Search Results (5,794)

Background/Objectives: Human papillomavirus (HPV) causes several cancers in both females and males. In France, HPV vaccination coverage among adolescents remains suboptimal, particularly among boys, and knowledge about HPV infection and vaccination is limited. This study assessed HPV-related knowledge, attitudes, and vaccination uptake among adolescents attending Rural Family Homes (RFHs). Methods: A sequential mixed-methods study was conducted between September 2023 and June 2024 among 895 adolescents aged 15–19 years attending 19 RFHs in France. Participants completed an anonymous self-administered questionnaire assessing sociodemographic characteristics, general vaccination knowledge, HPV-related knowledge, vaccination status, and determinants of vaccine uptake. Focus groups involving 59 adolescents explored perceptions of, barriers to, and information needs regarding HPV vaccination. Quantitative data were analyzed using chi-square tests and multivariable logistic regression; qualitative data were analyzed thematically. Results: Overall, 44% of participants had received at least one HPV vaccine dose and 31% received at least two doses. Coverage was significantly higher among girls than boys (55% vs. 28%, p < 0.001). Only 35% demonstrated adequate HPV-related knowledge. Parents and general practitioners were the main information sources. Vaccination uptake was associated with favorable subjective norms, female sex, and the belief that vaccination reduces cancer risk. Qualitative findings revealed persistent misconceptions about HPV-related risks, particularly among boys, and a substantial need for reliable information. Conclusions: Adolescents attending RFHs showed limited HPV-related knowledge and suboptimal vaccination coverage, particularly boys. Parental support and healthcare professional recommendations were associated with vaccine uptake. Targeted educational interventions and catch-up vaccination strategies among this population are needed to improve coverage and reduce the burden of HPV-related diseases. Full article

Background: Non-communicable disease (NCD) emergencies, including hypoglycaemia, stroke, acute coronary syndrome, and hypertensive crisis, call for prompt action by households and communities. The psychosocial mechanisms associated with emergency management behavior in rural Thailand, however, are not well understood. Objectives: The study pursued three objectives. It described levels of NCD emergency management behavior and the characteristics of emergency events reported during the preceding six months. It examined associations linking knowledge, Health Belief Model (HBM) constructs, social support, participation, self-efficacy, and emergency management behavior. Then, it identified the constructs with the strongest relations to behavior, along with an indirect pathway operating through self-efficacy, via structural equation modelling. Methods: A cross-sectional study analyzed data from 1321 community adults in Sisaket Province, Thailand, drawn from an initial 1407 records after excluding 86 with age below 21 years, incomplete data on SEM variables, or invalid disease-status coding. A structured, interviewer-administered questionnaire measured knowledge of NCD emergencies, HBM constructs, social support, family and community participation, self-efficacy, and emergency management behavior. Covariance-based SEM with item parcels and maximum-likelihood estimation was conducted; knowledge was treated as an observed variable. Results: Mean age was 58.0 years (SD = 14.3); 15.5% reported a recent emergency event. Knowledge was moderate-to-low (mean = 5.79/10; KR-20 = 0.440). Model fit was acceptable (CFI = 0.980; RMSEA = 0.047; SRMR = 0.049). Discriminant validity was supported by the Fornell–Larcker criterion for all constructs. Participation was strongly associated with self-efficacy (β = 0.858) and with emergency management behavior (β = 0.433); self-efficacy was also associated with emergency management behavior (β = 0.354). Participation had the largest total effect on behavior (0.737), combining a direct effect (0.433) and an indirect, self-efficacy-related effect (0.304). All structural-path variance inflation factors (VIF) were below 5.0 except participation behavior (VIF = 6.19), which remained below the more permissive threshold of 10.0. Conclusions: NCD emergency management behavior in this rural community was most strongly associated with family and community participation and with self-efficacy. Because the design was cross-sectional, these findings indicate association rather than confirmed causal or mediating pathways. Programmes should combine scenario-based knowledge with participatory practice, family role preparation, rehearsal of emergency-service (1669) activation, and confidence-building activities. Full article

Ebola virus disease (EVD) remains one of the most severe viral hemorrhagic fevers, with recurrent outbreaks challenging global healthcare systems. This narrative review traces the evolving epidemiology of EVD from the first recognized outbreaks in 1976 to the ongoing 2026 Bundibugyo virus public health emergency in the Democratic Republic of the Congo (DRC) and Uganda. Over nearly five decades, the recognized range of Ebola outbreak contexts and amplification mechanisms has broadened considerably: rural zoonotic spillovers remain the predominant mode of emergence, but the scale and reach of subsequent transmission increasingly depend on where introductions occur, on delays in detection, on population mobility, on ecological disruption, on armed conflict, on healthcare-associated transmission, and on viral persistence in survivors. Major advances in molecular epidemiology and genomic surveillance have improved outbreak investigation, enabling real-time transmission reconstruction and detection of survivor-linked resurgence. Vaccination, particularly ring vaccination with rVSV-ZEBOV, has shown high effectiveness against Zaire ebolavirus, yet vaccine equity gaps and the absence of licensed vaccines for Sudan virus and Bundibugyo virus remain critical vulnerabilities, though new candidate vaccines and therapeutics for Bundibugyo virus entered clinical evaluation in mid-2026. Artificial intelligence and digital technologies, including AI-assisted early warning systems, portable sequencing, drones, blockchain, and mobile health platforms, offer promising tools for outbreak preparedness, but robust evidence of their real-world operational impact during filovirus outbreaks remains limited, and their deployment in low-resource settings faces substantial barriers related to infrastructure, literacy, data costs, and governance. Integrated preparedness frameworks that combine ecological surveillance, resilient healthcare systems, community engagement, and international coordination under a One Health umbrella are increasingly viewed as a strategic necessity. The 2026 Bundibugyo outbreak reaffirms that despite decades of lessons, structural weaknesses in surveillance, response timeliness, and community trust continue to recur. Sustainable, multi-year financing, diversified vaccine platforms, regional manufacturing, and local co-design of digital tools are essential to translate lessons into lasting change. Preparedness is best understood as a continuous process rather than a reactive state. Full article

The presence of antimicrobial-resistant bacteria in fresh produce constitutes a significant public health concern, particularly in rural areas where untreated water is commonly used for irrigation. Certain Enterobacter species have been reported as causal agents of onion bulb rot, with Enterobacter cloacae experimentally demonstrated to cause bulb rot in onions. However, there is poor documentation of its effects in the Vhembe District, South Africa. This study investigated the detection and identification of enteric bacteria in onions, soil, and irrigation water, as well as the characterisation of the identified isolates. Thirty-six samples were analysed, comprising 13 onion samples, 4 irrigation water samples, and 9 soil specimens collected from three farms using selective and differential agar. Identification and enumeration in water and onion samples were performed with the Colilert Quanti-Tray. Physicochemical analysis of irrigation water indicated that Farm 3 had the highest electrical conductivity (EC) and total dissolved solids (TDS), as well as the lowest pH, while Farm 2 exhibited the greatest diversity of pathogenic Escherichia coli pathotypes, including enteroinvasive E. coli (EIEC), which was absent in Farm 3. Culture-based methods yielded 72 presumptive bacterial isolates, which were characterized using the VITEK 2 system. Identified species included Pseudomonas aeruginosa, Klebsiella pneumoniae, Klebsiella oxytoca, Citrobacter amalonaticus, Raoultella ornithinolytica, and members of the Enterobacter cloacae complex. Phylogenetic analysis revealed that most Enterobacter isolates closely matched reference strains of Enterobacter ludwigii. Antimicrobial susceptibility testing against 19 antibiotics demonstrated varied resistance patterns among the isolates. The Enterobacter cloacae complex exhibited the highest resistance (10/19 antibiotics), followed by Klebsiella pneumoniae (9/19) and Citrobacter amalonaticus (7/19). All isolates were resistant to colistin but remained susceptible to ciprofloxacin, with most also sensitive to gentamicin and amikacin. Future research should include additional farms and investigate antibiotic resistance at the genetic level to elucidate its origins. Full article

Background/Objectives: Food irradiation is a recognized method for the microbiological decontamination and preservation of plant raw materials; however, in the European Union, its use is subject to strict legal regulation and to a mandatory labelling obligation. For dietary supplements, which are legally classified as foodstuffs, this issue is particularly important for market transparency and the consumer’s right to information. The aim of this pilot study was to assess the presence of post-irradiation characteristics in selected dietary supplements available at retail in Poland, with particular attention to products containing valerian root (Valeriana officinalis L.), and to compare the results obtained with the information declared on the product labels. Methods: The analysis included 15 analytical samples representing 11 commercial formulations. The study was performed using the thermoluminescence method according to standard PN-EN 1788:2002 in an ISO/IEC 17025-accredited laboratory. Results: Thermoluminescence characteristics consistent with prior irradiation were observed in 7 samples, whereas 8 samples did not show such properties. Positive results concerned exclusively products containing valerian root, including replicate batches of two commercial formulations. None of the positive samples carried any label information about irradiation or exposure to ionizing radiation. The results indicate that some dietary supplements on the market may be subjected to irradiation without this being properly reflected in their labelling. Conclusions: Given the pilot nature of the study and the limited, non-random sample, the results should be treated as a premise for further analysis rather than as a basis for generalizing to the entire market. The results of this study indicate a need for broader analytical monitoring and targeted control of dietary supplements containing plant raw materials. Full article

Objectives: This study examined the within-person longitudinal associations between obesity-related eating behaviors and physical activity among community-dwelling Chinese older adults. Methods: Three waves of data were collected at three-month intervals from 1256 adults aged 65 years or older across 17 urban and rural communities. Physical activity was measured using the Physical Activity Rating Scale-3, and obesity-related eating behaviors were assessed using the seven-item Sakata Eating Behavior Scale Short Form. The eating-behavior scale was reverse-scored so that higher scores represented fewer problematic behaviors. The analysis examined longitudinal measurement invariance, gender differences, and prospective within-person associations using a random-intercept cross-lagged panel model. Results: The analysis identified small reciprocal within-person associations between obesity-related eating behaviors and physical activity. Occasions characterized by fewer problematic eating behaviors than usual were followed by higher-than-usual physical activity at the next wave. Higher-than-usual physical activity was likewise followed by fewer problematic eating behaviors. These associations remained similar after adjustment for the available demographic covariates. Men reported higher average physical activity, while women reported fewer problematic eating behaviors, but changes over time did not differ by gender. Conclusions: Physical activity and obesity-related eating behaviors showed small bidirectional within-person associations across three-month intervals. This reciprocal pattern suggests that the two behaviors are modestly connected within everyday routines and supports examining them together when studying health behavior dynamics in later life. Full article

This systematic review analysed the role, opportunities and challenges of digital technologies in promoting physical activity among rural children and adolescents aged 10–18. By identifying and analyzing 10 eligible studies across four major databases between June 2016 and June 2026, the research classified the tools used into five categories: behaviour-monitoring technologies (like wearable activity trackers), educational technologies (digital learning platforms), communication and social media technologies, immersive technologies (virtual and augmented reality), and digital health technologies. The implications of these tools were examined in relation to physical education curricula and the development of healthy lifestyles. While the available evidence suggests that these technologies support rural youth by enhancing self-monitoring, increasing health awareness, improving access to educational resources, and creating context-specific opportunities for active engagement, the data reveals that evidence of sustained improvements in moderate-to-vigorous physical activity remains limited. Furthermore, implementation is heavily hindered by barriers such as the digital divide, limited technological infrastructure, inequalities in resource access, and the threat of sedentary behaviours associated with excessive screen time. Consequently, the findings underscore a need for coordinated educational and health strategies, offering practical recommendations to integrate these digital technologies within rural educational settings to foster long-term active lifestyles. Full article

Background/Objectives: Dental caries remains one of the most prevalent chronic diseases in childhood, influenced by a combination of hygiene, dietary, and access-related behaviours that are largely shaped by parental involvement. This study aimed to evaluate oral hygiene habits, dietary risk factors, access to dental services, awareness of caries prevention, and the impact of oral health on the child, in relation to parent-reported dental caries in Romanian children and adolescents. Methods: A cross-sectional study was conducted using a structured online questionnaire completed by parents or legal guardians of 508 children and adolescents aged under 18 years. Associations between categorical variables and reported caries were assessed using chi-square tests and Cramér’s V. Ordinal variables were compared using the Mann–Whitney U test. A multivariable logistic regression identified independent predictors of reported caries, with robustness examined through sensitivity analyses. Results: Parent-reported caries was present in 61.2% of children. The strongest associations with caries were the absence of parental supervision during brushing (Cramér’s V = 0.364), the age at which children began brushing unsupervised (V = 0.354), and the reason for the last dental visit (V = 0.426). In the multivariable model, older age, absence of brushing supervision, sweets before bedtime, less frequent dental visits, and rural residence were independent predictors (all p < 0.05; Nagelkerke R² = 0.361). All six assessed dimensions of oral-health impact on the child were significantly associated with caries, with physical discomfort showing the largest effect (V = 0.349). Conclusions: Parent-reported caries risk in this population clustered around a small number of modifiable behaviours rather than any single dominant factor, while reported caries was associated with a substantial burden on children’s daily functioning. These findings point to sustained parental supervision and routine, non-symptomatic dental care as priority targets for future prevention efforts, although intervention studies are needed to confirm their effectiveness. Full article

Background: Loneliness in older adults is a global public health problem. Although robust evidence exists regarding its consequences, the evidence base is marked by a bias towards high-income countries and urban contexts. The rural Peruvian Amazon is a territory virtually absent from the scientific literature on ageing and loneliness. Methods: We conducted a descriptive–interpretive qualitative study based on 34 semi-structured interviews with adults aged 60 years and over, recruited through Cáritas-Requena. Analysis followed the reflexive thematic analysis framework. Purposive sampling with maximum variation criteria was employed. The study was complemented by a quantitative characterisation using the Barthel Index, the LSNS-6 scale, and the DUKE-UNC-11 questionnaire. Results: Four themes emerged: (1) structural and functional conditions as the substrate of loneliness; (2) family reconfiguration driven by internal migration, with notable prominence of skipped-generation households (grandparents caring for grandchildren); (3) lived experiences of emotional and social loneliness, including a contextual pattern of feeling lonely despite the physical presence of others, which we descriptively label “paradoxical loneliness”; and (4) coping resources, including faith, work, neighbourhood networks, non-human companionship, and habituation. The descriptive relational measures showed different distributions: objective social isolation (LSNS-6 < 12) was observed in 12.5% of participants, whereas low perceived functional social support (DUKE-UNC-11 < 32) was observed in 68.8%; these measures assess distinct constructs and were used solely to contextualise the qualitative findings. Conclusions: Among the service-connected older adults included in this study, loneliness was shaped by the interaction of family reconfiguration, material and health-related conditions, and locally available coping resources. The experience of feeling lonely despite the physical presence of others was compatible with Perlman and Peplau’s cognitive discrepancy model and is presented here as a context-specific interpretive pattern rather than as an independent dimension of loneliness. Full article

Villages within Key Ecological Function Zones (KEFZs) are governed by a common ecological-priority regime, yet their rural sustainable development potential (RSDP) continues to diverge. This suggests that ecological conditions are not sufficient determinants of rural development outcomes, but prerequisite boundaries within which social livability and economic sustainability are activated. Existing SDG localization studies often treat ecological, social, and economic dimensions as parallel and compensable components, making it difficult to identify the structural sources of village-level differentiation in ecologically constrained regions. Using 1108 administrative villages in the Leishui River Basin as analytical units, this study constructs a village-scale RSDP assessment framework based on panel data for 2010, 2015, 2020, and 2024. Ecological health is positioned as the prerequisite constraint layer, while social livability and economic sustainability are treated as development capacities. A three-dimensional coupling coordination degree model is used to measure the structural matching among ecological foundation, social support, and economic transformation capacity. Spatial autocorrelation, exploratory space–time data analysis, and K-means clustering are further applied to identify spatial dependence, evolutionary trajectories, and bottleneck types. The results show that the mean coordination level of RSDP increased from 0.5807 to 0.6522 during 2010–2024, but this improvement was driven by uneven subsystem trajectories. Economic sustainability improved most rapidly, and ecological health increased steadily, whereas social livability remained the main shortfall. Spatially, RSDP showed significant positive autocorrelation, but clustering intensity weakened and both high- and low-value clusters became more fragmented. The dominant constraint shifted from economic weakness to social-support deficits, indicating that population support, public services, and everyday living capacity became key bottlenecks once basic economic conditions improved. Four village types were identified: suburban integration-led, vulnerable fluctuation-constrained, stable balanced-development, and ecological-resource potential. By reframing ecological conditions as prerequisite constraints rather than parallel assessment dimensions, this study extends SDG-based rural sustainability assessment from composite level comparison to structural potential diagnosis and provides village-scale evidence for differentiated governance in KEFZs. Full article

Rural men in Australia experience poorer health outcomes compared to their urban counterparts, often due to barriers such as limited access to services, cultural norms around masculinity, and geographic isolation. This study explored the motivations underlying rural men’s participation in a student-led health promotion activity conducted by first-year paramedicine students at a large agricultural event. Using semi-structured verbal surveys with 60 participants, qualitative data were collected and analysed through an inductive content analysis approach. Three key themes were created to represent the reasons men engaged in the activity and the impact it had: factors that encouraged engagement and built trust, meeting multiple needs, and giving to student learning for the future. Participants were drawn to the activity by a welcoming environment, peer encouragement, and the consistent presence of health promotion at the event. Health promotion provided an opportunity for men to access basic health assessments, reflect on their wellbeing, and engage in conversations about physical and mental health in a supportive setting. Many participants also expressed a strong motivation to contribute to student learning, particularly through experiential interactions that allowed students to develop technical and interpersonal skills. The findings highlight the value of embedding health promotion activities in familiar, community-based settings and demonstrate the multitude of benefits for rural men. This research contributes to the growing evidence supporting innovative, community-engaged models of work-integrated learning that address health disparities while enhancing student education and rural workforce development. Full article

Extreme heat causes more deaths in Australia than any other natural hazard, yet the consistency and inclusivity of heat-health messaging by Australian state and territory health departments have not been systematically assessed. This study compared heat-health communication across all Australian jurisdictions using official health department websites (n = 8) and corresponding Facebook pages, from which 374 posts were analysed. Website content was examined comparatively across jurisdictions, while Facebook messaging was analysed across two key periods: the 2019–2020 Black Summer and the 2024–2025 summer. Using comparative qualitative content analysis, we examined message content, inclusivity, geographic specificity, and communication approaches for vulnerable populations. Substantial variation was observed across jurisdictions and over time. During 2019–2020, messaging showed a predominantly reactive pattern in the context of concurrent hazards, particularly bushfires and COVID-19. By 2024–2025, communication showed a more anticipatory pattern, with some jurisdictions adopting clearer heat-specific terminology, visual warning symbols, regionally targeted communication, and multilingual resources. However, no jurisdiction provided Indigenous-language translations or culturally tailored messaging for remote Indigenous communities, and limited attention was given to indoor heat exposure, power outages, and remote populations. These findings highlight the need for more coordinated, equitable, and context-specific heat-health communication strategies to strengthen climate adaptation and public health preparedness in Australia. Full article

Background: Individuals with inflammatory bowel disease (IBD) are at substantially increased risk for Clostridioides difficile infection (CDI), which leads to significantly higher morbidity and mortality compared to the general population. However, comprehensive national-level analyses of long-term mortality trends in this population remain limited. This study examines mortality trends associated with IBD and CDI in the United States from 1999 to 2023. Methods: This descriptive study utilized the CDC WONDER Multiple Cause-of-Death database. Deaths involving IBD (ICD-10: K50, K51) and CDI (A04.7) were identified among adults aged 25 years and older. Age-adjusted mortality rates (AAMRs) per 100,000 population were calculated with 95% confidence intervals and stratified by sex, race/ethnicity, urbanization, and census region. Joinpoint regression was applied to estimate the annual percent change (APC) in mortality. Results: Between 1999 and 2023, 76,084 deaths were recorded. Medical facilities accounted for 46% of deaths, followed by decedents’ homes (28.3%) and nursing home/long-term care facilities (16.5%). Overall mortality declined gradually from 1999 to 2018 (APC: −0.23, p < 0.05), increased sharply through 2021 (APC: +12.75, p < 0.05), and was then followed by a non-significant change through 2023 (APC: −2.69; 95% CI: −8.24 to 3.19), consistent with a plateau. Men consistently exhibited higher AAMRs than women. Non-Hispanic White individuals had the highest AAMRs (1.844 in 2023), while Non-Hispanic Black individuals experienced a sustained increase from 2016 onward (APC: +7.11, p < 0.05). Hispanic mortality increased steadily throughout the study period (APC: +1.31, p < 0.05). Rural populations had higher overall AAMRs than urban populations. The Midwest recorded the highest regional AAMRs by 2023 (1.867). Conclusions: Mortality increased significantly between 2018 and 2021, coinciding with the COVID-19 pandemic, though our study design cannot prove causation. Disparities by race/ethnicity, urbanization, and region persisted. These findings underscore the need for ongoing antibiotic stewardship, equitable healthcare access, and targeted public health interventions for this vulnerable population. Full article

Background/Objectives: Although lung cancer is the leading cause of cancer-related deaths in the United States, rates of screening have remained persistently low nationwide. This study sought to identify barriers, facilitators, and support strategies necessary for implementing a novel community health navigator workflow to improve lung cancer screening uptake in both rural and urban settings. Methods: Semi-structured interviews were conducted with primary care providers (n = 5), community scientists (n = 7), community health navigators (n = 4), and radiology staff (n = 2). Interview transcripts were analyzed using a rapid qualitative analysis approach. Three authors coded based on the Consolidated Framework for Implementation Research (CFIR) and the Expert Recommendations for Implementing Change (ERIC) frameworks using a hybrid deductive–inductive approach. Results: Participants highlighted several primary barriers: access to knowledge and information (e.g., knowledge of eligibility, knowledge of insurance coverage), IT infrastructure (e.g., quality of pack-year data), relative priority (e.g., need to discuss other conditions), and patient needs and resources (e.g., time off work, transportation, difficulty scheduling). Key facilitators for screening were again IT infrastructure (e.g., automated electronic health record alerts) as well as relational connections (e.g., trust between patients and providers). To address provider-level barriers, participants recommended educational meetings, using clinical champions, and providing feedback on current lung cancer screening rates. To address patient-level barriers, participants recommended health education tools, providing transportation vouchers, hosting weekend lung cancer screening clinics, and assisting with scheduling. Conclusions: A community navigator approach to lung cancer screening should address key barriers to implementation on both the patient and provider level, including knowledge, prioritization, and patient access. Full article

Background: Health security among structurally vulnerable populations depends not only on healthcare access but also on livelihood stability, caregiving capacity, and social participation. Evidence on how community-engaged participatory interventions address social determinants of health in low- and middle-income settings remains limited, particularly regarding how such interventions are implemented, documented, and evaluated in practice. Methods: This qualitative implementation study examined a participatory livelihood and caregiving intervention in a rural Thai setting. Over a nine-month period, 50 core participants from structurally vulnerable households engaged in integrated livelihood and caregiving activities. Data were collected through field observations, participatory reflection meetings, implementation records, LINE-group communication archives, and voluntary household financial logs, and were analysed using inductive thematic analysis. Results: Findings revealed perceived improvements across four interconnected dimensions of well-being: caregiving capacity, social connectedness, livelihood flexibility, and household economic buffering. Participants more consistently described household stabilization achieved through reduced expenditure, resource sharing, and livelihood diversification than rapid income growth. Sustained group participation was associated with strengthened peer support networks and greater self-reported confidence in managing caregiving and household challenges; however, these findings rest on self-reported and predominantly qualitative evidence, with financial documentation available for only a small, non-random subset of participants. Conclusions: These exploratory findings suggest that community-engaged livelihood and caregiving interventions may strengthen multidimensional health security by supporting stabilization processes rather than delivering immediate economic gains. Relational support, adaptive implementation, and community participation emerged as candidate mechanisms linking policy intentions to community health responsiveness. Health policy frameworks in comparable low- and middle-income settings may benefit from incorporating structural and relational social determinants alongside income-based metrics, although confirmatory research with comparison groups is needed before these implementation-level insights can inform generalizable policy guidance. Full article