Search Results (52)

The present study aimed to analyze the differences in psychopathological symptomatology between men and women who participate in online gambling, as well as to explore the relationship between this symptomatology and different risk profiles. The sample consisted of 382 participants, all university students from a province in Spain, of whom 261 were men (68.3%) and 121 were women (31.7%), with a mean age of 21.8 years (SD = 3.2; range = 18–30 years). Psychopathological symptomatology was assessed using the SAS-45, while gambling risk profiles were determined using an ad hoc questionnaire. The results of the risk profiles were formed by categorizing the SOG-RA Scale scores into non-risk gambler, at-risk gambler, and pathological gambler. The results evidenced that gender and risk profile are determining factors in the manifestation of psychopathological symptoms. It was observed that women tend to internalize their emotional problems, presenting higher levels of depression, anxiety, and interpersonal sensitivity, while men exhibit a greater propensity to externalize their symptoms, manifesting hostility, paranoid ideation, and psychoticism. Furthermore, gamblers with high-risk profiles showed higher scores in both internalizing and externalizing symptoms. Significant correlations were identified between risk profile, psychopathological symptomatology, and cognitive distortions, suggesting the need for comprehensive interventions differentiated by gender. These findings provide valuable information for the design of specific treatments that address the emotional and cognitive needs of problem gamblers, contributing to improving the effectiveness of therapeutic strategies in the context of problem gambling. University gambling is an emerging public health issue with consequences that extend beyond the individual, affecting educational, social, and economic well-being. This study addresses a critical gap by delineating gender-specific psychopathological profiles across gambling risk categories, providing actionable evidence to inform campus-based screening and targeted prevention strategies. The findings underscore the necessity of integrating gender-responsive interventions and upstream measures—such as early detection within student health services and harm-reduction messaging—to effectively mitigate gambling-related harm. Full article

Background: Chronic diseases such as type 2 diabetes mellitus and cardiovascular disease and their cardiometabolic risk factors require management, which includes lifestyle interventions. Rural and remote residents are disproportionately affected by these conditions compared to their urban counterparts. Studies have examined barriers to chronic disease and cardiometabolic risk factor management in urban environments, but rural perspectives remain underexplored, especially in Western Australia (WA) with its vast geography. This study examined rural general practitioners’ (GPs) views on barriers and facilitators to chronic disease and cardiometabolic care in rural WA through lifestyle management. Methods: This qualitative study used semi-structured interviews with 15 rural WA GPs recruited via rural networks using convenience and snowball sampling. Braun and Clarke’s reflexive thematic analysis was used to identify patterns and themes within the qualitative data that addressed the study questions. Results: According to rural general practitioners, major barriers to chronic disease and cardiometabolic risk care included geographic isolation, socioeconomic disadvantage and an obesogenic food environment in rural areas, as well as severe time and financial constraints for GPs and workforce shortages with a high turnover and lack of accessible allied health professionals. Facilitators included co-located multidisciplinary teams, case management/health coaching, better remuneration for complex consultations involving preventive care and upstream policy measures, such as improving healthy food affordability and availability. Conclusion: Rural patients face systemic, geographic and socioeconomic barriers that are substantially greater than those in urban settings; these barriers impact GPs caring for their patients with chronic disease and cardiometabolic risk factors. Targeted solutions to these barriers such as attention to workforce issues, investment in lifestyle coaching approaches and having dedicated case managers, could reduce rural–urban inequities in chronic disease outcomes. Full article

This study presents a well-to-wheel life-cycle assessment (WTW-LCA) comparing battery-electric heavy-duty trucks (BEVs) with conventional diesel trucks, utilizing real-world fleet data from Southern California’s Volvo LIGHTS project. Class 7 and Class 8 vehicles were analyzed under ISO 14040/14044 standards, combining measured diesel emissions from portable emissions measurement systems (PEMSs) with BEV energy use derived from telematics and charging records. Upstream (“well-to-tank”) emissions were estimated using USLCI datasets and the 2020 Southern California Edison (SCE) power mix, with an additional scenario for BEVs powered by on-site solar energy. The analysis combines measured real-world energy consumption data from deployed battery electric trucks with on-road emission measurements from conventional diesel trucks collected by the UCR team. Environmental impacts were characterized using TRACI 2.1 across climate, air quality, toxicity, and fossil fuel depletion impact categories. The results show that BEVs reduce total WTW CO₂-equivalent emissions by approximately 75% compared to diesel. At the same time, criteria pollutants (NO_x, VOCs, SO_x, PM_2.5) decline sharply, reflecting the shift in impacts from vehicle exhaust to upstream electricity generation. Comparative analyses indicate BEV impacts range between 8% and 26% of diesel levels across most environmental indicators, with near-zero ozone-depletion effects. The main residual hotspot appears in the human-health cancer category (~35–38%), linked to upstream energy and materials, highlighting the continued need for grid decarbonization. The analysis focuses on operational WTW impacts, excluding vehicle manufacturing, battery production, and end-of-life phases. This use-phase emphasis provides a conservative yet practical basis for short-term fleet transition strategies. By integrating empirical performance data with life-cycle modeling, the study offers actionable insights to guide electrification policies and optimize upstream interventions for sustainable freight transport. These findings provide a quantitative decision-support basis for fleet operators and regulators planning near-term heavy-duty truck electrification in regions with similar grid mixes, and can serve as an empirical building block for future cradle-to-grave and dynamic LCA studies that extend beyond the operational well-to-wheels scope adopted here. Full article

Intensive aquaculture and animal farming along riverbanks have emerged as significant drivers of downstream public health risks, facilitating the transmission of zoonotic pathogens and antimicrobial resistance (AMR) genes from farm effluents into natural water systems. In this study, we conducted a comprehensive 12-week water monitoring program at the Wei River in Shandong, China, using a combination of rapid detection techniques (RPA-LFD) and whole-genome sequencing to trace the origins of detected pathogens. RPA-LFD screening revealed the sequential appearance of Vibrio parahaemolyticus, Aeromonas veronii, norovirus GII, and Brucella spp. in surface water from March onward, coinciding with documented wastewater discharge events from upstream shrimp and fox farms. Subsequent isolation efforts confirmed the presence of V. parahaemolyticus and A. veronii in both river water and shrimp samples, while Brucella abortus was isolated from fox feces and water samples. Whole-genome sequencing of bacterial isolates revealed that V. parahaemolyticus strains from water and shrimp shared identical sequence types (ST150 and ST809) and resistance gene profiles, indicating a clonal relationship. Similarly, B. abortus isolates from water and fox feces differed by fewer than five SNPs, confirming farm-to-water transmission. Norovirus GII.3 and GII.6 sequences from water and fecal samples clustered phylogenetically with regional clinical strains, suggesting local circulation and environmental dissemination. Our findings highlight the critical role of river water monitoring as an early warning system for pathogen spread, emphasizing the need for integrated surveillance systems that monitor both water quality and the health of upstream farms and wildlife populations. The combined use of RPA-LFD and whole-genome sequencing provides a robust framework for real-time detection and source tracing of zoonotic pathogens, offering valuable insights for future environmental monitoring and public health interventions. Full article

A strong body of evidence indicates that social determinants impact health. While this research has identified a range of risk factors for health, health equity goals require recalibration further “upstream” towards structural drivers of health and aging inequities. Recognizing how systems of power and chronic exposures are embodied and facilitate differential risks and opportunities is important for expanding research at the gender–race–age nexus. Specifically, adopting a structural aging approach can help contextualize health outcomes for older Black women. Drawing from previous research, we explore how structural drivers shape health, examine their impact on Black women’s life experiences, stress exposures, and present a model for interpreting social trajectories of oppression, resistance, and marginalization (i.e., the STORM model) across the lifespan. Extending research on strength, resistance, resilience, and coping may open new opportunities to reframe and understand older Black women’s health. Importantly, developing structural competence can facilitate “seeing structures” and advocating for structural interventions leading to critically minded theory, practice, and policy that properly situate aging processes within broader, intersectional contexts. Full article

Background: Tobacco use remains a leading preventable cause of morbidity and mortality in the United States, with persistent disparities in cessation outcomes across socioeconomic and racial groups. While numerous interventions exist, their effectiveness is shaped by complex interrelated factors at individual, social, and healthcare system levels. Identifying and modeling these causal pathways is essential to inform equitable intervention design. Methods: This study applied the Evidence Synthesis for Constructing Directed Acyclic Graphs (ESC-DAG) protocol to integrate empirical findings from 35 quantitative studies examining barriers and facilitators of tobacco cessation intervention uptake in the United States. Using the Andersen and Aday Health Services Research Model as a guiding framework, we extracted, harmonized, and synthesized significant causal relationships into a unified DAG, distinguishing exposures, outcomes, mediators, and confounders. Results: The integrated DAG revealed that structural factors such as socioeconomic disadvantage, digital inequities, rurality, and cultural barriers exerted substantial influence on cessation outcomes. These upstream determinants operated through mediators including motivation, treatment engagement, and access barriers, while healthcare system factors such as provider engagement and proactive outreach emerged as consistent facilitators. Digital access and culturally tailored interventions were identified as underexplored yet potentially high-impact pathways. Discussion: The ESC-DAG methodology provided a structured approach to visualize and synthesize causal mechanisms beyond traditional review synthesis, highlighting points of intervention at both policy and practice levels. The findings underscore the importance of multi-level strategies, including financial support, digital equity initiatives, provider outreach, and culturally tailored cessation services. Conclusions: By applying ESC-DAG methodology, this study contributes a novel causal framework for understanding disparities in tobacco cessation intervention uptake. The resulting DAG can inform future statistical modeling, simulation studies, and equity-focused program design, supporting more effective public health strategies to reduce smoking prevalence and associated inequities. Full article

Mucormycosis (MCM) is an opportunistic fungal infection in immunocompromised hosts, most commonly associated with poorly controlled diabetes mellitus (DM). We conducted a retrospective review of 45 MCM cases diagnosed between 2010 and 2023 at a referral center in Central California, a region with high DM prevalence and significant healthcare disparities. Clinical features, histopathology, microbiology, treatment, and outcomes were analyzed. Ninety-six percent of patients had DM, and 69% had no other predisposing condition. Glycemic control was markedly poor: 36% had HbA1c > 10%, and 61% had HbA1c > 8%. Diabetic ketoacidosis (DKA) was present in 19% of patients and associated with 100% mortality. Rhino-orbito-cerebral mucormycosis (ROCM) accounted for 60% of cases and carried a 70% mortality rate. Angioinvasion, confirmed in 62% of biopsied cases, significantly increased mortality (69% vs. 28%, p = 0.015). In-hospital mortality remained high at 58%, consistent with outcomes reported in other high-burden settings. Over 60% of patients identified as Hispanic. ZIP code–based analyses revealed that 75% of individuals lived in neighborhoods with Healthy Places Index (HPI) scores below the 25th percentile, and 64% resided in areas with a Social Deprivation Index (SDI) of 85 or higher, indicating entrenched structural disadvantage. Our findings highlight that MCM in Central California disproportionately affects individuals with uncontrolled DM living in socially deprived areas. These data underscore the need for early diagnosis, targeted antifungal therapy, and upstream public health interventions addressing diabetes management and healthcare access. Full article

Short sleep duration (≤6 h) is a public health concern linked to cardiometabolic disease and premature mortality. However, persistent disparities across sociodemographic, psychosocial, and structural domains remain underexplored in recent nationally representative samples. We analyzed 2022 Behavioral Risk Factor Surveillance System (BRFSS) data, including 228,463 adults (weighted N ≈ 122 million). Sleep duration was dichotomized as short (≤6 h) versus adequate (≥7 h). Complex samples logistic regression estimated associations between sociodemographic, psychosocial, behavioral, and structural determinants and short sleep, accounting for survey design. The weighted prevalence of short sleep was 33.2%. Non-Hispanic Black (AOR = 1.56, 95% CI: 1.46–1.65) and American Indian/Alaska Native adults (AOR = 1.46, 95% CI: 1.29–1.65) were disproportionately affected compared with non-Hispanic White adults. Psychosocial factors contributed strongly: life dissatisfaction, limited emotional support, and low social connectedness increased odds, whereas high connectedness was protective. Food insecurity and smoking were significant structural and behavioral risks, while binge drinking and urbanicity were not. One-third of U.S. adults report short sleep, with marked disparities across demographic, socioeconomic status, psychosocial stressors, and structural barriers. Findings highlight the multifactorial nature of sleep health inequities and the need for multilevel interventions addressing both individual behaviors and upstream determinants. Full article

Breast cancer remains a leading cause of global cancer burden, with marked differences in incidence across countries. While biological risk factors are well established, understanding the broader structural and sociocultural influences has been less comprehensive. In this study, we analyzed harmonized data from 183 countries (2017–2023), encompassing 33 variables and 7 subvariables related to demographics, nutrition, environment, health, and healthcare access, drawn from open-access international databases. Spearman correlation analysis identified strong positive associations between breast cancer incidence and discontinued breastfeeding, high LDL cholesterol, out-of-pocket healthcare expenditure, and educational attainment. Conversely, poor sanitation, lack of handwashing facilities, unsafe water, and certain nutritional deficiencies exhibited robust negative correlations, likely reflecting under detection and reporting limitations in lower-resource settings rather than true protective effects. These findings were further explored using multiple linear regression, which explained approximately 73% of the variance in global breast cancer incidence. The final model highlighted discontinued breastfeeding, prevalence of cocaine use, unsafe sanitation, high out-of-pocket healthcare expenditure, limited handwashing access, and high processed meat consumption as the most influential independent predictors. Receiver operating characteristic (ROC) analysis confirmed strong predictive value for discontinued breastfeeding and out-of-pocket expenditure, with sanitation and hygiene variables showing paradoxical inverse associations. Our results emphasize that breast cancer risk is shaped not only by individual behaviors and genetics, but also by larger-scale structural, socioeconomic, and environmental factors. These patterns suggest that targeted interventions addressing both lifestyle behaviors and systemic inequities—such as promoting breastfeeding, reducing financial barriers to healthcare, and strengthening public health infrastructure—could meaningfully reduce the global burden of breast cancer. In conclusion, this study underscores the importance of multisectoral, equity-focused prevention strategies. It also highlights the value of country-level ecological analyses in uncovering upstream determinants of cancer incidence and calls for further research to disentangle individual and contextual effects in cancer epidemiology. Full article

Per- and polyfluoroalkyl substances (PFASs), called forever chemicals, persist in the environment and bioaccumulate, posing significant health risks. While epidemiological studies have linked exposure to specific PFAS types, perfluorooctanoic acid (PFOA) and perfluorooctane sulfonic acid (PFOS), to an increased incidence of various cancers, specific tumorigenesis mechanisms are unknown. Here, we investigated the potential molecular markers and signatures of perfluorooctane sulfonic acid (PFOS) and perfluorooctanoic acid (PFOA) tumorigenesis. We performed a comprehensive transcriptomic analysis across multiple species and tissue types (N = 529) using PFOS and PFOA-exposed RNA-Seq samples. Conserved signatures demonstrate significant disruptions in seven key carcinogenic characteristics including metabolic reprogramming, epigenetic modifications, immune suppression, oxidative stress, and genomic instability. Tumorigenic markers such as SERPINE1, FN1, PLIN2, ALDOA, TRIB3, and TSC22D3 and their associated pathways may act independently or synergistically to promote a pro-tumorigenic environment. Additionally, PPARα, LARP1, ACOX1, MYC, and MYCN were identified as key upstream regulators supporting disruptions in lipid metabolism, oxidative stress, and uncontrolled cell proliferation. In liver samples, low concentrations of PFOS and PFOA were sufficient to exhibit tumorigenic signatures associated with tumorigenesis initiation and development. Inferred mechanisms of ccRCC initiation and development were linked to lipid metabolism dysregulation and immunosuppressive signaling. In prostate and testicular xenograft tumor models, carcinogenic mechanisms for tumor progression and promotion were hypothesized. Receptor-mediated signaling and protein synthesis was disrupted in prostate cancer and epigenetic alterations and ECM remodeling observed in testicular cancer. We also explored potential therapeutic rescue strategies, including chemopreventive agents for early intervention. All our findings provide hypotheses for PFOS/PFOA-induced tumorigenesis; however, experimental studies are required to establish translational relevance. All the R codes developed in this study are publicly available. Full article

Introduction: Genetic plasticity and adaptive camouflage in critical pathogens have contributed to the global surge in multidrug-resistant (MDR) infections, posing a serious threat to public health and therapeutic efficacy. Antimicrobial resistance, now a leading cause of global mortality, demands urgent action through diagnostics, vaccines, and therapeutics. In India, the Indian Council of Medical Research’s surveillance network identifies Escherichia coli as a major cause of urinary tract infections, with increasing prevalence in human gut microbiomes, highlighting its significance across One Health domains. Methods: Whole-genome sequencing of E. coli strain ECG015, isolated from a human gut sample, was performed using the Illumina NextSeq platform. Results: Genomic analysis revealed multiple antibiotic resistance genes, virulence factors, and efflux pump components. Phylogenomic comparisons showed close relatedness to pathovars from both human and animal origins. Notably the genome encoded protein tyrosine kinases (Etk/Ptk and Wzc) and displayed variations in the envelope stress-responsive CpxAR two-component system. Promoter analysis identified putative CpxR-binding sites upstream of genes involved in resistance, efflux, protein kinases, and the MazEF toxin–antitoxin module, suggesting a potential regulatory role of CpxAR in stress response and persistence. Conclusions: This study presents a comprehensive genomic profile of E. coli ECG015, a gut-derived isolate exhibiting clinically significant resistance traits. For the first time, it implicates the CpxAR two-component system as a potential central regulator coordinating antimicrobial resistance, stress kinase signaling, and programmed cell death. These findings lay the groundwork for future functional studies aimed at targeting stress-response pathways as novel intervention strategies against antimicrobial resistance. Full article

Background: Rheumatic heart disease (RHD) remains a major contributor to childhood cardiovascular morbidity and mortality globally, particularly in low-resource settings. This study offers a thorough evaluation of the global, regional, and national burden of RHD among children aged 0–14 years, from 1990 to 2021, utilizing data from the 2021 Global Burden of Disease (GBD) study. Methods: We analyzed age-standardized incidence, prevalence, mortality, and disability-adjusted life years (DALYs) for RHD in 204 countries and territories. Novel methodological approaches included APC analysis to decompose temporal trends into age, period, and cohort effects, and inequality analysis to assess socioeconomic disparities. We calculated age-standardized rates and average annual percentage changes (AAPC) by sex, region, and socio-demographic index (SDI) level. Results: From 1990 to 2021, the global age-standardized death rate due to RHD in children declined by approximately 74%, from 1.24 to 0.32 per 100,000 (AAPC: −4.27%). Similarly, DALY rates dropped from 117.22 to 41.56 per 100,000 (AAPC: −3.30%). Despite this progress, the global age-standardized incidence rate increased modestly from 55.84 to 66.76 per 100,000 (AAPC: 0.58%), and prevalence rates also rose (AAPC: 0.53%). Females consistently experienced higher burden across all metrics. Inequality analysis demonstrated a concerning divergence: while mortality and DALY inequalities narrowed substantially (mortality slope index of inequality (SII) improved from −1.35 to −0.31), incidence and prevalence inequalities widened (incidence SII worsened from −112.60 to −131.90), indicating growing disparities in disease occurrence despite improved survival. Conclusions: While global mortality and DALYs from childhood rheumatic heart disease have declined substantially over the past three decades, a troubling paradox has emerged: rising incidence rates alongside widening socioeconomic inequalities in disease occurrence. This represents a critical public health challenge demanding targeted intervention strategies. The divergent trends in health outcomes, namely, improved survival rates but increased disease burden, reveal that while access to treatment has advanced, upstream prevention efforts remain critically inadequate among socioeconomically disadvantaged populations. Full article

Background: Antimicrobial resistance (AMR) poses significant risks to human and animal health, while the environment can contribute to its spread. National AMR surveillance programs are pivotal for assessing AMR prevalence, trends, and intervention outcomes; however, integrating advanced surveillance tools can be difficult. This pilot study, conducted by FAO ECTAD Indonesia and DGLAHS, the Indonesian Ministry of Agriculture, evaluated the costs and benefits of integrating the Nanopore MinION, Illumina MiSeq, and Sensititre system into a culture-based slaughterhouse–river surveillance system. Methods: Water samples were collected from six chicken slaughterhouses and adjacent rivers (pre- and post-treatment effluent, upstream, and downstream). Culture-based ESBL and general E. coli concentrations were estimated via the WHO Tricycle Protocol, while isolates (n = 42) were sequenced (MinION, MiSeq) and antimicrobial susceptibility testing conducted (Sensititre). Results: The Tricycle Protocol results provided estimates of effluent and river concentrations of ESBL and general E. coli identifying ESBL-to-general E. coli ratios of 13.8% and 6.2%, respectively. Compared to hybrid sequencing assemblies, MinION had a higher concordance than MiSeq for ARG identification (98%), virulence genes (96%), and locations for both (predominately plasmids). Furthermore, MinION concordance with Sensititre AST was 91%. Conclusions: Cost–benefit comparisons suggest sequencing can complement culture-based methods but is dependent on the value placed on the additional information gained. Full article

Background: Oral diseases represent a constant burden for health care and socio-economic systems as they are correlated to other non-communicable diseases. The aim of the proposed intervention is to test the effect of daily tooth brushing and oral health education on the oral health status of kindergarten children. Methods: The protocol will be conducted based on a previous epidemiological survey and conducted over 24 months; it has been developed on different levels. Dental hygienists will receive specific training to deliver oral health promotion to children and nursery educators. Training will focus on tailoring key messages to the specific age at visit; this will be outlined in the care pathway and offer practical preparation for delivering interventions and a toothpaste/toothbrush scheme. It will also, involving involve offering free daily tooth brushing to every 4–6-year-old child attending nursery. Data will be collected in four kindergartens in the capital or metropolitan areas, two kindergartens each in two large cities, and one kindergarten each in four villages from different geographic areas. Procedures used to assess the outcomes of each activity will be tailored to specific outcomes. Daily tooth-brushing activities will be monitored using qualitative research. A cost analysis including the distribution of necessary materials and correct delivery of products that shows price trends and percentage differences over the time span as well as consumer price index evaluation for the given time span will be conducted. Clinical outcomes will be evaluated using the caries incidence rate; this will be calculated for each tooth as the unit of analysis and evaluated using a multi-step approach. Discussion: Downstream oral health prevention interventions, like clinical prevention and oral health promotion, aim to enhance children’s quality of life. The program’s goal is to progress towards upstream interventions for a more significant impact. Full article

Suicide rates have increased in the US over the last decades. Schools often deliver suicide prevention trainings and there is growing evidence that these trainings in schools are effective. The current study examined a new upstream approach, CODE RED in which trainees complete their own safety plan prior to a mental health emergency. Participants were adult school personnel (n = 201) who completed CODE RED trainings and were surveyed using three validated 4-item measures: acceptability of intervention measure (AIM), intervention appropriateness measure (IAM), and feasibility of intervention measure (FIM). Open-ended questions were analyzed using a thematic approach. Of 201 participants who completed the survey, acceptability (18.0), appropriateness (17.9) and feasibility (18.0) were high as assessed by standardized implementation measures (each out of 20). Open-ended responses further indicated a great deal of satisfaction with the training. As a first step in determining acceptability and feasibility, CODE RED was found to be highly acceptable to adult school employees who found it applicable, appealing as an intervention, and easy to use. Most staff are hopeful that it will be useful with youth as well. It will be important to determine how this activity is used by youth and if it can be used in mental health crises to decrease symptoms. Full article