Search Results (903)

Gender-neutral terms such as “sex work” and “sex worker” have gained prominence in academic, activist, and policy discourses. Unlike terms such as ‘prostitutes’ and ‘prostitution,’ these terms serve to reduce stigma and emphasize the labor involved in sex work. However, numerous studies suggest that these terms carry different meanings across cultural contexts, and their impact is experienced differently by various sub-groups of sex workers. Although originally coined by American activist Carol Leigh to unify sex workers across genders and sectors, these terms are, in some settings—including Kolkata, India—met with silence, coded language, or secrecy, particularly among transient sex workers, including cisgender and transgender women. As researchers with two decades of ethnographic research with 46 cisgender and 37 transgender women engaged in sex work in Kolkata and Eastern India, the authors argue that such silence and non-verbal forms of communication should not be interpreted merely as ignorance or disengagement but rather as strategic/willful acts of agency or resistance. These practices enable sex workers situated in different contexts to navigate unequal power dynamics within NGOs, manage respectability, mitigate structural violence, and foster communal identity. By examining how diverse groups of sex workers employ silence and secrecy, this study contributes to a more nuanced and empathetic understanding of the complexities surrounding the former’s lives and their agency. The study results indicate that it is essential for scholars, advocates and activists to employ strengths-based, context-specific language and research practices to be able to hear the stories of subaltern groups like commercial sex workers. It is also suggested that training of service providers and helping professionals focus on accepting and honoring the language people use to identify themselves in varied spaces and contexts. Full article

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

Background/Objectives: Unhealthy lifestyles are closely linked to insulin resistance (IR) and adiposity. However, the mediating role of adiposity in the relationship between lifestyle factors and IR is not yet fully understood. Mediation analysis may help clarify the role of adiposity in the relationship between lifestyle factors and IR. Therefore, we aimed to explore the bidirectional relationship between adiposity and IR, and to evaluate the relationship between lifestyle factors and adiposity-mediated IR in Mexican adults. Methods: A longitudinal analysis was conducted using data from the Health Workers Cohort Study, with measurements taken every six years from 2004 to 2018. This study included 1134 participants aged from 18 to 70 years. Lifestyle factors were assessed using a self-administered questionnaire. IR was assessed using the Homeostasis Model Assessment (HOMA). Adiposity was measured through body mass index (BMI), waist circumference (WC), and body fat proportion (BFP), and BMI was used as the marker indicator to set the metric of adiposity. We fitted structural equation models with a cross-lagged specification to examine the relationships between adiposity and ln(HOMA). In our analysis, we considered baseline adiposity and ln(HOMA) as mediators of the relation between lifestyle factors and future adiposity and ln(HOMA). Models were stratified by sex and adjusted by baseline age. Results: Results from the cross-lagged panel model showed that, for both men and women, adiposity predicted subsequent increases in HOMA (+5.3% IC95%: 1.8%, 9.0% in men; +6.0% IC95%: 4.2%, 7.8% in women). In men, baseline adiposity acted as a mediator between lifestyle variables (physical activity, tobacco consumption, and sleep duration) and HOMA. Conclusions: Our results suggest that understanding both the relationship between adiposity and HOMA and the mediating effects of adiposity is crucial for developing effective interventions to reduce IR in the Mexican population. Full article

Introduction: Despite the key role of healthcare workers (HCWs) in tuberculosis (TB) prevention and control, there is a lack of regional data on their knowledge, attitudes, and practices (KAPs) regarding the disease in Atlantic Canada. Objectives: To assess the KAPs of HCWs and identify targets for educational interventions to enhance TB care and control. Methods: A cross-sectional study was conducted among HCWs in Atlantic Canada aged $\ge$19 years from October 2023 to February 2024. Participants were recruited via multiple channels such as social media, collegiate email lists, and snowball sampling. Survey data were collected using an online platform and analyzed using IBM SPSS Statistics v29. KAPs were assessed using Likert-type scales and internal consistency was evaluated using Cronbach’s alpha. Results: A total of 157 HCWs participated in this study (age range: 19 to 69 years); most were women (n = 145, 92%), born in Canada (n = 134, 85.4%), with nearly three-quarters (n = 115, 73.2%) who had never lived outside of Canada. Study participants demonstrated moderately high knowledge (M = 29.32, SD = 3.25) and positive attitudes (M = 3.87, SD = 0.37) towards TB and strong practices (M = 4.24, SD = 0.69) in TB care; however, gaps were identified in HCW abilities to recognize less common TB symptoms (e.g., rash and nausea), as well as inconsistent practices in ventilation and pre-treatment initiation. Internal consistency analysis indicated suboptimal reliability across all three KAP domains, with Cronbach’s alpha values falling below 0.7, thwarting further planned analyses. Conclusions: This study found overall moderate-to-strong TB-related KAPs among HCWs in Atlantic Canada; however, critical gaps in knowledge and practice were noted. This new information can now guide future educational initiatives and targeted training to enhance TB preparedness and ensure equitable care for patients in the region. Full article

HIV disproportionately affects key populations (MSM, transgender people, sex workers and psychoactive substance users), who face greater social vulnerability and limited healthcare access. This study aimed at analyzing sexual orientation and gender identity and their association with sexual practices, sexually transmitted infections and psychoactive substance use among PrEP users. Method: A cross-sectional study was conducted between January 2018 and June 2021 with 736 Brazilian PrEP users from a health service in São Paulo. Sociodemographic data, sexual behaviors, STI history (past 3 months) and psychoactive substances use (past 3 months) were extracted from clinical records. The associations were analyzed using binomial logistic regression (p < 0.05). Results: Most of the participants were cisgender men (93.4%) and homosexual (84.8%), with a mean age of 34.9 years old. Condomless sex was reported by 98.5%, and 18.4% had some recent sexually transmitted infection, mainly syphilis. Psychoactive substance use was reported by 55.4%, especially marijuana, club drugs, erectile stimulants and poppers. Transgender and cisgender women were more likely to report sex work and crack use. Homosexual and bisexual participants had higher odds of using erectile stimulants. Conclusions: The study reveals key links between gender, sexual orientation and risk behaviors, highlighting the need for inclusive, targeted prevention. Full article

The gastrointestinal tract mediates the absorption of nutrients from the diet, which is increasingly contaminated with toxic metal(loid) species (TMs) and thus threatens food safety. Evidence in support of the influx of TMs into the bloodstream of the general and vulnerable populations (babies, children, pregnant women, and industrial workers) has been obtained by accurately quantifying their blood concentrations. The interpretation of these TM blood concentrations, however, is problematic, as we cannot distinguish between those that are tolerable from those that may cause the onset of environmental diseases. Since TMs that have invaded the bloodstream may perturb biochemical processes therein that will eventually cause organ damage it is crucial to better understand their bioinorganic chemistry as these processes collectively determine their organ availability. Thus, bioinorganic processes of TMs in the bloodstream represent selectivity filters which protect organs from their influx and ultimately determine the corresponding exposure-response relationships. The need to better understand selectivity filters prompted us to mechanistically disentangle them into the major bioinorganic chemistry processes. It is argued that the detoxification of TMs in the bloodstream and the biomolecular mechanisms, which mediate their uptake into target organs, represent critical knowledge gaps to revise regulatory frameworks to reduce the disease burden. Full article

Background/Objectives: Job stress negatively affects physical and psychological health and can lead to behavioral changes such as unhealthy eating. This study aimed to evaluate the relationship between job stress levels, adherence to the Mediterranean diet, and the phytochemical index (PI). Methods: The study included 200 healthy individuals aged 18–50 working at the Tuzla Gum Factory. Data were collected through demographic and dietary questionnaires, two-day 24-h food records, PI values, and anthropometric measurements. Job stress was assessed using the Job Stress Scale, and Mediterranean diet adherence was assessed with the Mediterranean Diet Adherence Questionnaire. Results: Waist and hip circumference, waist/hip ratio, and BMI were significantly higher in individuals with high levels of job stress (p < 0.01). Unskilled workers reported higher stress than professionals (p < 0.01). Significant differences were found in carbohydrate and fiber intake among males and in energy, protein, carbohydrate, and vitamin A intake among females with varying stress levels (p < 0.01). No significant difference in Mediterranean diet adherence was observed between medium and high stress groups. However, women had higher adherence and PI scores than men (p < 0.01). Diet adherence was better among managers than service-sales and technical staff (p < 0.01). PI scores were higher in medium stress than high stress individuals (p < 0.05) and in those with a higher BMI compared to a normal BMI (p < 0.01). Conclusions: Job stress influences both anthropometric parameters and dietary habits. Effective stress management may improve adherence to the Mediterranean diet and phytochemical intake. Workplace strategies supporting healthy eating behaviors are recommended. Full article

This study investigates how topic-specific expression by women delivery riders on digital platforms predicts their community engagement, emphasizing the mediating role of self-disclosure and the moderating influence of cognitive and emotional language features. Using unsupervised topic modeling (Top2Vec, Topical Vectors via Embeddings and Clustering) and psycholinguistic analysis (LIWC, Linguistic Inquiry and Word Count), the paper extracted eleven thematic clusters and quantified self-disclosure intensity, cognitive complexity, and emotional polarity. A moderated mediation model was constructed to estimate the indirect and conditional effects of topic probability on engagement behaviors (likes, comments, and views) via self-disclosure. The results reveal that self-disclosure significantly mediates the influence of topical content on engagement, with emotional negativity amplifying and cognitive complexity selectively enhancing this pathway. Indirect effects differ across topics, highlighting the heterogeneous behavioral salience of expressive themes. The findings support a statistically grounded, semantically interpretable framework for predicting user behavior in high-dimensional text environments. This approach offers practical implications for optimizing algorithmic content ranking and fostering equitable visibility for marginalized digital labor groups. Full article

Background: Type 2 diabetes (T2D) is a major global health concern influenced by sociodemographic and lifestyle factors. This study compared T2D risk scores between commerce and industry sectors and assessed the associations of age, sex, education, physical activity, diet, and smoking with elevated risk. Methods: This cross-sectional study included 56,856 men and 12,872 women employed in the commerce (n = 27,448) and industry (n = 42,280) sectors across Spain. Anthropometric, clinical, and biochemical data were collected. Four validated T2D risk scores (QDscore, Finrisk, Canrisk, and TRAQ-D) were calculated. Multinomial logistic regression models estimated adjusted odds ratios (ORs) for high-risk categories by sociodemographic and lifestyle characteristics. Results: Women in the industrial sector had significantly higher age, BMI, waist circumference, and lipid levels than those in commerce; differences among men were less marked. Across all participants, higher T2D risk scores were independently associated with physical inactivity (OR up to 12.49), poor Mediterranean diet adherence (OR up to 6.62), industrial employment (OR up to 1.98), and older age. Male sex was strongly associated with high Canrisk scores (OR = 6.31; 95% CI: 5.12–7.51). Conclusions: Employment in the industrial sector, combined with sedentary behavior and poor dietary habits, is independently associated with higher predicted T2D risk. Workplace prevention strategies should prioritize multicomponent interventions targeting modifiable risk factors, especially in high-risk subgroups such as older, less-educated, and inactive workers. Full article

COVID-19 vaccine hesitancy in Pakistan is a barrier to optimal vaccine uptake and has been situated within a context of hesitancy towards other vaccines. A mixed-methods study was conducted during the initial COVID-19 vaccine roll-out in 2021 in four union councils in Peshawar, consisting of a cross-sectional survey, eight focus group discussions (FGDs) with community members and eight in-depth interviews with healthcare workers (HCWs) to assess perceptions toward vaccines. Multivariable logistic regression was used to assess factors associated with COVID-19 vaccine hesitancy. Of 400 survey participants, 57.3% were vaccine acceptant and 42.8% vaccine hesitant. Just over half (56.8%) perceived COVID-19 vaccines to be safe. Most (88%) reported trust in HCWs to provide accurate vaccine information. FGDs revealed that women received less information about the vaccine compared to men and cultural restrictions were barriers even for those willing to be vaccinated. Correlates of vaccine acceptance included male sex (aOR 2.25; 95% CI 1.29–3.91), age 50 years or greater (aOR 1.74; 95% CI 1.19–6.31), social network support (e.g., vaccine acceptance among an individual’s social network) in receiving COVID-19 vaccines (aOR 2.38; 95% CI 1.45–3.89), community concern about COVID-19 spread (aOR 2.84; 95% CI 1.73–4.66), and trust in HCWs to provide vaccine information (aOR 3.47; 95% CI 1.62–7.42). Future vaccine promotion should prioritize engaging community leaders, sharing transparent information, combatting misinformation and rumors, and implementing household-based interventions especially targeting the importance of vaccination among women and young people to increase uptake. Full article

Background: Metabolic syndrome (MS) is a major public health concern linked to an elevated risk of type 2 diabetes and cardiovascular disease. Simple, reliable screening tools are needed for early identification, especially in working populations. Objective: To compare the diagnostic accuracy of body mass index (BMI), waist-to-height ratio (WtHR), triglyceride–glucose index (TyG), and waist–triglyceride index (WTI) for detecting MS based on NCEP ATP III and IDF criteria in a large cohort of Spanish workers. Methods: This cross-sectional study analyzed data from 386,924 Spanish workers. MS was diagnosed using NCEP ATP III and IDF definitions. The four indexes were evaluated by sex using a receiver operating characteristic (ROC) curve analysis. Area under the curve (AUC), optimal cut-off points, and Youden’s index were calculated. Results: TyG and WTI had the highest AUC values in men (0.911 and 0.901, respectively) for NCEP ATP III-defined MS, while WtHR and WTI achieved the best performance in women (0.955 and 0.953, respectively). WtHR outperformed BMI in all subgroups. Optimal cut-off values were identified according to sex and the definition of MS: TyG (8.95 men, 8.51 women), WtHR (0.54 men, 0.51 women), and WTI (170.6 men, 96.5 women), supporting their practical implementation in occupational health programs. All indexes showed significant discriminatory capacity (p < 0.001). Conclusions: TyG, WtHR, and WTI are more effective than BMI in detecting MS among Spanish workers, with sex-specific patterns. Their ease of use and diagnostic strength support their adoption in occupational health programs for early cardiometabolic risk detection. Full article

Background: The aim of this scoping review is to analyze the health status of Roma and Sinti in Europe, highlighting the issues faced by children and women. In addition, we want to examine the access of these groups to health care services and to identify possible interventions to increase their use. Methods: Our research was conducted on Pubmed, Google Scholar, and the Trip Database. We selected articles written in English, Spanish, and Italian published since 2015. Results: Studies have shown that the health status of Roma and Sinti populations is generally worse than that of the rest of the population. Limited access to care is due to several specific factors, such as beliefs, traditions, and the lack of awareness of widespread direct and indirect discrimination against these groups by healthcare professionals. The studies reviewed have shown how mistrust can be broken down through multi-centered interventions linked to information, education, and communication through mediators able to interact with these populations, as well as through appropriate training of the health workers in charge. Conclusions: The health of the Roma and Sinti populations is commonly worse than that of the rest of the population. This is particularly true for the large proportion of people confined to suburban camps. However, the available evidence signals the low quality of life they experience and the need for interventions involving the communities and the establishment of ad hoc orientation or initial care contact points in the segregated areas. This could lead to an improvement in the integration of this population into the National Health Systems’ activities. Full article

This article examines the intersecting forces of gender, class, and education in early twentieth-century Britain through a feminist reading of Pip Williams’ historical novel The Bookbinder of Jericho. Centering on the fictional character Peggy Jones—a working-class young woman employed in the Oxford University Press bindery—the study explores how women’s intellectual ambitions were constrained by economic hardship, institutional gatekeeping, and patriarchal social norms. By integrating close literary analysis with historical research on women bookbinders, educational reform, and the impact of World War I, the paper reveals how the novel functions as both a narrative of personal development and a broader critique of systemic exclusion. Drawing on the genre of the female Bildungsroman, the article argues that Peggy’s journey—from bindery worker to aspiring scholar—mirrors the real struggles of working-class women who sought education and recognition in a male-dominated society. It also highlights the significance of female solidarity, especially among those who served as volunteers, caregivers, and community organizers during wartime. Through the symbolic geography of Oxford and its working-class district of Jericho, the novel foregrounds the spatial and social divides that shaped women’s lives and labor. Ultimately, this study shows how The Bookbinder of Jericho offers not only a fictional portrait of one woman’s aspirations but also a feminist intervention that recovers and reinterprets the overlooked histories of British women workers. The novel becomes a literary space for reclaiming agency, articulating resistance, and criticizing the gendered boundaries of knowledge, work, and belonging. Full article

Background/Objectives: Burnout and anger are prevalent among healthcare professionals in high-stress environments, particularly in addiction services. This study explores the relationship between burnout and anger among 124 operators working in public addiction services (SERD) in Calabria and Sicily. The objective is to assess how different anger dimensions contribute to burnout and identify protective factors that could inform targeted interventions. Methods: The sample consisted of 58 men and 66 women, with a mean age of 39.2 years (SD = 9.8), ranging from 25 to 59 years old. Burnout was measured using the Maslach Burnout Inventory (MBI), assessing emotional exhaustion, depersonalization, and personal accomplishment. Anger was evaluated through the State-Trait Anger Expression Inventory-2 (STAXI-2), examining trait anger, state anger, anger expression (anger-in, anger-out), and anger control. A cross-sectional design was used, with correlation and regression analyses controlling for gender and years of service. Results: High levels of burnout, particularly emotional exhaustion and depersonalization, were found. Emotional exhaustion correlated strongly with trait anger, indicating that individuals with a chronic predisposition to anger are more vulnerable to burnout. Suppression of anger (anger-in) significantly predicted depersonalization, exacerbating emotional disengagement from patients. Conversely, anger control acted as a protective factor, helping maintain a sense of personal accomplishment. Conclusions: These findings underscore the importance of emotional regulation in mitigating burnout among addiction service workers. Interventions such as emotional regulation training and anger management programs could help reduce psychological distress and promote resilience. Workplace strategies that support emotional well-being may improve both staff retention and patient care quality. Further research should explore longitudinal trends and intervention effectiveness. Full article

Background/Objective: Shift work has been increasingly associated with adverse metabolic outcomes, including insulin resistance (IR), a key contributor to cardiometabolic diseases. However, few large-scale studies have explored the association between shift work and validated IR indices across sociodemographic and lifestyle variables, stratified by sex. To investigate the relationship between shift work and four surrogate markers of insulin resistance—TyG índex, TyG-BMI, METS-IR (Metabolic score for insulin resistance), and SPISE-IR (Single-Point insulin Sensitivity estimator)—in a large Spanish working population and to assess how sociodemographic and behavioral factors modify these associations. Methods: This cross-sectional study included 53,053 employed adults (31,753 men and 21,300 women) across various regions and labor sectors in Spain. Participants were classified as shift or non-shift workers based on their work schedules. Data were collected during routine occupational health assessments and included anthropometric, clinical, biochemical, and behavioral variables. IR indices were calculated using standard formulas. Statistical analyses included t-tests, chi-square tests, and multivariable logistic regression, with stratification by sex. Results: Shift workers exhibited significantly higher levels of TyG, TyG-BMI, and METS-IR, and lower SPISE values compared to non-shift workers (all p < 0.001). These differences persisted after stratification by sex, age, education, and lifestyle factors. Logistic regression analyses confirmed that shift work independently predicted high IR risk across all indices, with adjusted ORs ranging from 1.49 to 1.89. Physical inactivity, low adherence to the Mediterranean diet, and alcohol consumption were the strongest modifiable predictors. Men exhibited a higher burden of IR than women across all indices. Conclusions: Shift work is independently associated with elevated insulin resistance in both men and women. These findings emphasize the importance of workplace health interventions targeting physical activity, diet, and substance use, particularly in populations engaged in non-standard work schedules. Full article