Search Results (3,193)

Early clinical exposure (ECE) has been associated with increased confidence, professionalism, and career exploration in undergraduate medical education. Student-run free clinics (SRFCs), such as the Health Outreach Project (HOP) at Drexel University College of Medicine, provide opportunities for preclinical students to engage in patient care and community outreach. This qualitative study explored medical students’ perceptions of participation in HOP. Fourteen third- and fourth-year medical students with prior HOP experience participated in four semi-structured focus groups conducted virtually over Zoom. Data were analyzed using an inductive thematic analysis approach. Four major themes emerged: (1) early clinical exposure and clinical skills development, (2) community engagement and patient-centered perspectives, (3) professional identity formation and career exploration, and (4) opportunities, limitations, and emotional challenges of outreach work. Participants described HOP as an important source of authentic clinical exposure that increased confidence in patient interactions and broadened awareness of social determinants of health and underserved populations. Students also reflected on the influence of HOP on professional identity formation, career interests, and perspectives on patient-centered care, while acknowledging frustrations related to systemic barriers and limited resources. These findings suggest that students perceive SRFCs as valuable experiential learning environments that support clinical preparedness and professional development early in medical training. Full article

Background: Fasting plasma glucose, glycated hemoglobin (HbA1c), and oral glucose tolerance testing remain central to the diagnosis and monitoring of dysglycemia, but they mainly reflect the average glycemic exposure or discrete time-point measurements and may not capture intraday and interday glucose fluctuations. Glycemic variability (GV) has been associated with oxidative stress, endothelial dysfunction, inflammation, and diabetes-related complications, although much of the evidence derives from experimental, clinical, and diabetes-care settings rather than occupational cohorts. Aim: This narrative review examines the physiological basis, measurement, and potential occupational relevance of GV and continuous glucose monitoring (CGM) in working populations. Methods: Literature was narratively selected from biomedical databases, major guidelines, consensus statements, and occupational-health sources, prioritizing reviews, clinical guidelines, cohort studies, mechanistic studies, and CGM studies. No systematic search, risk-of-bias assessment, or quantitative synthesis was performed. Main findings: CGM is an established technology in selected diabetes-care contexts and provides metrics such as coefficient of variation, time in range, time above range, and time below range. Its use in occupational medicine, however, remains investigational outside selected clinical circumstances. Work-related factors such as shift work, circadian disruption, sleep loss, psychosocial stress, irregular meal timing, sedentary behavior, and variable physical workload may influence glucose regulation, but direct evidence linking these exposures to CGM-measured GV in workers remains limited. Implications: Potential applications include research on occupational determinants of metabolic health, monitoring of workplace lifestyle interventions, and individualized management of workers with diabetes in safety-sensitive roles, provided that consent, confidentiality, clinical follow-up, equity, and data-governance safeguards are ensured. Conclusions: GV assessment may complement traditional metabolic markers in selected occupational-health contexts, but routine CGM-based surveillance of general worker populations is not currently supported by sufficient evidence. Further longitudinal and interventional studies are required. Full article

Background: Obesity is a major public health concern and shows a clear social gradient, with higher prevalence among individuals with lower socioeconomic position. Educational level is a key indicator of socioeconomic status, but the extent to which lifestyle factors explain its association with obesity remains unclear. Objective: To examine the association between educational level and obesity in a working-age population and to evaluate how adjustment for lifestyle factors influences the magnitude of the association between educational level and obesity. Methods: A cross-sectional study was conducted among 3108 working-age adults undergoing occupational health assessments in Spain. Educational level was categorised into three groups (higher, intermediate, and primary or none). Obesity was defined as a body mass index ≥30 kg/m². Lifestyle variables included smoking status, physical activity assessed using the International Physical Activity Questionnaire (IPAQ-SF), and adherence to the Mediterranean diet evaluated with the MEDAS-14 score. Sequential logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (95% CI), with progressive adjustment for demographic, behavioural, and clinical factors. Results: The overall prevalence of obesity was 16.6%, with a clear gradient across educational levels (11.5% in higher education vs. 19.8% in primary or no education). In crude analyses, individuals with the lowest educational level had higher odds of obesity (OR 1.89; 95% CI 1.46–2.45). Adjustment for age and sex attenuated the association (OR 1.72; 95% CI 1.32–2.24), with further reduction after inclusion of lifestyle factors (OR 1.63; 95% CI 1.24–2.13). In the fully adjusted model, the association remained statistically significant (OR 1.61; 95% CI 1.18–2.21), indicating that adjustment for lifestyle factors attenuated the association between educational level and obesity, although the association remained statistically significant. Conclusions: Lower educational level is associated with a higher risk of obesity. Adjustment for lifestyle factors attenuated this association, although a statistically significant relationship remained. These findings support the role of education as a fundamental determinant of health and highlight the need for strategies addressing broader social and structural determinants of obesity. Full article

Background: Operating rooms generate substantial visual data that is rarely captured systematically. Image-based AI (IBAI) systems using computer vision offer a new approach to real-time perioperative workflow monitoring, but evidence of their impact on surgical case volume remains limited. The aim of this study was to evaluate the association between deployment of an IBAI system and monthly surgical case volume in a high-acuity cardiothoracic operating suite, using synthetic control with difference-in-differences estimation. Methods: We deployed an IBAI system with wall-mounted cameras and a YOLO-based (You Only Look Once) object detection model coupled with a transformer-based event detector in a 15-room cardiothoracic suite at Houston Methodist Hospital (HMH), the tertiary academic hospital of Houston Methodist health system. The deployment was conducted under an IRB-determined quality improvement framework with patient consent for ambient video capture, defined retention limits, and restricted access to recordings. Over a 16-month period spanning 6 months pre-deployment and 10 months post-deployment, the system monitored 5417 surgical cases and automatically detected additional perioperative events including patient entry, draping, and room turnover. Using a synthetic control methodology, we compared post-deployment outcomes at the intervention site against a weighted combination drawn from a pool of 11 Houston Methodist sites that did not yet implement IBAI (116,098 cases across the comparison sites; 121,515 cases in the full analytic dataset). Results: The synthetic control analysis with difference-in-differences estimation showed a statistically significant increase of approximately 25 cases per month (95% CI 8.3 to 41.0; p < 0.01; Bonferroni-adjusted p < 0.05), corresponding to a 7% increase in monthly case volume relative to baseline. Conclusions: Our findings suggest that IBAI can meaningfully improve OR efficiency and support data-driven perioperative management. Future work should evaluate whether case volume gains generalize across other surgical specialties, assess changes in operational outcomes such as turnover time and first-case on-time starts, and examine clinicians’ perceptions of IBAI. Full article

Background: Work ability (WA) decreases with age. This cohort study investigated changes in WA over time among senior workers and explored associations between WA and objectively measured physical performance. Methods: A questionnaire regarding WA (0–100 points), work status and general health was sent out to individuals aged 50–65 years (n = 23,463) with a 6.5-year follow-up. A subgroup participated in a clinical substudy testing physical performance. Results: A total of 13,404 participants responded to the baseline questionnaire (56%) and 8474 (63%) responded at follow-up. Overall, WA decreased by –8.3 points over time (95% CI: –8.9 to –7.7). The decline was similar between genders and among senior workers with high or low physical work demands. The steepest decline in WA was among those aged 56–59 years at baseline (–10.3 points, 95% CI: –11.5 to –9.1). Clinical examination showed that WA was positively associated with higher isokinetic muscle strength, handgrip strength and functional capacity after adjusting for confounders (all p < 0.05). Conclusion: Work ability decreased over time among all senior workers. Clinical subgroup analyses revealed positive associations between physical performance and WA. Future longitudinal studies are needed to determine whether improving physical performance can reduce age-related decline in work ability. Full article

The contamination of aquatic ecosystems by synthetic dyes such as Safranin O poses significant environmental and health risks. This study reports the synthesis of TiO₂-ZnO heterostructures via a Ruta graveolens-mediated sol–gel method, where the plant extract acts as a structure-directing agent and precursor for residual carbon species. The resulting bio-hybrid catalyst achieved a degradation efficiency of 94% ± 2% under simulated solar irradiation, outperforming UV light (78% ± 3%) and visible light alone (81.18%). The optimal catalyst loading was determined to be 1.0 g L⁻¹, with maximum performance observed at near-neutral pH (6–7). Optical characterization revealed a direct bandgap of 2.69 eV, representing a significant red-shift from pristine TiO₂ and ZnO. The catalyst maintained 90% of its initial degradation efficiency after five consecutive regeneration cycles, demonstrating excellent reusability. Kinetic analysis confirmed pseudo-first-order behavior, while radical scavenging experiments identified superoxide radicals (•O₂⁻) as the dominant reactive species. This work establishes that plant-derived carbon precursors can effectively modify the electronic properties of TiO₂-ZnO heterojunctions, offering a sustainable approach for photocatalytic water remediation. Full article

Burn injuries are increasingly recognized as chronic conditions with enduring physical, psychological and social consequences that extend beyond acute survival. This narrative review synthesizes and interpretatively discusses recent evidence on health-related quality of life (HRQoL) in adult burn survivors, focusing on recovery patterns following discharge. Persistent physical sequelae—particularly chronic pain, pruritus, contractures and scarring—remain major determinants of reduced HRQoL, mainly mediated by functional limitation and self-perception. Psychological morbidity is common, with high rates of depression, anxiety and post-traumatic stress disorder, particularly early after injury, although post-traumatic growth may also emerge. Social reintegration, including return to work, is often delayed or incomplete and is influenced by injury severity, mental health status and social support. Recovery trajectories are nonlinear: the greatest improvements occur within the first six months, followed by slower gains up to 18–24 months, after which many patients fail to reach population norms. Pain and psychological symptoms may persist for years. Overall, these findings support a multidisciplinary, longitudinal approach to burn care, emphasizing early risk stratification and rehabilitation to optimize individualized recovery. In this narrative review, we aim to outline the main dimensions of long-term quality of life, with a particular focus on the temporal dynamics of recovery patterns. Full article

Areas where mining activities overlap with agricultural production may promote the mobilization of potentially toxic elements (PTEs) into soils and water resources, thereby creating exposure pathways for populations living or working in these environments. This study analyzes the concentration of PTEs in agricultural soils and irrigation water from Santa Rosa, southern Ecuador, and assesses the associated health risks for exposed agricultural workers. For this purpose, 35 soil samples were collected from farms and 12 water samples from the irrigation canal during the dry season of 2025. The concentration of PTEs in soil and water was determined using X-ray fluorescence (XRF) and inductively coupled plasma mass spectrometry (ICP-MS), respectively. The PTE concentration in both matrices was compared with the maximum permissible limits (MPL) established by Ecuadorian regulations. Non-carcinogenic hazard indices ($\mathrm{H}\mathrm{I}$) and carcinogenic risk ($\mathrm{T}\mathrm{C}\mathrm{R}$) were estimated following the U.S. EPA methodology. In soil, As and Cr were the PTEs of greatest concern, exceeding the MPL in 93% of the samples and by up to 4.4 and 2.4 times, respectively, while in water, all PTEs were below the MPL. Non-carcinogenic risk was below the recommended limit for soil and water ($\mathrm{H}{\mathrm{I}}_{\mathrm{s}\mathrm{o}\mathrm{i}\mathrm{l}}$ = 3.00 × 10⁻² and $\mathrm{H}{\mathrm{I}}_{\mathrm{w}\mathrm{a}\mathrm{t}\mathrm{e}\mathrm{r}}$ = 2.00 × 10⁻³), with As as the dominant contributor. Cancer risk was tolerable in soil ($\mathrm{T}\mathrm{C}{\mathrm{R}}_{\mathrm{s}\mathrm{o}\mathrm{i}\mathrm{l}}$ = 4.34 × 10⁻⁵), while in water it remained at a low level ($\mathrm{T}\mathrm{C}{\mathrm{R}}_{\mathrm{w}\mathrm{a}\mathrm{t}\mathrm{e}\mathrm{r}}$ = 1.65 × 10⁻⁶). These findings identify As and Cr as priority contaminants and support targeted monitoring and source-control measures in mining-influenced agricultural areas. Overall, by integrating agricultural soil and irrigation water quality with an occupational health risk assessment in Santa Rosa, this study contributes evidence to support future research in mining–agriculture coexistence areas. Full article

Large-amplitude and long-term vibration deformation under external environmental loads often occurs on tensile membrane structures. Proper sensor placement plays a vital role in effectively achieving the objectives of a structural health monitoring system. In order to optimize the sensor placement to identify the modal vibration parameters for tensile membrane structures, this paper proposes an optimal sensor placement method based on the Fisher information matrix (FIM) and improved random strategy discrete particle swarm optimization algorithm (IRSDPSO). Firstly, the structural modal order is selected by using the two-norm difference and trace change rate of FIM, and the number of sensors is determined based on the QR decomposition and MAC criterion. Secondly, an improved particle swarm optimization algorithm named IRSDPSO, which has the discrete characteristic, is proposed to arrange the placement of sensors. Finally, the convergence, stability and sensitivity are used to evaluate the effectiveness of optimal sensor placement results using a numerical modal test example of the plane bidirectional tensile membrane structure. The results show that the first nineteen modal frequencies can be accurately identified. This indicates that the proposed optimal sensor placement method can determine the number of sensors and arrange the placement of the sensors. The work is reasonable and feasible in the optimal sensor placement for the tensile membrane structure. Full article

The emergence and increasing use of artificial intelligence (AI) in healthcare have paved the way for highly personalized and time-saving approaches in the field of precision medicine. It can be applied to determine a prognosis, diagnosis, and recommended treatment, and may also be used for patient monitoring. As AI applications become more widely available, reliable and easy to use, they are rapidly reshaping the traditional roles of professionals and patients in the therapeutic relationship. On the positive side, professionals may have more time to communicate with patients and provide individualized care, whereas patients may become more empowered and autonomous due to AI-facilitated personalized information and monitoring. On the negative side, AI applications threaten to reduce the role of professionals to a mediating one in clinical decision-making, provide patients with misinformation, and lead to misunderstandings that hinder patients’ autonomy. In this narrative review, we examine the main ethical issues related to the AI-induced shift in roles in the therapeutic relationship, within four inter-related themes: the validity of claims that algorithms outperform humans in certain tasks; the ways in which AI saves time for health professionals but also takes time to properly explain and implement; the issues of trust and accountability, especially if AI suggestions lead to patient harm; and what AI’s alleged cost-effectiveness means for professionals’ employment and remuneration. Across the three roles, we find a common pattern: AI tends to absorb the technical and data-processing parts of clinical work while leaving its relational core to humans. Physicians move toward oversight and interpretation, nurses retain the attentiveness and responsiveness that define care, and patients gain tools for self-management that can widen autonomy or, left unguided, erode it. Whether the overall effect is benign depends less on the technology than on how outperformance is evidenced, how the freed time is used, how trust and accountability are anchored in people, and how cost pressures are managed. The article concludes with some suggestions for prudent use of AI in healthcare, indicating the appropriate measures that can be used to harness the power of AI without damaging the traditional cornerstones of the therapeutic relationship. Full article

Background: Cardiometabolic diseases are shaped by complex interactions between biological and social determinants. While socioeconomic inequalities in cardiometabolic risk are well established, less is known about how these inequalities are distributed across multidimensional cardiometabolic phenotypes and whether they differ by sex. Objective: We aimed to examine sex differences in the socioeconomic gradient of cardiometabolic phenotypes using latent class analysis in a working-age population. Methods: A cross-sectional study was conducted in 3108 adults aged 18–65 years undergoing occupational health assessments in the Balearic Islands (Spain). Educational level was used as an indicator of socioeconomic position. Cardiometabolic risk was assessed using obesity, insulin resistance (METS-IR), metabolic dysfunction-associated steatotic liver disease (FLI), atherogenic index of plasma, and metabolic syndrome. Latent class analysis was applied to identify cardiometabolic phenotypes. Multinomial logistic regression models stratified by sex and interaction analyses were used to assess associations between educational level and class membership. Tests for linear trend and predicted probabilities were also estimated. Results: Four cardiometabolic phenotypes were identified: low-risk (40.8%), obesity-dominant (24.1%), dysmetabolic (19.3%), and high-risk multimorbid (15.8%). A clear socioeconomic gradient was observed, with lower educational attainment associated with a higher likelihood of belonging to adverse cardiometabolic profiles. This gradient was stronger among women. For the high-risk multimorbid class, the relative risk ratio comparing low vs. high educational level was 1.82 (95% CI 1.34–2.46) in men and 2.47 (95% CI 1.68–3.64) in women (p for interaction = 0.012). A significant linear trend across educational levels was observed in both sexes (p for trend < 0.001). Predicted probabilities further confirmed a steeper increase in high-risk profiles among women with lower educational attainment. Conclusions: Cardiometabolic risk is structured into distinct phenotypic profiles that are socially patterned. Socioeconomic inequalities are strongly associated with adverse cardiometabolic phenotypes, with a more pronounced gradient among women. These findings highlight the need for gender-sensitive strategies addressing social determinants to reduce cardiometabolic health inequalities. Full article

Remote patient monitoring (RPM) is widely framed as a foundational technology for the next generation of chronic-disease care. Specific applications—pacemaker follow-up, hypertension cohorts, structured heart-failure programmes, post-surgical biosensor protocols, and virtual wards—now generate measurable clinical and economic value. Yet a decade of evaluations and implementation studies suggests that the surrounding ecosystem has matured unevenly: working applications coexist with persistent cross-cutting fragility. In this Perspective we argue that four structural gaps continue to constrain RPM’s promise at scale: (i) economic models that do not credibly compensate the asynchronous clinical work that RPM generates; (ii) ambiguous frameworks for professional liability and accountability for continuous data streams, intensified by artificial-intelligence (AI)-mediated decision support; (iii) privacy, equity, and benefit-sharing arrangements that do not yet make patients unambiguous net beneficiaries—a gap visible across very different health systems internationally; and (iv) engagement and adherence dynamics that determine whether programmes deliver value at all, but are still treated as secondary outcomes. The COVID-19 emergency briefly suspended much of the friction in this ecosystem and produced a useful natural experiment: what scaled rapidly under emergency conditions, and what subsequently atrophied, illuminates which gaps are technical, which are economic, and which are institutional. We close with a six-point research and policy agenda intended to move RPM from localised successes to a trustworthy, generalisable standard of care. Full article

Rapid urbanization in tropical Asia has led to a critical loss of green cover, exacerbating urban environmental challenges. While green roofs offer a promising Nature-based solution, their implementation in Asian countries is hindered by the prevalence of sloped roofs and high structural conversion costs. This research addresses this gap by developing a novel, lightweight vegetative roof tile designed as a direct structural replacement for conventional roofing materials in Sri Lanka. Existing roofing systems were studied, followed by a laboriousness study to determine the optimum tile dimensions. To meet these requirements, a modular tile measuring 900 mm × 1200 mm with a wave-shaped corrugated profile (a 10 mm rise and a 200 mm pitch) was engineered using SolidWorks 2024 and ABAQUS 2024 to meet Eurocode standards. Field investigations into plant health helped to finalize the depth of the roof tile as 2.5 cm. Following root penetration testing, fiber-reinforced plastic was selected for the tile structure to ensure durability while maintaining a total saturated weight of 52.5 kg/m². Biological testing demonstrated robust greening performance, with Axonopus compressus and Zoysia matrella achieving 100% survival rates and over 80% canopy coverage. This design methodology can be adapted across tropical Asia, contributing significantly to regional green infrastructure development and sustainable building practices. Full article

Executive functions (EFs) are key cognitive processes for behaviour. However, there is little information about interaction with the dimensions of health-related quality of life (HRQoL), therefore the objective of this study was to analyse the association between lifestyle habits (physical activity and screen time), sleep, HRQoL and EFs in children and adolescents. Specifically, this study aimed to identify the extent to which perceived well-being dimensions are associated with EFs and to determine the potential mediating role of HRQoL in the relationships between lifestyle habits and these cognitive domains, examining whether these direct and indirect pathways remain robust after adjusting for gender and age. A total of 943 children and adolescents (51.3% female) aged 10–17 years participated. Lifestyle parameters (PA Krece Plus, sleep duration and KIDSCREEN-10 questionnaire) and EFs (CogniFit neurocognitive assessment battery) were evaluated. The analysis of the individual KIDSCREEN-10 items revealed that perception of school performance presented the most consistent association with EFs, being positively related to attention (b = 16.39, p = 0.018), cognitive flexibility (b = 30.65, p = 0.005), inhibition (b = 24.66, p = 0.022), and working Memory (b = 42.33, p < 0.001). Furthermore, parental fairness reported a significant association for three out of four domains: attention (b = 13.89, p = 0.006), flexibility (b = 22.93, p = 0.003), and working Memory (b = 25.42, p < 0.001). Having enough time for self was also significantly related to attention performance (b = 12.60, p = 0.026). Regarding lifestyle habits, the composite lifestyle index (PA + ST) showed the most consistent positive association across all cognitive domains, while sleep duration was inversely associated with attention, cognitive flexibility, and working Memory. The mediation analysis revealed that global HRQoL significantly mediated the relationship between lifestyle habits and executive functions, accounting for 9.55% of the total effect on attention, 5.45% on cognitive flexibility, and 4.14% on working memory, whereas no mediation was observed for inhibition. In conclusion personal time, parental fairness, and school adjustment were positively associated with EFs. HRQoL and physical activity levels also showed consistent links with all EFs, whereas sleep duration was inversely related. Furthermore, mediation analysis revealed that global HRQoL acts as a critical indirect pathway, explaining a significant proportion of the lifestyle habits’ total effect on attention, cognitive flexibility, and working memory. Overall, these findings highlight the multifactorial and interrelated mechanisms shaping executive functioning in children and adolescents. Full article

The atmospheric air quality is one of the crucial factors determining people’s health, duration and quality of life. The importance of ammonia (NH₃) and ethylene (C₂H₄) is due to the fact that they are precursors of secondary organic aerosols (SOA) and phytotoxicants, which significantly affect air quality, cause human diseases and damage plants. The Fourier Transform Infrared (FTIR) spectrometry is a powerful tool for long-term monitoring of the atmospheric gas composition, including toxic gases. The paper presents the results of atmospheric FTIR measurements of NH₃ and C₂H₄ at the St. Petersburg State University observational site (59.88° N, 29.83° E, 20 m above sea level) located in a suburb of greater Saint Petersburg. This work demonstrates the applicability of the ground-based atmospheric FTIR spectroscopy to long-term monitoring of air pollution in urbanized areas and in particular to provide information on the NH₃ and C₂H₄ abundance in the atmosphere, including the analysis of their annual cycle, long-term trends, and positive anomalies. It was shown that for NH₃ and C₂H₄, a statistically significant decrease in column-averaged dry-air mole fraction values (X_NH3 and X_C2H4) was observed, amounting to (−2.3 ± 0.2)%/year for the 2009–2025 period and with the rate (−2.2 ± 0.4)%/year for the 2016–2025 period, respectively. Periodically recorded X_NH3 anomalies indicate the presence of intensive emission sources in the region, subjecting ecosystems in adjacent areas to constant exposure to NH₃ concentrations exceeding the critical level. Anomalously high values of X_NH3 and X_C2H4 were recorded simultaneously only once—on 17 October 2017. Using data on HCN total column (as a forest fire indicator) and the results of atmospheric dispersion modeling, it was shown that this pollution event was caused by the influence of biomass burning products emitted from wildfires located approximately 250 km to the north-west from the observational site in the Helsinki area (Finland). Full article