Search Results (2,889)

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

This study examined Croatian consumer attitudes towards fresh pork from the Black Slavonian pig, focusing on the following sustainability dimensions: environmental, social, economic sustainability, and animal welfare. A survey of 410 consumers was conducted in June 2021, using an online questionnaire assessing consumption habits, breed knowledge, and socio-demographic characteristics. Factor analysis identified four key dimensions: attention to animal welfare, support for local production and biodiversity, origin and information, and price and intrinsic quality. Cluster analysis revealed three distinct consumer segments: conscious consumers (32.4%), value-oriented consumers (37.3%), and uninvolved meat consumers (30.2%). Multinomial logistic regression showed that age, region, family economic status, and place of purchase significantly predicted cluster membership (Nagelkerke R² = 0.251, classification accuracy = 52.9%), while gender, education level, and household composition did not. Conscious consumers were characterised by older age, higher income, and a preference for direct purchasing channels, while value-oriented consumers favoured supermarkets and mid-range pricing. These findings highlight the need for improved consumer education, transparent labelling, targeted marketing strategies, and enhanced policy support to promote sustainable indigenous pig breed production and conservation. Full article

Increasing global water scarcity has intensified the adoption of water reuse as a sustainable strategy, particularly in regions affected by drought and pressure on natural resources. This paper presents a systematic review of the application of Life Cycle Assessment (LCA) in water reuse projects, focusing on research trends, methodological approaches, and opportunities for improvement. A systematic search was conducted in Web of Science, ScienceDirect, and Google Scholar for studies published from 2020 onwards using combinations of the keywords “life cycle assessment”, “LCA”, “water reuse”, “water recycling”, and “wastewater recycling”. Twelve studies were selected from 57 records identified, based on predefined eligibility criteria requiring quantitative LCA of water reuse systems. The results reveal a predominance of European research, reflecting regulatory advances and strong academic engagement in this field. The most frequently assessed impact categories were global warming, eutrophication, human toxicity and ecotoxicity, highlighting the environmental relevance of reuse systems. Energy consumption and water transport were identified as critical hotspots, especially in scenarios involving long distances and fossil-based energy sources. Nevertheless, most studies demonstrate that water reuse is environmentally viable, particularly when renewable energy and optimized logistics are applied. The review also emphasizes the need to better integrate economic and social dimensions and to adapt LCA methodologies to local conditions. Overall, the findings confirm LCA as a robust decision-support tool for sustainable planning and management of water reuse systems. Full article

Introduction: Pneumonitis represents one of the clinically significant adverse events observed in patients with non-small-cell lung cancer (NSCLC) who receive durvalumab as consolidation therapy after chemoradiotherapy (CRT). Although clinical factors such as radiation dose (e.g., V20) and interstitial lung abnormalities (ILAs) have been reported as risk predictors, accurate and objective prognostication remains difficult. This study aimed to develop a radiomics-based machine learning model to predict grade ≥ 2 pneumonitis. Methods: This retrospective study included patients with unresectable NSCLC who received CRT followed by durvalumab. Radiomic features, including first-order and texture and shape-based features with wavelet transformation were extracted from whole-lung regions on pre-durvalumab computed tomography (CT) images. Machine learning models, support vector machines, k-nearest neighbor, neural networks, and naïve Bayes classifiers were developed and evaluated using a testing cohort. Model performance was assessed using five-fold cross-validation. Conventional predictors, including V20 and ILAs, were also assessed using logistic regression and receiver operating characteristic analysis. Results: Among 123 patients, 44 (35.8%) developed grade ≥ 2 pneumonitis. The best-performing model, a support vector machine, achieved an AUC of 0.88 and accuracy of 0.81, the conventional model showed lower performance with an AUC of 0.71 and accuracy of 0.64. Conclusions: Radiomics-based machine learning demonstrated superior performance over clinical parameters in predicting pneumonitis. This approach may enable individualized risk stratification and support early intervention in patients with NSCLC. Full article

Background: Neurogenic bowel dysfunction (NBD) is a major chronic sequela of spinal cord injury (SCI) with substantial implications for rehabilitation and long-term management. However, population-level evidence describing how gastrointestinal (GI) diagnostic codes are used following SCI, particularly within administrative healthcare systems, remains limited. Methods: We conducted a nationwide retrospective cohort study using administrative claims data from the Korean National Health Insurance Service (NHIS). A total of 584,266 adults with trauma-related SCI encounters between 2009 and 2019 were identified. GI diagnostic codes—paralytic ileus (K56), irritable bowel syndrome (K58), and functional bowel disorders (K59)—were evaluated as administrative proxies for bowel dysfunction. Demographic characteristics, disability status, regional factors, and health behaviors were analyzed using multivariable logistic regression. Results: GI diagnostic codes were frequently recorded after SCI, most commonly irritable bowel syndrome (approximately 30%) and functional bowel disorders (approximately 37%), whereas paralytic ileus was uncommon. Greater disability severity, female sex, older age, and rural residence were consistently associated with higher odds of GI diagnostic coding. Physical activity showed robust inverse associations across all models. Inverse associations observed with smoking and alcohol consumption were interpreted as reflecting residual confounding or health-related selection, rather than biological protective effects. Conclusions: Patterns of GI diagnostic coding after SCI likely reflect the clinical burden and management needs of neurogenic bowel dysfunction within healthcare systems, rather than the development of new gastrointestinal diseases. These findings underscore the importance of individualized bowel management, incorporation of structured physical activity into rehabilitation programs, and equitable access to SCI rehabilitation services, particularly for individuals with greater disability or those living in rural areas. Full article

Background and Objectives: Access to anterior cruciate ligament reconstruction (ACLR) varies substantially across health systems, yet national-level data from Eastern Europe remain limited. This study provides the first nationwide, regionally stratified assessment of ACLR activity in Romania, examining geographic variation, socioeconomic and workforce determinants, and inequality. Materials and Methods: We conducted a retrospective cross-sectional analysis of all ACLRs reported in the national administrative hospital database (2017–2023), supplemented with demographic, GDP, and workforce statistics. Outomes included incidence per 100,000 population, private-sector share, and sex distribution. Regional differences were tested using Kruskal–Wallis and Dunn post hoc comparisons. Predictors of ACLR incidence and private-sector utilization were identified through multivariable Poisson and logistic models. Inequality metrics (Gini coefficients, P90/P10 ratios) and sensitivity analyses excluding Bucharest–Ilfov were also performed. Results: A total of 11, 080 ACLRs were recorded. Incidence varied markedly across regions, from a median of 40.0 per 100,000 in Bucharest–Ilfov to <1–3 per 100,000 in the South, South-East, and South-West (p < 0.001). Higher GDP per capita correlated with incidence (ρ = 0.36) and explained 45% of its variance. Private-sector involvement ranged from <5% in Bucharest–Ilfov and the South to 80–100% in the Centre, North-West, and South-East. In adjusted Poisson models, GDP, surgeon availability, and private-sector share were strong independent predictors of incidence (all p < 0.001). Private-sector access was primarily determined by the proportion of private orthopedic surgeons (OR 21.03). National inequality was extreme (Gini 0.842–0.752; P90/P10 > 10⁹), reflecting the concentration of procedures within a small number of counties. Results were consistent across sensitivity analyses. Conclusions: ACLR in Romania displays severe territorial inequities driven by socioeconomic development, workforce distribution, and uneven private-sector capacity. Targeted regional investment and coordinated workforce strategies are necessary to improve equitable access to surgical care. Full article

Background/Objectives: Autism Spectrum Disorder (ASD) is a lifelong neurodevelopmental disorder characterized by social, communication, and behavioral challenges. complementary and alternative medicine (CAM) is widely used by parents worldwide, yet research exploring parents’ experiences, particularly in Arab countries, is limited. This study explored mothers’ perceptions and experiences of CAM use for children with ASD, information-seeking behaviors and challenges encountered. Methods: A qualitative study using semi-structured interviews was conducted among twenty mothers at Autism Academy of Jordan in 2024. Inclusion criteria were mothers with children diagnosed with ASD for at least six months and those who had used at least one CAM therapy. Interviews were conducted via Skype, transcribed verbatim, and analyzed using NVivo 12 with inductive thematic analysis. Results: Three major themes emerged in this qualitative study: (1) mothers’ experiences with CAM and perceptions of benefit; (2) sources of information and decision-making processes; and (3) main challenges in selecting and implementing CAM. Mothers reported using therapies such as honey, black seed, camel milk, Hujama, olive oil, supplements, and region-specific programs like Andalosiah. Faith, cultural beliefs, and the desire for natural, safe interventions strongly influenced CAM selection. Internet searches and social media groups were primary information sources. Challenges included financial, logistical, emotional burdens, and lack of trustworthy, Arabic-language information sources. Conclusions: Mothers in Arab countries navigate CAM use for their children with ASD through culturally and religiously informed practices. Interventions should focus on developing evidence-based guidance, culturally sensitive counseling, and accessible information to support families in safe, informed CAM use. Full article

Background: Depression and eating disorders (EDs) represent significant and often multiple public health concerns. Healthcare workers, including medical residents, were affected by several stressors that the COVID-19 pandemic has engendered and amplified, potentially exacerbating mental health issues. Despite this, limited evidence is available regarding the association between depressive symptoms and possible EDs among Public Health Residents (PHRs). Methods: A nationwide cross-sectional study, the ‘Public Health Residents Anonymous Survey in Italy (PHRASI),’ was conducted between June and July 2022. A total of 379 PHRs participated in this study, filling in a self-administered questionnaire which included the PHQ-9 for assessing depressive symptoms and the SCOFF (Sick, Control, One, Fat, Food) test as a screening tool for possible EDs. Multivariable logistic regression evaluated associations between sociodemographic and training/work-related factors, depressive symptoms, and EDs. Results: Overall, 40.6% of respondents screened positive for possible EDs. Depressive symptoms had a positive association with possible EDs (aOR = 2.76; 95% CI = 1.55–4.93). Other factors associated with higher ED odds included region of residence (aOR = 1.92; 95% CI = 1.06–3.47), intention to repeat the test for another postgraduate course (aOR = 3.22; 95% CI = 1.25–8.3), and working more than 40 h per week (aOR = 1.91; 95% CI = 1.19–3.07). Conversely, having more than one child (aOR = 0.32; 95% CI = 0.13–0.78) was associated with lower odds. Conclusions: The findings highlight a significant association between depressive symptoms and positive screening for possible EDs, underscoring the need for integrated mental health support and preventive interventions within medical residency programmes, especially in the context of public health crises. Full article

High-quality agricultural products from the Lambayeque region have contributed to the growth of Peru’s agro-export sector and increased international trade. However, the need for agricultural exports to be more resilient and sustainable is demonstrated by the fact that markets are still concentrated, logistical costs are high, and global demand is constantly shifting. The purpose of this study is to use a gravity-based trade model and market intelligence techniques to analyse the agricultural exports from the Lambayeque region between 2015 and 2024. Using official data from the World Bank, AZATRADE, CEPII, and MINCETUR, we employed a quantitative explanatory approach. The results show that the concentration of businesses has significantly decreased while the value of exports has increased steadily. The Herfindahl–Hirschman Index increased from 6209 in 2015 to 1349 in 2024, and export destinations have become slightly more diverse. Exports are negatively impacted by geographic distance, but free trade agreements greatly benefit them. There is a lot of export potential in markets like Finland, Indonesia, Austria, Bolivia, and Vietnam. However, Israel and Hong Kong appear to be full. Overall, the findings indicate that Lambayeque’s export performance has improved, but it still runs the risk of becoming overly focused on a single sector. Long-term sustainability of the region’s agricultural exports depends on enhancing logistical infrastructure, bolstering market intelligence, and promoting regional diversity. Full article

Background: The rapid digital transformation in logistics requires the adaptation of transport companies to electronic information management, particularly through the implementation of electronic consignment notes (e-CMR). This study examines how the digitization of transport documentation affects the competitiveness, operational efficiency, and environmental performance of road freight transport companies. Methods: A questionnaire survey was conducted among Slovak and Czech carriers to analyze their experience and readiness for adopting e-CMR. The collected data were evaluated using descriptive and comparative methods to quantify economic and ecological impacts, focusing mainly on invoicing efficiency and paper consumption. Results: The results show that only a small share of carriers currently use e-CMR, primarily due to high software costs and the lack of partner participation. Nevertheless, digitization can significantly shorten the average invoicing delay by approximately 11.5 days, releasing around 7% of tied-up working capital and improving cash flow. From an environmental perspective, the replacement of paper CMR forms could save millions of sheets annually, leading to a substantial reduction in CO₂ emissions and paper waste within the V4 region. Conclusions: The findings confirm that the adoption of e-CMR improves economic performance, increases transparency, and contributes to sustainability, representing a crucial step toward a more competitive and environmentally responsible road freight transport sector in Europe. Full article

This study investigates thermal stress and energy-related anxiety as lived, multidimensional manifestations of energy poverty in Western Macedonia, Greece, a coal phase-out region undergoing just transition. Using a 261-household survey, we construct a thermal stress index from four Likert-type items capturing seasonal thermal adequacy, energy anxiety, and restricted use of rooms. High thermal stress is defined as the upper quartile of the index. Descriptive results indicate that high thermal stress affects 27.2% of households, exceeding a 20% threshold, while energy-related anxiety and restricted room use are widespread. We then estimate logistic regression models to examine whether vulnerability characteristics (disability-related thermal/electric needs, single parenthood, dependent children, benefit receipt, elderly presence), financial stress indicators (arrears, energy debt, frequent forced reductions in consumption), and socio-economic controls (income, employment, tenure, age, gender) predict high thermal stress. Adjusted models show that vulnerability markers do not retain statistically independent associations once controls are included. In contrast, tenure and energy-related financial stress are significantly associated with the probability of high thermal stress. The findings highlight the importance of measurement choices and suggest that experiential indicators capture energy-poverty dynamics that are not reducible to income-based targeting, with implications for just-transition policy design and energy justice. Full article

The gastronomic identity represents a blend of tradition, local resources, and cultural values that shape the authenticity and distinctiveness of a region’s gastronomy. Mačva, as an area in western Serbia, possesses an exceptionally rich gastronomic heritage whose tourism potential has not been sufficiently valorized. The subject of this research is the examination of the gastronomic identity of Mačva, and the purpose of the study is to determine how domestic tourists perceive the region’s gastronomic identity, which factors shape this identity, and the extent to which socio-demographic and perceptual characteristics influence the likelihood of purchasing traditional food products. The aim of this research is to develop an analytical framework to identify the key factors shaping the gastronomic identity of the Mačva region and to examine their influence on domestic tourists’ perceptions and consumer behavior related to the consumption and purchase of traditional food. The data were processed using exploratory factor analysis and binary logistic regression. The results indicate that respondents recognize the gastronomic culture of Mačva as an important component of the region’s cultural identity. The factor structure confirmed a three-dimensional model of gastronomic identity, comprising cultural–gastronomic heritage, authenticity and the promotion of gastronomy, and the region’s economic and social development. The results suggest that tourists’ intention to purchase traditional products is shaped by selected socio-demographic and perceptual factors, particularly gender and perceptions of gastronomy as a driver of economic and social development. The findings highlight the need for a differentiated approach to the development and positioning of the gastronomic offer, which may serve as a basis for formulating strategies for the development and branding of the Mačva region. Full article

The MALDI-TOF MS Bruker Biotyper MBT subtyping IVD module enables the early detection of cfiA-positive Bacteroides fragilis (cfiA+ BF) during bacterial identification. However, the relationship between genetic positivity, phenotypic resistance, and clinical outcomes has not been fully elucidated. This retrospective study analyzed B. fragilis isolates from three Hong Kong hospitals between 2021 and 2025 to examine their prevalence and the clinical utility of MALDI-TOF MS in rapid cfiA detection. Antibiotic susceptibility testing, cfiA gene detection using MALDI-TOF MS, and Oxford Nanopore sequencing were performed. Medical records were reviewed, and univariate analyses and multivariate logistic regression were used to identify factors associated with cfiA positivity and 30-day all-cause mortality. Overall, B. fragilis exhibited a high rate of antibiotic resistance. Concomitant resistance to carbapenems and metronidazole was identified in three isolates. Among the 166 isolates, 40 (24.1%) were cfiA-positive. cfiA detection by MALDI-TOF MS showed 100% concordance with the gene sequencing results and correlated strongly with phenotypic carbapenem resistance (Φ = 0.82, p < 0.001 for meropenem; Φ = 0.70, p < 0.001 for ertapenem; Φ = 0.63, p < 0.001 for imipenem). Phylogenetic analysis revealed two distinct clusters corresponding to cfiA status, each exhibiting genetic diversity based on multi-locus sequence typing (MLST). The cfiA+ BF isolates demonstrated high-level phenotypic carbapenem resistance in the presence of upstream insertion sequences. The predominant sequence type (ST) among cfiA+ BF isolates was ST157, and 70% of ST157 isolates harbored IS1187 in the upstream region of cfiA. Gene sequencing also identified other emerging beta-lactamase genes bla_OXA-347 and bla_MUN. The 30-day all-cause mortality following B. fragilis infection was 13.3%, with independent predictors including a high Charlson Comorbidity Index (OR = 1.30; p = 0.02) and the absence of early source control (OR = 4.84; p = 0.03). This study highlights the widespread occurrence of cfiA+ BF in Hong Kong and the clinical significance of rapid cfiA detection. Continuous surveillance is essential to monitor the ongoing threat of antibiotic resistance in B. fragilis. Full article

Galba truncatula acts as an intermediate host for several parasitic flukes of veterinary importance, but a targeted study on its spatial presence as well as the impact of environmental factors in Southeastern Europe has not been conducted. During the summer months of 2017 and 2018, a survey of 191 water bodies in 14 districts in Central, Southern and Western Bulgaria was conducted, with a focus on animal drinking fountains. Each site was assessed for snail presence and characterized by altitude, temperature, precipitation, shade and type of water body. Logistic regression modeling was used to identify the important factors related to the occurrence of snail species. The frequency of habitats found was 29.3%, with no differences observed between the studied districts (p > 0.05). Snails were present across a wide range of altitudes (78–1926 m), annual mean temperature (7.8–14.0 °C) and annual mean precipitation (523–796 mm). The high habitat frequencies were recorded in streams (60.0%) and on the banks on small rivers (50.0%). The presence of snails in the two studied types of fountains (without or with a concrete platform) was 24.1% and 17.2%, respectively, with no significant difference between them (p > 0.05). Regression analysis revealed temperature, shade, and type of water body as factors that could significantly influence the spatial presence of G. truncatula. The findings demonstrate the ecological adaptability of G. truncatula and highlight its presence in habitats with high potential for contact with domestic and wild ruminants. This information fills a regional knowledge gap and can support risk assessment and control measures for fluke-borne diseases in livestock and wildlife. Full article

The contemporary agricultural market is profoundly volatile, where agricultural prices are based on a complex supply chain, climatic irregularity or unscheduled market demand. Prices of crops need to be predicted in a reliable and timely manner for farmers, policy-makers and other stakeholders to take evidence-based decisions ultimately for the benefit towards sustainable agriculture and economic sustainability. Objective: The objective of this study is to develop and evaluate a comprehensive machine learning model for predicting agricultural prices incorporating logistic, economic and environmental considerations. It is the desire to make agriculture more profitable by building simple and accurate forecasting models. Methods: An assorted dataset was collected, which covers major factors to constitute the dataset of temperature, rainfall, fertiliser use, pest and disease attack level, cost of transportation, market demand-supply ratio and regional competitiveness. The data was subjected to pre-processing and feature extraction for quality control/quality assurance. Several machine learning models (Linear Regression, Support Vector Machines, AdaBoost, Random Forest, and XGBoost) were trained and evaluated using performance metrics such as R2 score, Root Mean Squared Error (RMSE), and Mean Absolute Error (MAE). Results: Out of the model approaches that were analysed, predictive performance was superior for XGBoost (with an R2 Score of 0.94, RMSE of 12.8 and MAE of 8.6). To generate accurate predictions, the ability to account for complex non-linear relationships between market and environmental information was necessary. Conclusions: The forecast model of the XGBoost-based prediction system is reliable, of low complexity and widely applicable to large-scale real-time forecasting of agricultural monitoring. The model substantially reduces the uncertainty of price forecasting, and does so by including multivariate environmental and economic aspects that permit more profitable management practices in a schedule for future sustainable agriculture. Full article