Search Results (4,904)

Background/Objectives: People with diabetes are more susceptible to viral respiratory infections and worse clinical outcomes related to COVID-19 and influenza. Vaccination is considered an important prevention strategy. This study aimed to analyze the vaccination status against COVID-19 and influenza among people with diabetes mellitus and associated factors. Methods: An analytical cross-sectional study was conducted between May 2024 and May 2025 in 42 Primary Health Care Units in a municipality in Minas Gerais, Brazil. A total of 316 individuals with type 1 or type 2 diabetes mellitus participated in the study. Data were collected using a structured instrument containing socioeconomic, cultural, behavioral, and clinical variables, in addition to verification of vaccination records through physical vaccination cards and information systems. Descriptive analyses and logistic regression models were performed to estimate crude and adjusted odds ratios, with respective 95% confidence intervals. Analyses were performed using Statistical Package for the Social Sciences and Stata. Results: Adherence to COVID-19 vaccination was 21.5%, whereas influenza vaccination adherence reached 85.4%. In the multivariable analysis of COVID-19 vaccination status, previous influenza vaccination (OR = 7.74; 95% CI: 1.81–33.2) and alcohol consumption (OR = 2.11; 95% CI: 1.13–3.89) were positively associated with vaccination. Conversely, access to social media or other communication channels (OR = 0.47; 95% CI: 0.24–0.92) and insulin use (OR = 0.42; 95% CI: 0.21–0.84) were associated with lower odds of COVID-19 vaccination. Regarding influenza vaccination, positive associations were identified for religious affiliation (OR = 6.46; 95% CI: 1.79–23.30), previous COVID-19 vaccination (OR = 10.2; 95% CI: 2.22–47.06), and longer duration of diabetes diagnosis (OR = 3.47; 95% CI: 1.32–9.20). In contrast, alcohol consumption (OR = 0.42; 95% CI: 0.21–0.86), insulin use (OR = 0.35; 95% CI: 0.16–0.76), and absence of medical follow-up (OR = 0.34; 95% CI: 0.13–0.85) were associated with lower odds of influenza vaccination. Conclusions: The findings revealed a heterogeneous vaccination pattern among individuals with diabetes mellitus, in which higher influenza vaccination coverage contrasted with low adherence to COVID-19 vaccination, reflecting not only differences in the historical consolidation of immunization strategies but also contemporary dynamics related to risk perception, trust, and information circulation. The strong association with previous vaccination history suggests that vaccine adherence is part of a continuum of preventive behaviors mediated by the relationship with healthcare services and by the internalization of healthcare practices over time. Full article

The rapid transformation of urban centers into smart environments introduces complex challenges at the intersection of technological advancement, environmental stewardship, and social justice. This study evaluates Lisbon’s smart city transition by establishing an integrated framework that links digital equity with Environmental, Social, and Governance principles. Employing a convergent qualitative research design, this paper triangulates a comprehensive regulatory policy analysis with primary empirical data gathered from twenty-five semi-structured interviews with municipal officials, academic experts, and residents of marginalized communities. The findings expose critical systemic disparities in digital infrastructure deployment, device affordability, and platform literacy across socio-economic strata, demonstrating how localized digital divides directly impede the execution of urban ESG objectives. While green financing mechanisms offer robust pathways for sustainable energy and transit infrastructure, their equity outcomes remain constrained without mandatory, transparent information disclosure systems that mitigate agency costs. Cultivating urban resilience requires shifting from tokenistic e-governance to genuine citizen empowerment. This study offers a novel theoretical contribution by operationalizing corporate ESG metrics within public urban governance frameworks, providing an empirical roadmap for municipal policymakers globally to balance digital innovation with structural inclusion and environmental accountability in smart city agendas. Full article

Periprosthetic joint infection (PJI) remains a major clinical challenge after total joint arthroplasty because of its association with prolonged antimicrobial therapy, repeated surgery, implant failure, functional disability, and substantial socioeconomic burden. Current strategies, including systemic antibiotics, debridement with implant retention, staged revision, and antibiotic-loaded cement spacers, remain indispensable but are limited by mature biofilm tolerance, protected microbial reservoirs, insufficient local drug penetration, persistent inflammation, and compromised periprosthetic bone repair. Increasing evidence indicates that PJI is not merely bacterial colonization of an implant surface, but a dynamic prosthetic interface disorder involving biofilm persistence, immune dysregulation, inflammatory osteolysis, and failed osseointegration. This review summarizes recent advances in anti-infective prosthetic interface design, emphasizing the transition from passive antibacterial coatings toward multifunctional immuno-antibacterial osseointegrative systems. The pathogenic basis of PJI is first discussed, including conditioning film formation, bacterial adhesion, biofilm maturation, protected reservoirs, immune evasion, and osteolysis. Current clinical management limitations are then evaluated, followed by emerging biomaterial strategies, including anti-adhesive and contact-killing surfaces, active antimicrobial coatings, mature biofilm disruption, biological antibiofilm therapies, smart infection-responsive delivery systems, and osteoimmunomodulatory interfaces. Particular attention is given to balancing early antibacterial activity with cytocompatibility, immune resolution, angiogenesis, mechanical durability, and long-term osseointegration. Finally, key translational barriers are highlighted, including load-bearing and tribological constraints, insufficiently standardized mature biofilm and animal models, limited clinical evidence for advanced smart materials, manufacturing reproducibility, sterilization compatibility, regulatory complexity, and application-specific clinical readiness. Future anti-PJI interfaces should evolve beyond unidirectional bacterial killing toward stage-specific systems integrating biofilm control, immune restoration, vascularized bone regeneration, and durable mechanical performance. Full article

Urban land use intensity (U-LUI) is a widely used term for describing urban development processes, yet its conceptualisation and measurement remain inconsistent. Existing approaches focus on isolated dimensions, such as structural density, functional activity, and socio-economic indicators, resulting in limited comparability and weak integration across scales and data sources. This paper reviews and synthesises current approaches to U-LUI with a focus on remote sensing (RS), in situ data and emerging urban data sources. It analyses definitions, related concepts of urban intensity and existing monitoring frameworks at national, European and global levels, and compares methodological approaches for observing U-LUI. Based on this synthesis, U-LUI is defined as a continuous, multidimensional and spatio-temporally dynamic property of urban systems that reflects the intensity of anthropogenic use. To operationalise this concept, the paper develops an integrative, trait-based framework comprising six indicator families: traits, genesis, structure, taxonomy, function and socio-economics. The proposed framework is illustrated and supported through the synthesis of existing RS approaches, urban monitoring concepts and representative examples from the literature, demonstrating its potential for consistent and scalable U-LUI assessment. These dimensions link physically observable characteristics with functional and contextual aspects of urban systems and provide a basis for more consistent quantification and comparison. The results highlight key challenges for U-LUI monitoring, including limited conceptual harmonisation, incomplete integration of dimensions and the need for improved data integration. The proposed framework supports more coherent and scalable assessments of U-LUI in research, monitoring and planning contexts. Full article

Drought is one of the most complex and impactful natural hazards under global climate change, exerting profound effects on water resources, agricultural productivity, ecosystem stability, and socio-economic systems. Despite extensive research, current drought studies remain fragmented due to inconsistent definitions, index-specific monitoring approaches, and limited understanding of cross-variable and cross-scale interactions. The objective of this review is to synthesize recent advances in drought monitoring and to establish an integrated understanding of drought as a coupled, multiscale process. We revisit traditional drought typologies, including meteorological, agricultural, hydrological, groundwater drought, and socio-economic drought, and critically evaluate their commonly used monitoring indices and data sources. We highlight that no single indicator can adequately capture the full dynamics of drought evolution, emphasizing the need for multi-index integration and process-based monitoring frameworks. Moreover, we examine the mechanisms of drought propagation, demonstrating that drought evolves through nonlinear and scale-dependent pathways linking atmospheric conditions, soil moisture, hydrological processes, and human water use. In particular, the emergence of flash drought reveals a shift from conventional water-deficit-driven processes to multi-process coupled dynamics, posing new challenges for early warning and prediction. Furthermore, we discuss how climate change and human activities jointly reshape drought characteristics by altering hydrological cycles, land–atmosphere interactions, and water resource management systems. The review reveals three major findings. First, drought monitoring is progressively shifting from single-index assessments toward integrated, multi-source monitoring frameworks. Second, drought propagation is inherently nonlinear and scale-dependent, involving complex interactions among climatic, hydrological, ecological, and human systems. Third, flash drought and groundwater drought have emerged as critical research frontiers due to their rapid evolution, monitoring challenges, and increasing impacts under climate change. Finally, we identify key challenges in drought research, including methodological uncertainties, data limitations, and the lack of a unified theoretical framework. These findings support a paradigm shift from traditional drought classification toward an integrated process-based perspective and provide guidance for the development of next-generation drought monitoring and early-warning systems. Full article

Invasive species require long-term characterization of their shifting population dynamics to understand their environmental impacts and socio-economic effects. The dynamics of freshwater bivalves depend on their biology, which is influenced by the vulnerability of the ecosystems. This study evaluates the coexistence of Corbicula fluminea and C. largillierti in a stream in the Argentine Pampa, integrating density, size, and reproduction. In this stream, characterized by a temperate climate and hydrological fluctuations, live specimens of both species were sampled monthly using a 0.07 m² cylinder. The anteroposterior length of each specimen was measured, and size distributions were analyzed by decomposing normal modes using the least-squares method. Gonadal cycles were compared with data from the previous literature. Since 2004, C. fluminea has dominated the system with significantly higher densities. Both species exhibited contrasting reproductive cycles. Hydrological instability in the stream limited both species. C. fluminea dominated due to its greater resilience and longevity under stress. In contrast, C. largillierti prioritized initial rapid growth, making it more sensitive to fluctuations. These results highlight that environmental instability conditions invasive success and interspecific competition in freshwater systems. Full article

Human fertility has declined sharply since 1950, and a growing body of evidence suggests that while conventional socioeconomic factors are well-established drivers of the broader demographic transition, they do not fully account for the timing and breadth of this trend. This review examines the Circadian-Light-Hygiene hypothesis, which proposes that daily light exposure is a fundamental regulator of reproductive health. We synthesize findings from photobiology, endocrinology, reproductive medicine, and epidemiology to evaluate how artificial light at night, insufficient daytime light, and irregular light–dark patterns may disrupt the hormonal timing systems that support reproduction. The available evidence indicates that such disruption can alter melatonin signaling, circadian gene regulation, and neuroendocrine rhythms, with downstream effects on ovulation, sperm quality, endometriosis, polycystic ovary syndrome, pregnancy outcomes, and developmental programming. Urbanization, screen use, and shift work appear to amplify these effects, while genetic variation may modify individual susceptibility. Although direct causal evidence in humans remains limited for several endpoints, the convergence of observational, experimental, and translational data supports circadian-light misalignment as a plausible, additional modulator of fertility decline, and a potentially modifiable contributor. Optimizing daily light exposure may therefore represent a low-cost and scalable strategy for improving reproductive health. Full article

Background: Seasonal influenza remains a major public health challenge worldwide, causing significant morbidity each year and imposing substantial burdens on individuals, healthcare systems, and national economies. Vaccination is considered the most effective available strategy for prevention; however, uptake rates vary considerably across countries, with many failing to achieve the recommended coverage levels. The aim of this umbrella review is to systematically synthesize and critically appraise the existing evidence on healthcare professionals’ beliefs, attitudes, and behaviors regarding seasonal influenza vaccination. Methods: This umbrella review was conducted in accordance with the PRISMA 2020 statement. A literature search was conducted in PubMed, the Cochrane Library, and Google Scholar. The following search terms were used: beliefs, attitudes, behaviors, influenza vaccination, flu vaccine, healthcare professionals and primary healthcare. The inclusion criteria were as follows: (1) Reviews, (2) Published after 1 January 2000, (3) English language, (4) Healthcare professionals as the target-population. Results: Twenty-five studies met the selection criteria and were included in this review. Twelve out of 25 studies were systematic reviews. Globally, vaccination uptake remains below recommended levels, with reported coverage ranging from approximately 2% to 44% in several settings, while rates can exceed 90% in countries with mandatory vaccination policies. North America demonstrates the highest vaccination coverage, while the lowest coverage is reported in Africa and South America. Overall, low- and middle-income countries show significantly lower vaccination behavior compared with high-income countries. Attitudes and beliefs appear to shape vaccination behavior in high-income countries. The main driver of acceptance is perceived protection of oneself and family, whereas hesitancy is mainly driven by concerns about side effects and vaccine safety. Across studies, non-physician healthcare professionals consistently demonstrated lower influenza vaccine acceptance compared with physicians, while pediatricians and general practitioners were found to receive the influenza vaccine more frequently. In addition, younger physicians and those with fewer years of professional experience showed higher vaccination coverage and a greater likelihood of recommending influenza vaccination to patients. Conclusions: Vaccination coverage, worldwide, is lower than what is recommended by the World Health Organization. Healthcare professionals working in hospital settings tend to be vaccinated at a higher rate compared with those working in primary care or community-based healthcare settings. The recommendations that healthcare professionals give are influenced by whether they accept influenza vaccines themselves. Beliefs and attitudes seem to influence behavior in countries where structural barriers, such as limited access to primary healthcare and socio-economic status are absent. Full article

Flooding in the Kathmandu Valley has intensified in recent years due to rapid urbanization, unregulated land-use change, and insufficient drainage infrastructure. Existing flood hazard assessments are often based on low-resolution datasets and lack proper field validation. This study presents an integrated flood modeling framework that combines Unmanned Aerial Vehicle (UAV)-derived Digital Elevation Models (DEMs), field-based flood measurements, and hydrological simulations to assess urban flood hazards in the Bagmati-Nakkhu confluence, Nepal. High-resolution UAV-derived DEM and field survey data, including flood marks and high-water levels, were used as the foundation for the analysis. Hydrological modeling was conducted using the Hydrologic Engineering Center—Hydrologic Modeling System (HEC-HMS) to estimate the peak discharges of the Nakkhu River (2000–2024), which were then used to derive design flows for return periods of 5 to 150 years using the Gumbel distribution. These flows were used as boundary condition inputs for the Hydrologic Engineering Center—River Analysis System (HEC-RAS) to simulate flood depth and inundation extent under different scenarios. Flood extents for the 27 September 2024 event were derived from Sentinel-2 imagery and validated against surveyed flood marks. Additionally, land use/land cover (LULC) mapping based on UAV data was used to support flood impact analysis. The results show that flood depths ranged from approximately 0.5 m to 2.8 m, with inundation areas increasing by 35–50% under extreme rainfall. Model validation demonstrated strong agreement with simulated results, with deviations generally within ±0.3–0.5 m. Scenario analysis further indicates that urban expansion significantly increases runoff and flood extent, particularly in low-lying areas near the river confluence. Socio-economic exposure analysis for the 27 September 2024 event indicates that approximately 2569 residents (56.4% of the study zone population) and 4.011 km (77.42%) of the local road network were exposed to inundation. Overall, the results demonstrate that integrating high-resolution UAV data, field observations, and hydrological modeling greatly improves the accuracy and reliability of flood hazard assessments in data-scarce urban environments. Full article

Bike-sharing systems (BSS) are a key component of sustainable urban mobility. However, their performance is strongly influenced by urban topography and socio-economic conditions. This study analyzes Barcelona’s public BSS, Bicing, to examine how altitude and neighborhood income affect bicycle availability, departures, and electric bicycle adoption. The main objective is to determine whether the observed “electric divide” is driven by income or by topographical necessity. The analysis uses 2023 data from 511 Bicing stations and income information from 62 neighborhoods obtained from Open Data Barcelona and the Spanish National Statistics Institute. Three indicators were constructed: bike availability ratio, departures ratio, and electric bicycle ratio. Results show a strong negative correlation between altitude and bike availability (r = −0.71) and a strong positive correlation between altitude and electric bicycle use (r = 0.78). High-altitude stations show lower availability and fewer departures, while electric bicycles dominate uphill trips. Although high-income neighborhoods initially appear to use more electric bicycles, regression results show that income becomes insignificant once altitude is controlled for. Therefore, electric bicycle adoption is driven mainly by physical necessity rather than socio-economic preference. Full article

This article systematically reviews natural disasters that occur globally and highlights their impact and associated challenges on the sustainable development of society and the economy. The presence of extensive research on the detrimental impact of natural disasters on mental health and other diverse elements of societal or economic well-being is found in this review. The study suggests that adversities can be minimized by employing the right public and private policies that support a post-disaster state, leading to enhanced disaster management initiatives and rehabilitation efforts. The PRISMA model was employed for the inclusion and exclusion criteria for the studies. Natural disasters being a threat to sustainability and the community’s well-being, the findings showcase the urgency to consider their long-term impact. Various forms of natural disasters that are due to disturbances related to land, water, air, or fire are considered in this study. The research scope aims towards worldwide sustainable development by gathering multiple inputs that enable changing the dynamics of disaster management. This study concludes with limitations and recommendations for future disaster preparedness and management in various scenarios. Full article

Virtual reality (VR) has shown promising potential for upper-extremity rehabilitation; however, its successful integration into clinical practice depends not only on therapeutic effectiveness but also on the acceptance of the technology by patients and healthcare professionals alike. Despite growing international research in this area, there is limited evidence on clinical attitudes toward VR rehabilitation in Thailand and other middle-income settings. This study investigates Thai patients’ and clinicians’ perceptions of VR for upper-extremity rehabilitation through two complementary studies focusing on perceived usability and usefulness. The first study evaluated the perceived usability of a VR rehabilitation game using the System Usability Scale (SUS) among 40 first-time VR users divided into younger and senior groups. The younger group reported a higher average SUS score (64.6) than the senior group (55.4). While both groups generally perceived VR rehabilitation positively, senior participants expressed greater concern regarding system complexity, consistency, and the need for technical assistance. Nevertheless, the findings indicate that VR remained an acceptable rehabilitation approach even among elderly first-time users in a population with relatively lower technological readiness. The second study explored clinicians’ perceptions of utilizing VR-generated movement data to support rehabilitation decision-making. Five rehabilitation professionals evaluated the potential usefulness of VR data visualizations for diagnosis and treatment monitoring. Clinicians generally perceived VR data as valuable, particularly for tracking rehabilitation progress rather than diagnostic decision-making. Feedback from interviews also highlighted practical considerations for future implementation, including the importance of normative data, simplified visualization formats, and the feasibility of clinical workflows. By combining patient usability perspectives with clinicians’ evaluations of clinical usefulness, this research provides a broader understanding of the factors influencing VR adoption for upper-extremity rehabilitation in Thailand. The findings contribute contextual evidence from an underrepresented healthcare environment and offer insights relevant to the future deployment of VR-assisted rehabilitation systems in similar socio-economic settings. Full article

This study, through a hybrid approach to post-occupancy evaluation (POE) of four types of high-energy-efficiency housing in rural Scotland, explores the manifestation, formation mechanism, and mitigation pathways of energy risks in high-energy-efficiency housing from environmental and socioeconomic dimensions. The findings reveal a “high-efficiency paradox”: better fabric performance and lower heating demand do not guarantee reduced carbon emissions, fuel poverty alleviation, or energy resilience. Actual energy risks are formed by the combined effects of multiple factors, including building size, energy infrastructure, resident characteristics, energy prices, and policy, exhibiting a clear systemic coupling characteristic. The study further verifies that, in the context of rural Scotland, relying solely on indicators such as EPC may lead to misjudgements of housing sustainability. Heating demand, total energy consumption, carbon emissions, and energy expenditure exhibit a partially decoupled relationship. Thus, rural housing sustainability should shift from a technically efficient approach to a comprehensive strategy integrating design, infrastructure, affordability, and social equity. The study proposes context-specific mitigation pathways including multi-source energy systems, place-sensitive policies, socio-economic support, and a multi-criteria assessment framework, providing empirical references for rural housing energy transition and energy risk governance. Full article

Obesity is increasingly recognized as a complex systemic disorder rather than a simple consequence of excess energy intake and fat accumulation. This review presents a systems biology framework that examines how obesity-driven disruption of inter-organ communication networks contributes to chronic disease susceptibility, with particular emphasis on colorectal cancer (CRC). Disrupted signaling among the brain, adipose tissue, liver, skeletal muscle, gut, and immune system generates maladaptive feedback loops that promote chronic metabolic inflammation (metaflammation), loss of physiological resilience, and progressive metabolic dysfunction. Within this framework, obesity is redefined as a network disease characterized by neuroendocrine dysregulation, adipose tissue remodeling, immune dysfunction, impaired organ crosstalk, and alterations in the gut microbiome. A central feature of this dysregulation is persistent low-grade inflammation driven by immune-metabolic reprogramming and sustained activation of inflammatory pathways. Obesity-associated metaflammation is further linked to accelerated biological aging through mechanisms involving cellular senescence, mitochondrial dysfunction, oxidative stress, and impaired metabolic resilience. These interconnected processes create a tumor-promoting environment by enhancing oncogenic signaling, disrupting intestinal barrier integrity, altering microbial and metabolic signaling, impairing immune surveillance, and promoting epithelial dysfunction, thereby increasing susceptibility to CRC. The review also examines how behavioral, circadian, environmental, and socioeconomic factors influence metabolic health and cancer risk. Finally, emerging translational opportunities, including biomarker-guided risk stratification, precision prevention, metabolic network restoration, and integrative lifestyle and pharmacological interventions, are discussed. Collectively, this review reframes obesity as a whole-body regulatory disorder and provides an integrated conceptual framework linking metabolism, inflammation, aging, and colorectal carcinogenesis to inform future prevention and therapeutic strategies. Full article

Youth drug abuse is a persistent public health concern in China. Community-based drug rehabilitation (CBDR), the final three-year stage of China’s official rehabilitation system, aims to help people who use drugs (PWUD) reintegrate into society, but reintegration remains limited, particularly among young PWUD. This study explores the social reintegration challenges faced by young PWUD aged 18 to 35 during the CBDR stage in Guangzhou, China. Semi-structured interviews were conducted with 16 participants and analyzed using reflexive thematic analysis (RTA). Three themes were identified: stigma and relational struggles, socioeconomic marginalization and daily life disruption, and limitations of the CBDR service model. These challenges were not separate but reinforced one another, with difficulties in one domain spilling into others and narrowing the space in which reintegration could occur. These findings suggest that addressing the reinforcing linkages between stigma, economic hardship, and service limitations requires a more coordinated approach to CBDR service provision, one that integrates vocational support into relapse prevention, builds flexibility into surveillance procedures, and provides participants and their families with realistic, evidence-based information about the prospects of recovery. Full article