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Article
Public Health and Healthcare
Nursing

Gwenne Louise McIntosh

,

Margaret M Conlon

,

Edel McGlanaghy

,

Freya Collier-Sewell

Abstract: Background There is a high correlation between a trauma history and development of mental health conditions. By providing safe and containing (trauma-informed) working relationships, mental health nurses can validate mental distress, reduce re-traumatisation and support recovery. Trauma informed education (TIE) has become commonplace in nurse education however, little is known about students’ experience of this and its impact on their practice. Purpose This study aimed to evaluate and explore student mental health nurses’ perspectives on TIE and its impact on their practice to contribute to the knowledge and evidence base that informs nurse and broader healthcare education. Methods This qualitative, phenomenological study used focus group interviews (n=3) with 11 mental health nursing students, reported using SRQR Checklist. Analysis Data generated was analysed using Braun and Clarke’s (2013) Reflective Thematic Analysis. Findings Three themes were identified: 1. A compass for practice; 2. Mental Health Nursing: Between paradigms; 3. Supporting personal development and wellbeing. Integrating TIE within nurse education can support students to adopt the principles of trauma-informed care (TIC) personally and in their practice. Improved self-awareness, recognition of trauma and adopting self-care strategies were valuable in supporting personal resilience and wellbeing, valuable in managing the challenges of mental health practice. Recommendations TIE has the potential to have a positive impact on wellbeing therefore integration should be considered for all healthcare programmes. Further interprofessional research is needed to establish the longer-term impact of TIE as students’ progress into their professional career. Limitations This is an initial small-scale study with self-selecting students which limits generalisability. Exploring sustained impact through longitudinal study may be valuable.
Article
Public Health and Healthcare
Public Health and Health Services

Robert Costa

,

Maria Araújo

,

Ingride Ferreira

,

Carla Minervino

Abstract: Global population aging demands understanding the determinants of healthy cognitive aging. This study aimed to examine the interrelations among executive functions, instru-mental activities of daily living and quality of life in older adults, considering the mediat-ing role of depression. Structural equation modeling was employed to estimate direct and indirect pathways between latent and observed variables, with the inclusion of depression as covariate in a sample of 124 community-dwelling older adults from João Pessoa, Brazil. Results indicated that executive function components were interrelated and associated with instrumental activities of daily living performance but did not exert a significant di-rect effect on quality of life. Depression emerged as the strongest predictor of satisfaction with life, negatively impacting all domains and mediating the relationship between exec-utive functioning and functional autonomy. The final model explained the major variance in quality of life compared to the variance in instrumental activities of daily living, with model fit indices supporting adequacy. These findings underscore the central role of de-pression in determining the self-perceived quality of life in aging, suggesting that inter-ventions should target both cognitive and affective domains to promote autonomy and well-being in older populations.
Article
Public Health and Healthcare
Public Health and Health Services

Dominika Doktorová

,

Timea Fedorová

Abstract:

We focused on a comparison of cognitive failures in nine women with anorexia nervosa and nine women of the regular population. Background/Objectives: It primarily focuses on memory, attention, psychomotor tempo, and executive function in a group of women with a diagnosis of anorexia nervosa and a group of women in the general population without a diagnosis of anorexia nervosa or other psychiatric diagnosis. The following methods were used for research purposes: the Cognitive Failure Questionnaire (CFQ), the Trail Making Test (TMT), and a semi-structured interview subsequently processed into a case study. We observed a significantly negative impact of anorexia nervosa on the cognition of respondents. Results: Through the above objective methods, it detects the significantly negative impact of mental anorexia on the cognition of female respondents. The findings from the quantitative methods are verified through the qualitative part in the form of an interview, which is also consistent with previous findings. Conclusions: We also consider it important to carry out longitudinal studies that would allow us to monitor how cognitive functions change during treatment and recovery from anorexia nervosa.

Review
Public Health and Healthcare
Nursing

Leon Wreyford

,

Raj Gururajan

,

Xujuan Zhou

,

Niall Higgins

Abstract: Background: Treatment nonadherence in oncology is prevalent and often assessed by surveys that miss the qualitative reasons underpinning nonadherence or treatment discordance. We aimed to synthesize evidence from Natural Language Processing (NLP) studies, primarily sentiment analysis of patient-generated content (social media, forums, blogs, review platforms, and survey free text), to identify communication-related and relational factors linked to nonadherence/concordance. Methods: We conducted a scoping review following PRISMA-ScR. Searches of PubMed, CINAHL, and Scopus (2013–early 2024) targeted NLP studies of the cancer patient experience; conventional reports were included where they clarified communication/adherence constructs. Data were charted against source, cancer type, NLP technique, and inferred adherence/concordance factors, then synthesized using discourse analysis and narrative synthesis. Results: Four patient side themes consistently emerged: (1) unmet emotional needs; (2) suboptimal information and communication; (3) unclear treatment concordance within patient/person-centred care; and (4) online misinformation dynamics (and perceptions of clinician bias). Sentiment analysis detected fine grained emotions (fear, disgust, sadness, surprise), informational gaps and trust issues that are often less visible in structured surveys. Conclusions: Patient voice data offer actionable insights for nursing practice: routine distress screening, teach back strategies, misinformation countermeasures, and explicit concordance checks. Integrating these into person-centred workflows may improve adherence and shared decision making. Registration: Not registered.
Review
Public Health and Healthcare
Health Policy and Services

Ioannis Adamopoulos

,

Aida Vafae Eslahi

,

Niki Syrou

,

Maad M. Mijwil

,

Pramila Thapa

,

Panagiotis Tsirkas

,

Antonios Bardavouras

,

Harshit Mishra

,

Konstantina Diamanti

,

Antonios Valamontes

+2 authors

Abstract: Economic crises characterized by financial instability, rising unemployment, and austerity measures are known to have profound social and public health consequences. While their economic impacts are widely studied, their effects on mental health across diverse populations and geographic regions remain fragmented and require synthesis. This scoping review aims to consolidate existing evidence on the relationship between economic crises and a broad range of mental health outcomes, including suicide, depression, anxiety, psychological distress, and health service utilization. Multiple databases (PubMed, EMBASE, Web of Science, Scopus, PsycINFO, EconLit) were explored for reports published between January 2000 and December 2025, following PRISMA-ScR guidelines. Totally, 122 studies met the inclusion criteria. Economic crises are consistently associated with adverse mental health outcomes. Key findings include increased suicide mortality, particularly among working-age men, with pronounced spikes during and after major crises such as the 2008 global financial crisis and the 1997 Asian financial crisis. Non-fatal suicidal behaviors (ideation, attempts, self-harm), depression, anxiety, and psychological distress also rise significantly, driven by unemployment, income loss, debt, and housing insecurity. Vulnerable groups, including the unemployed, low-income populations, youth, and those with pre-existing mental health conditions are disproportionately affected. The evidence also indicates mixed patterns in mental health service utilization, often constrained by austerity and access barriers. Social protection systems and supportive policies appear to mitigate negative mental health impacts. Economic crises exert a significant and multifaceted toll on population mental health, exacerbating inequalities and increasing the burden of mental disorders and suicidal behavior. The findings underscore the need for integrated policy responses that strengthen social safety nets, ensure accessible mental healthcare, and address the psychosocial and economic determinants of health during periods of financial instability. Research gaps remain, particularly in low- and middle-income countries and regarding long-term mental health trajectories post-crisis.
Article
Public Health and Healthcare
Primary Health Care

Lola Yesenia Acosta Vinueza

,

Rodrigo Roberto Alvear Reascos

Abstract: Background/Objectives: Mental disorders are a growing public health concern in Lat-in America, particularly among marginalized populations. This study aimed to identi-fy the prevalence and associated risk factors of mental disorders in Afro-descendant communities of the Río Chota Basin, a historically excluded population facing persis-tent social and economic inequalities. Methods: A cross-sectional descriptive study was conducted in several rural communities using random sampling. A total of 557 participants were assessed for sociodemographic factors and mental health status us-ing validated instruments: the Global Mental Health Assessment Tool–Primary Care (GMHAT/PC), the International Physical Activity Questionnaire (IPAQ), and the WHO STEPS questionnaire. Data was analyzed using descriptive statistics and infer-ential tests to determine associations between psychosocial, behavioral, and socioeco-nomic variables and the presence of mental disorders. Results: The overall prevalence of mental disorders was extremely high (60.7%), exceeding national and regional esti-mates. The most prevalent conditions were major depressive disorder (15.6–17.9%), anxiety disorders (10.2–12.3%), and psychosis with depressive symptoms (8.3–11.5%), with higher rates among women. Low fruit and vegetable intake and income below the minimum wage were significantly associated with greater prevalence. Severe stress and experiences of abuse or maltreatment showed the strongest associations with mental disorders (p < 0.001). Conclusions: Afro-descendant communities in the Río Chota Basin experience a disproportionately high burden of mental illness influenced by intertwined socioeconomic, psychosocial, and behavioral determinants. Culturally sensitive interventions that promote resilience, community support, and reduction of structural inequalities are urgently needed.
Article
Public Health and Healthcare
Public Health and Health Services

Jaewon Kim

,

Phuong Ha

,

Holden Yoon Seung Kim

Abstract: Visual impairment during adolescence can affect educational outcomes and psychosocial development, particularly in settings with limited access to comprehensive eye care. This study aimed to assess the prevalence of refractive errors and the adequacy of spectacle correction among secondary school students in Da Nang, Vietnam. A school-based cross-sectional survey was conducted among 8th-grade students at Le Do Secondary School in the Son Tra District. Visual acuity, refractive status, and spectacle use were evaluated using standard clinical procedures. Verbal consent was obtained from students, with teachers acting as guardians, and retrospective ethical approval was granted (IRB No. P01-202410-01-039). Of 350 eligible students, 315 were included in the analysis. Based on the better-seeing eye, 15.9% of students had myopia, and refractive errors were identified in 40.3% when either eye was considered. At the time of assessment, 24.8% wore spectacles; however, 41.6% required refractive correction, including 29.8% with uncorrected refractive error and 11.8% whose spectacles did not adequately correct their vision. These findings indicate gaps in both access to refractive services and the quality of provided corrections. Although limited to a single school, the results highlight the need for routine school-based vision screening and affordable, accurate spectacle provision. Larger, population-based studies are warranted to clarify the broader burden of refractive error among Vietnamese adolescents.
Article
Public Health and Healthcare
Public Health and Health Services

Elfriede Derrer-Merk

,

Maria-Fernanda Reyes-Rodrigez

,

Ashley Navarro-McCarthy

,

Mary Mulenga-Wincierz

,

Kate Mary Bennett

Abstract: The COVID-19 pandemic profoundly disrupted the lives of older adults, yet their experiences have remained underexplored. This paper draws on empirical evidence from a two-wave (W1 April-July 2020, W2 January-April 2021) qualitative study in the UK (n=62) and a companion study in Colombia (n=32), focusing on participants aged 60 and above. Data was analysed using constructivist grounded theory principles, leading to the development of an ecological theory of older adults' well-being at three interconnected levels: individual, community, and societal. Individual resources, such as adaptability and support systems, contributed to enhancing and maintaining their well-being. Community support and a sense of belonging were essential to meet the needs of people in later life, whilst necessary social health protection measures during the pandemic restricted social activities, further impacting well-being, mostly perceived as challenging. Cultural differences and societal support systems shaped participants' experiences. The study emphasises the interdependence of the different levels in impacting older adults' well-being, offers strategies for policy and practice, and advocates and contributes for the development of gerontological theories in the context of health crises.
Article
Public Health and Healthcare
Other

José Antonio Valeriano-Zapana

,

Mario Román Flores-Roque

,

Leonel Alonso Paccosonco-Sucapuca

,

Yudith Milagros Cari-Cari

,

Daniel Álvarez-Tolentino

,

Alex Huaman De La Cruz

Abstract: The COVID-19 pandemic created a natural experiment to assess air quality responses to emission reductions, yet evidence from Latin American coastal industrial cities remains scarce. This study examined how meteorological variability modulated the effects of COVID-19 restrictions on air quality in Ilo, a medium-sized coastal industrial city in southern Peru (~67,000 inhabitants). We analyzed daily concentrations of PM10, PM2.5, NO2, O3, and SO2 across six pandemic phases (January–December 2020) using multiple linear regression, variance decomposition, and Random Forest models. A health impact assessment translated PM2.5 changes into cardiovascular mortality estimates using Global Burden of Disease 2021 coefficients. Despite reduced anthropogenic activity, PM2.5 increased by 34% during early reopening (May–June: 16.9 vs. 12.6 µg/m³ baseline), whereas NO2 decreased consistently (13–19%), SO2 declined up to 65%, and O3 more than doubled (+108%) in austral winter. Variance decomposition revealed that O₃ variability was almost entirely meteorology-driven (98%), while PM2.5 and NO2 showed balanced contributions from meteorology and restrictions (~50% each). The PM2.5 increase corresponded to approximately 3 additional cardiovascular deaths per 100,000 population annually. Coastal meteorology can counteract emission reductions, generating counterintuitive air quality responses and underscoring the need for meteorological normalization in policy evaluation.
Review
Public Health and Healthcare
Public Health and Health Services

Luke Balcombe

Abstract:

Digital mental health uses technology—like the Internet, smartphones, wearables, and immersive platforms—to improve access to care. While these resources quickly expanded post COVID-19, ongoing issues include low user retention, poor digital literacy, unclear privacy rules, and limited proof of effectiveness and safety. AI chatbots, also known as agents and assistants that act as a therapist or companion, support mental health by delivering counseling and personalized interactions through various apps and devices. AI chatbots may boost social health and lower loneliness, however, they may also increase dependence and affect emotional outcomes. Their use remains largely unregulated, with concerns about privacy, bias, and ethics. Experiences vary; some users report positive results while others doubt their safety and impact, especially in crisis response. There is a need to better protect vulnerable users and engage the underserved, with input from various individuals with lived experience on what feels safe, supportive, or harmful when interacting with AI chatbots. Proper evaluation, standardized training by digital navigators, and ethical/clinical guidelines are crucial for safe, engaging and effective adoption of AI in mental health care and support.

Article
Public Health and Healthcare
Public Health and Health Services

Eser Ördek

,

Ahmet Beyazıt

,

Sadık Görür

,

Kenan Dolapçıoğlu

,

Fatih Gökalp

,

Nezih Tamkaç

Abstract:

Background/Objectives: Gynecological and obstetric surgeries carry a risk of urinary tract injuries, which remain important causes of surgical morbidity. This study aimed to evaluate the incidence, etiological factors, diagnostic timing, and management outcomes of urological injuries occurring during these procedures over a 10-year period in a high-volume single-center cohort. Methods: This single-center retrospective study reviewed urinary tract injuries that occurred during gynecologic and obstetric procedures performed between January 2014 and December 2024. Among 16,100 surgeries, 223 cases were identified and analyzed regarding injury incidence, etiology, type, diagnostic timing, and management strategies. Results: Bladder injuries constituted 62.3% of cases, ureteral injuries 28.7%, and genitourinary fistulas 9.0%. Most bladder injuries (98.6%) and the majority of ureteral injuries (68.8%) were recognized intraoperatively (p < 0.001). Bladder injuries were most frequently associated with cesarean section, whereas ureteral injuries were more common in malignant gynecologic surgeries (p < 0.05). Conclusions: Early recognition and timely intervention remain critical to reducing morbidity associated with iatrogenic urinary tract injuries. These findings underscore the importance of anatomical knowledge, meticulous surgical technique, and appropriate diagnostic evaluation to optimize perioperative outcomes in gynecologic and obstetric surgery.

Article
Public Health and Healthcare
Public, Environmental and Occupational Health

Dámaris Campaña-Cuichán

,

Isabel Masson-Palacios

,

Diana Vásquez-Muñoz

,

Samuel Iñiguez-Jimenez

Abstract: According to the World Health Organization (WHO), Musculoskeletal Disorders (MSDs) are the most common occupational disease worldwide, frequently affecting agricultural workers due to the physical demands of their labor activities. In this context, a descriptive, relational, cross-sectional study was conducted in rural communities of Loja, Ecuador, with the aim of determining the prevalence of MSDs and their relationship with sociodemo-graphic and occupational factors among agricultural workers. The sample consisted of 103 farmers who completed the Standardized Nordic Questionnaire (NMQ). The results showed a high prevalence of MSDs in this population, with symptoms reported over the past 12 months, particularly in the neck, lower back, and knees. Furthermore, a statis-tically significant association was observed between the presence of MSDs and BMI. In conclusion, MSDs represent a frequent health problem among farmers, highlighting the need to implement preventive strategies and occupational health promotion programs in rural communities.
Article
Public Health and Healthcare
Public Health and Health Services

Dalal Salem Aldossari

,

Komal Latif

,

Amjad Nasser Alsadoni

,

Orjuwan Hasan Alshehri

,

Rakan Ibrahim Binjathlan

,

Monirah Mutlaq Alenezy

,

Taif Farhan Alshahrani

,

Hana Ahmed Lubbad

,

Rana Saeed Alshamasi

,

Abdulmajead Khaled Alanazi

+3 authors

Abstract: Background and objectives: Research into clinicians' and pharmacists' experiences and perspectives on direct oral anticoagulants (DOACs) use in Saudi Arabia and the broader Middle Eastern area is limited. Therefore, we aimed to evaluate the perspectives and experiences of physicians and pharmacists practicing in Saudi Arabia who prescribe DOACs and dispense DOAC therapy, respectively. Methods: A cross-sectional study was undertaken utilizing an online survey instrument. We collected data via Google Forms. Between June and July 2024, the study questionnaire was distributed to community pharmacists, general practitioners [GPs], cardiologists, residents in internal medicine, and hospital pharmacists (primary and secondary healthcare professionals) working in Saudi Arabia. Results: Comprising 146 doctors and 167 pharmacists, 313 total healthcare professionals participated in the study. Of the weekly DOAC prescriptions, cardiologists had the most at 35%; internal medicine residents came next at 16.3% and general practitioners at 17.5%. Among pharmacists, 16.7% of community pharmacists and 23.9% of hospital pharmacists dispensed DOACs weekly. The most often prescribed and dispensed medications were rivaroxaban, edoxaban, and apixaban. Across all categories, Lexicomp was the most often used tool. Most respondents (98%) said they lowered the DOAC dose, when necessary. Especially in dosing, preoperative care, patient education, and medication interaction identification, internal medicine residents and hospital pharmacists expressed more confidence in managing DOACs. In these domains, community pharmacists expressed less trust. Conclusion: This study revealed that most participants preferred newer oral anticoagulants over warfarin and demonstrated a fairly good level of self-perceived knowledge regarding various aspects of the clinical use of DOACs. The study findings highlight the importance of focused training initiatives to standardize the use of DOACs, boost trust among community pharmacists and GPs, and ensure the safe and effective patient care.
Article
Public Health and Healthcare
Public Health and Health Services

José Genaro Ordóñez-González

,

Kenia Mayela Valdez-Delgado

,

Farah Zamira Vera-Maloof

,

Luis Alberto Cisneros-Vázquez

,

David A. Moo-Llanes

,

Jana Celina Ríos-Delgado

,

Rosa María Sánchez-Casas

,

Ildefonso Fernández-Salas

,

Cuauhtémoc Villarreal-Treviño

Abstract: Dengue outbreaks highlight the need to quantify how environments sustain populations of the mosquito vectors Ae. aegypti and Ae. albopictus. Most control activities focus on households, while non-residential premises receive little attention. We conducted a cross-sectional ovitraps survey in August 2025 in Tapachula, Chiapas, Mexico, deploying 593 ovitraps: 297 in residential neighborhoods and 293 in non-residential sites. We collected 42,758 eggs; 61.5% (n = 26,316) came from residential areas and 38.5% (n = 16,442) from non-residential areas. Ovitrap positivity was higher in residential versus in non-residential areas (92.6% vs. 87.0%; p = 0.025), and the mean number of eggs per ovitrap (88.6 ± 5.1 vs. 56.1 ± 3.3 eggs; p < 0.001), yielding 298.0 vs. 175.3 eggs/ha, respectively. From a subsample of 16,965 eggs, 7,543 adults emerged (44.5%), dominated by Ae. aegypti in residential areas (83.3%) and Ae. albopictus in non-residential areas (80.0%). Vector burden differed by species: Ae. aegypti densities were higher in residential areas (51.0 vs. 4.5 adults/ha), whereas Ae. albopictus densities were higher in non-residential sites (18.2 vs. 10.2 adults/ha). These patterns show that both residential and non-residential premises are important sources of dengue vectors and should be included in integrated surveillance and control strategies.
Article
Public Health and Healthcare
Other

Michel Ngoyi Ntambwe

,

Beni Lifayifi Bisuta

,

Flory Matabaro Balazire

,

Jocelyn Kakumba Mankulu

,

Roland Marini Djang’eing’a

,

Jérémie Kindenge Mbinze

Abstract: Introduction: World Health Organization (WHO) through its current Global Benchmarking Tools (cGBT) used in the self-assessment of regulatory authorities, found that regulatory functions in general and laboratory testing in particular in countries with low regulation are not compliant with ISO/IEC 17025:2017 and WHO Trs No. 957, 2010. It was noted that, to date, in sub-Saharan Africa, fewer than 10 countries have authorities that have reached at least Maturity Level 3. Objective: This study aimed to verify pharmacopeial methods in the detection of falsified medicines in accordance with ICH Q2(R1) requirements at in the D.R. Congo through a laboratory compliant with the ISO standard, estimated at maturity level 3. Methodology: Five concentration levels were prepared: 110%, 100%, 90%, and 80%, from the stock solution corresponding to 120% for the APIs (6 antimalarials and 1 antibiotic) allowed to identify non-compliant samples during the period from 2021 to 2024. Results: The methods, verified in compliance with ICH and WHO normative requirements, were deemed compliant and applicable under the applied conditions. And the non-compliant products were detected: 7/41 (17.1%) for Artemether & Lumefantrine, 3/11 (27.3%) for Sulfadoxine & Pyrimethamine, 1/46 (2.2%) for injectable Artesunate and 5/41 (12.2%) for Artemether & Lumefantrine (without any active ingredient). Conclusion: This research aimed to verify the relevance of pharmacopeial methods currently used in DR Congo for quality control to the ICH and WHO requirements with perspective of tackling medicines falsification. The obtained results showed the compliance of studied methods and allowed to identify substandard products for Artemether-Lumefantrine and Sulfadoxine and Pyrimethamine combinations. Also, they allowed the detection of lower concentration of Artesunate within injectable formulations. Which confirmed the real existence of the announced issue related to the falsified drugs circulation in developing countries.
Article
Public Health and Healthcare
Public Health and Health Services

Meg Louise Bennett

,

Ling Wu

,

Joshua Paolo Seguin

,

Patrick Olivier

,

Andrea Reupert

,

Anthony F Jorm

,

Sylvia Grant

,

Helen Vaxevanis

,

Mingye Li

,

Jue Xie

+1 authors

Abstract: Background/Objectives: Parental mental health challenges are associated with parenting difficulties and child mental health issues. Parenting interventions can support families, however, parents with mental health challenges face barriers to accessing parenting support, which is not consistently offered within adult mental health settings. Embedding technology-assisted parenting programs into these settings could provide accessible, holistic support. Partners in Parenting Kids (PiP Kids) is a digital parenting program designed to prevent child anxiety and depression, yet its suitability for parents with mental health challenges and fit within mental health services remains unclear. This study aimed to co-design and adapt PiP Kids for implementation in an Australian adult mental health service. Methods: Parents who recently sought mental health support (n=8) and service providers (n=7) participated in co-design workshops to explore needs and preferences for a technology-assisted parenting program and iteratively develop a prototype. Parents (n=3) trialled the online component of the prototype and participated in qualitative interviews to assess acceptability. Results: The adapted clinician-supported program was designed to facilitate 1) parent and clinician readiness for parenting support, 2) emotional and social support for parents and clinicians, 3) practical, personalised parenting knowledge, 4) parent-led empowerment and 5) accessible, integrated support. Prototype clinician training was developed to strengthen the clinician-support component. Parents indicated acceptability of the online prototype while reiterating the value of including face-to-face support. Conclusions: This study provides preliminary support for adapting and embedding technology-assisted parenting programs within adult mental health settings. Findings highlight key considerations for developing and implementing technology-assisted interventions that promote family-focused care for parents seeking mental health support.
Article
Public Health and Healthcare
Public Health and Health Services

Komla Koumi

,

Soyoung Jeon

,

Yu-Feng Lee

Abstract: The implementation of COVID-19 vaccination in the United States has revealed substantial disparities driven by geography, socioeconomic status, and political ideology. This study explores how these factors were associated with vaccination intake across 360 counties within four U.S.-Mexico border states with distinct socio-political traits. Using regression analysis and GIS mapping, it evaluates the effects of income, education, employment, age, race, ethnicity, occupation, metro status, border status, and political affiliation on first-dose, full vaccination, and booster rates. First-dose rates were found to be significantly higher in border counties (β = 11.184, p < 0.001) and metropolitan areas (β = 2.246, p = 0.040). Democratic population (β = 0.644, p < 0.001) and per capita income (β = 0.950, p = 0.002) were positively associated with the vaccination. Complete-dose vaccination showed significant results similar to those of the first-dose model. Booster was positively associated with Democratic affiliation (β = 0.206, p < 0.001), high school graduation level (β = 0.172, p = 0.007), and the proportion of individuals aged 65 plus (β = 0.484, p < 0.001). In contrast, it was negatively associated with unemployment rates (β = −0.410, p < 0.001). Race and ethnicity also were related to vaccination outcomes: A higher Black population share was linked to lower first-dose vaccination rates (β = −0.386, p < 0.001), whereas Native American population share was associated with increased vaccination. Booster intake increased with a higher Asian population (β = 0.383, p = 0.001) but slightly declined with a higher White population (β = −0.071, p = 0.019).
Hypothesis
Public Health and Healthcare
Public, Environmental and Occupational Health

Hessam Mirgolbabaei

Abstract: Background: Iranian sexual and gender minorities face criminalization, surveillance, and stigma, and existing measures of belonging and resilience are fragmented.Methods: We conducted a theory-driven narrative review coupled with a structured secondary synthesis of published quantitative studies on Iranian sexual and gender minorities. We developed a five‑anchor analytic framework—Subjectivity, Groundedness, Reciprocity, Dynamism, and Self‑determination—mapped reported indicators (e.g., internalized stigma, depression, suicidality, policing/arrest risk, peer support, emotional inhibition) to anchors, extracted summary statistics as presented in primary studies, and produced anchor‑specific narrative syntheses. No new human participants were recruited.Findings: Evidence converged on compromised Subjectivity (consistent associations between internalized stigma and depression), fragile Groundedness (very high suicidal ideation in transgender samples), protective Reciprocity (peer support associated with counter‑normative action), and coercion‑shaped Dynamism (identity/expression‑linked arrest and harassment structuring visibility). Self‑determination reflected autonomy trade‑offs, including psychological costs of concealment and heightened emotional inhibition. The mapping validates and operationalizes the five‑anchor model.Conclusions: The framework offers an operational, ethically cautious template for quantifying belonging, risk, and resilience in criminalizing settings and can guide safe measurement, reporting, and service design for communities under repression and for diaspora services.
Article
Public Health and Healthcare
Public Health and Health Services

Michael Paulse

,

Nomakhosi Mpofana

Abstract: Melasma management is challenged by heterogeneity in patient presentation, particularly among individuals with darker skin tones. This study applied k-Means clustering to identify patient subgroups that could inform precision treatment approaches. We analysed clinical and demographic data from 150 South African women with melasma using k-Means clustering. The optimal number of clusters was determined using the Elbow Method and Bayesian Information Criterion (BIC), with t-SNE visualization for validation. The k-Means algorithm identified seven distinct patient clusters explaining 52.6% of data variability (R²=0.526), with model evaluation metrics including BIC=951.630 indicating optimal model fit and a Silhouette Score of 0.200 suggesting moderate cluster separation, while the Calinski-Harabasz index of 26.422 confirmed relatively well-defined clusters that were characterized by distinct profiles including "The Moderately Sun Exposed Young Women," "Elderly Women with Long-Term Melasma," and "Younger Women with Severe Melasma," with key differentiators being age distribution and menopausal status, melasma severity and duration patterns, sun exposure behaviours, and quality of life impact profiles that collectively define the unique clinical characteristics of each subgroup. This study demonstrates how machine learning can identify clinically relevant patient subgroups in melasma. Aligning interventions with the characteristics of specific clusters can potentially improve treatment efficacy.
Brief Report
Public Health and Healthcare
Health Policy and Services

Estefania Benedetti

,

Maria Carolina Artuso

,

Alexander M. P. Byrne

,

Maria de Belen Garibotto

,

Martín Avaro

,

Luana Erica Piccini

,

Ariana Chamorro

,

Marcelo Sciorra

,

Vanina Daniela Marchione

,

Mara Laura Russo

+5 authors

Abstract: The H5N1 subtype of highly pathogenic avian influenza (HPAI) poses a major zoonotic threat due to its high fatality rate and capacity for cross species transmission. In early 2025, Argentina detected a novel triple reassortant A(H5N1) virus in Chaco Province, combining Eurasian, North American, and South American lineage segments. Genomic analyses of subsequent outbreaks in Buenos Aires and Entre Ríos confirmed persistence of this reassortant and additional HA substitutions (T204K, P251S) potentially linked to increased mammalian receptor affinity. Although PB2 sequences lacked canonical mammalian-adaptive markers (E627K, Q591K, D701N), all contained I292M, a mutation associated with human adaptation. Phylogenetic analyses revealed distinct genotypes and increasing divergence. These findings indicate ongoing viral evolution and adaptation within Argentina, emphasizing the urgent need for sustained genomic surveillance, timely data sharing, and integrated One Health strategies to mitigate zoonotic and socioeconomic risks associated with H5N1 spread in South America.

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