Search Results (9,664)

This study contributes to scientific theory by analyzing the models proposed within the framework of circular agriculture to determine how the three dimensions of sustainability—environmental, economic, and social—are integrated into their implementation. A systematic review was conducted on articles published between 2016 and 2025, indexed in the Scopus and Web of Science databases, as well as the relevant grey literature. The methodology employed an extensive content analysis designed to minimize bias, applying filters related to specific knowledge areas to delimitate the search scope and enhance the precision of the research. The findings reveal that the research on circular agriculture models is predominantly grounded in the principles of the circular economy and its associated indicators. Moreover, these models tend to focus on environmental metrics, often neglecting a comprehensive exploration of the social and economic dimensions of sustainable development. It can be concluded that a significant gap persists in the literature regarding the circularity of agriculture and its socio-economic impacts and the role of regulatory frameworks, aspects that future research must address in order to achieve sustainability in circular agriculture. Full article

With increasing life expectancy, the number of older people living with comorbid diabetes and frailty is increasing. The development of frailty accelerates diabetes-related adverse outcomes. Frailty is a multidimensional syndrome with physical, mental and social aspects which is associated with increased risk of hypoglycaemia, dementia and hospitalisation. Therefore, regular screening for all aspects of frailty should be an integrated part of the care plans of older people with diabetes. In addition, every effort should be made for prevention, which includes adequate nutrition combined with regular resistance exercise training. In already frail older people with diabetes, metabolic targets should be relaxed and hypoglycaemic agents should be of low hypoglycaemic risk potential. Furthermore, the metabolic phenotype of frailty should be considered when choosing hypoglycaemic agents and determining targets. With increasing severity of frailty, proactive chronological plans of de-escalation, palliation and end-of-life care should be considered. These plans should be undertaken in a shared decision-making manner which involves patients and their families. This ensures that patients’ views, wishes and preferences are in the heart of these plans. Full article

Objectives: Diabetes Mellitus involves demanding challenges that interfere with family functioning and routines. In turn, family and social context impacts individual glycemic control. This study aims to identify this recursive interplay, the mutual influences of family systems and diabetes management. Design: Data was collected through a cross-sectional design comparing patients, aged 22–55, with and without metabolic control. Methods: Participants filled out a set of self-report measures of sociodemographic, clinical and family systems assessment. Patients (91) were also invited to describe their perception about disease management interference regarding family functioning. We first examined the extent to which family variables grouped dataset to determine if there were similarities and dissimilarities that fit with our initial diabetic groups’ classification. Results: Cluster analysis results identify a two-cluster solution validating initial classification of two groups of patients: 49 with metabolic control (MC) and 42 without metabolic control (NoMC). Independent sample tests suggested statistically significant differences between groups in family subscales- family difficulties and family communication (p < 0.05). Binary logistic regression shed light on predictors of explained variance to no metabolic control, in four models: Sociodemographic, Clinical data, SCORE-15/Congruence Scale and Eating Behavior. Furthermore, groups differ on family support, level and sources of family conflict caused by diabetes management issues. Considering only patients who co-habit with a partner for more than one year (N = 44), NoMC patients score lower on marital functioning in all categories (p < 0.05). Discussion: Family-Chronic illness interaction plays a significant role in a patient’s adherence to treatment. This study highlights the Standards of Medical Care for Diabetes, considering caregivers and family members on diabetes care. Full article

Black gay and bisexual older men face numerous barriers across the life course that can contribute to negative health and well-being as they age. Drawing on strengths-based social determinants discussed in the health literature and literature on intersectionality, justice, and critical consciousness, this study examines qualitative data from seventeen Black gay and bisexual older men about sources and strategies of resilience and thriving amidst intersecting systems of power and oppression that shape health inequities. The findings revealed an evolution of positive support networks across their life courses, including biological family and families of choice such as “houses” and support groups. Early and ongoing negative experiences relating to intersecting positionalities (e.g., race, gender, sexual orientation) also provided sources of strength and resilience. Participants identified three strategies for building resilience and thriving: naming external ignorance, acknowledging common struggles, and reconciling contradictions. These strategies reflected various levels of critical consciousness that helped them navigate complex and intersecting systems of power that they encountered as Black gay men across the life course. Overall, the findings underscore the importance of considering intersecting systems of power and critical consciousness when examining resilience and social determinants of health and contribute new insights on a vastly understudied population. Full article

Heart failure (HF) is a major global health challenge, characterized by high morbidity, mortality, and frequent hospital readmissions. Despite the advent of guideline-directed medical therapies (GDMTs), the burden of HF continues to grow, necessitating a shift toward comprehensive, multidisciplinary care models. Heart Failure Disease Management Programs (HF-DMPs) have emerged as structured frameworks that integrate evidence-based medical therapy, patient education, telemonitoring, and support for social determinants of health to optimize outcomes and reduce healthcare costs. This review outlines the key components of HF-DMPs, including patient identification and risk stratification, pharmacologic optimization, team-based care, transitional follow-up, remote monitoring, performance metrics, and social support systems. Incorporating tools such as artificial intelligence, pharmacist-led titration, and community health worker support, HF-DMPs represent a scalable approach to improving care delivery. The success of these programs depends on tailored interventions, interdisciplinary collaboration, and health equity-driven strategies. Full article

Background: Health equity can only be achieved when every individual has access to quality healthcare without fear of being discriminated against. This study analyzed the sociodemographic characteristics associated with self-reported racial discrimination when receiving medical care in the United States. Methods: This quantitative cross-sectional study utilized the 2022 National Trends Survey 6. We performed a logistic regression analysis using 6102 survey responses from study participants who answered the question about perceived discrimination. Results: Older adults aged 75 years and above had significantly lower odds of reporting perceived discrimination when receiving medical care compared to those aged 18–34 years (AOR = 0.24; 95% CI: 0.10–0.58). The odds of reporting perceived discrimination were significantly higher among non-Hispanic Blacks (AOR = 7.30; 95% CI: 4.48–11.88), Hispanics (AOR = 3.56; 95% CI: 2.45–5.17), non-Hispanic Asians (AOR = 5.95; 95% CI: 2.25–15.73), and individuals identifying as non-Hispanic Other (AOR = 10.91; 95% CI: 5.42–21.98), compared to non-Hispanic Whites. Compared to individuals from households earning less than USD 20,000, the odds of reporting perceived discrimination when receiving medical care were significantly lower among individuals from households earning between USD 50,000 and <USD 75,000 (AOR = 0.42; 95% CI: 0.23–0.78) and those earning USD 75,000 or more (AOR = 0.43; 95% CI: 0.22–0.83). Conclusions: Despite having a multicultural and ethnically diverse population, racial discrimination persists in the United States and has become a barrier to achieving health equity. Health organizations should implement policies that ensure health workers attend mandatory anti-racism training. Full article

Introduction: The increasing cultural diversity of patients poses new challenges for nurses. Cultural competence, especially knowledge of the cultural determinants of health and illness, is an important element of professionalism in nursing care. The aim of this study was to analyse nurses’ self-assessment of cultural knowledge, with a focus on the six dimensions of the Giger and Davidhizar model, prior to formal training in this area. Methods: A triangulation method combining qualitative and quantitative analysis was used. The analysis included 353 statements from 36 master’s student nurses. Data were coded according to six cultural phenomena: biological factors, communication, space, time, social structure, and environmental control. Content analysis, ANOVA, Spearman’s rank correlation, and cluster analysis (k-means) were conducted. Results: The most frequently identified that categories were environmental control (34%), communication (20%), and social structure (16%). Significant knowledge gaps were identified in the areas of non-verbal communication, biological differences, and understanding space in a cultural context. Three cultural knowledge profiles of the female participants were distinguished: pragmatic, socio-reflective, and critical–experiential. Conclusions: The cultural knowledge of the participants was fragmented and simplified. The results indicate the need to personalise cultural learning and to take into account nurses’ level of readiness and experience profile. The study highlights the importance of the systematic development of reflective and contextual cultural knowledge as a foundation for competent care. Full article

The problem associated with the manifestation of burnout syndrome is the subject of ongoing interest. In recent years, occupational burnout has been actively studied among professionals in the helping professions (teachers, physicians, social workers, psychologists, prison officers, etc.). However, the phenomenon has been poorly studied among freelancers. Therefore, the aim of this study is to fill this gap by determining the level of burnout syndrome among Bulgarian freelancers and investigate the influence of some work environment factors on professional burnout in the sample. A survey of 1138 freelancers was carried out using the Burnout Self-Assessment Questionnaire developed by Maslach and a questionnaire developed in-house to explore the factors of the occupational environment and ask questions related to socio-demographic factors. Hypotheses are tested using correlation analysis and structural equation modelling. The study reveals high levels of emotional exhaustion (40.91%, n = 484). High values on the scale of depersonalization were reported for 26,3% of the respondents (n = 311). Only 3.1% of the respondents (n = 37) had high values on the reduced personal accomplishment scale. The high levels of burnout among freelancers could be influenced by the specific characteristics of their work environment and the nature of their tasks. Full article

To address the substantial disparities in operational characteristics between social vehicles and dedicated bus lanes, as well as the sub-optimal coordination control effects, a comprehensive approach is proposed. This approach integrates social vehicle arterial coordination with bus priority control in dedicated bus lanes. Initially, an analysis of the differences in travel time distribution on both types of roads is conducted. The likelihood of buses passing through upstream and downstream intersections without stopping is also assessed. This analysis aids in determining the correlated traffic states and the corresponding signal adjustment strategies for arterial coordination. Subsequently, an incentive mechanism is established by quantitatively analyzing vehicle delay losses and bus priority benefits based on the signal adjustment strategy. Finally, a deep reinforcement learning framework is proposed to solve, in real-time, the optimal signal adjustment strategy. Simulation experiments indicate that, in comparison to the arterial coordination of social vehicles and dedicated bus arterial coordination control, this method significantly reduces the average per capita delay by 38.63% and 27.43%, respectively, under conventional traffic flow scenarios. This is in contrast to the separate arterial coordination for social vehicles and dedicated bus lanes. Furthermore, it leads to a reduction of 52.17% in the number of bus stops at intersections when compared solely with the arterial coordination of social vehicles. In saturated traffic flow scenarios, this method achieves a reduction in average per capita delay by 29.7% and 9.6%, respectively, while also decreasing the number of bus stops at intersections by 39.5% and 8.7%, respectively. Full article

Background/Objectives: Dietary patterns have changed over time, characterising a process of nutritional transition that reflects socioeconomic and demographic inequalities among different populations. This study assessed changes in dietary consumption patterns and the associated social determinants, comparing two time periods in a sample of individuals from a state in the Northeast Region of Brazil. Methods: Data from the 2008–2009 and 2017–2018 Household Budget Survey for the state of Paraíba were analysed, totalling 951 and 1456 individuals, respectively. Foods were categorised according to the NOVA classification and compared based on sociodemographic and economic variables. To determine the factors that most strongly explain the contribution of each NOVA food group to the diet, beta regression analysis was conducted. Results: Differences were observed between the two periods regarding the dietary contribution of the NOVA food groups, with a decrease in consumption of unprocessed foods and an increase in ultra-processed foods. Living in urban areas, being an adolescent, and having an income above the minimum wage were associated with reduced intake of unprocessed foods in both periods. Additionally, being an adolescent and having more than eight years of schooling were associated with higher consumption of ultra-processed foods. Conclusions: The population under study showed changes in food consumption, reflecting a transition process that is occurring unevenly across socioeconomic and demographic groups, thereby reinforcing social inequalities. These findings can guide priorities in food and nutrition policies, highlighting the need for intervention studies to evaluate the effectiveness of such actions. Full article

The advanced determination of the type (foreshock–aftershock–swarm) of an ongoing seismic cluster is quite challenging; only retrospective solutions have thus far been proposed. In the period of January–March 2025, a seismic cluster, recorded between Santorini volcano and Amorgos Island, South Aegean Sea, caused considerable social concern. A rapid increase in both the seismicity rate and the earthquake magnitudes was noted until the mainshock of M_L = 5.3 on 10 February; afterwards, activity gradually diminished. Fault-plane solutions indicated SW-NE normal faulting. The epicenters moved with a mean velocity of ~0.72 km/day from SW to NE up to the mainshock area at a distance of ~25 km. Crucial questions publicly emerged during the cluster. Was it a foreshock–aftershock activity or a swarm of possibly volcanic origin? We performed real-time discrimination of the cluster type based on a daily re-evaluation of the space–time–magnitude changes and their significance relative to background seismicity using earthquake statistics and the topological metric betweenness centrality. Our findings were periodically documented during the ongoing cluster starting from the fourth cluster day (2 February 2025), at which point we determined that it was a foreshock and not a case of seismic swarm. The third day after the M_L = 5.3 mainshock, a typical aftershock decay was detected. The observed foreshock properties favored a cascade mechanism, likely facilitated by non-volcanic material softening and the likely subdiffusion processes in a dense fault network. This mechanism was possibly combined with an aseismic nucleation process if transient geodetic deformation was present. No significant aftershock expansion towards the NE was noted, possibly due to the presence of a geometrical fault barrier east of the Anydros Ridge. The 2025 activity offered an excellent opportunity to investigate deciphering the type of ongoing seismicity cluster for real-time discrimination between foreshocks, aftershocks, and swarms. Full article

Background/Objectives: Metabolic dysfunction-associated steatotic liver disease (MASLD) is a leading cause of chronic liver disease. It has known multifactorial pathophysiology, but the impact of social determinants of health (SDOH) on the rising prevalence of MASLD is poorly understood. We conducted a retrospective cross-sectional study to examine the influence of SDOH on MASLD using nationwide data from the 2017–2018 National Health and Nutrition Examination Survey (NHANES) study. Methods: We identified participants with MASLD based on liver ultrasound-based controlled attenuation parameter measurements consistent with diagnostic guidelines. We then used logistic regression models to examine associations between SDOH variables and MASLD, with a pre-specified focus on education and income, sequentially adjusting for sociodemographic factors, medical comorbidities, and other SDOH. Results: Our study found that higher education (odds ratio [OR] 0.77, 95% confidence interval [CI] 0.62–0.97, p = 0.024) but not higher income (OR 1.12, 95% CI 0.91–1.37, p = 0.3) was associated with lower odds of MASLD in multivariable adjusted models. We also identified a significant interaction between education level and food security, as well as interactions between food security and other significant SDOH. In the stratified analyses, higher education was significantly associated with lower odds of MASLD among participants with food security (OR 0.71, 95% CI 0.55–0.91, p = 0.007) but not among those with food insecurity (OR 1.26, 95% CI 0.76–2.11, p = 0.4). Conclusions: Our findings identify the potential impact of SDOH on odds of MASLD and suggest increased importance of food security relative to other SDOH. Full article

Understanding the social drivers of pro-environmental behavior in urban forests and green spaces is critical for addressing sustainability challenges. Subjective norms serve as a key pathway through which social expectations influence individuals’ behavioral intentions. Despite mixed findings in the literature regarding the impact of subjective norms on individuals’ intentions, there is a research gap about the determinants of this construct. This study was conducted to explore how social expectations shape perceived subjective norms among visitors of urban forests. A theoretical model was developed with subjective norms at its center, incorporating their predictors including social identity, media influence, interpersonal influence, and institutional trust, personal norms as a mediator, and behavioral intention as the outcome variable. Using structural equation modeling, data was collected and analyzed from a sample of visitors of urban forests in Tehran, Iran. The results revealed that subjective norms play a central mediating role in linking external social factors to behavioral intention. Social identity emerged as the strongest predictor of subjective norms, followed by media and interpersonal influence, while institutional trust had no significant effect. Subjective norms significantly influenced both personal norms and intentions, and personal norms also directly predicted intention. The model explained 50.9% of the variance in subjective norms and 39.0% in behavioral intention, highlighting its relatively high explanatory power. These findings underscore the importance of social context and internalized norms in shaping sustainable behavior. Policy and managerial implications suggest that strategies should prioritize community-based identity reinforcement, media engagement, and peer influence over top-down institutional messaging. This study contributes to environmental psychology and the behavior change literature by offering an integrated, empirically validated model. It also provides practical guidance for designing interventions that target both social and moral dimensions of environmental action. Full article

Tuberculosis (TB) remains a leading cause of death in Bangladesh, disproportionately affecting low socio-economic status (SES) populations. This review, guided by the WHO Social Determinants of Health framework and Rockefeller-Lancet Planetary Health Report, examined how social, economic, and ecological factors link SES to TB burden. The first literature search identified 28 articles focused on SES-TB relationships in Bangladesh. A second search through snowballing and conceptual mapping yielded 55 more papers of diverse source types and disciplines. Low-SES groups face elevated TB risk due to smoking, biomass fuel use, malnutrition, limited education, stigma, financial barriers, and hazardous housing or workplaces. These factors delay care-seeking, worsen outcomes, and fuel transmission, especially among women. High-SES groups more often face comorbidities like diabetes, which increase TB risk. Broader contextual drivers include urbanisation, weak labour protections, cultural norms, and poor governance. Recommendations include housing and labour reform, gender parity in education, and integrating private providers into TB programmes. These align with the WHO End TB Strategy, UN SDGs and Planetary Health Quadruple Aims, which expand the traditional Triple Aim for health system design by integrating environmental sustainability alongside improved patient outcomes, population health, and cost efficiency. Future research should explore trust in frontline workers, reasons for consulting informal carers, links between makeshift housing and TB, and integrating ecological determinants into existing frameworks. Full article

Urban heat islands (UHIs) are a growing sustainability challenge impacting public health, energy use, and climate resilience, especially in hot, arid cities like San Antonio, Texas, where land surface temperatures reach up to 47.63 °C. This study advances a data-driven, interdisciplinary approach to UHI mitigation by integrating Machine Learning (ML) with physical and socio-demographic data for sustainable urban planning. Using high-resolution spatial data across five functional zones (residential, commercial, industrial, official, and downtown), we apply three ML models, Random Forest (RF), Support Vector Machine (SVM), and Gradient Boosting Machine (GBM), to predict land surface temperature (LST). The models incorporate both environmental variables, such as imperviousness, Normalized Difference Vegetation Index (NDVI), building area, and solar influx, and social determinants, such as population density, income, education, and age distribution. SVM achieved the highest R² (0.870), while RF yielded the lowest RMSE (0.488 °C), confirming robust predictive performance. Key predictors of elevated LST included imperviousness, building area, solar influx, and NDVI. Our results underscore the need for zone-specific strategies like more greenery, less impervious cover, and improved building design. These findings offer actionable insights for urban planners and policymakers seeking to develop equitable and sustainable UHI mitigation strategies aligned with climate adaptation and environmental justice goals. Full article