Search Results (459)

The global shift toward an aging population presents significant challenges for healthcare systems. This is compounded by rising disability rates, fragmented care models that struggle to meet complex needs, and a digital divide caused by the emergence of smart technologies. This work aims to evaluate how the digital divide affects the adoption, usability, and perceived benefits of smart home technologies designed to support activities of daily living and health monitoring. The influences of socioeconomic status and geographic location (urban versus rural) on the digital divide are considered. Four databases (Web of Science™, Scopus^®, PubMed^®, and IEEE Xplore^®) were searched between 2014 and 2026, resulting in 71 studies that examined older adults, smart home technologies for daily living or health monitoring, and factors related to the digital divide. Findings were synthesized using the Technology Acceptance Model, Van Dijk’s Digital Divide Framework, and Health Behavior Models. Three key barriers were identified—economic, technical, and social—which disproportionately affected vulnerable groups. Smart Home Health Technologies (SH2Techs) present adoption challenges distinct from standalone devices because they require integrated infrastructure and sustained engagement. Limited research addressing the usability of non-clinical SH2Techs has identified the need for co-design, simplified interfaces, targeted training, and policy reforms to support equitable aging in place. Full article

Introduction: Globally, disabled individuals experience persistent social inequalities and health inequities, yet the health and wellbeing of Deaf, DeafBlind, blind, and partially sighted (DDBBPS) people remain profoundly under-researched and excluded from social science and health policy agendas. Existing studies narrowly focus on narratives of hearing and vision impairments within a medical model of disability, which pathologizes difference and obscures the biomedical origins of social inequalities and health inequities experienced by these groups. Methods: Drawing on critical disability studies and community-based literature, this narrative review introduces and applies the concept of medical violence to examine how systemic ableism, audism, and ocularcentrism shape DDBBPS people’s healthcare experiences. Results: We identify six interrelated manifestations of medical violence: denied interpreting services, inaccessible health communication, harmful interpersonal practices, health inequities and medical avoidance, absence of DDBBPS practitioners, and gaps in community-based care. Conclusions: These conditions reinforce a cycle of exclusion and misrepresentation, wherein DDBBPS persons are denied equitable access to healthcare and are simultaneously constructed as objects of cure rather than as knowledge holders. We argue for a community-based participatory research agenda led by and for DDBBPS communities to challenge ableist research paradigms and advance health equity. Full article

Background/Objectives: In traditional Chinese culture, grandparents often help care for grandchildren, especially in urban areas where parents face high work and life pressures. However, the physical and psychological impacts of grandchild care on older adults remain debatable. This study explored the associations between grandchild care, disability, and depressive symptoms among urban older adults, and examined whether disability mediates this link. Methods: Data were from the 2018 CHARLS study, including 1872 urban participants aged ≥60 years with grandchildren. Disability and depressive symptoms were assessed using the Activities of Daily Living (ADL) scale and Center for Epidemiologic Studies Depression Scale (CES-D), respectively. Group comparisons, multivariable logistic regression, and mediation analysis were performed. Results: Among caregivers, the prevalence of depressive symptoms was 19.2% and the prevalence of disability was 20.4%, both lower than among non-caregivers in unadjusted comparisons, though grandchild care was not independently significant in multivariable models. Female, disability, and depressive symptoms were significant risk correlates, while higher education, greater physical activity, and social participation were protective. The mediation analysis suggested that functional status partially mediated the relationship between grandchild care and depressive symptoms (proportion mediated = 33.70%). Conclusions: Grandchild care was associated with better physical and mental health among urban older adults in descriptive comparisons, though this association was attenuated in adjusted models. While moderate intergenerational involvement may offer social and psychological benefits, excessive caregiving burden should be prevented. Full article

Gender-based violence may be considered a failure or absence of care across the interpersonal, symbolic, and structural levels. Feminist scholars have called for closer attention to an ethic of care as one vital pathway to shared solidarity for social justice and relations of non-violence. Works from Black, Indigenous, queer and disability writers and activists have similarly illustrated the transformative potential of collective care for building community and ending systems of oppression. In this paper, we draw on this critical literature to argue for framing collective care as both a practice and a long-term objective in work to prevent gender-based violence. To illustrate this framing, we share empirical data from two Australian studies: one with young people using social media to prevent gender-based violence, and one with prevention practitioners who work with men and boys. Our findings are organised around four central themes: care as collaboration; transformative care; a politic of care; and collective care in structural change. These findings represent patterns in practice, political approach, and imagined futures among our research participants that we suggest are reflective of ongoing commitments to empathy, compassion, and accountability. These patterns are substantively distinct from much mainstream programmatic and policy approaches to gender-based violence prevention, which often reproduce individualistic frames and are constrained by funding and governance models. We argue that violence prevention is fundamentally a shared project of collective care: supporting one another to recognise, interrogate, and challenge the gendered norms and structures that perpetuate gender-based violence. This work is inescapably relational, political, personal, and motivated by a shared sense of caring for each other. Full article

Background: Individuals with intellectual and/or developmental disabilities (IDDs) experience persistent health inequities, exacerbated by the systemic lack of education of health care professionals about their care. In response to a 2020 call from the Administration for Community Living in the United States, five institutions formed the IDD Health Equity Consortium to develop a suite of educational materials and practice experiences to improve the education of health care professionals in the health and health care of individuals with IDDs. Methods: The Collective Impact Model, designed to align organizations and stakeholders around a shared agenda for system change, was used to organize IDD Health Equity Consortium programs. Backbone infrastructure included a cross-sector steering committee, an Advocate Advisory Committee, and three Consortium Action Networks focused on communication, measurement, and education, practice, and policy. A scoping review of the literature was conducted, and a Participatory Planning and Decision-Making process engaged individuals with IDDs, family members, students, faculty, and professionals in identifying important themes for developed materials. Results: Learning modules, case studies, service-learning experiences, and simulation experiences were developed across Consortium institutions and were disseminated across multiple other institutions, with beginning alignment with interprofessional and disability competencies. Mixed-methods evaluation strategies assessed learner outcomes, including knowledge checks and pre and post evaluations using established measures of skills, comfort levels, and approach; and interprofessional socialization, valuing, and collaborative practice behaviors. Conclusions: By involving individuals with IDDs in curriculum development and building multi-institution and cross-sector infrastructure, the Consortium developed scalable materials that address longstanding gaps in health care professional education. The developed suite of educational materials and practice experiences and early evaluation findings provided a foundation for further program refinement and future empirical studies examining long-term effects on practice and clinical outcomes. Full article

Background/Objectives: Authentic assessment—the systematic observation of naturally occurring social–emotional behavior by familiar caregivers—is increasingly mandated by international early childhood frameworks, yet the field lacks a comprehensive tool inventory, conceptual clarity on “authenticity,” and synthesized evidence on contextual coverage. This scoping review maps authentic social–emotional development (SED) assessment tools for children aged 0–8, examines how authenticity is conceptualized, and identifies gaps in cultural adaptation, disability inclusion, and age-range coverage. Methods: Following the Arksey and O’Malley framework enhanced by Levac et al. and JBI methodology, six databases (PsycINFO, ERIC, Education Source, MEDLINE, Scopus, Web of Science) were searched for English-language peer-reviewed publications (2006–2026), supplemented by hand-searching and forward citation tracking. Inclusion criteria targeted children aged 0–8 assessed via authentic modalities (naturalistic observation, play-based assessment, portfolio, performance-based tasks, curriculum-embedded measurement) in any global setting. Data charting used an integrated sociocultural and interpretive assessment framework. Reporting followed PRISMA-ScR. Results: Thirty-three studies yielded 43 instruments, 29 meeting authentic assessment criteria. Naturalistic observation predominated (23 studies; 69.7%), followed by play-based assessment (10; 30.3%); portfolio and curriculum-embedded approaches were under-represented. Most studies originated from the United States (57.6%) and targeted preschoolers (3–5 years; 75.8%), with thin coverage of infants/toddlers and primary-grade children. “Authenticity” was operationalized across ecological, participatory, and cultural dimensions rarely integrated theoretically. Conclusions: This review provides the first systematic landscape map of authentic SED assessment for children aged 0–8, confirming feasibility and diversity while revealing gaps in age coverage, geographic reach, and cultural adaptation. The integrated framework offers a potentially transferable analytic model, and findings can inform equitable, contextually responsive assessment practice and policy. Full article

The fashion industry faces growing pressure to demonstrate credible sustainability performance across environmental, social and economic dimensions, yet integrated approaches remain underdeveloped, particularly for small and medium-sized enterprises and social enterprises operating in circular textile systems. This article examines the case of INS3RTEGA, a Spanish textile social enterprise that combines post-consumer textile waste management with protected employment for people with disabilities. Using an exploratory single-case design informed by Triple Bottom Line thinking, the study develops a pragmatic assessment strategy that combines a partial Social Return on Investment (SROI)-style calculation, a simplified carbon-based estimation informed by life cycle thinking, and a set of non-monetised social inclusion and employment indicators. The results reveal a distinctive configuration of integrated sustainability performance: substantial avoided climate-related burden and high textile recovery rates, strong structural inclusion outcomes through disability-inclusive employment, and a modest partial monetised return under conservative and incomplete valuation assumptions. The case illustrates how socially inclusive circular fashion models may generate meaningful sustainability value that remains only partially visible through conventional financial or fully monetised metrics. The article discusses methodological implications for hybrid impact assessment in resource-constrained organisations and policy implications for the emerging European framework on sustainable and circular textiles. Full article

This prospective study investigated the association of dog ownership with the onset of disabling dementia and mortality using propensity score weighting based on the physical, social, and psychological characteristics of dog owners, and then examined the potential causality of this relationship using an instrumental variable model. Additionally, we examined the costs and effects of dog ownership using cost-effectiveness analysis. Overall, 11,224 older adults selected using stratified and random sampling strategies in 2016 were analyzed. Dog ownership was defined as current, past, and never. Disabling dementia was defined according to a physician rating under the long-term care insurance system in Japan and mortality was ascertained by the Japanese national vital statistics during the approximately 7.5-year follow-up period. Current and past dog owners had an odds ratio (OR) of 0.53 (95% CI: 0.43–0.66) and 0.97 (0.86–1.09) of the onset of disabling dementia compared to never owners. ORs for mortality were 0.63 (0.51–0.79) in current dog owners and 0.88 (0.78–0.99) in past dog owners. Causal analysis showed that current dog owners (OR = 0.52, 95% CI: 0.27–0.98) and past dog owners (OR = 0.75, 95% CI: 0.55–1.03) had low ORs for incident dementia compared to never dog ownership. Corresponding values for mortality showed low ORs, but no significant effect on current dog owners (OR = 0.59, 95% CI: 0.35–1.01) and past dog owners (OR = 0.77, 95% CI: 0.60–1.00) compared to never owners. Results of cost-effectiveness analysis showed that dog ownership produced small but positive gains in quality-adjusted life years (QALYs) and was dominant (cost-saving and QALY-increasing) from the public payer perspective, reducing publicly financed medical and long-term care costs while increasing QALYs; when private dog-ownership costs were included in a scenario analysis, the incremental cost-effectiveness ratio (ICER) was ¥6,744,174 per QALY compared with no-dog status. This prospective study shows that dog ownership has a potential protective effect against the onset of disabling dementia in older adults. The study also revealed the potential of dog ownership to reduce public spending with regard to long-term care and medical expenditures. Full article

Background: Disease-modifying therapies have profoundly changed the natural history of spinal muscular atrophy (SMA) type I, shifting rehabilitation priorities beyond survival and motor function toward participation, autonomy, and quality of life. However, rehabilitation models have not evolved at the same pace, and the role of early powered mobility in this new clinical scenario remains insufficiently conceptualized. Methods: This narrative review integrates current evidence on early powered mobility in children with severe motor disabilities with contemporary rehabilitation frameworks, including the International Classification of Functioning, Disability and Health (ICF), participation-based therapy, family-centered care, and the concept of on-time mobility. Evidence from the AMEsobreRuedas research program is incorporated to develop a conceptual framework for early powered mobility in children with SMA type I receiving disease-modifying therapies. Results: Current evidence suggests that early powered mobility should be understood as a developmental rehabilitation intervention rather than solely as an assistive technology for transportation. Independent mobility facilitates exploration, play, social interaction, autonomy, and participation, while positively influencing family experiences and expectations. Findings from the AMEsobreRuedas program further indicate that the benefits of powered mobility extend beyond driving skill acquisition, supporting participation, quality of life, and family well-being when implemented within meaningful daily contexts. Based on this evidence, a conceptual framework is proposed in which independent mobility acts as an early facilitator of developmental opportunities, with participation emerging through the interaction between the child, family, and environment. Conclusions: In the era of disease-modifying therapies, rehabilitation in SMA should move from a motor-centered approach toward a participation-oriented model. Early powered mobility represents a key intervention for promoting developmental opportunities and meaningful participation rather than simply compensating for motor impairment. The proposed conceptual framework may support clinical decision making and provide a foundation for future rehabilitation research in pediatric neuromuscular disorders. Full article

Against the backdrop of population aging, the well-being of older adults with disabilities in daily life and its underlying mechanisms has increasingly become an important research topic. Using data from the 2020 wave of the China Health and Retirement Longitudinal Study (CHARLS), this study focuses on 509 individuals aged 60 and above with disabilities. It incorporates informal social support, depression risk, and life satisfaction into a unified analytical framework, and employs ordered Logit models, binary Logit models, and the KHB decomposition method to examine their interrelationships and underlying mechanisms. The results show that: (1) informal social support is positively associated with the life satisfaction of older adults with disabilities; (2) informal social support is negatively associated with depression risk; and (3) depression risk is negatively associated with life satisfaction and plays a significant mediating role in the relationship between informal social support and life satisfaction, accounting for 23.25% of the total effect. From a daily life perspective, this study reveals that the well-being of older adults with disabilities is not solely derived from institutional resource provision, but is generated and sustained through ongoing social interactions and relational networks. The study therefore deepens our understanding of the everyday and relational dimensions of subjective well-being in later life. Full article

Background/Objectives: Despite the increasing rates of disability associated with aging, obesity, and osteoarthritis requiring surgery, optimizing rehabilitation after hospital discharge remains a major challenge and a key determinant of care safety, quality, and sustainability. The aim of this exploratory study is to evaluate the predictive performance of machine learning (ML) models for predicting Inpatient Rehabilitation Length Of Stay (IRLOS), Function in the Activities of Daily Living (FADL) and discharge destination (DD) in patients who underwent total joint replacement for hip and knee osteoarthritis, using Real-World Data routinely collected in a tertiary orthopedic hospital. Methods: 2103 patients were included and temporally split into a development cohort (2019; n = 1711) and a temporal validation cohort (2018; n = 392). A total of 73 routinely collected perioperative variables were used to train multiple ML models, including both black-box and transparent methods. IRLOS and FADL were modeled as regression tasks, while DD was treated as a binary classification task. Model development followed a rigorous pipeline with feature selection, cross-validation, and hyperparameter tuning. Performance was assessed using appropriate metrics and evaluated across joint type (hip/knee) and via temporal validation. Model interpretability was examined using SHAP and model-specific analyses, further supported by clinical analysis. Results: In temporal validation, models achieved modest performance for IRLOS (R² = 0.17; MAE = 2.52 days) and FADL (R² = 0.25; MAE = 2.25 days), with no significant performance degradation over time. DD prediction showed good discrimination (AUC = 0.85; balanced accuracy = 0.80) despite outcome imbalance, with high sensitivity (0.92) and negative predictive value (≈1.00), but low positive predictive value (0.09). Performance was stable across hip and knee subgroups. The interpretability analysis further highlighted several key predictors related to perioperative complexity (e.g., surgical duration and transfusion), baseline functional status, and social factors (e.g., living situation and employment), confirming that rehabilitation outcomes are multidimensional and influenced by both medical and non-medical determinants. Conclusions: The analysis identified several relevant predictors related to perioperative complexity, baseline functional status, and social context. The models showed stable behavior across intervention type and across time through temporal validation, suggesting that they capture relevant patterns in rehabilitation pathways, although predictive performance was moderate. Full article

The rapid expansion of artificial intelligence (AI) is accelerating data center construction and creating downstream implications for households. This study examines how AI-era data center costs (comprising construction, energy, water, grid upgrades, cooling, and lifecycle management) move through service supply chains and affect household prices in healthcare, transportation, education, banking, and commerce. It also considers the productivity and welfare benefits that AI may transmit. This study identifies four pass-through channels: utility-rate socialization of energy costs, cloud-platform pricing, sectoral pass-through from AI-adopting industries, and indirect effects through supply chains and labor markets. It introduces the AI-inflated net good basket, defined as transmitted cost minus transmitted benefit, to show how AI reshapes the overall net cost of household consumption rather than simply inflating individual prices. The study develops the AI Infrastructure Net Cost Pass-Through Model (AI-NCPM), a four-layer conceptual framework tracing net cost flows from data center investment to sectoral allocation and household outcomes. The model’s parameters are analytically specified but not empirically calibrated; numerical examples are illustrative rather than representing estimated effects. Its main contribution is an integrative framework linking cost pass-through, infrastructure cost socialization, two-sided platform allocation, environmental externalities, and household expenditure incidence within a single net-cost account. Because these effects originate in the design, construction, energy and cooling systems, and lifecycle operation of data centers, the analysis connects AI infrastructure economics to the built environment. The framework suggests that low-income, minority, rural, older adult, and disability-affected households may face disproportionate net burdens, as costs fall heavily on essential services while benefits accrue more readily to affluent and digitally connected households. Full article

The aging of social infrastructure, intensively constructed during periods of rapid economic growth, is a pressing challenge facing modern society. Conventional infrastructure asset management has disproportionately emphasized a “managerial financial perspective,” aiming to maintain physical functions within limited budgets. However, the malfunction of road appurtenances such as tunnel lighting facilities induces severe traffic accidents and chronic congestion, resulting in public health risks for users (physical trauma, psychological stress, and the deterioration of Disability-Adjusted Life Years: DALYs) as well as massive socio-economic losses. The primary novelty of this study lies in bridging the gap between stochastic engineering deterioration models—specifically, discrete-time Markov chain models predicting physical degradation—and socio-economic stakeholder value chains. This study constructs a “Social Life Cycle Cost (LCC) Optimization Model” that directly incorporates these social losses and stakeholder risk disparities into the evaluation function, addressing the limitations of conventional financial-centric LCC models. By conducting robust uncertainty and global sensitivity analyses via large-scale Markov Chain Monte Carlo simulations (number of trials $N={10}^5$), we reveal that a corrective maintenance strategy inheres a critical “fat-tail risk” of stochastically incurring catastrophic social losses. Conversely, preventive intervention at State C minimizes the expected total cost with statistical significance ($p<0.001$) and drastically decouples engineering costs from social risks. This research provides quantitative evidence that early infrastructure intervention functions as an indispensable “social investment” for mitigating public health risks under the specific parameters of the proposed model. Full article

Background: Heat exposure is a leading climate-related health threat, yet whether the heat–disease burden relationship is moderated by national adaptive capacity remains poorly quantified at the global level. We examined associations between heat exposure and cause-specific disability-adjusted life year (DALY) burden across climate vulnerability strata and projected future burden to 2050 under IPCC AR6 warming scenarios. Methods: We constructed a country–year panel spanning 187 countries and 34 years (1990–2023) by merging ERA5 reanalysis temperature data; GBD 2023 DALY rates for cardiovascular diseases (CVD), chronic kidney disease (CKD), and chronic respiratory diseases (CRD); ND-GAIN adaptive-capacity scores; and WHO GHO health system indicators. Countries were stratified into adaptive-capacity tertiles (Low: n = 63; Medium: n = 62; High: n = 62). We used two-way fixed-effects panel regression with country-clustered standard errors, a formal Chow test of slope equality, lagged exposure models, and a benefit-of-adaptation counterfactual. Future DALY burden was projected to 2030, 2045, and 2050 using country-specific ERA5 warming trends scaled to IPCC AR6 SSP scenario multipliers. Findings: The heat–CVD dose–response was 26 times larger in Low versus High adaptive-capacity countries (β = −346.2 vs. −13.1 DALY years per 100,000 per °C). The Chow test confirmed statistically significant slope heterogeneity across tertiles for all three outcomes (CVD: F = 22.0, p < 0.0001; CKD: F = 14.9, p < 0.0001; CRD: F = 9.4, p < 0.0001). CKD burden rose 47·8% globally between 1990 and 2023, with the strongest within-country heat–CKD association in Medium adaptive-capacity countries (β = −61.5, p < 0.0001). These findings were robust to lagged exposure specifications. Under SSP5-8.5 by 2050, Low adaptive-capacity countries face a projected CVD DALY rate change 23 times larger than High adaptive-capacity countries (−16.2% vs. −0.7%). Upgrading Low adaptive-capacity countries to High tertile standards would avert 15.6% of projected CVD DALY burden under SSP5-8.5 by 2050. Conclusions: Adaptive capacity substantially moderates the health consequences of heat exposure. The quantified benefit of adaptation investment—expressed as averted DALY burden—provides a direct metric for health-system strengthening and climate adaptation financing, particularly in low-income settings facing the steepest projected burden increases. These results position adaptive capacity as a critical social determinant of planetary health, linking Earth-system boundary transgression to inequitably distributed human disease burden across the global community. Full article

Language significantly influences how disability is perceived and experienced. Within disability studies, terminology carries symbolic, political, and epistemological implications. This essay critically examines the contemporary debate between person-first language (“person with a disability”) and identity-first language (“disabled person”) and proposes the alternative term “person in a situation of disability.” Grounded in the biopsychosocial model, this expression highlights the contextual, dynamic, and relational dimensions of disability. The article draws on historical, conceptual, and practical perspectives to show how environmental and social barriers construct disabling experiences. It argues that this terminology more accurately reflects contemporary understandings of disability as a modifiable interaction between the individual and their context. Such a shift has implications for research, public policy, education, and inclusive practices. Ultimately, adopting “Person in a Situation of Disability” moves beyond mere linguistic preference, representing a commitment to inclusive, anti-stigmatizing, and justice-oriented discourse. Full article