Search Results (669)

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

Grounded in health behavior theory, this study examined patterns of preventive health behavior in a culturally diverse, multilingual region of northern Italy using data from a representative population survey (n = 2090). Preventive behaviors were assessed using the 16-item Good Health Practices (GHP-16) scale. Latent profile analysis (LPA) identified five behavioral profiles, ranging from ‘Globally Low Engagers’ to ‘Comprehensive High Engagers’. Binary logistic regression compared ‘Globally Low Engagers’ to ‘Broadly Moderate Preventers’, examining predictors including gender, age, education, language, chronic disease status, health literacy (HLS-EU-Q16), patient activation (PAM-10), mistrust of health information, living situation, and healthcare employment. The results showed that men, younger adults, individuals with low patient activation, those living alone, and respondents with high mistrust of health information had higher odds of belonging to the low engagement group. Health literacy and language group membership were not significantly associated with the profile membership. Item-level comparisons revealed gender differences in information-seeking, oral hygiene, and dietary behaviors, with men reporting lower engagement. These findings support a segmentation-based understanding of preventive health behavior and highlight the need to address personal capacities and contextual barriers in interventions while challenging assumptions of uniformly higher female health vigilance. Full article

Background/Objectives: Despite the psychological benefits of breast reconstruction (BR) after mastectomy, uptake remains limited among women with breast cancer. This study explores psychosocial and personality predictors of BR intentions in the pre-mastectomy phase, aiming to inform strategies for mental health promotion in oncology care. Methods: This cross-sectional analysis used preoperative data from a longitudinal study at a university hospital in Greece. Women with primary breast cancer scheduled for mastectomy completed a battery of validated self-report measures, including the International Personality Item Big-Five Factor Markers (IPIP-BFFM), the Hospital Anxiety and Depression Scale (HADS), and the Short Form-36 Health Survey (SF-36). Demographic, clinical, and psychosocial data were also collected. Binary logistic regression was used to examine predictors of (a) BR information-seeking and (b) BR intention. Results: Seventy-four women participated (mean age = 61.1 years). Older age predicted lower BR intention (Exp(b) = 0.897, 95% CI: 0.829–0.970) and information-seeking (Exp(b) = 0.925, 95% CI: 0.859–0.997). Single/divorced status was associated with reduced BR information-seeking (Exp(b) = 0.053, 95% CI: 0.005–0.549). Openness to experience significantly predicted both outcomes (BR information-seeking: Exp(b) = 1.115, 95% CI: 1.028–1.209); BR intention: Exp(b) = 1.095, 95% CI: 1.016–1.181). Higher physical health-related QoL scores were associated with increased BR intention (Exp(b) = 1.039, 95% CI: 1.007–1.072), whereas higher mental health-related QoL (Exp(b) = 0.952, 95% CI: 0.912–0.994) and higher depression scores (Exp(b) = 0.797, 95% CI: 0.638–0.996) were linked to decreased BR intent. No psychological factor significantly predicted information-seeking. Conclusions: These findings underscore the value of psychosocial screening and personality-informed counseling prior to surgery. By identifying individuals less likely to seek information or consider BR, pre-mastectomy assessments can contribute to tailored, mental health-promoting interventions and support informed, patient-centered surgical decision-making. Full article

Background: Childhood hearing loss is a public health problem of critical importance associated with speech development, academic achievement, and quality of life. Parents’ awareness and knowledge about risk factors contribute to early detection and timely intervention.  Objective: This study aims to examine Jordanian mothers’ knowledge of childhood hearing loss risk factors and investigate the impact of education level and socioeconomic status (SES) on the accuracy and comprehensiveness of this knowledge with the moderating effect of health literacy. Material and Methods: The approach employed an embedded mixed-methods design with a dominant quantitative strand supported by qualitative data, utilizing quantitative surveys (n = 250), analyzed using structural equation modeling (SEM) in SmartPLS, and qualitative interviews (n = 10), analyzed thematically to expand upon the quantitative findings by exploring barriers to awareness and healthcare-seeking behaviors. Results: The accuracy and comprehensiveness of knowledge of hearing loss risk factors were also positively influenced by maternal knowledge of hearing loss risk factors. Maternal knowledge was significantly associated with both education level and socioeconomic status (SES). Furthermore, maternal knowledge and accuracy were significantly moderated by health literacy, such that mothers with higher health literacy exhibited a stronger relationship between knowledge and accuracy. Qualitative findings revealed that individuals encountered barriers to accessing reliable information and comprehending medical advice and faced financial difficulties due to limited options for healthcare services. Conclusions: These results underscore the need for maternal education programs that address specific issues, provide simplified healthcare communication, and enhance access to pediatric audiology services. Future research should explore longitudinal assessments and intervention-based strategies to enhance mothers’ awareness and detect early childhood hearing loss. Full article

This article focuses on how rising nativism, manifested through immigrants’ experiences of everyday discrimination, and Florida’s legal context (ascertained through immigrants’ fears of deportation), are related to immigrants’ hesitation when seeking healthcare services. Hesitation to seek healthcare, or healthcare hesitancy, is examined in the context of Florida’s SB1718, a law passed in 2023 that criminalized many aspects of being an immigrant. Based on a survey of 466 Florida immigrants and U.S. citizen adult children of immigrants, logistic regression analysis reveals that everyday experiences with discrimination are associated with a reluctance to seek healthcare services among this population. In particular, those with insecure legal immigrant status (i.e., undocumented and temporary statuses), those with financial hardship, and women demonstrate reluctance to engage with healthcare systems when controlling for other sociodemographic factors. Findings from this study exemplify how immigration policies that restrict access to healthcare and social services not only create logistical barriers to seeking care but also foster a climate of fear and exclusion that deters even those with legal status from seeking medical attention. Full article

Introduction: Visual impairment impacts millions of people around the world, with the vast majority of problems being treatable. Disadvantaged communities are unable to utilize the same resources to treat these problems due to a lack of knowledge or resources, in addition to the presence of barriers preventing access. The objective of this paper is to assess eye health awareness and evaluate the barriers for individuals from disadvantaged communities in order to inform future interventions and increase access to care. Methods: This is a pilot study utilizing an online anonymous questionnaire designed to assess the demographics, eye health awareness, and access to eye care of community-based patients. A comprehensive literature review was also conducted using PubMed, Scopus, and Google Scholar to evaluate barriers to eye care and methods to improve community health outcomes. The primary goal was to improve understanding of eye health awareness and access in order to inform future strategies that can help in improving eye health awareness and service availability. Results: The results indicated that 61.2% of respondents believed that eye exams are very important, and only 7.7% of participants believed that regular eye exams are not important. The majority of participants (75%) agree that regular eye exams help prevent serious eye conditions and 84.5% believe that eye health can affect quality of life. 35.6% of participants reported they had their eyes checked by a healthcare professional within the last year, while 21.2% reported never having an eye exam. Although the majority of participants found access to eye care services in their community somewhat or very easy, 8.6% and 9.5% of participants found access difficult and very difficult, respectively. Even though 45.6% of participants reported not facing any barriers regarding access to eye care, the cost of services, long waiting times, and lack of nearby eye care providers were often cited as barriers from the remainder of the participants. Moving forward, local interventions such as mobile eye clinics, public health workshops, and telehealth are viable options to obtain an understanding of the community’s health status in addition to creating opportunities to educate and provide health screenings. Conclusion: The results indicate that although there is awareness of the importance of eye health for the majority of participants, there is still a sizable minority who have insufficient understanding. Barriers to healthcare such as cost, waiting times, and proximity to providers are common problems that are preventing many from seeking eye care. Future interventions should be created to increase access and literacy amongst the community through telehealth, mobile eye clinics, and public health workshops. Additional efforts should be taken by healthcare stakeholders to enhance care delivery, implement policies, and improve awareness. Full article

In arid agricultural production, exploring suitable water-saving irrigation strategies and analyzing their water-saving mechanisms are of great significance. Alternating partial root-zone drying irrigation (APRI), a water-saving strategy, enhances the water use efficiency (WUE) of alfalfa (Medicago sativa L.) This paper aims to clarify the physiological mechanisms by which the APRI method enhances the physiological WUE of alfalfa, as well as the differences between this water-saving irrigation strategy, conventional irrigation (CI), and their water deficit adjustments, in order to seek higher water use efficiency for alfalfa production in arid regions. In this experiment, alfalfa was used as the research subject, and three irrigation methods, CI, fixed partial root-zone drying (FPRI), and APRI, were set up, each paired with three decreasing moisture supply gradients of 90% water holding capacity (WHC) (W1), 70% WHC (W2), and 50% WHC (W3). Samples were taken and observed once after every three complete irrigation cycles. Through a comparative analysis of the growth status, leaf water status, antioxidant enzyme activity, and osmotic adjustment capabilities of alfalfa under different water supplies for the three irrigation strategies, the following conclusions were drawn: First, the APRI method, through artificially created periodic wet–dry cycles in the rhizosphere soil, provides pseudo-drought stress that enhances the osmotic adjustment capabilities and antioxidant enzyme activity of alfalfa leaves during the early to middle phases of irrigation treatment compared to CI and FPRI methods, resulting in healthier leaf water conditions. Secondly, the stronger drought tolerance and superior growth conditions of alfalfa under the APRI method due to reduced water availability are key factors in enhancing the water use efficiency of alfalfa under this strategy. Full article

Background and Objectives: Urinary incontinence (UI) is a prevalent condition that significantly affects quality of life but remains underreported. Understanding the factors that influence patients’ decisions to seek medical consultation is essential for improving care-seeking behavior and ensuring timely intervention. This study aimed to identify the facilitators of seeking medical consultation among individuals with UI in a Saudi secondary care setting. Materials and Methods: A cross-sectional study was conducted from December 2024 to April 2025 among adult patients with UI attending urology and urogynecology outpatient clinics at a single tertiary center. Participants completed a structured, self-administered questionnaire that comprised sociodemographic data, the ICIQ-UI SF, and 33 potential motivators for seeking care, categorized into six domains. Results: A total of 241 participants were included in the study. The 33-item scale demonstrated excellent internal consistency (Cronbach’s α = 0.945). The most influential domains were daily and physical impact, followed by emotional and psychological factors. Top facilitators included interference with prayers (66.8%), use of pads (62.2%), social limitations (63.9%), frequent clothing changes (64.7%), and fear of worsening symptoms (63.5%). Cultural factors, such as access to same-sex specialists (52.2%), were also prominent. Logistic regression identified age, marital status, and motivators from several domains as significant predictors. Key independent predictors included prayer interference, leakage frequency, and gender-concordant care. Conclusions: Help-seeking for UI is influenced by physical, emotional, social, and cultural factors. Enhancing patient education, addressing sociocultural sensitivities, and promoting physician-led discussions foster earlier care-seeking and improve health outcomes in populations with traditionally low treatment uptake. Full article

Sexual minority women (SMW) are a resilient yet vulnerable population who may experience poor psychosocial outcomes due to minority stress associated with their marginalized status and traumatic experiences resulting from interpersonal and structural violence. When SMW are incarcerated, the trauma of this experience can exacerbate existing mental health challenges. Self-concept is a key measure of mental health that is associated with increased self-efficacy and positive psychosocial outcomes. This analysis explores the ways in which incarceration impacts the self-concept of SMW. Secondary data analysis of three qualitative interviews with formerly incarcerated SMW was conducted. Specifically, Gilligan’s Listening Guide was used to create “I poems” that articulate the participants’ narratives and contrapuntal voices. These poems were then analyzed to build knowledge about participants’ self-concept. This analysis informs our understandings of self-concept among SMW, violence against women, the vulnerability of binary constructs, and the ways in which people negotiate past, present and future selves. The findings can inform interventions that seek to mitigate the psychosocial risks faced by SMW and formerly incarcerated people and improve outcomes for these populations. Full article

With increasing global climate change, carbon neutrality has emerged as a common goal among the international community. In this study, we assessed the current status, development potential, and cost of carbon sequestration technology, proposing recommendations for strategic development. We adopted a comprehensive multi-method research strategy, including systematic literature analysis, case studies, and Bayesian fuzzy assessment, to analyze 13 large-scale carbon capture, utilization, and storage demonstration projects in China that include carbon sequestration segments. In addition, we conducted a comprehensive assessment of seven major carbon sequestration technologies. Hydrate-based carbon sequestration technology showed the highest overall carbon sequestration potential among the technologies. Although still in the initial research stage, this technology has significant sequestration and utilization potential, positioning it as a key focus for future development. Accordingly, we recommend increasing R&D investments to accelerate technology maturation. In terms of cost optimization, we highlight the need to focus on site costs, as well as injection and production, and to reduce related costs through technological innovation. Additionally, we explore the conceptual meaning of carbon sequestration and clarify the involved pathways. This study provides valuable insights for policymakers and investors seeking to promote the development of carbon sequestration technology in China. Full article

Background: The present study seeks to examine how social disparities relate to the prevalence of poor glycemic control (HbA1c ≥ 7%), comorbidities such as hypertension and dyslipidemia, and diabetes-related complications (microvascular or macrovascular) among Saudi patients diagnosed with type 2 diabetes. Methods: A cross-sectional study was conducted among 574 patients with type 2 diabetes mellitus (T2DM) attending family medicine clinics at King Saud University Medical City in Riyadh. Participants were selected using a simple random sampling technique and interviewed via phone using a validated questionnaire. Data collected included demographic and clinical variables. Descriptive statistics and multivariate logistic regression analyses were performed to assess the association between socioeconomic status (SES) and cardiovascular complications, including stroke, dyslipidemia, hypertension, and acute coronary syndrome. Result: The analysis revealed that certain socioeconomic factors significantly increased the odds of cardiovascular complications among patients with T2DM. Being female was associated with higher odds of hypertension (OR = 2.29, p = 0.014), dyslipidemia (OR = 2.59, p = 0.012), acute coronary syndrome (ACS) (OR = 2.35, p = 0.001), and stroke (OR = 2.17, p = 0.003). Divorced or widowed participants had significantly increased odds of ACS (OR = 2.91, p = 0.001) and stroke (OR = 2.83, p = 0.002). A lower educational level (secondary school or less) was significantly associated with increased odds of hypertension (OR = 2.64, p = 0.031), dyslipidemia (OR = 2.22, p = 0.005), and stroke (OR = 2.88, p = 0.042). Monthly income between 3001 and 6000 SAR was significantly associated with higher odds of ACS (OR = 2.61, p = 0.003) and stroke (OR = 2.64, p = 0.012). Participants with diabetes duration >15 years had higher odds of dyslipidemia (OR = 2.86, p = 0.004) and stroke (OR = 2.89, p = 0.005). Being retired or not working increased the odds of all four cardiovascular outcomes, with stroke showing the highest risk (OR = 3.18, p < 0.001). Living outside the Riyadh region was also associated with elevated risk across outcomes, notably stroke (OR = 1.52, p = 0.046). Conclusions: The study concluded that notable social disparities exist among diabetic individuals affected by cardiovascular conditions, such as stroke and acute coronary syndrome (ACS), as well as risk factors for cardiovascular disease like dyslipidemia (DLD). These findings can inform targeted cardiovascular risk reduction strategies and address health inequities among diabetic populations in Saudi Arabia. Full article

The affected family members (AFM) of relatives with substance use problems (RSU) play an important role in supporting their relatives to enter substance use treatment. This study investigated the help-seeking behaviours for their relatives by AFM in Brazil, including the characteristics of those who sought help and the risk factors for delaying it. A secondary analysis from a national cross-sectional study of 3030 AFM was performed. Participants were recruited from a range of services focused on AFM across each of the five Brazilian regions (North, Northeast, Central-West, Southeast, South). While 92.7% sought help, 66.0% delayed for an average of 37.2 (SD 70.71) months. Help seeking was associated with higher socioeconomic status and being from the Southeastern region. Barriers included the relative refusing help (31.5%) and the belief that help was not needed (20.6%). Longer delays were associated with female AFM, residents in the Central-West region, non-parents, older RSU, alcohol use, and withdrawal coping strategies. The findings show disparities in help-seeking behaviour across socioeconomic groups, regions, and substance types, highlighting the need for better healthcare workforce distribution and targeted interventions to educate AFMs on the importance of engagement with healthcare services. Full article

Sulfonamide drugs (SAs) are a class of emerging contaminants widely present in water environments, which has gradually attracted attention from scholars worldwide. Based on the Web of Science core collection database, this study employs bibliometric methods and visualization tools, such as CiteSpace, Bibliometrix, and VOSviewer, to systematically analyze the literature on the treatment of SAs from 2004 to 2024, exploring the research status, hotspots, and development trends in this field. The results indicate that research on SAs in the past 20 years can be categorized into three stages: initial exploration (2004–2008), slow development (2009–2016), and in-depth research (2017–2024), with an overall increasing trend in number of publications. China and the United States have published the most articles on SAs, with 2266 and 592 articles respectively, and the collaborative ties between the two countries are the strongest. The Chinese Academy of Sciences is the most prolific institution, having published 348 articles. Science of the Total Environment is the journal with the highest publication volume. Among the many SAs, sulfamethoxazole has garnered the greatest research interest, and its primary entry route into the water environment is through the discharge of sewage treatment plants. The research focus has gradually shifted from the source analysis of SAs in the environment to seeking efficient methods for removing SAs. Future research should prioritize investigations into antibiotic-resistant bacteria and antibiotic resistance genes associated with SAs. Full article

Objective: The aim of this study is to investigate uterine prolapse (UP) among women attending a semi-urban health center for routine gynecological examinations. Specifically, the study explores the potential association between UP and various established or suspected risk factors, including age, menopausal status, number and mode of deliveries, birth weight, smoking habits, and body mass index (BMI). Furthermore, it examines the relationship between the presence or severity of UP and the scores of specific questionnaires and their subscales. Finally, the study seeks to develop a predictive model for the likelihood of UP based on questionnaire responses. Methods: A quantitative study was conducted at the gynecological department of a health center in Greece from January 2021 to October 2022. A total of 134 women were recruited using convenience sampling during routine gynecological visits. The degree of prolapse was classified according to the International Continence Society (ICS) Pelvic Organ Prolapse Quantification (POP-Q) classification system. Data collection also included the use of validated instruments: the Australian Pelvic Floor Questionnaire (APFQ), the Urogenital Distress Inventory-6 (UDI-6), the Pelvic Floor Distress Inventory-20 (PFDI-20), and the Pelvic Floor Impact Questionnaire-7 (PFIQ-7). The data were processed with the Statistical Package for the Social Sciences (SPSS) v25. Results: Of the 134 participants, 21 (15.7%) aged 21 to 82 showed signs of UP, while 113 women (84.3%) did not. The average age of the women with UP was 55 years. Fourteen (10.4%) of these women were diagnosed with UP stage I, three of them (2.2%) with stage II, and four of them (3%) with stage III UP. There were no stage IV UP incidents. The risk factors associated with the disease include age, mode of delivery, parity, and duration of menopause. Regarding parity, every subsequent birth after the first one increases the likelihood of a UP incident by approximately 125%. Conclusions: Most women with UP did not exhibit severe symptoms, as UP typically does not manifest symptoms until it reaches a final stage. Considering the population aging and the increase in morbidity, a regular pelvic organ prolapse (POP) checkup should be established to facilitate early recognition, prevention, and treatment of symptoms. This study offers a potential tool for non-invasive screening to facilitate identifying UP in women early, which has not been previously reported. Full article

Abnormal deposition of β-amyloid (Aβ) is a core pathological feature of Alzheimer’s disease (AD). Syndecan-3 (SDC3), a type I transmembrane heparan sulfate proteoglycan (HSPG), is abnormally overexpressed in the brains of AD patients and model animals, specifically accumulating in the peri-plaque region of amyloid plaques. However, its regulatory mechanism in the process of Aβ deposition remains unclear. This study aims to clearly define the role of SDC3 in Aβ aggregation and neuroinflammation, two critical processes in AD pathogenesis. Specifically, we investigate how SDC3 modulates Aβ aggregation and its interaction with neuroinflammatory pathways, which may contribute to the progression of AD. By elucidating the mechanisms underlying SDC3’s involvement in these processes, we seek to provide new insights into potential therapeutic targets for AD. In this study, a 5×FAD mouse model with downregulated SDC3 expression was constructed. Behavioral assessments and synaptic function tests were performed to explore the effects of SDC3 on cognition in 5×FAD mice. Immunofluorescence co-localization technology was utilized to analyze the pathological co-deposition of SDC3 and Aβ in the hippocampus, cortex, and meningeal blood vessels. Quantitative assessments of pro-inflammatory cytokines such as Tnf-α and Cxcl10 in the brain were performed through histopathological analysis combined with qPCR. Western blotting was used to examine the phosphorylation status of STAT1/STAT3 and the expression changes of IBA1/GFAP to systematically analyze the molecular mechanisms through which SDC3 regulates AD pathology. This study revealed that SDC3 expression was significantly upregulated in the brain regions of the 5×FAD model mice and co-localized pathologically with Aβ. Cell lineage tracing analysis showed that the elevated SDC3 expression primarily originated from glial cells. Behavioral and pathological results demonstrated that downregulation of SDC3 significantly improved cognitive dysfunction in the model mice and effectively reduced the Aβ burden in the brain. Molecular mechanism studies showed that downregulation of SDC3 reduced the phosphorylation of STAT1 and STAT3, thereby inhibiting the activation of the JAK-STAT and cGAS-STING signaling pathways, reducing the activation of microglia/astrocytes and suppressing the expression of pro-inflammatory cytokines such as Tnf-α and Cxcl10. This study reveals that SDC3 co-localizes with Aβ pathology and synergistically exacerbates neuroinflammation. Knockdown of SDC3 can simultaneously reduce both Aβ deposition and the release of inflammatory factors from glial cells. Mechanistic research indicates that SDC3 drives a “glial activation–cytokine release” vicious cycle through the JAK-STAT and cGAS-STING signaling pathways. These findings suggest that SDC3 may serve as a key hub coordinating amyloid pathology and neuroinflammation in AD, providing new insights for the development of combination therapies targeting the HSPG network. Full article