Search Results (4,184)

Background/Objectives: Population aging represents a major social and public health challenge in Latin America. Mexico has made significant advances in regulatory and policy frameworks. Notable progress includes accession to the Inter-American Convention on Protecting the Human Rights of Older Persons (IACPHROP). It also includes the enactment of the Law on the Rights of Older Persons, and institutional reforms for social and cultural inclusion. This review evaluates Mexico’s alignment of aging policies with IACPHROP standards using an integrated framework of social determinants, policies, and legal obligations. This approach has not been previously reported for Mexico. Methods: Searches were conducted in electronic databases and official repositories. These included the World Health Organization, the Organization of American States, the Inter-American Human Rights System, and Mexican government regulations. Additional searches were performed in PubMed, Redalyc, SciELO, and Google Scholar. Results: Advances include universal non-contributory pensions, the expansion of healthcare coverage, and social inclusion programs. Important policy areas remain to be addressed, including the establishment of a national long-term care system, and the reduction of regional disparities in health coverage. In addition, the evidence linking specific policies to improve health outcomes remains heterogeneous. Conclusions: Mexico has built a solid foundation for the protection of older adults’ rights. The development of a long-term care system and the adoption of place-based approaches are also essential. Regional cooperation and community traditions play a pivotal role in achieving dignified, inclusive, and sustainable aging. Full article

Background: Health-related quality of life (HRQoL) and job satisfaction are important indicators of nurses and physicians’ wellbeing and system sustainability, particularly under conditions of high clinical demand. Although organizational determinants of nurses and physicians’ wellbeing have received increasing attention, evidence regarding protocol-based work as a specific organizational characteristic remains limited. Methods: A multicenter cross-sectional study was conducted in 11 Greek public hospitals between September 2022 and March 2023. The study included 405 nurses and physicians (214 nurses and 191 physicians). HRQoL was assessed with the SF-36 and job satisfaction with the MSQ-Short Form. Protocol-based work was assessed using a single self-reported dichotomous item referring to the use of standardized clinical protocols during the pandemic. Associations between workplace characteristics and outcomes were examined using multivariable linear regression models. Results: Vitality (57.24 ± 17.61 among nurses and 53.92 ± 16.93 among physicians) and general health (56.58 ± 19.81 and 53.42 ± 16.32, respectively) were the lowest-scoring HRQoL dimensions in both professional groups. Compared with physicians, nurses reported higher mental health (62.52 vs. 58.11, p < 0.05), social functioning (67.17 vs. 58.96, p < 0.05), and overall job satisfaction (3.23 vs. 2.98, p < 0.01), whereas physicians scored higher in physical functioning (83.47, p < 0.05) and bodily pain (72.87, p < 0.05). Conclusions: Several organizational characteristics were associated with wellbeing among nurses and physicians. Protocol-based work showed consistent associations with better HRQoL and job satisfaction across multiple outcomes. However, longitudinal studies are needed to determine whether these associations reflect causal relationships. Full article

Background/Objectives: Vaccine hesitancy remains a significant public health challenge in Japan, particularly following the HPV vaccine suspension (2013–2022) that severely damaged vaccination trust. Although prior studies have linked individual social capital to vaccination behavior in Japan, whether and how personal vaccination beliefs modify this association remains poorly understood. This study examined associations between individual social capital (resources accessed through personal social networks) and COVID-19 vaccination intention, and how these associations interact with personal vaccination beliefs based on the 7C model. Methods: A nationwide web-based survey (January 2024) included 7210 participants aged 20–69. Individual social capital was measured using civic participation, social cohesion (community trust), and reciprocity (mutual helping). Personal beliefs were assessed via the 7C model (psychological vaccination determinants framework) and factor-analyzed. Logistic regression examined associations; interaction analyses tested whether social capital effects differed across belief patterns. Results: Overall, 73.1% expressed intention to receive COVID-19 vaccination for 2024–2025. All social capital components positively associated with vaccination intention: social cohesion (adjusted OR = 1.80, 95% CI:1.58–2.04), reciprocity (adjusted OR = 1.64, 95% CI:1.33–2.02), and civic participation (adjusted OR = 1.29, 95% CI:1.10–1.51). Factor analysis identified three belief domains: individual and collective health responsibility, trust in vaccination systems, and safety concerns. Health responsibility beliefs substantially reduced social capital–vaccination associations when included in models. Safety concerns moderated effects of social cohesion (p < 0.001) and reciprocity (p = 0.011), with stronger effects among those with lower concerns. Civic participation was associated with vaccination intention mainly among those with higher institutional trust. Conclusions: Individual social capital was significantly associated with vaccination intention through complex belief interactions. Safety concerns act as crucial moderators. Multifaceted strategies addressing social capital, safety concerns, and institutional trust may be needed to increase vaccine uptake. Full article

Community Mobile Health Vehicles (CMHVs) represent an innovative healthcare delivery model that integrates medical services into residents’ daily community life. By extending healthcare coverage to underserved populations, CMHVs can improve access to health management services while enhancing the efficiency of healthcare resource utilization. However, existing studies have primarily focused on health outcomes or the adoption of digital health technologies, with limited attention paid to users’ willingness to utilize CMHVs and their relationship with sustainability dimensions, including social equity, economic efficiency, and environmental responsibility. Drawing on survey data collected from community residents in China, this study employs Exploratory Factor Analysis (EFA) to identify the key determinants influencing users’ willingness to use CMHVs. Furthermore, the Entropy Weight Method (EWM) is applied to prioritize both the identified factors and their corresponding design strategies according to their relative importance. The results reveal five principal determinants: Cognitive Ease, System Adaptability, Institutional Trustworthiness, Technical Reliability, and Environmental Compliance. These factors and their associated design strategies exhibit varying levels of importance in promoting user engagement, optimizing resource allocation, and facilitating community integration. Based on the findings, this study proposes a set of sustainability-oriented design prioritization strategies for CMHV service systems. The proposed framework provides both theoretical and empirical insights for urban healthcare service planning and supports the coordinated achievement of economic, social, and environmental sustainability goals. The study further offers evidence-based guidance for the implementation, continuous improvement, and long-term sustainability of CMHVs within urban healthcare and mobile health service systems. Full article

Background/Objectives: DNA methylation (DNAm)-based aging measures are increasingly being used in biological aging, disease vulnerability, and cancer-related risk. However, it remains unclear whether these measures capture a single generalized aging process or separable biological domains relevant to cancer-relevant biological vulnerability. Methods: Using data from the Family and Community Health Study (FACHS), we examine whether blood-based DNAm scores capture two distinct biological domains relevant to cancer susceptibility: a replication/mitotic domain, indexed by CellDRIFT, EpiTOC2, and MiAge, and an early-life systemic dysregulation domain, indexed by DunedinPACE, GrimAgeV2, and PhenoAge. Results: Regression results showed clear domain specificity. CRP, BMI, alcohol methylation, and AHRR/cg05575921 were positively associated with the early-life systemic dysregulation domain but showed weak or null associations with the replication/mitotic domain. Cross-domain tests confirmed significantly stronger associations for the early-life systemic dysregulation domain for CRP, BMI, and alcohol methylation, with a marginal difference for AHRR/cg05575921. In contrast, telomere-related methylation and immune-cell composition showed a different pattern. DNAmTL was inversely associated with both domains and did not differ significantly across domains. Conclusions: These findings suggest that blood-based DNAm aging measures do not reflect a single aging process. Instead, they distinguish at least two cancer-relevant methylation domains: one reflecting replication-driven mitotic aging and hematopoietic cell-turnover biology, and another reflecting early-life systemic dysregulation vulnerability linked to inflammation, metabolic risk, smoking methylation, and alcohol-related methylation. This two-domain framework may help clarify how blood DNAm profiles capture complementary biological processes relevant to cancer susceptibility and guide future studies of methylation-based cancer risk. Full article

Background: Hypertension requires lifelong antihypertensive medication to reduce cardiovascular risk. While most studies have focused on individual determinants of adherence, the role of perceived environmental and social characteristics remains unclear. This study examined the associations of depressive symptoms, satisfaction with the community environment, social participation, and social contact with antihypertensive medication non-adherence among older adults with hypertension in South Korea. Methods: A cross-sectional secondary analysis was conducted using the 2023 Korea Community Health Survey, including 44,822 adults aged 65 years and older with physician-diagnosed hypertension who were currently taking antihypertensive medication. Medication non-adherence was defined as taking medication on fewer than 24 of the previous 30 days, and associated factors were identified using complex sample multivariable logistic regression. Results: The prevalence of medication non-adherence was 0.4%. Higher satisfaction with the community environment was associated with lower odds of medication non-adherence (OR = 0.83, 95% CI = 0.72–0.95), whereas greater social participation was associated with higher odds (OR = 1.39, 95% CI = 1.09–1.78). Social contact, depressive symptoms, and the remaining characteristics were not significantly associated with medication non-adherence. Conclusions: Antihypertensive medication non-adherence among older adults is associated with perceived environmental characteristics as well as individual factors. Whether community-based approaches addressing these conditions can improve medication adherence requires evaluation in longitudinal or interventional studies. Full article

Background/Objectives: Digital inequalities are increasingly recognized as a health-equity issue, yet self-reported practical digital competence and psychosocial well-being among adults with severe disabilities remain understudied. This study examined their cross-sectional association and indirect associations through perceived self-determination in daily life and subjective social isolation in a parallel model. Methods: Cross-sectional data from 1519 adults in a 2023 Seoul survey were analyzed. Self-reported practical digital competence was assessed with six task-ability items, perceived self-determination in daily life with one item, and subjective social isolation with two items. Adjusted product-of-coefficients models used 2000 bootstrap replications to calculate bias-corrected confidence intervals. Results: Self-reported practical digital competence was positively associated with psychosocial well-being (b = 0.085, p < 0.001). The indirect association through perceived self-determination in daily life was significant in the main analysis (estimate = 0.076, BC 95% CI [0.050, 0.106]) and remained significant across all sensitivity analyses. Self-reported practical digital competence was not significantly associated with subjective social isolation (b = −0.026, p = 0.203), and the corresponding indirect association was nonsignificant (estimate = 0.006, BC 95% CI [−0.003, 0.016]) and inconsistent across specifications. The direct association was near zero and nonsignificant after both psychosocial variables were included. Conclusions: The indirect association through perceived self-determination in daily life was consistent across analyses, but this single-item measure should be interpreted as a narrow indicator of perceived autonomy or control rather than the broader multidimensional construct of self-determination. Evidence for subjective social isolation was limited and specification-sensitive, and simultaneous measurement precludes temporal or causal interpretation. Digital inclusion efforts may benefit from combining practical digital skills with opportunities to support meaningful goals and everyday choices. Broader relational and environmental supports may also be needed for subjective social disconnection, and longitudinal and intervention research is warranted. Full article

Background: Depression is a major health issue among older adults and is frequently accompanied by chronic physical conditions. Conventional care of depression in older adults is delivered through primary care settings and often fails to address the complex interactions between mental health, physical illness, and social determinants of health in this population. Integrated care models, characterized by coordinated, multidisciplinary, and patient-centered approaches, have emerged as a promising strategy for improving depression outcomes in late life. Objective: This scoping review aimed to characterize integrated care models for managing depression in older adults. The review examined the structure and implementation of these models and evaluated depression-related outcomes. Methods: A systematic literature search was conducted in PubMed and Google Scholar. Studies published in English between 2006 and February 2026 were considered. Eligible studies included randomized controlled trials (RCTs), cluster RCTs, and quasi-RCTs that evaluated integrated care interventions targeting depression in adults aged 65 years or older or mixed adult populations that included older adults. One reviewer conducted the search and initial screening, and four additional reviewers evaluated the eligibility of full-text reports and extracted data using a structured template. Results were synthesized descriptively. Results: Seventeen studies met the inclusion criteria. Integrated care interventions were implemented across primary care clinics, community health centers, and home healthcare programs in several countries. Participants commonly had depression alongside chronic medical conditions, including diabetes, hypertension, heart failure, or chronic obstructive pulmonary disease. Integrated care models varied in staffing, therapeutic components, specialist involvement, delivery intensity, and comparator conditions. Most interventions incorporated multidisciplinary care teams; structured symptom monitoring; care coordination; behavioral or psychological interventions; and, in some studies, chronic disease management, social support, or technology-supported follow-up. Thirteen studies reported a favorable depression-related finding at one or more assessment points; however, benefits were not always sustained, and some studies reported null- or comparator-favoring findings. Conclusions: Integrated care for depression in older adults encompasses heterogeneous models implemented across diverse healthcare contexts. Common themes included multidisciplinary collaboration, coordinated follow-up, structured psychological or behavioral treatment, symptom monitoring, and integration of mental and physical health management. Favorable outcomes were reported in most studies, but findings varied by population, setting, comparator, intervention intensity, and follow-up duration. These findings may inform future program design, although the effectiveness of the integrated care models and the independent contribution of individual components remain uncertain. Full article

Background/Objectives: Quality indicators are essential for evaluating and improving primary health care (PHC), but existing indicator sets differ considerably in their definitions, development methods, data requirements, and applicability across healthcare systems. This scoping review aimed to identify and synthesize quality indicators used to assess PHC services, describe the principal areas and methodological approaches represented, and identify persistent measurement gaps. Methods: A scoping review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. PubMed/MEDLINE, Embase, and CINAHL were searched from inception to December 2025, with an updated search conducted on 27 August 2026. Targeted grey-literature searches of World Health Organization, United Nations Children’s Fund, and Organisation for Economic Co-operation and Development sources were also undertaken. Two reviewers independently screened the records and assessed potentially eligible full texts. Data were synthesized narratively and interpreted using the Donabedian structure–process–outcome framework, the seven World Health Organization dimensions of healthcare quality, and PHC-specific functions and content areas. Results: Twenty-three sources were included, comprising empirical studies, indicator-development and consensus studies, methodological reviews, national quality-improvement programmes, and international performance-measurement frameworks. Recurring areas included chronic disease management, preventive care, medication safety, access, continuity, service delivery, patient safety, efficiency, and healthcare utilization. Patient-reported outcomes and experiences, equity, social determinants of health, structural capacity, and broader outcomes meaningful to patients and populations were less consistently represented. Substantial heterogeneity in indicator definitions, reporting levels, data sources, and methodological approaches limited direct comparison across frameworks. Conclusions: PHC quality measurement remains extensive but fragmented. Future frameworks should balance structure, process, and outcome indicators, incorporate outcomes that matter to people, and combine standardized core measures with context-specific, feasible, valid, and actionable indicators. Full article

Background: South Asian Muslim (SAM) communities remain significantly underserved by mainstream drug and alcohol (D&A) recovery services in England. Cultural and religious misalignment in service design creates structural barriers to engagement. Family members from SAM communities who support individuals with substance use disorders have identified structural, cultural, and religious barriers that hinder engagement with mainstream treatment services. This study builds on this body of evidence by working with service providers, commissioners and community stakeholders through participatory co-production to examine how these barriers can be addressed. Methods: Three participatory co-production workshops were held over a 12-week period. Data were also generated from a field visit to a culturally adapted recovery service and a content analysis of an Islamically adapted 12-step recovery workbook. Participants included commissioners, service providers, community ambassadors and service users (total n = 42 across three workshops; some participants attended more than one workshop). Results: Four interconnected themes that shaped recovery engagement were identified: (1) stigma and izzat operating as a collective structural risk management system; (2) confidentiality functioning as a precondition for engagement rather than a by-product of it; (3) service design, space and visibility as determinants of access; and (4) co-construction of religiously coherent recovery pathways. Low engagement among participants reflected rational risk management, in response to real social consequences, rather than cultural resistance. Conclusions: Findings suggest that inclusive recovery systems may benefit from the adaptation of mainstream services rather than the creation of parallel provision. Six evidence-based design principles are proposed for commissioners and service providers. Findings contribute to the evidence base for equitable health, culturally responsive D&A intervention design and have relevance beyond SAM communities to other marginalised faith communities across England. Full article

Parenting practices involving violent discipline are a global health concern, particularly among low-income families. While the current literature offers general prevalence data, it lacks a comprehensive global perspective evaluating how diverse sociodemographic, cultural, and historical contexts intersect within disadvantaged households. This scoping review protocol aims to map the global evidence on parenting practices related to physical and psychological violence used as disciplinary practices against children within low-income contexts. Following the JBI Manual for Evidence Synthesis and PRISMA-ScR guidelines, we will conduct a comprehensive search across databases, including MEDLINE/PubMed (via the National Library of Medicine), CINAHL (EBSCO), APA PsycINFO (APA), Embase (Elsevier), ERIC, IBECS (via the VHL) and the WHO Global Index Medicus to capture global evidence published in recent years. Studies published in English, Portuguese, and Spanish between January 2015 and June 2026 that report violent disciplinary practices by parents or caregivers of children aged 1–8 years will be included. Rayyan software will assist with study selection. Mapping these practices across diverse socioeconomic settings may clarify current research gaps and synthesize the characteristics of families globally, shifting the interpretation of violent discipline from isolated parental choices to broader understanding of its social determinants and providing a clearer baseline to support future child protection research. Full article

Background/Objectives: Lebanon is undergoing a rapid demographic transition, with older adults projected to exceed one-fifth of the population by 2050. Supporting healthy and independent aging requires a robust evidence base that extends beyond clinical care to encompass community, environmental, psychosocial, and policy dimensions of aging in place. This bibliometric review maps the landscape of gerontology and geriatrics research in Lebanon to identify research trends, gaps, and future priorities for advancing holistic approaches to aging. Methods: A bibliometric review was conducted of gerontology and geriatrics research published between 2015 and 2026. Publications were retrieved from the Scopus database and screened according to predefined eligibility criteria. Results: A total of 403 publications met the inclusion criteria. Research productivity increased steadily over the study period, reaching its highest level in 2025, although publications remained concentrated among a relatively small number of authors and institutions. The literature was predominantly oriented toward clinical, epidemiological, and public health aspects of aging, with comparatively limited attention to community-based aging, psychosocial well-being, age-friendly environments, policy, social participation, and other determinants that support older adults’ ability to age safely and independently within their communities. Research evaluating interventions outside tertiary healthcare settings was particularly scarce. Conclusions: This review provides the first bibliometric mapping of gerontology and geriatrics research in Lebanon and indicates that, despite substantial growth in scientific output, the identified literature is largely centered on diseases and institutional healthcare. Future research should adopt more holistic and multidisciplinary perspectives to promote psychosocial well-being and aging well in one’s community. These priorities may guide researchers, practitioners, and policymakers in developing strategies for aging well in Lebanon. Full article

Incarcerated women face elevated suicide risk at the intersection of chronic loss, cumulative trauma, and constrained environments. In prison, the death of a child constitutes a profound and overlooked traumatic bereavement. This conceptual manuscript examines how carceral environments restrict privacy, autonomy, family contact, mourning rituals, and social and clinical support, thereby adversely reshaping grief. The Dual Process Model of Coping and meaning-making frameworks are integrated to explain how incarceration may constrain oscillation between loss-oriented and restoration-oriented coping. Institutional functioning may resemble restoration-oriented behavior while lacking critical adaptive factors that define restorative coping. Restricted information, exclusion from rituals and relational validation, and punishment for grief-related behavior may obstruct narrative reconstruction, continuing bonds, and maternal identity reorganization. The model further considers how acute grief interacts with chronic stress, sustained threat responsivity, sleep disruption, and cumulative allostatic burden to intensify psychological and somatic distress without assuming a uniform neurobiological pathway. Social determinants of health, histories of victimization, substance use, and facility-level conditions are important sources of variation. Protective pathways are also specified, including family connection, peer support, cultural and spiritual practices, and clinical care. The paper concludes with testable propositions, a research agenda, and a framework for notification, stabilization, and continuing bereavement support. Full article

Background and Objectives: Yoga has been proposed as a supportive intervention to enhance mindfulness and reduce stress among nursing students, but evidence from mixed-method studies remains limited. This study aimed to examine the effects of a 12-week course-based yoga intervention on mindfulness and perceived stress and to explore students’ experiences of practicing yoga. Materials and Methods: A total of 42 second-year nursing students at a university in Istanbul, Türkiye, participated in a mixed-methods study, with 22 students enrolled in the elective Health and Yoga course constituting the intervention group and 20 students enrolled in another elective course constituting the control group. Group allocation was non-randomized and determined by students’ elective-course enrollment. The intervention group attended weekly 90 min yoga sessions for 12 weeks, delivered by a certified instructor (E-RYT 200). Quantitative outcomes were measured using the Mindful Attention Awareness Scale (MAAS) and Perceived Stress Scale (PSS), with baseline-adjusted ANCOVA and change score analyses performed to control for pre-test differences and gender. Effect sizes (partial η²) were reported, and 95% CIs were calculated for the mean differences in change scores. Qualitative data were collected via semi-structured interviews and analyzed thematically, integrating findings with quantitative results. Results: Baseline-adjusted ANCOVA revealed greater improvements in mindfulness (F(1, 39) = 29.686, p < 0.001, partial η² = 0.432) and perceived stress (F(1, 39) = 158.293, p < 0.001, partial η² = 0.802) in the intervention group, controlling for baseline scores. Change score analyses confirmed these findings: mindfulness increased (MD = 10.68, 95% CI [6.62, 14.75], p < 0.001) and perceived stress decreased (MD = −11.40, 95% CI [−13.32, −9.48], p < 0.001) significantly more in the intervention group than controls. Qualitative findings complemented the quantitative results, indicating perceived physical (flexibility, posture, pain reduction), mental (positive emotions, awareness, emotion regulation), and social (motivation, interaction) benefits of yoga. Some participants reported hesitation in applying yoga in nursing practice due to cultural barriers. Conclusions: The findings suggest that participating in a course-based yoga program may help improve mindfulness and support stress reduction among nursing students. Qualitative findings complemented the quantitative results by providing insight into students’ perceived physical, mental, and social experiences of yoga. Given the small, single-center, and self-selected sample, these findings should be interpreted cautiously. Larger, multicenter randomized studies with longer follow-up are needed to confirm these findings and assess their generalizability. Full article

Traditional benefit–cost analysis (BCA) summarizes the average net social benefit of a policy but often obscures how benefits and costs are distributed across groups. This is a major limitation in health policy settings, where decision-makers must assess both efficiency and equity. This article develops an integrated equity-weighted causal benefit–cost analysis (IEW-BCA) framework for equity-conscious policy evaluation. The framework links subgroup-specific causal effect estimates, explicit valuation functions, and equity weights within a single evaluation pipeline suitable for applied policy appraisal. It makes three contributions: first, it provides an implementable structure for combining causal heterogeneity with welfare-consistent valuation; second, it introduces a compound equity vector and associated weighting functions that extend income-based schemes and can be interpreted, under standard conditions, as a first-order approximation to a broad class of social welfare functions; and third, it develops equity-oriented summary tools, including a causal equity gradient and related dominance criteria, to improve transparency about distributional impacts. A stylized example illustrates implementation, and the discussion outlines implications for uncertainty, sensitivity analysis, and potential application in health economics, public health policy, and regulatory evaluation. Full article