full article

The relationship between ecosystem services (ESs) and human well-being (HWB) is a central issue of sustainable development. However, current research often relies on qualitative frameworks or indicator-based assessments, limiting a comprehensive understanding of the relationship between natural environment and human acquisition, which still needs to be strengthened. As an element transferred in the natural–society coupling system, carbon can assist in characterizing the dynamic interactions within coupled human–natural systems. Carbon, as a fundamental element transferred across ecological and social spheres, offers a powerful lens to characterize these linkages. This study develops and applies a novel analytical framework that integrates carbon flow as a unifying metric to quantitatively assess the spatiotemporal dynamics of the land use and land cover change (LUCC)–ESs–HWB nexus in Guizhou Province, China, from 2000 to 2020. The results show that: (1) Ecosystem services in Guizhou showed distinct trends from 2000 to 2020: supporting and regulating services declined and then recovered, and provisioning services steadily increased, while cultural services remained stable but varied across cities. (2) Human well-being generally improved over time, with health remaining stable and the HSI rising across most cities, although security levels fluctuated and remained low in some areas. (3) The contribution of ecosystem services to human well-being peaked in 2010–2015, followed by declines in central and northern regions, while southern and western areas maintained or improved their levels. (4) Supporting and regulating services were positively correlated with HWB security, while cultural services showed mixed effects, with strong synergies between culture and health in cities like Liupanshui and Qiandongnan. Overall, this study quantified the coupled dynamics between ecosystem services and human well-being through a carbon flow framework, which not only offers a unified metric for cross-dimensional analysis but also reduces subjective bias in evaluation. This integrated approach provides critical insights for crafting spatially explicit land management policies in Guizhou and offers a replicable methodology for exploring sustainable development pathways in other ecologically fragile karst regions worldwide. Compared with conventional ecosystem service frameworks, the carbon flow approach provides a process-based, dynamic mediator that quantifies biogeochemical linkages in LUCC–ESs–HWB systems, which is particularly important in fragile karst regions. However, we acknowledge that further empirical comparison with traditional ESs metrics could strengthen the framework’s generalizability. Full article

Background: Psychological problems post-stroke can negatively impact stroke survivors. Although general psychological services exist (e.g., NHS Talking Therapies), access remains limited, particularly for individuals with post-stroke communication and cognitive impairments. Stroke service staff report low confidence in managing psychological distress. This study is the first to explore the barriers and facilitators to implementing a novel intervention package comprising a cross-service care pathway and staff training to enhance post-stroke psychological provision. Methods: Staff from stroke and mental health services in four UK regions, recruited through purposive sampling to ensure diversity of services and professional roles, participated in semi-structured interviews or focus groups, guided by the Theoretical Domains Framework (TDF), before and after implementation of the intervention package. Pre-implementation interviews/groups identified anticipated barriers and facilitators to implementation and training needs, informing the development of site-specific intervention packages; post-implementation interviews/groups explored experienced barriers, facilitators and perceptions of the intervention. Interviews underwent thematic analysis using the TDF. Results: Fifty-five staff participated pre-implementation and seventeen post-implementation, representing stroke (e.g., nurse, physiotherapist, consultant) and psychology (e.g., counsellor, psychological therapist) roles across acute, rehabilitation, community, and voluntary services. Challenges anticipated pre-implementation included: limited specialist post-stroke psychological support; low staff confidence; and fragmented service pathways. Post-implementation findings indicated increased staff knowledge and confidence, enhanced screening and referral processes, and stronger inter-service collaboration. Implementation success varied across sites (with some sites showing greater ownership and sustainability of the intervention) and across staff roles (with therapy staff more likely than nursing staff to have received training). Conclusions: Effective implementation of an intervention package to increase psychological provision post-stroke requires staff engagement at all levels across all services. Staff investment influenced ownership of the intervention package, beliefs about priorities and overall enhancement of service capability. Full article

Assessing a city’s level of smartness according to global indices is a relatively new area of investigation. It is useful in encouraging a rethinking of urban digital strategies, although the different approaches to global smart city rankings have been subject to criticism. This paper highlights the methodological features of constructing the Smart City Index (SCI) from the IMD (International Institute for Management Development) based on residents’ assessments, their satisfaction with electronic services, and their perception of the priority of urban infrastructure areas. The Central European cities of the Visegrad region (Prague/Czech Republic, Budapest/Hungary, Bratislava/Slovakia, Warsaw and Krakow/Poland) were chosen as the basis for an in-depth analysis. The architectonics, i.e., the internal system of constructing and calculating city rankings by SCI, is analyzed. A comparative analysis of the technology indicators (e-services) in five cities of the Visegrad region, presented in the SCI, showed the smart features of each city. The progressive and regressive trends in the dynamics of smartness in the cities in the Visegrad region were identified in five urban spheres indicated in the Index: Government, Activity, Health and Safety, Mobility, and Opportunities. This also made it possible to identify certain methodological gaps in the SCI in establishing interdependencies between the data on the residents’ perception of the priority of areas of life in a particular city and the residents’ level of satisfaction with electronic services. In particular, the structural indicators “Affordable housing” and “Green spaces” are not supported by e-services. This research aims to bridge this methodological gap by proposing a model for evaluating the e-service according to the degree of coverage of different spheres of life in the city. The application of the project, as well as cross-sectoral and systemic approaches, made it possible to develop basic models for assessing the value of e-services. These models can be implemented by municipalities to assess and monitor e-services, as well as to select IT projects and elaborate strategies for smart sustainable city development. Full article

This study investigates the critical determinants of customer retention in casual dining restaurants within the context of the post-pandemic “new normal.” Anchored in service quality and consumer behavior theories, the research examines the influences of food quality, health measures, perceived price, brand image, ambiance, and location on customer decision making. Using Partial Least Squares Structural Equation Modeling (PLS-SEM), data from 336 respondents in the National Capital Region, Philippines were analyzed to assess the relationships among these variables and their effects on restaurant selection and customer retention. The results reveal that food quality (β = 0.698, p < 0.05) exerts the strongest influence on restaurant selection, followed by health measures (β = 0.477, p = 0.001), perceived price (β = 0.378, p < 0.02), and brand image (β = 0.341, p < 0.035). Furthermore, health measures (β = 0.436, p = 0.002) and restaurant selection (β = 0.475, p < 0.05) significantly enhance customer retention, while ambiance and location were not found to be significant predictors. These findings offer theoretical contributions to the service quality and consumer trust literature and provide practical and policy-relevant insights for food establishments adapting to health-driven consumer expectations. The study highlights the need for the strategic integration of safety protocols, pricing value, and brand positioning to foster long-term loyalty and resilience in the evolving food service market. Full article

Background/Objectives: Grief in cancer patients represents a multidimensional psychological response encompassing anticipatory, existential, and identity-related distress. While the recent literature has examined grief in caregivers, family members, and even healthcare professionals, the psychological grief experienced by patients themselves following a cancer diagnosis remains comparatively understudied and insufficiently characterized in empirical research. This systematic review aims to evaluate observational studies that used validated psychometric instruments to measure grief in adult cancer patients and to synthesize findings on the significance of grief in this population. Methods: Following PRISMA 2020 guidelines, a systematic search of PubMed, CINAHL, and PsycINFO was conducted to identify observational studies that employed validated tools to assess grief among adult cancer patients. The inclusion criteria required the use of psychometrically validated grief instruments and the collection of quantitative data. Fifteen studies met eligibility criteria and were included in the final analysis. Results: Grief symptoms were consistently present at moderate to high levels across diverse cancer types, care settings, and geographic regions. Preparatory Grief in Advanced Cancer (PGAC) scores often exceeded thresholds associated with clinical concern, with correlations observed between grief and psychological variables such as anxiety (r = 0.63), depression (r = 0.637), hopelessness (r = 0.63), and dignity (r = 0.654). Demographic factors (e.g., younger age, female gender) and illness perceptions (e.g., identity centrality, stigma) further intensified grief. Grief was a predominant psychological concern even when general distress measures failed to capture its presence. Conclusions: Future research is essential to identify an effective public health strategy for addressing grief through structured screening conducted in primary care and outpatient medical settings, coupled with accessible referral pathways to community-based support groups and coordinated follow-up services to facilitate grief management. Full article

Aboriginal and Torres Strait Islander people who inject drugs face persistent health inequities, highlighting the need for programs that meet the needs of these groups. This study explored how intersectional stigma and discrimination affect Aboriginal and Torres Strait Islander people’s access to quality healthcare. Aboriginal and Torres Strait Islander participants aged ≥18 years who had injected drugs within the past 12 months were recruited from two regional needle and syringe programs (NSPs) and a major city NSP in Queensland, Australia. Participants completed a structured survey and yarned with an Aboriginal researcher and non-Indigenous research assistant about their healthcare experiences. Through a process of reflexive and thematic analysis, three major qualitative themes emerged: participants’ social circumstances and mental health challenges made help-seeking difficult and complex; enacted stigma and racism diminished access to health services and the quality of care received; and injecting drug use was associated with disconnection from culture and community. Privileging the expertise and voices of those with lived/living experience is essential for the creation of culturally safe, inclusive, and destigmatising healthcare services for Aboriginal and Torres Strait Islander people who inject drugs. Full article

Agroecological transitions in collective urban gardens in Toulouse region were studied through the prism of global health (2011–2022). The specific meaning of “global health” in the context of urban gardens concerns the health of gardeners (well-being and physical health), plants, soil, and animals, as well as the interactions between humans and non-humans, which are crucial for gardeners. A sociotechnical research project was developed on four different collective gardening sites, consisting of the following: 1. surveys issued to 100 garden stakeholders to highlight issues and practices, participation in meetings with the social centers in charge of events, and focus groups; 2. participative agronomic and environmental measurements and field observations, including soil quality analyses; and 3. analysis of the available documentary corpus. In order to produce the results, these three research methods (surveys, agronomy, document analysis) were combined through a transdisciplinary approach, in that both the field experimentation outcomes and retrieved scientific publications and technical documents informed the discussions with gardeners. Consideration of the four different sites enabled the exploration of various contextual factors—such as soil or air quality—affecting the production of vegetables. A rise in the concerns of gardeners about the impacts of their activities on global health was observed, including aspects such as creating and enjoying landscapes, taking care of the soil and biodiversity, developing social connections through the transmission of practices, and regular outside physical activity and healthier eating. The increased consideration for global health issues by all stakeholders promotes the implementation of agroecological practices in gardens to improve biodiversity and adherence to circular economy principles. Four concepts emerged from the interviews: health, production of vegetables, living soil, and social interactions. Notably, nuances between the studied sites were observed, according to their history, environment, and organization. These collective gardens can thus be considered as accessible laboratories for social and agroecological experimentation, being areas that can strongly contribute to urban ecosystem services. Full article