Search Results (135)

Background: This study explored the observations and experiences of athletic trainers (ATs) regarding food security constraints and drivers among collegiate student-athletes through the framework of the social determinants of health (SDOH). Methods: Seventeen ATs from nine public Mountain West Division I schools participated in one of six 90 min, virtual focus groups conducted in July–December 2023. A phenomenological design and constructivist theoretical framework were employed to analyze transcripts, compile themes, infer food security constraints and drivers, and map them to SDOH domains. Results: Emerging constraints and drivers mapped to seven of the eight SDOH domains (education, employment, health systems and services, housing, income and wealth, physical environment, and social environment); no themes related to the public safety domain. Conclusions: ATs identified a considerable number of food security constraints and drivers; however, based on the findings of other studies, their observations were not comprehensive. Incorporating the findings of those other studies, food security constraints and drivers exist across all eight SDOH domains. Four concepts spanned multiple domains: student-athlete normative expectations, nutrition/food security prioritization, financial disparities, and residing off campus. To ensure food security among collegiate student-athletes, AT perceptions suggest that structural changes facilitating the implementation of necessary food drivers may be warranted. Full article

Education is a well-established determinant of health and well-being, yet its benefits may not be equally distributed across populations. This study examines whether educational attainment predicts psychological well-being, financial difficulty, and social support among deaf adults and whether these associations differ from those observed among hearing adults. Using nationally representative data from the U.S. Household Pulse Survey, we analyzed a weighted sample of adults aged 25–54 (N = 36,810), employing multivariate linear regression models that included education, hearing status, their interaction, and demographic covariates. Higher education was generally associated with more favorable outcomes among deaf adults, particularly in psychological well-being and social and emotional support, though effects were modest and less consistent for financial difficulty. Hearing adults reported significantly better outcomes across all domains, and interaction effects indicated that the benefits of education were significantly larger for hearing adults than for deaf adults. These findings suggest that while education remains beneficial for deaf people, its protective effects are limited, likely due to persistent structural and communication barriers. Given the importance of education, improving access alone will not eliminate disparities in well-being without concurrent efforts to address structural and social inequities. Full article

Introduction: Diabetic foot ulcers (DFUs) are a debilitating complication of diabetes, and management by multidisciplinary foot teams has been shown to reduce serious sequelae, such as amputations. There are stark racial and ethnic disparities in morbidity and mortality from DFUs, and multidisciplinary care has been shown to reduce lower extremity amputations, length of hospital stays and readmissions. This is a review of the impact of multidisciplinary care on DFUs, particularly regarding social determinants of health, with an illustrative case. Case Presentation: This is a case of a 32-year-old African American male with Type 1 Diabetes, a history of poor glycemic control, attention deficit hyperactivity disorder, tobacco and marijuana use disorder, and multiple social and structural barriers to care. He presented with bilateral Wagner grade 3 DFUs with osteomyelitis to the emergency department, requiring hospitalization. Upon discharge, he was referred to a multidisciplinary diabetes clinic and received coordinated support from endocrinology, podiatry, vascular surgery, infectious disease, pedorthics, and behavioral health. Comprehensive evaluation, intensive wound care with adjuvant hyperbaric oxygen therapy, offloading, blood glucose management and medical source control of infection were established for his treatment plan. At the three-month follow-up, the patient’s wound beds had significantly improved, and his Hemoglobin A1c declined from 12.6% to 9.3%. The right plantar wound completely epithelialized, and the left foot wound showed 90% contracture. Review and Discussion: This case highlights the importance of integrated, multidisciplinary care for DFUs, particularly in addressing both the clinical and social drivers of complications from diabetes. Full article

The Pan American Health Organization (PAHO) recognizes ethnicity as a structural determinant of health, yet ethnic–racial analyses of neglected tropical diseases remain scarce. This study investigated cumulative notification and mortality rates of American cutaneous leishmaniasis (ACL) in Brazil from 2016 to 2025 according to the official Brazilian race/color categories. Data were obtained from the Notifiable Diseases Information System (SINAN/DATASUS), and temporal and spatial patterns were analyzed. ACL showed marked geographic heterogeneity, with the highest cumulative notification rates concentrated in the North and Central-West regions. Indigenous and Asian populations presented the highest cumulative notification rates, whereas mortality rates were highest among Indigenous populations and remained elevated among Brown populations in several settings. Spatial clusters were concentrated mainly in the Brazilian Amazon, reinforcing the persistence of territorial inequalities in ACL distribution. Overall, the findings reveal substantial race/color and geographic disparities in both ACL occurrence and mortality in Brazil, underscoring the need for more equitable surveillance, prevention, and control strategies. Full article

Objective: To map the scientific evidence and identify knowledge gaps regarding the health of Black and Sexual and Gender Minority populations within the global context of health education. Introduction: Health education curricula should explicitly recognize, define, and address the specific needs and health disparities affecting Black and Sexual and Gender Minority populations to ensure that healthcare provision is comprehensive and inclusive in diverse settings. Eligibility criteria: Studies related to professional health training at undergraduate and graduate levels, as well as other educational modalities addressing healthcare provision for Black and Sexual and Gender Minority populations, were included. Methods: This scoping review was conducted following the JBI methodology. Studies were retrieved from Scopus, Web of Science, PubMed, Embase, MEDLINE, Virtual Health Library, CINAHL, ERIC, Cochrane Library, Brazilian Digital Library of Theses and Dissertations, ProQuest Dissertations & Theses Global, EBSCO databases, and the Networked Digital Library of Theses and Dissertations, without language or time restrictions. Two independent reviewers screened the studies and extracted data using a standardized form developed for this review. Concepts, definitions, structures, results, and applications of professional health education for the care of Black and Sexual and Gender Minority populations were systematically synthesized. The results were organized and presented in tabular and graphical formats, accompanied by a narrative summary. Results: A total of 104 studies were included. The evidence was predominantly concentrated in North America, particularly in the United States, with limited representation from other regions. Most studies were published after 2020, indicating a recent expansion of research interest. The methodological profile was characterized by a predominance of quantitative and descriptive designs, alongside qualitative and mixed-methods approaches. Thematic analysis revealed a concentration of studies addressing gender-affirming care, workforce diversity, social determinants of health, and discrimination, while intersectional approaches and long-term educational outcomes remained less explored. Conclusions: The available evidence indicates that health education has increasingly incorporated themes related to equity and diversity; however, the integration of structured and mandatory curricular approaches addressing the intersectional health needs of Black and Sexual and Gender Minority populations remains limited. The findings highlight the need for broader geographic representation, stronger methodological designs, and the development of comprehensive educational strategies capable of addressing structural inequalities within health training contexts. Full article

Healthcare disparities are widespread across the U.S. Mobile health programming is designed to dismantle systemic healthcare barriers for medically underserved communities. The purpose of this study was to assess the effectiveness of two southeastern U.S. mobile primary care programs. Guided by the Social Determinants of Health framework, this descriptive study examines the programs’ patient populations to determine reach and patient medical data to ascertain patients’ connection to the medical system and long-term primary care. Data were collected via electronic health record (EHR) and analyzed in Power BI and R. Basic descriptive, crosstab and chi-square statistics were conducted to assess the patient population and explore patient healthcare engagement prior to and following their initial mobile primary care visit. The results indicate that mobile primary care programs are utilized by systemically underserved groups, with both program A and B’s patient population identifying primarily as Latin/Hispanic (69.6% and 41.3% respectively), uninsured (99.1% and 59.8%), and Spanish-speaking (64.4% and 42.3%). Additionally, each program demonstrates an ability to engage patients in long-term primary care utilization via repeat utilizers (65.5% and 25.9%). McNemar’s chi-square results show that participation in either of the mobile primary care programs has a statistically significant, non-random measurable effect on patient primary care enrollment. Differences in program structure and findings are explored, and recommendations for future practice, research, and policy are discussed. Full article

Background/Objectives: An effective dental workforce is essential to ensure timely, high-quality oral healthcare across health systems worldwide. Many countries are currently facing challenges related to workforce supply, professional mobility, and the alignment between training capacity and population needs. Using Israel as an empirical case, this study examines long-term trends in the national dental workforce and explores their relevance for international workforce planning. Methods: A retrospective longitudinal analysis was conducted using Israel’s National Health Professions Database (“Oskim”), supplemented by data on dental education and specialty training. Descriptive longitudinal analyses were performed to evaluate workforce trends over time, and inferential statistical analyses were used to assess differences in demographic and geographic workforce distributions. Workforce indicators were analyzed using internationally standardized metrics to enable comparison with OECD healthcare systems. Results: The number of licensed dentists increased substantially, while the number of actively practicing dentists grew more moderately, reflecting a widening gap between licensure and workforce participation. Between 2008 and 2023, the number of licensed dentists increased by 49.9%, compared with a 40.4% increase in the actively practicing workforce. Accordingly, the practicing dentist-to-population ratio increased only slightly, from 0.80 to 0.84 per 1000 population. Israel reported 0.84 practicing dentists per 1000 population in 2023, exceeding the OECD average of 0.70. However, despite exceeding the OECD average, the relatively modest increase in the practicing workforce suggests that higher dentist-to-population ratios may overestimate actual workforce capacity when workforce participation patterns are not taken into account. Internationally trained dentists accounted for approximately 75% of new licensees, highlighting the role of professional mobility in shaping workforce supply. The proportion of dental specialists remained relatively stable at approximately 10%. In addition, the number of licensed dental hygienists increased by 96.1% (from 1468 to 2879), while the number of newly licensed hygienists declined by approximately 43% (from 174 to 100 annually). Conclusions: Despite substantial growth in the number of licensed dentists, the practicing workforce and specialist capacity expanded only modestly, and geographic disparities persisted. The difference between growth in licensed dentists and the actively practicing workforce highlights the importance of incorporating participation measures into national monitoring and oral health planning policies. The Israeli experience illustrates how workforce expansion driven by internationally trained dentists may coexist with structural challenges in participation, specialization, and distribution. These findings highlight broader considerations for oral health workforce planning and may provide insights for other health systems facing similar demographic and staffing dynamics. Because indicators of oral health need, service utilization, disease burden, and workforce productivity were unavailable, the study could not determine whether the observed workforce supply was adequate to meet population oral health needs. Full article

Background: Sustainable head and neck cancer (HNC) surgery is challenged by environmental impact, workforce shortages, inequitable access to advanced techniques, and policy constraints. Addressing these areas is critical for equitable, high-quality care. Methods: This structured narrative review synthesizes evidence on environmental sustainability, workforce development, technological innovation, health policy, and socioeconomic determinants in HNC surgery, without aiming to provide a systematic or exhaustive evidence synthesis. Sources included peer-reviewed literature, global workforce surveys, and international policy reports, with a focus on disparities between high-income countries (HICs) and low- and middle-income countries (LMICs). Results: Operating rooms produce up to 70% of hospital solid waste and consume 3–6 times more energy than other units; reusable instruments and improved waste segregation can reduce carbon footprints by over 50%. Workforce shortages are severe in LMICs, where subspecialty training is scarce; global partnerships, bidirectional education, and simulation-based learning can expand local capacity. Telemedicine, artificial intelligence, and three-dimensional printing enhance surgical planning, training, and access but may widen disparities without equitable deployment. Policy tools—including diagnosis-related groups, bundled payments, and universal coverage—affect access and innovation uptake. Pandemic preparedness underscores the value of resilient systems with flexible staffing and telehealth integration. Conclusions: HNC surgery requires coordinated action across environmental, workforce, technological, socioeconomic, and policy domains; however, future systematic reviews are needed to comprehensively map the evidence base and assess its methodological quality. Embedding sustainability in clinical practice, ensuring equitable innovation access, and aligning reimbursement with high-value care can strengthen system resilience, improve outcomes, and support long-term surgical service viability. Full article

Understanding the impact of neighborhood-level factors on stroke prevalence is crucial for addressing existing disparities. However, there is a distinct lack of ecological studies at the census tract level that investigate the social determinants of health (SDOH) influencing stroke prevalence within the U.S. Health and Human Services Region 3 (HHS Region 3: Delaware, Maryland, Pennsylvania, Virginia, West Virginia, and the District of Columbia). This study adopted a multivariate modeling approach to investigate the association between the 13 indicators of the Health Opportunity Index (HOI) and stroke prevalence at the census tract level in HHS Region 3 using four HOI indicator profiles and to highlight the specific SDOHs that are most associated with stroke prevalence. The four HOI indicator profiles include: (a) neighborhood and built environment profile, (b) social and community context profile, (c) resource profile, and (d) economic profile. The methodological approach was quantitative, using secondary data. The sample size was 8021 census tracts. The HOI was estimated for each census tract in the study area. Ordinary least squares regression (OLS) analysis and spatial lag model (SLM) were run to examine whether the 13 indicators of the HOI (categorized into four profiles) reliably predict stroke prevalence and to determine the most appropriate model that best identifies the strongest predictors of stroke prevalence. The results show that affordability, education, spatial segregation, and income inequality indicators were the strongest predictors of stroke prevalence in HHS Region 3. This granular research identifies the neighborhood-level SDOH most strongly linked to stroke prevalence, which can be leveraged to guide the development of targeted public health programs, quality improvement initiatives, resource allocation, and policy creation to combat stroke-related morbidity and mortality across census tracts in HHS Region 3. For example, the built environment, encompassing factors like employment access, affordable housing, and walkability, profoundly influences stroke prevalence and provides urban planners with practical insights for developing healthier, more equitable communities, such as creating neighborhood parks to encourage physical activity, a key factor in stroke prevention. This study also provides neighborhood organizations with the evidence needed to pursue grant funding and raise awareness about the socio-structural influences on stroke outcomes in their respective neighborhoods. Lastly, the insights generated from our study can facilitate collaborative decision-making processes with communities in HHS Region 3 regarding the prioritization of neighborhood-level SDOH for targeted public health interventions. This prioritization should focus on addressing predictors of stroke prevalence that are congruent with the community’s established priorities, thereby maximizing cost savings. Full article

Background: Dementia and Type 2 diabetes (T2D) represent two of the most pressing global public health challenges of our time, both exacerbated by physical inactivity. These conditions disproportionately affect Global Majority populations, who experience earlier onset, higher prevalence, and poorer access to culturally appropriate preventive care. However, conventional research and interventions often overlook the sociocultural and structural factors that underpin this disparity. This study synthesises current evidence to understand how these three conditions intersect and to identify equitable pathways for prevention and support. Methods: A meta-narrative review approach was employed to integrate evidence from diverse biomedical, public health, sociocultural and intervention science traditions. Searches were undertaken across MEDLINE/PubMed-adapted searches, CINAHL, PsycINFO, Web of Science Core Collection, AMED and ASSIA, supplemented by grey literature searching and citation chasing. Five meta-narratives were identified: biomedical and epidemiological, public health, health disparities, sociocultural and behavioural, and intervention science. Cross-narrative synthesis produced a conceptual framework linking upstream determinants, lifestyle factors, and disease outcomes. Results: The review revealed that structural inequities such as deprivation, environmental barriers and sociocultural factors including stigma, gendered norms, limited access to culturally appropriate facilities that restrict physical activity (PA) opportunities within Global Majority communities. These constraints elevate T2D and dementia risk through biological pathways involving insulin resistance, vascular injury, and neuroinflammation. Community-based participatory research (CBPR) interventions particularly those delivered in trusted cultural or faith settings emerged as effective strategies to improve PA, glycaemic control, and cognitive well-being. Conclusions: This synthesis reframes dementia and diabetes as interlinked within a wider syndemic driven by structural and sociocultural inequities. The proposed framework underscores the importance of culturally grounded, community-led approaches to promote brain health, reduce risk, and achieve equitable healthy ageing among Global Majority populations. Full article

Commercial determinants of health (CDoHs) describe how corporate practices influence population health. This scoping review aimed to characterize the extant evidence base regarding how CDoH in the sugar-sweetened beverage (SSB) industry affects health and health-related outcomes among Latinx populations in the United States of America (USA). The present study was conducted in accordance with the JBI methodology for scoping reviews. Overall, 1236 references were identified and imported for screening. After duplicate removal, screening, and full-text eligibility assessment, 33 studies met all inclusion criteria. SSB marketing and advertising was the most frequently examined CDoH (61%), including advertising exposure, messaging strategies, and warning label interventions. SSB taxation studies projected reductions in consumption and obesity prevalence. Outcomes associated with health focused primarily on perceptions of marketing and purchasing intentions (94%). Additional studies examined the impact on knowledge, attitudes, beliefs, and behaviors (e.g., purchasing and consumption of SSBs) (66%), while a few studies included chronic disease (27%) or healthcare outcomes (6%). Evidence highlights several gaps in CDoH research associated with SSBs, with 94% of the included studies focused on understanding marketing exposure, signaling a need to examine other domains of CDoH, SSB industry practices, and impacts on health disparities. Findings suggest that structural policy interventions such as taxation and stronger regulation of commercial practices are necessary to address higher exposure to marketing and consumption of SSBs among Latinx populations in the USA. Full article

Background/Objectives: Mental health and suicide prevention are increasingly recognized as critical components of sustainable development in the European Union (EU), particularly in light of the broader mental health challenges highlighted during the COVID-19 pandemic. This review aimed to explore suicide prevention policies and mental health strategies across selected European countries through a focused comparative analysis centered on the Republic of Cyprus. Methods: A narrative review design was applied. A purposive literature search focused on national strategies, epidemiological trends, policy papers, and peer-reviewed articles published from 2000 to January 2026 was followed. Databases searched included PubMed, Scopus, PsychInfo, Embase and Google Scholar, supplemented by grey literature from the World Health Organization (WHO), European Commission, and national health authorities. The review focused on selected European countries, i.e., the United Kingdom, Sweden, Finland, Greece, and the Republic of Cyprus, chosen to illustrate variation in suicide prevention policies, health system structures, and implementation frameworks. Evidence was critically appraised and synthesized thematically to identify commonalities and contrasts in policy, implementation and emerging challenges. Results: The review identified substantial variation in national suicide prevention strategies, monitoring systems, and policy implementation across the selected countries. Persistent gender- and age-related disparities in suicide patterns were observed, alongside the influence of socio-economic determinants, and the broader mental health effects associated with the COVID-19 pandemic. The findings also underscored the need for robust, gender-sensitive, and data-driven national strategies that are contextually grounded and equitably resourced. Conclusions: This review concludes with recommendations for enhancing mental health sustainability across Europe, emphasizing cross-sectoral coordination, improved surveillance systems, and future research priorities. Full article

Background and Objectives: Access to medicines is a fundamental determinant of health equity and a core pillar of universal health coverage, encompassing the timely availability, affordability, and appropriate use of essential medicines. Socioeconomic disparities may limit actual and timely access to pharmacological treatment, particularly in healthcare systems characterized by mixed public–private financing and significant out-of-pocket expenditures. This study aimed to evaluate socioeconomic determinants of access to medicines among Romanian patients with chronic diseases, focusing on income level, prescription reimbursement, perceived affordability, and substitution behavior during medicine shortages. Materials and Methods: A cross-sectional study was conducted between October and December 2024 using a structured online questionnaire administered to 200 adult patients diagnosed with cardiovascular diseases, diabetes mellitus, chronic hepatitis B and C, or oncological conditions, recruited at the “Prof. Dr. D. Hociotă” Institute of Phonoaudiology and Functional ENT Surgery, Bucharest, Romania. Associations between income and access-related variables were assessed using Spearman’s rank correlation coefficients with 95% confidence intervals. Binary logistic regression identified independent predictors of perceived difficulty in accessing medicines (p < 0.05). Results: Lower income was significantly associated with greater reliance on reimbursed prescriptions (r_s = −0.241, 95% CI: −0.37 to −0.10, p = 0.001) and fully reimbursed prescriptions (r_s = −0.305, 95% CI: −0.43 to −0.17, p < 0.001). Income was strongly correlated with perceived affordability of treatment (r_s = 0.601, 95% CI: 0.50–0.69, p < 0.001). In multivariate logistic regression analysis, income below 3000 RON/month (adjusted OR = 1.94, 95% CI: 1.05–3.58, p = 0.034) and insufficient affordability (adjusted OR = 4.12, 95% CI: 2.15–7.89, p < 0.001) were independently associated with perceived difficult access to treatment. Additionally, 80% of respondents reported purchasing substitute medicines when prescribed medicines were unavailable. Conclusions: This cross-sectional study indicates that socioeconomic status and perceived affordability are significant determinants of access to medicines among Romanian patients with chronic diseases attending a tertiary ENT centre. Financial vulnerability remains a major barrier despite existing reimbursement mechanisms. Policy interventions aimed at strengthening income-sensitive reimbursement strategies and ensuring consistent pharmaceutical availability may improve equitable access and therapeutic continuity. Full article

The transformation of healthcare systems presents a key challenge for EU Member States, as they face growing population needs, resource pressures, and ongoing health disparities among communities. Using a systems-thinking approach provides a suitable framework for analyzing how healthcare resources, behavioral and social health determinants, and overall population outcomes are interconnected. This study aims to explore these relationships from a systemic viewpoint within health communities across the European Union. The research employs a cross-sectional approach, utilizing aggregated data from all 27 EU Member States. It involves descriptive and factor analyses to create composite indices of healthcare resources, positive health determinants, and health outcomes. Furthermore, it uses a univariate Generalized Linear Model (GLM) and multilayer perceptron neural networks to model nonlinear relationships among variables. Cluster analysis is also conducted to classify Member States into different health performance typologies. The results emphasize connections between healthcare system resources and population health outcomes, illustrating how positive determinants impact health status and highlighting structural differences across European communities. The results indicate relevant associations between healthcare system resources and population health outcomes, whereas the analysis of positive health determinants suggests more complex, partly nonlinear patterns. The findings also highlight structural differences across European health communities. Full article

Introduction: Humanized care is a core indicator of nursing quality, yet its prevalence and determinants among Spanish undergraduates remain unclear. Methods: A cross-sectional survey was administered to fourth-year nursing students from public and private universities. Instruments included the Health Professional’s Humanization Scale (HUMAS), the Communication Styles Inventory-Revised (CSI-R) and a sociodemographic questionnaire that captured prior training: completion of ≥6 h role-playing seminars in patient–family communication. Results: Mean scores were 3.62 ± 0.48 for HUMAS and 2.50 ± 0.52 for CSI-R. Women exceeded men on HUMAS total (p = 0.025) and on Sociability, Emotional Understanding, Dispositional Optimism and Self-Efficacy (all p ≤ 0.013), but not on Affect-Regulation or CSI-R. Age correlated weakly with Optimism (r = 0.24) and Self-Efficacy (r = 0.21). Students who had completed the role-playing seminars recorded higher HUMAS totals (d = 0.50; p = 0.001) and sub-scores, with only a modest gain in Affect-Regulation, and showed a trend towards better CSI-R performance (p = 0.06). No differences emerged by university type. HUMAS and CSI-R correlated moderately (r = 0.32; p = 0.001). In multivariate analysis, training (β = 0.36; p = 0.001) and CSI-R (β = 0.26; p = 0.001) jointly explained 27.9% of humanization variance; male sex exerted a small negative effect (β = −0.19; p = 0.001), whereas age was nonsignificant. Conclusions: Structured communication seminars are a key factor associated with higher levels of humanization in senior nursing students, whereas sociodemographic influences are modest. Embedding longitudinal, simulation-rich modules in communication and emotional intelligence is therefore recommended to cultivate truly person-centered nurses and to narrow observed sex disparities. Full article