Search Results (7,166)

Extreme wind events, particularly tropical cyclones, pose the most severe safety threat to aging lattice steel space-truss structures in coastal regions, including transmission towers, communication and observation towers, and lattice supports of building-integrated wind-energy facilities. Such structures suffer progressive capacity degradation through multiple concurrent mechanisms, yet their actual residual safety margin under extreme wind loading remains poorly quantified. Current assessment practices rely on code-prescribed simplified wind speeds that ignore terrain-induced local amplification, and assume an intact structural condition that neglects in-service deterioration. This paper proposes a Risk-Based Safety Assessment Framework (RBSAF) that addresses both deficiencies through a five-step pipeline: (i) multi-scale wind field downscaling that resolves terrain-amplified wind profiles at individual structure sites; (ii) independent degradation models for atmospheric corrosion, bolt loosening, fatigue accumulation, and pitting corrosion; (iii) a multi-degradation coupling aggregation method that yields a unified Structural Health Index (SHI) capturing nonlinear interaction effects; (iv) code-based multi-scenario safety margin scanning with automatic identification of weak components; and (v) a risk-informed reinforcement priority mapping strategy. A representative 220 kV angle-steel lattice tower in a coastal mountainous corridor of Southeastern China is employed as the case study. Results show that after 30 years of service in an ISO 9223 C4 corrosive environment, the structure-level SHI decreases from 1.47 (intact, code wind) to 1.00 under the proposed coupled assessment with code-prescribed wind, and further to 0.76 when terrain amplification (15% speed-up) is considered, with the failure probability rising from 3.6% to 24.1%. Multi-degradation coupling causes an additional 28% capacity loss relative to single-factor assessment and substantially alters the weak-component ranking. Reinforcing the five most critical members restores the SHI to 1.25 with only a 2.8% steel-weight increase. The framework provides a systematic, quantitative tool for safety evaluation and maintenance prioritization of aging lattice steel structures in wind-prone built environments. Full article

Background: The association between female reproductive factors and laryngopharyngeal reflux (LPR) remains poorly understood. This study investigated the relationship between reproductive history and LPR risk in women using a large nationally representative cohort. Methods: We conducted a nested case–control study using linked data from the Korean National Health and Nutrition Examination Survey and the National Health Insurance Service database (2007–2017). Among 57,559 participants, 1347 women diagnosed with LPR were matched 1:1 with 1347 controls without reflux disease using propensity score matching based on age, income, and education level. Multivariable logistic regression analyses were performed to evaluate the associations between reproductive factors and LPR risk after adjustment for metabolic and lifestyle variables. Results: Women with a first childbirth at age ≥27 years had a significantly higher risk of LPR than those with earlier childbirth (adjusted odds ratio [aOR] 1.33, 95% confidence interval [CI] 1.08–1.63; p = 0.007). A menarche-to-first-birth interval of ≥17 years was also associated with an increased risk of LPR (aOR 1.56, 95% CI 1.15–2.15; p = 0.005). In addition, breastfeeding for <12 months was independently associated with a higher risk of LPR (aOR 1.26, 95% CI 1.04–1.53; p = 0.019). These associations remained significant after adjustment for potential confounders. Conclusions: Female reproductive factors potentially reflecting cumulative hormonal exposure were independently associated with LPR risk in this nationally representative cohort. First delivery at age ≥27 years, a menarche-to-first-birth interval ≥17 years, and breastfeeding <12 months were associated with LPR, suggesting that reproductive history should be considered when evaluating women with reflux-related symptoms. Full article

With the rapid growth of electric vehicles (EVs) and renewable energy generation, Vehicle-to-Grid (V2G) technology has emerged as a promising approach for transforming EVs from passive charging loads into flexible distributed energy storage resources. By enabling bidirectional power exchange between EV batteries and the power grid, V2G can support renewable energy accommodation, peak shaving, demand response, ancillary services, and local grid balancing. This review provides a systematic synthesis of recent advances in V2G systems for renewable energy integration, with particular emphasis on coordinated scheduling, economic mechanisms, battery degradation, and user engagement. First, the technical foundations of V2G are introduced, including Vehicle-to-Everything operating modes, bidirectional charging architecture, aggregation mechanisms, grid-support services, and renewable accommodation pathways. Second, major scheduling strategies are reviewed, including price-based, load-based, renewable-forecast-driven, centralized, distributed, and hybrid approaches. Third, the economic feasibility of V2G is examined from the perspectives of revenue streams, pricing mechanisms, business models, battery aging costs, and compensation schemes. In addition, user participation barriers, such as range anxiety, battery lifetime concerns, loss of control, uncertain financial returns, and data privacy, are discussed. Key challenges related to communication standards, interoperability, cybersecurity, market access, policy design, and pilot-scale validation are also summarized. Finally, future development directions are identified, including AI-based scheduling, aggregator platforms, fleet-scale V2G, degradation-aware optimization, carbon-aware electricity markets, and user-centered participation mechanisms. This review highlights that large-scale V2G deployment requires the integrated coordination of technical scheduling, economic incentives, battery health protection, and user acceptance in renewable-rich power systems. Full article

The postnatal period involves significant emotional and relational shifts that can challenge early mother–infant interactions, particularly under conditions of psychosocial vulnerability (e.g., maternal anxiety/depression) or infant-related risk (e.g., preterm birth). Maternal mentalization, operationalized as Parental Reflective Functioning (PRF), is a key protective factor for sensitive caregiving and dyadic regulation. Objectives: This protocol describes a multicenter, open-label, single-arm feasibility study evaluating a brief, fully online, mentalization-based video-feedback intervention (VFI-RF). The study is designed to assess the feasibility and acceptability of the intervention, rather than its efficacy. We aim to recruit 48 mothers, 24 in each of two risk groups, through socio-health services and neonatal intensive care units. Risk Group 1 will include mothers with clinically significant depressive and/or anxiety symptoms, defined as EPDS > 9 and/or GAD-7 ≥ 10, whereas Risk Group 2 will include mothers of preterm infants, defined as infants born before 37 weeks of gestation. Methods: The intervention consists of 8 + 2 synchronous online sessions over approximately 5 months. Mothers record brief everyday caregiving interactions (~5 min) to review with a trained clinician, focusing on the infant’s internal states and reflective meaning-making. Assessments occur at baseline (T0, infant age ~3 months), post-intervention (T1, ~8 months), and follow-up (T2, ~12 months). Primary feasibility outcomes include recruitment/referral metrics, uptake, retention, assessment completion, missing data, and participant-reported acceptability. Secondary exploratory clinical outcomes include maternal PRF, symptoms, parenting stress, social support, and mother–infant attachment, evaluated via validated self-report questionnaires. Results: The study is designed to evaluate referral and recruitment patterns, intervention uptake, and participant retention, as well as the acceptability and suitability of study procedures and outcome measures for a future controlled trial. Preliminary trajectories of change in maternal reflective functioning and early relational indicators will be examined descriptively and exploratorily. Conclusions: Findings will inform the feasibility and refinement of a brief online mentalization-based video-feedback intervention to support at-risk mother–infant dyads during the first postnatal year. Trial registration: Registered on Open Science Framework, osf.io/6g9ja, date of registration 4th March 2026. Full article

Background/Objectives: This cross-sectional observational study investigated factors associated with emergency room (ER) utilization for dental pain in a rural inland region of Portugal. The main objective was to examine the relationship between access to dental care, sociodemographic characteristics, oral health behaviors, and clinical outcomes with the use of emergency room services for dental problems. Methods: The study sample comprised 423 participants from the districts of Bragança and Vinhais, in Trás-os-Montes, aged 4 to 90 years, who attended their first dental medicine consultation. Participants completed a structured questionnaire addressing sociodemographic characteristics, general health, oral health behaviors, and dental prosthetic use, and underwent oral examination for assessment of the Decayed, Missing, and Filled Teeth (DMFT) index. Associations with reported ER utilization due to toothache were analyzed using Fisher’s exact test and the Mann–Whitney U test. Results: Overall, 28.4% of participants reported having visited the ER due to dental pain, and most cases were managed with medication followed by discharge. ER utilization was significantly associated with behavioral risk factors such as smoking, as well as poorer oral hygiene practices, including less frequent tooth brushing. In addition, participants who sought ER care presented higher DMFT scores, indicating a greater burden of untreated dental decay and tooth loss. Conclusions: These findings suggest that limited preventive dental care and unfavorable oral health behaviors are associated with to avoidable ER visits for dental pain in rural settings. This study reinforces the need to strengthen access to preventive oral health services and to advance the integration of dental care into Portugal’s National Health Service (SNS), particularly in underserved inland regions. Full article

Background: Breast cancer comprises 31.4% of all female cancers in Saudi Arabia (2020 Cancer Registry). Despite free national screening services existing since 2005, mammography utilization remains critically low. This study assessed breast cancer knowledge, attitudes, and practices (KAP) among females in Saudi Arabia and identified independent predictors of screening behavior. Methods: A cross-sectional study (December 2024–February 2025) enrolled 426 females aged ≥20 years from all 13 Saudi administrative regions using a quota-based design combining facility-based and online recruitment. Attitude and barrier domains were adapted from Champion’s Health Belief Model Scale (CHBMS), validated in Arabic; knowledge items used validated regional instruments. Knowledge-score reliability: KR-20 = 0.45; attitude subscale: α = 0.74. Binary logistic regression identified independent predictors of screening uptake (outcome: any screening in the preceding five years, coded as screened = 1; not screened = 0). Results: Mean composite knowledge score: 4.51 ± 1.52/7 (KR-20 = 0.45); 54.0% achieved high knowledge (≥5). Mammography uptake was 30.5% overall and 52.2% among women aged ≥40 (n = 136; the recommended target group). Predominant barriers: Fear of diagnosis (83.6%), belief in incurability (76.3%), radiation concern (73.2%), and pain anxiety (72.3%). Logistic regression (χ²(8) = 188.96, p < 0.001; McFadden’s pseudo R² = 0.323) identified older age (OR = 1.52; 95% CI: 1.21–1.92), higher income (OR = 1.57; 95% CI: 1.25–1.99), transportation barriers (OR = 3.39; 95% CI: 1.95–5.89), and family discouragement (OR = 3.03; 95% CI: 1.72–5.34) as significant predictors (all p < 0.001). Conclusions: A significant knowledge–practice gap persists across all 13 Saudi regions. These findings suggest several implications for a multi-level public health response to be evaluated through future intervention research; multi-level strategies targeting CHBMS Barriers are needed. Full article

Background/Objectives: Neuroprognostication after out-of-hospital cardiac arrest (OHCA) remains clinically challenging, particularly when withdrawal of life-sustaining treatment (WLST) is considered. International guidelines recommend delayed, multimodal assessment, but real-world descriptions of how this is operationalised within multidisciplinary pathways remain limited. Methods: We conducted a single-centre retrospective observational cohort study of adults admitted to a tertiary cardiac arrest centre intensive care unit following OHCA between June 2022 and December 2025. Patients were conveyed according to the British Cardiovascular Intervention Society OHCA pathway; therefore, this was a selected cardiac arrest centre cohort enriched for shockable rhythms and suspected reversible cardiac causes, rather than an unselected OHCA population. Patients who remained unconscious at ≥72 h following a sedation hold entered a structured multidisciplinary team (MDT) neuroprognostication pathway. Outcomes included survival to hospital discharge, Cerebral Performance Category (CPC) at discharge, neuroprognostication investigation use, and timing of WLST. Results: Of 406 patients admitted following OHCA, 310 were admitted to ICU and included in the analysis. The cohort was predominantly male (82.3%), with a mean age of 63.8 years; 82.9% had ventricular fibrillation as the initial rhythm. Overall, 182 patients (58.7%) survived to hospital discharge, of whom 160 (87.9%) had a favourable neurological outcome (CPC 1–2). A total of 119 patients entered the neuroprognostication pathway. Of these, 72 underwent WLST after completed MDT review, 10 died before MDT decision-making, and 37 survived to hospital discharge. Among patients undergoing WLST, investigation use was high: CT brain 100%, NSE 91.7%, EEG 90.3%, SSEP 88.9%, and MRI brain 27.8%. Median time to WLST was 5.5 days. Conclusions: In this selected tertiary CAC cohort, enriched for shockable rhythms through BCIS pathway-based conveyance, survival to hospital discharge was high and neurological outcomes among survivors were predominantly favourable. Within this setting, delayed, multimodal neuroprognostication and WLST decision-making were operationalised through a structured MDT pathway aligned with contemporary guideline recommendations. These findings provide contemporary real-world benchmark data on pathway implementation for comparable centres seeking to evaluate or develop structured neuroprognostication services. Full article

This qualitative study incorporates caregiver perspectives to identify their (1) experiences with medical and educational supports for their children with chronic TBI following inpatient rehabilitation and across the recovery trajectory and (2) recommendations to improve service provision for young people with TBI. Nineteen caregivers of children with complicated-mild-to-severe TBI participated in semi-structured virtual interviews. Participants were from a large Midwestern U.S. city. Researchers used reflexive thematic analysis, incorporating an experiential orientation and a deductive approach. Standards for Reporting Qualitative Research guided this process. Children were an average of 5.2 years post-injury, and age at injury ranged from 2.6 to 18.0 years, providing depth of caregiver experiences discussed in interviews. Four primary themes were identified: (1) TBI leads to lasting changes in the child, (2) the healthcare environment is overwhelming, (3) TBI forces a shift in caregiver responsibilities, and (4) school challenges persist over time. Caregivers generated concrete, experience-based recommendations, highlighting the need for increased support, resources, and education in specific areas following pediatric TBI. By centering caregiver voices across recovery, this study underscores their unique expertise in identifying system-level gaps and informing the development of interventions, services, and policies that better support children with TBI and their families over time. Full article

Youth substance abuse represents a complex social and security problem which cannot be adequately captured solely through crime statistics. In the context of the Slovak Republic, there is a lack of systematic research linking healthcare data on intoxications with criminological indicators, which limits the effective design of preventive measures. The research analyses substance abuse (according to ICD 10 F10–F19) among youth in the NUTS 3 regions of the Slovak Republic during 2019–2024 and their descriptive association with drug-related crime. Analysis is based on data provided by public administration entities—the National Health Information Centre of the Slovak Republic (data on youth hospitalisation), the Operational Centre of the Emergency Medical Service of the Slovak Republic (data on EMS call-outs) and the Ministry of Interior of the Slovak Republic (data on crime). The provided data represent the whole population of the Slovak Republic. To enable comparison between datasets, two standardised indices are constructed: an EMS index representing a number of EMS call-outs and urgent hospitalisations per 100,000 inhabitants of the respective youth age group and a crime index representing a number of drug-related criminal offences per 100,000 total regional inhabitants. A total of 4486 emergency interventions with F10–F19 diagnoses were identified, with the highest proportion being disorders caused by alcohol (F10), more common among juveniles (14–17) than in minors (6–13). The analysis identifies a moderate positive association between the regional EMS index for F10 and F11–F19 diagnoses (correl youth = 0.66; correl juveniles = 0.55) and a weak negative association between the F11–F19 EMS index and the drug-related crime index (correl youth = −0.28; correl minors = −0.52). The Pearson correlation coefficients are reported as descriptive indicators. Formal statistical inference was not the aim of this study. The findings suggest that crime statistics alone inadequately reflect the health risks of youth substance abuse, underscoring the need to link healthcare, criminological, and demographic data and to develop regionally targeted prevention. Full article

Background: Intraoperative vascular injuries during elective hip and knee arthroplasty are uncommon but limb-threatening complications. Real-world evidence on emergency on-call vascular management in this setting remains limited. We aimed to identify the intraoperative ischemia time threshold associated with progression to a more severe ischemic presentation (Rutherford IIb) at vascular consultation, in order to support early multidisciplinary activation and prevent irreversible ischemic limb damage. As a secondary aim, we described the clinical spectrum, treatment strategies, and 30-day outcomes of patients managed by a 24 h on-call vascular service (in-hospital coverage during working hours, formal on-call rota out of hours). Non-ischaemic events recorded in the series (e.g., isolated venous injuries and haemorrhagic complications) are documented as part of the overall clinical spectrum but were not the subject of specific time-related analysis. Methods: Single-centre retrospective analysis of 33 consecutive patients undergoing emergency vascular intervention for vascular injury during elective total knee (TKA) or total hip arthroplasty (THA) at a tertiary orthopaedic referral centre in Milan, Italy (January 2023—December 2025). The primary analytical objective was to identify the intraoperative ischemia time threshold associated with Rutherford IIb presentation at vascular consultation; 30-day limb salvage was the primary clinical outcome. Secondary outcomes included technical success, primary 30-day patency, postoperative ankle–brachial index (ABI), length of stay, and Clavien–Dindo complications. Non-ischaemic events (including isolated venous injuries and haemorrhagic complications) are documented as part of the clinical spectrum but were not subject to specific time-related analysis. Receiver operating characteristic (ROC) analysis assessed the discriminative role of intraoperative ischemia time for a Rutherford IIb presentation; univariate logistic regression explored predictors of postoperative complications. Results: Thirty-three patients (mean age 76.3 ± 6.3 years; 54.5% female; ≥2 comorbidities in 81.8%) underwent emergency vascular repair after TKA (60.6%) or THA (39.4%). Injuries were mixed arteriovenous (54.5%), purely venous (24.2%), or purely arterial (21.2%). Mean call-to-incision time was 45.4 ± 11.3 min. In the 25 ischemic cases, the mean intraoperative ischemia time was 130.4 ± 18.7 min. ROC analysis identified an optimal cut-off of 131 min for Rutherford IIb (AUC 0.851, 95% CI 0.679–0.982; p < 0.001), with sensitivity 81.8% and specificity 85.7%. Median ischemia time was significantly higher in IIb than IIa cases (144 vs. 124.5 min; p = 0.003). Technical success and 30-day limb salvage were 100% (95% CI 89.6–100); mean postoperative ABI 0.89 ± 0.03; primary 30-day patency 88.0% (95% CI 70.0–95.8), with secondary patency 100%. All postoperative complications were Clavien–Dindo grade 1; no Clavien–Dindo ≥ 2 events and no 30-day mortality were observed. Conclusions: A dedicated 24 h on-call vascular service achieves excellent 30-day limb salvage and patency in iatrogenic vascular injuries occurring during arthroplasty. An intraoperative ischemia threshold of 131 min identifies higher-risk presentations and supports rapid multidisciplinary activation in high-volume orthopaedic centres. Full article

Background: Respiratory failure (RF) is a frequently fatal complication of chronic liver disease (CLD), yet population-level data on RF-related mortality trends among adults with CLD are lacking. This study characterized temporal trends and demographic disparities in RF-related mortality among U.S. adults with CLD from 1999 to 2024. Methods: Death certificate data were obtained from the CDC WONDER database for adults aged ≥25 years with both RF (ICD-10: J96) and CLD (ICD-10: K70–K76) listed as an underlying or contributing cause of death. Age-adjusted mortality rates (AAMRs) per 100,000 were calculated using the 2000 U.S. standard population. Joinpoint regression identified temporal inflection points and annual percentage change (APC). Results: Among 241,075 deaths, the overall AAMR increased 3.2-fold from 2.237 (1999) to 7.162 (2021) per 100,000, then declined to 6.132 by 2024. Joinpoint analysis identified four segments: moderate increase (1999–2006; APC +2.40%), accelerated increase (2006–2018; APC +5.37%), late acceleration period (2018–2021; APC +13.10%), and post-pandemic decline (2021–2024; APC −4.32%; all p < 0.001). The 2024 AAMR remained 174.2% above baseline. The male-to-female rate ratio narrowed from 2.02 to 1.50, with females showing steeper acceleration (+14.38% vs. +12.36%). American Indian or Alaska Native individuals had the highest AAMRs and the most dramatic surge (APC +26.90%). Rural areas surpassed urban AAMRs by 2020, with steeper post-2007 acceleration (+8.74% vs. +5.51%). The Western U.S. consistently had the highest regional rates. Younger adults aged 25–34 and 35–44 showed 2.96-fold and 2.37-fold increases in crude mortality rates, respectively. Approximately 80% of deaths occurred in inpatient settings. Conclusions: RF-related mortality among U.S. adults with CLD increased more than threefold from 1999 to 2021, with a dramatic surge followed by incomplete decline. Persistent disparities by sex, race/ethnicity, urbanization, and region highlight the need for targeted interventions, including expanded screening for alcohol-associated and metabolic liver disease and improved access to hepatology services in underserved communities. Full article

Government-funded teacher education in China links financial support, teacher preparation, employment expectations, and post-graduation service obligations. Understanding how pre-service preschool teachers perceive this policy-based pathway is important for explaining their professional identity development; therefore, this study examined how policy satisfaction and perceived teacher support were associated with the professional identity of government-funded pre-service preschool teachers in Chongqing, Southwest China. Based on paper-based questionnaire data from 620 participants, Latent Profile Analysis identified four profiles: Dissatisfied–Low Support, Moderately Satisfied–Moderate Support, Highly Dissatisfied–Low Support, and Highly Satisfied–High Support. Multinomial logistic regression showed that only-child status and age significantly predicted profile membership, and one-way ANOVA and multiple regression further indicated that professional identity differed significantly across profiles, with lower scores observed in the less satisfied and less supported profiles after controlling for demographic covariates. These findings suggest that strengthening policy communication and accessible teacher support may help promote professional identity development among government-funded pre-service preschool teachers. Full article

Background/Objectives: Nursing home residents were among the most vulnerable populations during the COVID-19 pandemic, facing strict restrictive measures, limited access to medical services, and significant psychological consequences derived from institutional confinement. Despite the magnitude of these impacts, the perspective of residents themselves remain underrepresented in the qualitative literature, particularly in the Spanish context. The aim of this study was to analyze and describe the perspectives of residents in a nursing home regarding the restrictive measures adopted by the facility and their access to medical services during the COVID-19. Methods: An exploratory qualitative study was conducted with 24 residents of a nursing home in Cáceres, Spain. Data were collected through in-depth interviews and field notes, and analyze using inductive thematic analysis following Braun and Clarke’s framework. Results: Two main themes were identified: Necessary to feel safe, but unpleasant: accepting the restrictive measures (Accepting the measures; and Better safe, even if unpleasant) and Barriers to healthcare: abandonment, fear, and age-based exclusion (Neglect and abandonment by healthcare system; The residence as a “bubble” and fear of hospital transfer; and Not treated because of our age). Conclusions: The findings highlight the complexity of the experiences of older adults in residential care during the COVID-19 pandemic and underscore the urgent need to balance health protection with psychological well-being, dignity, and the rights of older people in future emergency responses. Full article

β-thalassemia is one of the most prevalent inherited hemoglobin disorders worldwide and represents a major public health challenge in Southeast Asia, particularly in Vietnam. The disorder is caused by pathogenic variants in the β-globin (HBB) gene, resulting in reduced or absent β-globin synthesis, ineffective erythropoiesis, chronic hemolytic anemia, and progressive multi-organ complications. Vietnam exhibits a high burden of thalassemia and related hemoglobinopathies, with approximately 13.8% of the population carrying a hemoglobinopathy-associated variant and substantial heterogeneity in distribution across ethnic groups and geographic regions. This review provides a comprehensive overview of the epidemiology, molecular characteristics, diagnostic strategies, treatment approaches, and prevention programs for β-thalassemia in Vietnam. Current evidence indicates that a limited number of recurrent HBB variants account for the majority of β-thalassemia alleles in the Vietnamese population, including codon 17 (A>T) (HBB: c.52A>T), codons 41/42 deletion (-TTCT) (HBB: c.126_129delTTCT), codons 71/72 (+A) (HBB: c.216_217insA), codons 95 (+A) (HBB: c.287_288insA), IVS-I-1 (G>T) (HBB: c.92+1G>T), IVS-I-5 (G>C) (HBB: c.92+5G>C), IVS-II-654 (G>T) (HBB: c.316+197C>T), -28 (A>G) (HBB: c.-78A>G), and -88 (C>T) (HBB: c.-138C>T). Diagnostic strategies generally follow a stepwise approach integrating hematological screening and hemoglobin analysis with confirmatory molecular testing. Advances in molecular diagnostics, particularly targeted polymerase chain reaction (PCR)-based assays and next-generation sequencing (NGS), have significantly improved detection of both carriers and affected individuals. Despite these advances, β-thalassemia continues to impose a considerable clinical, economic, and societal burden because many patients require lifelong blood transfusions, iron chelation therapy, and multidisciplinary management of disease-related complications. Major challenges include limited access to screening, prenatal diagnosis, and genetic counseling services, particularly in rural and ethnic minority populations, as well as the financial and technical barriers associated with advanced molecular diagnostics and emerging therapies. Strengthening nationwide screening programs, expanding access to prenatal and preconception genetic services, improving public awareness, and enhancing healthcare infrastructure are essential for reducing disease incidence and improving patient outcomes. In parallel, the integration of advanced molecular diagnostics and emerging gene-based therapies will be critical for advancing long-term disease control. This review highlights current knowledge gaps and proposes strategic priorities to support evidence-based policy development and comprehensive β-thalassemia prevention and management in Vietnam. Full article

This systematic review paper examines how technical, operational, and structural factors influence the adoption of digital agriculture among small-scale farmers in Sub-Saharan Africa. Guided by PRISMA protocols, the study applies a hybrid thematic synthesis across six dimensions: technical, operational, policy and regulatory, governance, social and cultural, and environmental. The findings indicate that digital tools can generate substantial benefits, including yield increases of 10–30% (documented primarily for mobile-based advisory services and precision input management in East African horticulture and West African cocoa value chains) and price gains of 15–25%, with adoption rates of 70–80% in settings characterised by robust infrastructure, strong institutional support, and effective value chain integration. However, these benefits are unevenly distributed and tend to concentrate in “islands of adoption” characterized by robust infrastructure, strong institutional support, and effective value chain integration. While technical (94.9%) and operational (91.5%) factors dominate the literature, their impact is constrained by persistent structural barriers, including weak policy implementation (79.7%), fragmented governance systems (76.3%), and socio-cultural exclusion—such as gender disparities, age-related digital divides, and language misalignment (71.2%). The review identifies five minimum conditions for meaningful adoption: (i) affordable connectivity and access to digital devices; (ii) context-specific digital literacy; (iii) culturally relevant, user-centred design; (iv) robust institutional ecosystems; and (v) enabling policy and financial frameworks. Overall, the findings underscore that digital agriculture adoption is a socio-technical process shaped not only by technological innovation but also by institutional arrangements and user capabilities. Comparative cases, such as Kenya’s Farm.ink and the less successful EZ Farm initiative, further highlight the importance of integrated, context-responsive approaches to ensure that digital agriculture enhances, rather than marginalizes, small-scale farmers. Full article