Search Results (519)

Peripheral vestibulopathy (PV) is a common disorder that causes dizziness and balance impairment, substantially affecting patients’ quality of life. When symptoms persist, they frequently lead to anxiety, depression, and an increased risk of social isolation. Although central vestibular compensation (CVC) often promotes functional recovery, current pharmacological options remain limited and are primarily aimed at symptom control. Consequently, they should be considered adjuncts rather than alternatives to rehabilitation-based strategies. Vestibular rehabilitation (VR) remains the cornerstone of treatment for promoting functional recovery in patients with PV. Based on the complementary mechanisms of adaptation, substitution, and habituation, VR enhances the central nervous system’s ability to compensate for vestibular deficits by optimizing the integration of visual, proprioceptive, and residual vestibular inputs. Robust evidence from both clinical and preclinical studies has demonstrated its efficacy in improving postural stability, dynamic balance, gaze stabilization, and overall functional performance. Experimental studies using animal models have further highlighted the critical role of active sensorimotor training in ecologically relevant environments for enhancing vestibular compensation. Pharmacological interventions may further facilitate these adaptive processes by modulating the neurobiological mechanisms underlying vestibular compensation, thereby improving responsiveness to rehabilitation. Likewise, emerging neuromodulation approaches, including galvanic vestibular stimulation, have shown promising potential to enhance neural plasticity and augment the effects of rehabilitation. Consequently, combining VR with targeted pharmacological therapies and/or vestibular stimulation techniques may provide synergistic benefits and maximize functional recovery. In conclusion, vestibular rehabilitation should remain the foundation of PV management and be integrated with pharmacological and neuromodulatory approaches within a multidisciplinary therapeutic framework. Further research is needed to optimize rehabilitation protocols, identify the biological determinants of successful vestibular compensation, and develop personalized therapeutic strategies aimed at maximizing functional recovery and improving patients’ quality of life. Full article

Tuberculosis (TB) remains one of the most burdensome infectious diseases in Indonesia. One contributing factor is the environment, particularly issues related to household ventilation and lighting. TB control efforts do not solely rely on medical interventions but also require a community-based approach that emphasizes active community involvement in preventing and controlling environmental risks to TB transmission. This study aims to analyze risk factors, distribution patterns, and their implications for environmentally based TB transmission risk control strategies. A mixed-methods design was conducted in two stages: first, risk factor analysis (with a case–control approach) and disease distribution pattern determination on environmental variables were performed, followed by a multidimensional scaling model (by using the Rapid Appraisal for Fisheries (RAPFISH) method) according to sustainability dimensions (ecological, economic, social, institutional, and technological) based on the resulting significant variables/indicators. This research was conducted in 2024, in four villages/nagari in West Sumatra of Indonesia. For quantitative analysis, data were collected through interviews, physical measurements of the environment, and determination of the coordinates of the residences of people with TB. Data were analyzed using bivariate and multivariate analyses. For the distribution pattern, Nearest Neighbor Analysis (NNA) in the ArcView program version 3.1 was used. Meanwhile, for qualitative data collection, focus group discussion (FGD) was performed. This study found that poor ventilation, minimal lighting, and a lack of stigma competency significantly increased the risk of TB transmission. Varied distribution patterns between regions demand adaptive and locally based strategies. The community-triggering approach is key to building community awareness and participation in creating a healthy and TB-free home environment. Full article

The transmission of trauma across generations has traditionally been explained through genetic, epigenetic, familial, and attachment-based mechanisms. While these approaches have generated valuable insights, they remain insufficient for explaining the persistence of psychological vulnerability in contexts where the original traumatic event has disappeared but maladaptive patterns continue to emerge across generations. This paper introduces the Contextual Resonance Theory of Psychopathology (CRTP), a novel cognitive–systemic framework proposing that transgenerational trauma is maintained through the recursive reproduction of trauma-shaped environments rather than exclusively through biological inheritance. According to this model, traumatic experiences generate adaptive cognitive, emotional, and behavioral responses that become embedded within family narratives, relational structures, institutional practices, and cultural expectations. Over time, these adaptations evolve into self-maintaining contextual systems that continuously communicate threat, unpredictability, and hypervigilance to subsequent generations. The theory introduces the concepts of contextual traumatic inertia, distributed psychopathology, and recursive contextual resonance to explain how vulnerability becomes socially reproduced even in the absence of direct trauma exposure. Drawing on predictive processing, ecological psychology, systems theory, and contemporary trauma research, the paper proposes that psychopathology emerges from persistent interactions between individuals and pathogenic environments rather than solely from intrapsychic dysfunction. Furthermore, a complementary mechanism termed corrective recontextualization is proposed as a pathway for reversing transgenerational vulnerability through repeated exposure to safe, predictable, and psychologically restorative contexts. The framework offers an integrative perspective capable of bridging cognitive neuroscience, developmental psychopathology, trauma studies, and mental health intervention research. Clinical, educational, organizational, and societal implications are discussed, alongside future directions for empirical validation and neurocognitive investigation. Full article

Background: This scoping review maps and synthesizes the scientific evidence on the epidemiological profile and determinants of sick leave and work-related accidents in Brazil, with an emphasis on studies using data from the Brazilian Federal Medical Expert Service of the Ministry of Social Security. Methods: Following the PRISMA-ScR guidelines and the JBI Manual for Evidence Synthesis, eight databases (SciELO, PubMed/MEDLINE, Scopus, Web of Science, LILACS, CINAHL, PsycINFO, Embase) were searched for quantitative observational studies published between 2000 and 2025. Out of the 218 studies identified, 18 met the eligibility criteria. Results: Cross-sectional designs (66.7%) and ecological/time-series designs (22.2%) predominated. The findings identified musculoskeletal disorders as the leading cause of work absence; mental disorders were the third leading cause, exhibiting an upward trend; and a significant influence of institutional factors, especially the Social Security Technical Epidemiological Nexus, on the observed patterns. Determinants operate at the individual, occupational/organizational, and institutional levels. Conclusions: Empirical research on work disability in Brazil remains fragmented, providing limited capacity for causal inference. The findings support five priority areas: sectoral risk management, workplace mental health, territorial strategies for musculoskeletal disorders, sick leave trajectory policies, and data governance, all of which necessitate longitudinal and quasi-experimental studies to evaluate interventions and the impact of institutional changes. Full article

Early childhood dental caries (ECC) remains one of the most prevalent and preventable chronic diseases affecting young children globally, yet behavioral and contextual determinants of its onset during the first 1000 days of life remain poorly understood and infrequently modeled in Latin American populations. This study presents a novel application of the PRECEDE diagnostic framework to conceptualize Early Childhood Dental Caries during the first 1000 days (1000ECDC) as a behaviorally rooted, socio-ecologically conditioned health problem. Drawing on a formative longitudinal pilot study (n = 10 mother–infant dyads, Caracas, Venezuela) and a complementary narrative literature review, we develop the first PRECEDE-based conceptual model linking maternal prenatal and postnatal behaviors to dental caries risk in a Latin American context. The model identifies dietary and feeding behaviors, oral health care practices, and healthcare service utilization as primary behavioral risk factors, modulated by predisposing factors (low oral health knowledge, limited self-efficacy, cultural norms), enabling factors (socioeconomic constraints, fragmented health systems), and reinforcing factors (social norms, family influence). Exploratory pilot findings indicated that more than 60% of children had advanced dental caries lesions at 24-month follow-up, consistent with regional estimates and underscoring the urgency of early intervention. This model provides practitioners and policymakers with a structured, evidence-informed diagnostic tool to guide the design of early-life oral health promotion programs, with particular relevance for low-resource Latin American settings. Future validation through expert consensus and prospective studies is warranted. Full article

Cognitive assessment and training are fundamental tools for supporting healthy aging and monitoring cognitive decline in older adults. Socially assistive robots are being investigated in this context because of their potential to provide multimodal, engaging, and personalized interactions during cognitive interventions. However, current evidence remains fragmented regarding the robotic embodiments, interaction strategies, and monitoring approaches used for cognitive assessment and training, as well as their ability to produce robust and long-term clinical benefits. To address this gap, this systematic review analyzes 37 studies identified through searches of Scopus, PubMed, and IEEE Xplore, following a PRISMA-based methodology. The review examines the main technological and methodological characteristics of the proposed systems, including robot embodiment, interaction capabilities, cognitive intervention paradigms, and the integration of multimodal monitoring technologies. The results highlight the predominance of humanoid robots and multimodal interaction strategies, together with an emerging use of adaptive and AI-based approaches. However, the available evidence is characterized by methodological heterogeneity, limited longitudinal validation, and a lack of standardized and ecologically valid evaluation protocols. Although the reviewed studies report encouraging findings concerning feasibility, engagement, acceptance, and preliminary cognitive outcomes, the evidence remains insufficient to identify the most effective robotic embodiment or confirm long-term clinical benefits. Larger comparative and longitudinal studies are therefore required. Full article

Background/Objectives: Exercise is an important component of rehabilitation programmes for stroke survivors, and adherence is key to ensuring the effectiveness of rehabilitation. However, adherence declines over time, especially as stroke survivors transition from in-hospital to post-discharge settings. The present review synthesised evidence on factors associated with exercise adherence among stroke survivors in China across two settings, using the socio-ecological model. This could provide a basis for developing effective intervention strategies to improve exercise adherence. Methods: A literature search was conducted via China National Knowledge Infrastructure, Wanfang, Weipu, PubMed, and Web of Science from inception to 30 December 2025. Only cross-sectional studies that examined factors associated with exercise adherence were included. Studies were screened against the inclusion and exclusion criteria. Data were extracted, categorised, and analysed using a semi-quantitative approach. The review protocol was not prospectively registered but was later registered on the Open Science Framework. Results: Twenty-three studies were included, of which 13 focused on the in-hospital setting and 10 on the post-discharge setting, published between 2013 and 2025, involving 7557 stroke survivors aged 18 to over 75 years, with a mean quality assessment score of 85.33%. Exercise adherence was generally at a medium level in both settings, with a slightly lower adherence index after discharge. During hospitalisation, 34 intrapersonal and five interpersonal factors were identified, while 29 intrapersonal, five interpersonal, and one environmental factor were identified after discharge. Sufficient evidence showed that educational level, functional independence, and self-efficacy were positively associated with exercise adherence across both settings. During hospitalisation, social support was also positively associated with adherence, while age and stroke severity were negatively associated. After discharge, marital status, knowledge, and attitude were positively associated, while time since stroke onset and balance impairment were negatively associated. Conclusions: Previous studies mainly focused on intrapersonal factors, followed by interpersonal factors, while environmental factors received limited attention. Future studies should examine potentially modifiable factors at all three levels and determine whether addressing these factors supports exercise adherence among stroke survivors during hospitalisation and after discharge. Full article

This study examines carrying capacity in parks and protected recreation areas as a measurement, monitoring, and adaptation component of sustainable visitor use management. For a concept-focused critical narrative review, Scopus and the Web of Science Core Collection were searched, and 2493 records were identified. After removing 819 duplicates, 1674 unique records were screened. Overall, 370 records were evaluated as topically eligible. A 78-source critical-synthesis core, comprising central database records, foundational books, and institutional documents identified through citation chaining, was evaluated against seven common criteria. The findings demonstrate that carrying capacity is not a single, context-independent visitor count. Rather, it is an adaptive process requiring the definition of desired ecological and experiential conditions, the monitoring of indicators and standards, and management intervention when thresholds are exceeded. The study’s contribution lies in comparing ROS, LAC, VAMP, CCAP, VIM, VERP, and IVUMF using common criteria, explaining the interdependence of physical, ecological, social, managerial, and economic dimensions, and jointly evaluating geographic transferability and digital data governance. In conclusion, sustainable management depends more on the organizational implementation of an indicator–standard–monitoring–action chain than on a numerical limit. Full article

Suicidal ideation among college students is a multicausal public health concern shaped by individual, family, social, and academic factors. Although prior research has consistently documented associations between psychological distress and suicide risk in this population, most studies analyze risk factors in isolation, leaving the joint contribution of variables across ecological levels insufficiently understood. The present study, framed within Bronfenbrenner’s ecological model of human development and Joiner’s interpersonal theory of suicide, examined the simultaneous influence of clinical, protective, academic, and victimization variables on suicidal ideation in college students. A cross-sectional design was employed with a sample of 553 undergraduate and graduate students (68.9% women; mean age = 20.93 years, SD = 3.81) from the University of Málaga (Spain), recruited through snowball and convenience sampling. Participants completed validated self-report measures of suicidal ideation (Paykel Suicide Scale), depression and anxiety (HADS), eating disorders (CBCAR), self-esteem (RSE), academic stress (SISCO), academic procrastination (APS-SF), bullying, cyberbullying, and social exclusion (QAEU), social support (QFSSS), family satisfaction, healthy habits, and family history of mental illness. Data were analyzed through Pearson and Spearman correlations and a robust multiple linear regression (ordinary least squares with HC3 robust standard errors and bias-corrected and accelerated bootstrap confidence intervals from 5000 resamples), complemented by an ordinal regression as a sensitivity analysis. The regression model accounted for 44.1% of the variance in suicidal ideation, with depression, anxiety, eating disorders, family history of mental illness, and bullying showing significant positive associations and self-esteem the strongest protective association. An ordinal regression sensitivity analysis yielded a consistent pattern, supporting the robustness of these findings. Family and social support, although correlated with lower ideation, lost statistical weight in the multivariate models, suggesting that their contribution operates indirectly, mainly through depression and self-esteem. Findings support the integration of clinical, social, and personal-resource components into college prevention programs, prioritizing early detection of psychopathology, anti-bullying protocols, interventions to strengthen self-esteem, and greater visibility of campus psychological services. Full article

Tropical forests sustain exceptional biodiversity and regulate global carbon and water cycles, yet degradation and incomplete recovery increasingly compromise these functions. We integrated bibliometric mapping with structured systematic synthesis to characterize research at the tropical-forest degradation–restoration interface, identify its most influential contributors and publications, and evaluate evidence on drivers, interventions, monitoring, and knowledge gaps. This study addresses three guiding scientific questions: (i) How has the field developed over time and across geographic space? (ii) Which authors, institutions, journals and publications have been most influential? (iii) What does the evidence indicate about degradation drivers, restoration strategies, monitoring approaches and knowledge gaps? Scopus and Web of Science were searched for peer-reviewed articles and reviews published from 1980 to 2025. After deduplication and PRISMA-based screening, 1075 publications were analyzed bibliometrically, and the 400 most-cited studies were coded against twenty predefined questions. Scientific output increased by 10.68% annually, with 483 publications appearing during 2020–2025. The corpus comprised 318 journals and 4470 authors. Forest Ecology and Management was the leading source (141 publications; 13.1%), while the twenty most productive journals accounted for 44.3% of the corpus. Brancalion P.H.S. was the most productive author (23 publications), followed by Chazdon R.L. and Tabarelli M. (20 each). Citation influence was concentrated: the twenty most-cited documents received 25.7% of all citations, led by Ribeiro M.C. (3339 citations), whereas Hua F. achieved the highest publication-year-normalized citation score among this group. Agricultural expansion, pasture establishment, and logging were the most frequently reported degradation pressures, but interactions among logging, fire, drought, and fragmentation were rarely quantified. Restoration evidence supported a context-dependent continuum from natural regeneration to assisted and active interventions, although planting and enrichment were more visible than direct passive–active comparisons. Carbon, biomass, plant diversity, and forest structure dominated outcome assessment, whereas fauna, ecological interactions, governance, and socioeconomic dimensions received less attention. Monitoring relied mainly on satellite imagery and field inventories, with limited evaluation of tool performance. Long-term trajectories and evidence from Africa, Southeast Asia, seasonally dry forests, and montane systems remained scarce. Overall, the field is rapidly consolidating but remains geographically and thematically uneven. Future research should quantify interacting degradation processes, evaluate multidimensional and long-term recovery, connect remote sensing with ecologically meaningful field indicators, and integrate governance and social conditions into restoration planning. The synthesis supports preventing further degradation and treating restoration as a context-specific complement, rather than a substitute, for protecting remaining native forests. Full article

Amid shifting urban renewal approaches and industrial restructuring in China, small and medium-sized cities face the challenge of conserving industrial heritage through adaptive reuse. Drawing on gazetteers, planning documents, and interviews, this paper examines the transformation of the Anqing Baiqitun Cement Plant into a cultural and creative park across environmental, social, economic, and governance dimensions. The case is significant as a typical heavy industrial heritage in a smaller city, while the enterprise’s restructuring and relocation have produced a rupture in collective memory and identity. The study finds that minimal intervention in the heavy industrial remains achieved carbon sequestration and emission reduction, succeeded in ecological restoration, and attained financial viability by leveraging local markets and intangible assets. However, the industrial past has been selectively reconstructed, creating a divide between the former industrial community and the present one, partly due to an over-reliance on Authorised Heritage Discourse logic and insufficient collaboration with the existing enterprise. Participatory governance, driven mainly by government coordination and market capital, proved efficient but lacked public engagement. The paper argues that regenerating industrial heritage in small and medium-sized cities requires not only physical upgrading but also social mechanisms that enable public participation in conservation. Full article

Introduction: This study explores obstetric providers’ perceptions of intimate partner violence (IPV) screening in the Chinese clinical setting, guided by the social–ecological model. Methods: Purposive sampling was employed to recruit eight obstetricians and 12 obstetric nurses from a tertiary general hospital in Suzhou, Jiangsu Province, China. Individual semi-structured interviews were conducted between December 2024 and September 2025. Results: Guided by the social–ecological model, this study examines factors influencing healthcare professionals’ engagement in intimate partner violence screening across four levels. A multilevel framework was distilled; four key themes were identified, including the intrapersonal level, interpersonal level, institutional level and community and policy level. (1) The intrapersonal level—healthcare professionals’ competence (knowledge base, communication skills, role identity, screening attitudes, and diagnostic ability); (2) the interpersonal level—interdisciplinary collaboration (internal referrals and external support); (3) the institutional level—hospital screening efficacy (screening resources and management systems); and (4) the community and policy level—social environment (policy support, educational resources, and cultural context). Conclusions: Multilevel factors impact IPV screening in China. These results indicate that a multidimensional model of intervention should be designed to promote IPV screening in China, including integrating IPV curricula into mandatory medical student training, enhancing interdisciplinary collaboration, conducting public education on IPV, implementing socio-cultural adjustments, challenging authoritative attitudes, and providing comprehensive social support. Full article

The paper analyzes the evolution and strategy development for sustainable community-based ecotourism (CBET) in the commune of Hoa Bac in Central Vietnam. It is based on a pilot project carried out from 2019 to 2025 within the scope of a larger research project funded by the German Federal Ministry of Research, Technology and Space (BMFTR) as part of the research line ‘Sustainable Urban Regions’. As a key component of the overall research approach, the goal of this pilot project along the Cu De River valley in the vicinity of the city of Da Nang has been a culturally adapted and ecologically sensitive tourism model that leads to income and socio-economic improvement, environmental protection and a decentralized low-impact infrastructure. The results of six years of qualitative longitudinal participatory research based on community workshops, interviews and surveys, direct observations as well as participatory field activities show how transformations in natural, cultural, human, social, financial and built capitals have shaped the transition from resource-dependent livelihoods to a diversified ecotourism economy. By mobilizing and empowering the local community, partly belonging to the Co Tu ethnic minority, sustainable development emerged not from isolated interventions but from a structured process of interlinked development strategies including cultural revitalization, environmental preservation, locally adapted agroforestry, skills and capacity development, cooperative governance, decentralized infrastructure, and income diversification. The study demonstrates that stakeholder and community empowerment, appropriately designed governance models (in this case the establishment of a tourism cooperative), targeted capacity development and knowledge transfer can strengthen the resilience and long-term sustainability of ecologically sound and culturally adaptive community-based tourism initiatives. Overall, the lessons learned from the research in Hoa Bac contribute to designing and implementing a holistic approach to CBET in rural settings. Full article

The United Nations 2030 Agenda often employs universalist metrics that overlook situated territorial ontologies. This study analyzes the Reverdece Association in Ráquira, Colombia, where an evolving self-determined peasant-mestizo family has articulated a model of resilience rooted in a Muisca-inspired worldview. Utilizing Participatory Action Research (PAR) and qualitative modeling in ATLAS.ti 26, this research examines how community practices generate functional sustainability outcomes. The findings reveal that the association’s efficiency stems from a “Coherence Framework” that synchronizes Identity (Being), Social Agency (Doing), and an Economy of Rootedness (Having). Central to this operational logic is the community making resource management decisions based on direct, somatic interactions with the landscape—such as evaluating fiber quality or water cycles—rather than relying on abstract market signals. By intentionally prioritizing long-term permanence, the association demonstrates that ecological regeneration is a natural outcome of their daily practices. This study concludes that community-led initiatives are more successful in achieving global sustainability goals than top-down institutional interventions. By recognizing situated epistemologies as valid forms of knowledge, the research suggests that the most resilient approaches to sustainability emerge from a collective commitment to regenerate ecosystems and maintain a dignified life within the territory. This indicates that locally grounded practices can complement and, in some cases, surpass standardized global indicators. Full article

Anemia among adolescent girls remains a persistent public health challenge in Indonesia, driven by limited nutritional knowledge, poor dietary practices, and suboptimal adherence to iron supplementation programs. This study is grounded in the Social–Ecological Model (SEM), which frames health behaviors as shaped by individual, interpersonal, institutional, and community-level factors. This study aimed to explore students’ knowledge and dietary behaviors related to anemia, assess perceptions of existing supplementation programs, and examine teachers’ and students’ perspectives on school-based digital education for anemia prevention in Denpasar, Bali. A qualitative descriptive design was employed across eight public junior high schools. Participants included eight teachers and 40 female students (aged 13–15 years) selected via purposive sampling. Data were collected through semi-structured in-depth interviews, non-participant observations, and document analysis. Thematic analysis was conducted using Atlas.ti version 23, with trustworthiness ensured through triangulation, member checking, peer debriefing, and iterative saturation assessment. Four inter-related themes emerged: (1) students held superficial, menstruation-centric conceptualizations of anemia with limited understanding of iron deficiency as an underlying cause; (2) dietary patterns were dominated by low-iron foods with poor vegetable consumption; (3) adherence to the Weekly Iron and Folic Acid Supplementation (WIFAS) program was inconsistent, hindered by side effects, forgetfulness, and low perceived benefit; and (4) both teachers and students expressed strong interest in digital education tools while identifying infrastructure and training gaps as barriers. Anemia prevention in school settings requires a multi-level approach integrating knowledge improvement, dietary behavior support, and institutional reinforcement. School-based digital education represents a contextually appropriate, youth-aligned innovation with strong potential to bridge the gap between health information and sustained behavioral change. Full article