Search Results (46)

Although Greece is a leading olive oil producer, research on olive tourism (OT) remains limited, restricting the development of evidence-based policies and strategies. This study utilises primary data from 55 qualitative interviews conducted with OT visitors across Greece in 2023 to examine the sociodemographic characteristics, visiting behaviours, motivations, and expectations of domestic OT participants. These visitors are primarily mature, highly educated individuals with medium to high income levels. Their main motivations include acquiring specialised knowledge, cultivating a personal interest in olive-related culture, and seeking connections with local and familial heritage. They prefer experiences that highlight the sociocultural and culinary aspects of olives and olive oil, especially those that facilitate the practical application of new knowledge. Interactivity, experimentation, social engagement, and outdoor activities are highly valued. Comparative analysis with OT studies from Spain, Portugal, and Italy reveals similarities in visitor demographics but also identifies notable differences in motivations and expectations. By addressing a significant research gap, these findings offer policymakers, tourism operators, and producers strategic guidance for OT development in Greece, as well as transferable insights useful to other olive-producing countries. The study also demonstrates the potential for well-designed OT initiatives to promote sustainable rural development, preserve cultural and environmental heritage, extend the tourism season, and strengthen local economies. 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

Intergenerational contact is a key component of the informal support systems that contribute to the wellbeing of older adults. As societies age and migration patterns diversify family structures, understanding how contact is sustained across generations becomes increasingly relevant for health equity and the sustainability of care systems. In this study, we conceptualise sustainability not in environmental terms but as social and health-system sustainability—that is, the long-term ability of families and care systems to maintain intergenerational ties, ensure equitable access to support, and remain resilient under demographic and social pressures. Drawing on theories of intergenerational solidarity and social capital, this study situates contact as both a resource for individual wellbeing and a pillar of care sustainability in diverse societies. We examine the frequency of contact between parents and adult children among adults aged 50 and above, comparing migrant and non-migrant populations across 25 European countries. Using data from Waves 7, 8, and the COVID-19 wave of the Survey of Health, Ageing and Retirement in Europe (SHARE), we assess both in-person and digital forms of contact before and during the pandemic. Results show that older migrants have less frequent contact with parents but more frequent contact with children than do non-migrants, with similar patterns attested across repeated cross-sections (2017, 2019, 2021). The strong contact observed in each cross-section, facilitated by digital tools, implies resilient family ties under public-health stress. However, resilience is uneven: weaker contact with parents among migrant populations reflects structural barriers such as visa restrictions, caregiving responsibilities, discrimination, language barriers, and unequal digital access. Moreover, differences in access and proficiency with digital tools suggest that digital contact did not compensate equally across groups. These findings underscore the importance of sustainable and inclusive strategies in ageing and health policy. Specifically, targeted digital literacy programmes for older migrants, policies supporting transnational caregiving, affordable internet access, mobility solutions, and anti-discrimination measures in family visitation are crucial to reducing inequities. Full article

Food insecurity is a pervasive public health issue in the United States. While food pantries attempt to alleviate this issue, their effectiveness is limited by structural and logistical barriers that affect service accessibility. Transportation is a frequently underexamined barrier for individuals trying to access food aid. The purpose of this study is to assess the interplay of client- and pantry-level characteristics and their influence on food aid accessibility across several transportation modalities. This cross-sectional survey study collected data from 430 food pantry clients concerning their demographics, transportation methods, and perceptions of transportation barriers. Pantry characteristics were also collected focusing on transportation infrastructure and operational policies. Individual and grouped comparisons were made between transportation methods in relation to pantry visitation, with those walking, biking, and taking a bus to the pantry grouped to compare to those taking a car. Higher food insecurity score, smaller household size, single relationship status, and race were independently associated with increased odds of walking, biking, or taking a bus to the pantry. Having closer bus stops, more bus lines, and no monthly use limits were independently associated with increased odds of walking, biking, or taking a bus to the pantry. Several characteristics were associated with specific transportation modalities when accessing food aid. Our results are particularly concerning given the increased food insecurity and additional vulnerabilities seen in those who walk, bike, or take the bus to the pantry. Transportation disadvantage may be ameliorated by less restrictive pantry use policies and more robust public transit. Full article

Background/Objectives: Leisure participation is vital for children’s development and family inclusion, yet families of children with developmental delays and disabilities face significant barriers. Guided by a health literacy framework, this study examined how personal and organizational health literacy shape access to inclusive leisure opportunities. Methods: Semi-structured interviews were conducted with 14 caregivers of young children (aged 2 to 6 years) with developmental delays and disabilities. A qualitative content analysis was applied to identify family and environmental factors shaping leisure participation. Results: Families with stronger personal health literacy engaged in diverse leisure activities, prioritizing children’s development through park visits and structured home routines. In contrast, weak organizational health literacy—reflected in limited inclusive facilities and support systems—restricted opportunities, increased caregiver stress, and forced adaptations such as traveling farther or rescheduling activities. These barriers underscored families’ vulnerability to exclusion while also highlighting their resilience in navigating daily life. Conclusions: This study demonstrates that health literacy functions at both personal and organizational levels to shape leisure participation. Beyond identifying barriers, it shows that leisure is intertwined with developmental needs and school readiness. By applying a health literacy lens, the study contributes to understanding family dynamics in inclusive leisure and underscores the need for responsive community services and inclusive policies. Full article

Background/Objectives: Understanding the medication prescribing patterns in pediatric primary care is essential for informing policy and clinical practice. In the Kingdom of Saudi Arabia (KSA), and following the 2018 antibiotic restriction policy, limited data exist on the patterns, types, and regimens of antibiotics prescribed during routine family medicine visits for children. This pharmacoepidemiological study aimed to describe the antibiotic prescribing patterns in a university-affiliated model primary healthcare center. Methods: A retrospective chart review was conducted for all the pediatric visits (<14 years) to general family medicine clinics between January and December 2024. Demographic characteristics, visit type, diagnosis, and antibiotic prescription details such as medication class, route, frequency, and duration were extracted from electronic medical records and analyzed descriptively. Results: Among the 2036 pediatric visits, 705 (34.63%) resulted in at least one prescription. Of these, 87 visits (12.34%) included an antibiotic. The most frequently prescribed antibiotic classes were nitroimidazoles (39.29%), penicillins (36.90%), and macrolides (10.71%). Penicillins were typically prescribed for 7 days twice daily as suspensions. Among the non-antibiotic prescriptions, vaccines, nutritional supplements, and analgesics were the most common. Follow-up consultations accounted for 34.09% of all the visits. Conclusions: A lower proportion of antibiotic prescriptions was found when compared to regional and international reports, which may reflect the impact of the antibiotic restriction policy in the country. The findings suggest a shift toward more cautious prescribing in primary care and align with the national efforts to regulate antimicrobial use. Ongoing surveillance of the prescribing trends is essential to evaluate the long-term effectiveness of these measures. Full article

The COVID-19 pandemic disrupted tourism systems worldwide, particularly ecologically sensitive and tourism-dependent regions such as the Galapagos Islands. This study investigated the impact of the pandemic on profiles of tourists visiting Santa Cruz Island by comparing an analysis from 2019 to data we gathered in 2021. Using survey-based data and cluster analysis, we identified significant shifts in tourist origin, travel modalities, and expenditure patterns. Results showed a marked increase in domestic tourism, with Ecuadorians becoming the dominant visitor group during the pandemic, primarily favoring land-based tourism and shorter stays. In contrast, international tourists remained present in niche, higher-spending segments associated with cruise-based and multi-island itineraries. These findings highlight a temporary yet meaningful transformation in the tourism dynamic, driven by changes in risk perception, economic factors, and policy restrictions. The emergence of these segments underscores the need for adaptive destination management strategies that align with sustainability goals, conservation priorities, and socioeconomic resilience. We also demonstrated the value of structured surveys as a cost-effective tool for evidence-based decision-making in resource-constrained settings. Full article

Substance use during pregnancy is an increasingly important yet under-recognized threat to maternal and child health. This narrative review synthesizes the current evidence available on the epidemiology, pathophysiology, clinical management, and policy landscape of prenatal exposure to alcohol, tobacco, opioids, benzodiazepines, cocaine, cannabis, methamphetamines, and other synthetic drugs. All major psychoactive substances readily cross the placenta and can remain detectable in breast milk, leading to a shared cascade of obstetric complications (hypertensive disorders, placental abruption, pre-term labor), fetal consequences (growth restriction, structural malformations), and neonatal morbidities such as neonatal abstinence syndrome and sudden infant death. Mechanistically, trans-placental diffusion, oxidative stress, inflammatory signaling, and placental vascular dysfunction converge to disrupt critical neuro- and cardiovascular developmental windows. Early identification hinges on the combined use of validated screening questionnaires (4 P’s Plus, CRAFFT, T-ACE, AUDIT-C, TWEAK) and matrix-specific biomarkers (PEth, EtG, FAEE, CDT), while effective treatment requires integrated obstetric, addiction, and mental health services. Medication for opioid use disorders, particularly buprenorphine, alone or with naloxone, confers superior neonatal outcomes compared to methadone and underscores the value of harm-reducing non-punitive care models. Public-health strategies, such as Mexico’s “first 1 000 days” framework, wrap-around clinics, and home-visiting programs, demonstrate the potential of multisectoral interventions, but are hampered by structural inequities and punitive legislation that deter care-seeking. Research gaps persist in polysubstance exposure, culturally tailored therapies, and long-term neurodevelopmental trajectories. Multigenerational, omics-enabled cohorts, and digital longitudinal-care platforms represent promising avenues for closing these gaps and informing truly preventive perinatal health policies. Full article

Prolonged exposure to public health crises in the post-pandemic era poses significant threats to global mental health. To address this, we developed a conceptual model to analyse the spatiotemporal distribution of public emotions, using Weibo data from the 2022 Beijing bar outbreak (9 June–18 August). The model integrates lexicon-based emotion analysis, spatial autocorrelation tests, and content analysis to provide a comprehensive understanding of emotional responses across stages and regions. The findings reveal a multi-peak emotional cycle spanning emergency, contagion, and resolution stages, with significant emotional clustering in emergency zones, surrounding areas, and regions visited by infected individuals. Through coding, we identified 24 main-categories and 90 sub-categories, distilled into nine core themes that illustrate the interplay between influencing factors, public emotions, and online behaviours. Positive public emotions (e.g., hopefulness, gratitude, optimism) were linked to pandemic improvements and policy implementation, driving behaviours such as supporting prevention measures and resisting misinformation. Negative emotions (e.g., anger, anxiety, sadness) stemmed from severe outbreaks, insufficient controls, and restrictions on freedoms, leading to criticism and calls for accountability. This study bridges big data analytics with behavioural science, offering critical insights into evolving public emotions and behaviours. By highlighting spatiotemporal patterns and emotional dynamics, it provides actionable guidance for governments and health organizations to design targeted interventions, foster resilience, and better manage future social crises with precision and empathy. Full article

Background/Objectives: This study examines the transformation of Turkey’s hospital sector from 2002 to 2022, focusing on physical capacity, service utilization, and workforce distribution in the public and private sectors. Methods: Longitudinal data from the Ministry of Health were analyzed using trend and breakpoint methods to evaluate hospital beds, qualified beds, intensive care beds, service volumes (outpatient visits, inpatient admissions, surgeries, and hospitalization days), and staffing (physicians, nurses, and midwives). Results: Findings reveal a marked shift in the balance between public and private providers. Due to public regulations effectively controlling resource allocation, the private sector’s share expanded to around one-fourth of the system. Private capacity in total beds rose from 7.53% to 21.00%, outpatient visits from 4.58% to 15.07%, and inpatient admissions from 10.10% to 30.63%. Breakpoint analyses indicate crucial turning points around 2005, 2008, and 2011, when policy changes restricted public capacity but facilitated private investment. Although the public sector’s share in total beds declined, its proportion of qualified and intensive care beds, as well as dialysis machines, increased, suggesting a strategic shift toward complex, high-quality services. Conclusions: Over the past 20 years, Turkey’s hospital sector exemplifies privatization without ownership transfer. Although delayed, private hospital expansion aligned with global neoliberal trends. Policy regulations played a key role in both promoting and limiting sector growth. A constant conflict exists between market-driven resource allocation and public health needs, which must be considered in restructuring efforts alongside private sector motivations. Full article

Background: Restrictions on family visitation to long-term care facilities (LTCFs) during the COVID-19 pandemic remain an area of contention for residents, family members and staff members. Current research has explored the experience of family members; however, fewer studies have explored the impact of visitation restrictions from the perspective of LTCF staff members. We examined the experiences of LTCF staff members in implementing visitation restrictions, including maintaining contact with families, in England over the course of the COVID-19 pandemic. Method: A sample of twenty-four LTCF staff members employed at eight LTCFs in one region of England was recruited. Qualitative, in-depth interviews were conducted with staff members to explore their experiences of implementing government policies during the COVID-19 pandemic. Thematic analysis was used to analyse data on maintaining contact and visitation with relatives. Results: Five broad themes were identified from the data. These were: (i) engaging with family members on visitation, (ii) facilitating visitation with family members, (iii) maintaining remote contact with family members, (iv) managing visitation restrictions with residents and (v) navigating equitable access for residents and family members. While some staff welcomed the introduction of national guidance on restrictions as a source to refer family members to for justification of the LTCFs’ decisions to restrict access, others reflected on the negative effect of limited social contact on resident wellbeing and difficulties in implementing the guidance. At times, LTCFs felt conflicted in their responsibility for supporting family members in visiting at the same time as communicating, enforcing and policing visitation restrictions. Guidance on facilitating remote contact required substantial time and resources required to support it. Discussion: The extent to which restricting visitation was a proportionate response to reducing the spread of COVID-19, within the wider context of negative impacts on relatives and family members, is an ongoing debate. This study identified some of the challenges experiences by LTCF staff in implementing such guidance, and calls into question the practicality of restricting visitation. Further research is needed on how social contact can be maintained between relatives and their families during pandemics, which is both equitable and achievable. Full article

Background/Objectives: The COVID-19 pandemic compelled countries worldwide to implement stringent visitation restrictions across hospitals, nursing homes, and long-term care facilities to mitigate viral transmission. While initially justified by the uncertainty surrounding the virus, these restrictions often lasted well beyond the acute stage of the pandemic, leading to substantial psychological and physical harm, particularly for older adults. This study assesses the effects of these controls and offers strategies to balance public health priorities with patients’ rights and psychological well-being during public health crises. Methods: An integrative review and comparative analysis of legislative measures and the psychological effects of visitation restrictions was undertaken. International and national visitation regulations and case studies were reviewed, and ethical frameworks were considered. Results: Our findings indicate that prolonged isolation due to extended visitation restrictions led to higher rates of anxiety, depression, and delirium among patients, creating ethical dilemmas for healthcare providers. Legal responses to this challenge varied globally. International human rights organizations called for policies bridging public health priorities with patients’ rights to family and caregiver support. Some U.S. states enacted proactive legislation to strengthen family visitation rights, while other jurisdictions lack these visitation protections. Conclusions: Prolonged visitation restrictions during the pandemic show the need for legislation integrating public health protections with in-person family and caregiver support. The ethical imperatives of limiting the psychological harm caused by healthcare isolation and the legislative solutions to protect public health and the psychological well-being of patients during health crises are discussed. Full article

Objective: The objective of this study is to identify, examine, and map the literature on infection prevention and control (IPAC) education and training for visitors to long-term care (LTC) homes. Introduction: Visitor restrictions during infectious outbreaks in LTC homes aim to reduce virus transmission to vulnerable residents. The COVID-19 pandemic highlighted the negative impacts of such restrictions, prompting the need for IPAC education for visitors. Inclusion Criteria: This review includes research, narrative papers, and grey literature on IPAC education and training for LTC visitors. It focuses on intentional education aimed at preventing infection transmission. Studies not involving visitors or offered in other settings were excluded. Methods: Following the JBI methodology for scoping reviews, bibliographic databases (CINAHL, Embase, AgeLine, Medline, and ERIC) were searched from 1990 to present in English or French. Data were extracted by two reviewers, focusing on the educational content, delivery mode, frequency, timing, and qualifications of educators. A narrative summary and descriptive statistics were produced. Results: The 26 included documents contained guidelines, policies, educational resources, and opinion papers. Pre-2020, healthcare workers were responsible for educating visitors. Post-2020, more detailed recommendations emerged on the frequency, content, and delivery methods. Key topics included hand hygiene (92.3%), respiratory hygiene (80.8%), and PPE use (73.1%). Conclusions: IPAC education and training for LTC visitors is essential for safe visitation. Future research should evaluate the effectiveness of these educational interventions. Full article

The state of Victoria, Australia, implemented one of the world’s most prolonged cumulative lockdowns in 2020 and 2021. Although lockdowns have proven effective in managing COVID-19 worldwide, this approach faced challenges in containing the rising infection in Victoria. This study evaluates the effects of short-term (less than 60 days) and long-term (more than 60 days) lockdowns on public mobility and the effectiveness of various social restriction measures within these periods. The aim is to understand the complexities of pandemic management by examining various measures over different lockdown durations, thereby contributing to more effective COVID-19 containment methods. Using restriction policy, community mobility, and COVID-19 data, a machine-learning-based simulation model was proposed, incorporating analysis of correlation, infection doubling time, and effective lockdown date. The model result highlights the significant impact of public event cancellations in preventing COVID-19 infection during short- and long-term lockdowns and the importance of international travel controls in long-term lockdowns. The effectiveness of social restriction was found to decrease significantly with the transition from short to long lockdowns, characterised by increased visits to public places and increased use of public transport, which may be associated with an increase in the effective reproduction number (R_t) and infected cases. Full article

Early integrated palliative care (EIPC) significantly improves clinical outcomes for patients with advanced cancer. Telehealth may be a useful tool to deliver EIPC sustainably and equitably. Palliative care clinicians completed a survey regarding their perceptions of the barriers, facilitators, and benefits of using telehealth video visits for delivering EIPC for patients with advanced lung cancer. Forty-eight clinicians across 22 cancer centers completed the survey between May and July 2022. Most (91.7%) agreed that telehealth increases access to EIPC and simplifies the process for patients to receive EIPC (79.2%). Clinicians noted that the elderly, those in rural areas, and those with less-resourced backgrounds have greater difficulty using telehealth. Perceived barriers were largely patient-based factors, including technological literacy, internet and device availability, and patient preferences. Clinicians agreed that several organizational factors facilitated telehealth EIPC delivery, including technological infrastructure (85.4%), training (83.3%), and support from study coordinators (81.3%). Other barriers included systems-based factors, such as insurance reimbursement and out-of-state coverage restrictions. Patient-, organization-, and systems-based factors are all important to providing and improving access to telehealth EIPC services. Further research is needed to investigate the efficacy of telehealth EIPC and how policies and interventions may improve access to and dissemination of this care modality. Full article