Search Results (2,190)

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

Despite growing global momentum to reduce the number of children who never received a dose of any vaccine, i.e., zero-dose (ZD) children, persistent geographic and social inequities continue to undermine progress toward universal immunization coverage. In Madagascar, where routine vaccination coverage remains below 50% in most regions, the non-governmental organization Doctors for Madagascar and public sector partners are implementing the SOAMEVA program: a targeted community-based initiative to identify and reach ZD children in sixteen underserved districts in the country’s south. This paper outlines the equity-sensitive evaluation design developed to assess the implementation and impact of SOAMEVA. It presents a forward-looking evaluation framework that integrates both quantitative program monitoring and qualitative community insights. By focusing at the fokontany level—the smallest administrative unit in Madagascar—the evaluation captures small-scale variation in ZD prevalence and program reach, allowing for a detailed analysis of disparities often masked in aggregated data. Importantly, the evaluation includes structured feedback loops with community health workers and caregivers, surfacing local knowledge on barriers to immunization access and program adoption. It also tracks real-time adaptations to implementation strategy across diverse contexts, offering insight into how routine immunization programs can be made more responsive, sustainable, and equitable. We propose eight design principles for conducting equity-sensitive evaluation of immunization programs in similar fragile settings. 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

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

Improving occupational health and safety (OHS) in the construction industry can contribute to the advancement of the Sustainable Development Goals (SDGs), particularly Goals 3 (Good Health and Well-being) and 8 (Decent Work and Economic Growth). Yet, workers’ risk-taking behaviors (RTBs) remain a persistent challenge. Drawing on Social Cognitive Theory and Social Information Processing Theory, this study develops and tests a social influence model to examine how foremen’s safety attitudes (SAs) shape workers’ RTBs. Drawing on survey data from 301 construction workers in China, structural equation modeling reveals that foremen’s SAs significantly and negatively predict workers’ RTBs. However, the three dimensions of SAs—cognitive, affective, and behavioral—exert their influence through different pathways. Risk perception (RP) plays a key mediating role, particularly for the cognitive and behavioral dimensions. Furthermore, interpersonal trust (IPT) functions as a significant moderator in some of these relationships. By identifying the micro-social pathways that link foremen’s attitudes to workers’ safety behaviors, this study offers a testable theoretical framework for implementing the Sustainable Development Goals (particularly Goals 3 and 8) at the frontline workplace level. The findings provide empirical support for organizations to move beyond rule-based management and instead build more resilient OHS governance systems by systematically cultivating the multidimensional attitudes of frontline leaders. Full article

Background/Objectives: Agricultural workers in Spain with a migratory background face challenging working and living conditions that significantly affect their health. This study aimed to explore how professionals in healthcare, social services, civil society organisations, and labour institutions perceive that the working conditions affect the physical health of this population. Methods: A qualitative descriptive study was conducted through 92 semi-structured interviews with professionals from six provinces in Spain. Data were analysed using thematic analysis following Braun and Clarke’s six-phase framework. Rigour was ensured through triangulation, independent coding, and interdisciplinary consensus. Results: Two overarching themes were identified: (1) the health consequences of workplace demands and environmental hazards, and (2) navigating health services such as sick leave and disability permits. These findings highlight how the impact of precarious working conditions and limited access to healthcare affect the physical health of migrant agricultural workers. Conclusions: The professionals interviewed described and relate precarious working conditions with adverse health outcomes among migrant agricultural workers. Their insights reveal the need for systemic reforms to enforce labour rights, ensure access to health services, and address the structural factors that contribute to exclusion and vulnerability. Full article

Introduction: Despite the key role of healthcare workers (HCWs) in tuberculosis (TB) prevention and control, there is a lack of regional data on their knowledge, attitudes, and practices (KAPs) regarding the disease in Atlantic Canada. Objectives: To assess the KAPs of HCWs and identify targets for educational interventions to enhance TB care and control. Methods: A cross-sectional study was conducted among HCWs in Atlantic Canada aged $\ge$19 years from October 2023 to February 2024. Participants were recruited via multiple channels such as social media, collegiate email lists, and snowball sampling. Survey data were collected using an online platform and analyzed using IBM SPSS Statistics v29. KAPs were assessed using Likert-type scales and internal consistency was evaluated using Cronbach’s alpha. Results: A total of 157 HCWs participated in this study (age range: 19 to 69 years); most were women (n = 145, 92%), born in Canada (n = 134, 85.4%), with nearly three-quarters (n = 115, 73.2%) who had never lived outside of Canada. Study participants demonstrated moderately high knowledge (M = 29.32, SD = 3.25) and positive attitudes (M = 3.87, SD = 0.37) towards TB and strong practices (M = 4.24, SD = 0.69) in TB care; however, gaps were identified in HCW abilities to recognize less common TB symptoms (e.g., rash and nausea), as well as inconsistent practices in ventilation and pre-treatment initiation. Internal consistency analysis indicated suboptimal reliability across all three KAP domains, with Cronbach’s alpha values falling below 0.7, thwarting further planned analyses. Conclusions: This study found overall moderate-to-strong TB-related KAPs among HCWs in Atlantic Canada; however, critical gaps in knowledge and practice were noted. This new information can now guide future educational initiatives and targeted training to enhance TB preparedness and ensure equitable care for patients in the region. Full article

Background: International migration is a growing global phenomenon involving diverse groups, such as labor migrants, international marriage migrants, refugees, and international students. International migrants face unique mental health challenges influenced by adversities such as social isolation and limited access to mental health services. This study employs bibliometric methods to systematically analyze the global body of literature on international migrants’ mental health. Methods: The literature on the mental health of international migrants published until October 2024 was searched using the Web of Science database. The search terms included (‘International migrants’ OR ‘migrant workers’ OR ‘international students’ OR ‘refugees’ OR ‘asylum seekers’ OR ‘smuggled migrants’) AND ‘mental health’. VOSviewer was used to conduct bibliometric analysis, focusing on co-authorship patterns, keyword co-occurrence, and citation networks. Results: Over the past four decades, research on the mental health of international migrants has grown substantially, with major migration destinations such as the United States, Europe, and Australia playing prominent roles in this field. ‘Post-traumatic stress disorder (PTSD)’ was the most frequent keyword in publications, with strong links to ‘trauma’ and ‘depression’. In recent years, with the impact of global socioenvironmental changes and emergencies such as the COVID-19 pandemic, the research focus has gradually shifted towards social support, service accessibility, and cultural adaptation. Conclusions: International migration is a far-reaching global phenomenon, and addressing the mental health of migrant populations is essential for advancing public health, social cohesion, and sustainable development. This study provides the first bibliometric overview of research in this domain, mapping its thematic evolution and collaborative structure. The findings offer valuable insights into the field’s development and may support future interdisciplinary collaboration and the formulation of culturally informed, evidence-based approaches in migrant mental health. Full article

HIV disproportionately affects key populations (MSM, transgender people, sex workers and psychoactive substance users), who face greater social vulnerability and limited healthcare access. This study aimed at analyzing sexual orientation and gender identity and their association with sexual practices, sexually transmitted infections and psychoactive substance use among PrEP users. Method: A cross-sectional study was conducted between January 2018 and June 2021 with 736 Brazilian PrEP users from a health service in São Paulo. Sociodemographic data, sexual behaviors, STI history (past 3 months) and psychoactive substances use (past 3 months) were extracted from clinical records. The associations were analyzed using binomial logistic regression (p < 0.05). Results: Most of the participants were cisgender men (93.4%) and homosexual (84.8%), with a mean age of 34.9 years old. Condomless sex was reported by 98.5%, and 18.4% had some recent sexually transmitted infection, mainly syphilis. Psychoactive substance use was reported by 55.4%, especially marijuana, club drugs, erectile stimulants and poppers. Transgender and cisgender women were more likely to report sex work and crack use. Homosexual and bisexual participants had higher odds of using erectile stimulants. Conclusions: The study reveals key links between gender, sexual orientation and risk behaviors, highlighting the need for inclusive, targeted prevention. Full article

Background/Objectives: In late 2019, the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) caused a pandemic called the ‘coronavirus disease 2019’ (COVID-19). After the acute SARS-CoV-2 infection, many individuals (up to 33%) complained of unexplained symptoms involving multiple organ systems and were diagnosed as having Long COVID-19 (LC-19). Currently, LC-19 is inadequately defined, requiring the formation of consistent diagnostic parameters to provide a foundation for ongoing and future studies of epidemiology, risk factors, clinical characteristics, and therapy. LC-19 represents a significant burden on multiple levels. The reduced ability of workers to return to work or compromised work efficiency has led to consequences at national, economic, and societal levels by increasing dependence on community services. On a personal scale, the isolation and helplessness caused by the disease and its subsequent impact on the patient’s mental health and quality of life are incalculable. Methods: In this paper, we used Walker and Avants’ eight-step approach to perform a concept analysis of the term “Long COVID-19” and define its impact across these parameters. Results: Using this methodology, we provide an improved definition of LC-19 by connecting the clinical symptomology with previously under-addressed factors, such as mental, psychological, economic, and social effects. This definition of LC-19 features can help improve diagnostic procedures and help plan relevant healthcare services. Conclusions: LC-19 represents a complex and pressing public health challenge with diverse symptomology, an unpredictable timeline, and complex pathophysiology. This concept analysis serves as a tool for improving LC-19 definition, but it remains a dynamic disease with evolving diagnostic and therapeutic approaches, requiring deeper investigation and understanding of its long-term effects. Full article

Background: Social media platforms play a crucial role in contemporary healthcare, facilitating patient participation and enabling communication among healthcare workers, as well as serving as a platform for medical awareness and advocacy. Social media use among healthcare workers has increased to 91%, with 65% using it for health promotion purposes. Nonetheless, current studies have not properly and empirically explored its dimensions. Objectives: This study therefore examines social media dimensions and the productivity of healthcare workers. Methods: Leveraging the professional productivity theory and digital engagement theory, the study employs SPSS to analyze the gathered data through a partial least squares (PLS-SEM) approach to explore social media dimensions and productivity among healthcare workers in a Nigerian Tertiary Hospital. Based on a cross-sectional descriptive survey design and stratified random sampling method, 344 medical workers were analyzed. Findings: The study found that fear of missing out, information sharing, social influence, trust, and social media usage have a significant impact on the productivity of healthcare professionals. Conclusions: This research adds to the growing academic research on the capabilities of social media within the circular economic systems aimed at advancing healthcare delivery in developing economies. The research offers a method for maximizing the use of social media within healthcare settings to foster enhanced healthcare outcomes, particularly productivity. Full article

Background. Healthcare workers’ health can be influenced by physical, psychological, social, emotional, and work-related stress. MountainTherapy Activities (MTAs) are an integrated therapeutic approach that uses nature to enhance their well-being through group activities like hiking. This cross-sectional study examines well-being levels among Italian Departments of Mental Health workers who do or do not participate in MTAs. It hypothesizes that MTAs may reduce burnout, boost psychological resilience, and increase job satisfaction. Methods. The study involved 167 healthcare workers from 11 Italian Local Health Authorities, divided into MTA (who take part in MTA; n = 83) and non-MTA (who have never participated in MTA; n = 84) groups. They completed five validated questionnaires on psychological distress, burnout, resilience, job engagement, and psychological safety. Data were compared between groups, considering MTA frequency and well-being differences during MTAs versus workplace activities. Results. MTA participants scored higher in psychological well-being (t(117.282) = −1.721, p = 0.044) and general dysphoria (t(116.955) = −1.721, p = 0.042). Additionally, during MTAs, they showed greater job engagement (vigor: t(66) = −8.322, p < 0.001; devotion: t(66) = −4.500, p < 0.001; emotional involvement: t(66) = −8.322, p = 0.002) and psychological safety (general: t(66) = −5.819, p < 0.001; self-expression: t(66) = −5.609, p < 0.001) compared to other activities. Conclusions. MTAs can be considered a valid intervention for the promotion of the mental health of healthcare workers. Full article

Purpose: Smoking is a major preventable cause of illness and death. Quitting smoking can reduce related health complications. Numerous factors, including age, socioeconomic status, smoking habits, and availability of support, influence smoking cessation success. Despite anti-smoking measures and smoking cessation clinics in Saudi Arabia, smoking-related deaths are increasing. This study aimed to identify factors influencing successful smoking cessation among Saudi adults and examine the relationship between cessation methods and success rates. Patients and methods: A cross-sectional study was conducted through an online survey targeting Saudi adults who had attempted to quit smoking of all types, whether traditional cigarettes, e-cigarettes, shisha, or others. Success was defined as quitting for at least six months. The data collected included sociodemographic details, smoking history, and experiences with cessation. Logistic regression analysis was used to identify factors associated with successful cessation. Results: Of 364 participants, 18.4% were successful quitters, with a mean age of 34.94. Occupation was a key predictor; freelance workers had significantly higher odds of unsuccessful quitting (OR = 12.96, 95% CI: 2.08–80.79, p = 0.006). Those who continued smoking despite illness were less likely to quit successfully (OR = 2.33, 95% CI: 1.16–4.68, p = 0.018). Early initiation of smoking also negatively impacted cessation success (OR = 1.10, 95% CI: 1.03–1.17, p = 0.006). Successful quitters reported fewer adverse symptoms during their attempts (p = 0.018) and employed behavioral strategies, such as disposing of tobacco products (p < 0.001), avoiding smoking triggers (p = 0.002), and engaging in exercise (p < 0.001). Confidence in quitting significantly contributed to success (p < 0.001). Conclusions: This study highlights the role of individual, social, and environmental factors in smoking cessation. Tailored interventions that address socioeconomic, psychological, and lifestyle factors are crucial for enhancing cessation success among Saudi adults. Full article

Certain industries will bear a disproportionate share of the burden of climate change. Climate change risk perceptions can impact workers’ mental health and well-being; increased climate change risk perceptions are also associated with more favourable adaptive attitudes. It is, therefore, important to understand whether climate risk perceptions differ across workers between industries. We conducted an online survey of British Columbians (16+) in 2021 using social media advertisements. Participants rated how likely they believed their industry (Natural Resources, Science, Art and Recreation, Education/Law/Government, Health, Management/Business, Manufacturing, Sales, Trades) would be affected by climate change (on a scale from “Very Unlikely” to “Very Likely”). Ordinal logistic regression examined the association between occupational category and perceived industry vulnerability, adjusting for socio-demographic factors. Among 877 participants, 66.1% of Natural Resources workers perceived it was very/somewhat likely that climate change would impact their industry; only those in Science (78.3%) and Art and Recreation (71.4%) occupations had higher percentages. In the adjusted model, compared to Natural Resources workers, respondents in other occupations, including those in Art and Recreation, Education/Law/Government, Management/Business, Manufacturing, Sales, and Trades, perceived significantly lower risk of climate change-related industry impacts. Industry-specific interventions are needed to increase awareness of and readiness for climate adaptation. Policymakers and industry leaders should prioritize sectoral differences when designing interventions to support climate resilience in the workforce. Full article

COVID-19 vaccine hesitancy in Pakistan is a barrier to optimal vaccine uptake and has been situated within a context of hesitancy towards other vaccines. A mixed-methods study was conducted during the initial COVID-19 vaccine roll-out in 2021 in four union councils in Peshawar, consisting of a cross-sectional survey, eight focus group discussions (FGDs) with community members and eight in-depth interviews with healthcare workers (HCWs) to assess perceptions toward vaccines. Multivariable logistic regression was used to assess factors associated with COVID-19 vaccine hesitancy. Of 400 survey participants, 57.3% were vaccine acceptant and 42.8% vaccine hesitant. Just over half (56.8%) perceived COVID-19 vaccines to be safe. Most (88%) reported trust in HCWs to provide accurate vaccine information. FGDs revealed that women received less information about the vaccine compared to men and cultural restrictions were barriers even for those willing to be vaccinated. Correlates of vaccine acceptance included male sex (aOR 2.25; 95% CI 1.29–3.91), age 50 years or greater (aOR 1.74; 95% CI 1.19–6.31), social network support (e.g., vaccine acceptance among an individual’s social network) in receiving COVID-19 vaccines (aOR 2.38; 95% CI 1.45–3.89), community concern about COVID-19 spread (aOR 2.84; 95% CI 1.73–4.66), and trust in HCWs to provide vaccine information (aOR 3.47; 95% CI 1.62–7.42). Future vaccine promotion should prioritize engaging community leaders, sharing transparent information, combatting misinformation and rumors, and implementing household-based interventions especially targeting the importance of vaccination among women and young people to increase uptake. Full article