Search Results (3,035)

Background/Objectives: Financial toxicity (FT) is increasingly recognised as a critical dimension of the cancer care continuum, reflecting both objective financial burden and subjective financial distress arising from cancer-related care. Head and neck cancers (HNC) may be particularly vulnerable to FT because treatment often involves multimodal care, functional morbidity, prolonged rehabilitation, and disruption to employment. This scoping review mapped and synthesised the literature on FT in a focused subset of head and neck cancers (HNC), namely malignancies of the oral cavity, oropharynx, nasopharynx, sinonasal tract, and major and minor salivary glands. Methods: A scoping review was conducted in accordance with the methodological guidance of the Joanna Briggs Institute for scoping reviews to identify and synthesise studies addressing FT in the selected HNC subsites. Searches were undertaken in MEDLINE, Embase, Scopus, Web of Science, CINAHL, EconLit, and Global Index Medicus for English-language studies published between 1 January 2015 and 1 January 2025. The search window was restricted to this period to capture the more contemporary evolution of FT as a distinct research construct in oncology. Eligible studies included adult patients and reported patient-level FT outcomes, including direct costs, indirect costs, out-of-pocket expenditure, financial hardship, financial distress, employment disruption, or related economic strain. Findings were synthesised narratively and organised thematically. Results: Twenty-five studies published between 2015 and 2025 were included. The evidence base was dominated by cross-sectional and retrospective designs, with limited prospective follow-up and very little intervention-focused research. FT was conceptualised heterogeneously across studies, spanning direct expenditure, indirect and non-medical costs, subjective financial distress, and coping-related consequences. Questionnaire-based approaches were used in 13 studies, but only a smaller subset employed FT-specific instruments such as COST. Across the literature, FT was most commonly associated with lower income, weaker financial protection, employment disruption, rural residence in some settings, and more intensive treatment. Reported downstream associations included poorer quality of life, psychological distress, care alteration, and work-related burden, although evidence for treatment delay or survival effects was more limited and should be interpreted cautiously. Conclusions: In this focused HNC subset, FT appears multidimensional, socially patterned, and clinically relevant. However, the literature remains methodologically fragmented, with inconsistent measurement and sparse longitudinal evidence. Future work should prioritise validated and tumour-specific assessment strategies, prospective study designs, and evaluation of mitigation interventions that address both direct and indirect burden across the cancer continuum. Full article

Vietnam’s exports expanded dramatically from $14.5 billion in 2000 to $405 billion in 2024, elevating the country to the world’s 22nd largest exporter despite persistent global shocks. This paper introduces the application of the Causal Machine Learning Approach to Resilience Estimation (CLARE) to industry-level trade analysis, utilizing a comprehensive panel of 97 HS2 sectors from 2000 to 2024 (2425 observations) drawn from UN COMTRADE and WITS databases. We implement Double Machine Learning to estimate causal effects of the Global Financial Crisis (2008–2009) and COVID-19 pandemic (2020–2021) on export growth. Results reveal stark industry disparities: electrical machinery (HS85) exhibits exceptional resilience, fueled by 72% high-technology content and low product concentration, while knitted apparel (HS61) proves highly vulnerable. Fixed effect regressions substantiate core hypotheses: a 10-percentage-point increase in high-tech share elevates the resilience index by 0.031 points (approximately 4.1% relative to the sample mean); a one-standard-deviation reduction in product HHI (0.14 units) yields a 0.026-point gain (3.6% relative); and each additional FTA contributes 0.047 points (approximately 6.2% relative), with all estimates significant at conventional levels. Robustness encompassing alternative learners, detrended outcomes, and synthetic controls upholds findings. Policy recommendations center on accelerating high-tech global value chain integration—targeting semiconductors and electric vehicles—while optimizing CPTPP and EVFTA utilization (currently 35%) and mitigating US–China market concentration (45% of exports). These insights chart pathways for Vietnam’s Vision 2045 high-income ambition amid intensifying geopolitical and climate risks, providing a replicable framework for other export-reliant emerging economies. Full article

Drought in Angola is a recurrent and cyclical natural phenomenon that poses significant environmental, economic, and social challenges, affecting water resources, agriculture, ecosystems, livestock, and vulnerable communities. This study investigates the temporal evolution and spatial behavior of drought in the provinces of Cunene, Huila, and Namibe over the period 1980–2024. Drought conditions were assessed using the Standardized Precipitation Index (SPI) and the Standard Precipitation–Evapotranspiration Index (SPEI) at multiple time scales. Trends were evaluated using the Modified Mann–Kendall test and Sen’s slope estimator, while drought intensity was analyzed using run theory. The results reveal a clear intensification of drought conditions in the last decade, characterized by an increase in frequency and intensity, particularly after 2010. Extreme drought events were identified in the early 1980s, the mid-1990s, and more recently in 2019 and 2021. Despite some regional variability, the three provinces exhibit consistent temporal patterns, with drought events generally occurring simultaneously over the study period. These findings highlight the increasing pressure on water and environmental systems and underscore the need for improved drought monitoring and forecasting approaches to support more effective adaptation and decision-making. Full article

Background/Objectives: Nutritional vulnerability (NV) describes the interaction of diet quality, access to food, health status and socioeconomic factors and may differ between neighborhoods. Nevertheless, there is still a limited amount of evidence regarding local NV variations in contrasting resource landscapes. The purpose of this study was to operationalize NV in Windham, Connecticut and conduct an analysis of its spatial distribution and the differences between neighborhoods for NV and specifically diet quality. Methods: NV was measured with four indicators, including two diet quality measures (liking-based DQI and short food frequency-based sHEI), food security, obesity, and SNAP participation. Areas of vulnerable concentration were determined through spatial mapping. Indicators related to each other were measured by Spearman correlation. To compare the contrasting neighborhoods (resource-dense vs. resource-limited), contextual differences were studied and differences in NV indicators, sociodemographic and movement factors were compared with the help of chi-square tests. Diet quality measures were jointly examined for concordance (both measures low or high) and discordance. Results: Area-level comparisons showed significant differences in mobility-related and sociodemographic characteristics, including vehicle access and education level (p < 0.05). High diet quality (measure concordance) was reported by individuals living in high-resourced regions; low diet quality (measure concordance) by individuals in low-resourced regions. Conclusions: The NV Map illustrated focal patterns of vulnerability determined by the interplay of sociodemographic disadvantage and mobility-related limitations and not by distance to food resources. These results give practical spatial data to promote specific nutrition and resource intervention. Full article

COVID-19 was a prolonged public-health shock that disrupted mobility, access to services, and household spending. Although the official U.S. poverty rate declined to 11.1%, the Supplemental Poverty Measure rose to 12.9%, suggesting that material hardship persisted unevenly across places. This study asks whether pre-existing livelihood vulnerability and local epidemic burden translated into geographically concentrated consumption losses during 2020–2022. Because sustained consumption loss can erode households’ health-related spending, tracking where spending declines concentrate helps connect local social and environmental conditions to how communities withstand a health crisis. We analyze consumer expenditure, unlike prior research relying on aggregate retail sales, to capture fine-grained economic strains as a proxy for shock-absorption capacity. A Livelihood Vulnerability Index (LVI) was calculated for each U.S. county using 16 socio-economic variables, and counties were classified as high- or low-risk. A multilevel model then examined how socio-economic and COVID-19 factors at county and census tract levels shaped consumption changes. Higher-risk communities experienced greater consumption reductions. At the census tract level, the non-White ratio, vacancy rate, built year, per capita income, education level, and housing value were significant. At the county level, COVID-19 cases and deaths, crowding, public transportation use, and vehicle availability mattered most. These findings support place-targeted strategies that combine public-health response with socio-environmental interventions to reduce disparities rooted in pre-existing vulnerability. Full article

Kuwait experiences persistently high levels of air pollution driven by industrial emissions, transportation, oil-related activities, and frequent desert dust storms. This study aims to synthesize and critically evaluate the available evidence on the relationship between air pollution, Air Quality Index (AQI), and health outcomes in Kuwait using a guided narrative review approach. A guided literature search identified 26 peer-reviewed studies published between 2014 and 2026 about Kuwait air pollution, which were assessed for methodological characteristics, pollutant types, health outcome categories, and vulnerable populations. The most frequently examined pollutants were particulate matter (PM_2.5: 69%; PM₁₀: 38%), followed by NO₂ (23%), multi-pollutant and AQI-based (19%), O₃ (12%), SO₂ (12%), VOCs and PAHs (8%). Health-related investigations most commonly addressed mortality and respiratory morbidity, while cardiovascular, metabolic, biomarker-based, and cancer-related outcomes were less frequently represented. Among studies reporting direct health outcomes, elevated PM_2.5 exposure was generally associated with increased risks of respiratory hospitalizations, cardiovascular events, and all-cause mortality. Susceptible populations identified across the literature include children, older adults, individuals with pre-existing chronic conditions, and outdoor workers, who may experience higher exposure levels and greater health vulnerability. However, a substantial proportion of the included studies focused primarily on exposure characterization or pollutant modeling without direct assessment of health outcomes. These studies nonetheless indicate consistently elevated pollutant levels and seasonal variability, which may plausibly contribute to population health risks. Overall, while the available Kuwait-specific evidence suggests potential adverse health effects linked to air pollution, the strength of direct epidemiological evidence remains limited. Important gaps persist, including the scarcity of long-term cohort studies, limited multi-pollutant analyses, and insufficient integration of AQI categories with health outcomes. These limitations highlight the need for more robust and longitudinal research to better quantify health risks and inform public health policy in Kuwait. Full article

Physicochemical and microbiological parameters are important indicators of drinking water quality. This study assessed the quality of groundwater used for drinking in four regions of Kosovo at 16 locations using an integrated assessment framework that combined physicochemical, microbiological, and Water Quality Index (WQI) approaches. The results reveal substantial spatial variability in water quality. While most physicochemical parameters remained within recommended limits, elevated values of total dissolved solids (up to 2792.5 mg/L), electrical conductivity (up to 2768.5 µS/cm), nitrate (up to 60.75 mg/L), and phosphate (up to 0.875 mg/L) were observed at several locations, indicating localized hydrogeochemical and anthropogenic influences. Dissolved oxygen levels were generally low (0.68–5.49 mg/L), reflecting limited aeration conditions in groundwater systems. Microbiological analysis revealed critical contamination, with Escherichia coli concentrations up to 299.9 CFU/100 mL, and all sampling sites exceeded permissible limits, indicating widespread fecal pollution and rendering the groundwater unsafe for direct consumption. WQI assessment further confirmed this condition, where 93.75% of locations were classified as medium quality using the NSF-WQI method, whereas the WA-WQI method categorized 68.75% of samples as poor and 6.25% as very poor. The novelty of this study lies in the integrated evaluation of hydrogeochemical processes and microbiological contamination using dual WQI methods and multivariate statistical analysis, providing a comprehensive understanding of groundwater degradation pathways. The findings are significant for policymakers, environmental managers, and public health authorities, highlighting the urgent need for groundwater treatment, improved sanitation infrastructure, and sustainable water resource management strategies in vulnerable regions. Full article

Background: Older adults hospitalized with acute heart failure frequently present with multimorbidity, frailty, and reduced physiological reserve. This makes accurate prognostic assessment particularly challenging in internal medicine. Traditional heart failure risk models often fail to capture this multidimensional vulnerability. The PROFUND index, developed to estimate medium-term mortality in multimorbid patients, and serum albumin, an established biomarker of nutritional and inflammatory status, may provide complementary prognostic information. This formed the aim of the present study. This study’s objective is to evaluate the individual and combined prognostic value of the PROFUND index and serum albumin for one-year mortality in patients admitted with AHF. Methods: We conducted a prospective, multicenter cohort study within the PROFUNDIC registry. We included consecutive adults hospitalized with AHF or decompensated chronic heart failure who met European Society of Cardiology diagnostic criteria and had NT-proBNP levels >1500 pg/mL. PROFUND scores were obtained at admission, and hypoalbuminaemia was dichotomized as ≤3.5 g/dL. The primary outcome was one-year mortality, analyzed using Kaplan–Meier survival estimates, Cox proportional hazards models, and time-dependent ROC curves. Results: Among 544 included patients (mean age 85 years; 60% women), high PROFUND scores (>7) were present in 39% and hypoalbuminaemia in 55%. Both variables independently predicted one-year mortality, with the highest risk observed in patients presenting both high PROFUND scores (HR 2.26; 95% CI 1.66–3.09; p < 0.001) and hypoalbuminaemia (HR 1.70; 95% CI 1.18–2.46; p = 0.0046). The combined use of these markers modestly improved discriminatory performance compared with the PROFUND index alone (HR 2.83; 95% CI 1.72–4.64; p < 0.000). Conclusions: These findings suggest that integrating clinical complexity, assessed by the PROFUND index, with serum albumin provides a simple and clinically meaningful approach to early risk stratification in very elderly multimorbid patients treated in internal medicine wards. Full article

Small-scale inland fisheries in the Amazon are critical for food security, yet their sustainability is increasingly threatened by overexploitation and environmental degradation. In data-limited contexts such as the northern Ecuadorian Amazon, the absence of continuous monitoring constrains the development of adaptive management strategies. This study develops an integrated socio-ecological baseline to support the establishment of fisheries agreements in five Indigenous communities of the Napo and Aguarico rivers. Through a participatory monitoring approach, we generated reproductive parameters (gonadosomatic index, fecundity, size at first maturity), population structure metrics, and length–weight relationships for key subsistence species across three hydrological phases. Reproductive investment exhibited marked seasonality, with peak gonadosomatic indices during rising waters in most species, identifying a critical period for protection. Life-history strategies ranged from high-fecundity periodic strategists to low-fecundity equilibrium species, implying differentiated vulnerability to harvesting. Community perceptions prioritized large migratory catfish and floodplain habitats, aligning with biological indicators of vulnerability. High performance in technical training demonstrated the feasibility of long-term local monitoring systems. By linking biological indicators with local ecological knowledge, this study proposes a pathway from baseline assessment to adaptive co-management. The framework presented here provides a transferable model for strengthening sustainability, governance, and food security in tropical small-scale fisheries facing persistent data limitations. Full article

Surface water systems are increasingly exposed to multiple pressures generated by climate variability, intensified water resource exploitation, and evolving geopolitical dynamics. This study provides a novel contribution by identifying critical threshold effects and non-linear interactions that influence nitrate concentrations through an integrated information systems framework. It develops an integrated information-system-based analytical framework that combines hydrological, climatic, geopolitical, and strategic indicators to shape the broader contextual framework within which hydrological and climatic pressures operate, rather than serving as direct predictors. Considering the nitrate concentration in rivers as a key parameter of water quality, the paper goes beyond univariate analysis of nitrite concentration, examining its relationship with four explanatory variables: the Water Exploitation Index Plus (WEI+), the number of heat stress days (Heat_Stress), the Geopolitical Risk Index (GPR), and a proxy variable representing the presence of strategic infrastructure (Nuclear_State) using a Reduced Error Pruning Tree (REPTree) decision tree algorithm with 10-fold cross-validation. The results indicate that climatic stress emerges as the primary predictor, with a critical threshold of approximately 7.83 heat stress days, beyond which nitrate concentrations increase significantly. Under conditions of high climatic stress and intensive water exploitation (WEI+ ≥ 67.39), predicted nitrate levels exceed 20 mg/L and can reach extreme values of up to 58.82 mg/L. In contrast, low hydrological pressure (WEI+ < 0.39) combined with moderate climatic stress is associated with very low nitrate concentrations, around 2.75 mg/L. The model demonstrates strong predictive performance, with a correlation coefficient of 0.976, a Mean Absolute Error (MAE) of 0.593, a Root Mean Squared Error (RMSE) of 2.046, and a Receiver Operating Characteristic (ROC) area exceeding 0.94 for classification tasks. While geopolitical and strategic variables do not act as direct predictors, they contribute to shaping the contextual framework influencing water resource management and environmental vulnerability. Overall, the study highlights the non-linear and systemic nature of water quality dynamics and demonstrates the effectiveness of decision tree-based models within integrated information systems for supporting environmental monitoring and decision-making under conditions of climate stress and geopolitical uncertainty. Full article

Background/Objective: Postoperative recovery after spine surgery varies substantially and cannot be fully explained by structural pathology alone. This study evaluates postoperative outcomes using a structured 2 × 2 Surgical Trauma Gradient integrating exposure-related invasiveness (minimally invasive vs. open) and biomechanical strategy (decompression vs. fusion), and examines the modifying role of Type-D personality. Methods: This observational cohort study included 200 patients undergoing elective spine surgery. Patients were stratified into four surgical subgroups: minimally invasive decompression, open decompression, minimally invasive fusion, and open fusion. Primary outcomes included pain intensity (Visual Analog Scale), functional disability (Oswestry Disability Index), patient satisfaction (Patient Satisfaction Index), and postoperative complications at 12-month follow-up. Surgical invasiveness was modeled both categorically and as an ordinal gradient. Multivariable regression, logistic regression, interaction analysis, and longitudinal mixed-effects models were applied. Results: Postoperative outcomes demonstrated a consistent gradient across increasing surgical burden. In multivariable models, higher surgical invasiveness independently predicted greater residual pain (β = 0.69; 95% CI 0.55–0.82; p < 0.001) and higher functional disability (β = 6.20; 95% CI 5.10–7.30; p < 0.001). Increasing invasiveness was also associated with lower patient satisfaction (β = −0.38; 95% CI −0.47 to −0.29; p < 0.001) and higher complication risk (OR = 1.64; 95% CI 1.12–2.41; p = 0.01). Type-D personality independently predicted worse postoperative pain (β = 0.41; p = 0.008) and significantly modified the association between surgical burden and pain (interaction β = 0.22; p = 0.012). Conclusions: Postoperative outcomes follow a structured Surgical Trauma Gradient influenced by both surgical burden and psychosocial vulnerability, particularly Type-D personality. Integrating these dimensions may improve perioperative risk stratification and support individualized treatment strategies. Full article

This study examines the evolution of the scientific literature on mining and heavy metals, with a particular focus on biosanitary risks associated with childhood exposure. The research integrates a systematic literature review following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) methodology, combined with a bibliometric analysis of Scopus-indexed publications, international epidemiological data, and an evaluation of the socio-environmental context in Ecuadorian mining regions. The PRISMA-based screening process was applied to identify, filter, and select relevant peer-reviewed studies, enabling the delimitation of a focused corpus of literature, with particular attention given to scientific contributions produced by Latin American researchers and institutions. The results reveal a significant concentration of knowledge production among a limited number of countries and institutions, the dominance of English as the main language of scientific communication, and the centrality of journals in environmental sciences and toxicology. While notable progress has been made in identifying contaminants and exposure pathways, governance structures, territorial disparities, and policy implementation processes remain insufficiently explored. In Ecuador, the rapid growth of mining concessions in ecologically sensitive zones presents potential threats to children’s neurocognitive development, highlighting the urgent need for ongoing surveillance, biomonitoring programs, and preventive public health measures. The study emphasizes the importance of strengthening regional research capacity and fostering more equitable international scientific collaborations to ensure that knowledge production is responsive to local contexts and effectively safeguards vulnerable populations. Full article

Background: Hypernatremia is an infrequent but clinically relevant electrolyte disorder in older adults and is associated with poor outcomes. Patients managed through Hospital-at-Home (HaH) programs, particularly those living in institutional settings, are especially vulnerable due to functional dependency and cognitive impairment. Evidence regarding the prevalence and prognostic impact of hypernatremia in HaH settings remains limited. Methods: We conducted a retrospective observational cohort study including all patients admitted to a Hospital-at-Home unit between 2019 and 2024. Patients were classified according to care setting as home-dwelling or institutionalized. Hypernatremia was defined as a serum sodium concentration >145 mmol/L. Sociodemographic, functional (Barthel Index), and cognitive (Global Deterioration Scale) variables were collected. Mortality during HaH admission and at 30, 60, and 90 days was analyzed, and survival was assessed using Kaplan–Meier methods. Results: A total of 4501 patients were included, of whom 2701 were treated at home and 1800 in institutional settings. Hypernatremia was significantly more prevalent among institutionalized patients than among home-dwelling patients (3.1% vs. 0.8%, p < 0.001). Institutionalized patients with hypernatremia showed greater functional dependency (Barthel Index 11 vs. 15, p = 0.041) and more advanced cognitive impairment (GDS 6 vs. 5.5, p = 0.033) compared with those without hypernatremia. Mortality among institutionalized patients with hypernatremia was high, reaching 32.9% during HaH admission, 61.2% at 30 days, 70.6% at 60 days, and approximately 79% at 90 days. Kaplan–Meier analysis demonstrated a rapid decline in survival during the first month following diagnosis. Conclusions: In Hospital-at-Home programs, hypernatremia is more prevalent among institutionalized older adults and is strongly associated with severe functional and cognitive impairment and very high short- and medium-term mortality. These findings suggest that hypernatremia should be considered a marker of advanced frailty rather than an isolated electrolyte disturbance. Full article

The Linpan in western Sichuan is a composite rural landscape of “household-water-forest-field” on the Chengdu Plain. Under the interference of human activities, problems such as landscape fragmentation and ecological function degradation have become increasingly serious, threatening regional ecological security. The specific components involved in the “study on ecological risk sequence” include landscape disturbance degree, landscape vulnerability degree, landscape connectivity, and human activity intensity. Given the lack of long-term ecological risk research on the Linpan landscape in Chongzhou City to support conservation decisions, this study takes it as the object. Based on five phases of land use data from 2003 to 2023, a landscape ecological risk assessment model was constructed. This model is a deterministic and nonlinear comprehensive evaluation model. The determinism is reflected in the fact that, based on specific influencing factors, a unique and definite result can be obtained through a fixed indicator system and calculation method. The nonlinearity is reflected in the fact that the comprehensive risk index does not involve a simple linear superposition of the various factors; instead, the evaluation result is obtained by integrating the factors through nonlinear approaches such as weighted coupling. Using ArcGIS and spatial analysis methods, based on a temporal resolution of 5 years and a spatial resolution of 30 m, the spatiotemporal evolution characteristics were revealed. The results show that: (1) From 2003 to 2023, the Linpan landscape pattern in Chongzhou City underwent significant evolution, characterized by “reduction in agricultural land, expansion of construction land, and slight recovery of ecological land”. Landscape fragmentation intensified, connectivity decreased, but overall aggregation remained stable. (2) The evolution of the landscape pattern drove the ecological risk to show a stable pattern of “low in the northwest and high in the southeast”. The global Moran’s I value decreased from 0.887 to 0.832, indicating that risk aggregation intensified in the early period and was alleviated in the later period. (3) Landscape disturbance degree is the key factor dominating the change in the comprehensive ecological risk index. Compared with similar studies, this research shares the commonality of urbanization-driven fragmentation exacerbation risk, but also exhibits the uniqueness of Linpan structural resilience and conservation policies promoting a reduction in high-risk areas. This study can provide a scientific basis for Linpan protection, land use optimization, and ecological security pattern construction in Chongzhou City. Full article

This study proposes and evaluates a specialized Recreational Water Quality Index (IR-WQI) designed to prioritize the bathers’ safety and comfort. Focusing on the Năvodari–Mamaia sector (2022–2024), the research investigates how different weighting configurations—prioritizing either microbiological safety or physicochemical stability—affect the accuracy of bathing water assessments. The IR-WQI was tested across four scenarios, comparing the sensitivity of a specialized pH-based “bather-comfort” penalty function against models that include salinity as a weighted constant. Results demonstrate high categorical stability, with 93.3% of monitoring sites maintaining their qualitative classification regardless of the weighting scheme. However, the inclusion of salinity was found to inflate quality scores, potentially masking fecal contamination at vulnerable sites. Scenario 1, which prioritizes microbiological indicators (60% weight) and incorporates a pH filter, provides a transparent and conservative diagnostic tool for coastal managers, thereby supporting sustainable tourism and informed decision-making for beach safety. Full article