Search Results (4,651)

Climate change is intensifying flood risks globally, yet preparedness behaviors vary dramatically across governance contexts. While past disaster research suggests that institutional trust enables individual preparedness, this relationship remains unexplored in high-capacity governance systems where citizens hold exceptionally strong confidence in government response. We examined this dynamic in the United Arab Emirates, where several surveys have found extremely high levels of public confidence in the local government institutions. In our survey of 900 respondents in the emirates of Dubai and Sharjah we also found that 97% of the respondents had confidence in local government institutions. However, interestingly we also found that while 77% of residents reported past experience with floods, household flood preparedness was markedly low. Using covariance-based structural equation modeling, we tested whether government trust mediates relationships between flood experience, risk perception, and household preparedness. The results revealed that government trust exhibited a strong negative association with flood preparedness, suggesting that institutional confidence may suppress rather than enable household protective action. Notably, flood experience was associated with reduced government trust, likely reflecting the impact of disappointment with service restoration times that exceeded individual expectations. This erosion of trust created positive mediation, indicating that flood experience was associated with increased preparedness. Conversely, higher risk perception was associated with increased trust, which was associated with reduced preparedness through negative mediation. Direct relationships between flood experience and preparedness were statistically non-significant, indicating complete mediation through the trust pathway. Socioeconomic status was positively associated with flood preparedness, with wealthier residents displaying higher protective behaviors. While these findings seem to challenge conventional disaster preparedness theory, the results align with the moral hazard and dependency arguments. Our results show that state-led disaster management in high-capacity governance systems may inadvertently create dependency that increases systemic vulnerability crowding out endogenous adaptive behavior. Building resilience in such contexts requires reframing institutional trust to emphasize shared responsibility rather than externalized protection. Full article

Background: Falls among older adults are a major public health concern associated with injury, disability, reduced mobility, and loss of independence. Functional impairment, chronic diseases, and unsafe home environments may increase the risk of falls. This study examined environmental, functional, and health-related factors linked to falls among community-dwelling older adults in Iran. Methods: A comparative cross-sectional study was conducted among 329 community-dwelling older adults. Data were collected using standardized assessments of functional ability, home safety, health status, and fall history. Conventional regression and Elastic Net analyses were applied to identify significant predictors of falls. Results: Overall, 28.6% of participants reported at least one fall during the previous 12 months. Falls were significantly more common among females, adults aged ≥85 years, individuals without a spouse, and those with lower educational levels. Fallers showed poorer mobility, balance, and functional independence, greater fear of falling, and a higher risk of home accidents (all p < 0.001). Elastic Net analysis identified use of movement aids as the strongest risk factor, whereas better Performance-Oriented Mobility Assessment (POMA) scores were the main protective factor. Conclusions: Falls among community-dwelling older adults appear to result from the interaction of physical, medical, socioeconomic, and environmental factors. These findings highlight the need for multidimensional fall-prevention strategies in primary care settings. Full article

Background/Objectives: Prostate biopsy is essential for diagnosing prostate cancer. Social determinants of health (SDOH), including socioeconomic status, race, occupation, education, and environment, affect access, outcomes, and quality of life. Recognizing disparities from technology access to complications is crucial for equitable care. A systematic review examined how SDOH impacts biopsy access, technology, and complications. Methods: A systematic search of PubMed, Web of Science, and Scopus was performed to identify eligible studies published through February 2026. We included studies that evaluated the association between one or more SDOHs and prostate biopsy. Relevant outcomes included biopsy utilization, use of specific biopsy technologies (e.g., magnetic resonance imaging (MRI)-guided, transperineal), and post-procedural complications. Results: Nine observational studies met the inclusion criteria. The findings revealed disparities across three key domains. First, access to advanced biopsy technology was uneven. Four studies showed that Black men were significantly less likely than White men to receive MRI-guided biopsies. Additionally, post-biopsy outcomes showed that Black and Hispanic men faced significantly higher rates of post-biopsy infection and hospitalization compared to White men. Lastly, patients in rural areas, those in public hospitals, and individuals with lower socioeconomic status demonstrated reduced access to modern techniques, including MRI-guided or transperineal biopsy. Conclusions: Social and economic factors influence who receives a prostate biopsy and who has access to advanced technologies. Minority and low-income patients face diagnosis barriers and higher complication rates, highlighting systemic inequities. The healthcare system often rewards access over need, and without bold policy changes, gaps in technology and resources will worsen, moving us further from truly equitable prostate cancer care. Full article

Dengue Virus (DENV) circulates as four antigenically distinct serotypes whose dominance fluctuates over time in many endemic regions, a phenomenon known as serotype shift that is frequently associated with large outbreaks and increased disease severity. This review, through a synthesis of epidemiological, virological, immunological, entomological, and environmental evidence, observes that serotype shift likely arises from the interaction of multiple determinants rather than solely from viral evolution, with population immunity playing a central role. The accumulation of serotype-specific herd immunity, together with short-lived cross-protection and Antibody-Dependent Enhancement (ADE), reshapes population susceptibility and creates ecological space for heterologous serotypes with higher transmission potential. The synthesis of global dengue studies indicates that these immune dynamics interact with viral genetic diversity, vector competence, climate variability, and human factors such as demography, socioeconomic status, population density and mobility to drive cyclical and sometimes abrupt changes in serotype dominance. Notably, the review indicates that serotype changes often precede or coincide with more clinical severity and patterns of outbreaks, with direct implications for the process of forecasting outbreaks, vaccine performance, and preparedness to respond with appropriate health measures. On the whole, this review confirms the opinion that the change of dengue serotype occurrence becomes a consequence of interconnected biological and ecological processes involved in the transmission of dengue serotype shifts in hyperendemic areas. Full article

Aim: To evaluate the status of the nutritional management of diet-treated IEM in Brazil from the perspectives of healthcare professionals, patients, and families. Methods: Data were collected through two nationwide digital questionnaires administered to healthcare professionals involved in dietary management (n = 37) and to patients and caregivers (n = 278), addressing professional training, workload, access to resources, treatment adherence, and socioeconomic factors. Results: Healthcare professionals from 20 out of the 26 Brazilian states participated, most of them female (81%) and dietitians (81%). Although more than half had over 10 years of experience, 59% considered their training insufficient to work with IEM. Only 19% reported exclusive dedication to the field, and 54% were the sole professional responsible for dietary prescriptions at their center. Weekly workload dedicated to IEM varied widely. Among the patients and families, phenylketonuria (60.4%) and glycogen storage disease (25.9%) were the most frequent conditions. Higher educational level and longer time since diagnosis were associated with a better understanding of dietary management (p < 0.05). Among patients on protein-restricted diets, most reported regular use of protein substitutes, although 92% reported poor palatability and 36% reported supply problems. Access to special low-protein foods was limited, and over half of the families reported some level of food insecurity. Conclusions: Significant systemic, logistical, and socioeconomic barriers to optimal dietary management of IEM persist in Brazil, highlighting the need for strengthened public policies, professional training, and equitable access to dietary resources. Full article

Background: Multiple Myeloma (MM) remains the most common indication for Autologous Stem Cell Transplant (ASCT). ASCT use is disproportionately lower in older adults, Black patients with MM, as well as those living in rural areas and of low socioeconomic status (SES). Low utilization of ASCT is linked to poor outcomes. There are numerous barriers to ASCT access and limited interventions to address disparate outcomes in patients with MM. Methods: This is an ambispective study conducted at a single institution to identify and mitigate barriers to ASCT utilization. In aim one, we retrospectively evaluated ASCT utilization and overall survival (OS) for MM patients accounting for clinical, geographic (Rural Urban Commuting Area—RUCA), and socioeconomic factors (Yost). In aim two, based on the observations of the retrospective study, we conducted a prospective feasibility study to improve access for vulnerable patients with MM (older adults, Black patients, rural and/or Appalachian residence) using a virtual ASCT consultative model with patient navigation, coordinated with local oncology centers. Poisson regression estimated the relative risk of receiving ASCT. OS was calculated from MM diagnosis to the date of death censoring survivors at last contact and analyzed using Kaplan-Meir. Cox proportional hazard models estimated the hazard ratio for risk of death. The multivariable model was built including significant risk factors from the univariable models to estimate the independent effect of each risk factor. Results: Among 1799 patients, median age of diagnosis was 61 (range 17–87), race was self-identified as White (85.6%), Black (13.1%), or other (1.3%) and it was primarily metropolitan (n = 1205, 71.2%) and 1169 (65%) received a transplant. The hazard of death was lower for those who received a transplant (vs. no transplant, HR = 0.63, 95%CI 0.53–0.74, p < 0.001), patients identified as Black (vs. White, HR = 0.66, 95%CI 0.51–0.85, p = 0.001) and higher SES areas (quartile 2–4 vs. quartile 1, HR = 0.69, 95%CI 0.58–0.83, p < 0.001). Prospectively with patient navigation and virtual consultation (n = 35), half of the patients sought virtual consultation, 68% of patients were eligible for transplant, 43% went on to receive ASCT, of which 42% of patients were non-metropolitan and 15% of patients were from an Appalachian county. Using this strategy, no difference was observed in ASCT utilization by age (31% in age > 70 vs. 45% in age 65–70 vs. 78% in age < 65, p = 0.10), geographical area (47% in metro vs. 50% in non-metro, p = 0.99), or race (46% in White vs. 60% in Black, p = 0.66). Conclusions: Implementing patient navigation and virtual transplant consultation can effectively enhance access to ASCT among underserved MM populations while reducing the influence of racial and geographic differences. Full article

Background: Cardiometabolic diseases are shaped by complex interactions between biological and social determinants. While socioeconomic inequalities in cardiometabolic risk are well established, less is known about how these inequalities are distributed across multidimensional cardiometabolic phenotypes and whether they differ by sex. Objective: We aimed to examine sex differences in the socioeconomic gradient of cardiometabolic phenotypes using latent class analysis in a working-age population. Methods: A cross-sectional study was conducted in 3108 adults aged 18–65 years undergoing occupational health assessments in the Balearic Islands (Spain). Educational level was used as an indicator of socioeconomic position. Cardiometabolic risk was assessed using obesity, insulin resistance (METS-IR), metabolic dysfunction-associated steatotic liver disease (FLI), atherogenic index of plasma, and metabolic syndrome. Latent class analysis was applied to identify cardiometabolic phenotypes. Multinomial logistic regression models stratified by sex and interaction analyses were used to assess associations between educational level and class membership. Tests for linear trend and predicted probabilities were also estimated. Results: Four cardiometabolic phenotypes were identified: low-risk (40.8%), obesity-dominant (24.1%), dysmetabolic (19.3%), and high-risk multimorbid (15.8%). A clear socioeconomic gradient was observed, with lower educational attainment associated with a higher likelihood of belonging to adverse cardiometabolic profiles. This gradient was stronger among women. For the high-risk multimorbid class, the relative risk ratio comparing low vs. high educational level was 1.82 (95% CI 1.34–2.46) in men and 2.47 (95% CI 1.68–3.64) in women (p for interaction = 0.012). A significant linear trend across educational levels was observed in both sexes (p for trend < 0.001). Predicted probabilities further confirmed a steeper increase in high-risk profiles among women with lower educational attainment. Conclusions: Cardiometabolic risk is structured into distinct phenotypic profiles that are socially patterned. Socioeconomic inequalities are strongly associated with adverse cardiometabolic phenotypes, with a more pronounced gradient among women. These findings highlight the need for gender-sensitive strategies addressing social determinants to reduce cardiometabolic health inequalities. Full article

Background: The food environment plays a significant role in determining children’s nutritional status, especially in socially vulnerable settings, where the high availability of ultra-processed beverages can contribute to both overweight and nutritional deficiencies, such as anemia. Thus, this study aimed to assess the association between the availability of fruits, vegetables, and ultra-processed beverages in the food environment and the occurrence of overweight and anemia in children living in socially vulnerable areas. Methods: This is a cross-sectional study with an ecological component, conducted between 2020 and 2021, involving 665 children residing in 40 favelas and urban communities in Maceió, Alagoas, Brazil. Socioeconomic, anthropometric, and hematological data were collected, along with a characterization of the food environment in 624 establishments using the AUDITNOVA tool, focusing on the availability of fruits, vegetables, and ultra-processed beverages. The outcomes investigated were overweight (BMI-for-age z-score > +2) and anemia (hemoglobin < 11 g/dL). Multilevel models were used to assess the associations between the food environment and the outcomes of interest. Results: The prevalence of overweight was 19.7%, while anemia affected 50.4% of the children assessed. Greater availability of fruits and vegetables was associated with a lower chance of being overweight (OR: 0.82; 95% CI: 0.79–0.98). In contrast, high availability of ultra-processed beverages was associated with a higher chance of being overweight (OR: 1.35; 95% CI: 1.07–1.84) and anemia (OR: 1.53; 95% CI: 1.04–2.29). Conclusion: Food environments characterized by widespread availability of ultra-processed beverages were associated with a higher prevalence of overweight and anemia among children. In comparison, greater availability of fresh or minimally processed foods was associated with a lower prevalence of overweight. These findings highlight the importance of public policies that promote healthier food environments in socially vulnerable areas. Full article

The classic tripartite life-course model (education, work, and retirement) is under increasing pressure from rising longevity and structural labour-market change. This study examines how Millennials and Generation Z in Portugal conceptualise retirement and the life course, asking whether these cohorts adhere to a standardised, sequential logic or aspire to more fluid, multi-stage trajectories, and whether observed differences reflect generation or socioeconomic position. A cross-sectional survey of 234 participants aged 18–43 assessed perceptions of retirement, openness to non-linear life cycles, future concerns, preparation strategies, and orientations towards lifelong learning. Responses were analysed using non-parametric tests (Mann–Whitney U, Kruskal–Wallis) and multivariate linear regression, with outcomes stratified by income, education, and occupational status. Participants showed a widespread preference for greater flexibility around the tripartite sequence rather than its abandonment, the statutory retirement age persisting as a reference point. Trust in the public pension system was low and cross-cutting, with over 70% doubting its capacity to ensure an adequate retirement, while Generation Z reported significantly greater concern about losing professional purpose. Socioeconomic position was a more consistent stratifier than generation for financial preparation, which rose with income and education; distrust, by contrast, was predicted by neither socioeconomic position nor generation in multivariate models. These findings indicate that biographical deinstitutionalisation may already be underway among younger Portuguese cohorts, with structural risks increasingly individualised, carrying implications for the redesign of life-course policies and social protection systems in an era of longevity. Full article

This study examined Saudi adolescents’ digital use, experiences of cyberbullying, and willingness to seek help when facing online risks. Furthermore, the study examined how perceived online safety, preferred reporting sources, exposure to online safety education, and demographic characteristics are associated with resistance to help-seeking. A cross-sectional online survey was completed by 302 adolescents aged 11–17 years across Saudi Arabia. Descriptive statistics, one-way ANOVAs, and hierarchical multiple regression were used to explore patterns and predictors of resistance to help-seeking. Descriptively, the results showed near-universal smartphone access, high daily screen time, and that a substantial minority had experienced recent cyberbullying, including repeated victimization. Although most participants reported feeling safe online, many expressed uncertainty and endorsed self-reliant or avoidant responses, with over half agreeing they would “just ignore” cyberbullying. Parents were the most frequently identified reporting source, yet around one-fifth of adolescents said that they would not seek help from anyone. Regression analyses indicated that female gender, higher socioeconomic status, feeling less safe online, and receiving online safety education from multiple sources were associated with lower resistance to help-seeking, whereas greater cyberbullying exposure predicted higher resistance. Overall, the results highlight the need for multi-source, culturally grounded online safety education and strengthened reporting pathways across families, schools, and digital platforms to support Saudi adolescents who experience cyberbullying and related online harms. Full article

Background/Objectives: Mental health problems among university students represent a growing public health concern and are shaped by both psychological and socioeconomic determinants that may act independently and interactively. This systematic review aimed to evaluate the separate and combined effects of these determinants on depression, anxiety, stress, and psychological distress in higher education students. Methods: A structured and targeted search strategy using predefined keyword groups and Boolean combinations across PubMed, Scopus, Web of Science, and Google Scholar identified 99 records, of which 19 duplicates were removed. After screening 80 titles and 52 abstracts, 34 full-text articles were assessed for eligibility, and 30 studies were ultimately included in the final review. Data were extracted on study characteristics, mental health outcomes, psychological determinants, socioeconomic factors, and their interactions. Results: The included studies consistently showed that psychological factors, including resilience, coping strategies, loneliness, self-efficacy, and perceived control, were associated with mental health outcomes, with higher resilience and self-efficacy linked to lower levels of depression and anxiety, and maladaptive coping and loneliness associated with increased psychological distress. Socioeconomic determinants, including financial stress, low socioeconomic status, parental education, housing insecurity, and food insecurity also independently contributed to elevated risks of depression, anxiety, and stress. Importantly, several studies demonstrated an interaction between these domains, where socioeconomic disadvantage amplified the adverse effects of poor coping capacity, low resilience, and social isolation, whereas social support and adaptive coping mitigated these effects. Conclusions: Student mental health is influenced by both distinct and interacting psychological and socioeconomic mechanisms, emphasizing the need for integrated institutional strategies that address structural vulnerabilities alongside individual psychological resilience. Full article

Objectives: To evaluate associations between social vulnerability and rheumatoid arthritis (RA)-related mortality in the United States, with emphasis on domain-specific effects of the Social Vulnerability Index (SVI). Methods: We conducted a county-level ecological study of RA-related mortality from 2010 to 2019 using age-adjusted mortality rates and the Centers for Disease Control and Prevention SVI. Gamma regression models examined associations between RA mortality and overall SVI and four thematic domains, including socioeconomic status, household composition and disability, minority status and language, housing type and transportation by using both continuous and quartile-based measures. Results: Between 2010 and 2019, 354,280 deaths occurred among individuals with RA, corresponding to a mean age-adjusted mortality rate of 9.7 per 100,000 population. In multivariable analyses adjusting for all SVI domains, household composition and disability vulnerability demonstrated the strongest and most consistent positive association with mortality, with a dose–response relationship across quartiles. Housing type and transportation vulnerability showed a modest positive association. Minority status and language vulnerability was inversely associated with mortality, whereas socioeconomic vulnerability was not significant in continuous models but demonstrated an inverse association with mortality in quartile-based analyses. Conclusions: RA mortality is differentially associated with specific domains of social vulnerability rather than overall vulnerability burden. Household composition and disability represent clinically salient risk factors, demonstrating the relevance of functional status and caregiving context in RA outcomes. Domain-specific assessment of social vulnerability may enhance clinical risk stratification and inform more targeted, patient-centered RA management. Full article

India exhibits substantial variation in neonatal mortality across regions and socioeconomic groups. This study used nationally representative survey data (2019–2021) to examine wealth-based inequalities in neonatal mortality. Socioeconomic disparities were assessed using Erreygers’ Normalized Concentration Index (ECI) and concentration curves, with subgroup analyses by residence, state development status (Empowered Action Group (EAG) vs. non-EAG), district typology, and region. Inequality was further decomposed using the Wagstaff method. Analysis of 176,843 most recent live births revealed marked rural–urban disparities, with neonatal mortality in rural areas (18.3 per 1000 live births) 1.6 times higher than in urban areas (11.5). Neonatal mortality was significantly concentrated among poorer households (ECI: −0.0123; p < 0.001), with greater inequality in urban areas, EAG states, and non-aspirational districts. Regional variation was evident, with the highest inequality in the Western and Central regions. Decomposition analysis showed that inequality was primarily driven by adverse household conditions and maternal risk factors concentrated among poorer populations. Key contributors included unclean cooking fuel, higher parity, large family size, normal delivery and inadequate antenatal care. These findings highlight the need for equality-focused strategies addressing both social determinants and gaps in access to quality maternal and newborn care. Full article

Snake envenomation causes acute cerebrovascular complications, but its long-term effect on stroke risk remains unclear. This study suggests that snake envenomation may be associated with long-term stroke risk. Using the Korean National Health Insurance Service database, we conducted a nationwide population-based cohort study to evaluate the long-term risk of stroke following snake envenomation. A total of 764 adult patients diagnosed with snake envenomation and treated with antivenom were identified and matched with 3056 control patients (1:4) by age, sex, and socioeconomic status, excluding those with prior cerebrovascular disease. Stroke outcomes were defined using ICD-10 diagnostic codes and healthcare utilization criteria. After a 1-year lag period was applied to minimize reverse causation, multivariable Cox proportional hazards models were used to estimate adjusted hazard ratios for total, ischemic, and hemorrhagic strokes. During 10 years of follow-up, snake envenomation was associated with a significantly increased risk of total stroke (aHR 1.42 (95% CI 1.01–1.99)), particularly hemorrhagic stroke (aHR 2.55 (95% CI 1.12–5.80)), whereas no significant association was observed with ischemic stroke. Interaction analyses showed a stronger association among men with diabetes mellitus, particularly for hemorrhagic stroke. In addition, severe envenomation with disseminated intravascular coagulation or requiring transfusion was associated with a higher long-term risk of hemorrhagic stroke. These findings highlight the need for further investigations of long-term cerebrovascular complications of snake envenomation, particularly hemorrhagic stroke in vulnerable populations. Full article

Background/Objectives: Consumption of ultra-processed foods (UPF) has been linked to poorer diet quality and adverse health outcomes. Although Chile ranks among the highest consumers of UPFs in Latin America, studies using primary dietary data, especially among older adults, are scarce. This study aimed to describe the food intake of Chilean older adults according to the degree of food processing, and to explore the association between UPF intake and sociodemographic, economic and health factors. Methods: A cross-sectional study of 434 non-institutionalized older adults (≥60 years) living in the Metropolitan Region of Chile was conducted. Dietary intake was assessed using interviewer-administered 24h recall, with a second assessment 8–15 days later in a random subsample (n = 60). Foods were classified according to the NOVA system into minimally processed foods (MPFs), culinary ingredients, processed foods (PF), or UPF. Usual energy intake was estimated using the MSM. Sociodemographic (sex, age, area), economic (income, education, health system), and health-related variables (chronic conditions, sedentary lifestyle, tobacco use) were collected through home-visit questionnaires. Anthropometric and functional measurements were taken by trained nutritionists. The association between UPF intake and studied variables was evaluated using multivariate fractional probit regression, with mean marginal effects presented. Results: Most of the participants were women (86.2%), aged 70–79 years (47.9%), and residents of urban areas (76.3%). Most of their calories came from MPF (45.7%), followed by PF (25.5%) and UPF (16.6%). Higher UPF intake was associated with living in an urban area (+3.8%; 95% CI 1.2–6.3%), higher education (+3.5%; 95% CI 1.1–6.0%), and being affiliated with the private health system (+9.1%; 95% CI 4.1–14.0%). Conclusions: In this community-based sample of Chilean older adults, UPF intake was associated with socioeconomic factors but not health status. Full article